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Summary: This study investigated how changing or maintaining parent‐set bedtimes over time relates to adolescents' sleep timing, latency, and duration. Adolescents (n = 2509; Mage = 12.6 [0.5] years; 47% m) self‐reported their sleep patterns, and whether they had parent‐set bedtimes on two separate occasions in 2019 (T1; 12.6 years) and 2020 (T2; 13.7 years). We identified four groups based on parent‐set bedtimes: (1) bedtime rules at both T1 and T2 (46%, n = 1155), (2) no bedtime rules at T1 nor T2 (26%, n = 656), (3) bedtime rules at T1 but not T2 (19%, n = 472), (4) no bedtime rules at T1 but a parent‐set bedtime at T2 (9%, n = 226). As expected, the entire sample showed that bedtimes generally became later and sleep duration shorter across adolescence, but the change differed among the groups. Adolescents whose parents introduced bedtime rules at T2 reported earlier bedtimes and longer sleep duration (~20 min) compared with adolescents with no bedtime rules at T2. Importantly, they no longer differed from adolescents who consistently had bedtimes across T1 and T2. There was no significant interaction for sleep latency, which declined at a similar rate for all groups. These results are the first to suggest that maintaining or re‐introducing a parent‐set bedtime may be possible and beneficial for adolescents' sleep. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities (ID) die on an average 20 years earlier to the general population. They have higher rates of multimorbidity and polypharmacy. Around 25% of people with ID report chronic constipation. The England Learning Disabilities Mortality Review found that nearly 25% of deaths identified constipation as a long‐term health problem. However, the likely risk factors for constipation related harm are poorly enumerated. We sought to identify possible specific high‐risk factors by examining the clinical characteristics of people with ID admitted to hospital with constipation. Methods: Data of people with ID admitted with constipation in two general hospitals covering a population of 1.3 million from 2017 to 2022 were reported using the STROBE guideline for cohort studies. Collected data included age, gender, intellectual disability severity, recorded medication, presenting complaint and co‐morbidities. The medication anticholinergic burden was calculated using the anticholinergic burden scale. Continuous variables were summarised by mean and standard deviation if normally distributed, with categorical variables summarised by the number and percentage in each category. Results: Of 46 admissions (males 52%), 57% had moderate to profound ID, 37% had epilepsy, 41% prescribed antiseizure medication (ASM) and 45% were on laxatives. Average age was 46 years. The anticholinergic burden score mean was 2.3 and median, one. Conclusions: We can hypothesise that people with more severe ID, suffering from epilepsy and on ASM may be more at risk of developing severe constipation. Some admissions may be avoided with earlier use of laxatives in the community. [ABSTRACT FROM AUTHOR]

To probe the potential role of Th1 versus Th2 reactivity underlying the hygiene hypothesis, intrinsic levels of Th1-associated and Th2-associated antibodies in the serum of wild rodents were compared with that in various strains of laboratory rodents. Studies using rat lung antigens as a target indicated that wild rats have substantially greater levels of autoreactive, polyreactive immunoglobulin G (IgG), but not autoreactive, polyreactive IgM than do laboratory rats, both on a quantitative and qualitative basis. Increased levels of serum IgG and IgE were observed in both wild rats and wild mice relative to their laboratory-raised counterparts, with the effect being most pronounced for IgE levels. Further, wild rats had greater intrinsic levels of both Th1- and Th2-associated IgG subclasses than did lab rats. The habitat (wild versus laboratory raised) had a more substantial impact on immunoglobulin concentration than did age, strain or gender in the animals studied. The presence in wild rodents of increased intrinsic, presumably protective, non-pathogenic responses similar to both autoimmune (autoreactive IgG, Th1-associated) and allergic (IgE, Th2-associated) reactions as well as increased levels of Th1-associated and Th2-associated IgG subclasses points toward a generally increased stimulation of the immune system in these animals rather than a shift in the nature of the immunoreactivity. It is concluded that, at least to the extent that feedback inhibition is a controlling element of immunoreactivity, an overly hygienic environment may affect the threshold of both types of immune responses more so than the balance between the different responses. [ABSTRACT FROM AUTHOR]

Investigations of the etiology and epidemiology of pathogenic diseases can be genetically divided into several stages. Initially, attention is concentrated upon describing and quantifying the disease symptoms themselves, so that new outbreak may be recognized easily by other workers. The second phase focuses attention upon the environmental factors responsible for the optimum spread of the pathogen and for the development of the disease. Initially, a knowledge of these factors is used in order to predict the likelihood of future disease outbreaks. This approach has been used with considerable success on many serious plant diseases.

Little is known about the incidence of cancer among farmworker populations or about effective strategies for communicating with farmworkers about cancer prevention. Some studies suggest that farmworkers may have unusually high incidences of skin and cervical cancers. With these two cancers as the focus, a group of interviewers, researchers, and health communication specialists set out to create, implement, and evaluate a cancer control demonstration project geared toward farmworkers. In 1994, a situation analysis was conducted to identify constraints and opportunities for providing farmworkers with cancer control information and services. The situation analysis provided valuable information to aid in developing intervention and evaluation strategies. This paper outlines how and why the situation analysis was conducted and what was learned with regard to the farmworker population on the Delmarva Peninsula. Living conditions and the local availability of cancer control services are described. Obstacles to conducting research and interventions with farmworkers are highlighted. Based on what was learned, recommendations are made for designing cancer control research and intervention for farmworkers. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the connection of capnography sampling tube to an intravenous cannula.

