„Optische Biopsie“ erspart unnötige Exzisionen

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Mit dem Tablet dem Formularwust entgehen

Erstanamnese, Aufklärungsbögen, Einverständniserklärung — in der Praxis von Stefanie Baum und Dr. Sonja Ehlen füllen Patienten solche Formulare nur noch auf dem Tablet aus. Das bringt den Ärztinnen mehr Zeit für ihre Patienten und stärkt die Bindung an die Praxis.

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Wann die Dermatoskopie keine IGeL ist

Bei der Früherkennungsuntersuchung auf Hautkrebs kann die Auflichtmikroskopie zum Einsatz kommen. Wünscht der Kassenpatient die Dermatoskopie, muss er sie als IGeL bezahlen. Doch es gibt eine Ausnahme.

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Addressing Saddle Nose Deformity

To the Editor Saddle nose deformity is one of the most complex cases that a rhinoplasty surgeon has to deal with. Surgery to address this deformity is tricky, with nasal airflow often being impaired in order to achieve a cosmetic improvement of the nose. When properly planned and executed, however, the outcome of surgery addressing saddle nose deformity can be quite rewarding for both the patient and the surgeon.

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Addressing Saddle Nose Deformity

In Reply We appreciate the kind words from Dr Xavier regarding our article and would like to elaborate on some of the statements in his letter. Dr Xavier comments on the Cakmak algorithm's type 4 deformity and suggests addressing these patients similarly to those with type 3a and type 3b deformities (using an L-strut affixed to holes drilled in the nasal bones), plus using a nonstructural graft, such as diced cartilage in fascia or diced cartilage with fibrin glue placed along the nasal dorsum, from the radix to the supratip area. We would like to emphasize that our main goal in saddle nose reconstruction is first and foremost to reconstruct a more projected, widened, and strengthened dorsal septum for the nasal skeleton to sit on and to continue to reconstruct from there when possible. The Cakmak algorithm enables functional improvement by restoring the ideal strength and height of the septal skeleton, reestablishing ideal connections between the upper lateral and dorsal septal cartilages, and correcting nasal valve angles as well as producing a positive aesthetic result.

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Effect of mold type, diameter, and uncured composite removal method on depth of cure

Abstract

Objective

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

Material and methods

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey–Kramer post hoc multiple comparison tests (α = 0.05).

Results

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

Conclusion

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

Clinical relevance

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

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Effect of mold type, diameter, and uncured composite removal method on depth of cure

Abstract

Objective

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

Material and methods

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey–Kramer post hoc multiple comparison tests (α = 0.05).

Results

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

Conclusion

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

Clinical relevance

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

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Influence of Cyclic Fatigue in Water on Screw Torque Loss of Long-Span One-Piece Implant-Supported Zirconia Frameworks

Abstract

Purpose

It is still unclear whether four, six, or more implants should be used when restoring fully edentulous maxillae. This research evaluated the in vitro screw torque loss of zirconia frameworks supported by six implants and cantilevered zirconia frameworks supported by four implants.

Materials and Methods

Computer aided design/computer-assisted machining was used to fabricate 10 one-piece frameworks. Standardized pressable porcelain crowns were fabricated and luted to the frameworks. Specimens were divided into two groups (n = 5): AO4, cantilevered 12-unit full-arch fixed dental prosthesis supported by four implants; AO6, 14-unit supported by six implants. An opposing mandibular dental arch was fabricated with bis-acrylic composite resin. Specimens were submitted to 200 N underwater cyclic load at 2-Hz frequency for 1 × 10⁶ cycles in a controlled 37°C temperature. A digital torque gauge assessed the initial and postload screw removal torque. Linear mixed-effects model was used for statistical analysis (α = 0.05).

Results

Significant screw torque loss was found for AO6 after cyclic loading (before: 36.20%/after: 52.82%; p < 0.05). Group AO6 (36.20%) presented lower preload loss before the cyclic loadings compared with AO4 (60.10%) (p < 0.05).

Conclusions

Cyclic loading and lower implant-to-replaced-units ratio do not seem to compromise screw stability compared with higher implant-to-replaced-units ratio; however, a steep drop in preload was found before cyclic loading for both groups.

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Predictable Outcomes with Porcelain Laminate Veneers: A Clinical Report

Abstract

This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock-ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.

