Investigation on how renewal of complete dentures impact on dietary and nutrient adequacy in edentulous patients

PurposeThe aim of this study is to investigate changes of diet and nutrient adequacy between complete denture wearers with their existing dentures and those with new dentures.MethodsAfter obtained their written informed consent 30 patients who visited Nihon University School of Dentistry at Matsudo Affiliated Hospital from March 2004 to November 2005 were asked to record their 3 consecutive day's meals and to take a picture of them. Furthermore, foods which they can eat with their dentures were examined the questionnaire developed by Hirai. Referring to the obtained records and pictures, one dietitian interviewed to confirm the exact intakes of meals. In addition, the masticatory ability was calculated using the questionnaire. The nutrient adequacy and masticatory score determined at the time of the first and second survey were examined by repeated-measures ANOVA. A p-value less than 0.05 was considered statistically significant.ResultThe total intake of energy and nutrients was almost over 100% in both the groups. However, no statistically significant difference was obtained. The masticatory score with the existing and new denture were 66.1 ± 18.5 and 58.3 ± 19.9, respectively. The score increased significantly in the new denture group when compared with that of the existing denture group.ConclusionThe self-evaluation of the masticatory function improved after the switch from the old to new dentures.     

The influence of vertical dimension of occlusion changes on the electroencephalograms of complete denture wearers

PurposeThe present study was conducted to identify how changes in the vertical dimension of occlusion (VDO) affect the sensory perception and activity of the brain in complete denture wearers using an electroencephalogram (EEG).MethodsSubjects were 21 individuals wearing complete dentures who regularly visited the Division of Prosthodontics at Tsurumi University Dental Hospital for checkups (12 males and 9 females, average age: 76.6). Based on their original dentures, two duplicate dentures with different VDO (−3 mm and +5 mm) were fabricated. EEG activity and occlusal force were measured before and after gum chewing with each denture in all subjects. Negative indicator scores for psychological conditions and stable neuronal activity (Dα) were calculated using EEG data. Statistical analysis was performed using the Wilcoxon test to compare changes in the sensory perception, activity of the brain, and occlusal force (α = 0.05).ResultsAfter gum chewing with the +5-mm denture, a significant increase was observed in the negative indicator score (p < 0.05). No significant difference was found in the Dα values before and after gum chewing with any of the dentures (p > 0.05). A significant decrease was observed in the occlusal force between the original denture and the −3-mm denture (p < 0.05).ConclusionPsychological condition and occlusal force were influenced by immediate changes in the VDO of the complete denture.     

The nocturnal use of complete dentures and sleep stability in edentulous elders

ObjectiveTo evaluate the stability of sleep quality and the impact of nocturnal use of complete dentures on sleep quality in an elderly edentulous population over a one-year period.Materials and methodsWritten informed consent was obtained from 172 edentulous elders who agreed to enrol in a longitudinal cohort study. A total of 153 participants completed the follow-up after one year. Perceived quality of sleep and daytime sleepiness were measured using the Pittsburgh Sleep Quality Index (PSQI, score 0–21) and the Epworth Sleepiness Scale (ESS, score 0–24) at baseline (T₀) and at follow-up (T₁). Data on oral health related quality of life, type of mandibular dentures (conventional versus implant-retained mandibular overdenture), nocturnal wear of the dentures and socio-demographic status were obtained by means of the OHIP-20 questionnaire, a clinical examination form and a socio-demographic questionnaire.ResultsNo statistically significant differences were detected in the global PSQI mean scores and EES mean scores from baseline (PSQI 4.77 ± 3.32; EES 5.35 ± 3.72) to the follow-up assessment (PSQ1 5.04 ± 3.50; EES 5.53 ± 4.34). Edentate elders wearing prostheses at night had poorer daytime sleepiness scores than those who removed their prostheses at night (p = 0.003 unadjusted model; p = 0.058 adjusted for age, gender, type of prosthesis and the OHIP-20 total score).ConclusionResults of this study suggest that wearing complete dentures while sleeping has little effect on sleep quality or daytime sleepiness.     