Objective: The aim of this report is to present the complete workflow of 3D virtual patient for planning and performing implant surgery with magnetically retained 3D-printed stackable guides., Clinical Considerations: A 3D-printed stackable system was proposed based on bone, dental, and facial references. Initially, a 66-year-old male patient was digitalized through photographs, cone beam computed tomography, and intraoral scans (Virtuo Vivo, Straumann). All files were merged to create a 3D virtual patient in the planning software (coDiagnostiX, Straumann). Sequential stackable guides were designed, printed, and cured. Magnets were inserted into connectors, and the interim protheses received color characterization. Four mounted guides were produced for the specific purposes of pin fixation, bone reduction, implant placement, and immediate provisionalization. After surgery and healing period, patient digital data were updated. Final implant positions were compared to planned values and inconsistencies were clinically acceptable. The mean angular deviation was 5.4° (3.2-7.3) and mean 3D discrepancies were of 0.90 mm (0.46-1.12) at the entry point and 1.68 mm (1.00-2.20) at implant apex. Case follow-up revealed stability, patient's comfort, and no intercurrences., Conclusion: Magnetically retained stackable guides provide treatment accuracy and reduce surgical and prosthetic complications. The projected virtual patient enhances decision-making and communication between the multidisciplinary team and the patient, while decreases time and costs., Clinical Significance: Bidimensional diagnosis and freehand implant placement have limitations and outcomes often rely on professionals' expertise. Performing facially driven virtual planning improves treatment predictability. This approach promotes function, esthetic harmony, and patient satisfaction. Implant guided surgery and 3D printed prostheses constitute a reproducible digital workflow that can be implemented into clinical practice to optimize dental care., (© 2024 Wiley Periodicals LLC.)

Purpose: This study aimed to assess the influence of magnetic resonance imaging (MRI) protocol on the decision-making for the positioning of dental implants in edentulous arches in comparison to planning based on cone beam computed tomography (CBCT)., Materials and Methods: One phantom was scanned with CBCT and two MRI protocols (T1- and T2-weighted). Two calibrated examiners performed digital implant planning (coDiagnostiX, Dental Wings), considering a digital prosthetic planning and alveolar ridge surface scan. Four implants were planned for each patient dataset, and the angular deviation between the long axis of the implants and the prosthetic planning occlusal plane was measured., Results: Each examiner planned 40 implants, 12 implants with CBCT and 28 implants with MRI (16 with T1 and 12 with T2 images). Significant differences in angle deviation were observed between CBCT, T1, and T2 in the anterior region for both examiners (p = 0.009 for examiner 1 and p = 0.042 for examiner 2). Implants planned with CBCT showed significantly lower angular deviation than those based on the T1 and T2 scans for both examiners (p = 0.028 and p = 0.046 for examiner 1 and p = 0.028 and p = 0.027 for examiner 2). No significant difference in angular deviation was found between T1 and T2 for both examiners (examiner 1: p = 0.600, examiner 2: p = 0.916)., Conclusion: Compared to CBCT planning, the MRI protocol influenced decision-making for anterior dental implants, with angular deviations within acceptable clinical thresholds, but further studies are needed to validate these findings., (© 2024 by the American College of Prosthodontists.)

Introduction: There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia., Method: Using data from a national survey of Australian trans young people (N = 859, M age  = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach., Results: Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction., Discussion and Conclusions: While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care., (© 2024 The Author(s). Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Objective: This systematic review aims to understand the limitations and benefits of the guided direct restorative technique, to optimize the final outcomes, considering the evolution from analog to digital, including planning, the diversification of guides, and the different resins employed., Methodology: A search was conducted in the electronic databases PubMed, Cochrane, and through manual searches, initiated in May 2023 and updated in April 2024. The following search strategy was used: ((injectable composite resin) OR (direct pressed composite)) OR (3D-guided), utilizing the PICO framework., Results: Initially, 739 articles were retrieved. After applying inclusion and exclusion criteria, 33 studies were considered suitable for data extraction, including 12 in vitro studies and 21 case reports or technique descriptions. The articles focused on comparisons of techniques, flowable, heated, and conventional resins, as well as various technique reports with variations in guides, materials, and planning, potentially aiding clinicians in more effective and safer execution of this restorative technique., Conclusion: The utilization of digital workflows presents greater solutions to the challenges of the guided direct restorative technique. Understanding the properties of the resins used is crucial for the results and should be chosen according to the patient's needs., Clinical Significance: A guided direct restorative procedure can deliver previously planned dental treatment based on individualized planning. This method ensures greater reproducibility in aesthetics and occlusion, resulting in superior quality work for the patient., (© 2024 Wiley Periodicals LLC.)

Objective: To evaluate the effect of different modeling agents on color changes, surface roughness, and translucency parameters over time in Bulkfill resin composites., Material and Methods: Sixty specimens were prepared using three Bulkfill resin composites (Tetric N-Ceram Bulkfill, Filtek One Bulkfill and Opus Bulkfill) and three modeling agents (Wetting Resin, Optibond FL and Ambar APS). All specimens were subjected to a simulated tooth-brushing (Baseline, 50.000 cycles, 100.000 cycles), and surface roughness was measured at each interval. Surface topography was evaluated. The translucency parameter and color changes were assessed after 24-h, 7-, 14- and 30-day immersion in water, wine, and coffee. Data was analyzed using ANOVA and Bonferroni test., Results: All specimens increased roughness after simulated tooth-brushing (p < 0.05). Wetting Resin decreased roughness on Tetric N-Ceram Bulkfill (p < 0.05). The translucency parameter remained unaltered for all groups. All groups changed color after 30-days of immersion in wine and coffee (p < 0.05). Ambar APS and Wetting Resin on Tetric N-Ceram Bulkfill showed higher color changes when immersed in coffee (p < 0.05)., Conclusion: The use of modeling agents does not jeopardize translucency properties but may affect surface roughness and color properties of Bulkfill resin composites depending on their composition., Clinical Significance: The findings of this study suggest that surface roughness and color properties are affected by the differences in the composition between modeling agents and Bulkfill resins composites., (© 2024 Wiley Periodicals LLC.)

