Effect of Dentin Contamination with Hemostatic Agents and Cleaning Techniques on Bonding with Self-Adhesive Resin Cement.

BACKGROUND Dentin contamination with hemostatic agents before bonding indirect restorations negatively affects the bond strength. However, the consensus on which materials could be used to clean contamination of hemostatic agents has not been explored. The aim of this study was to assess the effect of Katana Cleaner applied on the surface of dentin contaminated with hemostatic agents on the shear bond strength (SBS) of self-adhesive resin cement by comparing it with three other surface cleaners. MATERIAL AND METHODS Ninety dentin specimens were divided into a no contamination group (control) (n=10), 4 groups contaminated with 25% aluminum chloride (Viscostat Clear) (n=40), and 4 groups contaminated with 20% ferric sulfate (Viscostat) (n=40). Subsequently, 4 different cleaners were used for each contamination group (water rinse, phosphoric acid, chlorhexidine, and Katana Cleaner). Then, self-adhesive resin cement was directly bonded to the treated surfaces. All specimens were subjected to 5000 thermal cycles of artificial aging. The shear bond strength was measured using a universal testing machine. RESULTS Two-way analysis of variance showed that the contaminant type as the main factor was statistically non-significant (p=0.655), cleaner type as the main factor was highly significant (p<0.001), and interaction between the contaminant and cleaner was non-significant (p=0.51). The cleaner type was the main factor influencing the bond strength. Phosphoric acid and chlorhexidine showed better performance than Katana Cleaner. CONCLUSIONS Cleaning dentin surface contamination with phosphoric acid and chlorhexidine had better performance than with Katana Cleaner.

Flexural strength, flexural modulus and microhardness of milled vs. fused deposition modeling printed Zirconia; effect of conventional vs. speed sintering.

BACKGROUND: Various methods can be used for creating zirconia dental restorations, including 3-dimensional (3D) printing and computer-aided design/ computer-aided manufacturing (CAD/CAM) milling. The fused deposition modeling (FDM) printing method for zirconia presents numerous advantages, albeit research on the mechanical properties of these materials and resultant restorations remains scarce. Such developments are undeniably intriguing and warrant further investigation. The objective of the present study was to evaluate the impact of the sintering firing cycle (Conventional vs. Speed sintering) on the flexural strength, flexural modulus, and Vickers Microhardness of milled vs. FDM printed zirconia. METHODS: A total of 60 bars (2 × 5 × 27 mm) were fabricated for flexural strength testing, along with 40 discs (12 × 1.5 mm) for Vickers microhardness testing. Half of the specimens underwent conventional sintering, while the other half underwent a speed sintering cycle. The flexural strength and modulus were determined by a three-point bending test in a universal testing machine. The microhardness of the specimens was evaluated using a Vickers microhardness tester. Statistical analysis was performed using a two-way ANOVA test with a post-hoc Tukey test (p < 0.05). RESULTS: CAD/CAM milled zirconia had significantly higher flexural strength and modulus than FDM-printed zirconia. The sintering process did not significantly affect the flexural strength or modulus of milled or FDM-printed zirconia. The milled speed sintering group had significantly higher values in the Vickers microhardness test compared to the other groups. CONCLUSIONS: The mechanical properties of FDM-printed zirconia specimens were not found to be comparable to those of milled zirconia. Speed sintering cycle may produce milled zirconia restorations with similar flexural strength and modulus to conventional sintering, and even higher Vickers Microhardness values.

Effect of Repressing Lithium Disilicate Glass Ceramics on The Shear Bond Strength of Resin Cements.