Evaluation of physical properties of fiber-reinforced composite resin

ObjectivesThis study aimed to investigate physical properties of a fiber-reinforced CAD/CAM resin disc, which included woven layers of multi-directional glass fibers.MethodsFiber orientations of CAD/CAM specimens (TRINIA, SHOFU) were specified as longitudinal (L), longitudinal-rotated (LR), and anti-longitudinal (AL). A fiber-reinforced composite (everX posterior, GC (E)) and a conventional composite (Beauti core flow paste, SHOFU (B)) were also tested.A three-point bending test and a tensile test with notchless prism-shaped specimens were conducted using a universal testing machine (AUTOGRAPH AG-IS, Shimadzu). A water absorption test was also carried out after the specimens were stored in water for 24 h or 1 week. Flexural strength and fracture toughness were obtained by conducting a three-point bending test.ResultsTRINIA L and LR groups showed significantly high flexural strength (254.2 ± 22.3 and 248.8 ± 16.7 MPa, respectively). Those were approximately 2.5 times higher than those in AL, E, and B groups (96.8–98.0 MPa) (p < 0.05, ANOVA and Tukey HSD test). No significant difference was shown in flexural modulus among the experimental groups. The fracture toughness in L group (9.1 ± 0.4 MPa/m^1/2) was found to be significantly higher than those in other groups (1.9–3.0 MPa/m^1/2; p < 0.05). TRINIA group demonstrated significantly lower water absorption (4.7 ± 1.9 μg/mm³) than did E (16.1 ± 3.1 μg/mm³) and B (17.3 ± 3.7 μg/mm³) groups (p < 0.05).SignificanceTRINIA demonstrated distinct anisotropy. TRINIA can be used as a superior restorative material when specifying directions of its fiber mesh layers.     

Blood flow in denture-supporting maxillary mucosa in response to simulated mastication by loading

PurposeThe purpose of this study was to determine the effect of number of chewing strokes on change in blood flow in denture-supporting maxillary mucosa.MethodsSubjects consisted of 11 healthy dentate men. Mastication was simulated by intermittent loading (10 N, 1/0.75 Hz) on a lateral area of the hard palate using a 2-cm² test plate. Loading duration was set at 1, 4, 8 or 12 min (80, 320, 640 or 960 chewing strokes). A non-contact laser Doppler blood flow meter was used to determine change in blood flow and time taken for recovery to 110% of the pre-loading value. Mean blood flow at pre-loading and at each duration of intermittent loading were compared using a repeated measures ANOVA (α = 0.05) and the Dunnett test. Recovery times for each loading duration were compared using a one-way ANOVA (α = 0.05) and the Bonferroni-test.ResultsThree subjects showed no increase in mean blood flow with loading. Eight subjects consistently showed an increase in mean blood flow during intermittent loading relative to at pre-loading. Duration of loading yielded no significant difference in mean blood flow. Significant differences were observed in recovery time between at after 8 min loading and at after the other 3 loading (1, 4, and 12 min loading) durations.ConclusionNumber of simulated chewing strokes showed no influence on mean blood flow during intermittent loading in denture-supporting mucosa. It did, however, affect recovery time taken for blood flow to return to its pre-loading level.     

The effect of complete dentures on body balance during standing and walking in elderly people

PurposeTo investigate the influence of wearing complete dentures on postural control in standing and walking.MethodsThirty-four edentulous patients participated in this study. All the subjects were wearing complete dentures, and the dentures were adjusted or replaced with new dentures when necessary. Measurements were performed under two conditions: wearing dentures and not wearing dentures. Standing stability was evaluated by the locus of center of mass, and gait stability was evaluated by the gait velocity, stride and gait cycle. In addition, gait stability was also evaluated by the maximum acceleration, maximum angle rate, lateral equilibrium, root mean square and harmonic ratio with a tri-axial accelerometer at a sampling rate of 66 Hz. Differences for the locus of center of mass, gait velocity, gait cycle and stride length were assessed with the paired t test (P < 0.05). Other outcomes were compared with the Wilcoxon signed-rank test (P < 0.05).ResultsWith denture wear, the locus of center of mass was significantly shortened, and the gait velocity and harmonic ratio of the vertical angle rate were significantly increased; though other parameters showed no differences. Complete dentures produced an effect on the stability of edentulous patients under both static and dynamic conditions.ConclusionsThese results indicate that wearing complete dentures may be an effective aid to maintain and improve balance and control for elderly people.     