Objective: This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket-shield technique., Materials and Methods: A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal-Wallis test and Dunn's post hoc test., Results: Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other., Conclusions: The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length., Clinical Significance: Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket-shield technique more predictable., (© 2024 Wiley Periodicals LLC.)

Background and Aims: Alcohol use and anxiety often co-occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and cost-effectiveness of a web-based, self-guided alcohol and anxiety-focused program, compared with a web-based brief alcohol-focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects., Design: This RCT will be conducted with a 1:1 parallel group., Setting: The study will be a web-based trial in Australia., Participants: Individuals aged 17-30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety (n = 500) will be recruited through social media, media (TV, print) and community networks., Intervention and Comparator: Participants will be randomly allocated to receive a web-based, integrated alcohol-anxiety program plus technical and motivational telephone/e-mail support (intervention) or a web-based brief alcohol-feedback program (control)., Measurements: Clinical measures will be assessed at baseline, post-intervention (2 months), 6 months (primary end-point), 12 months and 18 months. Co-primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge-drinking frequency; alcohol-related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post-intervention), health-care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention-to-treat framework. The economic evaluation will analyze individual-level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change., Comments: This will be the first trial to test whether a developmentally targeted, web-based, integrated alcohol-anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol-anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost., (© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Aims: The aim of this study was to measure the effectiveness of an on-line, neuroscience-based harm reduction intervention (The Illicit Project) on substance use, harms and knowledge over a 12-month period., Design: We used a two-arm cluster-randomized controlled trial., Setting: The study was conducted at eight secondary schools across New South Wales, Australia., Participants: A total of 950 (mean age = 15.9; standard deviation = 0.68) in grades 10-12 at participating schools in 2020 took part., Intervention and Comparator: The Illicit Project intervention group (schools = five, n = 681) received an on-line, universal substance use and harm reduction programme over three classes. The active control group (schools = three, n = 269) received school-based health education as usual., Measurements: Self-report questionnaires assessed primary [alcohol, nicotine, cannabis, 3,4-methylenedioxymethamphetamine (MDMA), cocaine and prescription drug misuse] and secondary outcomes (alcohol-related harms and drug literacy) at baseline and the 6- and 12-month follow-up assessment., Findings: Approximately 63% (n = 595) of the sample completed the 12-month follow-up assessment, including 58% of the intervention group (n = 396/679) and 66% of the active control group (n = 179/271). Participants in the intervention group had slower annual increases in binge drinking [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.89], nicotine use (OR = 0.80, 95% CI = 0.52-1.23), MDMA use (OR = 0.14, 95% CI = 0.02-1.00), cocaine use (OR = 0.06, 95% CI = 0.01-0.64) and prescription drug misuse (OR = 0.07, 95% CI = 0.01-0.54) compared with the active control group. There was limited evidence of an intervention effect on cannabis use and alcohol-related harm (P > 0.5). The secondary outcomes showed that the intervention group maintained higher levels of drug literacy knowledge (β = 3.71, 95% CI = 1.86-5.56) and harm reduction help-seeking skills (β = 1.55, 95% CI = 0.62-2.48) compared with the active control group., Conclusion: The Illicit Project (an on-line, neuroscience-based substance use harm reduction intervention) was effective in slowing the uptake of risky substance use and improving drug literacy skills among late secondary school students in Australia, compared with school-based health education as usual., (© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Objectives: Natural restorations combine digital workflow and shell technique to create CAD/CAM restorations with the form and texture of natural teeth. This case report describes an interdisciplinary digital workflow combined with CAD/CAM natural restorations to achieve the naturalness of an anterior rehabilitation., Clinical Considerations: A 38-year-old patient attended to the office with esthetic issues. An interdisciplinary treatment plan was conducted, which included periodontal surgery to recreate the gingival contour, associated with bleaching and manufacturing CAD/CAM ceramic veneers to return an optimal teeth surface texture and shape., Conclusions: The design and manufacturing of CAD/CAM natural restorations using a digital workflow allowed a predictable result and overcame the limitations of conventional shell technique., Clinical Significance: Conventional shell technique is used to create restorations with the form and texture of natural teeth. This article presents a combination of the conventional shell technique with a digital workflow, facilitating the design and manufacturing of CAD/CAM natural restorations., (© 2023 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Objectives: For decades, the dental community has discussed which materials would be the ideal substitutes for lost tooth structure. Initially, the biomimetic approach advocated that feldspathic ceramics would be the material of choice for enamel. However, given the complexity of obtaining excellent dental technicians and the financial cost, are composite resins a suitable replacement? The optical properties with opalescence and fluorescence effects, as well as this material's high fracture toughness, indicate it as a long-lasting restorative material. However, because this material depends on the operator's expertise, knowledge of layering techniques and the selection of each material for the different layers is required. Thus, knowledge of the polychromatic technique through a bioinspired approach is necessary to obtain results of life-like restorations. This article aims to review the polychromatic layering technique (PLT), considering the optical and mechanical properties of dentin and enamel and correlating these properties with current composite resins to guide clinicians in selecting the most suitable restoratives for their clinical challenges., Clinical Considerations: The polychromatic layering technique is revisited, cross-referencing the properties of dentin and enamel with current composite resin restoratives and their biomimetic properties. The effectiveness and predictability of the PLT are corroborated in clinical cases of varying degrees of difficulty requiring different layering strategies., Conclusion: After the bio-inspired analysis, using nature as a model to be understood and followed, it is possible to note how the polychromatic technique remains current and viable in mimicking nature, providing esthetic and natural results in the layering of composite resins., Clinical Significance: Composite resins effectively replicate the optical and mechanical characteristics of natural dentin and enamel through the bioinspired approach presented by the polychromatic layering technique., (© 2023 Wiley Periodicals LLC.)

Objective: Maintenance of adequate interproximal tissue height between an implant and a natural tooth or between adjacent implants represents an esthetic challenge in implant dentistry. The aim of this case report is to describe a modified technique referred to as the beyond the gap filling (BGF) approach designed to improve the horizontal and vertical components of the facial aspect and particularly the height of interproximal bone peaks around immediately placed implants into fresh extraction sockets., Clinical Considerations: Four patients (five teeth) requiring anterior tooth extraction were treated with the BGF approach that included: (a) minimally traumatic tooth extraction; (b) immediate implant placement without flap elevation; (c) installation of a narrow profile healing abutment to protect the implant during grafting; (d) grafting with a construct with 90% bovine bone granules and 10% porcine collagen packed coronally to the facial and interproximal bone walls above the level of the bone crest; and (e) delivery of an immediate restoration., Conclusions: The current report suggests that the level/height of the interproximal bone crests between an implant and a natural tooth or between two adjacent implants can be improved by the BGF approach and, consequently, papilla height can be maintained in cases with a high risk of papilla height collapse and, consequently, esthetic outcomes can be maximized., Clinical Significance: The BGF is a simple technique to be used by clinicians to prevent significant papilla collapse in anterior immediate implants and consequently achieve maximum esthetic outcomes in implant dentistry., (© 2022 Wiley Periodicals LLC.)

Background and Aims: Alcohol consumption is increasing among older adults. Rethink My Drink is a brief internet-delivered intervention to reduce alcohol consumption and related harms, adapted specifically for older adults. This protocol for a large-scale randomised controlled trial will evaluate whether Rethink My Drink is effective in reducing alcohol consumption and cognitive decline in a sample of older risky drinkers, compared with an active control., Design: 1:1 parallel group, randomised controlled trial., Setting: Online trial in Australia., Participants: Hazardous or harmful drinkers (defined as those scoring ≥5 on the Alcohol Use Disorders Identification Test [AUDIT]) age 60 to 75 years old (n = 842). Participants will be recruited from August 2021 to August 2022 through online social media advertisements and community networks., Intervention and Comparator: Participants will be randomly allocated to receive access to Rethink My Drink (intervention) or Alcohol: The Facts (comparator), an online patient information booklet provided by New South Wales (NSW) Health., Measurements: Primary outcomes include (i) average weekly standard drinks and (ii) rate of cognitive decline. Secondary outcomes include (i) typical quantity of drinks per drinking day; (ii) heavy episodic drinking; (iii) age-specific risky drinking; (iv) alcohol-related harms; (v) subjective cognitive complaints; and (vi) quality of life. All primary and secondary outcomes will be assessed at baseline, post-intervention (4 weeks) and 12 months. Effectiveness will be evaluated using multilevel linear regression, adjusting for baseline demographic differences. Bonferroni adjustments will be used to control for multiple comparisons. Multiple imputation, regression weighting and sensitivity analyses will assess the effect of attrition., Comments: This will be the first large-scale trial, internationally, to examine whether a brief internet-delivered intervention is effective in reducing alcohol consumption and cognitive decline among older adults. If successful, the intervention will provide an accessible and highly scalable treatment to reduce risky alcohol consumption in older adulthood., (© 2021 Society for the Study of Addiction.)

Objective: The present case report describes digital approaches to plan an orthodontic and periodontal rehabilitation at the anterior esthetic zone., Clinical Considerations: A young patient attended to the dental practice with esthetic concerns. The facially driven digital planning showed the need of an interdisciplinary treatment to improve smile harmony. Orthodontic treatment was conducted with aligners, followed by periodontal and restorative approaches. Tooth alignment was performed with 31 aligners, whereas eight aligners were used for refinement. Harmony between pink and white esthetics was improved with crown lengthening, followed by bleaching., Conclusion: By using a conservative approach, a successful esthetic result was achieved respecting functional and biological principles., Clinical Significance: Digital resources can be used to the interdisciplinary esthetic planning taking into consideration the harmony between smile and face. This approach allows a predictable outcome of the treatment., (© 2022 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Objective: The aim of this report is to present an interdisciplinary approach with novel concepts to virtually plan and achieve esthetics and function., Clinical Considerations: Despite the advancements in the digital workflow applied to restorative dentistry, the final outcomes are commonly not similar to initial planning. To overcome this major limitation, three concepts are proposed: guided dentistry, digital quality control and "copy-paste" dentistry. Guided dentistry consists of simulations in 3D software and also includes the manufacture of guides/appliances to assist dentists in all clinical steps. Digital quality control involves the use of intraoral scanners and 3D software to compare the real outcomes with the pre-operative simulations after every procedure. "Copy-paste" dentistry is a consequence of the previous two concepts. Using the capacity of the software to overlap files, the original project can be maintained and adapted to achieve results more comparable with the initial design. The proposed method associates facially driven treatment planning and periodontal and restorative procedures to perform the patient's dental rehabilitation., Conclusion: Through a guided workflow and digital control of clinical steps, the final outcomes obtained were equivalent and closer to the initial design., Clinical Significance: In interdisciplinary cases, the treatment plan needs to address individual requirements and to coordinate sequential clinical stages. It is challenging to meet these demands in a conventional process. The proposed concepts engage technological resources to orientate the procedures and to provide assessment in each step. This approach enables the development of a complete and accurate functional-esthetic rehabilitation. Ultimately, the technique presented is reproducible and the results reflect the established plan., (© 2021 Wiley Periodicals LLC.)

