Clinical effects of electromagnetic stimulation as an adjunct to periodontal therapy

The clinical effects of electromagnetic stimulation (EMS) on periodontal soft tissues and alveolar bone level were studied among 23 patients. The sides of the arch to receive EMS were randomly selected and exposed for a period of eight weeks following periodontal surgery. The contralateral control sides received surgery only. The electromagnetic signal was a multiple pulse signal with 21 asymmetrical quasirectangular pulses per burst and a burst frequency of 16.9 Hz. The peak magnetic field strength reached 0.46 Gauss. Changes from baseline in clinical attachment level, probing depth, and radiographic alveolar bone level were assessed at six, 12, and 18 months postsurgically. A greater gain of clinical attachment level following EMS was observed only for pockets with initial depth of 1 to 3 mm. There were no consistent differences between test (EMS) and control sides in the change of clinical attachment level or probing depth for pockets deeper than 4 mm. Radiographically, the test sides demonstrated statistically significant gain of alveolar bone level compared with the control sides at six months following surgery. Hereafter, the rates of change were similar in the stimulated and unstimulated sides, and the total gain of alveolar bone level remained greater in the test side throughout the observation period. Within the limitations of this study, it was concluded that electromagnetic stimulation does not promote gains in clinical attachment or alveolar bone level to the extent that it can be recommended as an adjunct to conventional periodontal therapy.     

In vivo effects of a SnF2 gel on acid-softened enamel

The purpose of this investigation was to study the intra-oral rehardening of acid-softened enamel and fluoride uptake from SnF2 gel. Bovine enamel slabs were softened with 0.1 mol/L lactate buffer at pH 4.0 for 14 hrs and then mounted in a mandibular removable Hawley appliance. Control slabs were worn for 96 hrs by seven adult males whose teeth were brushed daily with a fluoride-free dentifrice. Test slabs were exposed once/day to 0.4% SnF2 gel. The gel was swabbed onto the slabs for one minute before being replaced in the mouth unrinsed. The natural dentition was brushed 4 X /day with a fluoride-free dentifrice. Microhardness testing was performed after intra-oral exposure (IOE) and after acid-resistance-testing (ART) following immersion in 0.01 mol/L lactate buffer for 24 hrs at pH of 4.0. Fluoride uptake was measured on separate controls, test slabs, and test slabs after ART, with 0.5 mol/L HClO4 etches of from 15 to 60 sec. The F content was measured with a F-ion-specific electrode and the phosphate content by spectrophotometry. Following IOE, microhardness recovery was 35.6% for control and 37.9% for test slabs, and control slabs retained 1.4% resistance to acid, as compared with 18.6% for the test slabs. The F content of control slabs was significantly less than that of SnF2-treated slabs from 5 to 60 micron in depth, and the F content of SnF2-treated slabs after ART was significantly less at depths of from 5 to 35 micron than that of SnF2-treated slabs not exposed to ART. Both control and SnF2 enamel slabs demonstrated rehardening after IOE, but only SnF2-treated enamel retained a significant fraction of that rehardening after ART.     

The use of panoramic radiography in the evaluation of asymptomatic adult dental patients

This article examines the efficacy of panoramic radiography alone and in combination with intraoral films as part of the "full-mouth" radiographic evaluation of asymptomatic dental patients in the diagnosis of dental caries and periodontal disease. Three full-mouth radiographic surveys--the panoramic alone, the panoramic plus posterior bitewing, and the periapical plus posterior bitewing--are compared. Two forms of measurement--comparative and incremental--were used to identify the radiographic survey with the highest single diagnostic yield when measured against the consensus standard. The findings show that the panoramic radiograph alone exhibits very low sensitivities to dental caries, ranging from 0.6% on anterior teeth to 25.6% on premolars. Even when posterior bitewing radiographs are added to the panoramic films, the sensitivities are significantly below those of the full-mouth periapical and bitewing survey. In contrast, the sensitivities of all three radiographic surveys in the diagnosis of periodontal disease are quite high, ranging from 87% to 96%, so that differences are not clinically significant. However, specificities tended to be low for periodontal disease and high for caries. Thus, for dental caries and (to a lesser extent) periodontal disease, the panoramic radiograph was inferior to the full-mouth intraoral series in its ability to correctly detect evidence of the disease.     