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Quality Evaluation of Zirconium Dioxide Frameworks Produced in Five Dental Laboratories from Different Countries

Abstract

Purpose

The aim of this study was to assess and compare quality as well as economic aspects of CAD/CAM high strength ceramic three-unit FDP frameworks ordered from dental laboratories located in emerging countries and Switzerland.

Material and Methods

The master casts of six cases were sent to five dental laboratories located in Thailand (Bangkok), China (Peking and Shenzhen), Turkey (Izmir), and Switzerland (Bern). Each laboratory was using a different CAD/CAM system. The clinical fit of the frameworks was qualitatively assessed, and the thickness of the framework material, the connector height, the width, and the diameter were evaluated using a measuring sensor. The analysis of the internal fit of the frameworks was performed by means of a replica technique, whereas the inner and outer surfaces of the frameworks were evaluated for traces of postprocessing and damage to the intaglio surface with light and electronic microscopes. Groups (dental laboratories and cases) were compared for statistically significant differences using Mann-Whitney U-tests after Bonferroni correction.

Results

An acceptable clinical fit was found at 97.9% of the margins produced in laboratory E, 87.5% in B, 93.7% in C, 79.2% in A, and 62.5% in D. The mean framework thicknesses were not statistically significantly different for the premolar regions; however, for the molar area 4/8 of the evaluated sites were statistically significantly different. Circumference, surface, and width of the connectors produced in the different laboratories were statistically significantly different but not the height. There were great differences in the designs for the pontic and connector regions, and some of the frameworks would not be recommended for clinical use. Traces of heavy postprocessing were found in frameworks from some of the laboratories. The prices per framework ranged from US$177 to US$896.

Conclusions

By ordering laboratory work in developing countries, a considerable price reduction was obtained compared to the price level in Switzerland. Despite the use of the standardized CAD/CAM chains of production in all laboratories, a large variability in the quality aspects, such as clinical marginal fit, connector and pontic design, as well as postprocessing traces was noted. Recommended sound handling of postprocessing was not applied in all laboratories. Dentists should be aware of the true and factitious advantages of CAD/CAM production chains and not lose control over the process.

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Removal of cyanobacteria from synthetic and real water by dielectric barrier discharge process

Abstract

The feasibility of cyanobacteria removal from freshwater by a dielectric barrier discharge (DBD) process is investigated. Seven commercial and environmental cyanobacteria strains, as well as real algae-laden water, were tested. The removal of the cyanobacteria was evaluated by analyzing the changes in chlorophyll a content, total organic carbon (TOC) concentration, and cell morphology. Nearly total removal of chlorophyll a was achieved within 20 min, while the TOC analysis exhibited an increase-decrease-increase trend in 60 min of treatment, likely due to the oxidation of intracellular and intercellular materials. Observation under light microscopy revealed the disruption of intracellular and intercellular structures within 5 min of DBD treatment and thus supported the TOC analysis. Increasing the salinity of the medium from 0 to 5 parts per thousand (ppt) improved treatment efficiency, where similar level of chlorophyll a removal (around 93 %) was achieved in only half the treatment time. Application of DBD on real algae-laden water from a fish farm yielded higher treatment efficiency than in synthetic medium, indicating the promising application of DBD as a means to control cyanobacteria bloom in fresh and estuary water bodies.

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Removal of trihalomethane from chlorinated seawater using gamma radiation

Abstract

Chlorine addition as a biocide in seawater results in the formation of chlorination by-products such as trihalomethanes (THMs). Removal of THMs is of importance as they are potential mutagenic and carcinogenic agents. In this context, a study was conducted that used ionizing radiation to remove THMs from chlorinated (1, 3, and 5 mg/L) seawater by applying various dosages (0.4–5.0 kGy) of gamma radiation. Bromoform (BF) showed a faster rate of degradation as compared to other halocarbons such as bromodichloromethane (BDCM) and dibromochloromethane (DBCM). In chlorine-dosed seawater, total irradiation dose of 0.4 to 5 kGy caused percentage reduction in the range of 6.9 to 76.7 %, 2.3 to 99.6 %, and 45.7 to 98.3 % for BDCM, DBCM, and BF, respectively. During the irradiation process, pH of the chlorinated seawater decreased with increase in the absorbed dose; however, no change in total organic carbon (TOC) was observed. The results show that gamma dose of 2.5 kGy was adequate for maximum degradation of THM; but for complete mineralization, higher dose would be required.