Objective: This article provides an update on the direct-indirect composite veneer technique., Clinical Considerations: Composite veneers have long been used as a conservative and esthetic treatment option for anterior teeth. While they are generally performed using a direct technique, there has been renewed interest in the direct-indirect composite veneer technique because of its advantages and broad indications for restoration of tooth color and morphology. In the direct-indirect composite veneer technique, the selected composites are initially applied on the tooth using a layering approach, without any bonding agent, sculpted to a primary anatomic form with slight excess, and light-cured. The partially polymerized veneer is then removed from the tooth, heat-tempered, and finished to final anatomy and processed extra-orally before being luted. Advantages of this technique include enhanced physical and mechanical properties afforded by the tempering process, unrivaled marginal adaptation, enhanced finishing and polishing, and the ability to try-in the veneer before luting, enabling a shade verification and modulation process that is not possible with the direct technique. The direct-indirect approach also affords enhanced gingival health and patient comfort., Conclusion: This article reviews the direct-indirect composite veneer technique, and outlines critical steps and tips for clinical success., Clinical Significance: The direct-indirect technique for composite veneers combines advantages of the direct composite placement technique with those of the indirect veneer technique, including operator control, single-visit fabrication and delivery, increased material properties, and excellent esthetics., (© 2020 Wiley Periodicals LLC.)

Objective: Despite all advantages provided by the digital workflow, its application in clinical practice is still more focused on device manufacturing and clinical execution than on treatment planning and communication. The most challenging phases of treatment, comprehensive planning, diagnosis, risk assessment, and decision-making, are still performed without significant assistance from digital technologies. This article proposes a new dental software classification based on the digital workflow timeline, considering the moment of patient's case acceptance as key in this classification, and presents the ideal software tools for each phase., Clinical Considerations: The proposed classification will help clinicians and dental laboratories to choose the most appropriate software during the treatment planning phase and integrate virtual plans with other software platforms for digitally guided execution. A dento-facial interdisciplinary planning platform virtually simulates interdisciplinary clinical procedures and assists in the decision-making process., Conclusions: The suggested classification assists professionals in different phases of the digital workflow and provides guidelines for improvement and development of digital technologies before treatment plan acceptance by the patient., Clinical Significance: Three-dimensional interdisciplinary simulations allow clinicians to visualize how each dental procedure influences further treatments. With this treatment planning approach, predictability of different procedures in restorative dentistry, orthodontics, implant dentistry, periodontal, and oral maxillofacial surgery is improved., (© 2021 Wiley Periodicals LLC.)

Background Cardiovascular safety is an important consideration regarding the benefits versus risks of electronic cigarette use (EC) for public health. The single-use cardiovascular effects of EC have been well studied but may not reflect effects of ad libitum use throughout the day. We aimed to compare the circadian hemodynamic effects as well as 24-hour biomarkers of oxidative stress, and platelet aggregation and inflammation, with ad libitum cigarette smoking (CS) versus EC versus no tobacco product use. Methods and Results Thirty-six healthy dual CS and EC users participated in a crossover study in a confined research setting. Circadian heart rate, blood pressure and plasma nicotine levels, 24-hour urinary catecholamines, 8-isoprostane and 11-dehydro-thromboxane B2, and plasma interleukin-6 and interleukin-8 were compared in CS, EC, and no nicotine conditions. Over 24 hours, and during daytime, heart rate and blood pressure were higher in CS and EC compared with no tobacco product conditions ( P <0.01). Heart rate on average was higher with CS versus EC. Urinary catecholamines, 8-isoprostane, and 11-dehydro-thromboxane B2 were not significantly different, but plasma IL-6 and IL-8 were higher with both CS and EC compared with no tobacco product ( P <0.01). Conclusions CS and EC had similar 24-hour patterns of hemodynamic effects compared with no tobacco product, with a higher average heart rate with CS versus EC, and similar effects on biomarkers of inflammation. EC may pose some cardiovascular risk, particularly to smokers with underlying cardiovascular disease, but may also provide a harm reduction opportunity for smokers willing to switch entirely to EC. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02470754.

