In-vitro evaluation of fracture resistance of teeth restored with different high-viscosity glass ionomer restorative materials and bulk-fill composite resins.

OBJECTIVES: This study aimed to evaluate the effect of restorations made with a glass-hybrid restorative system (GHRS), a high-viscosity glass ionomer restorative material (HVGIC), a high-viscosity bulk-fill composite resin (HVB), a flowable bulk-fill composite resin (FB), and a nanohybrid composite resin (NH), which are commonly preferred in clinical applications on the fracture resistance of teeth in-vitro. MATERIALS AND METHODS: One hundred intact human premolar teeth were included in the study. The teeth were randomly divided into ten groups (n = 10). No treatment was applied to the teeth in Control group. Class II cavities were prepared on the mesial surfaces of the remaining ninety teeth in other groups. For restoration of the teeth, a GHRS, a HVGIC, a HVB, a FB, and a NH were used. Additionally, in four groups, teeth were restored using NH, GHRS, and HVGIC with open and closed-sandwich techniques. After 24 h, fracture resistance testing was performed. One-way ANOVA and Tukey HDS tests were used for statistical analysis of the data. RESULTS: The fracture resistance values of Control group were statistically significantly higher than those of GHRS, HVGIC, FB, NH, HVGIC-CS, GHRS-OS, and HVGIC-OS groups(p < 0.05). There was no statistically significant difference observed between the fracture resistance values of Control, HVB, and GHRS-CS groups (p > 0.05). CONCLUSION: It can be concluded that the use of HVB and the application of GHRS with a closed-sandwich technique may have a positive effect on the fracture resistance of teeth in the restoration of wide Class II cavities. CLINICAL RELEVANCE: The use of high-viscosity bulk-fill composite resin and the application of glass-hybrid restorative system with the closed-sandwich technique in the restoration of teeth with wide Class II cavities could increase the fracture resistance of the teeth.

Long-term Outcome Comparison of 2 Techniques for Embolization of Splenic Artery Aneurysms.

PURPOSE: The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques. MATERIALS AND METHODS: Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques. RESULTS: The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750). CONCLUSIONS: Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period. CLINICAL IMPACT: Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques.

Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series.

Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an "eye of the tiger" configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.

Incidental Dural Tears During Lumbar Spine Surgery: Prevalence and Evaluation of Management Outcomes.

INTRODUCTION:  Incidental dural tears (IDTs) are sometimes observed as an intraoperative complication associated with lumbar spine surgery. Commonly, this complication is recognized and repaired during surgery, but if it is undiagnosed or inadequately treated, a variety of consequences may occur. Many techniques have been developed to treat cerebrospinal fluid (CSF) leakage, and each has its limitations.  Objectives: To assess the prevalence of incidental dural tears in lumbar spine surgeries and evaluate the outcomes of the sandwich technique in the management of this complication. METHODS: A total of 92 patients who underwent lumbar spine surgery at the Royal Rehabilitation Center in Amman from January 2018 to December 2021 were retrospectively reviewed. Patients were divided into two groups: group A (patients without IDT) and group B (patients with IDT), where group B was repaired using the sandwich technique. The follow-up period was six months. Further, the sandwich technique involves repairing the dural defect with interlocking sutures, painting medical glue around the dural incision, covering this with gelatin sponge, and finally covering the gelatin sponge with medical glue again. RESULTS: The overall prevalence of IDT in the study group was 14.1%. IDT was more common among elderly patients above the age of 60 (17.2%), females (16.7%), patients with multiple lumbar levels treated (66.7%), open approaches (21%), and those who had previous spinal surgery (72.7%). Most IDTs were diagnosed and managed intraoperatively (84.6%). Among those patients, only one complained of a surgical site infection. Patients in group B had a significantly higher postoperative length of hospital stay, amount of drainage, and operative time compared to group A (P<0.001). Regarding postoperative pain, patients in group B had significantly higher pain on the Numerical Pain Scale at day three post-operation compared to patients in group A (P<0.001). CONCLUSION: Based on our results, the sandwich technique was effective in the management and prevention of CSF leakage. Further prospective studies with long-term follow-up are needed to confirm our findings.

Clinical evaluation of subgingival open sandwich restorations: 3-year results of a randomized double-blind trial.

