Lasers in dentistry. Epilogue

Laser use in the dental clinic requires scientifically demonstrated improvement for patient and/or dentist, easily obtainable equipment, adequate training and safety. These aspects are summarized for all laser applications. Improvement has not been shown for all applications. In the Netherlands manufacturer-independent training is little available. Safety requires care, but not a large investment. Economical aspects include an adequate compensation for the necessary investment. For only a few applications laser treatment leads to decreased cost or time of treatment. However, also increased compensation by insurers or patients may be possible; some patients will be willing to pay more when laser treatment is less unpleasant than traditional treatment or, in the case of diagnosis, leads to better information.     

Local application of n-3 or n-6 polyunsaturated fatty acids in the treatment of human experimental gingivitis

BACKGROUND: Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15-lipoxygenase pathways, which show opposite effects to the pro-inflammatory arachidonic acid metabolites such as leukotriene B4 (LTB4). AIMS: The aim of this clinical study was to evaluate the effects of topical application of n-6 or n-6 polyunsaturated fatty acids in patients with experimental gingivitis. METHODS: In each subject, similar teeth served as experimental and control over a 21-day non-hygiene phase and a 9-day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4 concentration was analyzed by reversed-phase high-pressure liquid chromatography. RESULTS: After 21 days of plaque growth, the BOP, GCF and LTB4 levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9-day period significantly reduced the GCF in the n-6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range)). CONCLUSION: The topical application of n-6 or n-6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing with n-6 fatty acids could reduce the level of GCF in established experimental gingivitis.     

Biomechanical response of bovine temporomandibular joint disc to prolonged tensile stress

This study was designed to evaluate the influence of prolonged tensile stress on the viscoelasticity of the temporomandibular joint (TMJ) disc. Twenty discs from 10, 3-year-old cattle were used. Tensile stress of 1.5 MPa was applied to specimens from the discs for 10, 20, 40 and 60 min. Following the prescribed period of tension for creep, the specimens were removed from the tension device and any recovery observed for 20 min. In all specimens, strain increased at the onset of stress application and reached almost steady conditions after 5 min. Although, the strain became slightly larger when the creep time was longer, no significant differences were found in the strains between any two tests with different periods of creep. The residual strain increased significantly with creep duration, and similarly the degree of recovery decreased significantly. In 10- and 20-min creep tests, the residual strains were 0.1 and 1.0%, the specimens in 40- and 60-min tests revealed irreversible changes in length. It was concluded that continuous loading for >40 min causes creep damage in bovine TMJ disc, and that prolonged sustained tension affects the recovery of joint homeostasis.     

Prospective evaluation of implants connected to teeth

PURPOSE: This prospective clinical trial examined the effect on teeth and implants when rigidly or non-rigidly connected in a cross-arch model. MATERIALS AND METHODS: Thirty patients received 2 implants, 1 on each side of the mandible, and were restored with 3-unit fixed partial dentures connected either rigidly or non-rigidly to an abutment tooth. Patients were followed for at least 5 years post-restoration. RESULTS: Repeated-measures analysis revealed no significant difference in crestal bone loss at implants (rigid versus non-rigid methods). An overall significant difference (P < .001) was found comparing methods for teeth. Paired t tests revealed no significant differences in crestal bone levels for implants or teeth at the 5-year recall. Kaplan-Meier methods and the Cox proportional hazards model showed no differences between attachment methods with regard to success based on survival and bone loss criteria. During the 5-year recall period, 1 implant (rigid side) was removed. Four implants developed bone loss greater than 2 mm during the course of this trial. One tooth on the rigid side and 2 teeth on the non-rigid side had greater than 2 mm of crestal bone loss and were removed secondary to fractures. In all, 5 abutment teeth were removed, all of which had been treated with root canal therapy and fractured at the interface of the post within the tooth. There was no clear relationship of tooth fracture to attachment. Repeated-measures analysis of mobility values revealed no significant changes over the time course of this study, and paired t tests revealed no statistically significant differences between implants for mobility. Repeated-measures analysis and paired t tests for probing depth revealed no significant changes over the time course of this study. There were no significant differences in soft tissue indices for either attachment method. The percentage of patients who had measurable intrusion was 66% for the non-rigid group, and 44% for the rigid group; 25% of the non-rigid teeth had greater than 0.5 mm intrusion, compared with 12.5% for the rigid group. For the 2 time periods evaluated, there was no significant increase in intrusion over time. The non-rigid-side implant required more nonscheduled visits to treat problems than the rigid implant and the teeth. Discussion: Most patients were treated successfully with rigid or non-rigid attachment of implants to teeth. CONCLUSION: The high incidence of intrusion and non-scheduled patient visits suggest that alternative treatments without connecting implants to teeth may be indicated.     

