Bacteriological studies on endodontic paper points

Four brands of endodontic paper points were subjected to tests for sterility, antibacterial activity, and suitability as vehicles for bacteriological sampling procedures. No brand showed growth in the sterility assay. One brand showed weak but reproducible antibacterial activity. Recovery of viable bacteria after absorption into the points varied and appeared to depend both on the brand of point and on the bacterial strain used. One brand appeared ineffectual for clinical bacteriological sampling procedures.     

Colonization of the human oral cavity by a strain of Streptococcus mutans

Streptococcus mutans strain JH1001 produces a bacteriocin that can kill virtually all other strains of this micro-organism. The ability of JH1001 to colonize the human oral cavity was tested in a study involving five subjects and three different infection regimens, all of which involved multiple exposures to large numbers of organisms. Two and one-half years after infection, JH1001 was found to have persistently colonized three of the subjects. The indigenous S. mutans in one subject were reduced below the level of detection. Levels of (total) S. mutans and S. sanguis were not affected in persistently colonized subjects. Mutants of indigenous S. mutans resistant to the bacteriocin were not observed. The results indicate the importance of host variability and infection regimen for superinfection by this strain of S. mutans. The efficient replacement of indigenous S. mutans by JH1001 in one subject lends support to the eventual application of replacement therapy to the prevention of dental caries.     

The relationships between streptococcal species and periodontopathic bacteria in human dental plaque

The existence of antagonistic and commensal relationships between microorganisms was investigated. The predominant cultivable flora in 172 plaque samples from active and non-active sites in 32 human subjects with destructive periodontitis was determined. The presence of putative periodontopathic organisms (Bacteroides gingivalis, Bacteroides intermedius, Bacteroides forsythus, Wolinella recta, Actinobacillus actinomycetemcomitans, and Eikenella corrodens) in a site was correlated with the absence of certain viridans streptococci (Streptococcus sanguis, Streptococcus uberis and Streptococcus intermedius), and vice versa. A strong commensal relationship was found between B. gingivalis and Strep. intermedius. The second study involved 3 subjects with intractable periodontitis whose plaque harboured large numbers of one or more of these periodontopathic organisms. This plaque contained fewer organisms capable of inhibiting the growth of the periodontopathic strains in vitro when compared with a clinically-healthy control subject. Intermediate levels of inhibitors were found in plaque taken from non-active lesions. The majority of inhibitors in plaque from the healthy control were viridans streptococci. Hydrogen-peroxide production by these organisms appears to be the principal mechanism of growth inhibition for periodontopathic organisms. Bacterial interactions may thus be causally related to both periodontal health and disease.     

Non-surgical treatment of peri-implant pathology

Abstract:  Introduction:  Peri-implant pathologies consist of an inflammatory process affecting the soft and hard tissues surrounding the implants. Chlorhexidine is considered the gold standard antiseptic, with a large variety of choice in administration. In this study, a protocol for the irrigation of peri-implant pockets with a chlorhexidine gel, using a plastic needle for the delivery of the product into the peri-implant pockets is described. Study participants and methods:  Nine patients with at least one implant presenting peri-implant pathology (inflamed soft tissue associated with bone loss around the implant) were enrolled in this prospective clinical study, and followed-up for 1 year, where clinical parameters such as modified plaque index, modified bleeding index, probing pocket depths, attachment levels were assessed at baseline, 1 month, and 1 year after implementation of the treatment protocol. Results:  Treatment success was achieved in eight of the nine patients (and in 11 of the 13 implants) according to the success criteria adopted by the authors of this study. Discussion:  Infection control lies at the heart of peri-implant treatment. The control of three factors such as optimal diagnosis, removal of the aetiological factor of the disease (proper removal of debris and decontamination of the peri-implant sulcus/pocket) and a good patient's oral hygiene self-care represents the key to success, resulting in good treatment outcomes when managing peri-implant pathologies. The protocol used (irrigation of peri-implant pockets with chlorhexidine gel delivered by a plastic needle) is considered to be of utility.     

