Application of Evidence-based Prosthodontics in Practice

Evidence - based medicine (EBM)is to use current best evidence in care of the patients. The philosophy of EBM has been drawing increasingly more attention from the medical care professionals working in various fields, who are not only the beneficiaries of EBM but also its strong promoters. When such evidence-based concept was app- lied to dental field, it was defined by the Ameri- can Dental Association as following:“Evidence- based dentistry or EBD is an approach to oral health care th…     

Establishment of Streptococcus mutans in infants induces decrease in the proportion of salivary α-haemolytic bacteria

International Journal of Paediatric Dentistry 2012; 22: 139–145 Objective. For paediatric dentists, an indicator to assess caries risk of infants is very important. Conventionally, the number and/or proportions of Streptococcus mutans have been employed as risk indicator; however, because such figures reflect the existing situation, they are not suitable for assessing caries risk of infants that have not yet been infected with S. mutans. Thus, we searched for an indicator for the establishment of S. mutans. Methods. To evaluate the changes caused by the establishment of S. mutans in the microbiota of the infant oral cavity, we monitored changes in the oral microbiota of two pre‐dentate infants over a 3‐year period and in a cross‐sectional study of 40 nursery school‐aged children by cultivation of saliva on nonselective blood agar, Mitis‐Salivarius agar, and Mitis‐Salivarius agar supplemented with bacitracin combined with identification of selected isolates. Results. Two longitudinal observations suggested that the establishment of S. mutans would induce a decrease in α‐haemolytic bacteria in the microbial population of the oral cavity. This suggestion was compensated with the results of cross‐sectional study, and it was revealed that the establishment of 10³ CFU/mL of mutans streptococci in saliva might be predicted by a microbiota comprising less than approximately 55% of α‐haemolytic. Conclusion. Decrease in the proportion of α‐haemolytic bacteria in saliva of infant was found to be applicable as an indicator to predict the establishment of S. mutans and to assess dental caries risk as a background for planning of dental care and treatment in the infants before infection with S. mutans.     

Anti-inflammatory effects of EMD in the presence of biomechanical loading and interleukin-1β in vitro

Enamel matrix derivative (EMD) used to promote periodontal regeneration has been shown to exert anti-inflammatory effects. This in vitro study was performed to investigate if the anti-inflammatory actions of EMD are modulated by the local cellular environment, such as inflammation or occlusal, i.e., biomechanical, loading. Human periodontal ligament cells were seeded on BioFlex plates and incubated with EMD under normal, inflammatory, and biomechanical loading conditions for 1 and 6 days. In order to mimic inflammatory and biomechanical loading conditions in vitro, cells were stimulated with interleukin (IL)-1β and exposed to dynamic tensile strain, respectively. The gene expression of IL-1β, IL-1 receptor antagonist (IL-1RN), IL-6, IL-8, IL-10, and cyclooxygenase (COX)-2 was analyzed by real-time RT-PCR and the IL-6 protein synthesis by enzyme-linked immunoassay. For statistical analysis, Student's t test, ANOVA, and post-hoc comparison tests were applied (p < 0.05). EMD downregulated significantly the expression of IL-1β and COX-2 at 1 day and of IL-6, IL-8, and COX-2 at 6 days in normal condition. In an inflammatory environment, the anti-inflammatory actions of EMD were significantly enhanced at 6 days. In the presence of low biomechanical loading, EMD caused a downregulation of IL-1β and IL-8, whereas high biomechanical loading significantly abrogated the anti-inflammatory effects of EMD at both days. Neither IL-1RN nor IL-10 was upregulated by EMD. These data suggest that high occlusal forces may abrogate anti-inflammatory effects of EMD and should, therefore, be avoided immediately after the application of EMD to achieve best healing results.     