The aim of this study was to investigate the effect of repeated pressing of lithium disilicate ceramic on the shear bond strength (SBS) of three types of resin cement. METHODOLOGY: A lithium disilicate ceramic (IPS e.max® Press) was first heat-pressed to form rectangular disk specimens. Then, leftovers were used for the second and third presses. A total of 90 specimens were prepared and separated, according to the number of pressing cycles, into three groups: 1st, 2nd, and 3rd presses (n = 30). Each group was further subdivided into three groups (n = 10) according to the type of resin cement used, as follows: Multilink N (MN), Variolink Esthetic DC (VDC), and Variolink Esthetic LC (VLC). All the cement was bonded to the ceramic surface, which was etched with hydrofluoric acid and primed with Monobond Plus. All samples were light-cured and stored for 24 h. Shear bond strength was tested on a universal testing machine. RESULTS: A two-way ANOVA was used to evaluate the influence of repeated pressing cycles and cement type as well as their interaction. The results indicated that cement type has a significant impact (p < 0.001) but not the number of pressing cycles (p = 0.970) or their interaction (p = 0.836). The Bonferroni post-hoc test showed that the SBS of MN was significantly higher than that of VDC and VLC in the first press and second press cycles, respectively. The SBS of MN was significantly higher than that of VDC and VLC cements in the third pressing cycle. There was no significant difference in the SBS between VLC and VDC in all three pressing cycles. CONCLUSION: The results of the current study did not report a detrimental effect of repeated pressing up to three cycles on the shear bond strength of the IPS e.max® Press. Multilink resin cement showed the highest SBS to IPS e.max® Press at the third pressing cycle. For all types of cement and heat pressing cycles, the majority of cement failures were adhesive. No cohesive failures occurred in any of the tested resin cements, regardless of the cement type or the number of heat pressing cycles tested.

Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review.

INTRODUCTION: In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS: A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS: A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION: IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.

Mechanical Properties of Three-Dimensional Printed Provisional Resin Materials for Crown and Fixed Dental Prosthesis: A Systematic Review.

The emergence of digital dentistry has led to the introduction of various three-dimensional (3D) printing materials in the market, specifically for provisional fixed restoration. This study aimed to undertake a systematic review of the published literature on the Mechanical Properties of 3D- Printed Provisional Resin Materials for crown and fixed dental prosthesis (FDP). The electronic database on PubMed/Medline was searched for relevant studies. The search retrieved articles that were published from January 2011 to March 2023. The established focus question was: "Do provisional 3D-printed materials have better mechanical properties than conventional or milled provisional materials?". The systematically extracted data included the researcher's name(s), publication year, evaluation method, number of samples, types of materials, and study outcome. A total of 19 studies were included in this systematic review. These studies examined different aspects of the mechanical properties of 3D-printed provisional materials. Flexural Strength and Microhardness were the frequently used mechanical testing. Furthermore, 3D-printed provisional restorations showed higher hardness, smoother surfaces, less wear volume loss, and higher wear resistance compared to either milled or conventional, or both. 3D-printed provisional resin materials appear to be a promising option for fabricating provisional crowns and FDPs.

Successful Surgical Management of Gastric Antral Vascular Ectasia in a Patient with End-Stage Renal Disease: A Case Report and Literature Review.

BACKGROUND Gastric antral vascular ectasia (GAVE) is a rare clinical entity that presents with acute upper-gastrointestinal bleeding or chronic anemia. It is characterized by endoscopic watermelon appearance of the stomach. It is usually associated with other comorbidities; however, few articles have previously described GAVE in patients with end-stage renal disease. Its management is controversial, and endoscopic management is considered the treatment of choice. CASE REPORT A middle-age female patient, on regular hemodialysis for ESRD, was referred to the surgical out-patient clinic as a refractory GAVE after failure of endoscopic management as she became blood transfusion-dependent. She underwent laparoscopic subtotal gastrectomy with a Billroth II reconstruction of gastrojejunostomy. She had a smooth postoperative course and was followed up in the clinic for 12 months with no complications. Her hemoglobin level was stable at 9.4 g/dL without further blood transfusion. CONCLUSIONS Gastric antral vascular ectasia is usually associated with other comorbidities; however, an association between GAVE and CKD is rare. Its management is controversial, and endoscopic management is considered the preferred method of treatment. Laparoscopic subtotal gastrectomy is an effective management modality for GAVE, with dramatic improvement and good outcomes in terms of bleeding, blood transfusion requirements, and nutritional status.

