Vergleichende klinische und immunhistochemische Charakterisierung keratozystischer odontogener Tumoren und Ameloblastome im Hinblick auf das Rezidivrisiko

Background

With the new term “keratocystic odontogenic tumour” (KCOT) keratocyts are even in the nomenclature a close differential diagnosis to ameloblastomas (A).

Purpose

Recurrence of KCOT and A were retrospectively compared with regard to treatment and immunohistochemical markers of cell cycle and migration and cell architecture.

Patients und Methods

Biopsies harvested over a period of 22 years of 101 patients (86 KCOT, 15 A) were examined. The histopathological slides were stained with H&E and with the immunohistochemical markers: Cyclin D1, Collagen IV, p16, Cox-2-Laminin-5 and Tenascin-C.

Results

Mean age KCOT 47 years (range 14–80 years), A 41 years (range 16–79 years). Gender KCOT: m:f?=?2:1; A: m:f?=?3:2. Region of origin mandible with predilection of the angle and the ramus: KCOT: 76; A: 12. Maxilla: KCOT: 18; A: 3. Multiple lesions were found in 5 KCOT patients. Treatment primary KCOT: cystectomy (46), cystostomy (6), cystectomy and curettage (17), cystectomy and marginal ostectomy (14), resection (11). A: resection (10), enucleation (5). Recurrence rate KCOT: 11,7% after 5,5 years. Recurrence after: cystostomy (4), cystectomy (6), cystectomy and curettage (3), cystectomy and marginal ostectomy (2). A: no recurrences. Immunohistochemistry Cell cycle associated and extracellular matrix proteins did not differ in quantity in KCOT and A, and did also not differ in recurrent and non-recurrent KCOT.

Conclusions

1. KCOT are in the own cohort more likely recurrent than A.
2. Recurrence rate of KCOT can not be predicted by the used (most common) markers of cell cycle, migration and modulation of architecture.
3. Higher recurrence rate of KCOT in the patients examined is proposed due to less extensive resection.

     

The Basic Erosive Wear Examination (BEWE) applied retrospectively to two studies

Objectives

A scoring method for tooth erosion is needed to enable community-based assessments. The aim of this study was to evaluate the Basic Erosive Wear Examination (BEWE) scoring method, using data previously collected from two studies.

Materials and methods

In a national survey of erosion in children and adolescents, a representative, 20 % nationwide sample of 2,251 children, aged 6, 12 and 15 years, was examined. Erosion, recorded for all surfaces of permanent teeth, was converted to a BEWE score. For a group of referred patients, erosion was scored for 351 patients and then converted to a BEWE score.

Results

From the national survey, no erosion was seen in permanent teeth of 6 years old, but was present in 12 years old (19.9 % boys, mean BEWE of 0.22; 11.0 % girls, mean BEWE of 0.079; p?<?0.001). Among 15 years old, erosion was seen in 30.7 % of subjects (38.3 % boys, mean BEWE of 1.00; 22.7 % girls, mean BEWE of 0.42; p?<?0.001). For the referred patients, the BEWE score was 9.4 for subjects with gastric reflux symptoms but 6.0 for those without symptoms (p?<?0.001).

Conclusions

The value of scoring with the BEWE methodology was clearly demonstrated, showing increasing severity of erosion between 12 and 15 years and gender differences in erosion severity. Intrinsic acid erosion clearly caused an increased BEWE score.

Clinical relevance

The BEWE scoring methodology appears valuable for assessing erosion in populations.     

Bipolar Vessel Sealing System Versus Suture Ligation in Selective Neck Dissection

Aim

To evaluate whether the use of electrothermal bipolar vessel sealing system reduces the blood loss and operating time, with lesser complications as compared to suture ligation in selective neck dissection in patients with oral cancer.

Materials and Methods

The study was conducted in the Department of Oral and Maxillofacial Surgery of our institute from January 2015 to December 2016. The sample consisted of 60 patients, divided into Groups I and II with 30 subjects in each. In Group I electrothermal bipolar vessel sealer and in Group II suture ligation were used. The outcome measures recorded were: blood loss, operating time, quality of surgical field, postoperative pain on days 1, 2, and 3, drainage volume at 24, 48, and 72 h, edema, complications, and duration of hospital stay.

