Clinical and Immunoinflammatory Evaluation of One‐Stage Full‐Mouth Ultrasonic Debridement as a Therapeutic Approach for Smokers With Generalized Aggressive Periodontitis: A Short‐Term Follow‐Up Study

Background: This study aims to evaluate the effect of one‐stage full‐mouth ultrasonic debridement (OSFMUD) on clinical and immunoinflammatory parameters in smokers with generalized aggressive periodontitis (GAgP). Methods: Fourteen smoking and 14 non‐smoking patients with GAgP were selected. After initial supragingival therapy, patients were treated by OSFMUD. Full‐mouth parameters evaluated were: 1) plaque index (PI); 2) bleeding scores (BS); 3) probing depth (PD); and 4) clinical attachment level (CAL). Clinical evaluation was performed, and gingival crevicular fluid (GCF) was collected for selected sites (ss) at baseline and 1, 3, and 6 months. GCF was analyzed via enzyme‐linked immunosorbent assay for: 1) receptor activator of nuclear factor‐κ B ligand (RANKL); 2) osteoprotegerin (OPG); 3) interleukin (IL)‐6; and 4) tumor necrosis factor (TNF)‐α, whereas secreted osteoclastogenic factor of activated T‐cells (SOFAT) was evaluated by Western blotting. Results: Significant reduction (P <0.05) was observed between baseline and 6 months for: 1) PI; 2) BS; and 3) PD, with no difference between smoking and non‐smoking patients (P >0.05). Regarding CAL, only non‐smoking patients showed a significant decrease (P <0.05). Significant reduction (P <0.05) was observed in both groups for: 1) PIss; 2) PDss; 3) bleeding on probing; and 4) relative CAL. Smoking and non‐smoking patients presented significantly decreased levels of IL‐6 and TNF‐α over time (P <0.05); however, no difference was observed between groups (P >0.05). RANKL was significantly different (P <0.05) only for non‐smokers at 6 months, whereas OPG was not significant (P >0.05). SOFAT expression was significantly lower (P <0.05) after OSFMUD for non‐smokers only. Conclusion: Considering the clinical and immunoinflammatory parameters evaluated in this short‐term follow‐up study, it can be concluded that OSFMUD can be used as an alternative treatment for smokers with GAgP.     

Shear bond strength of a ceramic to Co-Cr alloys

STATEMENT OF PROBLEM: Different combinations of Co-Cr alloys bonded to ceramic have been used in dentistry; however, the bond strength of ceramic to metal can vary because of different compositions of these alloys. PURPOSE: The purpose of this study was to evaluate the shear bond strength of a dental ceramic to 5 commercially available Co-Cr alloys. MATERIAL AND METHODS: Five Co-Cr alloys (IPS d.SIGN 20, IPS d.SIGN 30, Remanium 2000, Heranium P, and Wirobond C) were tested and compared to a control group of an Au-Pd alloy (Olympia). Specimen disks, 5 mm high and 4 mm in diameter, were fabricated with the lost-wax technique. Sixty specimens were prepared using opaque and dentin ceramics (VITA Omega 900), veneered, 4 mm high and 4 mm in diameter, over the metal specimens (n=10). The shear bond strength test was performed in a universal testing machine with a crosshead speed of 0.5 mm/min. After shear bond testing, fracture surfaces were evaluated in a stereomicroscope under x25 magnification. Ultimate shear bond strength (MPa) data were analyzed with 1-way ANOVA and the Tukey HSD test (alpha =.05). RESULTS: The mean (SD) bond strengths (MPa) were: 61.4 (7.8) for Olympia; 94.0 (18.9) for IPS 20; 96.8 (10.2) for IPS 30; 75.1 (12.4) for Remanium; 71.2 (14.3) for Heranium P; and 63.2 (10.9) for Wirobond C. Mean bond strengths for IPS 20 and IPS 30 were not significantly different, but were significantly (P<.001) higher than mean bond strengths for the other 4 alloys, which were not significantly different from each other. CONCLUSIONS: Bond strength of a dental ceramic to a Co-Cr alloy is dependent on the alloy composition.     