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Analysis of predictors related to soil contamination in recreational areas of Romania

Abstract

Soil contamination in recreational areas can considerably affect children's health, as they are the segment of the population most sensitive to anthropogenic contamination. Soil contamination in recreational areas is influenced by a number of factors such as type and age of the recreational area, nearby traffic intensity, proximity to industrial areas, presence of vegetation, level of usage, treated wood structures, and the extent of maintenance operations carried out in the area. These can most often be observed during a simple site visit. The purpose of the present research is to analyze to which extent the presence of these factors can trigger an alarm signal, highlighting soil contamination in urban recreational areas. In this regard, soil contamination was scaled using the integrated pollution index applied on nine distinctive contaminants (As, Cu, Cd, Zn, Pb, Hg, Co, Ni, Mg) identified using inductively coupled plasma mass spectrometry (ICP-MS). Multiple linear regression analysis was performed in order to assess predictors of soil contamination. The research was carried out in a number of 88 recreational areas, parks, and playgrounds from 19 Romanian cities, revealing the fact that proximity to industrial areas and intensive traffic had statistically significant effects on soil contamination. Furthermore, it was observed that in 78 out of the 88 analyzed locations, the concentrations of contaminants exceeded the guidelines established through national legislation, thus confirming the presumption that high concentrations of contaminants exist in the parks and playgrounds of Romania.

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Anpassung des Mitgliedsbeitrags

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Despistaje de tuberculosis latente en el paciente con psoriasis moderada grave candidato a terapia sistémica y/o biológica

Publication date: Available online 3 December 2015
Source:Actas Dermo-Sifiliográficas
Author(s): A. Martínez-López, J. Rodriguez-Granger, R. Ruiz-Villaverde
Los pacientes con psoriasis moderada-grave que van a iniciar tratamiento con agentes biológicos deben ser monitorizados para la detección de infección tuberculosa latente antes, durante y después del tratamiento. En el último informe publicado de BIOBADADERM la prevalencia de infección latente por M.tuberculosis (ILMT) alcanzaba el 20,5% de los pacientes psoriásicos tratados con agentes biológicos en nuestro país. En la actualidad no existe un método diagnóstico gold standard que permita una aplicación sistemática y consensuada, con variaciones en los diferentes países según el grado de endemicidad y vacunación con BCG. La prueba de tuberculina (PT) continúa siendo el método de elección para el diagnóstico de infección, pero presenta importantes limitaciones en su sensibilidad (principalmente en pacientes inmunodeprimidos). Esta situación, junto a su falta de especificidad conocida, errores en su administración, la subjetividad en la interpretación de los resultados, la necesidad de una segunda visita para la lectura y la ausencia de privacidad hacen de ella una prueba limitada, cuyas principales ventajas resultarían su bajo coste y fácil realización. Por eso la mayoría de los estudios de coste beneficio se inclinan por el método IGRA para el diagnóstico de la ILMT, ya que minimiza los falsos positivos (especialmente en población vacunada), eliminando costes extra y efectos secundarios de la quimioprofilaxis antituberculosa. Valoramos la aplicabilidad en pacientes psoriásicos candidatos a terapia biológica y discutimos la necesidad de su realización previamente a terapia sistémica convencional, puesto que la mayoría de las guías actuales no consideran imprescindible su realización.Screening to detect latent tuberculosis infection (LTBI) is essential before patients with moderate to severe psoriasis start treatment with biologics and vigilance will continue to be needed during and after such treatment. The most recently analyzed statistics from the BIOBADADERM registry show a 20.5% prevalence of LTBI in psoriasis patients treated with biologics in Spain. Various screening protocols are in effect in different countries according to their levels of endemic TB and bacillus Calmette-Guérin (BCG) vaccination, and there is no consensus on a gold-standard approach to the diagnosis of LTBI. Tuberculin skin testing (TST) continues to be the diagnostic method of choice in spite of its limited sensitivity, mainly in immunocompromised patients. Additional problems include the TST's well-established lack of specificity, errors in application, subjectivity in the interpretation of results (which must be read during a second visit), and lack of privacy; the main advantages of this test are its low cost and ease of application. Most cost-benefit studies are therefore inclined to favor using interferon-γ release assays to detect LTBI because they minimize false positives (especially in BCG-vaccinated individuals), thereby eliminating the extra costs and side effects of unnecessary chemoprophylaxis. We review the methods used for LTBI screening in psoriasis patients who are candidates for biologic therapy. Additionally, given the fact that most guidelines do not currently consider it necessary to screen patients about to start conventional systemic therapy, we discuss the reasons underlying the need for such screening.



