Effect of Different Primers on the Shear Bond Strength of Orthodontic Brackets Bonded to Reinforced Polyetheretherketone (PEEK) Substrate.

This in vitro study assessed the effect of different primers on the shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic brackets bonded to reinforced polyetheretherketone (PEEK) substrate. A total of 40 specimens were randomly distributed to two groups based on the primer used for orthodontic bonding: group 1 (control)-Transbond XT adhesive with Visio.link primer and group 2 (test)-orthodontic adhesive (Transbond XT) with traditional orthodontic primer. After bonding, specimens were thermocycled followed by SBS testing and ARI scoring of debonded specimens. Data were analyzed using the unpaired independent t-test and the Chi-square test. Group 1 specimens showed significantly higher SBS values (21.38 ± 1.48 MPa) compared to group 2 specimens (18.63 ± 1.29 MPa) (p < 0.0001). Adhesive remnant index scores showed no significant variations in bond failure modes and distributions between groups. The SBS obtained by the tested primers exceeded the clinically recommended value. Consequently, there is a comparable clinical application for both tested primers in orthodontic bonding, especially the traditional orthodontic primer, where the availability of Visio.link in clinical practice is not ensured.

The Effect of Die Material on the Crown Fracture Strength of Zirconia Crowns.

BACKGROUND: Determination of the eligibility of several tooth analog materials for use in crown fracture testing. METHODS: A standardized premolar crown preparation was replicated into three types of resin dies (C&B, low modulus 3D printed resin; OnX, high modulus 3D printed resin composite; and highest modulus milled resin composite). 0.8 mm zirconia crowns were bonded to the dies and the maximum fracture load of the crowns was tested. Twelve extracted human premolars were prepared to a standardized crown preparation, and duplicate dies of the prepared teeth were 3D printed out of C&B. Zirconia crowns were bonded to both the dies and natural teeth, and their fracture load was tested. RESULTS: There was no statistical difference between the fracture load of zirconia crowns bonded to standardized dies of C&B (1084.5 ± 134.2 N), OnX (1112.7 ± 109.8 N) or Lava Ultimate (1137.5 ± 88.7 N) (p = 0.580). There was no statistical difference between the fracture load of crowns bonded to dentin dies (1313 ± 240 N) and a 3D-printed resin die (C&B, 1156 ± 163 N) (p = 0.618). CONCLUSIONS: There was no difference in the static fracture load of zirconia crowns bonded to standardized resin dies with different moduli or between a low modulus resin die and natural dentin die.

The Effect of Restoration Thickness on the Fracture Resistance of 5 mol% Yttria-Containing Zirconia Crowns.

BACKGROUND: To determine what thickness of 5 mol% yttria zirconia (5Y-Z) translucent crowns cemented with different cements and surface treatments would have equivalent fracture resistance as 3 mol% yttria (3Y-Z) crowns. METHODS: The study included 0.8 mm, 1.0 mm, and 1.2 mm thickness 5Y-Z (Katana UTML) crowns and 0.5 and 1.0 mm thickness 3Y-Z (Katana HT) crowns as controls. The 5Y-Z crowns were divided among three treatment subgroups (n = 10/subgroup): (1) cemented using RMGIC (Rely X Luting Cement), (2) alumina particle-abraded then luted with the same cement, (3) alumina particle-abraded and cemented using a resin cement (Panavia SA Cement Universal). The 3Y-Z controls were alumina particle-abraded then cemented with RMGIC. The specimens were then loaded in compression at 30° until failure. RESULTS: All 5Y-Z crowns (regardless of thickness or surface treatment) had a similar to or higher fracture force than the 0.5 mm 3Y-Z crowns. Only the 1.2 mm 5Y-Z crowns with resin cement showed significantly similar fracture force to the 1 mm 3Y-Z crowns. CONCLUSION: In order to achieve a similar fracture resistance to 0.5 mm 3Y-Z crowns cemented with RMGIC, 5Y-Z crowns may be as thin as 0.8 mm. To achieve a similar fracture resistance to 1.0 mm 3Y-Z crowns cemented with RMGIC, 5Y-Z crowns must be 1.2 mm and bonded with resin cement.

