A scoping review of root canal revascularization: relevant aspects for clinical success and tissue formation

The aim of this scoping study was to evaluate the survival rate and nature of tissue formed inside root canals of human immature permanent teeth with necrotic pulps (NIPT) under root canal revascularization (RCR). The search was performed in SciVerse Scopus®, PubMed/MEDLINE, Web of Science®, BIREME and in the grey literature up to November 2015. The keywords were selected using MeSH terms and DECs. Two independent reviewers scrutinized the records obtained considering specific inclusion criteria. The included studies were evaluated in accordance with a modified Arksey and O’ Malley's framework. From 375 studies that were evaluated, 75 were included. A total of 367 NIPT were submitted to RCR, from which only 21 needed further endodontic treatment. The weighted mean follow‐up time was 17.6 months. The data were derived mainly from case reports (69%) or small case series (15%). NaOCl [0.5–6%] was applied as the disinfecting solution in almost all studies. Triple antibiotic paste was as effective as Ca(OH)₂ as on intracanal medicament. De novo tissue was cementum and poorly mineralized bone positive to bone sialoprotein (BSP) but negative to dentine sialoprotein (DSP). Failures were associated mainly with reinfection of the root canal. The majority of included studies reported a significant increase in both root length and width. However, as most of these data came from case reports, they must be interpreted with care, as most were focused on treatment successes (not failures). Therefore, well‐designed randomized controlled trials comparing RCR with available apexification treatments are needed to address this gap in the literature.     

Construction, expression, and immunogenicity of the Schistosoma mansoni P28 glutathione S-transferase as a genetic fusion to tetanus toxin fragment C in a live Aro attenuated vaccine strain of Salmonella.

A vector has been constructed to allow genetic fusions of guest antigens via a hinge domain to the C terminus of the highly immunogenic C fragment of tetanus toxin. A fusion has been constructed with the gene encoding the protective 28-kDa glutathione S-transferase (EC 2.5.1.18) from Schistosoma mansoni. The recombinant vector has been electroporated into the nonvirulent Salmonella typhimurium aroA live vaccine strain SL3261. The corresponding chimeric protein is stably expressed in a soluble form in Salmonella as evaluated by Western blotting with fragment C and glutathione S-transferase antisera. Mice immunized intravenously with a single dose of the live recombinant bacteria elicit antibodies to both fragment C and glutathione S-transferase as detected by enzyme-linked immunosorbent assays. Furthermore, all of the mice were solidly protected when challenged with lethal doses of either tetanus toxin or the virulent Salmonella typhimurium strain C5. Mice have also elicited antibodies to fragment C and glutathione S-transferase after oral immunization. It may be that a live trivalent vaccine against typhoid, tetanus, and schistosomiasis is feasible.     

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

Introduction

Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, ‘persistent disease’ is defined as the situation where the patient has not been cured by the first operation. The term ‘recurrent hyperparathyroidism’ is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence.

Methods

Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation.

Results

Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease.

Conclusions

Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate.     

Clinical studies in restorative dentistry: New directions and new demands

Clinical research of restorative materials is confounded by problems of study designs, length of trials, type of information collected, and costs for trials, despite increasing numbers and considerable development of trials during the past 50 years. This opinion paper aims to discuss advantages and disadvantages of different study designs and outcomes for evaluating survival of dental restorations and to make recommendations for future study designs. Advantages and disadvantages of randomized trials, prospective and retrospective longitudinal studies, practice-based, pragmatic and cohort studies are addressed and discussed. The recommendations of the paper are that clinical trials should have rational control groups, include confounders such as patient risk factors in the data and analysis and should use outcome parameters relevant for profession and patients.     

Mothers who silence themselves: a concept with clinical implications for women living with HIV/AIDS and their children

The number of women newly infected with the human immunodeficiency virus (HIV) continues to rise. Women living with HIV or the acquired immunodeficiency syndrome (AIDS) are often mothers who deal with the unenviable task of balancing the stigma and physical needs of illness with the needs of their families and, in particular, their children (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). This article addresses both the communication style and subsequent concept identified in women living with HIV/AIDS called "silencing the self," and the clinical implications for pediatric nurses who support and offer family-centered care to their patients. Mothers living with HIV/AIDS, often view the needs of the children primary as they deal with the trajectory of their own illness. In doing this, they effectively "silence" their own needs and may actually put their own psychosocial and physical needs in abeyance. It is critical that nurses in pediatric practice consider how to tangibly assess, refer, and educate mothers who silence their own needs in the process of providing care for their children.     

