The relationship between biologic concepts and fabrication of surgical guides for dental implant placement

This article reviews guidelines for construction of surgical guides to direct dental implant placement. Biologic principles are discussed with regard to the mesiodistal, buccolingual, and apicocoronal insertion of implants. The application of these data to develop surgical guides is discussed. Also, with respect to specific prosthetic reconstructions, a variety of guides are described that can be fabricated for partially and fully edentulous arches.     

Interaction of gram-negative periodontal pathogens with retinoic acid-induced and dimethyl sulfoxide-induced HL-60 cells

As a first step toward elucidating the reasons for differences among periodontal pathogens in their cytotoxic effects on HL-60 cells, we used transmission electron microscopy to examine morphological aspects of granulocyte-bacteria interactions. Unopsonized Actinobacillus actinomycetemcomitans strain Y4 and Bacteroides gingivalis ATCC 33277 adhered to, and were phagocytosed by, retinoic acid-induced and dimethyl sulfoxide-induced HL-60 cells. In contrast, there was only minimal interaction between Wolinella recta ATCC 33238 and these induced granulocyte-like cells. Only isolated examples of adherence of W. recta to HL-60 cells were seen. In specimens prepared for routine transmission electron microscopy, ingested W. recta were not observed. In immunogold experiments, phagocytosed W. recta were noted, but only rarely. Opsonization of A. actinomycetemcomitans, B. gingivalis and W. recta with specific antisera appeared to increase their level of interaction with the HL-60 cells. We suggest that the HL-60 cell line may be useful in elucidating structure-function relationships between human neutrophil-like cells and putative periodontopathogens.     

The impact of third molar symptoms, pain, and swelling on oral health-related quality of life.

PURPOSE: This study was designed to assess the impact of "pain and swelling" associated with third molars on patients' quality of life before surgery. PATIENTS AND METHODS: The data for these analyses were obtained from a larger ongoing study designed to examine the surgical and medical management of problems associated with third molars. Data from 480 patients with 4 third molars scheduled for removal were used in the analysis. Questionnaires administered presurgery assessed patients' medical and dental history, their reasons for seeking third molar removal, and sociodemographic characteristics. Adverse impacts on oral health-related quality of life were measured using the 14-item Oral Health Impact Profile (OHIP) questionnaire. The primary outcome variable was the percentage of people reporting 1 or more of the 12 non-pain-specific OHIP items "fairly often" or "very often" during the 3 months before enrollment. RESULTS: One third (178 of 480) of patients said they were seeking third molar surgery because of current or previous symptoms of pain/swelling, and 17% reported 1 or more of the 12 non-pain-specific OHIP items. In the multivariate logistic regression model, the odds of one or more impacts was greater for people who presented because of symptoms (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.7 to 4.8), who were aged 25 years or more (OR, 1.9; 95% CI, 1.1-3.3), and who had a self-reported history of tooth loss due to pathology or trauma (OR, 2.9; 95% CI, 1.9 to 5.5). CONCLUSIONS: Adverse impacts on quality of life occurred for 1 in 8 patients seeking third molar surgery, and the odds increased 3-fold for patients who had experienced pain/swelling compared with those who were asymptomatic.     

Clinical recommendations for avoiding and managing surgical complications associated with implant dentistry: a review

Proposing to place endosseous implants is an integral facet of dental treatment plans. Their insertion is usually associated with a low incidence of untoward events. However, despite careful planning, surgical complications can arise: infection, intraoral hemorrhage, wound dehiscence, postoperative pain, lack of primary implant stability, inadvertent penetration into the maxillary sinus or nasal fossa, sinus lift sequelae, neurosensory disturbances, injuries to adjacent teeth, tissue emphysema, and aspiration, or ingestion of surgical instruments. This article addresses some surgical complications associated with dental implant placement and discusses how to avoid and manage them when they occur.     

Torsional strength and toughness of nickel-titanium rotary files

Introduction

The aim of this investigation was to compare torsional strength, distortion angle, and toughness of various nickel-titanium (NiTi) rotary files.

Methods

Five NiTi rotary instruments with different cross-sectional geometries were selected: TF and RaCe with equilateral triangle, ProTaper with convex-triangle, ProFile with U-shape, and Mtwo with S-shape. The size 25/.06 taper of TF, RaCe, ProFile, and Mtwo and the ProTaper F1 files were tested, all with the same diameter at D5. A metal mounting block with a cubical hole was constructed in which 5 mm of the file tip was rigidly held in place by filling the mold with a resin composite. The files were subjected to clockwise rotation at 2 rpm in a torsion tester. The torque and angular distortion were monitored until the file failed. The data were compared statistically for the yield and ultimate strengths, plastic hardening period, and toughness.