Background and Aims: Relative pharmacological effects of e-cigarettes and cigarettes during 24 hours of ad-libitum use have not been described. In this study, 24-hour blood plasma nicotine concentrations and 48-hour subjective effects with use of cigarettes and e-cigarettes were measured among dual users., Design: Two-arm within-subject cross-over design with preferred e-cigarette or cigarette ad-libitum use over 48 hours., Setting: Hospital research ward in San Francisco, California, USA., Participants: Thirty-six healthy dual users of e-cigarettes and cigarettes (n = 8, 25% females)., Measurements: Twenty-four-hour blood plasma nicotine and cotinine concentrations and 48-hour self-reported nicotine withdrawal symptoms and rewarding effects., Findings: Analyses used analysis of variance (ANOVA)-based mixed models with order of product (e-cigarette or cigarette) and product type (combustible cigarette or type of e-cigarette) as fixed effects, and subject as a repeated effect. During a 24-hour period, e-cigarettes produced lower nicotine exposure than cigarettes for the majority of users, although 25% received more nicotine from e-cigarettes, which was predicted by more frequent e-cigarette use or greater dependence. Compared to cigarette smoking, nicotine exposure for variable-power tank users was similar, while cig-a-like (t (30)  = 2.71, P = 0.011, d = 0.745) and fixed-power tank users (t (30)  = 3.37, P = 0.002, d = 0.993) were exposed to less nicotine. Cigarettes were rated higher than e-cigarettes on some desirable subjective effects (e.g. psychological reward, t (322)  = 7.24 P < 0.001, d = 0.432), but withdrawal symptom reduction was comparable. No differences were found between e-cigarette types, but Bayes factors indicate that these measures were insensitive., Conclusions: During a 24-hour period in a hospital setting in the United States, nicotine exposure for dual users of e-cigarettes and cigarettes was similar when using cigarettes or variable-power tank devices only but was lower for those using cig-a-like or fixed-power devices only. Despite lower nicotine levels, all types of e-cigarette were effective in preventing withdrawal symptoms. E-cigarettes were rated less rewarding than cigarettes., (© 2019 Society for the Study of Addiction.)

Aim: To describe systemic nicotine exposure and subjective effects of electronic cigarettes (e-cigarettes) in people who use both e-cigarettes and cigarettes (dual users), including within-subject comparisons of e-cigarette and cigarette use., Design: Two-arm, counterbalanced cross-over study. Participants used their usual brand of e-cigarette or cigarette during a standardized session in a 2-week study., Setting: Hospital research ward, San Francisco, CA, USA., Participants: Thirty-six healthy (eight women, 28 men) participants., Measurements: Plasma nicotine was analyzed by gas chromatography-tandem mass spectrometry; nicotine withdrawal, urge to smoke and vape, affective states, craving, satisfaction and psychological reward were measured by standardized questionnaires., Findings: Compared with cigarettes, average maximum plasma nicotine concentration (C max ) was lower with e-cigarettes [6.1 ± 5.5 ng/ml, mean ± standard deviation (SD) versus 20.2 ± 11.1 ng/ml, P < 0.001] and time of maximal concentration (T max ) was longer (6.5 ± 5.4 versus 2.7 ± 2.4 minutes, P < 0.001). Use of both products resulted in a reduction in the severity of withdrawal symptoms, negative affect and urge to use either product. E-cigarettes were less rewarding and satisfying and reduced craving to a lesser degree than cigarettes. We were not able to detect any differences in withdrawal symptoms, affective states and urge to smoke cigarettes between e-cigarette and cigarette use., Conclusion: Systemic nicotine exposure was, on average, lower with single use of e-cigarettes compared with cigarettes, and e-cigarettes were judged to be less satisfying and rewarding and reduced craving less than cigarettes., (© 2020 Society for the Study of Addiction.)

Purpose: To perform a systematic review on studies assessing clinical outcomes in patients rehabilitated with complete-arch fixed implant-supported prostheses according to the time of loading., Materials and Methods: Data obtained from patient and clinical outcomes, as implant failure, success rate, survival rate, biological complications, technical complications, mechanical complications, and marginal bone loss, were included on this review. The search was performed on databases PubMed, Scopus, and Cochrane. Cochrane Collaboration tool was used to assess the risk of bias of randomized controlled studies, and an adapted version of Newcastle-Ottawa scale was used for observational studies. All data were tabulated according to the time of loading: (1) immediate restoration/loading, (2) early loading, and (3) conventional loading., Results: From a total of 4027 studies identified through the three databases, six of them were randomized controlled trials, five of them were prospective observational studies, and another five were retrospective observational studies. In total, 5954 implants, 1294 patients and 1305 full-arch fixed implant-supported prostheses were included in this review. There was a wide heterogeneity among clinical studies regarding the study design and treatment procedures. Thus, pooled estimates were not performed in order to avoid potential biases. The methodological assessment by the Modified Newcastle-Ottawa scale showed a moderate quality of observational studies. Regarding the RCTs studies, all of them presented at least one element of bias according to the Cochrane Collaboration tool for assessing risk of bias., Conclusion: There is evidence of high survival-success implant rate (95-100%) for either loading protocols (immediate restoration/loading, early loading, and conventional loading). However, careful attention must be taken by clinician when interpreting the results reported in clinical studies. Future studies should be performed using standardized methodology in order to determine the true predictability regarding immediate, early, and conventional loading protocols., (© 2019 by the American College of Prosthodontists.)

Background and Aims: The experience of alcohol use among adolescents is complex, with international differences in age of purchase and individual differences in consumption and consequences. This latter underlines the importance of prediction modeling of adolescent alcohol use. The current study (a) compared the performance of seven machine-learning algorithms to predict different levels of alcohol use in mid-adolescence and (b) used a cross-cultural cross-study scheme in the training-validation-test process to display the predictive power of the best performing machine-learning algorithm., Design: A comparison of seven machine-learning algorithms: logistic regression, support vector machines, random forest, neural network, lasso regression, ridge regression and elastic-net., Setting: Canada and Australia., Participants: The Canadian sample is part of a 4-year follow-up (2012-16) of the Co-Venture cohort (n = 3826, baseline age 12.8 ± 0.4, 49.2% girls). The Australian sample is part of a 3-year follow-up (2012-15) of the Climate Schools and Preventure (CAP) cohort (n = 2190, baseline age 13.3 ± 0.3, 43.7% girls)., Measurements: The algorithms used several prediction indices, such as F 1 prediction score, accuracy, precision, recall, negative predictive value and area under the curve (AUC)., Findings: Based on prediction indices, the elastic-net machine-learning algorithm showed the best predictive performance in both Canadian (AUC = 0.869 ± 0.066) and Australian (AUC = 0.855 ± 0.072) samples. Domain contribution analysis showed that the highest prediction accuracy indices yielded from models with only psychopathology (AUC = 0.816 ± 0.044/0.790 ± 0.071 in Canada/Australia) and only personality clusters (AUC = 0.776 ± 0.063/0.796 ± 0.066 in Canada/Australia). Similarly, regardless of the level of alcohol use, in both samples, externalizing psychopathologies, alcohol use at baseline and the sensation-seeking personality profile contributed to the prediction., Conclusions: Computerized screening software shows promise in predicting the risk of alcohol use among adolescents., (© 2018 Society for the Study of Addiction.)

