Acetaminophen effects upon formalin-evoked flinching, postformalin, and postincisional allodynia and conditioned place preference.

Introduction: We explored in mice, the analgesic, tolerance, dependency, and rewarding effects of systemic acetaminophen (APAP). Methods: Studies employed adult mice (C57Bl6). (1) Intraplantar formalin flinching + post formalin allodynia. Mice were given intraperitoneal APAP in a DMSO (5%)/Tween 80 (5%) or a water-based formulation before formalin flinching on day 1 and tactile thresholds assessed before and after APAP at day 12. (2) Paw incision. At 24 hours and 8 days after hind paw incision in male mice, effects of intraperitoneal APAP on tactile allodynia were assessed. (3) Repeated delivery. Mice received daily (4 days) analgesic doses of APAP or vehicle and tested upon formalin flinching on day 5. (4) Conditioned place preference. For 3 consecutive days, vehicle was given in the morning in either of 2 chambers and in each afternoon, an analgesic dose of morphine or APAP in the other chamber. On days 5 and 10, animals were allowed to select a "preferred" chamber. Results: Formalin in male mice resulted in biphasic flinching and an enduring postformalin tactile allodynia. Acetaminophen dose dependently decreased phase 2 flinching, and reversed allodynia was observed postflinching. At a comparable APAP dose, female mice showed similarly reduced phase 2 flinching. Incision allodynia was transiently reversed by APAP. Repeated APAP delivery showed no loss of effect after sequential injections or signs of withdrawal. Morphine, but not APAP or vehicle, resulted in robust place preference. Conclusions: APAP decreased flinching and allodynia observed following formalin and paw incision and an absence of tolerance, dependence, or rewarding properties.

In vitro comparison of the accuracy of an occlusal plane transfer method between facebow and POP bow systems in asymmetric ear position.

PURPOSE: This in vitro study aimed to compare the accuracy of the conventional facebow system and the newly developed POP (PNUD (Pusan National University Dental School) Occlusal Plane) bow system for occlusal plane transfer in asymmetric ear position. MATERIALS AND METHODS: Two dentists participated in this study, one was categorized as Experimenter 1 and the other as Experimenter 2 based on their clinical experience with the facebow (1F, 2F) and POP bow (1P, 2P) systems. The vertical height difference between the two ears of the phantom model was set to 3 mm. Experimenter 1 and Experimenter 2 performed the facebow and POP bow systems on the phantom model 10 times each, and the transfer accuracy was analyzed. The accuracy was evaluated by measuring the angle between the reference virtual plane (RVP) of the phantom model and the experimental virtual plane (EVP) of the upper mounting plate through digital superimposition. All data were statistically analyzed using a paired t-test (P < .05). RESULTS: Regardless of clinical experience, the POP bow system (0.53° ± 0.30 (1P) and 0.19° ± 0.18 (2P) for Experimenter 1 and 2, respectively) was significantly more accurate than the facebow system (1.88° ± 0.50 (1F) and 1.34° ± 0.25 (2F), respectively) in the frontal view (P < .05). In the sagittal view, no significant differences were found between the POP bow system (0.92° ± 0.50 (1P) and 0.73° ± 0.42 (2P) for Experimenter 1 and 2, respectively) and the facebow system (0.82° ± 0.49 (1F) and 0.60° ± 0.39 (2F), respectively), regardless of clinical experience (P > .05). CONCLUSION: In cases of asymmetric ear position, the POP bow system may transfer occlusal plane information more accurately than the facebow system in the frontal view, regardless of clinical experience.

Comparison of fit and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems.