The principles and effectiveness of X-ray scatter correction software for diagnostic X-ray imaging: A scoping review.

PURPOSE: An anti-scatter grid is often used in X-ray radiography to reduce the scattered X-rays generated from the patient. However, the presence of a grid means the patient dose subsequently increases. Recently,severalmanufacturers have developedsoftwarethat is capable of correctingfor scattered X-rays withouttheuse ofa conventional grid. This scoping review aims to systematically map the research assessing scattering correction software and to identify any existing knowledge gaps. METHODS: This scoping review involved conducting a systematic search in PubMed, Scopus, and Web of science to reveal studies that were relevant to the research question. Articles published between 01.01.2000 and 31.12.2021 examining X-ray scatter correction software for X-ray imaging were included. A part of the PRISMA model and PICO framework were utilised to establish eligibility criteria. A structured summary table was utilised to extract data from the selected articles. RESULTS: In this scoping review, 20 years of literature in X-ray conventional radiography. 11 articles were included in the data synthesis. The study populations of the included studies were varied: patients, image quality phantoms and anatomical phantoms. The clinical applications of X-ray scatter correction software were found to be limited to specific body parts (cervical spine, chest, shoulder, lumbar spine, hip and pelvis). The scatter correction software appears to be effective in terms of image quality and in reducing the radiation dose. However, the conventional grid still provides a higher image quality. CONCLUSIONS: X-ray scatter correction software can be effective and provides potentialbenefits for some circumstances or clinical scenarios.

Knowledge, Attitude, and Perception of Parents in the Najran Region Toward the Use of Herbal Medicine in the Treatment of Asthma in Their Children.

BACKGROUND: Asthma is a prevalent and persistent condition affecting the respiratory system, defined by the presence of fluctuating and reversible symptoms associated with the restriction of airflow, heightened sensitivity of the bronchial tubes, and inflammation within the airways. Saudi Arabia has a high prevalence of this chronic illness, making it one of the most often seen conditions in the country. A popular therapeutic approach within the realm of complementary and alternative medicine for individuals with asthma is the use of herbal medications. Nevertheless, the efficacy of these medicines in treating asthma is often supported by inadequate data. OBJECTIVES: This study aimed to determine the knowledge, attitude, and perception of parents toward the use of herbal medicines in the treatment of asthma in their children in the Najran Region. METHODS: In this cross-sectional study, the participants received an electronic self-administered survey via social media channels. The survey instrument comprises a set of questions that have been gathered from prior studies that have comparable research aims. The questionnaire sheet will contain three parts. Data were analyzed with IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). The sample and outcome variables were summarized using the descriptive statistics of frequencies, percentages, means, and standard deviations. Data were analyzed by type of provider as appropriate, and the Pearson chi-square test was used to compare the observed data; the paired sample t-test was used to test the difference between the means of the pretest and post-test. RESULTS: Fifteen percent of the respondents personally suffer from asthma, while 85.0% do not. Additionally, 25.7% of the respondents indicated that one of their children suffers from asthma, while 74.3% stated that their children do not suffer from asthma. The data also show that the statement "Asthma symptoms are dry cough, shortness of breath, and wheezing" received a 51.4% "Strongly Agree" response, 37.9% "Agree," 9.3% "Neutral," 0.9% "Disagree," and 0.5% "Strongly Disagree." The majority of respondents (51.4%) reported obtaining information about asthma from doctors. A notable portion of respondents (35.5%) reported using herbs or folk medicines to treat asthma in their children. A substantial portion of respondents (44.9%) reported not using medicinal herbs at all. Despite this, 41.6% of respondents expressed belief in the idea of taking herbs as a treatment. CONCLUSION: In conclusion, the knowledge, attitude, and perception of parents toward the use of herbal medicine in the treatment of asthma in their children are multifaceted and influenced by cultural, social, and individual factors. Understanding these dynamics is essential for developing culturally sensitive healthcare interventions and policies that align with the beliefs and practices of the community.

