fMRI language dominance and FDG-PET hypometabolism.

BACKGROUND: Atypical language dominance is common in patients with temporal lobe epilepsy. We examined the association of left temporal hypometabolism with laterality of fMRI activation in a language task in a cross-sectional study. METHODS: Thirty patients with temporal lobe epilepsy (mean age 32.4 ± 11.0 years [range 18-55]; epilepsy onset 15.3 ± 11.3 years [range 0.8-40]; 22 left focus, 8 right focus) had (18)fluoro-deoxyglucose (FDG)-PET using noninvasive cardiac input function. After MRI-based partial volume correction, regional glucose metabolism (CMRglc) was measured and asymmetry index, AI = 2(l - R)/(L + R), calculated. fMRI language dominance was assessed with an auditory definition decision paradigm at 3 T. fMRI data were analyzed in SPM2 using regions of interest from Wake Forest PickAtlas (Wernicke area [WA], inferior frontal gyrus [IFG], middle frontal gyrus [MFG]) and bootstrap laterality index, LI = (l - R/L + R). RESULTS: Nineteen patients had ipsilateral temporal hypometabolism; 3 of 4 patients with atypical language had abnormal FDG-PET. Increasing left midtemporal hypometabolism correlated with decreased MFG LI (r = -0.41, p < 0.05) and showed trends with WA LI (r = -0.37, p = 0.055) and IFG LI (r = -0.31, p = 0.099); these relationships became more significant after controlling for age at onset. Increasing hypometabolism was associated with fewer activated voxels in WA ipsilateral to the focus and more activated voxels contralaterally, but overall, activation amount in left WA was similar to subjects without left temporal hypometabolism (t = -1.39, p > 0.10). CONCLUSIONS: We did not find evidence of impaired blood oxygenation level-dependent response in hypometabolic cortex. Regional hypometabolism appears to be a marker for the temporal lobe dysfunction that leads to displacement of language function.

A proposal for a new classification of lesions of exposed tooth surfaces.

In the presence of improved methods of identification and treatment of lesions on the exposed surfaces of teeth, it should now be acknowledged that the GV Black "classification of carious cavities" is out of date. This paper describes a new system, proposed in 1997, discussed broadly throughout the profession, and eventually modified. The system has been adopted in several regions around the world as being a useful corollary to the current developing concept of minimal intervention dentistry. It is now desirable to adopt a new approach to the identification and recording of the lesions caused by both caries and non-carious tooth loss. A major advantage arising from its adoption would be that it would encourage the profession to minimise the amount of normal healthy tooth structure that is often sacrificed in pursuit of the cavity designs as suggested by Black. The authors are members of a Project Group of the FDI Science Committee, and this paper explains the concept and offers justification for the adoption of the system.

Investigation of an adhesive system used with direct and indirect applications.

A laboratory investigation was performed that examined the adhesive properties of a new adhesive system. Contrasts were made with other commercially established systems, and indirect and direct bonding procedures were investigated. For the indirect evaluation, simulated restorations were bonded with an experimental resin cement. Sealing was assessed through microleakage analysis. Adhesive strength value was measured by shear bond strength methods. Further, the marginal quality of the restorations was assessed using scanning electron microscopy. Finally, the adhesive shear bond strengths were established using direct bonding.

Advances in restorative core materials.

The use of core build-up materials is likely to increase in coming years. The ease of use of direct materials, such as amalgam and composite-based core materials, will most certainly dominate product selection. The historic standard of the custom cast post-and-core technique is decreasing in the private practice of dentistry. Providing the foundation for a restoration that will endure the masticatory stresses that occur in the oral cavity for prolonged periods is a goal all conscientious dentists are pursuing. Only with a thorough understanding of the individual patient's oral conditions can an accurate assessment be made regarding material selection. Minimizing the risks associated with failure should include a knowledge of the material's properties, the forces that the core build-up must withstand, the occlusal scheme of the patient, and the final type of restoration or prosthesis to be fabricated. An extreme amount of professional judgement and past experience must be used in the absence of sound scientific validation. Unfortunately, little sound research, especially clinical research, exists to assist dentists in this area. New clinical studies in this area would be of tremendous benefit to the practicing dentists and would benefit the general public greatly.

Indirect composite resin materials for posterior applications.

Indirect composite resin restorations were introduced a number of years ago as possible alternatives to traditional metallic or ceramic-based indirect restorations. However, the earlier formulations did not provide evidence of improvement in mechanical and physical properties over chairside-placed direct composite resin materials. Because they required more tooth structure removal than direct restorations, their use became unpopular and was abandoned by most clinicians. Over the past few years, a new class of composite resin indirect materials has surfaced in the profession. Various technologies have been suggested as reinforcement mechanisms. Fibers, matrix modifications, and an assortment of innovations have been proposed for enhancing indirect composite resin restorations. Applications are from inlay restorations all the way to multi-unit fixed prostheses. This manuscript summarizes some of the progress made in this area. When available, data is presented to provide clinicians with guidelines and indications for the use of these materials.

A TEM study of two water-based adhesive systems bonded to dry and wet dentin.

To keep the exposed collagen scaffold penetrable to resin, it has been recommended that the conditioned dentin surface be maintained in a visibly moist condition, a clinical technique commonly referred to as wet bonding. In this study, resin-dentin interfaces produced with two water-based adhesive systems--OptiBond (OPTI, Kerr) and Scotchbond Multi-Purpose (SBMP, 3M)--were compared by transmission electron microscopy, following the application of either a dry- or a wet-bonding technique. The hypothesis advanced was that the ultramorphology of the hybrid layer would differ depending on which bonding method was applied. A morphologically well-organized hybrid layer of collagen fibrils intermingled with resin in tiny interfibrillar channels was consistently formed by the OPTI system. The SBMP system was found to produce a hybrid layer with a more variable ultrastructure, less distinctly outlined collagen fibrils, and a characteristic electron-dense phase located at its surface. No major differences in hybrid layer ultrastructure were observed when the two adhesive systems investigated were bonded to either dry or wet dentin. When the adhesives were dry-bonded, no ultrastructural evidence of collapsed demineralized collagen, incompletely or not at all infiltrated by resin, could be detected. In addition, when the two adhesives were bonded to wet dentin, no signs of overwetting phenomena, that would have indicated that water was ineffectively removed, were apparent. It has been hypothesized that the amount of water provided with the hydrophilic primer solution of either of the two adhesive systems investigated suffices to re-hydrate and re-expand the gently air-dried and collapsed collagen network. Further research should be directed to determine whether this hypothesized self-rewetting effect can be extrapolated to other adhesive systems that provide water-based primers.