PURPOSE: This study aims to clinically compare the fitness and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems. MATERIALS AND METHODS: Total of 40 patients were enrolled in this study, and 9 different zirconia crowns were prepared per patient. Each crown was made through the cross-application of 3 different design software (EZIS VR, 3Shape Dental System, Exocad) with 3 different processing devices (Aegis HM, Trione Z, Motion 2). The marginal gap, absolute marginal discrepancy, internal gap(axial, line angle, occlusal) by a silicone replica technique were measured to compare the fit of the crown. The scanned inner and outer surfaces of the crowns were compared to CAD data using 3D metrology software to evaluate trueness. RESULTS: There were significant differences in the marginal gap, absolute marginal discrepancy, axial and line angle internal gap among the groups (P < .05) in the comparison of fit. There was no statistically significant difference among the groups in terms of occlusal internal gap. The trueness ranged from 36.19 to 43.78 µm but there was no statistically significant difference within the groups (P > .05). CONCLUSION: All 9 groups showed clinically acceptable level of marginal gaps ranging from 74.26 to 112.20 µm in terms of fit comparison. In the comparison of trueness, no significant difference within each group was spotted. Within the limitation of this study, open CAD-CAM systems used in this study can be assembled properly to fabricate zirconia crown.

Comparison of digital and conventional assessment methods for a single tooth preparation and educational satisfaction.

INTRODUCTION: Digital feedback for tooth preparation can provide dental practitioners with more objective and accurate evaluations compared to conventional methods. This study aimed to evaluate the educational effect and satisfaction of digital feedback compared with those of the conventional putty index method for tooth preparation. MATERIAL AND METHODS: Forty-eight third-grade dental students were selected. All students performed a full-coverage preparation on a right mandibular first molar resin tooth. They were randomly divided into four groups (n = 12)-no guide (control), putty index, digital feedback, and digital and putty index assessment. Three-dimensional analysis was performed using an analysis software (GomInspect 2018, Gom) to evaluate the amount of tooth structure removed. At the end of the practice, the students completed a questionnaire to evaluate the educational satisfaction of the respective methods. RESULTS: There was no statistical significance of the amount of preparation amongst groups in most of the measured areas only except for several specific points. Overall occlusal surface showed 0.99 ± 0.27 mm in the N group (no guide) and 1.15 ± 0.31 mm in the D group (digital feedback), and overall axial surface showed no statistical differences (p > .05). The groups that used digital assessment showed a high level of satisfaction compared with conventional assessment. CONCLUSIONS: It was difficult to confirm that the digital-based feedback promotes accurate tooth preparation compared to conventional feedback within the limitation of this study. However, it improved educational satisfaction and permitted objective evaluation.

Comparison of two-lung and one-lung ventilation in bilateral video-assisted thoracoscopic extended thymectomy in myasthenia gravis: a retrospective study.

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease, and early thymectomy is recommended. Since the introduction of video-assisted thoracoscopic surgery, the safety and effectiveness of carbon dioxide insufflation in the thoracic cavity (capnothorax) has been controversial. This study aimed to compare the safety and effectiveness of ventilation methods in bilateral video-assisted thoracoscopic extended thymectomy (BVET) with capnothorax. METHODS: We retrospectively investigated the medical records of patients with MG who underwent BVET between August 2016 and January 2018. Patients were divided into two groups: group D (n = 26) for one-lung ventilation and group S (n = 28) for two-lung ventilation. We set nine anesthesia time points (T0-T8) and collected respiratory and hemodynamic variables, including arterial O2 index (PaO2/FiO2). RESULTS: SpO2 at T1-T3 and T8 was significantly lower in group D than in group S. The FiO2 in group S was lower than that in group D at all time points. The number of PaO2/FiO2 ≤ 300 and PaO2/FiO2 ≤ 200 events was significantly higher in group D than in group S. Hemodynamic variables were not significantly different between the two groups at any time point. The duration of surgery and anesthesia was shorter in group S than in group D. CONCLUSIONS: This retrospective study suggests that anesthesia using two-lung ventilation during BVET with capnothorax is a safe and effective method to improve lung oxygenation and reduce anesthesia time.

