A new approach to define defect extensions of endodontically treated teeth: inter- and intra-examiner reliability

For endodontically treated teeth, there are no standardized measures available to define the extent of loss in tooth substance prior to final restoration. In this study, defect size was classified and the applicability of the classification was tested related to the inter- and intra-examiner reliability. For classification, three parameters were investigated: (i) remaining tooth substance in the vertical dimension (level A-D, aspect I), (ii) remaining tooth substance as regarded horizontally (mm; bucco-lingual and mesio-distal, aspect II), and (iii) size of the orifice (mm; aspect III). Four non-calibrated or (pre-trained) examiners were asked to gauge and classify 20 casts of clinically broken down teeth. The measurements were repeated twice every alternative week giving three separate readings. Inter-examiner reliability was determined at weeks 1, 3 and 5. The intra-examiner reliability was compared between readings 1 and 2, 1 and 3, and 2 and 3. As statistical tests, intra-class correlation (ICC) and Cohen's kappa (weighted) were used at a significance level of P < 0.05. Inter- and intra-examiner reliability for ordinal data (aspect I) revealed, with one exception, 'moderate' to 'very good' evaluations. Inter- and intra-examiner reliability (ICC) of metric data of aspect II and III was primarily 'excellent'. It may be concluded that the newly developed classification could be applied as an appropriate and reproducible method to define defect extension in endodontically treated teeth.     

Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures Part II: high condylar and condylar head fractures

This study prospectively evaluated closed reduction (CR) outcomes in non-displaced, non-dislocated high-condylar and condylar-head fractures (Class VI after Spiessl and Schroll) and open reduction and internal fixation (ORIF) of displaced (Class III) or dislocated (Class V) fractures. Thirty-eight patients with 54 fractures (16 (42%) with bilateral fractures, 14 (37%) CR, 24 (63%) ORIF) were enrolled in a 1 year follow-up that 18 patients with 33 fractures completed. Condylar translation in Class VI fractures recovered to 11 mm for vertical opening, 8mm for protrusion and 10 mm for mediotrusion; Class III synonymously 8 mm, 8 mm and 6 mm; and Class V 7 mm, 6mm and 7 mm; incisal movements recovered to 38 mm, 8 mm and 8 mm in Class VI; 55 mm, 7 mm and 10 mm in Class III with 1 (8%) malocclusion, 1 (8%) impaired vertical opening and 55 mm, 7 mm and 9 mm in Class V with 2 (18%) malocclusions. Fragment-reduction versus the non-fractured condyle was -0.3 mm to +1.3 mm and +3 degrees to +9 degrees in Class VI, -1 mm to -0.2 mm and +3 degrees to +2 degrees in Class III, -3.3 mm to +3.1 mm and -11.2 degrees to +1 degrees in Class V. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. Joint movements were within normal range at 1-year follow-up except Classes III and V vertical opening translation. After predefined criteria, 92% successful outcomes were attained. Multiple factor analysis should be used to prospectively evaluate the unacceptable clinical outcomes. Class VI fractures with intact vertical support should prospectively be evaluated whether these benefit from ORIF.     

Rosiglitazone reduces the evolution of experimental periodontitis in the rat

The peroxisome proliferator-activated receptor-gamma (PPAR-gamma) receptor appears to play a pivotal role in the regulation of cellular proliferation and inflammation. Recent evidence also suggests that rosiglitazone, a PPAR-gamma agonist, reduces acute and chronic inflammation. We hypothesized that rosiglitazone would attenuate periodontal inflammation. In the present study, we investigated the effects of rosiglitazone in a rat model of ligature-induced periodontitis. At day 8, ligation significantly induced an increase in neutrophil infiltration, as well as of gingivomucosal tissue expression of iNOS, nitrotyrosine formation, and poly (ADP-ribose) polymerase activation. Ligation significantly increased Evans blue extravasation in gingivomucosal tissue and alveolar bone destruction. Intraperitoneal injection of rosiglitazone (10 mg/kg 10% DMSO daily for 8 days) significantly decreased all of the parameters of inflammation, as described above. Analysis of these data demonstrated that rosiglitazone exerted an anti-inflammatory role during experimental periodontitis, and was able to ameliorate the tissue damage associated with ligature-induced periodontitis.     

Synthetic, pure-phase beta-tricalcium phosphate ceramic granules (Cerasorb) for bone regeneration in the reconstructive surgery of the jaws

The aim of this study was to investigate the long-term effect of the ceramic beta-tricalcium phosphate (beta-TCP) at different sites of alveolar reconstruction and to evaluate its properties. From 1997 to 2002, beta-TCP was implanted as bone substitute in 152 patients using a standardized study protocol. Main indications were the filling of large mandibular cysts (n=52), secondary and tertiary alveolar cleft grafting (n=38), periodontal defects (n=24) and maxillary sinus floor augmentation (n=16). For defects exceeding 2cm in diameter, beta-TCP was combined with autologous bone taken from the retromolar area, the maxillary tuberosity or the chin region. A radiological, clinical and ultrasonographical examination was carried out 4, 12 and 52 weeks postoperative. In 16 cases, biopsies were taken after 12 months indicating complete bony regeneration. While wound-healing disturbances occurred in 9.2% of cases, partial loss of the bone substitute material was found in 5.9%, while total loss occurred in only 2%. Complete radiological replacement of beta-TCP by autologous bone was found after approximately 12 months, indicating its osteoconductive properties. Because of its versatility, low complication rate and good long-term results, synthetic, pure-phase beta-TCP is a suitable material for the filling of bone defects in the alveolar region.