Fracture resistance of premolars restored with inlay and onlay ceramic restorations and luted with two different agents

AbstractPurposeThe purpose of this study was to evaluate the fracture resistance of human maxillary premolars restored with 2 ceramic systems (Vitadur Alpha and In Ceram) comparing 3 preparation designs and 2 luting agents.MethodsSeventy sound teeth were prepared to receive ceramic restorations (Vitadur Alpha; n=14) as follows: (1) control, sound premolars, with no preparation, (2) inlays, (3) partial onlays (palatal cuspid coverage), (4) total onlays (both cuspids coverage), and (5) total onlays with an In Ceram core. The ceramic restorations were cemented using Enforce or RelyX ARC (half restorations with each cement), placed into the cavity and held under pressure, except for the control group. The teeth were subjected to compressive axial loading at 0.5mmmin−1 using a 9mm steel ball until fracture. Data were analyzed by 3-way ANOVA and post hoc Tukey's test (α=.05).ResultsThere was a significant difference between cements and among preparation designs (P<.05). All restorations cemented with Enforce exhibited significantly higher fracture resistance (P<.05). Inlay restorations showed similar fracture resistance when compared to control group (P>.05). Partial and total onlays did not statistically differ and showed the weakest performance. The use of an In Ceram core did not produce higher fracture resistance.ConclusionsWithin the limitations of this study, the cements tested had different mechanical properties, while cuspid coverage did not result in improved fracture resistance of the restored teeth

The Effect of Luting Agents and Ceramic Thickness on the Color Variation of Different Ceramics against a Chromatic Background

Objectives: The aim of this study was to assess the influence of various ceramic thicknesses and luting agents on color variation in five ceramic systems. Methods: Fifteen disc-shaped ceramic specimens (11 mm diameter; shade A3) were fabricated with each of the six veneering ceramics tested, with 1, 1.5, or 2 mm thickness (n=5). Resin composite discs (Z-250, shade C4) were used as bases to simulate a chromatic background. The cementation of the veneers was carried out with an opaque resin-based cement (Enforce, shade C4), a resin-based cement (Enforce, shade A3), or without cement (C4, control group). Color differences (??E*) were determined using a colorimeter. Three-way ANOVA was used to analyze the data, followed by a Tukey post-hoc test (??=.05). Results: The L*a*b* values of the ceramic systems were affected by both the luting agent and the ceramic thickness (P<.05). In general, there was no difference between the control group and the group using the resin-based cement. The use of an opaque luting agent resulted in an increase of the color coordinates a*, b*, L*, producing differences in ??E* values for all ceramics tested, regardless of the thickness (P<.05). For the 2-mm thick veneers, higher values in the color parameters were obtained for all ceramics and were independent of the luting agent used. Conclusions: The association of 2-mm thickness with opaque cement presented the strongest masking ability of a dark colored background when compared to a non- opaque luting agent and the other thicknesses tested. (Eur J Dent 2011;5:245-252

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research