Bacterial and yeast flora of root surface caries in elderly,ethnic Chinese

OBJECTIVES: Root caries is emerging as a significant problem in the middle aged and elderly. As little data is available on the microbiology of root caries in Chinese cohorts, we evaluated 30 such lesions in elderly, institutionalized, ethnic Chinese. METHODS: Samples of carious dentine were aseptically taken from root caries lesions of 18 subjects (five males and 13 females, mean age 79.67 +/- 8.57). The cultivable bacteria, both aerobic and anaerobic, were isolated and identified using standard methods and commercial identification kits. The yeasts were isolated on Sabouraud's agar and identified using the API system. RESULTS: The main findings were: (1) of the total isolates, 91.09% were Gram-positive and 8.91% were Gram-negative microorganisms; (2) the proportions of cocci and rods were 36.68 and 63.31%, respectively; (3) the predominant groups of organisms isolated were Streptococcus spp., Lactobacillus spp., Staphylococcus spp. and Actinomyces spp. with isolation frequencies of 100, 90.00, 73.33 and 63.33%, respectively; (4) the isolation frequency of yeasts belonging to Candida spp. (63.33%) was notably high although the proportion of yeasts within each sample was low (0.01%). Candida dubliniensis, a newly identified yeast species particularly prevalent in HIV infection, comprised 14.29% of yeasts. CONCLUSIONS: This study provides baseline information on the microbiologic features of root caries in the elderly, ethnic Chinese. Whilst our data on the most predominant bacteria isolated in root caries concur with those from other regions of the world the isolation of C. dubliniensis from these lesions has not been documented before.     

Lack of effect of chlorhexidine varnish on Streptococcus mutans transmission and caries in mothers and children

In a randomized clinical trial, we evaluated the effect of a 10% chlorhexidine varnish (Chlorzoin) on the mother-child transmission of Streptococcus mutans and on subsequent caries experience. Chlorhexidine (n = 38) or a placebo varnish (n = 37) was applied to the dentitions of 75 mothers at a time when their first babies were about 6 months old (approximate time of first tooth emergence). Three more applications at weekly intervals and subsequent applications at 6-month intervals followed the initial application. The mother-child pairs were followed up until the child's fourth birthday. Maternal salivary S. mutans levels in the treatment group remained significantly lower (p < 0.05) compared to the control group up to 12 months after the initial application. However, this intervention did not significantly alter the S. mutans colonization in children or the caries increment in either the mother or the child.     

Physiological properties of periodontal mechanosensitive neurones in the posteromedial ventral nucleus of rat thalamus

Unitary discharges of periodontal mechanosensitive (PM) neurones responding to mechanical tooth stimulation were recorded from the posteromedial ventral nucleus (VPM) of rat thalamus. PM neurones are distributed in the ventromedial area in the rostral two-thirds of the VPM nucleus. Maxillary and mandibular tooth-sensitive neurones are arranged in dorsoventral sequence. Of the PM neurones, 36% were slowly adapting to pressure applied to the tooth and 67% were rapidly adapting. The majority of PM units were sensitive to the contralateral incisor tooth. Response magnitudes of the slowly adapting neurones varied with stimulus direction and were directionally selective to mechanical tooth stimulation. The optimal stimulus direction was labiolingual or linguolabial. Rapidly adapting neurones were directionally non-selective to tooth stimulation. The threshold for mechanical stimulation was <0.05 N. Mean response latencies evoked by electrical stimulation of the peripheral receptive fields were 4.6 ms in the slowly adapting neurones and 5.8 ms in the rapidly adapting neurones.