Antibacterial and antiplaque efficacy of a commercially available octenidine-containing mouthrinse

Objectives

The purpose of this clinical study was to determine the antibacterial and antiplaque efficacy of a recently introduced octenidine-containing mouthrinse (Octenidol®) in comparison with established antiseptic mouthrinses.

Materials and methods

In a 4-day plaque-regrowth study employing a four-replicate cross-over design, a 0.1 % octenidine mouthrinse (Octenidol®/OCT-MR) was compared with a 0.12 % chlorhexidine mouthrinse (Paroex®/CHX-MR), an essential oil mouthrinse (Listerine®/EO-MR), and a placebo mouthrinse/P-MR. Plaque regrowth was assessed with a modified Quigley-Hein plaque index. The antibacterial effect was assessed by taking bacterial counts from the tooth surface and oral mucosa after professional tooth cleaning and after first rinsing with the allocated mouthrinse on days 1 and 5. Sixteen volunteers suspended tooth cleaning and rinsed twice daily with the allocated mouthrinse for 4 days.

Results

All tested antiseptic mouthrinses were significantly more effective than the placebo mouthrinse in inhibiting plaque, but no significant differences were observed between OCT-MR and CHX-MR, OCT-MR and EO-MR, and CHX-MR and EO-MR. After 4 days, comparable bacterial count levels were found on both the tooth surface and mucosa applying OCT-MR and CHX-MR, which were significantly lower than that of EO-MR and P-MR.

Conclusion

Octenidol® and Paroex® showed comparable antibacterial and antiplaque efficacy in the human oral cavity.

Clinical Relevance

The recently introduced octenidine-containing mouthrinse Octenidol® may become a suitable alternative to 0.12 % chlorhexidine-containing mouthrinses such as Paroex®.

     

Modified technique for endoscopic endonasal reduction of medial orbital wall fracture using an absorbable packing

Purpose

The purpose of this study was to describe a modified technique using only biological dura substitute (Lyoplant®) associated or not to a sheet of Medpore® (porous polyethylene plate) avoiding the use of Silastic® or Merocel® packing for endoscopic endonasal reduction of medial orbital wall fracture.

Methods

An interventional case report was used involving two patients with medial orbital wall fracture that were treated with the modified technique. Postoperatively, the patients were evaluated for visual acuity, enophthalmos, extraocular motility, and diplopia.

Result

Twelve months after surgery, patients recovered completely without any residual eye symptoms or complications, and postoperative CT showed a completely corrected medial orbital wall fractures.

Conclusion

The reported technique proved itself to be safe and effective, and it may be expected to have advantages over the conventional endoscopic approach using a non-absorbable packing, avoiding the need for long-term nasal packing and a secondary removal procedure.

     

Mechanical and microstructural properties of fixation systems used in oral and maxillofacial surgery

Objectives

This paper aims to evaluate in vitro the mechanical and microstructural properties of internal fixation systems used in oral and maxillofacial surgeries.

Materials and methods

Four brands of internal fixation systems (screws and 4-hole straight plates) were selected and assigned to four groups: G1 Leibinger®, G2 Tóride®, G3 Engimplan®, and G4 Medartis®. The systems were submitted to Vickers hardness testing, metallographic and interstitial elements chemical composition analyses. Data were submitted to ANOVA and Tukey’s test for statistical analysis.

Results

Plates in groups 1, 2, and 3 showed similar microstructure and mechanical properties, different from those in G4 revealing larger grains. In all groups, the screws showed similar microstructure, with uniform arrangement and size of grains; the screws showed higher hardness values than those observed for the plates.

Conclusions

The results indicate that all materials tested are adequate for use in oral maxillofacial surgeries.

     

Intermittent or continuous ultrasonically activated irrigation: micro-computed tomographic evaluation of root canal system cleaning

Objectives

The aim of this study was to evaluate the efficacy of two passive ultrasonic irrigation (PUI) methods and conventional manual irrigation (CMI) in root canal system (RCS) cleaning.

Materials and methods

Artificial single-rooted teeth were used. Four lateral canals were made 2 and 7 mm short from the apex. Root canals were filled with a contrast solution. The specimens were divided into four groups (n = 8): PUI1—intermittent flushing; PUI2—continuous flushing; CMI1—at 1 mm; and CMI2—at 3 mm. Micro-computed tomographic images were obtained. New images were taken after the irrigation protocols enabling the evaluation of the contrast solution volume (in mm³) within RCS (main and lateral root canals) in comparison to the initial analysis. The comparison among groups was performed using ANOVA and Tukey’s tests with 5 % significance level.