OBJECTIVES: To provide a 3-year follow-up of previously treated patients to assess and compare the periodontal responses and clinical performance of proximal subgingival open sandwich restorations. MATERIALS AND METHODS: Ninety-five adults participated in the study, with a combined total of 120 compound Class II cavities. These cavities had gingival margins located below the CEJ. Four different restorative materials were used to elevate the dentin/cementum gingival margins of the cavities: resin-modified glass ionomer, glass hybrid, flowable bulk-fill composite, or ion-releasing material, which were then completed with the same overlaying composite. Different periodontal and clinical evaluations, based on the criteria set by the World Dental Federation (FDI) criteria, were performed at different time intervals, including baseline, 6 months, 1, 2, and 3 years. RESULTS: The type of base material did not affect the periodontal evaluations. There were no statistically significant differences between different time intervals or base material groups in any of the evaluated FDI parameters. However, the ion-releasing material scored significantly worse in the radiographic evaluation than any of the other groups. CONCLUSIONS: All tested materials are suitable for proximal subgingival open sandwich restorations, as long as the restoration/tooth margin is at least 2-mm away from the bone crest. CLINICAL SIGNIFICANCE: Clinicians can confidently choose any of the tested materials for proximal subgingival open sandwich restorations, as they have shown good outcomes from both periodontal and clinical perspectives.

Grynfeltt Hernia (GH): A Rare Case of Hernia.

Grynfeltt hernia (GH) is extremely rare among all abdominal wall hernias, so both diagnosis and treatment can be challenging. Surgery, open or laparoscopic, is the only definitive treatment. We present a case of a 71-year-old woman with GH (initially misdiagnosed as a lipoma), its approach, and treatment. We performed a hernioplasty with two meshes (preperitoneal and subaponeurotic position) by an open approach: Sandwich technique. This technique is safe, feasible, and associated with no short-term complications or relapses.

Alternating Layers of Morselized Allograft and Injectable Ceramic Bone Graft Substitute in Acetabular Reconstruction: A Novel 'Sandwich' Technique.

Background: Impaction of morselized allograft is an appealing procedure for addressing the bone defects. However, concerns remain about its suitability for massive defects. We used a novel "sandwich" technique by impacting the morselized allograft in layers with an intervening layer of injectable bone graft substitute for restoring bone defects during acetabular reconstruction in total hip arthroplasties. Methods: From August 2015 to June 2017, 17 revisions, 4 rerevisions, and 3 complex primary total hip arthroplasties were operated by this novel technique. Postoperatively, serial X-rays were evaluated at regular intervals. Clinical and functional outcomes were assessed by the Harris hip score. To examine if introducing an injectable bone substitute into allograft stock increased its load-bearing capability, simulated mechanical testing using Synbone samples was conducted in the laboratory. Results: The mean Harris hip score significantly improved from 54.6 preoperatively to 86.8 at the latest follow-up. Graft incorporation was seen in all the cases. There was no evidence of component migration or loosening as compared to the X-rays at 3 weeks and 3 months in all the cases. With revision of component as end point, the survivorship was 100% at 82 months. The mechanical testing reported a higher capability of allograft samples when compared to those without bone substitutes. Conclusions: Our data confirms that the use of the "sandwich" technique is a reliable option for major acetabular reconstruction. Early weight bearing is a significant value addition, and short-term results confirm good clinical and functional outcome. Longer follow-up is necessary to assess the status of the construct in the long term.

The sandwich technique to preserve the internal iliac artery during EVAR for ruptured abdominal aortic aneurysm with congenital anomalies.

Congenital abnormalities of the iliac artery are uncommon and often discovered incidentally during the diagnosis or treatment of peripheral vascular diseases such as abdominal aortic aneurysm (AAA) and peripheral arterial diseases. The endovascular treatment of infrarenal AAA can be complicated by anatomic abnormalities in the iliac arteries, such as the absence of the common iliac artery (CIA) or overly short bilateral common iliac arteries. We present a case of a patient with a ruptured AAA and bilateral absence of the CIA, successfully treated by endovascular intervention combined with preservation of the internal iliac artery using the sandwich technique.

Vertical ridge augmentation of atrophic posterior mandible with corticocancellous onlay symphysis graft versus sandwich technique: clinical and radiographic analysis.

Alveolar ridge augmentation of atrophic posterior mandibular ridge represents a challenge in oral and maxillofacial surgery to restore aesthetic and function. The aim of the study was to compare the clinical and radiographic outcomes of bone formation in atrophic posterior mandibles augmented using onlay symphysis cortico-cancellous bone block with that augmented using sandwich bone augmentation technique (Inlay). Twelve patients were selected with missing mandibular posterior teeth. CBCT were done for all patients preoperatively to assess the residual bone height, ranged between 5 and 7 mm from the inferior alveolar nerve with adequate sufficient alveolar ridge width more than 4 mm. Patients required bone augmentation procedure with autologous onlay chin graft (group I) versus those used as inlay sandwich technique (group II). Clinical and radiographic analysis were done to analyses the newly formed bone and bone height. Percent of change in bone height was also calculated and revealed that group I was higher than group II, however, statistically insignificant differences between the two groups were found regarding the percentage of newly formed bone. Vertical ridge augmentation procedures using onlay chin graft took lesser time than the interpositional grafting with fixation technique, however, both techniques are promising for vertical ridge augmentation.

