Randomized clinical trial on the survival of lithium disilicate posterior partial restorations bonded using immediate or delayed dentin sealing after 3 years of function

Objectives: The survival and success rate and the quality of survival of partial ceramic restorations bonded employing Immediate (IDS) or Delayed Dentin Sealing (DDS) in vital molar teeth were evaluated in a randomized clinical trial with within-subject comparison study.Materials and methods: 30 patients received two lithium disilicate ceramic (IPS-e.max press, Ivoclar Vivadent) partial restorations on vital first or second molar teeth (N = 60). The two teeth randomly received either IDS (test group, n = 30) or DDS (control group, n = 30). Partial ceramic restorations were luted (Variolink Ultra, Ivoclar Vivadent) two weeks after preparation. Evaluations were performed at 1 week, 12 months and 36 months post-operatively, using qualitative (FDI) criteria. Representative failures were evaluated microscopically (SEM) and by means of simplified qualitative fractography analysis.Results: One absolute failure occurred in the DDS group due to (secondary) caries. The overall survival rate according to Kaplan-Meier after 3 years was 98.3% (FDI criteria score 1-4, n = 59) and the overall success rate was 85% (FDI criteria score 1-3, n = 51), with no significant difference between restorations in the IDS and DDS group (p = 0.32; Kaplan-Meier, Log Rank (Mantel-Cox), CI = 95%). For the quality of the survival, no statistically significant differences were found between IDS and DDS (p = 0.7; Kaplan-Meier, Log Rank (Mantel-Cox), CI = 95%) restorations on any follow-up timepoints for any of the FDI criteria (Wilcoxon, McNemar, p &gt; 0.05).Conclusion: Adhesively luted partial ceramic restorations in vital molar teeth have a good prognosis, however IDS did not show any differences in success and survival rates after 3 years of function.</p

The changing structure of Dutch mental health care

Current mental health care policy in The Netherlands emphasizes a major shift from intramural to extramural care. A decline in psychiatric hospital admissions is to result from (a) intensified psychiatric care offered by non-residential provider agencies, (b) an increase in sheltered housing and day care capacity and (c) an integral role in mental health care for the general practitioner. To allow for such a far reaching change, fortification of the greatly fragmented non-residential sector of Dutch mental health care was necessary (in 1982 more than 300 agencies in a country of 14.5 million inhabitants). Mergers have recently led to 60 Regional Institutes for Ambulatory Mental Health Care (RIAGG). This amalgamation within the non-residential sector is considered a major step towards the integration of the entire Dutch mental health care system. The article provides insight into the development of mental health care policy in The Netherlands and offers an analysis of the process of merger of non-residential services. As a necessary preface to this material a sketch of the historical and administrative context of Dutch health care is provided.mental health care restructuring policy development

Prospective randomized clinical trial on the survival of lithium disilicate posterior partial crowns bonded using immediate or delayed dentin sealing: short-term results on tooth sensitivity and patient satisfaction

This prospective randomized clinical trial evaluated tooth sensitivity and patient satisfaction after the provision of partial ceramic restorations bonded using immediate (IDS) or delayed dentin sealing (DDS) on vital molar teeth through a within-subject comparison study. Between December 2013 and May 2016, a total of 30 patients (13 women, 17 men; mean age, 54 years old) received two lithium disilicate ceramic (IPS-e.max press, Ivoclar Vivadent) partial restorations on vital first or second molar teeth (N=60). The two teeth randomly received either IDS (test group, n=30) or DDS (control group, n=30). Partial preparations were performed on all teeth and directly after tooth preparation. IDS was achieved using self-etch adhesive (Clearfil SE Primer and Adhesive, Kuraray) followed by the application of flowable resin (Clearfil Majesty Flow, Kuraray). Partial ceramic restorations were bonded (Variolink Ultra, Ivoclar Vivadent) two weeks after preparation. The teeth were evaluated preoperatively and at one week, three months, and 12 months postoperatively using a cold test and a questionnaire for perceived tooth sensitivity. Patient satisfaction was evaluated using a visual analog scale (VAS). Data were analyzed using McNemar, chi-squared, and Wilcoxon signed rank tests (α=0.01). There was no significant difference in patient-reported tooth sensitivity between the preoperative phase and all other time points (p>0.01). There was also no significant difference between IDS and DDS (p>0.01) for all items on the questionnaire. VAS scores did not differ significantly between the IDS and DDS groups for all items in the questionnaire at all time points (p>0.01). No tooth sensitivity change was noticed with the application of partial ceramic indirect restorations. This clinical study could not confirm that IDS is more advantageous than DDS in terms of tooth sensitivity and patient satisfaction at 1 year of clinical service of partial ceramic restorations

Turkey, Bursa, Istanbul and vicinities (Back), Series: K502, Sheet NK 35-12, 1956, 1:250 000

