A new approach to define defect extensions of endodontically treated teeth: inter- and intra-examiner reliability

For endodontically treated teeth, there are no standardized measures available to define the extent of loss in tooth substance prior to final restoration. In this study, defect size was classified and the applicability of the classification was tested related to the inter- and intra-examiner reliability. For classification, three parameters were investigated: (i) remaining tooth substance in the vertical dimension (level A-D, aspect I), (ii) remaining tooth substance as regarded horizontally (mm; bucco-lingual and mesio-distal, aspect II), and (iii) size of the orifice (mm; aspect III). Four non-calibrated or (pre-trained) examiners were asked to gauge and classify 20 casts of clinically broken down teeth. The measurements were repeated twice every alternative week giving three separate readings. Inter-examiner reliability was determined at weeks 1, 3 and 5. The intra-examiner reliability was compared between readings 1 and 2, 1 and 3, and 2 and 3. As statistical tests, intra-class correlation (ICC) and Cohen's kappa (weighted) were used at a significance level of P < 0.05. Inter- and intra-examiner reliability for ordinal data (aspect I) revealed, with one exception, 'moderate' to 'very good' evaluations. Inter- and intra-examiner reliability (ICC) of metric data of aspect II and III was primarily 'excellent'. It may be concluded that the newly developed classification could be applied as an appropriate and reproducible method to define defect extension in endodontically treated teeth.     

Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures Part II: high condylar and condylar head fractures

This study prospectively evaluated closed reduction (CR) outcomes in non-displaced, non-dislocated high-condylar and condylar-head fractures (Class VI after Spiessl and Schroll) and open reduction and internal fixation (ORIF) of displaced (Class III) or dislocated (Class V) fractures. Thirty-eight patients with 54 fractures (16 (42%) with bilateral fractures, 14 (37%) CR, 24 (63%) ORIF) were enrolled in a 1 year follow-up that 18 patients with 33 fractures completed. Condylar translation in Class VI fractures recovered to 11 mm for vertical opening, 8mm for protrusion and 10 mm for mediotrusion; Class III synonymously 8 mm, 8 mm and 6 mm; and Class V 7 mm, 6mm and 7 mm; incisal movements recovered to 38 mm, 8 mm and 8 mm in Class VI; 55 mm, 7 mm and 10 mm in Class III with 1 (8%) malocclusion, 1 (8%) impaired vertical opening and 55 mm, 7 mm and 9 mm in Class V with 2 (18%) malocclusions. Fragment-reduction versus the non-fractured condyle was -0.3 mm to +1.3 mm and +3 degrees to +9 degrees in Class VI, -1 mm to -0.2 mm and +3 degrees to +2 degrees in Class III, -3.3 mm to +3.1 mm and -11.2 degrees to +1 degrees in Class V. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. Joint movements were within normal range at 1-year follow-up except Classes III and V vertical opening translation. After predefined criteria, 92% successful outcomes were attained. Multiple factor analysis should be used to prospectively evaluate the unacceptable clinical outcomes. Class VI fractures with intact vertical support should prospectively be evaluated whether these benefit from ORIF.     

Synthetic, pure-phase beta-tricalcium phosphate ceramic granules (Cerasorb) for bone regeneration in the reconstructive surgery of the jaws

The aim of this study was to investigate the long-term effect of the ceramic beta-tricalcium phosphate (beta-TCP) at different sites of alveolar reconstruction and to evaluate its properties. From 1997 to 2002, beta-TCP was implanted as bone substitute in 152 patients using a standardized study protocol. Main indications were the filling of large mandibular cysts (n=52), secondary and tertiary alveolar cleft grafting (n=38), periodontal defects (n=24) and maxillary sinus floor augmentation (n=16). For defects exceeding 2cm in diameter, beta-TCP was combined with autologous bone taken from the retromolar area, the maxillary tuberosity or the chin region. A radiological, clinical and ultrasonographical examination was carried out 4, 12 and 52 weeks postoperative. In 16 cases, biopsies were taken after 12 months indicating complete bony regeneration. While wound-healing disturbances occurred in 9.2% of cases, partial loss of the bone substitute material was found in 5.9%, while total loss occurred in only 2%. Complete radiological replacement of beta-TCP by autologous bone was found after approximately 12 months, indicating its osteoconductive properties. Because of its versatility, low complication rate and good long-term results, synthetic, pure-phase beta-TCP is a suitable material for the filling of bone defects in the alveolar region.     

