The goal of this prospective randomized clinical trial was to compare 2 cohorts of standardized cleft patients with regard to functional speech outcome and the presence or absence of palatal fistulae. The 2 cohorts are randomized to undergo either a conventional von Langenbeck repair with intravelar velarplasty or the double-opposing Z-plasty Furlow procedure. A prospective 2 × 2 × 2 factorial clinical trial was used in which each subject was randomly assigned to 1 of 8 different groups: 1 of 2 different lip repairs (Spina vs. Millard), 1 of 2 different palatal repair (von Langenbeck vs. Furlow), and 1 of 2 different ages at time of palatal surgery (9-12 months vs. 15-18 months). All surgeries were performed by the same 4 surgeons. A cul-de-sac test of hypernasality and a mirror test of nasal air emission were selected as primary outcome measures for velopharyngeal function. Both a surgeon and speech pathologist examined patients for the presence of palatal fistulae. In this study, the Furlow double-opposing Z-palatoplasty resulted in significantly better velopharyngeal function for speech than the von Langenbeck procedure as determined by the perceptual cul-de-sac test of hypernasality. Fistula occurrence was significantly higher for the Furlow procedure than for the von Langenbeck. Fistulas were more likely to occur in patients with wider clefts and when relaxing incisions were not used.
The ages of 6,761 restorations replaced in permanent teeth, 6,088 in adults > or =19 years of age and 673 in adolescents < or =18 years, were available for analyses. The results showed that the median age of amalgam restorations in adults was 11 years and that of resin-based composite restorations 8 years. This difference in longevity was significant (P = 0.000 l). The median age of failed conventional glass ionomer restorations in adults was 4 years and for resin-modified glass ionomer 2 years. In adolescents, the median longevity of failed amalgam restorations was 5 years and that of composite restorations 3 years, while both types of glass ionomers had a median longevity of 2 years. The data were subdivided based on clinician gender and practice setting. The results showed that the median age of amalgam and composite restorations replaced Its male clinicians was higher than that for female clinicians irrespective of clinical setting. The median age of amalgam and composite restorations replaced by salaried dentists was significantly lower than that by private practitioners. Minor differences were noted in longevity of restorations between male and female patients. The age of replaced restorations was shortest for the group of clinicians with the least clinical experience and highest for those that graduated > or = 30 years ago.
This practice-based study aimed to record the use of restorative materials, the type of restoration by class, and the reason for and the age of failed restorations in primary teeth by means of a survey of placement and replacement of restorations in 1996 and 2000/2001. Written alternative criteria for placement and replacement of restorations were provided for the participating clinicians. Details on 2281 restorations showed that primary caries was the main reason for inserting restorations in primary teeth. Replacements of failed restorations represented 14% of the fillings (n = 2040) in 1996 and 9% in 2000/2001 (n = 241). More than 80% or the fillings in primary teeth were of tooth-colored material, predominantly of the light-cured type. About 50% of failed amalgam and glass ionomer-type restorations were replaced due to secondary caries. The median age of amalgam restorations (3 years) was significantly higher than that of tooth-colored restorations (2 years). Any possible advantage of a cariostatic effect of glass ionomer-type materials is apparently annulled by their short longevity compared with amalgam.
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