A new periapical index based on cone beam computed tomography

The purpose of this study was to evaluate a new periapical index based on cone beam computed tomography (CBCT) for identification of apical periodontitis (AP). The periapical index proposed in this study (CBCTPAI) was developed on the basis of criteria established from measurements corresponding to periapical radiolucency interpreted on CBCT scans. Radiolucent images suggestive of periapical lesions were measured by using the working tools of Planimp software on CBCT scans in 3 dimensions: buccopalatal, mesiodistal, and diagonal. The CBCTPAI was determined by the largest lesion extension. A 6-point (0-5) scoring system was used with 2 additional variables, expansion of cortical bone and destruction of cortical bone. A total of 1014 images (periapical radiographs and CBCT scans) originally taken from 596 patients were evaluated by 3 observers by using the CBCTPAI criteria. AP was identified in 39.5% and 60.9% of cases by radiography and CBCT, respectively (P < .01). The CBCTPAI offers an accurate diagnostic method for use with high-resolution images, which can reduce the incidence of false-negative diagnosis, minimize observer interference, and increase the reliability of epidemiologic studies, especially those referring to AP prevalence and severity.     

CLEANING ABILITY OF CHLORHEXIDINE GEL AND SODIUM HYPOCHLORITE ASSOCIATED OR NOT WITH EDTA AS ROOT CANAL IRRIGANTS: A SCANNING ELECTRON MICROSCOPY STUDY

The aim of this study was to evaluate the cleaning efficacy of 2% chlorhexidine gluconate gel (CHX) compared to 2.5% sodium hypochlorite solution (NaOCl) associated or not with 17% EDTA used as irrigants during the biomechanical preparation. Fifty freshly extracted single-rooted human teeth with complete apex formation were randomly divided into five groups: G1 - sterile saline, G2 - 2.5% NaOCl, G3 - 2% CHX, G4 - 2.5% NaOCl + EDTA and G5 - 2% CHX + EDTA. The specimens of G1 were subdivided into two control groups. The teeth were decoronated and the coronal and middle root thirds were prepared with Gates-Glidden burs, and the apical third was reserved to manual instrumentation. All procedures were performed by a single operator. In all groups, 2 mL of irrigant was delivered between each file change. The teeth were sectioned and prepared for analyses under scanning electron microscopy (SEM). SEM micrographs were graded according to a score scale by two examiners. Data were analyzed statistically by Kruskal-Wallis and Dunn tests at 1% significance level. The best results were obtained in the groups in which the irrigant was used followed by the chelating agent. No statistically significant difference was observed among G4, G5 and the positive control group (p<0.01). The groups G2 and G3 were significantly different from the others, presenting the worst cleaning capacity. In conclusion, the use of the chelating agent is necessary to obtain clean canal walls, with open tubules and no heavy debris. The use of 2% chlorhexidine gluconate gel alone is not able to remove the smear layer.     

Alternative adhesive strategies to optimize bonding to radicular dentin

This study tested the hypothesis that bond strengths of filling materials to radicular dentin might be optimized by using an indirect dentin bonding procedure with an acrylic core material. Roots of human teeth were endodontically prepared and obturated with EndoREZ, Epiphany, or the bonding of an acrylic point with SE Bond by using a direct or an indirect bonding technique. Bond strengths of endodontic sealers to radicular dentin were measured with a thin slice push-out test. Push-out strengths of EndoREZ and Epiphany to radicular dentin were less than 5 megapascals (MPa). The direct bonding technique with acrylic points and the self-etching adhesive had push-out strengths of 10 MPa, increasing to 18 MPa with the indirect technique. The use of the indirect bonding protocol with an acrylic point to compensate for polymerization stresses appears to be a viable means for optimizing bond strengths of endodontic filling materials to radicular dentin.     

Effect of different surface treatments on In-Ceram Alumina roughness. An AFM study

Objectives

The aim of this study was to evaluate the influence of different treatments on the surface roughness of In-Ceram Alumina (VITA, Säckingen, Germany).

Methods

The ceramic blocks were polished (4000 grit) and sandblasted (SB) with airborne particle abrasion Al₂O₃; 110 μm particle size; 2.8 bar; 20 s. The following treatments were performed: (1) no treatment; (2) Rocatec System (RC): after SB treatment, sandblasting with silica powder; 30 μm particle size; 2.8 bar; 20 s. (3) Neodymium:yttrium–aluminium–garnet (Nd:YAG) laser (ND) application of graphite powder (stain) on the ceramic surface and Nd:YAG laser irradiation (distance: 1 mm, 100 mJ, 20 Hz, 2 W, and 141.54 J/cm²). (4) Nd:YAG laser plus Rocatec System: after ND treatments, RC was applied. Digital images (20 μm × 20 μm) from the surfaces were obtained by means of an AFM microscope in taping mode (Nanoscope IIIa, Digital Instruments). Roughness was measured in 10 μm × 10 μm boxes. Roughness (R_a) data (nm) were analyzed by one-way ANOVA (p < 0.05).