Wear of lithium disilicate opposed by various ceramic materials.

OBJECTIVES: To compare volumetric wear of lithium disilicate against different ceramic (3 mol% yttria-stabilized (3Y) zirconia, 5 mol% yttria-stabilized (5Y) zirconia, lithium disilicate, porcelain and enamel antagonists). MATERIALS AND METHODS: Forty lithium disilicate (e.max CAD) specimens (n = 8/antagonist) were wet sanded to 1200grit SiC and mounted into a UAB wear device. Antagonist spheres (diameter = 4.75 mm) were made from polished 3Y zirconia, 5Y zirconia, lithium disilicate, porcelain and human enamel. A two-body wear test was performed with 20 N load and 1.5 mm slide for 400,000 cycles at 1 Hz. 33% glycerin was used as a lubricant. Wear facets were measured with optical profilometry. Wear scar areas of antagonists were measured with digital microscopy. Scanning electron microscopy was performed on wear facets and scars. Vicker's microhardness was measured of all antagonist materials. All data were compared with 1-way ANOVA and Tukey post-hoc analysis. RESULTS: Significant differences in lithium disilicate volumetric wear (mm3 ) occurred with various antagonist materials: 0.38 ± 0.01a (3Y zirconia), 0.33 ± 0.01b, (5Y zirconia), 0.16 ± 0.01c (lithium disilicate), 0.11 ± 0.03d, (enamel), and 0.07 ± 0.01e (porcelain). The lithium disilicate antagonist demonstrated a larger wear scar than other materials. Zirconia was the hardest material and enamel the least hard. CONCLUSIONS: Zirconia causes significant wear on lithium disilicate and lithium disilicate causes significant wear against itself. CLINICAL SIGNIFICANCE: When selecting a material to oppose an existing lithium disilicate crown, a porcelain or lithium disilicate surface would cause significantly less wear to the existing crown. If an existing zirconia crown exists opposed to a prepared tooth, lithium disilicate may not be an ideal material selection to restore the tooth.

Characterization of materials used for 3D printing dental crowns and hybrid prostheses.

OBJECTIVES: To compare the filler weight percentage (wt%), filler and resin composition, flexural strength, modulus, and hardness of several 3D-printed resins to direct and indirect restorative materials. MATERIALS AND METHODS: Four 3D-printed resins (C&B MFH, Ceramic Crown, OnX, and OnX Tough), one milled resin composite (Lava Ultimate), one conventional composite (Filtek Supreme), and one ceramic (IPS e.max CAD) were evaluated. Filler wt% was determined by the burned ash technique, and filler particle morphology and composition were analyzed by scanning electron microscopy and energy-dispersive spectroscopy, respectively. Organic resin composition was analyzed by Fourier transform infrared spectroscopy. Three-point bend flexural strength and modulus of the materials were determined by ISO 4049 or ISO 6872. Vickers microhardness was measured. Data were compared with a one-way analysis of variance (ANOVA) and Tukey post hoc analysis. Linear regression analysis was performed for filler wt% versus flexural strength, modulus, and hardness. RESULTS: 3D-printed resins were composed of various sized and shaped silica fillers and various types of methacrylate resins. Significant differences were found among filler wt% with some materials around 3% (C&B MFH), others between 33% and 38% (OnX Tough and OnX), others around 50% (Ceramic Crown), and some around 72% (Filtek Supreme and Lava Ultimate). All 3D-printed resins had significantly lower flexural strength, modulus, and hardness than the conventional and milled resin composites and ceramic material (p < 0.001). Filler wt% demonstrated a linear relationship with modulus (p = 0.013, R2 = 0.821) and hardness (p = 0.018, R2 = 0.787) but not flexural strength (p = 0.056, R2 = 0.551). CONCLUSIONS: 3D-printed resins contain from 3% to 50% filler content. Filler wt% alone does not affect flexural strength, but strength may be affected by resin composition as well. Although the 3D-printed resins had lower flexural strength, modulus, and hardness than milled and conventional composite and ceramic, they demonstrated nonbrittle plastic behavior. CLINICAL SIGNIFICANCE: The properties of 3D-printed resins vary based on their composition, which affects their clinical applications.