Clinical evaluation of the fit of lithium disilicate crowns fabricated with three different CAD-CAM systems.

STATEMENT OF PROBLEM: The fit and performance of prostheses fabricated using various computer-aided design and computer-aided manufacturing (CAD-CAM) systems have been evaluated. However, most studies were conducted in vitro, and relatively few have addressed gingival parameters and prosthesis fit under clinical conditions. PURPOSE: This clinical study aimed to compare the fit of lithium disilicate crowns produced using 3 CAD-CAM systems and evaluate clinical results up to 6 months after delivery. MATERIAL AND METHODS: Forty participants requiring a single crown were recruited. Three monolithic lithium disilicate crowns were fabricated per participant by using 3 different CAD-CAM systems (intraoral scanners, CAD software, and milling machines): CEREC group (CEREC Bluecam, CEREC AC, CEREC MC); EZIS group (EZIS PO, EZIS VR, EZIS HM); and TRIOS group (TRIOS 3, EXO-CAD, ARUM-4X). The fit of the prostheses was assessed via a silicone replica technique, and the most acceptable crown was delivered; 12 were selected from the CEREC group, 16 from the EZIS group, and 12 from the TRIOS group. Follow-up clinical examinations were performed at 1, 3, and 6 months after delivery. The Kruskal-Wallis test with the post hoc Mann-Whitney U test was conducted to analyze significant differences in crown fit and periodontal conditions among the groups (α=.05). RESULTS: The marginal gap of the CEREC group was significantly higher than that of the EZIS group, and the occlusal gap of the EZIS group was significantly lower than those of the CEREC and TRIOS groups (P<.05). Probing depth, bleeding index, and plaque index showed no intergroup differences at 6 months (P>.05). CONCLUSIONS: The lithium disilicate crowns of all groups showed clinically acceptable fit. No significant differences were found among the groups in terms of periodontal conditions after 6 months.

Evaluating the Wear of Resin Teeth by Different Opposing Restorative Materials.

The aim of this study was to evaluate the wear properties of resin teeth with different opposing dental restorative materials. One type of resin tooth (Trubyte Biotone) was tested against six types of restorative materials including type III gold alloy (GO), monolithic zirconia (MZ), lithium disilicate glass ceramic (LD), nickel-chromium alloy (NC), feldspathic ceramic (FC), and steatite (ST). Two-body wear tests were performed under a vertical load of 5 kgf and thermo-cycling at 5/55 °C with a total of 120,000 cycles. The wear amount was quantified by measuring the volume loss of the resin teeth and the vertical substance loss of the opposing materials using three-dimensional images. The FC group showed a significantly greater amount of wear of the resin teeth, followed by the ST, NC, LD, MZ, and GO groups. The GO group showed significantly less wear of resin teeth than the other groups. There were no statistically significant differences in the wear of opposing restorative materials between groups. Within the limits of this study, it is recommended that zirconia, rather than feldspathic ceramic, should be used for restorations in the esthetic zone, and gold alloy should be used for areas with little or no esthetic demand.

Anaphylactic reaction with hydroxyethyl starch during anesthesia - A case report.

BACKGROUND: Hydroxyethyl starch (HES), a class of synthetic colloid solutions, has been widely used to treat perioperative hypovolemia. The use of HES, however, is associated with the risk of allergic reactions. CASE: An 83-year-old man was scheduled to undergo an open reduction and internal fixation of a pertrochanteric fracture under spinal anesthesia. He had no history of allergy. Five minutes after HES administration, hypotension, agitation, and skin rash were developed. HES infusion was terminated due to a suspected anaphylactic reaction. The vital signs recovered following administration of phenylephrine, dexamethasone, and hydrocortisone. Serum tryptase and total immunoglobulin E levels were elevated in plasma samples collected following the commencement of the allergic reaction during surgery. CONCLUSIONS: In the present report, the risk of anaphylactic reaction with HES and the laboratory tests needed to support the diagnosis are highlighted.