Precise joint preserving surgery by using Three-Dimensional Printing Technology for metastatic periacetabular bone tumor: A technique note and preliminary report.

BACKGROUND/PURPOSE: Complex arthroplasties for periacetabular metastatic lesions can result in complications including infection and prosthesis loosening owing to poor bone quality. A new surgical protocol has been developed as a joint-sparing surgery to avoid complications after arthroplasties. The main surgical steps are: (a) conservative and accurate tumor resection with aid of 3D printing model-assisted preoperative resection simulation and preparation of pre-contour plate, (b) reconstruction with structural bone graft through the sandwich technique for augmentation of subchondral bone. METHODS: This retrospective study consisted of 6 patients (5 with metastatic bone tumors and one with multiple myeloma). The pelvic bone resection as defined by Enneking and Dunham were typed I + II in 2 patients and type II in 4 patients. The medical records, images, musculoskeletal tumor society (MSTS) score and visual analogue scale (VAS) were used for evaluation. RESULTS: The mean operative time was 234 minutes, and the average surgical blood loss was 1408 mL. The mean follow-up period was 21 months. The mean VAS significantly decreased at postoperative 1-week and 1-year follow-up. There were no intraoperative or early postoperative complications. The median MSTS score during the final follow-up was 26 points (range, 14-28 points). Except for one case who experienced severe joint destruction, all the other five cases were classified as excellent or good (>15). CONCLUSION: With precise tumor resection and reconstruction with sandwich procedure, the joint-sparing surgery can be performed in selected patients with metastatic periacetabular tumors.

Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Correlation between different methodologies used to evaluate the marginal adaptation of proximal dentin gingival margins elevated using a glass hybrid.

Objectives: This study aimed to evaluate the effect of aging on the marginal quality of glass hybrid (GH) material used to elevate dentin gingival margins, and to analyze the consistency of the results obtained by 3 in vitro methods. Materials and Methods: Ten teeth received compound class II cavities with subgingival margins. The dentin gingival margins were elevated with GH, followed by resin composite. The GH/gingival dentin interfaces were examined through digital microscopy, scanning electron microscopy (SEM) using resin replicas, and according to the World Dental Federation (FDI) criteria. After initial evaluations, all teeth were subjected to 10,000 thermal cycles, followed by repeating the same marginal evaluations and energy dispersive spectroscopy (EDS) analysis for the interfacial zone of 2 specimens. Marginal quality was expressed as the percentage of continuous margin at ×200 for microscopic techniques and as the frequency of each score for FDI ranking. Data were analyzed using the paired sample t-test, Wilcoxon signed-rank test, and Pearson and Spearmen correlation coefficients. Results: None of the testing techniques proved the significance of the aging factor. Moderate and strong significant correlations were found between the testing techniques. The EDS results suggested the presence of an ion-exchange layer along the GH/gingival dentin interface of aged specimens. Conclusions: The marginal quality of the GH/dentin gingival interface defied aging by thermocycling. The replica SEM and FDI ranking results had stronger correlations with each other than either showed with the digital microscopy results.

Comparative Evaluation of Microleakage in Class II Restorations Using Open- and Closed-Sandwich Techniques With Zirconomer as an Intermediate Material: An In-Vitro Study.

Aim To evaluate and compare the microleakage In class II restorations using open- and closed-sandwich techniques with zirconomer as an intermediate material. Material and method  Twenty-six non-carious mandibular first molars were selected and randomly divided into two groups (groups 1 and 2 where n=13). A standardized Class II preparation was made with the cervical margin 1 mm below the cementum-enamel junction. Samples of group 1 were restored using the open-sandwich technique and samples of group 2 with the close-sandwich technique, and zirconomer was used as an intermediate restorative material. Following that, the restorations underwent 200 heat cycles with dwell times of 20 seconds at 5°C and 55°C. Dye penetration and scanning electron microscope (SEM) analysis using the replica approach were used to assess adaptation at the cervical margin. The data were statistically analyzed using the Paired T-test (p<0.05). Results Lower dye penetration was seen in the open-sandwich technique compared to the closed-sandwich technique (p<0.001). Conclusion When comparing the open-sandwich technique with the closed one, it was observed that less microleakage was seen in the open-sandwich technique as it has better marginal adaptation and fewer voids.