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Langzeit-Experiment unter der Haut

Die Substanzen, die Tattoos ihre Farbe geben, werden eigentlich zum Färben oder Lackieren von Konsumgütern hergestellt oder entstehen bei der unvollständigen Verbrennung fossiler Brennstoffe. Was sie anrichten, wenn sie dauerhaft in die Haut eingebracht werden, ist weitgehend unbekannt.

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Buchbesprechung „Das diabetische Fußsyndrom. Über die Entität zur Therapie“

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„Nur ein Bruchteil der Gifte entsteht beim Lasern“

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Oxybutynin vermindert übermäßiges Schwitzen

Für Menschen, die übermäßig schwitzen, scheint laut einer aktuellen randomisierten placebokontrollierten Studie niedrigdosiertes Oxybutynin eine effektive Therapieoption zu sein.

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Ist ein Ganzkörperscreening überflüssig?

Müssen Teilnehmer am Screening auf Hautkrebs von Kopf bis Fuß untersucht werden? Belgische Dermatologen haben eine Alternative hierzu getestet.

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„Optische Biopsie“ erspart unnötige Exzisionen

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Mit dem Tablet dem Formularwust entgehen

Erstanamnese, Aufklärungsbögen, Einverständniserklärung — in der Praxis von Stefanie Baum und Dr. Sonja Ehlen füllen Patienten solche Formulare nur noch auf dem Tablet aus. Das bringt den Ärztinnen mehr Zeit für ihre Patienten und stärkt die Bindung an die Praxis.

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Wann die Dermatoskopie keine IGeL ist

Bei der Früherkennungsuntersuchung auf Hautkrebs kann die Auflichtmikroskopie zum Einsatz kommen. Wünscht der Kassenpatient die Dermatoskopie, muss er sie als IGeL bezahlen. Doch es gibt eine Ausnahme.

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Addressing Saddle Nose Deformity

To the Editor Saddle nose deformity is one of the most complex cases that a rhinoplasty surgeon has to deal with. Surgery to address this deformity is tricky, with nasal airflow often being impaired in order to achieve a cosmetic improvement of the nose. When properly planned and executed, however, the outcome of surgery addressing saddle nose deformity can be quite rewarding for both the patient and the surgeon.

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Addressing Saddle Nose Deformity

In Reply We appreciate the kind words from Dr Xavier regarding our article and would like to elaborate on some of the statements in his letter. Dr Xavier comments on the Cakmak algorithm's type 4 deformity and suggests addressing these patients similarly to those with type 3a and type 3b deformities (using an L-strut affixed to holes drilled in the nasal bones), plus using a nonstructural graft, such as diced cartilage in fascia or diced cartilage with fibrin glue placed along the nasal dorsum, from the radix to the supratip area. We would like to emphasize that our main goal in saddle nose reconstruction is first and foremost to reconstruct a more projected, widened, and strengthened dorsal septum for the nasal skeleton to sit on and to continue to reconstruct from there when possible. The Cakmak algorithm enables functional improvement by restoring the ideal strength and height of the septal skeleton, reestablishing ideal connections between the upper lateral and dorsal septal cartilages, and correcting nasal valve angles as well as producing a positive aesthetic result.

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Effect of mold type, diameter, and uncured composite removal method on depth of cure

Abstract

Objective

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

Material and methods

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey–Kramer post hoc multiple comparison tests (α = 0.05).

Results

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

Conclusion

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

Clinical relevance

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

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Effect of mold type, diameter, and uncured composite removal method on depth of cure

Abstract

Objective

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

Material and methods

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey–Kramer post hoc multiple comparison tests (α = 0.05).

Results

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

Conclusion

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

Clinical relevance

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

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Influence of Cyclic Fatigue in Water on Screw Torque Loss of Long-Span One-Piece Implant-Supported Zirconia Frameworks

Abstract

Purpose

It is still unclear whether four, six, or more implants should be used when restoring fully edentulous maxillae. This research evaluated the in vitro screw torque loss of zirconia frameworks supported by six implants and cantilevered zirconia frameworks supported by four implants.