Evaluation of test protocol variables for dental implant fatigue research

ObjectivesThis work begins to explore the influence of cycling rate and environment on fatigue testing of dental implants according to the ISO protocol 14801.MethodsTwenty-four Straumann implants (4.1 mm × 12 mm) were tested up to five million cycles per ISO 14801: loaded at either 2 or 30 Hz in room air at 25 °C or normal saline at 37 °C (n = 6 per group). Implant displacements/cycle were captured during all testing. Fracture-surface features were examined using scanning electron microscopy (n = 12). Two complimentary methods were developed to estimate fatigue crack growth rates.ResultsFailures (bulk fracture) were found to be bi-modally distributed, either <350,000 cycles or >1.5 million cycles at both cycling rates. Following initial crack formation, fatigue crack growth required merely 1100–4200 cycles to failure. Initial crack pop-in was statistically more likely under 2 Hz than 30 Hz (χ², p < 0.05) but testing in air and normal saline were equivalent in terms of likelihood of fracture versus runout (χ², p > 0.6). On a microscopic level, fatigue crack growth rates appears to be similar at 2 and 30 Hz, but may be slower in the presence of saline versus dry at 2 Hz.SignificanceImplant failure under fatigue conditions involved “classic” damage mechanisms. Failure appears more likely at 2 Hz than 30 Hz for reasons that remain to be elucidated. Saline may enable chemically assisted crack growth involving grain boundaries during the stage of fatigue crack growth, but did not influence likelihood of failure.     

Bridging the gap between clinical failure and laboratory fracture strength tests using a fractographic approach

ObjectiveThe aim of this study was to analyze and to compare the fracture type and the stress at failure of clinically fractured zirconia-based all ceramic restorations with that of morphologically similar replicas tested in a laboratory setup.MethodsReplicas of the same shape and dimensions were made for 19 crowns and 17 fixed partial dentures, all made of veneered zirconia frameworks, which fractured during intra-oral service. The replicas were statically loaded by applying axial load in a universal testing machine. The principles of fractography were used to identify the location and the dimensions of the critical crack and to estimate the stress at failure. Failure was classified according to origin and type (P < 0.05 was considered significant).ResultsClinically fractured restorations failed due to either: delamination of the veneer ceramic (28.2 ± 9 MPa), defects at core veneer interface (27.7 ± 6 MPa), the generation of Hoop stresses (884.3 ± 266 MPa), radial cracking (831 MPa), or fracture of the connector (971 ± 343 MPa). The replicas failed by mainly by cone cracking of the veneer ceramic (52.4 ± 34.8 MPa) or by fracture of the connector (1098.9 ± 259 MPa). The estimated stress at failure was significantly higher for the replicas compared to the clinically fractured restorations (F = 6.8, P < 0.01).SignificanceWithin limitations of this study, careful design of fracture strength test would lead to more clinically relevant data. The performance of zirconia veneered restorations could be further improved with careful design considerations.     

Effect of storage in artificial saliva and thermal cycling on Knoop hardness of resin denture teeth

PurposeThis study aimed to evaluate the effect of different storage periods in artificial saliva and thermal cycling on Knoop hardness of 8 commercial brands of resin denture teeth.MethodsEigth different brands of resin denture teeth were evaluated (Artplus group, Biolux group, Biotone IPN group, Myerson group, SR Orthosit group, Trilux group, Trubyte Biotone group, and Vipi Dent Plus group). Twenty-four teeth of each brand had their occlusal surfaces ground flat and were embedded in autopolymerized acrylic resin. After polishing, the teeth were submitted to different conditions: (1) immersion in distilled water at 37 ± 2 °C for 48 ± 2 h (control); (2) storage in artificial saliva at 37 ± 2 °C for 15, 30 and 60 days, and (3) thermal cycling between 5 and 55 °C with 30-s dwell times for 5000 cycles. Knoop hardness test was performed after each condition. Data were analyzed with two-way ANOVA and Tukey's test (α = .05).ResultsIn general, SR Orthosit group presented the highest statistically significant Knoop hardness value while Myerson group exhibited the smallest statistically significant mean (P < .05) in the control period, after thermal cycling, and after all storage periods. The Knoop hardness means obtained before thermal cycling procedure (20.34 ± 4.45 KHN) were statistically higher than those reached after thermal cycling (19.77 ± 4.13 KHN). All brands of resin denture teeth were significantly softened after storage period in artificial saliva.ConclusionStorage in saliva and thermal cycling significantly reduced the Knoop hardness of the resin denture teeth. SR Orthosit denture teeth showed the highest Knoop hardness values regardless the condition tested.     