Time-dependent effect of intense capsule-coffee and bleaching on the color of resin-infiltrated enamel white spot lesions: an in vitro study.

Background and Objectives: White spot lesions (WSLs) are a common problem that can be conservatively managed by resin infiltration. Consumption of dark beverages such as coffee causes staining of dental hard tissues, which can deteriorate the esthetic qualities of treated WSLs. The aims of this study were to investigate the effect of dark coffee heavy consumption on ICON® resin infiltrated WSLs and the influence of bleaching on them after staining. Methods: Twenty surfaces from sound human extracted third molars were used in the study. Two square-shaped buccal and lingual window areas had artificially created WSLs (received buccal resin infiltration afterward). Using VITA Easyshade, the baseline ΔE was recorded. Espresso coffee was used to immerse all surfaces for 8 days. The color coordinates according to CIE LAB were recorded for all surfaces at 2, 4, 6, and 8 days of immersion, and ΔE was calculated at each timepoint. After 8 days, in-office bleaching was applied to all surfaces according to the manufacturer's instructions and the color. Coordinates and ΔE were recorded. For statistical analysis, an independent sample t-test was used to compare each group. A general linear mixed model (GLMM) repeated measure ANOVA was applied for statistical analysis of L*and changes due to staining over time. Results: Analysis of time as a main effect on the L values of surfaces was statistically highly significant (p < 0.01). The interaction of time with surfaces under investigation and type of surface (test vs. control) as a main effect were non-significant (p = 0.47 and p = 0.35, respectively). Bleaching showed a significant difference in color lightness in both test and control surfaces compared to the mean L value at 8 days of staining (p < 0.01). Conclusion: Capsule-coffee consumption gradually influences the esthetic of resin infiltration on treated teeth. However, bleaching materials might restore an esthetic shade.

The Effect of Repeated Pressing on the Flexural Strength, Color Stability, Vickers Hardness, and Surface Topography of Heat-Pressed Lithium Disilicate.

The aim of this study was to investigate the effect of repressing leftover heat-pressed lithium disilicate material on its mechanical and optical properties. A lithium disilicate ingot (IPS e.max® Press, IvoclarVivadent, Schaan, Liechtenstein) shade (A1) low translucency was first heat-pressed to yield ceramic bars and disks. Then, the second and third presses were fabricated from the leftovers of the previous pressing cycles. A total of 36 bars and 15 disk specimens were fabricated and divided into three groups according to the number of pressing cycles (n = 12 bars and n = 5 disks): P1: first press (control), P2: second press, and P3: third press. The specimens were tested for flexural strength, color change, Vickers hardness, and surface topography under scanning electron microscopy. One-way ANOVA testing was used to evaluate flexural strength and hardness, while an independent t-test was performed to evaluate color change. There was no significant difference in flexural strength as the number of heat-pressed cycles increased (p = 0.283). Similarly, there was no significant difference in the microhardness values between all groups (p = 0.220). The overall color change ∆E between P1-P2 and P1-P3 were 2.01 and 2.14, respectively. The SEM images showed evenly distributed and densely packed lithium disilicate crystals in the P1 group. However, larger and less densely packed crystals were noticeable in P2 and P3. The IPS e.max Press could be repressed up to two times without an adverse effect on mechanical properties or color stability. These results may support the reuse of pressed lithium disilicate for economical purposes, but further clinical evaluation should be conducted to confirm these findings.

Fabrication of Definitive Cast for Complete Mouth Rehabilitation by Using Resin-Transfer Coping.

One of the most challenging steps in dentistry is taking final impressions for full mouth rehabilitation of a dentate patient. Final impressions should include the necessary details needed to fabricate a definitive cast. This cast will be used to construct indirect restorations in the laboratory. Besides all the improvement of impression materials and systems used for taking final impressions, the intraoral cavity is a challenging environment and there are some cases that prevent clinicians from recording the needed details in a single final impression. The objective of this case report is to describe a technique for fabrication of a definitive cast for a full mouth rehabilitation case by using resin-transfer coping impression technique. This technique is used as an alternative option for cases that prevent the clinician from capturing all the needed details in a single full-arch final impression.