Results

No differences in ceramic surfaces roughness occurred after any of the tested treatments (p = 0.54).

Conclusions

High-alumina ceramic surface roughness was not increased with any of the tested treatments.     

Comparison of different methods involved in the planning of clinical crown lengthening surgery

There is little material in the literature that compares biological width measurements in periapical and bite-wings radiographs with clinical measurements. The purpose of this study was to compare measurements of biological width taken by three different methods which are frequently used for planning periodontal surgery - periapical radiograph, bite-wing radiograph and transperiodontal probing - with the trans-surgical measurements. Thirty-four sites from twenty-one subjects were analyzed. The intra-class correlation coefficients between measurements obtained trans-surgically (gold standard) and those obtained by transperiodontal probing, periapical radiography and bite-wing radiography were determined. Average measurements were compared using the Wilcoxon test at a significance level of 0.05. Also, the frequency distribution of differences between test measurements and the gold standard was calculated. The results showed that transperiodontal probing (mean 2.05 mm) was the most accurate measurement, as compared to the gold standard (mean 1.97 mm), with no statistically significant difference observed. On the other hand, periapical and bite-wing radiographic mean values (1.56 mm and 1.72 mm, respectively) were smaller than the gold standard, with statistically significant differences (p < 0.05). It was concluded that transperiodontal probing was the most accurate measurement, as compared to the gold standard, followed by that obtained with the bite-wing radiograph. The clinical relevance of these results could be that planning for crown lengthening surgery should, preferably, include transperiodontal probing.     

Early loading of machined-surface Brånemark implants in completely edentulous mandibles: healed bone versus fresh extraction sites

Background: Restoration of edentulous mandibles with dental implants installed with a two‐stage or one‐stage surgical approach, yet with delayed loading, is a predictable and successful treatment. Purpose: The present prospective study evaluated the success up to 3 years of function of nonroughened machined‐surface Brånemark System implants (Nobel Biocare AB, Gothenburg, Sweden) loaded early or immediately with a fixed 12‐unit bridge. Materials and Methods: In total, 184 implants were installed in 36 patients:30 with healed bone and 6 with some remaining teeth, which were extracted simultaneously with implant installation. The provisional or final prostheses were installed 0 to 52 (mean 18.2) days later. Results: Thirteen of 184 (7.1%) implants failed within 3 months of loading in 5 of 36 (13.9%) patients:1 of 153 implants (0.7%) failed in healed bone, and 12 of 31 (39%) failed in fresh extraction sites. This consequently meant a loss of 3 of 36 (8.3%) prostheses, all in the extraction group. No implants were lost during 3 years of functional loading (16 patients, 75 implants). The average marginal bone level measured initially and after 1, 2, and 3 years was 0.8 mm (SD = 0.5), 1.0 mm (SD = 0.4), 1.1 mm (SD = 0.3), and 1.4 mm (SD = 0.5), respectively. Conclusions: Four to six Brånemark implants with nonroughened machined titanium surfaces can be loaded early or immediately with cross‐arch restorations in healed mandibulary bone, but this cannot be recommended for fresh extraction sites.     

Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for Treatment of Leaks Following Sleeve Gastrectomy

Background

Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved.

Methods

In 21 pts (18 F, 41 years), one or two plastic pigtail stents were delivered across the leak 25.6 days (4–98) post-surgery. In all patients, nasojejunal tube was inserted. Check endoscopy was done at 4 to 6 weeks with either restenting if persistent leak, or removal if no extravasation of contrast in peritoneal cavity, or closure with an Over-the-Scope Clip® (OTSC®) if contrast opacifying the crossing stent without concomitant peritoneal extravasation.

Results

Twenty-one out of 21 (100 %) patients underwent check endoscopy at average of 30.15 days (26–45) from stenting. In 7/21 (33.3 %) patients leak sealed, 2/7 needed OTSC®. Second check endoscopy, 26.7 days (25–42) later, showed sealed leak in 10 out 14; 6/10 had OTSC®. Four required restenting. One patient, 28 days later, needed OTSC®. One healed at 135 days and another 180 days after four and seven changes, respectively. One patient is currently under treatment. In 20/21 (95.2 %), GL have healed with EID treatment of 55.5 days (26–?180); all are asymptomatic on a normal diet at average follow-up of 150.3 days (20–276).

Conclusions

EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required.