Efficacy of a mouthrinse based on hydroxyapatite to reduce initial bacterial colonisation in situ

ObjectiveThe present in situ - investigation aimed to specify the impact of pure hydroxyapatite microclusters on initial bioadhesion and bacterial colonization at the tooth surface.DesignPellicle formation was carried out in situ on bovine enamel slabs (9 subjects). After 1 min of pellicle formation rinses with 8 ml of hydroxyapatite (HA) microclusters (5%) in bidestilled water or chlorhexidine 0.2% were performed. As negative control no rinse was adopted. In situ biofilm formation was promoted by the intraoral slab exposure for 8 h overnight. Afterwards initial bacterial adhesion was quantified by DAPI staining and bacterial viability was determined in vivo/in vitro by live/dead-staining (BacLight). SEM analysis evaluated the efficacy of the mouthrinse to accumulate hydroxyapatite microclusters at the specimens’ surface and spit-out samples of the testsolution were investigated by TEM.ResultsCompared to the control (2.36 × 10⁶ ± 2.01 × 10⁶ bacteria/cm²), significantly reduced amounts of adherent bacteria were detected on specimens rinsed with chlorhexidine 0.2% (8.73 × 10⁴ ± 1.37 × 10⁵ bacteria/cm²) and likewise after rinses with the hydroxyapatite testsolution (2.08 × 10⁵ ± 2.85 × 10⁵ bacteria/cm², p < 0.001). No demonstrable effect of HA-particles on Streptococcus mutans viability could be shown. SEM analysis confirmed the temporary adsorption of hydroxyapatite microclusters at the tooth surface. Adhesive interactions of HA-particles with oral bacteria were shown by TEM.ConclusionHydroxyapatite microclusters reduced initial bacterial adhesion to enamel in situ considerably and could therefore sensibly supplement current approaches in dental prophylaxis.     

Degree of conversion of Filtek Silorane Adhesive System and Clearfil SE Bond within the hybrid and adhesive layer: An in situ Raman analysis

ObjectivesTo examine the degree of conversion (DC) of the adhesive interfaces created by Filtek Silorane Adhesive and Clearfil SE Bond using micro-Raman spectroscopy.MethodsThe adhesives were applied on human dentin in accordance with manufacturer's instructions. Specimens were cut to expose the bonded interfaces to the micro-Raman beam (Ranishaw InVia; laser wl 785 nm). Raman spectra were collected along the dentin/self-etching primer/adhesive interface at 1 μm intervals. The relative intensities of bands associated with mineral (P–O functional group at 960 cm^?1) and adhesive (C–C–O group at 605 cm^?1) components within the bonded interface were used to detect monomer penetration into the dentin matrix and to calculate the degree of conversion (CC at 1640 cm^?1 as reaction peak, C–C–O at 605 cm^?1 as reference peak). Data were statistically analyzed with two-way ANOVA.ResultsDC of Filtek Silorane Adhesive was 69 ± 7% in the adhesive layer, increasing (p < 0.05) to 93 ± 5% in the primer and 92 ± 9% in the hybrid layer. Clearfil SE Bond showed a DC of 83 ± 3% in the hybrid and 85 ± 3% in the adhesive layer. Thus, Filtek Silorane Adhesive showed a higher DC than Clearfil SE Bond in the hybrid layer (p < 0.05), but a lower DC in the adhesive (p < 0.05).SignificanceAs high DC is a fundamental pre-requisite for the stability of the bond over time, this study supports the hypothesis that optimal stability of Filtek Silorane Adhesive can be obtained. However, further research is needed to investigate the mechanical properties of the hybrid layer created by Filtek Silorane Adhesive and its long-term stability.     