Results

There was no difference among PUI1, PUI2, and CMI1 regarding the contrast solution removal from RCS (p > 0.05). These methods demonstrated greater cleaning than CMI2. At the apical third, CMI2 showed lower cleaning capacity when compared to the other methods (p < 0.05).

Conclusions

PUI with intermittent or continuous flushing and CMI with the needle placed 1 mm from the working length were efficient in cleaning the main and lateral root canals.

Clinical relevance

Root canal irrigation plays an important role in cleaning and disinfection of the RCS. Effective apical irrigation is an important procedure during root canal treatment. PUI and CMI (at 1 mm short) were effective in cleaning of the main and simulated lateral root canals.

     

Recent Advances in Face Lift to Achieve Facial Balance

Introduction

Facial balance is achieved by correction of facial proportions and the facial contour. Ageing affects this balance in addition to other factors. We have strived to inform all the recent advances in providing this balance.

Method

The anatomy of ageing including various changed in clinical features are described. The procedures are explained on the basis of the upper, middle and lower face.

Results

Different face lift, neck lift procedures with innovative techniques are demonstrated.

Conclusion

The aim is to provide an unoperated balanced facial proportion with zero complication.

     

Bone regeneration with recombinant human bone morphogenetic protein 2: a systematic review

Aim

The aim of this work was to perform a systematic literature review on the clinical application of rhBMP-2 in bone reconstruction prior to placing implants.

Materials and Methods

A PUBMED search was made about the subject and nine clinical trials were selected according to strict inclusion criteria.

Results

Overall success rates of bone regeneration with rhBMP-2 was 81.4% and success of implants placed was 87.4%. Most frequent adverse events were pain, edema and erythema.

Conclusion

It was concluded that the treatment with rhBMP-2 foi satisfactory in most cases and the placement of dental implants in the bone regenerated with rhBMP-2 is feasible.

     

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review

Purpose

The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures.

Methods

In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed.

Results

This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively.

Conclusions

Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

     

Bone grafting material in combination with Osteogain for bone repair: a rat histomorphometric study

Objectives

Enamel matrix derivative (EMD) has been successfully used for the regeneration of periodontal tissues including new cementum, periodontal ligament, and alveolar bone. Combination of EMD with bone grafting materials has however generated variable clinical results. Recently, we have demonstrated that a new formulation of EMD in a liquid carrier system (Osteogain®) has improved physicochemical properties for the adsorption of EMD to a bone grafting material. The aim of the present study was to investigate the regenerative potential of Osteogain®, in combination with a bone graft, on new bone formation in a rat femur defect model.

Materials and methods

Fifty-four critically sized femur defects (3 mm in diameter) were created bilaterally in 27 rats and treated following the group allocation: (1) drilled unfilled control, (2) a natural bone mineral (NBM), and (3) NBM + Osteogain®. All defects were histologically analyzed at 2, 4, and 8 weeks after surgical intervention. Micro-CT analysis, hematoxylin and eosin (H&E) staining, and Safranin O staining were performed to quantify new bone formation.

Results

Significantly more new bone formation was observed in defects treated with NBM + Osteogain® at both 4 and 8 weeks when compared to NBM alone and the control unfilled defects (P?<?0.05). Histologically, the formation of more mature mineralized bone with the presence of osteocytes were found more commonly in defects treated with Osteogain® + NBM at 8 weeks post-healing when compared to NBM alone.

Conclusions

The present study demonstrate that Osteogain® in combination with a bone grafting material improves the speed and quality of new bone formation in rat osseous defects.

Clinical relevance

Future clinical research are now warranted to fully characterize the benefits of Osteogain®, a new formulation of enamel matrix proteins delivered in liquid formation when used in combination with a bone grafting material.

     

A novel noise filtered and occlusion removal: navigational accuracy in augmented reality-based constructive jaw surgery

Purpose

Augmented reality-based constructive jaw surgery has been facing various limitations such as noise in real-time images, the navigational error of implants and jaw, image overlay error, and occlusion handling which have limited the implementation of augmented reality (AR) in corrective jaw surgery. This research aimed to improve the navigational accuracy, through noise and occlusion removal, during positioning of an implant in relation to the jaw bone to be cut or drilled.

Method

The proposed system consists of a weighting-based de-noising filter and depth mapping-based occlusion removal for removing any occluded object such as surgical tools, the surgeon’s body parts, and blood.

