Sensitivity answers sought in amalgam alloy microleakage study.

Sensitivity often occurs shortly after an amalgam restoration is placed. This phenomenon has been related in part to microleakage at the amalgam/tooth interface. When microleakage characteristics of a large number of commercially available dental amalgams were examined, results showed wide variation in the amount of microleakage.

Factors influencing the sealing behavior of retrograde amalgam fillings.

In this study, the sealing behavior of apical (retrograde) amalgam fillings was evaluated with particular regard to the nature of the amalgam and the manipulative procedures used. With the use of an in vitro air pressure test, four high-copper alloys and one traditional composition low-copper alloy were selected for determination of their microleakage characteristics. Measurements were made on both normal and water-contaminated mixes, and the effect of mix plasticity was evaluated. In addition, both setting and postsetting dimensional changes of these alloys were determined. The results showed that amalgams differ in their ability to provide a complete seal and that low plasticity mixes result in greater microleakage. All zinc-containing alloys that were contaminated with water exhibited a postsetting or delayed expansion. However, only the low-copper alloy exhibited a delayed expansion of a magnitude that might induce root fracture.

Mandibular paresthesia secondary to cerebrovascular changes.

An unusual case of mandibular paresthesia as the only presenting symptom of a cerebrovascular accident is presented. The differential diagnosis of inferior alveolar nerve paresthesia is discussed. Obtaining a definitive diagnosis depends on a thorough medical and dental history complemented by a complete clinical and radiographic examination. The etiology of cerebral vascular accidents is reviewed, as well as risk factors that may increase the possibility of a cerebrovascular accident.

Factors affecting the marginal leakage of amalgam.

On the basis of reports of an increased incidence of postoperative sensitivity associated with the use of a particular spherical amalgam alloy, an investigation of in vitro marginal leakage was initiated. An air pressure test was applied to simulated Class I restorations made from this alloy and a control alloy. Factors such as mix plasticity, condensation force, and condensation technique also were examined. The results showed that the spherical alloy in question had a greater tendency for marginal leakage than the control alloy. For both alloys studied, the following factors are important in reducing marginal leakage: increased plasticity of the mix; increased condensation force; condensation of each increment directly along or against cavity walls in overlapping thrusts; and burnishing the amalgam after condensation. Although it is not known what percentage of postoperative sensitivity is caused by leakage of amalgam restorations, the results of this study indicate that leakage can be minimized by using optimum amalgam manipulative procedures and that a reduced incidence of postoperative sensitivity is likely to result.

Effect of age on the creep of a high-copper amalgam.

A previous study of the effect of final Hg content on the static creep of a single-composition high-Cu amalgam alloy showed a sudden increase or jump in creep at a specific Hg content, and the presence of the Sn-Hg phase (gamma 2) at final Hg contents subsequent to this creep jump. This observation is consistent with the less-than-optimum clinical performance reported for this alloy. A repetition of these tests conducted on test specimens 3 months and 6 months of age showed the creep jump to shift to higher Hg contents. However, even at 6 months of age, the final Hg content to be expected in clinical restorations was still positioned after the initiation of the creep jump where a small amount of gamma 2 is known to be present.

Problems in evaluating chronic toxicity of contraceptive steroids in dogs.

The long-term effects of oral contraceptive steroids including a combination of norethindrone and ethynylestradiol, a sequential regimen of dimethisterone and ethynylestradiol, and daily administration of megestrol acetate were studied in female beagle dogs at dose levels of 1, 10, or 25 times the projected human dose levels. The major findings included cystic endometrial hyperplasia and pyometra requiring hysterectomies and alopecia for the norethindrone-ethynylestradiol and dimethisterone-ethynylestradiol treated dogs. These groups did not have accentuated mammary development or treatment-related hyperplastic or neoplastic changes. For dogs given dimethisterone-ethynylestradiol, numerous acne-like lesions occurred in the skin of the mammary areas. Dogs given the higher dose levels of megestrol acetate had marked mammary stimulation, hyperplastic and neoplastic changes in the mammary glands, and clinical and pathologic changes typical of diabetes mellitus. Mammary changes of nodular hyperplasia, benign mixed tumor, and adenocarcinoma appeared as distinct entities although constant and intense mammary stimulation may be a common denominator. Such mammary changes have not been found in long-term studies in monkeys or rats with megestrol acetate, and the relevance of the canine mammary changes to projecting potential tumorigenesis in women is questioned.

PIP: The long-term (7-year) effects of oral contraceptive steroids including a combination of norethindrone and ethinyl estradiol, a sequential regimen of dimethisterone and ethinyl estradiol, and daily administration of megestrol acetate were studied in female beagle dogs at dose levels of 1, 10, or 25 times the projected human dose levels. The major findings included cystic endometrial hyperplasia and pyometra requiring hysterectomies and alopecia for the norethindrone-ethinyl estradiol and dimethisterone-ethinyl estradiol treated dogs. These groups did not have accentuated mammary development or treatment related hyperplastic or neoplastic changes. For dogs given dimethisterone-ethinylestradiol, numerous acnelike lesions occurred in the skin of the mammary areas. Dogs given the higher dose levels of megestrol acetate had marked mammary stimulation, hyperplastic and neoplastic changes in the mammary glands, and clinical and pathologic changes typical of diabetes mellitus. Mammary changes of nodular hyperplasia, benign tumor, and adenocarcinoma appeared as distinct entitles although constant and intense mammary stimulation may be a common denominator. The relevance of the canine mammary changes to projecting potential tumorigenisis in women is questioned.