Fracture resistance of zirconia surveyed crowns with four different occlusal rest seat designs.

PURPOSE: To determine the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia surveyed crowns for a mandibular first molar without occlusal rest and with four different rest seat designs. MATERIALS AND METHODS: Seventy CAD-CAM zirconia 4Y-PSZ (IPS e.max ZirCAD MT for CEREC A1, C15, Ivoclar Vivadent) crowns (14 specimens/group) were designed and fabricated with a dental chairside CAD-CAM system (CEREC PrimeScan, and CEREC MCXL Dentsply Sirona). The restorations were divided into groups according to the following rest seat designs: (1) Surveyed crown without rest seat, (2) surveyed crowns with disto-occlusal rest seat, (3) surveyed crowns with disto-occlusal extended rest seat, (4) surveyed crowns with interproximal rest seat, and (5) continuous rest seat. Crowns were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using resin luting cement (Multilink Automix, Ivoclar Vivadent) to resin-printed dies (Grey Resin V4, FormLabs). Subsequently, the crowns were subjected to 200,000 load cycles at 1 Hz with 20 N force and then loaded with a steel indenter until fracture. The test results were analyzed with one-way Analysis of Variance (ANOVA) and HSD Tukey post-Hoc test. RESULTS: The mean fracture resistance of surveyed crowns without and with different rest seats was significantly different from each other. Surveyed crowns with no rest seat displayed the highest resistance (4238 N) followed by crowns with continuous rest seat (3601 N), crowns with disto-occlusal extended rest seat (3283 N), and crowns with disto-occlusal rest seat (3257 N). Crowns with interproximal rest seat displayed the lowest fracture resistance (2723 N). CONCLUSIONS: Surveyed crowns without rest seats had a higher fracture resistance than crowns with rest seats Surveyed crowns with interproximal rest seats presented the lowest fracture resistance among all rest seat designs. Crowns with disto-occlusal rest seats, disto-occlusal extended rest seats, and continuous rest seats displayed similar fracture resistance.

Utility of chest radiograph severity scoring in emergency department for predicting outcomes in COVID-19: A study of 1275 patients.

OBJECTIVE: To measure the reliability and reproducibility of a chest radiograph severity score (CSS) in prognosticating patient's severity of disease and outcomes at the time of disease presentation in the emergency department (ED) with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: We retrospectively studied 1275 consecutive RT-PCR confirmed COVID-19 adult patients presenting to ED from March 2020 through June 2020. Chest radiograph severity score was assessed for each patient by two blinded radiologists. Clinical and laboratory parameters were collected. The rate of admission to intensive care unit, mechanical ventilation or death up to 60 days after the baseline chest radiograph were collected. Primary outcome was defined as occurrence of ICU admission or death. Multivariate logistic regression was performed to evaluate the relationship between clinical parameters, chest radiograph severity score, and primary outcome. RESULTS: CSS of 3 or more was associated with ICU admission (78 % sensitivity; 73.1 % specificity; area under curve 0.81). CSS and pre-existing diabetes were independent predictors of primary outcome (odds ratio, 7; 95 % CI: 3.87, 11.73; p < 0.001 & odds ratio, 2; 95 % CI: 1-3.4, p 0.02 respectively). No significant difference in primary outcome was observed for those with history of hypertension, asthma, chronic kidney disease or coronary artery disease. CONCLUSION: Semi-quantitative assessment of CSS at the time of disease presentation in the ED predicted outcomes in adults of all age with COVID-19.