Field trial on caries prevention with xylitol candies among disabled school students

BACKGROUND: In a 1999 survey high caries levels were found among physically disabled school students in Kuwait. OBJECTIVES: A field study was planned to test the efficacy of xylitol candies in preventing caries among individuals in two special schools in Kuwait. METHODS: Altogether 176 students were examined in 2002 and 145 (105 in xylitol group and 40 in the control group) after 18 months' intervention. The WHO criteria were used in recording caries according to surfaces (third molars were excluded) by 2 calibrated examiners (E.H., M.S.). The students were allocated to the xylitol group only if the parent/caregiver returned the informed consent form. School health nurses distributed xylitol candies to the students 3 times during the school day (after breakfast and lunch, and before leaving the school). RESULTS: In the xylitol group, the baseline DS and DMFS scores were 3.4 and 8.2 and in the follow-up 1.9 and 7.1, respectively. In the control group, the baseline scores were DS 3.9 and DMFS 9.8, and the follow-up scores DS 3.9 and DMFS 13.2. CONCLUSION: Xylitol seemed to have a strong preventive and a clear remineralizing effect on caries.     

The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine

OBJECTIVES: The authors conducted a randomized, double-blind, two-way crossover clinical trial to compare the pharmacokinetics and cardiovascular effects of 11.9 milliliters of 4 percent articaine hydrochloride (HCl) plus 1:100,000 epinephrine (A100) with those of 11.9 mL of 4 percent articaine HCl plus 1:200,000 epinephrine (A200). METHODS: During two testing sessions, the authors administered injections of A100 and A200 over a seven-minute period (in one-cartridge doses unless otherwise noted): maxillary right first molar infiltration, maxillary left first molar infiltration, maxillary right first premolar infiltration, maxillary left first premolar infiltration, right inferior alveolar injection, left inferior alveolar injection, right long buccal infiltration (one-half cartridge) and left long buccal infiltration (one-half cartridge). They analyzed venous blood samples for articaine levels. They used noninvasive acoustic tonometry to measure a variety of cardiovascular parameters over a two-hour period. RESULTS: Plasma concentration curves of articaine over time were similar for both solutions, with peak concentrations and times to maximum concentration being 2,037 nanograms per milliliter and 22 minutes for A100 and 2,145 ng/mL and 22 minutes for A200. At the 10-minute point, the mean systolic blood pressure and heart rate were significantly elevated (P < .05) with A100 versus A200. CONCLUSIONS: Maximum dose recommendations for the A100 solution also can be applied to the A200 solution. A200 produces less cardiovascular stimulation than does A100. CLINICAL IMPLICATIONS: A200 is as safe as A100, and may be preferable to A100 in patients with cardiovascular disease and in those taking drugs that reportedly enhance the systemic effects of epinephrine.     

Assessment of correlation between computerized tomography values of the bone, and maximum torque and resonance frequency values at dental implant placement

summary The aim of this study was to determine the bone density in the designated implant sites using computerized tomography (CT), the fastening torque values of dental implants, and the implant stability values using resonance frequency analysis. Further aim was to evaluate a possible correlation between bone density, fastening torque and implant stability. Eighty‐five patients were treated with 158 Brånemark System implants. CT machine was used for preoperative evaluation of the jawbone for each patient, and bone densities were recorded in Hounsfield units (HU). The fastening torque values of all implants were recorded with the OsseoCare equipment. Implant stability measurements were performed with the Osstell machine. The average bone density and fastening torque values were 751·4 ± 256 HU and 39·7 ± 7 Ncm for 158 implants. The average primary implant stability was 73·2 ± 6 ISQ for seventy implants. Strong correlations were observed between the bone density, fastening torque and implant stability values of Brånemark System TiUnite MKIII implants at implant placement (P < 0·001). These results strengthen the hypothesis that it may be possible to predict and quantify initial implant stability and bone quality from pre‐surgical CT diagnosis.