Materials and Methods

Computer aided design/computer-assisted machining was used to fabricate 10 one-piece frameworks. Standardized pressable porcelain crowns were fabricated and luted to the frameworks. Specimens were divided into two groups (n = 5): AO4, cantilevered 12-unit full-arch fixed dental prosthesis supported by four implants; AO6, 14-unit supported by six implants. An opposing mandibular dental arch was fabricated with bis-acrylic composite resin. Specimens were submitted to 200 N underwater cyclic load at 2-Hz frequency for 1 × 10⁶ cycles in a controlled 37°C temperature. A digital torque gauge assessed the initial and postload screw removal torque. Linear mixed-effects model was used for statistical analysis (α = 0.05).

Results

Significant screw torque loss was found for AO6 after cyclic loading (before: 36.20%/after: 52.82%; p < 0.05). Group AO6 (36.20%) presented lower preload loss before the cyclic loadings compared with AO4 (60.10%) (p < 0.05).

Conclusions

Cyclic loading and lower implant-to-replaced-units ratio do not seem to compromise screw stability compared with higher implant-to-replaced-units ratio; however, a steep drop in preload was found before cyclic loading for both groups.

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Predictable Outcomes with Porcelain Laminate Veneers: A Clinical Report

Abstract

This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock-ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.

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Quality Evaluation of Zirconium Dioxide Frameworks Produced in Five Dental Laboratories from Different Countries

Abstract

Purpose

The aim of this study was to assess and compare quality as well as economic aspects of CAD/CAM high strength ceramic three-unit FDP frameworks ordered from dental laboratories located in emerging countries and Switzerland.

Material and Methods

The master casts of six cases were sent to five dental laboratories located in Thailand (Bangkok), China (Peking and Shenzhen), Turkey (Izmir), and Switzerland (Bern). Each laboratory was using a different CAD/CAM system. The clinical fit of the frameworks was qualitatively assessed, and the thickness of the framework material, the connector height, the width, and the diameter were evaluated using a measuring sensor. The analysis of the internal fit of the frameworks was performed by means of a replica technique, whereas the inner and outer surfaces of the frameworks were evaluated for traces of postprocessing and damage to the intaglio surface with light and electronic microscopes. Groups (dental laboratories and cases) were compared for statistically significant differences using Mann-Whitney U-tests after Bonferroni correction.

Results

An acceptable clinical fit was found at 97.9% of the margins produced in laboratory E, 87.5% in B, 93.7% in C, 79.2% in A, and 62.5% in D. The mean framework thicknesses were not statistically significantly different for the premolar regions; however, for the molar area 4/8 of the evaluated sites were statistically significantly different. Circumference, surface, and width of the connectors produced in the different laboratories were statistically significantly different but not the height. There were great differences in the designs for the pontic and connector regions, and some of the frameworks would not be recommended for clinical use. Traces of heavy postprocessing were found in frameworks from some of the laboratories. The prices per framework ranged from US$177 to US$896.

Conclusions

By ordering laboratory work in developing countries, a considerable price reduction was obtained compared to the price level in Switzerland. Despite the use of the standardized CAD/CAM chains of production in all laboratories, a large variability in the quality aspects, such as clinical marginal fit, connector and pontic design, as well as postprocessing traces was noted. Recommended sound handling of postprocessing was not applied in all laboratories. Dentists should be aware of the true and factitious advantages of CAD/CAM production chains and not lose control over the process.

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Removal of cyanobacteria from synthetic and real water by dielectric barrier discharge process

Abstract

The feasibility of cyanobacteria removal from freshwater by a dielectric barrier discharge (DBD) process is investigated. Seven commercial and environmental cyanobacteria strains, as well as real algae-laden water, were tested. The removal of the cyanobacteria was evaluated by analyzing the changes in chlorophyll a content, total organic carbon (TOC) concentration, and cell morphology. Nearly total removal of chlorophyll a was achieved within 20 min, while the TOC analysis exhibited an increase-decrease-increase trend in 60 min of treatment, likely due to the oxidation of intracellular and intercellular materials. Observation under light microscopy revealed the disruption of intracellular and intercellular structures within 5 min of DBD treatment and thus supported the TOC analysis. Increasing the salinity of the medium from 0 to 5 parts per thousand (ppt) improved treatment efficiency, where similar level of chlorophyll a removal (around 93 %) was achieved in only half the treatment time. Application of DBD on real algae-laden water from a fish farm yielded higher treatment efficiency than in synthetic medium, indicating the promising application of DBD as a means to control cyanobacteria bloom in fresh and estuary water bodies.