Oxygen distribution and consumption in rat lower incisor pulp

The aim was to determine the oxygen tension (P(O(2))) and rate of oxygen consumption in the pulp. Twelve rats were anaesthetised and artificially ventilated. Under an operating microscope, a recessed oxygen-sensitive microelectrode was inserted into the pulp through a small saline-covered cavity on the labial surface of the lower incisor. P(O(2)) was measured as a function of the transverse distance from the saline medium through to the middle of the pulp. Oxygen profiles were characterised by a decline of oxygen tension outside the pulp in the saline medium and a steeper gradient across the interface, before a localised oxygen consuming region corresponding to the odontoblasts. A plateau with some localised fluctuations was then followed by an increase in oxygen tension in the middle of the pulp. The average oxygen tension in the plateau region was 23.2 mmHg+/-2.1 mmHg (n=12). A mathematical model was used to extract oxygen consumption data from P(O(2)) profiles recorded from non-perfused pulp (created by reducing systemic blood pressure). The analysis revealed that there was a distinct oxygen consumption zone in the outer pulp, which anatomically corresponded to the odontoblast layer. The average oxygen consumption rate of the odontoblasts was 3.2+/-0.2 ml O(2)/min per 100g pulp tissue. The zone of high oxygen consumption was 68.7 micro m+/-6.9 micro m (n=24) thick. It is concluded that pulpal oxygen distribution is heterogeneous and that the odontoblast could be a major oxygen consumer within the rat incisor pulp.     

Resistance to maxillary premolar fractures after restoration of class II preparations with resin composite or ceromer.

OBJECTIVE: The aim of this study was to evaluate the resistance to fracture of intact and restored human maxillary premolars. METHOD AND MATERIALS: Thirty noncarious human maxillary premolars, divided into three groups of 10, were submitted to mechanical tests to evaluate their resistance to fracture. Group 1 consisted of intact teeth. Teeth in group 2 received mesio-occlusodistal cavity preparations and were restored with direct resin composite restorations. Teeth in group 3 received mesio-occlusodistal cavity preparations and were restored with ceromer inlays placed with the indirect technique. After restoration, teeth were stored at 37 degrees C for 24 hours and then thermocycled for 500 cycles at temperatures of 5 degrees C and 55 degrees C. RESULTS: Statistical analysis revealed that group 3 (178.765 kgf) had a significantly greater maximum rupture load than did group 1 (120.040 kgf). There was no statistically significant difference between groups 1 and 2 or between groups 2 and 3. CONCLUSION: Class II cavity preparations restored with indirect ceromer inlays offered greater resistance to fracture than did intact teeth. The fracture resistance of teeth restored with resin composite was not significantly different from that of either the ceromer or intact teeth.     

Location,arrangement and possible function of interodontoblastic collagen fibres in association with calcium hydroxide-induced hard tissue bridges

AIM: To assess the location, arrangement and possible function of interodontoblastic collagen fibres in association with calcium hydroxide-induced hard tissue bridges by using light and transmission electron microscopy techniques and immunohistochemical staining localization. METHODOLOGY: Prior to the study, an animal use protocol form was reviewed and approved by the Screening Committee for Animal Research of the Tokyo Medical and Dental University. Exposed monkey pulps were capped with a hard-set calcium hydroxide and histopathologically evaluated at 3, 14, 21, 30 and 90 days, using light microscopy with silver staining and transmission electron microscopy to differentiate structural features of interodontoblastic collagen fibres. In addition, an attempt was made to identify and to differentiate between several types of collagen and fibronectin using immunohistochemical localization techniques. RESULTS: At 14 days, interodontoblastic collagen fibres were observed extending from the original dentine, passing through the odontoblasts, and consisted of two portions: a thick fibril and a thin fibril. At 21 days, interodontoblastic collagen fibres were seen penetrating into the predentine and becoming incorporated into the mineralized dentine. At 30 days, interodontoblastic collagen fibres reached the cell process. Although interodontoblastic collagen fibres were no longer observed near the odontoblastoid cells at the area of the newly formed tubular dentine, interodontoblastic collagen fibres were observed embedded within the primary formed dentine bridge. Immunohistochemical staining demonstrated type I collagen and fibronectin within the interodontoblastic collagen fibres. CONCLUSIONS: Interodontoblastic collagen fibres were routinely detected throughout early dentine bridges. Interodontoblastic collagen fibres are thought to be important for initial dentine bridging to induce and support a dentinogenesis framework.     

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.