PURPOSESurface color is one of the main criteria to obtain an ideal esthetic. Many factors such as the type of the material, surface specifications, number of firings, firing temperature and thickness of the porcelain are all important to provide an unchanged surface color in dental ceramics. The aim of this study was to evaluate the color changes in dental ceramics according to the material type and glazing methods, during the multiple firings.MATERIALS AND METHODSThree different types of dental ceramics (IPS Classical metal ceramic, Empress Esthetic and Empress 2 ceramics) were used in the study. Porcelains were evaluated under five main groups according to glaze and natural glaze methods. Color changes (ΔE) and changes in color parameters (ΔL, Δa, Δb) were determined using colorimeter during the control, the first, third, fifth, and seventh firings. The statistical analysis of the results was performed using ANOVA and Tukey test.RESULTSThe color changes which occurred upon material-method-firing interaction were statistically significant (P<.05). ΔE, ΔL, Δa and Δb values also demonstrated a negative trend. The MC-G group was less affected in terms of color changes compared to other groups. In all-ceramic specimens, the surface color was significantly affected by multiple firings.CONCLUSIONFiring detrimentally affected the structure of the porcelain surface and hence caused fading of the color and prominence of yellow and red characters. Compressible all-ceramics were remarkably affected by repeated firings due to their crystalline structure.

PURPOSEThe color of the ceramic restorations is affected by various factors such as brand, thickness of the layered the ceramic, condensation techniques, smoothness of surface, number of firings, firing temperature and thickness of dentin. The aim of this study was to evaluate the color change and surface roughness in dental porcelain with different thicknesses during repeated firings.MATERIALS AND METHODSDisc-shaped (N=21) metal-ceramic samples (IPS Classic; Ivoclar Vivadent; Shaar, Liechtenstein) with different thickness were exposed to repeated firings. Color measurement of the samples was made using a colorimeter and profilometer was used to determine surface roughness. ANOVA and Tukey tests with repeated measurements were used for statistical analysis.RESULTSThe total thickness of the ceramics which is less than 2 mm significantly have detrimental effect on the surface properties and color of porcelains during firings (P<.05).CONCLUSIONRepeated firings have effects on the color change and surface roughness of the dental ceramics and should be avoided.

Background Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.

Aims The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process. Methods and results  Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60–25.9], (Sb) (aHR 1.21, 95% CI: 1.08–1.35), and (Su) (aHR 1.27, 95% CI: 1.14–1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45–2.06) and (Sy) (aHR 1.29, 95% CI: 1.00–1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55–0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16–1.56). Conclusion  Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.

The tested whitening agent did not affect the surface roughness of either resin-based restorative material. Both materials became brighter after whitening. The behavior of the materials in the yellow/blue axis was opposite to each other after whitening. Each material had clinically unacceptable color change after whitening (ΔE > 5.5); however, the magnitude of the color change of materials was similar (p > 0.05). According to the results of this study, with the use of materials tested, patients should be advised that existing composite restorations may bleach along with the natural teeth, and replacement of these restorations after whitening may not be required.