Other

“The objective of this randomized control trial was to compare the five-year clinical performance of direct and indirect resin composite restorations replacing cusps. In 157 patients, 176 restorations were made to restore maxillary premolars with Class II cavities and one missing cusp. Ninety-two direct and 84 indirect resin composite restorations were placed by two operators, following a strict protocol. Treatment technique and operator were assigned randomly. Follow-up period was at least 4.5 yrs. Survival rates were determined with time to reparable failure and complete failure as endpoints. Kaplan-Meier five-year survival rates were 86.6% (SE 0.27%) for reparable failure and 87.2% (SE 0.27%) for complete failure. Differences between survival rates of direct and indirect restorations [89.9% (SE 0.34%) vs. 83.2% (SE 0.42%) for reparable failure and 91.2% (SE 0.32%) vs. 83.2% (SE 0.42%) for complete failure] were not statistically significant (p = .23 for reparable failure; p = .15 for complete failure). Mode of failure was predominantly adhesive. The results suggest that direct and indirect techniques provide comparable results over the long term (trial registration number: ISRCTN29200848).”

“When comparing cases and controls receiving their first MMR vaccine before and after 36 months of age, there was a statistically significant increase in autism cases specifically among African American males who received the first MMR prior to 36 months of age. Relative risks for males in general and African American males were 1.69 (p=0.0138) and 3.36 (p=0.0019), respectively. Additionally, African American males showed an odds ratio of 1.73 (p=0.0200) for autism cases in children receiving their first MMR vaccine prior to 24 months of age versus 24 months of age and thereafter.”

Background: Aerosols and droplets are produced during many dental procedures. With the advent of the droplet-spread disease severe acute respiratory syndrome, or SARS, a review of the infection control procedures for aerosols is warranted.

Types of studies reviewed: The authors reviewed representative medical and dental literature for studies and reports that documented the spread of disease through an airborne route. They also reviewed the dental literature for representative studies of contamination from various dental procedures and methods of reducing airborne contamination from those procedures.

Results: The airborne spread of measles, tuberculosis and SARS is well-documented in the medical literature. The dental literature shows that many dental procedures produce aerosols and droplets that are contaminated with bacteria and blood. These aerosols represent a potential route for disease transmission. The literature also documents that airborne contamination can be minimized easily and inexpensively by layering several infection control steps into the routine precautions used during all dental procedures.

Clinical implications: In addition to the routine use of standard barriers such as masks and gloves, the universal use of preprocedural rinses and high-volume evacuation is recommended.

The aim of this review is to give a survey of the use of high-power lasers for root canal cleaning and disinfection. There are two approaches: the first using a fiber in a dry root canal and exposing the root canal wall to the laser light with a spiral motion, and the other using the fiber in irrigant in the root canal or at the orifice. The laser-target interaction is different: a direct exposure of the substrate to laser light is the aim of the spiral motion, whereas the aim of the second technique is activation and agitation of the irrigant (laser activated irrigation / LAI). A limitation of the fiber is the straight forward emission. Modification of the fiber tip into a more conical shape allows for more lateral emission. This modification, however, does not result in far better cleaning and disinfection. Taking into account that all irrigants are water-based solutions, it is possible to create cavitation bubbles and to induce shockwaves and agitation in the irrigant with Erbium lasers. The newer technology allows for the use of low energy during a very short exposure time, resulting in high peak powers. Investigations on the latter topic have demonstrated that the creation of cavitation resulting in the induction of liquid agitation and shock waves in the irrigant may result in an in-depth cleaning and disinfection. Erbium lasers are the first choice for the activation of endodontic irrigants. Research in this respect has demonstrated that LAI performs “equal to” or “better than” ultrasonic activation. Other wavelengths with a solid absorption in water are now to be explored

OBJECTIVES:

This in vitro study aimed to investigate the ability of Candida albicans (C. albicans) and Enterococcus faecalis (E. faecalis) to penetrate dentinal tubules of instrumented and retreated root canal surface of split human teeth.

MATERIALS AND METHODS:

Sixty intact extracted human single-rooted teeth were divided into 4 groups, negative control, positive control without canal instrumentation, instrumented, and retreated. Root canals in the instrumented group were enlarged with endodontic instruments, while root canals in the retreated group were enlarged, filled, and then removed the canal filling materials. The teeth were split longitudinally after canal preparation in 3 groups except the negative control group. The teeth were inoculated with both microorganisms separately and in combination. Teeth specimens were examined by scanning electron microscopy (SEM), and the depth of penetration into the dentinal tubules was assessed using the SMILE view software (JEOL Ltd).

RESULTS:

Penetration of C. albicans and E. faecalis into the dentinal tubules was observed in all 3 groups, although penetration was partially restricted by dentin debris of tubules in the instrumented group and remnants of canal filling materials in the retreated group. In all 3 groups, E. faecalis penetrated deeper into the dentinal tubules by way of cell division than C. albicans which built colonies and penetrated by means of hyphae.

CONCLUSIONS:

Microorganisms can easily penetrate dentinal tubules of root canals with different appearance based on the microorganism size and status of dentinal tubules.