Imaging patients with obesity.

Obesity is a major global health issue, which directly impacts on health and is associated with multiple comorbidities. This editorial explores the challenges and clinical decision making relating to imaging patients with obesity.

Iatrogenic Esophageal Perforation After Laparoscopic Heller's Myotomy Treated Successfully with Endoscopic Stent: Case Report and Literature Review.

BACKGROUND Achalasia cardia is a neuro-degenerative motility disorder, which results in the loss of esophageal peristalsis along with failure of the lower sphincter to relax in response to swallowing. It is relatively rare, with a prevalence of 10 cases per 100 000 individuals. The criterion standard in the management of achalasia is laparoscopic Heller's myotomy with partial fundoplication. Esophageal perforation is one of the earliest major complications that could be managed by primary repair. However, it has been reported that esophageal perforations in achalasia cases can be managed with esophageal stenting after primary repair failure. CASE REPORT We are reporting a case of achalasia after Heller's myotomy in a 37-year-old man, which was complicated by iatrogenic esophageal perforation and was successfully managed by esophageal stenting after failed primary repair. CONCLUSIONS Esophageal stenting is a safe and effective management in cases of esophageal perforation after Heller's myotomy procedure.

Evaluation of the accuracy of 2 digital intraoral scanners: A 3D analysis study.

STATEMENT OF PROBLEM: Evidence for the accuracy of a recently introduced intraoral scanner is lacking. PURPOSE: The purpose of this in vitro study was to evaluate and compare the trueness (validity) and precision (reliability) of 2 intraoral scanners by scanning a quadrant and a sextant. MATERIAL AND METHODS: A maxillary typodont with plastic teeth made from a shade A3 polymethyl methacrylate was scanned (n=10) with each intraoral scanner (Planmeca Emerald and 3Shape TRIOS 3) to obtain sextant and quadrant scans. Control scans were made with an industrial optical scanner. The scans were analyzed with a 3D reverse engineering software program and an independent samples t test and general linear model 2-way analysis of variance (α=.05). RESULTS: The 3Shape TRIOS 3 scanner showed no significant difference between the sextant and quadrant scans in trueness (P=.118) or in precision (P<.285). The Emerald scanner had statistically significant higher trueness for the sextant scan (P=.007). The 3Shape TRIOS 3 scanner had better performance in trueness and precision when compared with the Emerald scanner. CONCLUSIONS: The 3Shape TRIOS 3 scanner was found to be more accurate than the Emerald scanner in terms of trueness and precision, regardless of the scanning field. The Emerald scanner's trueness decreased as the scanning field increased from a sextant to a quadrant.

Laparoscopic Double-Tract Esophago-Jejunostomy Reconstruction for Iatrogenic Esophageal Perforation After Endoscopic Pneumatic Dilatation for Achalasia: A Case Report.

BACKGROUND Achalasia is a rare primary esophageal motility disorder of unknown etiology, with significant negative impact on patient quality of life. Esophageal perforation is the most serious complication after pneumatic dilatation for achalasia, with a high mortality rate of up to 20%. Double-tract reconstruction is used mainly after proximal gastrectomy for gastric cancer, with the advantage of functional preservation of the stomach. We report a case of iatrogenic esophageal perforation after endoscopic pneumatic dilatation for achalasia that was successfully managed by laparoscopic proximal gastrectomy with double-tract reconstruction. CASE REPORT An elderly man started to manifest desaturation during endoscopic dilatation for achalasia, and multiple esophageal perforations were confirmed just above the gastroesophageal junction. During diagnostic laparoscopy, multiple perforations were found 2 cm proximal to the gastroesophageal junction extending 5 cm proximally with multiple linear mucosal tears. A trial of primary repair was difficult and double-tract reconstruction was performed by transection of the distal esophagus above the perforations and proximal gastrectomy. Then, 3 anastomoses were performed: end-to-end esophago-jejunostomy, end-to-side jejuno-jejunostomy, and side-to-side gastro-jejunostomy 15 cm distal to the esophago-jejunostomy site. After a smooth postoperative course, he was discharged home and was followed up regularly. CONCLUSIONS Esophageal perforation is the most serious complication after endoscopic pneumatic dilatation for achalasia. Double-tract reconstruction is a feasible and effective reconstruction modality following esophageal resection that avoids complications of esophago-gastrostomy. This technique deserves to be considered a valid treatment modality for advanced and complicated cases of achalasia, but further research is needed.