Four cases report: Treatment of knee joint cartilage defects using autologous chondrocyte patch implantation.

Introduction: Autologous chondrocyte implantation (ACI) is a crucial method for the treatment of defects in articular cartilage. However, the extant methods for the preparation of autologous chondrocyte patch are relatively complicated and money-consuming. Therefore, an efficient, reliable, easy-to-follow, and cost-effective technique is needed to overcome constraints. This case report aims to introduce an autologous chondrocyte patch fabrication technique to repair knee joint cartilage defects and report our typical cases with a 2-year follow-up. Case presentation: We described four cases in which patients complained of knee joint pain. According to radiological examination, the patients were diagnosed as knee joint cartilage defect. Arthroscopy and autologous chondrocyte patch implantation were performed as well as a 2-year follow up of patients. The autologous chondrocyte patch for knee joint cartilage repair was fabricated using a "sandwich" technique. The preoperative and postoperative knee function was evaluated by four subjective evaluation systems. MRI was performed for all patients to achieve more intuitionistic observation of the postoperative radiological changes of defect sites. The quality of repaired tissue was evaluated by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART). Postoperative follow-up showed improvement in clinical and MOCART scores for all patients. However, one patient complained of knee joint pain after walking for a long time or recreational activities from 12- to 18-month postoperatively. The location of pain for this patient was not in accordance with the location of cartilage defect. Conclusion: The patients undergoing autologous chondrocyte patch implantation demonstrated clinical improvement and good quality of repaired tissue postoperatively. The procedure is an efficient and cost-effective treatment for knee joint cartilage defect in this report. In addition, patients with osteoarthritis carry the risk of a poor outcome after the procedure, and whether to have a procedure should be considered carefully.

Sandwich graft technique outcomes in medium and large size nasal septal perforations / Resultados da técnica de enxerto sanduíche em perfurações do septo nasal de médio e grande porte

Abstract Introduction: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. Objective: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. Methods: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2cm, Group B: ≥ 2 cm). Results: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). Conclusion: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Resumo Introdução: O tratamento cirúrgico da perfuração do septo nasal de médio e grande porte ainda é um desafio. Várias técnicas são usadas, com e sem enxertos de interposição. Objetivo: Descrever o uso da técnica de enxerto sanduíche que usamos nas perfurações de septo nasal de médio e grande porte e apresentar os resultados. Método: Revisamos retrospectivamente os prontuários de pacientes que foram operados com a técnica de enxerto sanduíche entre janeiro de 2014 e dezembro de 2018, com acompanhamento por pelo menos seis meses. Os dados demográficos, escores de sintomas, exames e achados cirúrgicos dos pacientes foram extraídos dos registros hospitalares. Os resultados cirúrgicos foram apresentados de acordo com as etiologias (idiopática ou iatrogênica) e os tamanhos da perfuração (Grupo A: < 2cm, Grupo B: >2cm). Resultados: Revisamos 52 casos e 56 cirurgias. O diâmetro médio das perfurações foi de 19,2 mm. A taxa de sucesso após as cirurgias iniciais foi de 84,6% (44/52). Após quatro cirurgias de revisão, a perfuração foi fechada em 88,5% dos casos (46/52). As taxas de sucesso para os Grupos A e B foram, respectivamente, 90,0% e 86,4% (p = 0,689). As taxas de sucesso nos casos idiopáticos e iatrogênicos foram, respectivamente, 93,3% e 86,5% (p = 0,659). Conclusão: Este estudo mostrou que a taxa de sucesso da técnica de enxerto sanduíche foi maior nas perfurações de médio porte do que nas de grande porte e nas perfurações idiopáticas do que nas iatrogênicas, mas sem significância estatística. Esse dado demonstrou que o tamanho da perfuração não foi tão importante na técnica de enxerto sanduíche quanto nas técnicas com uso de retalho.

Salvaging the Unsalvageable Giant Cell Tumors of Bone: The 'Longitudinal Sandwich Technique'.

Management of Campanacci Grade III Giant Cell Tumors of bone (GCT) is challenging. Although selected cases of Grade III GCTs can still be managed with intralesional extended curettage, wide excision of the lesion is usually recommended when there is extensive cortical destruction. This study describes the outcome of 'longitudinal sandwich technique' for extended curettage of Grade III GCTs with more than 50% cortical destruction. Here, the deficiency of cortex was made up for by using bone graft/graft substitute, used alongside cement placed in a longitudinal fashion. Twelve patients operated with this technique between Jan 2012 and Jan 2018 were reviewed. Majority of the lesions involved the lower limbs. Bone graft was used in eight whereas commercial bone graft substitute was used in the remaining four, along with bone cement in all. On follow-up ranging from 38 to 84 months (median follow-up 59 months), there were 4 local recurrences (33.33%). All recurrences were managed successfully with repeat surgery without the need for bony resection. Mean MSTS score during the last follow-up was 25.08 ± 2.31 and all patients were disease-free during the last follow-up. 'Longitudinal sandwich technique' helps to expand the indications of extended curettage even for aggressive Grade III GCTs, with satisfactory outcomes.