Influence of loading frequency on implant failure under cyclic fatigue conditions

ObjectivesPreliminary studies on implant fatigue testing suggested that fractures were more likely to occur at 2 Hz than at 30 Hz (χ², p < 0.05). This investigation explores frequency and base elastic modulus effects on strain, strain rate and failure.MethodsA total of 66 implants were mounted in different base materials (acrylic, glass-filled epoxy, aluminum) and loaded up to 10⁶ cycles per ISO 14801 (20 N to 420–500 N) at frequencies of 2 Hz and 30 Hz (chosen to accelerate frequency as the stressor). Absolute strain magnitudes and strain rates under varying loading conditions and with different base materials were measured using one strain-gauged implant. Failure probability distributions were analyzed by both Weibull and life data analysis. Measured strain was used to validate an FEA model. Fracture surfaces were examined by SEM.ResultsNumber of failures and failure-rates-per-cycle differed significantly between implants tested at 2 Hz versus 30 Hz (p < 0.05). Strain magnitude was independent of frequency. Strain rates were highly correlated with frequency (linear r² > 0.99) and differed significantly under failure conditions (420 N): 2 Hz = 8292 μstrain/s; (500 N): 30 Hz = 80,840 μstrain/s. Measured and FEA-calculated strains were similar. Fracture surfaces were indistinguishable (2 Hz versus 30 Hz).SignificanceFatigue failure was significantly more likely at 2 Hz than 30 Hz whereas base material and loading magnitude seemed to have only minor influence. Absolute strain was identical at these frequencies suggesting strain rate sensitivity for this commercially pure titanium implant. Both the Weibull and SEM analyses support an identical failure mechanism with damage accumulation more severe at lower frequencies, an interpretation consistent with strain rate sensitivity.     

Effect of denture adhesives on oral moisture: A multicenter randomized controlled trial

PurposeThe purpose of this study was to investigate the effect of denture adhesives on oral moisture in a 10-center parallel randomized clinical trial.MethodsTwo hundred edentulous subjects wearing complete dentures were allocated into three groups: cream-type adhesive, powder-type adhesive and control groups. The adhesives (and saline solution in the control group) were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention for eight meals over 4 days were obtained. For the main outcome, oral moisture was measured with a moisture checking device. Secondary outcomes were denture satisfaction, masticatory performance, denture retention, and occlusal force. In addition to between-group and within-group comparisons of oral moisture, investigations for secondary outcomes were undertaken in subgroups classified according to the degree of oral moisture at baseline (normal subgroup and dry mouth subgroup). Intention-to-treat analysis was also performed.ResultsBetween-group and within-group comparisons of oral moisture showed no significant differences. The cream-type and powder-type denture adhesives were significantly effective in the dry mouth group for denture satisfaction ratings of ability to masticate, stability, retention, and comfort of mandibular dentures (p < 0.05). The masticatory performance and retentive force of the dry mouth denture adhesive using groups were significantly improved after intervention (p < 0.05).ConclusionsThe oral moisture of complete denture wearers was not influenced by the use of denture adhesives. Our findings showed that denture adhesives improved subjective denture satisfaction, masticatory performance, and retention for complete denture patients with oral dryness.     

Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: A comparative study in beagles

ObjectiveThe aim of the study was to evaluate the effects of the combined use of dentin matrix protein-1 (DMP1) gene-modified bone marrow stromal cells (BMSCs) and Bio-Oss^® for maxillary sinus floor augmentation (MSFA) implant placement in dogs.Materials and methodsBMSCs were derived from bone marrow of six beagles and cultured. The cells were transduced with a lentiviral vector overexpressing the DMP1 gene and enhanced green fluorescent protein (EGFP) gene (Lenti-DMP1/EGFP) in test group, and with a lentiviral vector encoding EGFP gene (Lenti-EGFP) in control group. Six dogs received sinus augmentations using the bilateral approach with a simultaneous implant placement at each site respectively. At the same concentration, 2 × 10⁷ cells/ml, one sinus was grafted using a mixture of autologous DMP1/EGFP gene-modified BMSCs and Bio-Oss^® (DMP1 group), and the contralateral sinus was grafted with autologous EGFP gene-modified bMSCs and Bio-Oss^® (EGFP group). After a 3 month healing period, bone regeneration and osseointegration were evaluated using histologic and histomorphometric methods.ResultsThe bone-implant contact (BIC) and the bone area fraction in the DMP1 group (BIC: 34.67% ± 8.23%, bone area fraction: 35.16% ± 3.32%) were significantly greater compared with the EGFP group (BIC: 26.06% ± 5.16%, bone area fraction: 20.74% ± 1.63%) (P < 0.05). No significant difference between the residual bone substitute material volume (BSMV) in the DMP1 group (35.86 ± 7.35) and the EGFP group (32.16 ± 9.16) was found in our study (P > 0.05).ConclusionBMSCs modified with the DMP1 gene can be used as an adjunct to Bio-Oss^® to enhance new bone formation and the osseointegration of dental implants in MSFA of dogs.     