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Removal of trihalomethane from chlorinated seawater using gamma radiation

Abstract

Chlorine addition as a biocide in seawater results in the formation of chlorination by-products such as trihalomethanes (THMs). Removal of THMs is of importance as they are potential mutagenic and carcinogenic agents. In this context, a study was conducted that used ionizing radiation to remove THMs from chlorinated (1, 3, and 5 mg/L) seawater by applying various dosages (0.4–5.0 kGy) of gamma radiation. Bromoform (BF) showed a faster rate of degradation as compared to other halocarbons such as bromodichloromethane (BDCM) and dibromochloromethane (DBCM). In chlorine-dosed seawater, total irradiation dose of 0.4 to 5 kGy caused percentage reduction in the range of 6.9 to 76.7 %, 2.3 to 99.6 %, and 45.7 to 98.3 % for BDCM, DBCM, and BF, respectively. During the irradiation process, pH of the chlorinated seawater decreased with increase in the absorbed dose; however, no change in total organic carbon (TOC) was observed. The results show that gamma dose of 2.5 kGy was adequate for maximum degradation of THM; but for complete mineralization, higher dose would be required.

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Analysis of predictors related to soil contamination in recreational areas of Romania

Abstract

Soil contamination in recreational areas can considerably affect children's health, as they are the segment of the population most sensitive to anthropogenic contamination. Soil contamination in recreational areas is influenced by a number of factors such as type and age of the recreational area, nearby traffic intensity, proximity to industrial areas, presence of vegetation, level of usage, treated wood structures, and the extent of maintenance operations carried out in the area. These can most often be observed during a simple site visit. The purpose of the present research is to analyze to which extent the presence of these factors can trigger an alarm signal, highlighting soil contamination in urban recreational areas. In this regard, soil contamination was scaled using the integrated pollution index applied on nine distinctive contaminants (As, Cu, Cd, Zn, Pb, Hg, Co, Ni, Mg) identified using inductively coupled plasma mass spectrometry (ICP-MS). Multiple linear regression analysis was performed in order to assess predictors of soil contamination. The research was carried out in a number of 88 recreational areas, parks, and playgrounds from 19 Romanian cities, revealing the fact that proximity to industrial areas and intensive traffic had statistically significant effects on soil contamination. Furthermore, it was observed that in 78 out of the 88 analyzed locations, the concentrations of contaminants exceeded the guidelines established through national legislation, thus confirming the presumption that high concentrations of contaminants exist in the parks and playgrounds of Romania.

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Anpassung des Mitgliedsbeitrags

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Despistaje de tuberculosis latente en el paciente con psoriasis moderada grave candidato a terapia sistémica y/o biológica

Publication date: Available online 3 December 2015
Source:Actas Dermo-Sifiliográficas
Author(s): A. Martínez-López, J. Rodriguez-Granger, R. Ruiz-Villaverde
Los pacientes con psoriasis moderada-grave que van a iniciar tratamiento con agentes biológicos deben ser monitorizados para la detección de infección tuberculosa latente antes, durante y después del tratamiento. En el último informe publicado de BIOBADADERM la prevalencia de infección latente por M.tuberculosis (ILMT) alcanzaba el 20,5% de los pacientes psoriásicos tratados con agentes biológicos en nuestro país. En la actualidad no existe un método diagnóstico gold standard que permita una aplicación sistemática y consensuada, con variaciones en los diferentes países según el grado de endemicidad y vacunación con BCG. La prueba de tuberculina (PT) continúa siendo el método de elección para el diagnóstico de infección, pero presenta importantes limitaciones en su sensibilidad (principalmente en pacientes inmunodeprimidos). Esta situación, junto a su falta de especificidad conocida, errores en su administración, la subjetividad en la interpretación de los resultados, la necesidad de una segunda visita para la lectura y la ausencia de privacidad hacen de ella una prueba limitada, cuyas principales ventajas resultarían su bajo coste y fácil realización. Por eso la mayoría de los estudios de coste beneficio se inclinan por el método IGRA para el diagnóstico de la ILMT, ya que minimiza los falsos positivos (especialmente en población vacunada), eliminando costes extra y efectos secundarios de la quimioprofilaxis antituberculosa. Valoramos la aplicabilidad en pacientes psoriásicos candidatos a terapia biológica y discutimos la necesidad de su realización previamente a terapia sistémica convencional, puesto que la mayoría de las guías actuales no consideran imprescindible su realización.Screening to detect latent tuberculosis infection (LTBI) is essential before patients with moderate to severe psoriasis start treatment with biologics and vigilance will continue to be needed during and after such treatment. The most recently analyzed statistics from the BIOBADADERM registry show a 20.5% prevalence of LTBI in psoriasis patients treated with biologics in Spain. Various screening protocols are in effect in different countries according to their levels of endemic TB and bacillus Calmette-Guérin (BCG) vaccination, and there is no consensus on a gold-standard approach to the diagnosis of LTBI. Tuberculin skin testing (TST) continues to be the diagnostic method of choice in spite of its limited sensitivity, mainly in immunocompromised patients. Additional problems include the TST's well-established lack of specificity, errors in application, subjectivity in the interpretation of results (which must be read during a second visit), and lack of privacy; the main advantages of this test are its low cost and ease of application. Most cost-benefit studies are therefore inclined to favor using interferon-γ release assays to detect LTBI because they minimize false positives (especially in BCG-vaccinated individuals), thereby eliminating the extra costs and side effects of unnecessary chemoprophylaxis. We review the methods used for LTBI screening in psoriasis patients who are candidates for biologic therapy. Additionally, given the fact that most guidelines do not currently consider it necessary to screen patients about to start conventional systemic therapy, we discuss the reasons underlying the need for such screening.



