ABSTRACT
This case shows a 3-unit bridge fabricated with the Cerec Scan system and a single Vita Mark II ceramic blank in service for over two years. The expanded capabilities of the Cerec 3 allow the operator to create restorations that have typically been relegated to the laboratory realm even for Cerec users.
Subject(s)
Computer-Aided Design , Dental Porcelain , Denture Design , Denture, Partial, Fixed , Cementation , Female , Humans , Mandible , Middle AgedABSTRACT
A step-by-step guide to creating excellent occlusal surfaces using Correlation mode, C-Stat and "Anatomical Outlining" is presented. Potential pitfalls are also discussed.
Subject(s)
Computer-Aided Design , Dental Occlusion , Dental Prosthesis Design , Humans , Jaw Relation Record , Medical Informatics Applications , Photography, Dental , SoftwareABSTRACT
This article describes the evolution of the CEREC CAD/CAM restorative system and its ability to create esthetic, durable ceramic- and resin-based restorations chairside. Included is discussion about specific techniques for color enhancement and modification to increase the esthetic result. The three machinable materials currently available for use with the CEREC system also are discussed.
Subject(s)
Ceramics , Computer-Aided Design , Crowns , Dental Porcelain , Dental Prosthesis Design , Esthetics, Dental , Composite Resins , Dental Polishing , Dental Veneers , Humans , Software , ZirconiumABSTRACT
In summary, the opportunity for producing very natural, life-like full porcelain crowns and veneers is available for Cerec 2 users. Materials specially formulated by Vita for the Mark II blocks provide results which match the esthetics of natural teeth. These results can be routinely achieved with a little training. Training is available through the Academy of Computerized Dentistry, Washington, DC.
Subject(s)
Ceramics , Computer-Aided Design , Crowns , Dental Veneers , Ceramics/chemistry , Color , Dental Porcelain/chemistry , Dental Prosthesis Design , Esthetics, Dental , Humans , Surface PropertiesSubject(s)
Computer-Aided Design , Crowns , Dental Porcelain , Dental Prosthesis Design , Ceramics , Cuspid , Dental Polishing , Dental Restoration Failure , Humans , Male , Middle AgedABSTRACT
The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704 (28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1 +/- 26 min vs. 99.9 +/- 133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death (6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9 +/- 4.4 and 43.5 +/- 4.8, respectively with a nadir of 32.9 +/- 5.6 vs. 33.0 +/- 5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in the hands of experienced operators the transbrachial approach to acute coronary intervention in the acute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy as the femoral approach.
Subject(s)
Angioplasty, Balloon, Coronary/methods , Cardiac Catheterization/methods , Emergencies , Myocardial Infarction/therapy , Aged , Brachial Artery , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Tissue Plasminogen Activator/administration & dosage , Urokinase-Type Plasminogen Activator/administration & dosageABSTRACT
Coagulation analysis was performed on blood samples from 386 patients with acute myocardial infarction drawn before, during, and after a continuous intravenous infusion of 150 mg recombinant tissue-type plasminogen activator (rt-PA) (Activase). Plasma rt-PA rose to peak levels of 2.1 +/- 3.1 micrograms/ml (mean +/- SD). Fibrinogen levels measured by coagulation rate and by sulfite precipitation decreased from baseline levels of 3.0 +/- 0.9 and 3.2 +/- 1.0 g/l, respectively, to nadir levels of 1.4 +/- 0.75 and 1.8 +/- 0.92 g/l, respectively, and were associated with peak levels in serum of fibrinogen-degradation products (FDP) of 230 +/- 470 micrograms/ml. Forty percent of patients experienced a nadir functional-fibrinogen level of less than 1.0 g/l, whereas 20% fell below 0.5 g/l. Nadir fibrinogen levels did not correlate with patency of the infarct-related coronary artery at 90 minutes or with risk of coronary vessel reocclusion within 7-10 days. However, the risk of coronary artery reocclusion was inversely related to the baseline functional fibrinogen level (p = 0.0008), with the magnitude of its drop to nadir level (p = 0.0003) as well as to peak levels of FDP (p = 0.038). Quantitative blood loss correlated with all markers for systemic fibrinogenolysis including nadir fibrinogen level (r = -0.20, p = 0.0011), percent decrease of fibrinogen (r = 0.22, p = 0.001), and peak FDP levels (r = 0.14, p = 0.020). Both patients who experienced intracranial hemorrhage presented with high baseline fibrinogen levels and experienced extensive degradation of coagulable fibrinogen. Overall, patients at greatest risk of systemic fibrinogenolysis tended to be relatively older women with lower body weight.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Blood Coagulation/drug effects , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Blood Coagulation Tests , Fibrinogen/drug effects , Humans , Tissue Plasminogen Activator/pharmacologyABSTRACT
PURPOSE: Little attention has been paid to the importance of clinical factors associated with bleeding complications caused by the use of thrombolytic agents. The goal of our study was to examine clinical and hematologic factors associated with an increased risk of bleeding in a prospectively observed population that received intravenous tissue plasminogen activator for acute myocardial infarction. PATIENTS AND METHODS: Bleeding complications were evaluated in 386 consecutive patients treated with 150 mg of tissue plasminogen activator over six to eight hours for acute myocardial infarction. All patients also underwent immediate cardiac catheterization. RESULTS: Quantitation of blood loss during the patients' hospital stay included a median drop in hematocrit of 11.4 points, a median nadir hematocrit of 31.2, a 14 percent rate of significant clinically evident bleeding, and a 31 percent rate of transfusion of two or more units of blood. All of these parameters were much more severe in patients treated with coronary artery bypass surgery. Access site hematoma was the most common source of bleeding (45 percent of patients), whereas 8 percent had gastrointestinal bleeding, two patients had retroperitoneal bleeding, and two patients had intracranial bleeding. The median nadir fibrinogen was 1.3 g/liter. Multiple linear regression models were used to investigate the relationship between clinical variables, including multiple hematologic measurements, and measures of the amount of blood loss. The use of coronary artery bypass grafting was the variable most closely associated with hemorrhage. Other invasive procedures (angioplasty and intra-aortic balloon pumping) were also associated with increased bleeding. Among the patient descriptors examined, lighter weight, older age, female sex, and history of hypertension were associated with greater blood loss. Of laboratory coagulation parameters, only nadir fibrinogen levels were significantly associated with more bleeding. CONCLUSION: Careful clinical evaluation may improve assessment of the risk/benefit ratio of thrombolytic therapy.