Results

There were 36 males and 24 females with a mean age of 50.76 ± 12.6 years. Blood loss was significantly less for Group I than for Group II (p = 0.001); the operating time was significantly less in Group I than in Group II (p = 0.001); Group I had better quality of surgical field (p = 0.001); less pain on postoperative evening, day 2 and day 3 (p < 0.05); and less drainage volume at 24 and 48 h (p < 0.05). Postoperative edema, complications, need for perioperative blood transfusion, and duration of hospital stay postsurgery were similar in both groups.

Conclusion

The electrothermal bipolar vessel sealer was efficacious in terms of reducing blood loss and operating time while providing a better surgical field and patient compliance without increasing the perioperative morbidity.

     

The relationship between implant stability and bone health markers in post-menopausal women with bisphosphonate exposure

Objectives

The authors assessed the relationship between implant stability and bone turnover markers in patients with and without a history of bisphosphonate (BP) exposure for treatment of osteopenia/osteoporosis.

Materials and methods

One dental implant site was evaluated in 58 post-menopausal women with a spectrum of bone health in a "best practice" prospective cohort study. Each site had a previous or simultaneous bone augmentation procedure. BP exposure at enrollment was categorized as "never" or "past/current" exposure. Implant stability was assessed by resonance frequency analysis (RFA ISQ) at surgery and 8 weeks post-implant. Bone turnover markers, C-telopeptide collagen crosslinks (sCTX) and procollagen ?1 N-terminal telopeptide (P1NP), were measured pre-treatment, 1, and 8 weeks following implant surgery.

Results

Mean age was 62.4?±?6.8 years; 66 % were osteopenic/osteoporotic. Average RFA ISQ at placement for all participants was 63.5?±?11.3, at 8 weeks post-surgery 74.2?±?9.4 (p?<?0.01). Among "past/current" BP users, there was a significant negative correlation between RFA ISQ values at 8 weeks post-implant placement and sCTX and P1NP values at 1 week (ρ?=??.65 and ρ?=??.55, respectively; p?<?0.01) and 8 weeks (ρ?=??.64 and ρ?=??.52, respectively; p?<?0.05).

Conclusion

RFA ISQ values increased between implant placement and 8 weeks post-surgery demonstrating successful osseointegration. Lower bone turnover was associated with better implant stability among patients with a history of BP exposure.

Clinical relevance

Further investigation of the relationship between BP exposure and implant stability is warranted in a larger population, as results may strongly impact on clinical practice decisions.     

Herpes simplex virus reactivation and dental procedures

Objectives

Dental extraction is reported to trigger recurrent herpes labialis (RHL).

Aim

This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures.

Materials and methods

Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocompetent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n?=?19; dental filling under local anesthesia, n?=?14; molar extraction under local anesthesia, n?=?15; and molar extraction under general anesthesia, n?=?9) and compared to 32 healthy controls (mean age 33 years).

Results

None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls.

Conclusion

Molar extraction increases the risk of oral HSV-1 shedding but not of RHL. Procedure-related nerve damage probably accounts for HSV reactivation.

Clinical relevance

Antiviral prophylaxis for RHL is not routinely recommended for dental procedures, regardless of a prior history of RHL.     

Radiologic bone loss in patients with bisphosphonate-associated osteonecrosis of the jaws: a case–control study

Objectives

Most patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) report a previous tooth extraction at the necrosis site before the diagnosis was made. At older ages, most teeth are extracted due to periodontal disease, which is per se another BP-ONJ trigger factor. The aim of this study was to evaluate the periodontal status of BP-ONJ patients using panoramic radiographs compared to a control.

Materials and methods

All patients treated for BP-ONJ up to January 1, 2010 comprised the study. The very first panoramic radiograph was analyzed. The number of remaining teeth and the radiographic bone loss from the cemento-enamel junction to the crestal bone were measured. For each patient, one control was analyzed (matching for gender and age).

Results

One hundred twenty-nine BP-ONJ panoramic radiographs and 129 controls were analyzed (68 women, 61 men; 67.3?±?9.7 years; osteoporosis [n?=?11], breast cancer [n?=?33], multiple myeloma [n?=?61], prostate cancer [n?=?24]). The average number of remaining teeth was 12.9?±?8.4 for BP-ONJ and 16.4?±?9.4 for the control (p?=?0.02). The average radiographic bone loss was 5.5?±?2.3 mm for BP-ONJ and 3.1?±?1.1 mm for the control (p?<?0.001); 96.6 % of BP-ONJ and 77.5 % had radiographic bone loss of more than 5 mm. Radiographic bone loss in the molar region was the highest for both groups (BP-ONJ 6.0?±?2.3 mm; control 3.6?±?1.4 mm).

