The gout epidemic in French Polynesia: a modelling study of data from the Ma'i u'u epidemiological survey.

BACKGROUND: Gout is the most common cause of inflammatory arthritis worldwide, particularly in Pacific regions. We aimed to establish the prevalence of gout and hyperuricaemia in French Polynesia, their associations with dietary habits, their comorbidities, the prevalence of the HLA-B*58:01 allele, and current management of the disease. METHODS: The Ma'i u'u survey was epidemiological, prospective, cross-sectional, and gout-focused and included a random sample of adults from the general adult population of French Polynesia. It was conducted and data were collected between April 13 and Aug 16, 2021. Participants were randomly selected to represent the general adult population of French Polynesia on the basis of housing data collected during the 2017 territorial census. Each selected household was visited by a research nurse from the Ma'i u'u survey who collected data via guided, 1-h interviews with participants. In each household, the participant was the individual older than 18 years with the closest upcoming birthday. To estimate the frequency of HLA-B*58:01, we estimated HLA-B haplotypes on individuals who had whole-genome sequencing to approximately 5× average coverage (mid-pass sequencing). A subset of individuals who self-reported Polynesian ancestry and not European, Chinese, or other ancestry were used to estimate Polynesian-ancestry specific allele frequencies. Bivariate associations were reported for weighted participants; effect sizes were estimated through the odds ratio (OR) of the association calculated on the basis of a logistic model fitted with weighted observations. FINDINGS: Among the random sample of 2000 households, 896 participants were included, 140 individuals declined, and 964 households could not be contacted. 22 participants could not be weighted due to missing data, so the final weighted analysis included 874 participants (449 [51·4%] were female and 425 [48·6%] were male) representing the 196 630 adults living in French Polynesia. The estimated prevalence of gout was 14·5% (95% CI 9·9-19·2), representing 28 561 French Polynesian adults, that is 25·5% (18·2-32·8) of male individuals and 3·5% (1·0-6·0) of female individuals. The prevalence of hyperuricaemia was estimated at 71·6% (66·7-76·6), representing 128 687 French Polynesian adults. In multivariable analysis, age (OR 1·5, 95% CI 1·2-1·8 per year), male sex (10·3, 1·8-60·7), serum urate (1·6, 1·3-2·0 per 1 mg/dL), uraturia (0·8, 0·8-0·8 per 100 mg/L), type 2 diabetes (2·1, 1·4-3·1), BMI more than 30 kg/m2 (1·1, 1·0-1·2 per unit), and percentage of visceral fat (1·7, 1·1-2·7 per 1% increase) were associated with gout. There were seven heterozygous HLA-B*58:01 carriers in the full cohort of 833 individuals (seven [0·4%] of 1666 total alleles) and two heterozygous carriers in a subset of 696 individuals of Polynesian ancestry (two [0·1%]). INTERPRETATION: French Polynesia has an estimated high prevalence of gout and hyperuricaemia, with gout affecting almost 15% of adults. Territorial measures that focus on increasing access to effective urate-lowering therapies are warranted to control this major public health problem. FUNDING: Variant Bio, the French Polynesian Health Administration, Lille Catholic University Hospitals, French Society of Rheumatology, and Novartis.

Chairside Computer-Aided Design/Computer-Aided Manufacture All-Ceramic Crown and Endocrown Restorations: A 7-Year Survival Rate Study.

PURPOSE: The objective of the present study was to analyze the clinical outcomes of 447 monoblock ceramic chairside computer-aided design/computer-aided manufacture (CAD/CAM) reconstructions over a 7-year functional period. Of these reconstructions, 212 were peripheral crowns and 235 were endocrowns. MATERIALS AND METHODS: The restorations were placed between 2003 and 2008 in a total of 323 patients. They were created using a chairside CAD/CAM method and the same materials in all cases. All of the crowns were manufactured and glued during the same clinical session by the same practitioner. Data were descriptively analyzed and survival probabilities were calculated using Kaplan-Meier statistics. RESULTS: Of the 447 restorations, only 6 failures occurred, resulting in a success rate of 98.66%. All of the failures were the result of a partial ceramic fracture. Of the six ceramic fractures, five appeared on peripheral crowns and one on an endocrown. All fractures appeared in the first 24 months, including two in the first month. Log-rank test comparing incidence rates between crowns and endocrowns showed no significant differences (P = .08). CONCLUSION: This survival rate study reinforced the use of CAD/CAM full ceramic crowns and endocrowns on molars, showing a much more favorable survival rate for endocrowns.

Glass Ceramic CAD/CAM crowns and severely altered posterior teeth: a three levels study.

For many practitioners, longevity of full glass ceramic crowns in the posterior area, molars and premolars, remains a real challenge. The purpose of this article is to identify and evaluate the parameters that can significantly influence their resistance when preparing a tooth. The analysis proposed in this article relies on interrelated studies conducted at three levels: in vitro (mechanical tests), in silico (finite elements simulations) and in vivo (clinical survival rates). The in vitro and the in silico studies proved that an appropriate variation of the geometric design of the preparations enables to increase up to 80% the mechanical strength of ceramic reconstructions. The in vivo clinical study of CAD/CAM full ceramic crowns was performed in accordance with the principles stated within the in vitro and the in silico studies and provided a 98.97% success rate over a 6 years period. The variations of geometric design parameters for dental preparation allows for reconstructions with a mechanical breaking up to 80% higher than that of a non-appropriate combination. These results are confirmed in clinical practice.

Minimally Invasive All-ceramic Preparation for the Occlusal Face: The "V Preparation".

A clinical case illustrates and explains step by step a minimally invasive molar occlusal surface preparation for all-ceramic bonded restoration. The sequential use of calibrated burs, following the specific procedure, systematically and quickly, provides a perfectly calibrated reduction of the occlusal face even for an inexperienced practitioner. This preparation increases the bonding surface and optimizes the accommodation of constraints that provides a more resistant reconstruction and favors the preservation of the vital tooth. This procedure, called a "V preparation" or V prep, is discussed in the case report below.

Comparative mechanical behavior of dentin enamel and dentin ceramic junctions assessed by speckle interferometry (SI).

OBJECTIVE: The dentin-enamel junction (DEJ) plays a crucial role in dental biomechanics; however, little is known about its structure and mechanical behavior. Nevertheless, natural teeth are a necessary model for prosthetic crowns. The mechanical behavior of the natural DEJ and the dentin ceramic junction (DCJ) manufactured with a CAD-CAM system are compared. METHODS: The reference samples undergo no modification, while the experimental samples were drilled to receive a cemented feldspathic ceramic crown. Longitudinally cut samples were used to achieve a planar object observation and to look "inside" the tooth. A complete apparatus enabling the study of the compressive mechanical behavior of the involved tooth by a non-contact laser speckle interferometry (SI) was developed to allow nanometric displacements to be tracked during the compression test. RESULTS: It is observed that the DEJ acted as a critical zone accommodating the movement between dentin and enamel. A smooth transition occurs between dentin and enamel. In the modeled prosthetic, the same kind of accommodation effects also occurs, but with a steeper transition slope between dentin and ceramic. SIGNIFICANCE: On the natural tooth, the stress accommodation arises from a differential behavior between enamel and dentin from the DEJ. In the ceramic crown, the cemented dentin-ceramic junction should play this role. This study demonstrates the possible realization of prosthetic crown reconstructions approaching biomechanical behaviors.