Comparison of the Microtensile Bond Strength of a Polyetherketoneketone (PEKK) Tooth Post Cemented with Various Surface Treatments and Various Resin Cements.

The aim of this in-vitro research was to evaluate the microtensile bond strength in the newly introduced PEKK tooth post with various surface treatments and resin cements. A fiberglass tooth post was included in order to compare it with PEKK as a possible post material. The microtensile bond strengths of the fiberglass post (FRC Postec Plus) and the PEKK post (Pekkton®) were tested using three kinds of self-adhesive resin cements (G-CEM LinkAce, Multilink Speed, and RelyX U200) and one self-etching resin cement (PANAVIA F2.0). The surface treatments of the fiberglass posts were processed according to the manufacturer's recommendations (F1, application of 37% phosphoric acid etching gel and silanization). For the PEKK post groups, various surface treatments were performed like no surface treatment (P1), sandblasting (P2), silica-coating and silanization (P3), and sandblasting with a composite primer (P4). In the surface treatment, PEKK posts with silica coating and silane treatment (P3) showed a significantly higher microtensile bond strength (mean MPa: 18.09, p < 0.05). The highest microtensile bond strength was shown when the PEKK posts were treated with a silica coating and silane treatment and cemented with RelyX U200 (mean MPa: 22.22). The PEKK posts with surface treatments of silica-coating and silanization or sandblasting displayed superior microtensile bond strengths (mean MPa: 18.09 and 16.25, respectively) compared to the conventional fiberglass posts (mean MPa: 14.93, p < 0.05).

Accuracy of several implant bite registration techniques: an in-vitro pilot study.

PURPOSE: This study evaluated the accuracies of different bite registration techniques for implant-fixed prostheses using three dimensional file analysis. MATERIALS AND METHODS: Implant fixtures were placed on the mandibular right second premolar, and the first and second molar in a polyurethane model. Aluwax (A), Pattern Resin (P), and Blu-Mousse (B) were used as the bite registration materials on the healing abutments (H) or temporary abutments (T). The groups were classified into HA, HP, HB, TA, TP, and TB according to each combination. The group using the bite impression coping was the BC group; impression taking and bite registration were performed simultaneously. After impression and bite taking, the scan bodies were connected to the lab analogs of the casts. These casts were scanned using a model scanner. The distances between two reference points in three-dimensional files were measured in each group. One-way ANOVA and Duncan's test were used at the 5% significance level. RESULTS: The smallest distance discrepancy was observed in the TB group using the temporary abutments. The Blu-Mousse and HP groups showed the largest distance discrepancy. The TB and BC groups showed a lower distance discrepancy than the HP group (P=.001), and there was no significant difference between the groups using the temporary abutments and healing abutments (P>.05). CONCLUSION: Although this study has limitations as an in-vitro investigation, the groups using the temporary abutments to hold the Blu-Mousse record and bite impression coping showed greater accuracy than the group using the healing abutments to hold the pattern resin record.

The Effect of Reduced Graphene Oxide-Coated Biphasic Calcium Phosphate Bone Graft Material on Osteogenesis.

This study was conducted to evaluate the effect of biphasic calcium phosphate (BCP) coated with reduced graphene oxide (rGO) as bone graft materials on bone regeneration. The rGO-coated BCP bone graft material was fabricatied by mixing rGO and BCP at various concentrations. The surface charge of rGO-coated BCP was measured to be -14.43 mV, which formed a static electrostatic interaction. Cell viabilities were significantly diminished at higher concentrations of ≥100 µg/mL. The calvarial defects of 48 rats were implanted rGO-coated BCPs at a weight ratio of 2:1000 (rGO2), 4:1000 (rGO4), and 10:1000 (rGO10), repectively. BCP was used as a control group. The micro-CT and histological analysis were performed to evaluate new bone formation at 2 and 8 weeks after surgery. The results showed that the new bone volume (mm³) was significantly higher in the experimental groups than in the control group. Histological analysis showed that new bone areas (%) were significantly higher in the rGO2 and rGO10 than in the control, and significantly higher in rGO4 than in the rGO2 and rGO10. Conclusively, the rGO-coated BCP was found to be effective on osteogenesis and the concentration of the composite was an important factor.