Conclusion

Prevalence and severity of periodontal disease in patients with BP-ONJ is higher compared to healthy controls.

Clinical relevance

Patients with periodontal disease might be at a higher risk of developing BP-ONJ; therefore, periodontal disease therapy in patients who are about to receive bisphosphonates should be undertaken.     

Matrix Metalloproteinase-9 (MMP-9) Expression in Different Subtypes of Ameloblastoma

Background

Ameloblastoma is a common benign odontogenic tumor of the jaw with a local invasive and highly destructive behavior and can develop in any age, with peak prevalence in 3rd–4th decade. Ameloblastoma can be divided into six histological types: follicular, plexiform, acanthomatous, desmoplastic, granular, and basal cell. Matrix metalloproteinase-9 (MMP-9) (92-kD gelatinase/type IV collagenases = gelatinase B) is involved in bone resorption by degradation of extracellular matrix and osteoclasts recruitment. Recent studies have found that MMP-9 is expressed by ameloblastoma and has a role in ameloblastoma local invasiveness.

Objective

To analyze MMP-9 expression between different histological types of ameloblastoma.

Material and Method

Forty samples of ameloblastoma were collected through consecutive sampling and the MMP-9 expression was detected using immunohistochemistry.

Result

All samples showed positive MMP-9 expression with moderate to strong intensity. 82.4 % plexiform type and 83.3 % mixed type have strong immunoexpression, significantly different with follicular type with only 36.4 % (P < 0.05).

Conclusion

Ameloblastoma plexiform and mixed type have higher MMP-9 expression than ameloblastoma follicular type. Different MMP-9 expression may contribute in different ameloblastoma biological behavior.     

In vitro radiographic density of dental posts measured by digital radiography

Objectives

This study evaluated the radiopacity of seven commercial root canal posts.

Methods

Digital radiographs of the seven commercial posts and of the same commercial posts and four artificial aluminum posts inserted in lower canines were obtained with a CCD-based digital sensor. The radiopacity of the posts was expressed as mm aluminum/mm material (mmAl). Subsequently, the radiographs were presented to five trained evaluators who were asked to rank their acceptability scores as not acceptable, acceptable, or excellent.

Results

Analysis of variance revealed significant differences in radiopacity among the posts (P < 0.05). The radiopacities of zirconium and titanium posts were significantly higher than those of fiber posts (P < 0.05). The minimum aluminum thickness for acceptance in the root canals was 1.2 mmAl.

Conclusions

All of the examined posts presented satisfactory radiopacity for clinical application.     

Operative time,blood loss,hemoglobin drop,blood transfusion,and hospital stay in orthognathic surgery

Purpose

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery.

Methods

A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included.

Results

The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night.

Conclusions

In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

     

In vitro evaluation of the erosive potential of viscosity-modified soft acidic drinks on enamel

Objective

The objective of this in vitro study was to investigate the effect of viscosity-modified soft acidic drinks on enamel erosion.

Materials and methods

A total of 108 bovine enamel samples (??=?3 mm) were embedded in acrylic resin and allocated into six groups (n?=?18). Soft acidic drinks (orange juice, Coca-Cola, Sprite) were used both in their regular forms and at a kinetic viscositiy of 5 mm²/s, which was adjusted by adding hydroxypropyl cellulose. All solutions were pumped over the enamel surface from a reservoir with a drop rate of 3 ml/min. Each specimen was eroded for 10 min at 20 °C. Erosion of enamel surfaces was measured using profilometry. Data were analyzed using independent t tests and one-way ANOVAs (p?<?0.05).

Results

Enamel loss was significantly higher for the regular (Coca-Cola, 5.60?±?1.04 μm; Sprite, 5.49?±?0.94 μm; orange juice, 1.35?±?0.4 μm) than for the viscosity-modified drinks (Coca-Cola, 4.90?±?0.34 μm; Sprite, 4.46?±?0.39 μm; orange juice, 1.10?±?0.22 μm).

