Characterisation of microparticle waste from dental resin-based composites

Clinical applications of resin-based composite (RBC) generate environmental pollution in the form of microparticulate waste. Methods: SEM, particle size and specific surface area analysis, FT-IR and potentiometric titrations were used to characterise microparticles arising from grinding commercial and control RBCs as a function of time, at time of generation and after 12 months ageing in water. The RBCs were tested in two states: (i) direct-placement materials polymerised to simulate routine clinical use and (ii) pre-polymerised CAD/CAM ingots milled using CAD/CAM technology. Results: The maximum specific surface area of the direct-placement commercial RBC was seen after 360 s of agitation and was 1290 m2/kg compared with 1017 m2/kg for the control material. The median diameter of the direct-placement commercial RBC was 6.39 μm at 360 s agitation and 9.55 μm for the control material. FTIR analysis confirmed that microparticles were sufficiently unique to be identified after 12 months ageing and consistent alteration of the outermost surfaces of particles was observed. Protonation-deprotonation behaviour and the pH of zero proton charge (pHzpc) ≈ 5–6 indicated that the particles are negatively charged at neutral pH7. Conclusion: The large surface area of RBC microparticles allows elution of constituent monomers with potential environmental impacts. Characterisation of this waste is key to understanding potential mitigation strategies

Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial.

BACKGROUND: Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES: The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS: DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS: Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS: With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time

The environmental impact of dental amalgam and resin-based composite materials

Direct-placement dental restorative materials include dental amalgam, glass ionomer, resin-modified glass ionomer, compomer and resin-based composite (RBC). The choice of restorative material is determined by its ability to restore the structure and/or the aesthetic appearance of the dentition and to impart a net therapeutic value. In this way, the most appropriate material system is chosen to manage each particular clinical situation in the most effective manner. The most commonly used direct-placement materials in everyday modern dentistry are dental amalgam and resin-based composites. To date, concerns about the environmental impact from the use of dental materials has focused on dental amalgam and mercury release. It is now evident that the continued use of dental amalgam is time-limited on the basis of environmental pollution as recommended by the Minamata Treaty. The recommendations include a planned phase-down of use of dental amalgam with an anticipated complete phase-out by 2030. The environmental impact of other restorative dental materials deserves further consideration. This article provides a detailed overview of the environmental issues associated with the use of dental amalgam, the potential environmental issues associated with the alternative resin-based composite restorative materials and to consider recommendations for further research

Behavior of dental composite materials in sterilized and non-sterilized landfill leachate

Treatment of used and unused dental resin based composites resulting from the activities of dental industries and clinics is challenging. Disposal to landfill site is commonly utilized to manage this waste. We investigated the release of monomers from dental composites in landfill leachate and the chemical changes of sterilized and non-sterilized leachate in the existence of dental composites. Solid phase micro-extraction (SPME) coupled with high performance liquid chromatography (HPLC) was used to extract and quantify the released monomers. Chemical characterization of leachate was carried out using pH meter, gas chromatography (GC), ion chromatography (IC) and inductively coupled plasma mass spectrometry (ICP-MS). The HPLC results, revealed that Bis-GMA, TEGDMA, UDMA, HEMA and BPA monomers were released from dental composites. According to the results of pH, GC, IC and ICP-MS, the presence of dental composites has no significant effect in the chemistry of leachate except increasing the production of CH4 and CO_2. However, autoclaving increased pH values and decreased calcium concentration in sterilized samples. Furthermore, Mn^concentration increased and Fe^ concentration decreased in non-sterilized samples due to microbial activities

Simultaneous detection of monomers associated with resin-based dental composites using SPME and HPLC

As resin-based composites (RBC) replace dental amalgam for environmental reasons, there is a requirement to understand the environmental impact of this alternative dental restorative material. In this study we standardize the simultaneous detection of five monomeric components associated with RBCs using high performance liquid chromatography (HPLC) coupled with solid-phase microextraction (SPME). Factors affecting method performance (detection wavelength, calibration conditions, method sensitivity/accuracy/precision, extraction time/efficiency) are evaluated using standard solutions containing the mixture of TEGDMA, UDMA, Bis-GMA, BPA and HEMA. Detection sensitivity and analytical efficiency of the method is optimized for these compounds using 200 nm detection wavelength, PDMS/DVB fiber and extraction time of 90 min. Analytical accuracy of the HPLC is >95% for all monomers, with precision of 2.3–5.1%. Detection limits under the conditions described are 25 µg/L for HEMA, BPA, UDMA, Bis-GMA, and 100 µg/L for TEGDMA. The extraction time is governed by the largest molecular weight compounds

Differences between familial and sporadic dilated cardiomyopathy: ESC EORP Cardiomyopathy & Myocarditis registry

Aims: Dilated cardiomyopathy (DCM) is a complex disease where genetics interplay with extrinsic factors. This study aims to compare the phenotype, management, and outcome of familial DCM (FDCM) and non-familial (sporadic) DCM (SDCM) across Europe. Methods and results: Patients with DCM that were enrolled in the prospective ESC EORP Cardiomyopathy & Myocarditis Registry were included. Baseline characteristics, genetic testing, genetic yield, and outcome were analysed comparing FDCM and SDCM; 1260 adult patients were studied (238 FDCM, 707 SDCM, and 315 not disclosed). Patients with FDCM were younger (P\ua0<\ua00.01), had less severe disease phenotype at presentation (P\ua0<\ua00.02), more favourable baseline cardiovascular risk profiles (P\ua0 64\ua00.007), and less medication use (P\ua0 64\ua00.042). Outcome at 1\ua0year was similar and predicted by NYHA class (HR 0.45; 95% CI [0.25\u20130.81]) and LVEF per % decrease (HR 1.05; 95% CI [1.02\u20131.08]. Throughout Europe, patients with FDCM received more genetic testing (47% vs. 8%, P\ua0<\ua00.01) and had higher genetic yield (55% vs. 22%, P\ua0<\ua00.01). Conclusions: We observed that FDCM and SDCM have significant differences at baseline but similar short-term prognosis. Whether modification of associated cardiovascular risk factors provide opportunities for treatment remains to be investigated. Our results also show a prevalent role of genetics in FDCM and a non-marginal yield in SDCM although genetic testing is largely neglected in SDCM. Limited genetic testing and heterogeneity in panels provides a scaffold for improvement of guideline adherence

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

Aims The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry Methods and results: 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P&lt;0.001), less family history of HCM (HT and DM P&lt;0.001), higher New York Heart Association (NYHA) class (P&lt;0.001), atrial fibrillation (HT and DM P&lt;0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P&lt;0.001; DM P = 0.003). Stroke was more frequent in HT (P&lt;0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P&lt;0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. Conclusion Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits