Introduction:The purpose of this study was to compare the stress distributions in the teeth treated through minimally invasive access (MIA) designs to those of the teeth treated through traditional straight-line access and their relationship to the final restoration using three-dimensional finite element analysis (FEA).Materials and Methods:Four FEA models of an extracted mandibular first molar were constructed. An intact model served as the control, whereas the other three were prepared with either an MIA or traditional straight-line access. Simulated composite access fillings with or without a simulated gold crown were applied to the models, followed by application of an occlusal load of 100 N. Von Mises stresses in the teeth were then calculated and analyzed.Results:Stress values within the dentin for baseline, MIA with composite filling, MIA with composite filling and crown, and traditional access with composite filling and crown were 10.14 MPa, 6.98 MPa, 11.79 MPa, and 16.81 MPa, respectively. Higher stress values indicate that the tooth is more prone to fracture.Conclusions:A traditional endodontic access cavity may render a tooth more susceptible to fracture compared with an MIA design.
This report presents findings supporting the hypothesis of a clinically relevant subtype of childhood speech sound disorder, provisionally titled speech delay-developmental psychosocial involvement (SD-DPI). Conversational speech samples from 29 children who met inclusionary criteria for SD-DPI were selected from a case record archive at a university speech clinic for children. Participants with SD-DPI had been characterized by speech clinicians and caregivers as having speech delay with psychosocial issues that required attention in the course of at least 1 semester of speech treatment. The 29 participants were divided into 2 subgroups, based on clinicians' and parents' records indicating either approach-related negative affect (n = 23) or withdrawal-related negative affect (n = 6). Each participant with SD-DPI was matched by age, gender, and type of speech involvement to 3 comparison speakers with speech delay of unknown origin (n = 87). Analyses of the conversational speech samples indicated that in comparison with participants in the control group, those with SD-DPI had significantly more severe speech delay, averaging approximately 7% to 10% lowered speech competence in conversation. The clinical prevalence of SD-DPI was estimated at approximately 12% of children referred to the university speech clinic in the present study. The authors interpret the present findings to indicate that approach-related or withdrawal-related negative affect, negative emotionality or mood, and decreased task persistence or attention are risk factors for increased severity of expression of speech delay.
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