Conclusion

For both regular and viscosity-modified forms, Coca-Cola and Sprite caused higher enamel loss than orange juice. Increasing the viscosity of acidic soft drinks to 5 mm²/s reduced enamel erosion by 12.6–18.7 %.

Clinical relevance

The erosive potential of soft acidic drinks is not only dependent on various chemical properties but also on the viscosity of the acidic solution and can be reduced by viscosity modification.     

Oral and genital HPV genotypic concordance between sexual partners

Objectives

The aim of this study was to verify human papillomavirus (HPV) transmission and genotype concordance among heterosexual couples.

Materials and methods

Thirty-one married couples were evaluated. All male subjects presented with clinically diagnosed HPV-related malignant or potentially malignant lesions and underwent peniscopy and penile swab. Their female counterparts underwent swabs of the uterine cervix and oral mucosa. HPV-DNA detection was performed by polymerase chain reaction and restriction fragment length polymorphism.

Results

HPV-DNA was detected in the penis, vagina/cervix, and oral cavity of 16 couples (51.61 %). Of these, HPV-DNA concordance was observed in 14 couples (87.5 %). HPV-DNA was amplified in penile and oral sites of 14 couples. Of these, 13 couples reported fellatio (92.85 %), most of them (10 couples, 76.9 %) without condom use. HPV-DNA concordance was observed in 7/10 of these couples (70 %). The three couples (100 %) who reported use of condom during fellatio were HPV-DNA discordant (p?=?0.025).

Conclusions

Lifetime number of female sexual partners and detection of HPV-DNA in the penile mucosa are surrogate markers of exposure to HPV during marriage. Consistent use of condoms may reduce the risk of HPV transmission.

Clinical relevance

Oral acquisition of HPV from oro-genital contact is influenced by lack of condom use and previous sexual behavior of the male partner. In addition, oral transmission of the virus due to fellatio is as common as genital transmission.     

Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation

Objectives

The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation.

Materials and methods

Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted.

Results

Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p?>?0.05) among them.

Conclusions

Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation.     

Fermentation of sugars and sugar alcohols by plaque Lactobacillus strains

Objective

The objective was to analyse the ability of Lactobacillus strains isolated from supragingival plaque of subjects with hyposalivation and from healthy controls to ferment sugars and sugar alcohols.

Material and methods

Fifty strains isolated from interproximal plaque from subjects with radiation-induced hyposalivation (25 strains), subjects with primary Sjögren’s syndrome (16 strains) and from subjects with normal salivary secretion rate (9 strains) were tested. Growth and pH were determined after 24 and 48 h of anaerobic incubation in vials containing basal media with 1 % of glucose, fructose, sucrose, mannitol, sorbitol or xylitol.

Results

No differences between strains isolated from hyposalivated subjects and controls were detected. All strains lowered the pH to <5.0 from fructose and the majority of the strains from glucose and sucrose. A pH of <5.5 was seen for 52 % of the strains using mannitol, 50 % using sorbitol and 36 % using xylitol. The ability to produce acids from sugars and sugar alcohols was highest among strains of Lactobacillus rhamnosus, Lactobacillus casei and Lactobacillus paracasei and lowest among Lactobacillus fermentum strains.

Conclusion

A large number of Lactobacillus strains are able to ferment not only sugars but also the sugar substitutes mannitol, sorbitol and xylitol to pH levels critical for enamel demineralisation.

Clinical relevance

Our findings suggest that products containing mannitol, sorbitol and/or xylitol may contribute to the acidogenic potential of the dental plaque and especially in hyposalivated subjects with high numbers of lactobacilli.     

Randomized clinical evaluation of a light-cured base material for complete dentures

Objectives

The purpose of this study was to compare plaque adhesion, tissue reaction, and technical complications for complete dentures based on visible light-cured resin (VLCR) or on conventional poly(methyl methacrylate) (PMMA).

Materials and methods

A stratified randomized cohort study was designed with 52 patients treated with a complete denture in the maxilla (n?=?28), the mandible (n?=?2), or both (n?=?22). Seventy-four dentures were manufactured, 38 of PMMA and 36 of VLCR. Investigators and patients were unaware of the nature of the denture base material. Plaque adhesion, tissue reaction, and technical complications were investigated 4 weeks after denture insertion (baseline). Recall investigations were performed after 6, 12, and 24 months.