Results

The maxillary (upper jaw) and mandibular (lower jaw) jaw bone sample results show that the proposed method can achieve the image overlay error (video accuracy) of 0.23~0.35 mm and processing time of 8–12 frames per second compared to 0.35~0.45 mm and 6–11 frames per second by the existing best system.

Conclusion

The proposed system concentrates on removing the noise from the real-time video frame and the occlusion. Thus, the acceptable range of accuracy and the processing time are provided by this study for surgeons for carrying out a smooth surgical flow.

     

Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Purpose

To clarify pre- and postoperative C-reactive protein (CRP) levels in patients with facial fractures and to investigate the influence of perioperatively administered dexamethasone on postoperative CRP levels.

Patients and methods

Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone (Oradexon®), whereas patients in the control group received no glucocorticoid. The analysis included patients who had CRP measured pre- and postoperatively.

Results

A total of 73 adult patients with facial fractures were included in the final analysis. Mean CRP level was elevated preoperatively and the level increased further after surgery. However, postoperative CRP rise was significantly impeded by dexamethasone (p?<?0.001), regardless of gender, age, treatment delay, site of fracture, surgical approach, and duration of surgery. CRP rise halved on the 1st postoperative day when dexamethasone was used. In addition, dexamethasone resulted in a CRP decrease on the 2nd postoperative day, whereas the CRP rise continued in the control group.

Conclusions

CRP rise is a normal body response after facial fracture and surgery that can be markedly reduced with dexamethasone. CRP changes should be considered with caution if perioperative dexamethasone is used.

     

Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances—a prospective randomized controlled trial

Objectives

The development of white spot lesions around orthodontic brackets and gingivitis is a common problem during orthodontic treatment with fixed appliances. This prospective randomized double-blind controlled clinical trial investigated the preventive efficacy of a one-time application of two commonly used fluoride varnishes in patients with low to moderate caries risk.

Materials and methods

Ninety adolescent orthodontic patients with a low to moderate caries risk were prospectively randomized to three groups of 30 patients each: (1) standardized dental hygiene with fluoride toothpaste and one-time application of placebo varnish (control) or (2) of elmex® fluid or (3) of Fluor Protector S on all dental surfaces at the start of fixed therapy. The extent of enamel demineralization and gingivitis was determined with the ICDAS and the gingivitis index (GI) at baseline and after 4, 12, and 20 weeks.

Results

Each treatment group showed a significant increase of the ICDAS index, but not of the GI over the course of time with no significant intergroup differences detectable.

Conclusions

A one-time application of fluoride varnish at the start of orthodontic treatment did not provide any additional preventive advantage over sufficient dental hygiene with fluoride toothpaste with regard to formation of white spots and gingivitis in patients with a low to moderate caries risk.

Clinical relevance

In dental practice, patients often receive an application of fluoride varnish at the start of orthodontic treatment with fixed appliances. However, the efficacy of this procedure is still unclear.

     

Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles

Background

In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem.

Aim

The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients.

Materials and methods

The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time.

Results

This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy.

Conclusion

The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.

     

Comparison of implant versus tooth-supported zirconia-based single crowns in a split-mouth design: a 4-year clinical follow-up study

Objectives

This study aims to evaluate the 4-year clinical performance of tooth versus implant-supported single-unit zirconia crowns (LAVA?) placed on posterior region.

Materials and methods

Twenty-four patients (10 men and 14 women) who had received 48 single crowns (24 implant-supported and 24 tooth-supported) from January 2007 to December 2009, were included. California Dental Association (CDA) quality assessment system, plaque and gingival index scores were used to evaluate the performance of the crowns at baseline and at all follow-up examinations.

Results

During the follow-up period, no fracture of zirconia coping has occurred. Major complication was chipping in three patients that required a new crown fabrication. Except for the failure ones, all crowns in both groups were rated as satisfactory at the follow-up examinations based on the CDA quality assessment criteria. There were no statistically significant differences between tooth and implant-supported crowns in terms of periodontal parameters.

Conclusions

The present 4-year follow-up clinical study demonstrates that single-unit tooth- and implant-supported zirconia crowns have similar prosthetic and periodontal outcomes.

Clinical relevance

Single-unit implant or tooth-supported zirconia crowns may be considered acceptable treatment modalities for restoration of either missing or compromised posterior teeth

     

Bone and Skin-Supported Stereolithographic Surgical Guides for Cranio-Facial Implant Placement

Purpose

Osseointegrated skin-penetrating implants enhance the retention and stability of the craniofacial prostheses and provide the long-term comfort. However, to determine the implant locations is a great challenge facing the surgeon. Implants may either be located in conventional manner or by STL generated surgical guides.