Laboratory "In-vitro" Evaluation of the Parallel Stent Graft Association for the Iliac Sandwich Technique.

OBJECTIVES: The Iliac Sandwich is an off-label technique that uses parallel stent grafts to treat aortoiliac aneurysms. The purpose of this experimental study is to evaluate the conformability and juxtaposition of stent grafts combinations used in this technique through in-vitro mechanical evaluation, computed tomography (CT) analyses, and a controlled pulsatile flow system. METHODS: The combinations of two Viabahn® ("V-V") or Viabahn® and Excluder® iliac extension ("V-E") were analysed using CT imaging with measurement of the gutter area by two independent analysts before and after balloon angioplasty. In a second phase, the parallel stent combinations were also evaluated using CT imaging after being implanted in the aortic aneurysm model with a pulsatile flow system with controlled temperature, viscosity, and density. RESULTS: The "V-E" group had a better conformability when compared to the "V-V" group, ensuring smaller gutter areas (0.0064 cm2 ± 0.01 vs. 0.0228 cm2 ± 0.03, p < 0.001). Post dilatation with two non-compliant balloons resulted in enlargement of the gutter area (Area A, p 0.065; Area B, p 0.071). Conversely, post dilatation with a non-compliant balloon for the internal iliac component and a compliant balloon for the external iliac device reduced the gutter area (Area A, p 0.008; Area B, p 0.010). CONCLUSION: The combination of Viabahn® and Excluder® iliac extension device ("V-E") had a smaller gutter area compared to two Viabahn® parallel stents for the Iliac Sandwich Technique. Post dilatation using a non-compliant balloon for the internal iliac device and a compliant balloon for the external iliac provided superior conformability and juxtaposition.

Evaluation of Shear Bond Strength between Resin Composites and Conventional Glass Ionomer Cement in Class II Restorative Technique-An In Vitro Study.

The success of dental restorations depends mainly on the ability to bond to other filling materials and tooth substances, in order to resist the multitude of forces acting on the bond within the oral cavity. Although the shortcomings of composite resins have been significantly reduced over the past three decades, microleakage due to shrinkage under masticatory loads is unavoidable. In order to overcome such problems, two materials laminated with matched properties can be used to achieve optimum results. The sandwich technique is an approach in which dentine is replaced by glass ionomer cement (GIC), and enamel is replaced by composite resin. In the past, numerous materials have been proposed with adequate properties to be used in this manner, but the results are conflicting in terms of bonding to the various forms of GIC, and the appearance of microcracks or gap formation during functional loading. This study aimed to evaluate the shear bond strength (SBS) and mode of failure between the following core materials: composite resins (CR) (Methacrylate Z350™, Ceram X™, and Spectrum™) with a base material of glass ionomer cement (GIC, Ketac Molar™). Eight samples were made with the help of polytetrafluoroethylene sheets (TEFLON, Wilmington, DE, USA). Each sheet consisted of holes which were 4 mm in diameter and 2 mm in thickness. The combination of materials was sandwiched. The samples were stored in distilled water and then placed in an incubator for 24 h in order to ensure complete polymerization. The samples were thermocycled for 500 cycles between 5-55 °C/ 30 s. Following thermocycling, SBS testing was performed using a universal testing machine. Additionally, scanning electron microscopy (SEM) was performed on representative samples for the bond failure analysis between GIC and the composite resins. The Ceram-X™ nanocomposite showed significantly higher bond strength than Methacrylate Z350™ or Spectrum™ (p = 0.002). The Methacrylate Z350™ and the Spectrum™ composite specimens demonstrated a similar SBS (p = 0.281). The SBS of the Ceram X™ to GIC was the highest compared to Methacrylate Z350™ and Spectrum™. Therefore Ceram X™ may produce a better bond with GIC, and may protect teeth against recurrent caries and failure of the restoration. Methacrylate Z350™ is comparable to Spectrum™ CR and can be used as an alternative. A combination of adhesive and mixed failure was observed in Methacrylate Z350™ CR and GIC, while adhesive failure was predominantly found in both Ceram X™ and Spectrum™ with GIC restorations.

Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength.

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.