Issues: This overview of reviews will synthesise information from existing reviews to provide a summary of the evidence for universal alcohol and illicit drug prevention strategies across different intervention settings., Approach: Academic databases, including Medline, EMBASE and PsycInfo were searched on 1 August 2016. All reviews and meta-analyses of universal alcohol and drug prevention conducted since 2006 were included. The reviews included in this overview were grouped according to the different settings where prevention strategies have been applied (i.e. family, school, college, workplace, leisure, healthcare, community, media and policy)., Key Findings: Fifty-two reviews met the inclusion criteria and were included in this report. There is sufficient evidence to support universal preventive interventions for alcohol in family and school settings. In terms of reducing drug use, there is sufficient evidence to support the use of school- and leisure-based universal primary prevention strategies. Based on evidence published in the last 10 years, mass media campaigns to do not appear to be effective in reducing drug use. More evidence is needed to support preventive interventions in college, workplace, healthcare and community settings., Implications: Through the identification of settings where preventive interventions are effective, this overview can be used to guide alcohol and drug policy and the allocation of resources., Conclusion: The evidence base for universal prevention in several settings could be strengthened, guiding priorities for future research., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

The process of tooth loss throughout life associated with severe occlusal wear may pose a challenge in the rehabilitation of partially edentulous arches. In these cases, many therapeutic procedures are necessary because each tooth must be restored to obtain the correct anatomical contour and recover the occlusal vertical dimension (OVD). A removable partial denture (RPD) with occlusal/incisal coverage, also known as an overlay RPD, is an alternative treatment option with fewer interventions, and, consequently, lower cost. This clinical report reviews the principles involved in the clinical indication for an overlay RPD, as well as the necessary planning and execution, to discuss the feasibility and clinical effectiveness of this treatment, identifying the indications, advantages, and disadvantages of this procedure through the presentation of a clinical case. The overlay RPD can be an alternative treatment for special situations involving partially edentulous arches in patients who need reestablishment of the OVD and/or realignment of the occlusal plane, and it can be used as a temporary or definitive treatment. The main advantages of this type of treatment are its simplicity, reversibility, and relatively low cost; however, further studies are needed to ensure the efficacy of this treatment option., (© 2015 by the American College of Prosthodontists.)

Objective: The aim of this review was to update the literature with regard to the digital methods available by CEREC Chairside system to register and design the occlusion, to report their efficacy and technical innovations in the field of Restorative Dentistry. A search strategy was performed using the key-words: "virtual articulator," or "CAD-CAM and occlusal recording," or "CAD-CAM and occlusion register," or "CAD-CAM and occlusal contacts," or "CAD-CAM and prosthesis.", Material and Methods: Inclusion criteria comprised studies evaluating the use of digital methods available by CEREC System for occlusal registration and design during prosthodontics treatment. PubMed and Cochrane library and reference lists were searched up to January 2016., Results: The search resulted in 280 articles after removing duplicates. Subsequently, 233 records were excluded and 49 studies were selected for reading in full. Eleven articles were considered eligible for the systematic review (4 in vitro and 7 clinical studies)., Conclusion: Scientific evidence suggests that digital methods were accurate to register and design the occlusion of dental prostheses. Nevertheless, further clinical studies are required to establish a conclusion with regard to its accuracy in prosthodontics treatment., Clinical Significance: Digital technologies allow the design of occlusal surfaces of CAD-CAM fabricated prostheses using innovative approaches. This systematic review aimed to update the literature to help dentists determine the most appropriate digital method to register and design the occlusal surface of CAD-CAM crowns. (J Esthet Restor Dent 28:208-220, 2016)., (© 2016 Wiley Periodicals, Inc.)

Unlabelled: Noncarious cervical lesions are highly prevalent and may have different etiologies. Regardless of their origin, be it acid erosion, abrasion, or abfraction, restoring these lesions can pose clinical challenges, including access to the lesion, field control, material placement and handling, marginal finishing, patient discomfort, and chair time. This paper describes a novel technique for minimizing these challenges and optimizing the restoration of noncarious cervical lesions using a technique the author describes as the class V direct-indirect restoration. With this technique, clinicians can create precise extraoral margin finishing and polishing, while maintaining periodontal health and controlling polymerization shrinkage stress., Clinical Significance: The clinical technique described in this article has the potential for being used routinely in treating noncarious cervical lesions, especially in cases without easy access and limited field control. Precise margin finishing and polishing is one of the greatest benefits of the class V direct-indirect approach, as the author has seen it work successfully in his practice over the past five years., (© 2015 Wiley Periodicals, Inc.)