In vitro evaluation of endodontic debris removal as obtained by rotary instrumentation coupled with ultrasonic irrigation

The cleaning capacity of rotary Ni-Ti instrumentation using Profile GT files, coupled with irrigation energised by ultrasound, was evaluated. Thirty-six human mandibular incisors were instrumented in vitro using the crown-down technique with the Profile GT system to 1 mm from the anatomical apex to a size 30.04 taper file. The instrumented teeth were then divided randomly into four groups where various final irrigations were used: Group I: 100 ml of 1% NaOCl with a Luer-Lok syringe (control group); Group II, Group III and Group IV: final irrigation with 100 ml of 1% NaOCl energised by ultrasound for 1, 3 and 5 min, respectively. After biomechanical preparation, the apical thirds of the roots were submitted to histological processing and examination. The specimens were analysed at 40x magnification and the images submitted to morphometric analysis with an integration grid. anova showed a statistically significant difference (P < 0.01) between the irrigation techniques. Group I (Luer-Lok syringe) showed the highest percentage of debris (35.81 +/- 4.49) and was statistically different from the other groups energised by ultrasound: Group II (27.28 +/- 4.49), Group III (24.39 +/- 5.72) and Group IV (18.46 +/- 5.25). It was concluded that rotary instrumentation using Ni-Ti files associated with final irrigation of 1% NaOCl energised by ultrasound leads to better debris removal from the apical third of mesio-distally flattened root canal.     

Absence of sustained effects of acute fluoride exposure on cyclic AMP levels in the adult rat.

Previously published results from studies of the in vivo effects of fluoride on cyclic AMP are contradictory. Because of the important physiological role of cyclic AMP as a "second messenger" in numerous metabolic processes, it was important to clarify the effect of fluoride on cyclic AMP. This study was designed to monitor cyclic AMP levels in the plasma, liver and kidney of rats at intervals of 0.5, 4 and 24 hours following acute intraperitoneal or intubated treatment with a single dose of 15 mg fluoride/kg and to relate cyclic AMP levels to plasma and tissue fluoride concentrations determined at the same time.     

Temporomandibular joint dysfunction syndrome: a close association with systemic joint laxity (the hypermobile joint syndrome)

Sixty-two patients admitted for elective reconstructive surgery of the temporomandibular joint (TMJ) and eight seen as outpatients with a chief complaint of TMJ dysfunction during the same time interval were evaluated for possible etiologic factors contributing to the disease. All hospitalized patients had severe, end-stage degenerative changes within the TMJ, whereas outpatients had less severe disease and did not require surgery. TMJ dysfunction in some patients was said to be a result of established causes including bruxism, malocclusion, and trauma. No patient in this series had evidence of a systemic inflammatory polyarthritis. Of the 70 patients, 38 (54%) met criteria, based on those of Carter and Wilkinson, as modified by Beighton et al., sufficient to warrant a diagnosis of the hypermobile joint syndrome. Five patients had classic Ehlers-Danlos syndrome and therefore were not patients with "benign hypermobility," and an additional two cases were described as "marfanoid" and as possible Ehlers-Danlos syndrome, respectively. Radiographs showed TMJ hyperextensibility in four hypermobile patients. Long-term surgical outcome was identical in the hypermobile and nonhypermobile groups. The incidence of hypermobility in this series is strikingly higher than the expected incidence in an otherwise population. Magnetic resonance images of the TMJs on separate groups of asymptomatic normal and hypermobile women identified excessive anterior movement in the hypermobile group, together with abnormal anterior disk position in some. We hypothesize that hypermobility within the TMJ may cause accelerated disk destruction and degenerative disease.     

Capitation and indemnity in dental insurance.

The literature reviewed over the past year indicates several new trends in the area of health care capitation and indemnity third-party coverage. These trends point toward an increase in capitation and managed care and a decrease in traditional indemnity insurance. As employers seek to control all types of health care costs, they will also require employees to take care of a larger portion of the bill. As managed care plans increase, there will be a new emphasis on methods of plan evaluation. Cost will cease to be the only consideration. As quality comes into greater focus, there will be a need to define quality care in objective terms. Parameters of care will be needed as well as performance standards. Providers will be put increasingly at financial risk as managed care administrators seek to reduce provider numbers and control utilization. Capitated dental care is not as prevalent nationwide as is capitated medical care. Developments in general health care will influence how widespread it will become in the next decade.     

Predictable seating of the single-unit cast restoration

Prior to cementation, a cast restoration must be clinically evaluated in a number of critical areas. The proximal contacts and internal surface of the casting, as well as centric and excursive occlusion, require assessment and generally require adjustment before cementation. The time necessary to accomplish these adjustments is not predictable. A technique is presented that permits the majority of these adjustments to be completed in the laboratory, thus minimizing the clinical time required to seat the casting.     

Reconstruction of the defect at the donor site of the temporalis muscle flap

A method for the immediate correction of the defect created at the donor site of the temporalis muscle flap is described. It uses a performed acrylic prosthesis. A case is presented in which the prosthesis could have been used to good effect, and two cases are reported to show the successful use of this technique.