Titanium is notable for its biocompatibility and is used as biologic implant material across surgical specialties, especially in metal-sensitive individuals. However, rare cases of titanium hypersensitivity reactions are reported in the literature. This article discusses the properties and biological behavior of titanium and provides a thorough review of the literature on reported cases, diagnostic techniques, and approach to management of titanium hypersensitivity.

Contact (allergic) dermatitis is a skin disorder related to natural exposure to various allergens. Systemic contact dermatitis (SCD) describes a cutaneous eruption in response to systemic exposure to an allergen. The exact pathologic mechanism remains uncertain. Herein we describe a 36-year-old woman with symmetric systemic allergic contact dermatitis, unresponsive to conventional treatment, associated with dental alloy-contact hypersensitivity. We did skin patch testing and the blood lymphocyte transformation test (LTT) from the dental allergen series to assess contact allergy to restorative dental materials. On patch testing, positive allergic contact dermatitis reactions to metals occurred (nickel, potassium dichromate, and gold). Nickel hypersensitivity was confirmed by LTT, which also revealed silver-amalgam sensitization. Our case report highlights the need to consider adverse reactions to base-metal dental alloys in the differential diagnosis of cases of systemic allergic contact dermatitis.

STUDY DESIGN:

Retrospective case report.

OBJECTIVE:

To report the first known case of immunological camouflage of a metal spinal implant with carbon coating.

SUMMARY OF BACKGROUND DATA:

Metal sensitivity is common and is a consideration when choosing orthopedic implants in susceptible individuals. The sensitivity often is to nickel, cobalt, or chromium, and titanium is used as a safe alternative. However, when the allergy is also to titanium, solutions may be much more difficult. This case describes an innovative solution to a complex metal allergy that includes titanium in a child requiring spinal instrumentation for early-onset scoliosis.

METHODS:

At age 6 years 7 months, the patient underwent an uncomplicated placement of bilateral posterior Vertical Expandable Prosthetic Titanium Ribs (VEPTRs; Synthes, Inc., West Chester, PA). At that time, there were no known metal allergies. At 3 weeks, the right side had become erythematous and had serosanguineous drainage. It briefly improved after each of 2 surgical debridements and a course of intravenous antibiotics, but within 6 weeks of the index procedure, the pain was still worsening. A titanium allergy was suspected and blood was sent for allergy testing. A test confirmed hypersensitivity to titanium, niobium, molybdenum, iron, and aluminum, among others. The remaining rod was removed. An in vivo trial for tolerance to high-grade stainless-steel implants was done. The implant was removed after 2 weeks because of systemic symptoms that occurred.

RESULTS:

A plasma-spray, carbon-coated VEPTR rod was designed. A rod sample was inserted into the patient’s forearm for trial. After 3 months, there was no appreciable reaction. Carbon-coated VEPTRs were placed without complications. The patient has undergone multiple lengthening using the carbon-coated VEPTRs.

CONCLUSIONS:

In the rare patient with multiple allergies, choosing orthopedic implants can be challenging. An innovative carbon coating was applied by plasma spray to the VEPTR system, with good results.

Oral infections have been associated with an increased risk for myocardial infarction (MI) and other cardiovascular diseases (CVD). Conversely, low, regular alcohol consumption is associated with a lower association of CVD. The objective was to test the novel hypothesis that oral infections are modified by regular alcohol drinking which has the effect of lowering the incidence of MI’s. The effect has been observed where tooth extractions where carried out due to infections and compared with extractions unconnected to infections. Oral infections and in particular periodontal infections impose an infectious load on the health in many people. In its advanced forms (periodontal pockets ≥ 6mm) periodontitis affects ∼10-15% of adults. The infection runs a chronic course with exacerbations. The bacteria cause local infection destructive to the supporting tissues of the teeth and have been detected in systemic diseases through bacterial products and bacteria entering the circulation. The often persistent, long term history of chronic periodontal infection in individuals is a challenge to the immune system. Over 700 oral bacteria and other microorganisms have been identified, many of which are virulent. Control of the level of oral microbiota is through well known oral hygiene measures. Alcohol by being bactericidal is a factor that may reduce the bacterial level in the oral cavity. If this effect truly exists, it should be observed through reduction of infections in the mouth. Tooth extraction is the ultimate consequence of periodontal and dental infections and a reduction of tooth extraction due to infections should therefore be observed. The hypothesis was tested using the screening data of the Oslo II-study in a cross sectional analysis. The Oslo-study included men aged 48-67 years. The main finding was that the effect of a drinking pattern of 2-7 times per week reduced the risk of MI among men who had a history of tooth extractions due to infections versus tooth extraction for other causes or no extractions. This hypothesis supports an explanation as to why oral infection is a weaker independent risk factor for CVD in some studies. It also gives an indication of the reason for an added benefit by a regular drinking pattern as part of the Mediterranean diet. The important consequence of this hypothesis is the added importance of optimal oral hygiene for the prevention of CVD as well as for the benefit of good oral health.