Effect of water-bath post-polymerization on the mechanical properties,degree of conversion,and leaching of residual compounds of hard chairside reline resins

ObjectivesThis study evaluated the effect of water-bath post-polymerization at 55 °C for 10 min (WB) on the content and leaching of residual compounds, degree of conversion, flexural strength, and hardness of hard chairside reline resins (Kooliner: K, New Truliner: N, Ufi Gel hard: U, and Tokuso Rebase Fast: T).MethodsLeaching experiments were made by storing specimens (n = 48) in artificial saliva at 37 ± 1 °C and analyzing residual monomers and plasticizer by HPLC. Analysis of residual monomer and plasticizer content (n = 48) was also made by HPLC. Degree of conversion (n = 40) was analyzed by using FT-Raman spectroscopy. A 3-point loading test was used to evaluate the flexural strength of the specimens (n = 80). One fragment of each flexural test specimen was then submitted to Vickers microhardness test.ResultsWB produced a significant decrease (p < 0.050) in the amount of residual compounds eluted from the materials within the first hour of immersion. With the exception of material U, WB decreased the duration of release of the residual compounds evaluated. All materials evaluated exhibited significantly (p < 0.050) lower values of residual monomer and plasticizer (material N) after WB compared with the control groups. WB increased the degree of conversion of K and T resins and the hardness of N, K, and T resins (p < 0.050). Only material K showed an increase in flexural strength after WB (p < 0.050).SignificanceImmersion of relined dentures in water at 55 °C for 10 min can be used to reduce the amounts and duration of release of residual compounds and improve mechanical properties of some of the materials evaluated.     

Effect of self-setting α-tricalcium phosphate between segments for bone healing and hypoaesthesia in lower lip after sagittal split ramus osteotomy

AimsThe aim of this study was to evaluate hypoaesthesia of the lower lip and bone formation using self-setting α-tricalcium phosphate (Biopex^®) between the proximal and distal segments following sagittal split ramus osteotomy (SSRO) with bent absorbable plate fixation.Subjects and methodsThe subjects were 40 patients (80 sides) who underwent bilateral SSRO setback surgery. They were divided into a Biopex^® group (40 sides) and a control group (40 sides). The Biopex^® was inserted into the anterior part of the gap between the segments in the Biopex^® group. Trigeminal nerve hypoaesthesia in the region of the lower lip was assessed bilaterally using the trigeminal somatosensory-evoked potential (TSEP) method. Ramus square, ramus length, and ramus width, the square of the Biopex^® at the horizontal plane under the mandibular foramen were assessed preoperatively, immediately after surgery, and 1 year postoperatively by computed tomography (CT).ResultsThe mean measurable period and standard deviation were 9.3 ± 15.7 weeks in the control group, 5.3 ± 8.3 weeks in the Biopex^® group, and there was no significant difference. Ramus square after 1 year was significantly larger than that prior to surgery and new bone formation was found between the segments in both groups (P < 0.05). In the Biopex^® group, the square of the Biopex^® after 1 year was significantly smaller than that immediately after surgery (P < 0.05).ConclusionThis study suggested that inserting Biopex^® in the gap between the proximal and distal segments was useful for new bone formation and it did not prevent the recovery of lower lip hypoaesthesia after SSRO with bent absorbable plate fixation.     

Treatment of trigeminal neuralgia with bupivacaine HCL using a temporary epidural catheter and pain pump: Preliminary study

ObjectivesTrigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe paroxysmal pain in the face. The treatment for trigeminal neuropathic pain disorder continues to be a major therapeutic challenge, as relief provided by medical therapy generally decreases over time. When medical therapy fails either due to poor or diminishing responses to drugs or to unacceptable side effects, peripheral intervention or surgical management of TN should be considered.Study designFourteen patients (eight men and six women) who were not responsive to further medical treatment and who were diagnosed with TN previously at other health centres were selected for treatment. For this purpose, the affected nerve was infused with 60 mL (1 mL h^?1) of 0.5% bupivacaine HCl with a pain pump via an temporary epidural catheter. Patient’s visual analogue scores (VAS) were recorded on the fifth preoperative day and on postoperative day 5, 2 weeks, 1, 3, 6 and 9 months.ResultsThere was a significant difference between mean preoperative and postoperative VAS value at day 5, 2 weeks, 1, 3, 6 and at the end of 9 months ((68.85 ± 1.43) (13.57 ± 6.68) (11.43 ± 6.70) (14.29 ± 6.52) (20.71 ± 6.41) (20.71 ± 6.41) and (21.43 ± 6.10) respectively; 1P < 0.05). Two of 14 patients did not show any pain relief.ConclusionsContinuous administration of 60 mL of 0.5% bupivacaine HCl at 1 mL h^?1 with a pain pump and epidural catheter can be used as a transition treatment for patients with side effects from high-dose antiepileptic drugs and for patients awaiting neurosurgery or individuals who refuse cranial surgery. It should not be considered as an alternative treatment of neurosurgical approaches, such as MVD, which has a definite long-lasting results.     

Elevation of white blood cells and platelet counts in patients having chronic periodontitis

Background and aimMany risk factors that might contribute to the pathogenesis of atherosclerosis have been proposed, including chronic inflammation and infection. Furthermore, systemic inflammatory responses to periodontal bacteria have been suggested as a pathogenetic link between periodontal disease and atherosclerosis. The purpose of this study was to estimate the white blood cell (WBC) and platelet counts in chronic periodontitis patients.Materials and methodsFifty patients with chronic periodontitis and 50 patients with healthy periodontium were included in this study. Oral hygiene status, pocket probing depth (PPD) and clinical attachment level (CAL) were measured. During clinical evaluation, venous blood samples were taken to analyze the WBC and platelet counts. Statistical analysis was utilized to compare differences across groups.ResultsPeriodontitis patients demonstrated a significantly higher WBC count (7.22 ± 1.42 × 10⁹ cells/L) than that of control patients (5.64 ± 1.56 × 10⁹ cells/L; P < 0.001). The platelet count of patients with chronic periodontitis (290.73 ± 56.56 × 10⁹ cells/L) was also significantly higher compared to the healthy group (223.37 ± 50.27 × 10⁹ cells/L; P < 0.001).ConclusionLevels of WBCs and platelets are elevated in periodontitis patients compared to healthy controls.     

Esterases affect the physical properties of materials used to seal the endodontic space

Materials used to seal the endodontic space are subjected to enzymatic degradative activities of body fluids and bacteria.ObjectivesTo assess effects of simulated human salivary, blood and bacterial esterases (SHSE) on physical properties of typical restorative material and root canal sealers.MethodsSpecimens of set methacrylate-based resin composite (Bisfil^TM2B; RC), calcium-silicate sealer (EndoSequence^®; BC) or epoxy-resin sealer (AH-Plus^®; ER) were tested after up to 28 Days exposure to phosphate buffered saline (PBS) or SHSE, using ANSI/ADA-57:2000 and ISO-6876:2012.ResultsRegardless of media, microhardness increased with time for BC remained unchanged for ER and decreased for RC (p < 0.05). SHSE moderated the increase for BC compared to PBS (28.0 ± 4.8 vs. 38.1 ± 7.9 KHN) at 7 Days, and enhanced the decrease for RC at 7 Days (55.6 ± 7.1 vs. 66.3 ± 6.5 KHN) and 28 Days (52.3 ± 9.2 vs. 62.6 ± 8.5 KHN). Compressive strength was enhanced only for BC by either media. BC expanded with time for both incubation conditions; SHSE moderated the expansion compared to PBS at 7 Days (0.026 ± 0.01% vs. 0.049 ± 0.007%). Shrinkage of ER was similar for both incubation media and was lower than that for RC (p < 0.05). Shrinkage of RC was enhanced by SHSE compared to PBS at 7 Days (0.5 ± 0.07% vs. 0.38 ± 0.08%). Weight loss was lowest for ER and highest for BC (p < 0.05). It was enhanced by SHSE compared to PBS for BC at 28 Days (2.40 ± 0.2 vs. 2.96 ± 0.19 W L%), and for RC at 7 Days (0.54 ± 0.09 vs. 0.80 ± 0.1 W L%).SignificanceSimulated body fluids and bacterial esterases affected the physical properties of test materials, suggesting potential impacts on sealing ability and resistance to bacterial ingress, and tooth strength ultimately affecting their clinical performance.