Progestogen-related gross and microscopic changes in female Beagles.

Long-term studies of megestrol acetate and chlormadinone acetate in 100 female dogs are in progress. Doses of zero, one, 10 and 25 times the expected human dose of megestrol acetate and 25 times the expected human dose of chlormadinone acetate (on a milligram per kilogram body weight basis) are being given daily. During the first 4 years, eight dogs from each of the five groups were killed. The principal gross findings included enlarged uteri with mucoid material in the lumina, mammary development in dogs given middle and high doses of megestrol acetate and chlormadinone acetate, and thickened gallbladder walls in dogs given high doses of each. Histologic evaluation showed inhibition of ovulation for progestogen-treated dogs and suppression of ovarian follicular development with the high doses. Cystic endometrial hyperplasia was slight in the low-dose dogs and moderate to severe in most of the high-dose dogs; a few also had ulcerative endometritis and pyometra. The mammary glands of dogs given the middle and high doses produced lobules, acini, and secretion exceeding natural metestrus. Slight to marked cystic mucinous hyperplasia occurred in the gallbladders of most dogs given the high doses. Tow high-dose megestrol dogs had clinical signs and microscopic pancreatic, renal, and ocular changes indicative of diabetes mellitus.

A four-year evaluation of the chronic toxicity of megestrol acetate in dogs.

PIP: A 4-year evaluation of the chronic toxicity of megestrol acetate in dogs is reported. .01, .1 or .25 mg of megestrol acetate/kg/day or .25 mg of chlormadinone acetate/kg/day was administered orally for 4 years t o female beagle dogs. The hormone-treated dogs tended to gain more weig ht than did the controls (controls vs. .25 mg megestrol acetate every month after the 3rd p less than .01). All treated dogs revealed decreased evidence of estrus. Mucoid vaginal discharges were more prevalent among the middle and high dose groups. Mean hemoglobin, packed cell volume and total erythrocyte values were slightly decreased while mean total leucocyte count and erythrocyte sedimentation rates were slightly increased in the middle and high dose groups. Clotting me chanism did not reveal any disturbances. Evidence of diabetes consistin g of bilateral cataracts, elevated serum glucose concentrations and glycosuria after 4 years in 2 of 16 high-dose megestrol acetate and in 6 of 15 chlormadinone acetate-treated dogs was revealed. It is concluded that the effects of megestrol acetate were similar but less severe than those of chlormadinone acetate.^ieng

Mammary nodules in dogs during four years' treatment with megestrol acetate or chlormadinone acetate.

PIP: A 7 year study of megestrol and chlormadinone in female dogs is in progress. This report characterized histopathologically 60 mammary nodules during the first 4 years of the study. 100 purebred female beagles, 6-12 months of age, were randomly assigned to 5 equal groups. One group was used as a control. Oral doses were .01, .10, and .25 mg/kg/day of megestrol acetate in coconut oil in capsules and of chlormadinone acetate .25 mg/kg/day in lactose tablets. These doses were 1, 10, and 25 times the projected dose of megestrol for humans and about 25 times the human dose of chlormadinone. After 2 years 4 dogs from each group were necropsied. One high-dose megestrol-treated and 1 chlormadinone-treated dog had benign mixed mammary tumors. Palpable nodules were first observed at 16 months in the chlormadinone-treated dogs, at 18 months in dogs given the high dose megestrol and at 27 months in the dogs treated with middle-dose megestrol. Transitory nodules were found in 4 control dogs after 21 months and in low dose megestrol-treated dogs at 26 months. Of 38 grossly detected nodules evaluated microscopically from the megestrol-treated dogs 27 were nodular hyperplasia, 5 were benign mixed mammary tumors, 3 were ductal dialatations, 1 was a lymph node, 1 was fat necrosis and 1 was the umbilicus. Of 22 nodules from the chlormadinone-treated dogs 12 were nodular hyperplasia, 4 benign mixed mammary tumors, 1 chondromucoid degeneration and 1 adenocarcinoma with widespread metastases. 3 nodules were lymph nodes and 1 other had no mammary tissue. Involutions, regression and sclerosis of many areas of nodular hyperplasia were evident at 4 years. Thus of the 60 nodules evaluated during the first 4 years of the study 50 were non-neoplastic and 10 were neoplastic. It is considered that the 1 adenocarcinoma may have been spontaneous and not a treatment-related neoplasm. A precursor stage through nodular hyperplasia apparently did not occur.^ieng

Mammary nodular hyperplasia in intact rhesus monkeys.

PIP: Clinical and pathological findings of subcutaneous nodules in the breast regions of 2 untreated control intact female Rhesus monkeys in a long-term study of an oral contraceptive steroid are described. 1 nodule, which was excised early in the study, showed changes characteristic of nodular mammary hyperplasia; no features of neoplasia were present. Some of the nodules were transient. None of the nodules showed a progressive growth pattern during repeated clinical examination over 17-20 months.^ieng