Fetal diagnosis of cleft lip: natural history and outcomes

Previous studies have suggested that most fetuses diagnosed prenatally with cleft lip have multiple associated anomalies, that fetuses with isolated cleft lip/palate are uncommon, and that their ultimate outcome is poor (Lopoo, 1999). However, our clinical experience failed to make a similar connection. The purpose of this study was to examine the natural history and current outcomes of fetuses diagnosed with cleft lip. A retrospective study was performed on all patients undergoing fetal ultrasonography over a 7-year period (1993-2001) in a tertiary referral center. All patients who had a fetal diagnosis of cleft lip were reviewed (N = 57). Fifty-seven fetuses with cleft lip were identified. Forty-three of 57 patients have complete records. Of these, 18 patients (43%) had terminations for associated severe malformations. Three fetuses (7%) had intrauterine or neonatal demise. The remainder, 22 fetuses (53%) survived to term. Of this group, 18 (82%) of 22 infants were diagnosed postnatally with isolated cleft lip/palate and no associated anomalies. Only 4 of 22 had associated anomalies. All recorded terminations were performed with known karyotyping. We demonstrate that a significant percentage of fetuses diagnosed ultrasonographically with cleft lip/palate in our study were isolated and that this subset of patients has an excellent prognosis and outcome. This may provide further or alter implications for genetic counseling and management.     

Management of the Class III malocclusion treated with maxillary expansion,facemask therapy and corrective orthodontic. A 15-year follow-up

The facial growth of Class III malocclusion worsens with age, in this case, the early orthopedic treatment, providing facial balance, modifying the maxillofacial growth and development. A 7.6-year old boy presented with Class III malocclusion associated with anterior crossbite; the mandible was shifted to the right and the maxilla had a transversal deficiency. Rapid maxillary expansion followed by facemask therapy was performed, to correct the anteroposterior relationship and improve the facial profile. The patient was followed for a 15-year period, after completion of the treatment, and stability was observed. Growing patients should be monitored following their treatment, so as to prevent malocclusion relapse.     

Effects of Endodontic Infections on the Maxillary Sinus: A Case Series of Treatment Outcome

This article shows the follow-up of several cases of maxillary sinusitis of dental (usually endodontic) origin, with different manifestations, diagnostic challenges, and outcomes.Cases from 14 patients from 3 countries and treated by 7 different endodontists are presented, all of them with inflammatory sinus changes represented by mucositis, osteoperiostitis, and/or partial/full obstruction. All cases showed dental and/or sinus signs/symptoms that resolved after dental management. In 13 cases, the sinus condition had an endodontic origin, 4 of them concurrently with periodontal involvement. In 1 case, sinusitis was caused by trauma to the face. All cases but 1 had a satisfactory response of the periradicular tissues and maxillary sinus to treatment that consisted of root canal therapy, root amputation, extraction, or trauma management.The successful management of most cases reported in this article emphasizes the importance of endodontics as a specialty engaged in saving teeth and promoting health not only in the oral cavity but also in other areas that may be affected by infections of endodontic origin, including the maxillary sinus.     

Impact of medication therapy management on pharmacotherapy safety in an intensive care unit

Background Drug-related problems are mostly preventable or predictable circumstances that may impact on health outcomes. Clinical pharmacy activities such as medication therapy management can identify and solve these problems, with potential to improve medication safety and effectiveness. Objective To evaluate ability of medication therapy management service to detect drug-related problems and prevent adverse drug events. This study also aimed to assess the risk factors for drugrelated problem occurrence. Setting Medical intensive care unit of a public tertiary hospital in Brazil. Methods Patients were evaluated by a clinical pharmacist, who provided medication therapy management service. Detected drug-related problems were categorized according to the Pharmaceutical Care Network Europe methodology and analyzed in multinomial regression to identify risk factors. Main outcome measure Potential risk factors for drug-related problem occurrence. Results The proposed medication therapy management service allowed detection of 170 drug-related problems that had potential to reach patients causing harm and other 50 unavoidable adverse events. Drug-related problems identified were more often associated with antibacterial use, caused by improper combinations or inadequate drug dosage. These problems required interventions that were accepted by the multidisciplinary team, resulting in more than 85% adherence and total problem solving. Main risk factors identified were previous diagnosis of kidney injury (OR?=?8.38), use of midazolam (OR?=?7.96), furosemide (OR?=?5.87) and vancomycin (OR?=?4.82). Conclusion Medication therapy management proved to be an effective method not only for drug-related problem detection, but also for adverse drug event prevention, contributing to improve patient safety.