Cross-Medium Photoacoustic Communications: Challenges, and State of the Art.

The current era is notably characterized by the major advances in communication technologies. The increased connectivity has been transformative in terrestrial, space, and undersea applications. Nonetheless, the water medium imposes unique constraints on the signals that can be pursued for establishing wireless links. While numerous studies have been dedicated to tackling the challenges for underwater communication, little attention has been paid to effectively interfacing the underwater networks to remote entities. Particularly it has been conventionally assumed that a surface node will be deployed to act as a relay using acoustic links for underwater nodes and radio links for air-based communication. Yet, such an assumption could be, in fact, a hindrance in practice. The paper discusses alternative means by allowing communication across the air-water interface. Specifically, the optoacoustic effect, also referred to as photoacoustic effect, is being exploited as a means for achieving connectivity between underwater and airborne nodes. The paper provides background, discusses technical challenges, and summarizes progress. Open research problems are also highlighted.

Digital evaluation of Bolton's tooth size discrepancies among different malocclusions categories of Egyptian adolescent orthodontic population: A retrospective study.

OBJECTIVE: This retrospective investigation aimed to compare Bolton's ratios among different malocclusion groups of Egyptian adolescent orthodontic patients with original Bolton's standards. MATERIALS AND METHODS: Pre-treatment dental casts of 588 Egyptian subjects, 290 males and 298 females with mean age 16.7±2.2 years, were randomly selected and classified into 220 class I (108 males and 112 females), 230 class II (112 males and 118 females), and 138 class III (68 males and 70 females) groups. Mesiodistal widths from first molar to first molar were measured on 3-dimensionally scanned models via software and ratios were calculated. Two-way analysis of variance compared ratios as a function of skeletal classification and gender. Additionally, percentages of significant discrepancy outside 2 standard deviations (SDs) were calculated. RESULTS: The anterior mean ratio for the total sample were higher (79.4±4.7) and overall mean ratio was lower (90.1±5) than Bolton's standards. The differences between the obtained and standard values were statistically significant (P<0.001). However, there were no significant differences in either anterior ratio (P=0.637) or overall ratio (P=295) regarding gender. Class I cases showed the highest mean anterior ratio of 80±5.7 whereas class II and class III cases had the lowest ratio of 78.5±4.6 and 78.7±3.5, respectively. Concerning overall ratio, class III subjects had the highest ratio of 91.8±2.6 with no substantial distinction from class II cases (90.2±4.7) but was significantly different from class I cases that demonstrated the lowest ratio (89.7±5, P=0.020). High percentages of patients displayed clinically significant tooth size discrepancies (TSD), exceeding either above or below 2SD of Bolton's values, which were more marked in the anterior ratio. These were 25.2% and 7.4% for anterior ratio and 3.4% and 15.4% for overall ratio. CONCLUSIONS: Tooth size ratios of Egyptian orthodontic patients are generally different than the original Bolton's standards. Patients with class I and class III malocclusions had greater anterior and overall ratios than those with class II malocclusions with no considerable gender differences in either ratio.

Can yield, soil C and aggregation be improved under long-term conservation agriculture in the eastern Indo-Gangetic plain of India?

