Anti-Mullerian hormone normogram in an Irish subfertile population.

BACKGROUND: There has been much interest in the use of anti-Mullerian hormone (AMH) as a biomarker in the assessment of ovarian reserve, and debate on its use as a predictor of assisted reproductive technology (ART) outcomes. Normal levels have not been well defined, and age-based reference ranges may have a role in counselling patients. AIMS: To determine AMH levels in females attending with subfertility, identify age-specific centiles and the age-related decline, to create population normograms to be used in patient counselling prior to ART. METHODS: Retrospective study in a tertiary academic Assisted Conception Centre analysing AMH levels in female patients attending for investigation of subfertility between January 2009 and December 2011 (n = 3,058). RESULTS: Few patients have AMH levels within external laboratory pre-defined "normal fertility potential" ranges. Only 8.1 % had "optimal fertility" and 18.6 % "satisfactory", with 54.6 % "low" fertility and 15.9 % in the "very low/undetectable" group. By age 32, over 50 % of women have AMH levels categorised as "low fertility" (AMH ≤19.5 pmol/L), increasing to 75 % by age 39. Based on a regression model a decrease in mean AMH of 1.72 pmol/L/year was measured. CONCLUSIONS: We recommend that each ART centre defines their "own" normograms for accurate advice for and treatment of their patients. External laboratory-defined "normal" and "abnormal" AMH levels should be filtered and adapted to the reality of each population. These findings need to be considered when counselling patients and planning treatments as age-specific population normograms can provide a tailored approach.

Assisted reproductive technology treatment outcomes.

Information on the outcomes of ART treatments in Ireland is not readily available to Irish practitioners. The data for hospital affiliated clinics has been made available for many years and is included in the hospital reports. We present a 10-year analysis of the Irish ART results voluntarily reported by six out of seven IVF clinics. The data was collected from published ESHRE reports and from results (2007-8) not yet published. Data collected included: number of clinics and ART cycles, female age, clinical and multiple pregnancy rates and treatment complications. The clinical pregnancy rate per embryo transfer was 31.7% for IVF and 29.8% for ICSI. The proportion of singleton, twin and triplet deliveries for IVF and ICSI combined was 75%, 23.35% and 1.64%. The rate of ovarian hyperstimulation was 0.8%. ART practice in Ireland is safe, effective and responsible. Financial and societal savings could result from the introduction of state funded IVF with compulsory eSET where recommended.

Variable polymerisation shrinkage and the interfacial micropermeability of a dentin bonding system.

PURPOSE: Adhesive bonds are subjected to competing stresses whilst a restoration is setting. This study aimed to determine the effect of these stresses on a chemically- and light-activated dentin adhesive (Scotch Bond MultiPurpose Plus: SBMP+) by assessing the morphology and micropermeability of the interfacial region. MATERIALS AND METHODS: Restorative materials and techniques were selected to impart differing setting stresses to the adhesive interface. An amalgam (Dispersalloy), a light-activated composite (Z100) with a high- or low-intensity curing light, and chemically-activated composite (Adaptic) were placed either in bulk (4 mm thickness) or in one thin layer (2 mm) in occlusal cavities in 55 freshly extracted third molars. In addition, thin composite restorations were placed on 15 horizontally sectioned teeth using a glass slide as a rigid clear matrix. The pulp chambers of all samples were filled with rhodamine B dye solution for 4 hours. Samples were longitudinally sectioned and the interfacial dye leakage measured using a confocal optical microscope. Data were analysed using the Kolmogorov-Smirnov test. RESULTS: In occlusal cavities, Z100 had significantly more leakage than the amalgam and Adaptic. There was no significant difference in micropermeability between large and small increments, or curing light intensity for Z100, but when placed in bulk, there was evidence of incomplete composite polymerisation near the cavity floor, especially with the low intensity curing light. Cohesive failure of the deep resin composite and gap formation were a frequent finding with the high-intensity light curing. The least leakage for Z100 was achieved with a thin layer on flat dentin. In contrast, the chemically-activated composite performed well in bulk when the surface of the restoration was freely exposed, but badly when constrained by the glass matrix. CONCLUSION: Restoration setting stress is critical in the microscopic integrity of the adhesive bond to dentin.

Conventional glass ionomers as posterior restorations. A status report for the American Journal of Dentistry.

The search for a material to replace amalgam continues as a major quest in materials science. Resin composites may offer one solution but an alternative class of material, the glass ionomer cements (GICs) may have some potential for fulfilling this role. GICs were first introduced to the dental profession in 1976, and have now become an accepted part of the dental armamentarium, especially for use in low load bearing situations. They possess a low coefficient of thermal expansion similar to that of tooth structure, physicochemical bonding to both enamel and dentin, and the release of fluoride ions into the adjacent tooth tissue. These properties help to reduce marginal leakage and may contribute to a reduced incidence of recurrent decay in the restored tooth. Fluoride released into the ambient fluids has a caries-preventive effect in neighboring teeth by enhancing remineralization and inhibiting demineralization of the dental hard tissues. The main criticisms of the GICs are their brittleness, poor surface polish, porosity and surface wear. To overcome some of these deficiencies, considerable attention has been directed at improving their physical properties, especially with the addition of metal powders, the metal-modified GICs. Different metal powders have been tried, including alloys of silver and tin, pure silver, gold, titanium, palladium and stainless steel. There is conflicting data as to whether or not these materials are sufficiently strong for use in high stress restorations, especially their potential use as replacement materials for amalgam fillings.

Confocal microscopic observation of structural changes in glass-ionomer cements and tooth interfaces.

This study aimed to develop techniques to allow dynamic imaging of a cavity before, during and after placement of glass-ionomer restorative materials. Cavities were cut in recently extracted third molars and the teeth longitudinally sectioned. Each hemisected tooth surface was placed in green modelling compound at 90 to the optical axis of the microscope. The cavity surface was imaged using a video rate confocal microscope in conjunction with an internally focusable microscope objective. The sample on the stage was pushed up to the objective lens which 'clamped' the cover glass onto it. Water, glycerine or oil was placed below the coverglass, with oil above. Internal tooth structures were imaged by changing the internal focus of the objective. The restorative material was then placed into the cavity. Video images were stored either onto video tape or digitally, using a frame grabber, computer and mass memory storage. Software controls produced time-lapse recordings of the interface over time. Preliminary experiments have examined the placement and early maturation of conventional glass-ionomer cements and a syringeable resin-modified glass-ionomer cement. Initial contact of the cement matrix and glass particles was visible as the plastic material rolled past the enamel and dentine, before making a bond. Evidence for water movement from the dentine into the cement has also been seen. After curing, the early dimensional changes in the cements due to water flux were apparent using the time-lapse facility. This new technique enables examination of developing tooth/restoration interfaces and the tracking of movement in materials.