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Langzeit-Experiment unter der Haut

Die Substanzen, die Tattoos ihre Farbe geben, werden eigentlich zum Färben oder Lackieren von Konsumgütern hergestellt oder entstehen bei der unvollständigen Verbrennung fossiler Brennstoffe. Was sie anrichten, wenn sie dauerhaft in die Haut eingebracht werden, ist weitgehend unbekannt.

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Buchbesprechung „Das diabetische Fußsyndrom. Über die Entität zur Therapie“

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„Nur ein Bruchteil der Gifte entsteht beim Lasern“

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Oxybutynin vermindert übermäßiges Schwitzen

Für Menschen, die übermäßig schwitzen, scheint laut einer aktuellen randomisierten placebokontrollierten Studie niedrigdosiertes Oxybutynin eine effektive Therapieoption zu sein.

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Ist ein Ganzkörperscreening überflüssig?

Müssen Teilnehmer am Screening auf Hautkrebs von Kopf bis Fuß untersucht werden? Belgische Dermatologen haben eine Alternative hierzu getestet.

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„Optische Biopsie“ erspart unnötige Exzisionen

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Mit dem Tablet dem Formularwust entgehen

Erstanamnese, Aufklärungsbögen, Einverständniserklärung — in der Praxis von Stefanie Baum und Dr. Sonja Ehlen füllen Patienten solche Formulare nur noch auf dem Tablet aus. Das bringt den Ärztinnen mehr Zeit für ihre Patienten und stärkt die Bindung an die Praxis.

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Wann die Dermatoskopie keine IGeL ist

Bei der Früherkennungsuntersuchung auf Hautkrebs kann die Auflichtmikroskopie zum Einsatz kommen. Wünscht der Kassenpatient die Dermatoskopie, muss er sie als IGeL bezahlen. Doch es gibt eine Ausnahme.

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Addressing Saddle Nose Deformity

To the Editor Saddle nose deformity is one of the most complex cases that a rhinoplasty surgeon has to deal with. Surgery to address this deformity is tricky, with nasal airflow often being impaired in order to achieve a cosmetic improvement of the nose. When properly planned and executed, however, the outcome of surgery addressing saddle nose deformity can be quite rewarding for both the patient and the surgeon.

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Addressing Saddle Nose Deformity

In Reply We appreciate the kind words from Dr Xavier regarding our article and would like to elaborate on some of the statements in his letter. Dr Xavier comments on the Cakmak algorithm's type 4 deformity and suggests addressing these patients similarly to those with type 3a and type 3b deformities (using an L-strut affixed to holes drilled in the nasal bones), plus using a nonstructural graft, such as diced cartilage in fascia or diced cartilage with fibrin glue placed along the nasal dorsum, from the radix to the supratip area. We would like to emphasize that our main goal in saddle nose reconstruction is first and foremost to reconstruct a more projected, widened, and strengthened dorsal septum for the nasal skeleton to sit on and to continue to reconstruct from there when possible. The Cakmak algorithm enables functional improvement by restoring the ideal strength and height of the septal skeleton, reestablishing ideal connections between the upper lateral and dorsal septal cartilages, and correcting nasal valve angles as well as producing a positive aesthetic result.