Deteriorating soil health, diminishing soil organic carbon (SOC), development of subsurface hard compact layer and declining system productivity are barriers to achieving sustainable production in the traditional rice-wheat cropping system (TA) in the eastern Indo-Gangetic Plain of India. Conservation agriculture (CA), which favours minimum soil disturbance, crop residue retention and crop diversification could be a viable alternative to the TA to address most of those major problems. With that in mind, a long-term experiment is being implemented at ICAR-RCER, Patna, Bihar, India, with four treatments: (a) TA, (b) full CA (fCA) and (c and d) partial CA (pCA1 and pCA2), differing in crop establishment methods, cropping system and crop residue management in a randomized complete block design. Measurement of soil health parameters was carried out in the 11th year of the experiment. The results revealed a beneficial effect of CA and 46 and 40% increase in SOC concentration and stock, respectively, under fCA over TA in the 0-7.5-cm soil layer. The effect of partial CA (pCA1 and pCA2) was variable, but an increasing trend was always observed under pCA compared to TA. There was an enrichment in SOC content of aggregates under CA irrespective of size class; however, no relation was found between SOC content and aggregate diameter. The contribution of macroaggregates to SOC stock was larger (36-66%) under CA in the 0-7.5-cm soil layer. Adoption of CA improved the macroaggregate content, MWD and GMD of aggregates, and aggregation ratio. Soil macropore content was greater under fCA, whereas other parameters were similar among treatments. The impact of CA was mostly limited to 0-7.5 cm soil layer and a maximum up to 15 cm soil depth while evaluation until 60 cm soil depth was realized. The yield of rice in CA was comparable to or higher than in TA, whereas the system rice equivalent yield was always higher (38-53%) under CA than under the conventional practices. Therefore, a CA-based cropping system must be encouraged, to increase SOC status, improve aggregation stability and, consequently, sustain or increase system productivity, in order to achieve food and nutritional security in the eastern Indo-Gangetic Plain of India. HIGHLIGHTS: Effects of long-term conservation agriculture (CA) on soil C, aggregation and yield were evaluated.CA improved SOC concentration and stock by 46 and 40%, as well as macroaggregate SOC stock by 36-66%.Macro-aggregation and mean weight diameter improved in CA but was mostly limited to a shallow soil depth.CA can be promoted for sustainability of a rice-wheat system due to higher productivity (38-53%).

Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke).

BACKGROUND: Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. OBJECTIVE: The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. METHODS: This study was a randomized controlled, outcome assessor-blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. RESULTS: A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). CONCLUSIONS: The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. TRIAL REGISTRATION: ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330.

Recognition and Importance of New Definitions of Peripancreatic Fluid Collections in Managing Patients with Acute Pancreatitis.

Our understanding of the etiopathogenesis of acute pancreatitis has matured tremendously in the last 3 decades. Advanced cross-sectional imaging with 3-dimensional techniques along with use of intravenous contrast to image the presence or absence of organ tissue perfusion has allowed early recognition of necrotizing pancreatitis. With this knowledge, the old terms to describe what used to be called 'peri-pancreatic fluid collections' we now recognize are no longer accurate nor appropriate. The 2013 revised Atlanta Classification has introduced a new, accurate, objective classification of acute pancreatitis and terminology for the natural history of all forms of acute pancreatitis that is easy to use and will help in both the description of the disease and its appropriate treatment. This review will describe these pancreatic and peri-pancreatic collections with added insight into their natural history.

An alternative approach for delineating eco-sensitive zones around a wildlife sanctuary applying geospatial techniques.

The dynamics, degradation, and conservation of forest ecosystems are matters of prime concerns worldwide at the present. Proper planning and management of a forest area are essentially needed to protect it from the grasp of burgeoning pressure of urban-industrial sprawl. Establishment of eco-sensitive zones (ESZs), which act as buffer areas around the core forests, is one of the key approaches towards achieving this goal. This paper deals with the applicability of geospatial techniques to identify the ESZ around an Indian wildlife sanctuary following the different rules and acts prescribed by the Government of India. Gumti Wildlife Sanctuary, located in the northeastern state of Tripura in India, has been selected here as a case study. Collected pieces of information on the distribution of biodiversity and human population in the area were also used to make the approach more holistic. As inferred from this study, remote sensing and geographical information systems were found to be easily implementable and time as well as cost-effective tools for this purpose with a distinct advantage of spatial as well as temporal accuracy in identifying the existing land use and land cover patterns in pilot assessments. However, the results indicated that only appropriate hybridization of field-based information on the biodiversity and ecological aspects of the forest as well as patterns of human interferences with the remote sensing and GIS-based data could make this approach more relevant in actual implementations.