Expression and roles of CCN2 in dental mesenchymal cells in primary culture—With findings in a case of odontogenic myxofibroma

Purpose of the researchTooth germ development involves multiple events, including cell proliferation and cell differentiation. Connective tissue growth factor (CTGF/CCN2) is a signaling protein involved in tooth germ development, and we investigated how it is expressed and what roles it may have in primary cultures of mesenchymal cells derived from the developing tooth germ. We also examined the expression of CCN2 in a human odontogenic myxofibroma, a benign tumor of odontogenic mesenchymal origin, and considered the possible roles of CCN2 in the development of myxofibromas.Materials and methodsMesenchymal cells of early bell-stage tooth germs were isolated from Day-90 bovine embryos and placed in primary culture. A resected specimen from a patient with odontogenic myxofibroma was prepared for immunohistochemical studies.Principal resultsThe CCN2 expression level in proliferating odontogenic mesenchymal cells freshly isolated from the early bell stage of developing bovine tooth germs and placed in primary culture was 3 times higher than that in the confluent non-proliferating cells. Recombinant CCN2 significantly increased the proliferation and type I collagen expression in odontogenic mesenchymal cells in primary culture. Immunohistochemical analysis on myxofibroma case revealed that CCN2 was detectable in MIB-1, a cellular marker of proliferation-positive odontogenic mesenchymal cells adjacent to capillary blood vessels and in the endothelial cells of the vessels in the tumor.Major conclusionCCN2 signaling would influence the proliferation of and extracellular matrix production by dental mesenchymal cells. Our results suggest that the same mechanisms of CCN2 action toward dental mesenchymal cells would also be operative in the odontogenic myxofibroma microenvironment.     

Management of exposure of three-dimensional mandibular reconstructive plates in mandibular reconstruction： Report of 2 cases

Expmisure of three dimensionil mmdibuiar reconstnietive plate was a main complcation is clinical application ,which includ intaond expusure and exlsuoul exposure .This paper reporbed two typical cases with plate expostre und reviewed the litralmes in unaly in the canses of plate exposure and its preventive measures .     

Reliability of ultrasonography and sialography in the diagnosis of sjögren's syndrome

Objectives. The purpose of this study was to evaluate quantitatively observer performance with ultrasonography and sialography in the diagnosis of parotid gland involvement of Sjögren's syndrome.Study design. Sixty-four parotid gland sialograms and 65 ultrasonograms were prepared for observer performance experiments. They included both modalities in 24 Sjögren's syndrome and 19 nonspecific parotitis cases, 21 normal parotid gland sialograms, and 22 normal ultrasonograms in healthy volunteers. The images were randomly sequenced and presented to five observers who were asked to describe several findings and finally to determine the imaging diagnosis by ranking the abnormal features and the diagnosis on a five-point-rating scale. Observer performance was evaluated on the basis of the reliability of findings interpreted and the diagnostic accuracy of each modality from observers' rating scores.Results. The diagnostic accuracy of sialography was very high, nearly perfect. The diagnostic accuracy of ultrasonography was lower than that of sialography; resulting from the lower incidence of characteristic findings in the disease groups and lower sensitivity on ultrasonography. In the differentiation of Sjögren's syndrome from the normal, however, the diagnostic accuracy of ultrasonography increased to 80% for all cases, and up to nearly 90% in the advanced sialographic stages.Conclusion. Ultrasonography is useful for the diagnosis of Sjögren's syndrome in the advanced stages. Taking the noninvasiveness of this technique into account, we recommend first applying ultrasonography to the diagnosis of Sjögren's syndrome and performing sialography when no positive findings are detected on ultrasonography.     

Biocompatibility of a Self-adhesive Gutta-percha–based Material in Subcutaneous Tissue of Mice

Introduction

The purpose of this study was to evaluate the biocompatibility of a self-adhesive gutta-percha material and compare it with that of conventional gutta-percha.

Methods

Standard quantities of bioactive gutta-percha and conventional gutta-percha were directly inserted subcutaneously into the dorsal connective tissue of 30 BALB/c mice according to ISO 10993-6. After 7, 21, and 63 days each, 10 animals were euthanized, and the materials and surrounding tissue were removed. Tissue samples were subjected to histological processing resulting in 5-μm-thick slices stained with hematoxylin-eosin and Gomori trichrome stain. A grade ranging from I–IV was used to classify the inflammatory reaction. The Mann-Whitney U test with Bonferroni correction was used to compare the grade of inflammation induced by the materials at each time point. Qualitative evaluation of biocompatibility over time was also performed.

