The effects of systemic alendronate with or without intraalveolar collagen sponges on postextractive bone resorption: a single masked randomized clinical trial

Alendronate is a bisphosphonate frequently used to reduce bone resorption. It has been used for osteoporosis, Paget's disease, and also as adjunctive therapy for periodontal disease. The aim of this study was to evaluate the effect of systemic alendronate with or without endoalveolar collagen sponge on vertical bone resorption after lower wisdom tooth extraction. Forty patients referred for wisdom tooth impaction were selected. Before surgery, patients were randomly assigned to receive one of the following pharmacologic treatments: no medication (group 1), postextractive endoalveolar collagen sponge (group 2), systemic alendronate for 4 months starting the day of surgery (group 3), and group 2 + group 3 (group 4). Standardized orthopantomographic evaluation was obtained during recruitment (T1), immediately after surgery (T2), and 4 months (T3) to evaluate crestal and alveolar socket changes. Results indicate that at T2, crest and socket level did not show significant differences between the four groups. At T3, test sites treated showed less bone resorption compared with controls. In particular, higher vertical bone height levels and a faster intraalveolar healing were achieved in groups 3 and 4. Systemically given alendronate may be used successfully to reduce vertical bone resorption after wisdom tooth extraction.     

Influence of thermal and mechanical load cycling on microtensile bond strengths of total and self-etching adhesive systems

This study evaluated the influence of different thermal (TC) and mechanical (MC) cycling protocols on microtensile bond strength (muTBS) to cervical dentin margins of Class II restorations using two total-etch (TE) adhesives and one self-etching (SE) primer. Class II slot cavities were prepared on the mesial surfaces of 168 bovine incisors and were divided into three groups according to the bonding system used: Single Bond, OptiBond Solo Plus and Clearfil SE Bond. All cavities were restored with Filtek Z250 composite. Following restorative procedures, the restored teeth were allocated to seven subgroups (n = 8) according to the thermal/mechanical protocol performed: G1-control (no cycling), G2-100,000 MC, G3-200,000 MC, G4-500,000 MC, G5-100,000 MC+1,000 TC, G6-200,000 MC+1,000 TC, G7-500,000 MC+1,000 TC. TC was performed using 5 +/- 2 degrees C and 55 +/- 2 degrees C baths, with a dwell time of 60 seconds in each bath. MC was achieved with an axial force of 80 N at 2 cycles/second. The restorations were sectioned perpendicular to the cervical bonded interface into two 0.8-1-mm thick slabs. The slabs were trimmed at the interface to obtain a cross-sectional surface area of 0.8-1 mm2. All specimens were then subjected to muTBS (v = 0.5 mm/minute). Fracture mode analysis was performed using SEM. Bond strength mean values (MPa) were analyzed with ANOVA 3-way and Tukey's test (alpha = 5%). Dunnett's test was used to compare tested groups against Control groups of each adhesive system (alpha = 56%). SE primer presented lower mean bond strength values when compared to TE adhesives (p = 0.05). In addition, specimens restored with the SE primer did not resist to the 200,000 and 500,000 MC associated with TC. The application of 100,000 MC did not present a significant decrease in bond strength when compared to the control. Mixed failures were predominant for all groups. The higher the amount of thermal/mechanical cycles, the greater the number of mixed failures and the lower the percentage of adhesive failures.     

Rapid prototyping: a new method of preparing trays for indirect bonding.

This article describes a new method of preparing trays for indirect bracket bonding. Computer-aided technology is used to design the individualized trays, which are then produced with a rapid prototyping procedure. Application in clinical practice and the advantages of time savings and accurate bracket placement are discussed.     

Chlorhexidine's effect on sealing ability of composite restorations following Er:YAG laser cavity preparation

AIM: The aim of this study was to evaluate the influence of chlorhexidine on microleakage of composite restorations in class V cavities prepared with a carbide bur (CB) and a erbium:yttrium-aluminum-garnet (Er:YAG) laser. METHODS AND MATERIALS: Cavity preparations were created on the buccal surfaces of 48 bovine incisors using different methods then equally dividing them into four groups. Groups I and II were prepared with a #56 CB in a high speed handpiece while Groups III and IV were prepared with a Er:YAG laser at 350m J/4Hz on enamel and at 80.24 J/cm2 on dentin. The cavity preparations were rinsed with 2% chlorhexidine solution before the application of Clearfill SE Bond system and placement of a Z100 composite resin restoration. After 24 hours, the teeth were polished, thermocycled, and sealed with cosmetic varnish. The samples were then immersed in 2% methylene blue for four hours and sectioned in the buccolingual direction to determine the degree of microleakage. RESULTS: After statistical analysis (Kruskal-Wallis, p<0.05), no significant differences were verified among the tested groups and between the evaluated cervical or incisal margins of the restoration. CONCLUSION: The use of the chlorhexidine did not interfere with the adhesion process regardless of whether a CB or the Er:YAG laser were used to prepare class V cavities when restored with the tested self-etching adhesive system.     

The Lindblom roller.

Neuropathic pain is caused by injury of the peripheral or central nervous system. The neurological examination of the sensory system in neuropathic pain patients guides the anatomical localization of the injury. Among the sensory modalities to be tested, priority should be given to those subserved by small peripheral sensory fibers or by the spinothalamic tract that most commonly are abnormal in neuropathic pain patients. Testing of cold and warm perception was traditionally carried out in the clinic using tubes filled with water at different temperatures, a cumbersome method that has limited the routine examination of these sensory modalities. The Lindblom roller offers a practical and effective method of readily testing temperature perception and is among the best available clinical tools for delineating the anatomical boundaries of a sensory abnormality. Routinely use of the Lindblom roller shall be standard bedside clinical assessment of neuropathic pain patients. To exemplify this statement we describe two patients affected by complex and fluctuating painful sensory abnormalities caused by an extradural mass compressing the spinal cord. The level of the injury was readily localized with a roller kept at room temperature.