Increased radiation dose and projected radiation-related lifetime cancer risk in patients with obesity due to projection radiography.

PURPOSE: Primarily to evaluate the radiation dose delivered to patients with obesity in projection radiography and its relationship to the patient's size. A secondary purpose is to estimate the subsequent projected radiation-related lifetime cancer risk to patients with obesity compared to normal-weight patients. METHOD AND MATERIAL: Data from 1964 patients from a bariatric clinic in the UK were reviewed with the relevant permission. 630 patients were identified to have a projection radiography history and were included in the study. Patients' dose area product (DAP) data were collected for all projection radiography. Multiple exams in one day including a single DAP reading and exams with no records of DAP and exposure factors were excluded. Correlations were calculated and data analysed to yield the third quartile for each examination using STATA 14. Absorbed doses were generated from PCXMC simulation, utilising DAP data from this study and the UK national diagnostic reference level (NDRL), to calculate the effective risk for patients with obesity compared to patients with normal-weight. RESULTS: Patients with obesity received higher DAPs for all examinations included in this study compared to NDRL. Abdominal and lumbar spine radiographs DAPs were the highest (17.6 and 30.31 Gy cm2) compared to the NDRL (2.5 and 4 Gy cm2). Only moderate to low correlations were found between patient's size and DAPs in the abdomen and chest radiographs. The projected radiation-related lifetime cancer risk for patients with obesity is up to 153% higher than for adult patients with normal weight. CONCLUSION: Patients with obesity receive higher DAPs than normal-weight adults which may be in excess of that expected due to their size. Therefore, radiation-related lifetime cancer risk is increased in patients with obesity as a result of medical radiation exposures. This indicates more dose optimisation research is needed in this group of patients to reduce dose rate and variation.

High prevalence of vitamin D deficiency in the sunny Eastern region of Saudi Arabia: a hospital-based study

This study evaluated the vitamin D status of a cohort of healthy young Saudi Arabians in the Eastern region of Saudi Arabia. A sample of 139 blood donors [87 males and 52 females] answered a questionnaire about their clinical history, including intake of vitamin D supplements and calcium-rich foods and exposure to sunshine. Blood samples were taken for routine biochemistry, serum 25-hydroxyvitamin D [25[OH]3] and plasma parathyroid hormone [PTH] levels. Serum 25 [OH]D levels did not differ significantly between males and females, although the levels were low [10.1 [SD 4.6] ng/mL and 9.9 [SD 4.5] ng/mL respectively]. When subjects with elevated PTH levels were excluded, serum 25[OH]3 levels were still in the deficiency range. There was a high prevalence of a vitamin D deficiency in this sample of Saudi Arabians despite > 65% of participants having adequate exposure to sunlight and > 90% reporting adequati intake of dairy products

Kinetically controlled self-assembly of pseudorotaxanes on crystallization.

[reaction: see text] Mixing of equimolar amounts of cyclobis(paraquat-p-phenylene) (CBPQT(4+)) with a bis-4-methylphenyl ether (MPE twice) of a 1,5-dioxynaphthalene (DNP) derivative in MeCN/CH(2)Cl(2) (3:1) results in the formation of a [2]pseudorotaxane which, on crystallization, yields a [4]pseudorotaxane in the solid state that is stabilized by multiple [C-H...F] interactions: a mixture of the same components in a 1:3 ratio affords a crystalline [2]pseudorotaxane after vapor diffusion of methyl-tert-butyl ether into a solution of these components in MeCN/CH(2)Cl(2) (3:1).