Results

Bioactive gutta-percha was more biocompatible than conventional gutta-percha at each time interval (P < .05). Tissue exposed to bioactive gutta-percha reached “no inflammation” (grade I) at the 21-day interval, whereas it took 63 days for the conventional gutta-percha to reach the “slight inflammation” level (grade II).

Conclusions

Bioactive gutta-percha presented good tissue reaction at all time points. It may serve as an alternative to gutta-percha in terms of biocompatibility.     

The Influence of Adalimumab on the Healing of Apical Periodontitis in Ferrets

Introduction

Given the increasing use of anti–tumor necrosis factor α (anti-TNFα) biologic medications, and their interferences with the immune-inflammatory response, this study evaluated the effect of adalimumab (anti-TNFα), on healing and healing time of apical periodontitis (AP) in ferrets.

Establishment and maintenance of asepsis in endodontics – a review of the literature

Objectives: Successful endodontic treatment depends on effective measures to eliminate and prevent infection of root canals. Initially treatment should start with isolation and disinfection of the operating field. This review makes an inventory of the available knowledge regarding its establishment and maintenance.

Materials and methods: A literature search was conducted in the PubMed database in order to identify clinical trials examining disinfection or unintentional contamination of the endodontic operative field. A list of 115 articles was obtained and screened. Five relevant articles were identified. These articles were read in full text. The reference lists from these articles were checked manually for additional studies and three studies were obtained. A total of eight articles met the inclusion criteria.

Results: There was a great variety in terms of aim, method, and material of the included studies. None could prove a totally reliable aseptic operative field and not one chemical, or combination of chemicals, were found in more than one study.

Conclusions: No study documented complete asepsis following initial disinfection, and no study could document predictable maintenance of an established bacteria-free surface. Critical appraisal and standardization of the disinfection and aseptic procedures in endodontics are needed.     

The role of the orthodontist in the diagnosis of Gorlin’s syndrome

Gorlin’s syndrome is a relatively rare generalized disorder. Its diagnosis in childhood is usually through oral abnormalities. Some of the most frequent clinical features of this syndrome are discovered through radiographs commonly used in orthodontia. Thus, the orthodontist may be able to contribute to its diagnosis. The article shows three clinical cases that illustrate the role that the orthodontist may play in diagnosis of this syndrome. (Am J Orthod Dentofacial Orthop 1999;115:89-98)     

Efficacy of HPA Lanolin? in treatment of lip alterations related to chemotherapy

The side effects of chemotherapy on the lips may cause esthetic and functional impact and increase the risk of infection. HPA Lanolin^® is an option for supportive therapy because it has anti-inflammatory, antimicrobial and moisturizing properties.

Objective:

To evaluate the efficacy of this product in the prevention of lip alterations in a population of patients undergoing chemotherapy.

Material and Methods:

Patients undergoing chemotherapy (n=57) were examined and distributed into two groups: study (used HPA Lanolin^®) and control (without supportive therapy on the lips). We evaluated the patients two weeks after chemotherapy, registering oral alterations, symptoms of pain, discomfort, limitation of mouth opening and dehydration, classified according to a visual analogue scale.

Results:

Patients who used HPA Lanolin^® had lower dehydration and experienced improvement of lip dryness (p<0.001). The main symptoms were dehydration, discomfort, limitation of mouth opening, pain. The main clinical signs were dry lips, mucositis, cheilitis, hematoma, swelling and cracking. We found no difference concerning the variables of pain, discomfort, and limitation of mouth opening between the study and control group.

Conclusions:

We suggest that HPA Lanolin^® is effective in reducing the symptoms of dehydration and the signs of lip dryness resulting from toxicity of chemotherapy, proving to be an interesting alternative supportive therapy for cancer patients.