Materials and Methods

Present study reports the CT based 3D virtual modeling, preoperative virtual planning and the implant placement by using a STL surgical guide, in an anotia case.

Results

Employed materials and the methods facilitated the implant surgery while improving the operational security.

Conclusions

CT based 3D virtual modeling of the surgical site, determining the implant locations virtually and the STL guided placement of the craniofacial implants, were found useful applications in order to facilitating the surgical intervention and providing prevention from complications.

     

Complications of Midface Swing for Management of Juvenile Nasopharyngeal Angiofibroma

Introduction

Access osteotomies provide direct exposure to inaccessible areas of the deep part of craniofacial skeleton for treating pathologies involving vital structures. The use of maxillary swing approach for gaining wide access to the nasopharynx, infratemporal fossa, parapharyngeal space, middle fossa of skull base. Though the maxillary swing requires transfacial incision for wide exposure but with careful handling the scar is minimum and this approach can be used in young people.

Materials and Methods

Surgical resection is carried out following preoperative embolization of the involved feeder vessels. Total 16 cases were considered for this study.

Results

This article highlights cases successfully treated in our institution, the mention of complications associated with the cases along with management.

Conclusion

Maxillary swing is a good approach for getting access to the deep pathologies like JNA.

     

A new digital denture procedure: a first practitioners appraisal

Background

Historically, the complete removable denture is the last prosthetic procedure to switch to digital techniques whose advantages are mainly observed in the laboratory stages; however, it is not possible to measure the depressibility of the oral mucosa using optical cameras, thus conventional impression techniques are still necessary. This article describes the clinical and laboratory procedure and practitioners appraisal of the first fifteen digitally designed complete removable dental prostheses.

Methods

Several systems are now available including the Wieland® Digital Denture® which offers a complete procedure. This system is composed of a five axis-milling machine combined with a laboratory scanner and a design software application. Fifteen rehabilitations were carried out using the Wieland® system.

Results

The practitioner’s role is simplified by intraoral recording with a central point and a reduced number of sessions. The prosthesis laboratory requires considerable investment in learning and equipment, making it possible to obtain ideal mounting assemblies in accordance with the occluso-prosthetic concept of bilateral balanced occlusion. The absence of polymerization and therefore of base deformation risks reduce the equilibration step. Finally, the creation of templates as an alternative to the assembly of teeth on wax makes it possible to functionally validate (masticatory and phonatory) the future dentures. However, this procedure still presented some limitations in terms of scanning and software scope of applications.

Conclusion

Digital denture design software is relatively efficient and helps to standardize clinical results. However, to this date, improvements of the software are still required for a routine use.

     

Apical pressure created during irrigation with the GentleWave™ system compared to conventional syringe irrigation

Objectives

The purpose of this study is to compare pressures at the apical foramen created by conventional syringe irrigation and the GentleWave? System, which releases high-velocity degassed irrigants to the pulp chamber and uses broad-spectrum sound energy for cleaning.

Materials and methods

The apical pressure generated during irrigation was measured for palatal and distobuccal root canals of four extracted maxillary molars after no instrumentation, minimal instrumentation to a size #15/.04, instrumentation to a size #40/.04 taper, and after perforating the apical foramen to size #40. The root canals opened into an air-tight custom fixture coupled to a piezoresistive pressure transducer. Apical pressures were measured for the GentleWave? System and syringe-needle irrigation at different irrigant flow rates, with the needle tip at 1 and 3 mm from the apical foramen using 30-gauge (G) open-ended or side-vented safety tip needles.

Results

The GentleWave? System generated negative apical pressures (P < 0.001 compared with syringe irrigation); the mean pressures were between ?13.07 and ?17.19 mmHg. The 30 G needles could not reach the 1 and 3 mm from the working length in uninstrumented and 1 mm in minimally instrumented canals. The mean positive pressures between 6.46 and 110.34 mmHg were measured with needle irrigation depending on the flow rate, needle insertion depth, and size of the root canal.

Conclusions

The GentleWave? System creates negative pressure at the apical foramen during root canal cleaning irrespective of the size of canal instrumentation. Positive apical pressures were measured for syringe irrigation.

Clinical relevance

Negative pressure during irrigation contributes to improved safety as compared to high-positive pressure.