Results

TF and RaCe had significantly lower yield strength than other systems. TF had a significantly lower ultimate strength than other files, whereas Mtwo showed the greatest. ProFile showed the highest distortion angle at break, followed by TF. ProFile also showed the highest toughness value, whereas TF and RaCe both showed a lower toughness value than the others (P < .05). Fractographic examination revealed typical pattern of torsional fracture for all brands, characterized by circular abrasion marks and skewed dimples near the center of rotation.

Conclusions

Under the limitations of the present study, the 5 tested NiTi rotary files showed a similar mechanical behavior under torsional load, with a period of plastic deformation before actual torsional breakage but with unequal strength and toughness value.     

Comparison of a sonic and a manual toothbrush for efficacy in supragingival plaque removal and reduction of gingivitis

Abstract A new sonic electric toothbrush (Sonicare®) and a traditional manual toothbrush were compared for efficacy in removing supragingival plaque and reducing gingival inflammation in a 12-week, single-blind clinical trial. 60 subjects with a gingival index (GI) of >1.5 and no probing depths >5 mm were randomly assigned to use either the manual or sonic brush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque scores were taken at baseline and at 1.2, 4. and 12 weeks using the Turesky modification of the Quigley-Hein plaque index. Gingival inflammation was assessed by the GI. bleeding tendency score, presence or absence of bleeding on probing, volumetric measurements of gingival crevicular fluid (GCF). and aspartate aminotransferase (AST) levels in GCF. Repeated measures multivariate analyses of variance were used to delect time- and device-dependent differences for all clinical assessments between the 2 groups over the 5 visits. Both types of brush were effective in removing supragingival plaque. The sonic brush was statistically superior, on a percentage reduction basis, in removing supragingival plaque from the dentition taken as a whole (F-statistic; p=0.012) and was particularly better in hard-to-reach areas such as posterior teeth (F-statistic; p=0.003) and interproximal sites (F-statistic; p=0.004). Both devices were equally effective in reducing gingival inflammation. The sonic brush exhibited less tendency to cause gingival abrasion than the manual brush (1 incident with sonic, 5 incidents with manual), confirming the safely of this product as an oral hygiene device.     

The impact of the SARS-CoV-2 pandemic on the management of chronic limb-threatening ischemia and wound care

In the wake of the coronavirus pandemic, the critical limb ischemia (CLI) Global Society aims to develop improved clinical guidance that will inform better care standards to reduce tissue loss and amputations during and following the new SARS-CoV-2 era. This will include developing standards of practice, improve gaps in care, and design improved research protocols to study new chronic limb-threatening ischemia treatment and diagnostic options. Following a round table discussion that identified hypotheses and suppositions the wound care community had during the SARS-CoV-2 pandemic, the CLI Global Society undertook a critical review of literature using PubMed to confirm or rebut these hypotheses, identify knowledge gaps, and analyse the findings in terms of what in wound care has changed due to the pandemic and what wound care providers need to do differently as a result of these changes. Evidence was graded using the Oxford Centre for Evidence-Based Medicine scheme. The majority of hypotheses and related suppositions were confirmed, but there is noticeable heterogeneity, so the experiences reported herein are not universal for wound care providers and centres. Moreover, the effects of the dynamic pandemic vary over time in geographic areas. Wound care will unlikely return to prepandemic practices. Importantly, Levels 2–5 evidence reveals a paradigm shift in wound care towards a hybrid telemedicine and home healthcare model to keep patients at home to minimize the number of in-person visits at clinics and hospitalizations, with the exception of severe cases such as chronic limb-threatening ischemia. The use of telemedicine and home care will likely continue and improve in the postpandemic era.     

A stroke volume-based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain-dead donors

Brain-dead donors are frequently hypovolemic and hypotensive requiring vasopressor support. We studied a stroke volume-based fluid resuscitation and vasopressor weaning protocol prospectively on 64 hypotensive donors, with a recent control cohort of 30 hypotensive donors treated without a protocol. Stroke volume was measured every 30 minutes for 4 hours by pulse contour analysis or esophageal Doppler. A 500 mL saline fluid bolus was infused over 30 minutes and repeated if the stroke volume increased by 10%. No fluid was infused if the stroke volume did not increase by 10%. Vasopressors were weaned every 10 minutes if the mean arterial pressure was greater than 65 mm Hg. The protocol group received 1937 ± 906 mL fluid compared to 1323 ± 919 mL in the control group (P = .003). Mean time on vasopressors was decreased from 957.6 ± 586.2 to 176.3 ± 82.2 minutes (P<.001). Donors in the protocol group were more likely to donate four or more organs than donors in the control group (OR = 4.114, 95% Confidence Interval (CI) = 1.003-16.876). While more organs were transplanted per donor in the protocol group (3.39 ± 1.52) than in the control group (2.93 ± 1.44) (P = .268), the difference did not reach statistical significance. A goal-directed fluid resuscitation protocol decreased organ ischemia and may increase organs transplanted.     

Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain

International Urology and Nephrology - The rehabilitation of post-prostatectomy urinary incontinence has traditionally focused on pelvic floor strengthening exercise. The goal of this study was to...