A Clinical Retrospective Study of Distal Extension Removable Partial Denture with Implant Surveyed Bridge or Stud Type Attachment.

This study was performed to make comparative analysis of the clinical findings between the two different types of the implant-assisted removable partial dentures: removable partial dentures using implant surveyed bridge as an abutment (ISBRPD) and overdenture type of removable partial denture using implant attachment (IARPD). Implant cumulative survival rate, marginal bone resorption, probing depth, peri-implant inflammation, bleeding, plaque, calculus, and complications were evaluated on 24 patients who were treated with implants in conjunction with removable partial denture and have used them for at least 1 year (ISCRPD: n = 12; IARPD: n = 12). There was no failed implant and all implants were functioning without clinical mobility. Marginal bone loss of ISCRPD (1.44 ± 0.57 mm) was significantly lower than that of IARPD (p < 0.05). There was no significant difference in probing depth, peri-implant inflammation, bleeding, and plaque between the two groups (p > 0.05), while the calculus was significantly more observed in ISCRPD group than in IARPD group (p < 0.05). The retention loss of IARPD was the most common complication. Within the limits of the present study, it was found that well-planned ISBRPD was clinically appropriate. Longitudinal and systematic clinical studies are necessary to confirm these results.

Comparison of the fit of cast gold crowns fabricated from the digital and the conventional impression techniques.

PURPOSE: The purpose of this study was to compare the fit of cast gold crowns fabricated from the conventional and the digital impression technique. MATERIALS AND METHODS: Artificial tooth in a master model and abutment teeth in ten patients were restored with cast gold crowns fabricated from the digital and the conventional impression technique. The forty silicone replicas were cut in three sections; each section was evaluated in nine points. The measurement was carried out by using a measuring microscope and I-Soultion. Data from the silicone replica were analyzed and all tests were performed with α-level of 0.05. RESULTS: 1. The average gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. 2. In marginal and internal axial gap of cast gold crowns, no statistical differences were found between the two impression techniques. 3. The internal occlusal gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. CONCLUSION: Both prostheses presented clinically acceptable results with comparing the fit. The prostheses fabricated from the digital impression technique showed more gaps, in respect of occlusal surface.

In vitro assessment of cutting efficiency and durability of zirconia removal diamond rotary instruments.

STATEMENT OF PROBLEM: Recently, zirconia removal diamond rotary instruments have become commercially available for efficient cutting of zirconia. However, research of cutting efficiency and the cutting characteristics of zirconia removal diamond rotary instruments is limited. PURPOSE: The purpose of this in vitro study was to assess and compare the cutting efficiency, durability, and diamond rotary instrument wear pattern of zirconia diamond removal rotary instruments with those of conventional diamond rotary instruments. In addition, the surface characteristics of the cut zirconia were assessed. MATERIAL AND METHODS: Block specimens of 3 mol% yttrium cation-doped tetragonal zirconia polycrystal were machined 10 times for 1 minute each using a high-speed handpiece with 6 types of diamond rotary instrument from 2 manufacturers at a constant force of 2 N (n=5). An electronic scale was used to measure the lost weight after each cut in order to evaluate the cutting efficiency. Field emission scanning electron microscopy was used to evaluate diamond rotary instrument wear patterns and machined zirconia block surface characteristics. Data were statistically analyzed using the Kruskal-Wallis test, followed by the Mann-Whitney U test (α=.05). RESULTS: Zirconia removal fine grit diamond rotary instruments showed cutting efficiency that was reduced compared with conventional fine grit diamond rotary instruments. Diamond grit fracture was the most dominant diamond rotary instrument wear pattern in all groups. All machined zirconia surfaces were primarily subjected to plastic deformation, which is evidence of ductile cutting. Zirconia blocks machined with zirconia removal fine grit diamond rotary instruments showed the least incidence of surface flaws. CONCLUSIONS: Although zirconia removal diamond rotary instruments did not show improved cutting efficiency compared with conventional diamond rotary instruments, the machined zirconia surface showed smoother furrows of plastic deformation and fewer surface flaws.