This prospective randomized clinical trial evaluated tooth sensitivity and patient satisfaction after the provision of partial ceramic restorations bonded using immediate (IDS) or delayed dentin sealing (DDS) on vital molar teeth through a within-subject comparison study. Between December 2013 and May 2016, a total of 30 patients (13 women, 17 men; mean age, 54 years old) received two lithium disilicate ceramic (IPS-e.max press, Ivoclar Vivadent) partial restorations on vital first or second molar teeth (N=60). The two teeth randomly received either IDS (test group, n=30) or DDS (control group, n=30). Partial preparations were performed on all teeth and directly after tooth preparation. IDS was achieved using self-etch adhesive (Clearfil SE Primer and Adhesive, Kuraray) followed by the application of flowable resin (Clearfil Majesty Flow, Kuraray). Partial ceramic restorations were bonded (Variolink Ultra, Ivoclar Vivadent) two weeks after preparation. The teeth were evaluated preoperatively and at one week, three months, and 12 months postoperatively using a cold test and a questionnaire for perceived tooth sensitivity. Patient satisfaction was evaluated using a visual analog scale (VAS). Data were analyzed using McNemar, chi-squared, and Wilcoxon signed rank tests (alpha=0.01). There was no significant difference in patient-reported tooth sensitivity between the preoperative phase and all other time points (p>0.01). There was also no significant difference between IDS and DDS (p >0.01) for all items on the questionnaire. VAS scores did not differ significantly between the IDS and DDS groups for all items in the questionnaire at all time points (p>0.01). No tooth sensitivity change was noticed with the application of partial ceramic indirect restorations. This clinical study could not confirm that IDS is more advantageous than DDS in terms of tooth sensitivity and patient satisfaction at 1 year of clinical service of partial ceramic restorations

Restoration choices for endodontically treated posterior teeth

There aren't any generally accepted guidelines for the restoration of an endodontically treated tooth. With a questionnaire among dental general practitioners and endodontists, several restorative treatment options for endodontically treated molars and premolars were identified. The questionnaire inventoried the influence of various parameters on treatment preferences. For each case, additional questions were put about material choice, cuspal coverage and the use of root canal posts. Both groups identified the vertical root fracture as the most common reason for extraction. The dentist general practitioner waited longer than the endodontist to make a permanent restoration in the case of apical periodontitis. Treatment preferences were found to be the same for premolars and molars. In the case of premolars, a root canal post was indicated more often and the location of the wall (bearing/non-bearing) influenced the choice of cuspal coverage. Of the dentist general practitioners and endodontists, 51-53% and 75-94%, respectively, preferred a partial over a full crown preparation in the case of single-walled teeth

Effect of Immediate Dentin Sealing and Surface Conditioning on the Microtensile Bond Strength of Resin-based Composite to Dentin

This study evaluated the microtensile bond strength (μTBS) of resin-based composite (RBC) to dentin after different immediate dentin sealing (IDS) strategies and surface-conditioning (SC) methods and on two water storage times. Human molars (n=48) were randomly divided into eight experimental groups involving four different IDS strategies-IDS-1L with one layer of adhesive, IDS-2L with two layers of adhesive, IDS-F with one layer of adhesive and one layer of flowable RBC, and DDS (delayed dentin sealing) with no layer of adhesive (control)-and two different SC methods-SC-P with pumice rubbing and SC-PC with pumice rubbing followed by tribochemical silica coating. The μTBS test was performed after one week and after six months of water storage, being recorded as the "immediate" and "aged" μTBS, respectively. Composite-adhesive-dentin microspecimens (0.9×0.9×8-9 mm) were stressed in tension until failure to determine the μTBS. Failure mode and location of failure were categorized. Two-way analysis of variance was applied to analyze the data for statistically significant differences between the experimental groups (p<0.05). Two-way analysis of variance revealed no significant differences between the one-week μTBS specimens for IDS strategy (p=0.087) and SC methods (p=0.806). However, the interaction of IDS strategy and SC methods appeared statistically significant (p=0.016). The six-month specimen evaluation showed no significant difference in μTBS for SC (p=0.297) and SC/IDS interaction (p=0.055), but the μTBS of the IDS strategies differed significantly among them (p=0.003). For tribochemical silica-coated IDS, no significant effect of aging on μTBS was recorded (p=0.465), but there was a highly significant difference in μTBS depending on the IDS strategy (p<0.001). In addition, the interaction of IDS and aging was borderline statistically significant (p=0.045). The specimens failed mainly at the adhesive-dentin interface for all experimental groups. Dentin exposure during clinical procedures for indirect restorations benefits from the application of IDS, which was shown to result in higher bond strength. No significant differences were found between cleaning with solely pumice or pumice followed by tribochemical silica coating