The self-assembling protein nanoparticle (SAPN) is an antigen-presenting system that has been shown to be suitable for use as a vaccine platform. The SAPN scaffold is based on the principles of icosahedral symmetry, beginning from a monomeric chain that self-assembles into an ordered oligomeric state. The monomeric chain contains two covalently linked α-helical coiled-coil domains, an N-terminal de novo-designed pentameric tryptophan zipper and a C-terminal de novo-designed trimeric leucine zipper, which assemble along the internal symmetry axes of an icosahedron. In this study, we incorporated the membrane proximal external region (MPER) of HIV-1 gp41 from HXB2 into the N-terminal pentamer, referred to as MPER-SAPN, attempting to reproduce the α-helical state of the 4E10 epitope while maintaining a structurally less-constrained 2F5 epitope. Sprague-Dawley rats were immunized with MPER-SAPNs, and their sera were analyzed for induced humoral anti-HIV-1 responses. We show that high membrane proximal external region-specific titers can be raised via the repetitive antigen display of MPER on the SAPN without the need for adjuvant. However, none of the sera displayed a detectable neutralizing activity against HIV-1. Thus, 4E10- and 2F5-like neutralizing antibodies could not be elicited by MPER conformationally restrained in the SAPN context., (© 2012 John Wiley & Sons A/S.)

Unlabelled: Light dynamics is a relevant phenomenon with respect to esthetic restorations, as incorrect analysis of the optical behavior of natural dentition may lead to potential clinical failures. The nature of incident light plays a major role in determining the amount of light transmission or reflection, and how an object is perceived depends on the nature of the light source. Natural teeth demonstrate translucency, opalescence, and fluorescence, all of which must be replicated by restorative materials in order to achieve clinical success. Translucency is the intermediary between complete opacity and complete transparency, making its analysis highly subjective. In nature, the translucency of dental enamel varies from tooth to tooth, and from individual to individual. Therefore, four important factors must be considered when appraising translucency. Presence or absence of color, thickness of the enamel, degree of translucency, and surface texture are essential components when determining translucency. State-of-the-art resin composites provide varying shades and opacities that deliver a more faithful reproduction of the chromaticity and translucency/opacity of enamel and dentin. This enables the attainment of individualized and customized composite restorations. The objective of this article is to provide a review of the phenomena of translucency and opacity in the natural dentition and composite resins, under the scope of optics, and to describe how to implement these concepts in the clinical setting., Clinical Significance: Choosing composite resins, based on optical properties alone, in order to mimic the properties of natural tooth structures, does not necessarily provide a satisfactory esthetic outcome. In many instances, failure ensues from incorrect analysis of the optical behaviors of the natural dentition as well as the improper use of restorative materials. Therefore, it is necessary to implement a technique that enables a restorative material to be utilized to its full potential to correctly replicate the natural teeth., (© 2011, COPYRIGHT THE AUTHORS. JOURNAL COMPILATION © 2011, WILEY PERIODICALS, INC.)

X-linked hypohidrotic ectodermal dysplasia (XLHED) is characterized by severe hypohidrosis, hypotrichosis, and hypodontia. The gene responsible for this pleiotropic syndrome (ED1) consists of 12 exons, 8 of them coding for a transmembrane protein (ectodysplasin-A; EDA-A) involved in the developmental process of epithelial-mesenchymal interaction. ED1 mutations that cause alterations in this protein lead to the XLHED phenotype. The major objective of the present study was to detect ED1 mutations in four Brazilian families with the XLHED phenotype and to compare them to the more than 60 different mutations already reported. DNA of the EDA-A coding exons was amplified by PCR, and single strand conformation analysis (SSCA) of the electrophoretic bands was carried out in polyacrylamide gel stained with silver nitrate. Two of these four families showed altered DNA band patterns. Subsequent DNA sequencing of the two mutated exons showed: (1) a 36 nucleotide deletion at exon 5 responsible for the loss of four Gly-X-Y repeats of the collagen subdomain of EDA-A; (2) a guanine deletion at exon 6 (966 or 967 sites) that alters EDA-A after amino acid 241 and leads to a premature ending at amino acid 279. This mutation at exon 6 seems not to have been reported previously and determines a truncated EDA-A without a part of its extracellular domain that contains the whole TNF homologue subdomain. These two DNA mutations are compatible with the XLHED phenotype. In the other two families the PCR-SSCA methodology was unable to detect any mutation responsible for the XLHED phenotype., (Copyright 2003 Wiley-Liss, Inc.)

The characteristics of severe neutropenia with a delayed onset following administration of rituximab have been evaluated in 53 consecutively treated patients. All but one patient received rituximab for the treatment of non-Hodgkin's lymphoma. Eight episodes of grade 4 neutropenia were detected between 1 and 5 months after rituximab, when administered alone on five occasions, and on three occasions in combination with chemotherapy, where neutrophil counts had recovered prior to the development of neutropenia. In three episodes, the patients presented with sepsis. Development of neutropenia did not correlate with either the presence of detectable disease or the administration of further treatment. Neutropenia was associated with selective depletion of neutrophil precursors in all but one episode, where it was associated with generalized bone marrow hypoplasia. All episodes developed after a period of either normal or mildly depressed neutrophil counts following treatment with rituximab, and persisted for between several days and several months, before undergoing spontaneous recovery in four instances, and after administration of filgrastim in the remainder. Episodes of neutropenia were associated with disordered immune status manifested by lymphopenia and hypogammaglobulinaemia, raising the possibility that either disturbance of the balance of lymphocyte subsets or an immune dyscrasia induced by rituximab resulted in the development of this type of neutropenia.

The background to the anaesthesia being practised in Lesotho, a developing country in southern Africa is described. The results of a recent survey covering the anaesthetic apparatus and techniques currently employed in the country's sixteen district hospitals are discussed, and consideration is given to possible anaesthetic developments for the future.