Effects of Different Implant Osteotomy Preparation Sizes on Implant Stability and Bone Response in the Minipig Mandible.

PURPOSE: The purpose of this study was to investigate the influence of implant and drill diameters on the stability of implant and bone response. MATERIALS AND METHODS: An implant (GS II, Osstem Implant) with a 3.5-mm diameter and drills with three different diameters, differentiating the volume of bone compacted by the implant, were used in this study. Measurement of the insertion torque and observation of bone compression patterns were done during implant site preparation in minipigs. Also, analysis of resonance frequency, histomorphology, marginal bone resorption, and new bone formation were performed. RESULTS: Microstrains and microcracks occurred in cortical bone around the thread when a drill with a smaller diameter than that of the thread was used. Higher implant stability was shown and maintained when a small-diameter drill was used. When using a drill with a smaller diameter than the root diameter of the implant thread, the bone-to-implant contact/bone area (BIC/BA) was higher than the wider drill during the whole test period. However, the use of a wide drill was the most rapid in increasing the BIC/BA value by new bone formation. In the cancellous bone, the speed of new bone formation was not different in each test group. However, the formation of new bone was faster when a large-diameter drill was used in the cortical bone. There was no significant difference in marginal bone loss (MBL) according to drill diameters, but the speed of MBL was fast when using a drill that was smaller than the root diameter of the implant thread. CONCLUSION: Implant stability, BIC, and BA were high when using a final drill that was smaller than the root diameter of the implant thread compared with a wide final drill. However, the speed of new bone formation was relatively slow and the speed of MBL was relatively fast if the final drill was excessively smaller.

Head elevation by 3 vs. 6 cm in ProSeal laryngeal mask airway insertion: a randomized controlled trial.

BACKGROUND: The sniffing position (neck flexion by head elevation and head extension) is commonly used for insertion of a laryngeal mask airway. However, the appropriate degrees of head elevation and head extension are unclear. In the present study, the success rate of ProSeal™ laryngeal mask airway (LMA ProSeal) insertion using two degrees of head elevation was evaluated. METHODS: This prospective randomized, controlled study included 80 adult patients aged 18 to 90 years. In the 3 cm (n = 40) and 6 cm (n = 40) groups, the LMA ProSeal was inserted while the head was elevated 3 cm and 6 cm, respectively, using a pillow of the corresponding height. The success rate, and incidence of blood staining on cuff, sore throat and hoarseness were assessed. The alignments of laryngeal and oral axes were also evaluated. RESULTS: The first attempt success rate was higher in the 3 cm than the 6 cm group (87 % vs. 60 %, P = 0.014). In 86 % of patients in the 6 cm group and 50 % of patients in the 3 cm group in whom the second attempt failed, the third insertion attempt was successful by using a pillow height of the opposite group. The alignments of the two axes were not different between the two groups (P > 0.05). CONCLUSIONS: The first attempt success rate of ProSeal laryngeal mask insertion was higher with 3 cm than 6 cm head elevation in adult patients. TRIAL REGISTRATION: Identifiers: NCT02058030 (08/05/2015), Unique Protocol ID: phdkim1.

Clinical evaluation of mandibular implant overdentures via Locator implant attachment and Locator bar attachment.