The influence of haemostatic agents on healing of healthy human dental pulp tissue capped with calcium hydroxide

AIM: To investigate the hypothesis that different haemostatic agents could impair the histological response of human pulps capped with calcium hydroxide. METHODOLOGY: Forty-five third molars scheduled for extraction were selected. Class I cavities with pulp exposures were prepared. Three agents were used to control bleeding: 0.9% saline solution (control, n = 14), 5.25% sodium hypochlorite (n = 16) and 2% chlorhexidine digluconate (n = 15). The pulps were dressed with hard-setting calcium hydroxide cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed and prepared for histochemical techniques. The biological response was categorized using the following criteria: inflammatory response, soft tissue organization, reactionary dentine and reparative dentine. Data were submitted to statistical analysis, using nonparametric Kruskal-Wallis one-way analysis of variance on ranks. Differences amongst groups were detected using Dunn's method. RESULTS: The statistical analysis disclosed that whilst inflammatory response decreased over time, reactionary dentine deposition and reparative dentine formation increased in the latter periods of evaluation (P < 0.05). The three agents had similar performances for all criteria evaluated. The conventional pulp response to calcium hydroxide was observed over time, and complete pulp healing was observed in 88% of the specimens after 90 days. CONCLUSION: The three haemostatic agents did not impair the healing process following pulp exposure and capping with calcium hydroxide at different time intervals investigated.     

Cervical microleakage in MOD restorations: in vitro comparison of indirect and direct composite

This study compared microleakage between indirect composite inlays and direct composite restorations. Forty-eight standard inlay MOD cavities, with cervical margins located either in enamel or dentin, were prepared in extracted human third molars. The specimens were randomly divided into 3 groups (n=16). In the control group, the cavities were restored with the composite Filtek Z250 (3M ESPE). For the experimental groups, indirect restorations were made with the Artglass (Heraeus-Kulzer) or Belleglass HP (Kerr Laboratories) systems and cemented with the dual curing cement RelyX ARC (3M ESPE). The adhesive system Single Bond (3M ESPE) was applied on all groups. The specimens were submitted to thermolcycling, coated with nail varnish, then immersed in 2% basic fuchsine aqueous solution for 24 hours. The teeth were then sectioned and leakage scores were evaluated (40x), based on a standard ranking. Data were submitted to statistical analysis (Mann-Whitney and Kruskal-Wallis tests) with a 95% confidence level. No statistical difference was found between substrates (p=0.595), and the materials performed similarly in dentin (p=0.482). Direct restorations showed higher leakage than indirect restorations at the enamel margins (p=0.004). Within the limitations of this experimental design, overall leakage was similar between both substrates, while the indirect systems provided a better sealing than direct composites only in enamel.     

Immunohistochemical expression of fibronectin and tenascin after direct pulp capping with calcium hydroxide

The aim of this study was to investigate the expression of 2 extracellullar matrix glycoproteins, fibronectin (FNC) and tenascin (TNC), following direct pulp capping with calcium hydroxide (CH). Third molars scheduled for extraction were used. Standardized class I cavities with pulp exposures were prepared. After control of bleeding, CH powder was applied in the exposure sites, which were covered with CH cement (Dycal; Dentsply) and the cavities were filled with zinc oxide-eugenol cement. Three teeth were extracted at each post-treatment period (1, 7, 14, and 30 days). Demineralized and paraffin-embedded specimens were stained for histologic technique (hematoxylin-eosin) and for immunohistochemical analysis. Anti-TNC and anti-FNC monoclonal antibodies were used with the streptavidin-biotin complex method. Generally, similar patterns of immunohistochemical expression were observed for TNC and FNC in the pulp tissue as a whole. In the exposure site, TNC immunostaining increased over time, exhibiting a thicker immunostaining pattern within 30 days. The imunohistochemical technique showed expression of both glycoproteins during pulp healing process.     

Microleakage of seven adhesive systems in enamel and dentin

AIM: The aim of this study was to evaluate the microleakage of seven adhesive systems on two substrates (enamel and dentin). METHODS AND MATERIALS: Class V cavities were performed in buccal and lingual surfaces of 56 bovine incisors. The cervical margin was located in dentin and the incisal margin in enamel. The specimens were randomly divided into seven groups (n=16), according to the adhesive system employed: Single Bond; Excite; One Step Plus; Gluma One Bond; Magic Bond; One Up Bond F; and One Coat Bond. The cavities were incrementally filled with a hybrid composite Filtek Z250 and polymerized with a XL 3000 light curing unit. After polishing, the specimens were submitted to thermal cycling followed by dye immersion. Leakage was evaluated under magnification (40X) based on a standard ranking. Data were subjected to statistical analysis (Kruskal-Wallis). RESULTS: Enamel margins exhibited lower leakage than dentin margins (p<0.01). The majority of the specimens were leakage-free and materials performed similarly. Conversely, in dentin most of the specimens exhibited the highest leakage degree and significant differences among materials (p<0.05) were found, with Excite exhibiting the lowest leakage degree. It was concluded enamel provided better sealing and the adhesive system was a significant factor only in dentin.