adam

Cutaneous and systemic hypersensitivity reactions to implanted metals are challenging to evaluate and treat. Although they are uncommon, they do exist, and require appropriate and complete evaluation. This review summarizes the evidence regarding evaluation tools, especially patch and lymphocyte transformation tests, for hypersensitivity reactions to implanted metal devices. Patch test evaluation is the gold standard for metal hypersensitivity, although the results may be subjective. Regarding pre-implant testing, those patients with a reported history of metal dermatitis should be evaluated by patch testing. Those without a history of dermatitis should not be tested unless considerable concern exists. Regarding post-implant testing, a subset of patients with metal hypersensitivity may develop cutaneous or systemic reactions to implanted metals following implant. For symptomatic patients, a diagnostic algorithm to guide the selection of screening allergen series for patch testing is provided. At a minimum, an extended baseline screening series and metal screening is necessary. Static and dynamic orthopaedic implants, intravascular stent devices, implanted defibrillators and dental and gynaecological devices are considered. Basic management suggestions are provided. Our goal is to provide a comprehensive reference for use by those evaluating suspected cutaneous and systemic metal hypersensitivity reactions.

Dentists and patients are facing a perplexity between saving a compromised tooth through endodontic treatment and restoration or by extraction and replacement with an implant. The purpose of this paper was to compare the success rates of these two treatments. Success was measured as the longevity of the tooth or implant. Studies which met strict inclusion criteria to ensure best evidence were included. Searches were performed in Ovid Medline, Pubmed, Scopus database, and the Cochrane Library. Evidence-based groups were formed following the assessment of inclusion/exclusion criteria. The overall success rates for primary endodontic, nonsurgical retreatment, and surgical treatment were (86.02%), (78.2%), and (63.4%), respectively, implants was 90.9%. In conclusion, choice between implant and endodontic therapy cannot be exclusively based on outcome as both treatments differ in the biological process, diagnostic modalities, failure patterns, and patients preferences. More research is required with improved study designs before long-term success rates can be compared.

Diagnosis, instrumentation, obturation and restoration are the main steps involved in the treatment of teeth with pulpal and periapical diseases. Elimination or significant reduction of irritants and prevention of recontamination of the root canal after treatment are the essential elements for successful outcomes. Although many advances have been made in different aspects of endodontics within the last few years to preserve natural dentition, the main objective of this field re-mains elimination of microorganisms from the root canal systems and prevention of recontamination after treatment. The common belief that inadequate obturation is the major cause of endodontic failures has been proven to be fallacious as obturation reflects the adequacy of cleaning and shaping. In other words, what you take out of a root canal may be more important than what you put in it.

Sevoflurane is currently used as an inhaled anaesthetic agent with few adverse drug reactions. Skin reaction after general anaesthesia is uncommon. We report a case of fluoroderma after exposure to sevoflurane