PURPOSE: The aim of this study was to evaluate the clinical findings and patient satisfaction on implant overdenture designed with Locator implant attachment or Locator bar attachment in mandibular edentulous patients. MATERIALS AND METHODS: Implant survival rate, marginal bone loss, probing depth, peri-implant inflammation, bleeding, plaque, calculus, complications, and satisfaction were evaluated on sixteen patients who were treated with mandibular overdenture and have used it for at least 1 year (Locator implant attachment: n=8, Locator bar attachment: n=8). RESULTS: Marginal bone loss, probing depth, plaque index of the Locator bar attachment group were significantly lower than the Locator implant attachment group (P<.05). There was no significant difference on bleeding, peri-implant inflammation, and patient satisfaction between the two denture types (P>.05). The replacement of the attachment components was the most common complication in both groups. Although there was no correlation between marginal bone loss and plaque index, a significant correlation was found between marginal bone loss and probing depth. CONCLUSION: The Locator bar attachment group indicates lesser marginal bone loss and need for maintenance, as compared with the Locator implant attachment group. This may be due to the splinting effect among implants rather than the types of Locator attachment.

Effect of activation modes on the compressive strength, diametral tensile strength and microhardness of dual-cured self-adhesive resin cements.

The purpose of this study was to compare the compressive strength, diametral tensile strength and microhardnss of several selfadhesive resin cements (Rely-X U200, Clearfill SA Luting, G-CEM LinkAce, Maxcem Elite, PermaCem 2.0, and Zirconite) using different activation modes (self-cured, light-cured) and testing time (immediately, 24 h, thermocycling). Specimens were prepared for the compressive strength (Ø 4×6 mm) and diametral tensile strength and microhardness (Ø 6×3 mm) according to ISO standards. The strength after 24 h was higher than immediately after. In addition, G-CEM showed the highest values. In terms of the activation modes, Rely-X U200, PermaCem 2.0 had higher values in the light-curing than the self-curing. In conclusion, all cements demonstrated clinically available strength values and revealed differences in strength according to their composition, testing time and activation mode. Furthermore, correlation was found between the microhardness (degree of conversion) and mechanical strengths of the cements tested.

A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased anesthesiologist discomfort compared to a pillow of 4 cm height during tracheal intubation in adult patients.

BACKGROUND: Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients. METHODS: This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient's head was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist's discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed. RESULTS: There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups. The discomfort score during tracheal intubation was higher in the 8 cm group when the patient's head was elevated 4 cm first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of head elevation. CONCLUSIONS: A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients.

Comparison of changes in retentive force of three stud attachments for implant overdentures.

PURPOSE: The aim of this study was to compare the changes in retentive force of stud attachments for implant overdentures by in vitro 2-year-wear simulation. MATERIALS AND METHODS: Three commercially available attachment systems were investigated: Kerator blue, O-ring red, and EZ lock. Two implant fixtures were embedded in parallel in each custom base mounting. Five pairs of each attachment system were tested. A universal testing machine was used to measure the retentive force during 2500 insertion and removal cycles. Surface changes on the components were evaluated by scanning electron microscopy (SEM). A Kruskal-Wallis test, followed by Pairwise comparison, was used to compare the retentive force between the groups, and to determine groups that were significantly different (α<.05). RESULTS: A comparison of the initial retentive force revealed the highest value for Kerator, followed by the O-ring and EZ lock attachments. However, no significant difference was detected between Kerator and O-ring (P>.05). After 2500 insertion and removal cycles, the highest retention loss was recorded for O-ring, and no significant difference between Kerator and EZ lock (P>.05). Also, Kerator showed the highest retentive force, followed by EZ lock and O-ring, after 2500 cycles (P<.05). Based on SEM analysis, the polymeric components in O-ring and Kerator were observed to exhibit surface wear and deformation. CONCLUSION: After 2500 insertion and removal cycles, all attachments exhibited significant loss in retention. Mechanism of retention loss can only be partially explained by surface changes.