Results

After 6, 12, and 24 months, plaque adhesion was significantly higher for VLCR dentures than for PMMA dentures. Tissue reaction was comparable for both groups, however. After 6, 12, and 24 months, need for repair was significantly greater for VLCR prostheses. The mean number of additional aftercare sessions per patient after 24 months was 50 % higher for VLCR than for PMMA.

Conclusions

Good oral hygiene must be established by patients treated with VLCR dentures, to remove biofilm from these dentures. Increased aftercare must also be taken into account when this material is used.

Clinical relevance

VLCR might be a viable alternative to PMMA for patients with allergic reactions to residual monomer or benzoyl peroxide.     

Zeitpunkt der chirurgischen Zahnsanierung bei odontogenen Abszessen

Background

Surgical relief and drainage as well as adjunct medicinal and physical therapy of dental abscesses are indisputable treatment options. It is currently controversial at what time the tooth extraction should take place. The aim of this study was to determine whether there are differences in treatment success depending on the time of tooth extraction.

Patients and methods

A randomized patient sample (n=177) from two clinics was examined that differed in the therapy only regarding the time of tooth extraction. Post-surgical complications, inpatient care, duration of surgeries and incidents during anesthesia were examined.

Results

Statistically significant differences for inpatient care were impressive. done Abscess incision and tooth extraction performed simultaneously led to an average hospital stay of 8 days compared to 11 days when done at two different times. Duration of surgeries was also significantly shorter for the single procedure. Post-surgical complications only occurred in 2–4% of all cases.

Discussion

Opinions expressed in the literature include complete refusal to do tooth extraction immediately, or extraction of the causal teeth while providing antibiotic protection or even complete support of immediate extraction. Considering all factors, this study supports a single procedure with a shorter duration of hospital stays depending on local, personnel and logistical circumstances, especially regarding the forthcoming introduction of the DRGs.     

The use of lithium as a marker for the retention of liquids in the oral cavity after rinsing

Objective

The aim of this study was to validate the use of lithium as a marker to indicate the retention of simple liquids in the oral cavity and use this to determine how much liquid is retained in the oral cavity following 30 s of rinsing.

Materials and methods

This is a validation study in which saliva was spiked with known concentrations of lithium. Twenty healthy participants then rinsed their mouths with either water or a 1 %?w/v carboxymethylcellulose (CMC) solution for 30 s before expectorating into a collection cup. Total volume and concentration of lithium in the expectorant were then measured, and the percentage of liquid retained was calculated.

Results

The mean amount of liquid retained was 10.4?±?4.7 % following rinsing with water and 15.3?±?4.1 % following rinsing with 1 %?w/v CMC solution. This difference was significant (p?<?0.01).

Conclusions

Lithium was useful as a marker for the retention of liquids in the oral cavity, and a value for the amount of water and 1 %?w/v CMC solution remaining in the oral cavity following a 30-s rinse was established.

Clinical relevance

The present study quantifies the retention of simple fluids in the oral cavity, validating a technique that may be applied to more complex fluids such as mouth rinses. Further, the application of this method to specific population groups such as those with severe xerostomia may assist in developing effective saliva substitutes.     

Effect of seating forces on cement–ceramic adhesion in microtensile bond tests

Objectives

The aim of this study was to evaluate the effect of different seating forces during cementation in cement–ceramic microtensile bond strength (μTBS).

Materials and methods

Forty-five blocks (5?×?5?×?4 mm³) of a glass-infiltrated alumina-based ceramic (In-Ceram Alumina) were fabricated according to the manufacturer’s instructions and duplicated in resin composite. Ceramic surfaces were polished, cleaned for 10 min in an ultrasonic bath, silica coated using a laboratory type of air abrasion device, and silanized. Each treated ceramic block was then randomly assigned to five groups (n?=?9) and cemented to a composite block under five seating forces (10 g, 50 g, 100 g, 500 g, and 750 g) using a dual-cured resin cement (Panavia F). The ceramic–cement–composite assemblies were cut under coolant water to obtain bar specimens (1 mm?×?0.8 mm²). The μTBS tests were performed in a universal testing machine (1 mm/min). The mean bond strengths values were statistically analyzed using one-way ANOVA (α?≤?0.05).