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Effect of mold type, diameter, and uncured composite removal method on depth of cure

Abstract

Objective

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

Material and methods

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey–Kramer post hoc multiple comparison tests (α = 0.05).

Results

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

Conclusion

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

Clinical relevance

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

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Effect of mold type, diameter, and uncured composite removal method on depth of cure

Abstract

Objective

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

Material and methods

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey–Kramer post hoc multiple comparison tests (α = 0.05).

Results

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

Conclusion

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

Clinical relevance

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

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Influence of Cyclic Fatigue in Water on Screw Torque Loss of Long-Span One-Piece Implant-Supported Zirconia Frameworks

Abstract

Purpose

It is still unclear whether four, six, or more implants should be used when restoring fully edentulous maxillae. This research evaluated the in vitro screw torque loss of zirconia frameworks supported by six implants and cantilevered zirconia frameworks supported by four implants.

Materials and Methods

Computer aided design/computer-assisted machining was used to fabricate 10 one-piece frameworks. Standardized pressable porcelain crowns were fabricated and luted to the frameworks. Specimens were divided into two groups (n = 5): AO4, cantilevered 12-unit full-arch fixed dental prosthesis supported by four implants; AO6, 14-unit supported by six implants. An opposing mandibular dental arch was fabricated with bis-acrylic composite resin. Specimens were submitted to 200 N underwater cyclic load at 2-Hz frequency for 1 × 10⁶ cycles in a controlled 37°C temperature. A digital torque gauge assessed the initial and postload screw removal torque. Linear mixed-effects model was used for statistical analysis (α = 0.05).

Results

Significant screw torque loss was found for AO6 after cyclic loading (before: 36.20%/after: 52.82%; p < 0.05). Group AO6 (36.20%) presented lower preload loss before the cyclic loadings compared with AO4 (60.10%) (p < 0.05).

Conclusions

Cyclic loading and lower implant-to-replaced-units ratio do not seem to compromise screw stability compared with higher implant-to-replaced-units ratio; however, a steep drop in preload was found before cyclic loading for both groups.

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Predictable Outcomes with Porcelain Laminate Veneers: A Clinical Report

Abstract

This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock-ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.

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Quality Evaluation of Zirconium Dioxide Frameworks Produced in Five Dental Laboratories from Different Countries

Abstract

Purpose

The aim of this study was to assess and compare quality as well as economic aspects of CAD/CAM high strength ceramic three-unit FDP frameworks ordered from dental laboratories located in emerging countries and Switzerland.

Material and Methods

The master casts of six cases were sent to five dental laboratories located in Thailand (Bangkok), China (Peking and Shenzhen), Turkey (Izmir), and Switzerland (Bern). Each laboratory was using a different CAD/CAM system. The clinical fit of the frameworks was qualitatively assessed, and the thickness of the framework material, the connector height, the width, and the diameter were evaluated using a measuring sensor. The analysis of the internal fit of the frameworks was performed by means of a replica technique, whereas the inner and outer surfaces of the frameworks were evaluated for traces of postprocessing and damage to the intaglio surface with light and electronic microscopes. Groups (dental laboratories and cases) were compared for statistically significant differences using Mann-Whitney U-tests after Bonferroni correction.

Results

An acceptable clinical fit was found at 97.9% of the margins produced in laboratory E, 87.5% in B, 93.7% in C, 79.2% in A, and 62.5% in D. The mean framework thicknesses were not statistically significantly different for the premolar regions; however, for the molar area 4/8 of the evaluated sites were statistically significantly different. Circumference, surface, and width of the connectors produced in the different laboratories were statistically significantly different but not the height. There were great differences in the designs for the pontic and connector regions, and some of the frameworks would not be recommended for clinical use. Traces of heavy postprocessing were found in frameworks from some of the laboratories. The prices per framework ranged from US$177 to US$896.

Conclusions

By ordering laboratory work in developing countries, a considerable price reduction was obtained compared to the price level in Switzerland. Despite the use of the standardized CAD/CAM chains of production in all laboratories, a large variability in the quality aspects, such as clinical marginal fit, connector and pontic design, as well as postprocessing traces was noted. Recommended sound handling of postprocessing was not applied in all laboratories. Dentists should be aware of the true and factitious advantages of CAD/CAM production chains and not lose control over the process.

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