Results

Different seating forces resulted in no significant difference in the μTBS results ranging between 13.1?±?4.7 and 18.8?±?2.1 MPa (p?=?0.13) and no significant differences among cement thickness.

Conclusions

Excessive seating forces during cementation seem not to affect the μTBS results.

Clinical relevance

Excessive forces during the seating of single all-ceramic restorations cementation seem to display the same tensile bond strength to the resin cement.     

Prevalence of feeding disorders in children with cleft palate only: a retrospective study

Objectives

The purpose of this study in children with cleft palate only (CPO) is to (1) explore the prevalence of feeding problems on a retrospective basis, (2) investigate rates of nasogastric (NG) feeding, (3) examine the prevalence of associated disorders and/or syndromes (AssD/S), (4) investigate if there are certain risk factors associated with feeding difficulties, NG feeding, and failure of breastfeeding, and (5) investigate the effect of palatoplasty on feeding difficulties.

Materials and methods

In total, 90 questionnaires were included in this study. The medical records were reviewed.

Results

Feeding difficulties were reported in 67 % (n?=?60) of all cases. NG feeding was given in 32 % (n?=?28) of all children. Forty-nine children (54 %) have associated malformations. There is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. The severity of the cleft is significantly related to the prevalence of AssD/S. After palatoplasty, feeding difficulties improved in 79 % of the CPO children.

Conclusions and clinical relevance

First, our results clearly indicate that children with CPO are at high risk of developing feeding difficulties (67 %); NG feeding is often necessary (32 %). Second, our results also indicate that the more severe the cleft, the more likely the chance for AssD/S. Third, the severity of the cleft is significantly related to the prevalence of AssD/S. Fourth, there is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. Fifth, improvement of feeding difficulties after surgery supports the importance of the soft palate closure in relation to sucking patterns and feeding skills.     

Radiographic examination of apical extrusion of root canal irrigants during cavitation induced by Er,Cr:YSGG laser irradiation: an in vivo study

Objectives

The purpose of the present study was to test the hypothesis that apical extrusion of the irrigant occurs during laser-driven irrigation in vivo.

Materials and methods

Three hundred human root canals, in 181 patients, were divided into two groups: the no lesion group (n?=?140) and the lesion group (n?=?160). All the root canals were enlarged using a crown down technique up to size 30–80 K-files, depending on the original condition of the root canal. For the final irrigation, the teeth were irrigated with a mixture of radiopaque contrast medium and NaOCl in solution. The solution was activated for 60 s in teeth with one canal or two canals and for 120 s in teeth with three or four canals.

Results

Radiopaque contrast medium was absent from the periapical tissues of all samples.

Conclusions

No contrast medium was observed radiographically in the periapical tissues. The hypothesis that apical extrusion of root canal irrigants occur during laser cavitation was rejected

Clinical relevance

It appears that the power of the laser used at 1 W for 1–2 min can drive the irrigation solution to the tip of the canal without harming the apical tissues.     

Effect of periodontal treatment on peak serum levels of inflammatory markers

Background and objective

Some subjects with untreated periodontitis exhibit elevated levels of distinct inflammatory markers in serum. The aim of the study was to assess whether nonsurgical periodontal therapy changes the levels of these markers and lowers these peaks.

Methods

Forty periodontally diseased subjects received nonsurgical periodontal therapy (full-mouth scaling and root planing within 48 h) with either adjunctive systemic amoxicillin and metronidazole (n?=?19) or placebo (n?=?21). Serum samples, obtained at baseline (BL) and 3 months after treatment (M3), were evaluated for 15 cytokines and 9 acute-phase proteins using the Bio-Plex bead array multianalyte detection system. For each analyte, peak values were defined as greater than the mean?+?2 standard deviations (SD) of measurements found in 40 periodontally healthy persons. Proportions were compared using Fisher’s exact test.

Results

At M3, a significantly better primary clinical outcome (persisting pockets of >4 mm with bleeding on probing) was obtained in patients treated with scaling and root planing plus antibiotics compared to those receiving placebo (3.3?±?5.1 vs. 6.8?±?7.8 pockets per patient, p?p?=?0.003). With regards to the reduction of peaks, no specific benefit of adjunctive antibiotics could be seen.

Conclusion

Subjects with untreated periodontitis may show high peaks for several inflammatory markers in serum simultaneously. Nonsurgical periodontal treatment with or without antibiotics reduced most of these peak levels.