Articaine hydrochloride: a safe alternative to lignocaine?

A focused literature search to appraise the safety and suitability of articaine as a substitute for lignocaine was conducted. An evidence-based approach to the current available literature suggests that articaine is an effective and well-tolerated anaesthetic for dental use. However, practitioners should be aware of a possible, as yet unproven, link between 4% concentrations of local anaesthetic solution and nerve damage. Clinical Relevance: The purpose of this paper is to share the findings of our focused literature review with general dental practitioners and outline the available evidence on the safety and use of articaine as a substitute for lignocaine.     

Effect of chlorhexidine on dental plaque and gingivitis in mentally retarded children

ABSTRACT The purpose of the investigation was to determine the effect of chlorhexidine mouthrinses as a supplement to toothbrushing in the plaque control of mentally retarded children. Fifty-four mentally subnormal children 7–14 years of age took part in the investigation. During the first period, half of the children rinsed their mouths with 0.2 % chlorhexidine gluconate solution twice a day. The rest of the children used a placebo mouth-rinse. After an 8-week interval a “cross-over” experiment was carried out during which a 0.1 % chlorhexidine solution was used. Plaque and gingival indices were scored at the beginning of each period, after 3 weeks, and at the termination after 6 weeks. The results revealed that mouthrinses with 0.1 % as well as 0.2 % chlorhexidine gluconate reduced plaque and gingivitis in mentally retarded children. The results were statistically significant (P < 0.05) for both concentrations. Furthermore, the investigation confirmed the occurrence of certain side effects such as discoloration of teeth and tongues.     

Severe proliferative congenital temporomandibular joint ankylosis: a proposed treatment protocol utilizing distraction osteogenesis

The classical treatment for temporomandibular joint (TMJ) ankylosis in children: 1) joint release; 2) arthroplasty; 3) reconstruction; and 4) postoperative physical therapy (PT), is often unsuccessful. Postoperative physical therapy is difficult in the young patient due to poor cooperation. Moreover, there is a subgroup of patients who have a refractory congenital proliferative bony process that is the cause of their disease. In these patients, a role for distraction osteogenesis (DO) has been defined. We present a series of young patients with congenital proliferative TMJ ankylosis. Some have failed classic treatment. In such cases, DO is used to expand the mandibular size and soft tissue matrix. This creates a static open bite, facilitates mid-facial growth, and avoids compromise of the airway, speech, nutrition, and oral hygiene. To maintain these objectives, mandibular DO may be repeated as the child matures. Once skeletal maturity is reached, DO is used to normalize occlusion and further expand the soft tissue envelope prior to definitive reconstruction and aggressive post-op PT. In seven patients, this protocol has been used. Five patients are currently in the active phase of growth and undergoing interim treatment with mandibular DO. Two patients have reached skeletal maturity and have completed the protocol of DO with definitive arthroplasty and reconstruction. DO is a valuable aid in the treatment of the problematic child with congenital proliferative TMJ ankylosis. Interim DO, prior to definitive arthroplasty and reconstruction, can provide a static open bite that prevents progressive deformity and its associated functional disturbances.     

A practice-based evaluation of the handling of a new self-adhesive universal resin luting material

OBJECTIVE: Ease of handling of materials may be considered helpful to achieving good results. The handling properties of a new self-adhesive universal resin luting material were tested in clinical use. METHOD AND MATERIAL: Thirteen practitioners were selected at random from the Product Research and Evaluation by Practitioners (PREP) Panel, a United Kingdom-based group of dental practitioners prepared to complete evaluations of new materials and techniques in the practice environment. Explanatory letters, questionnaires and packs of the luting material were sent to the evaluators. The practitioners were asked to use the material and return the questionnaire. RESULTS: 144 restorations were placed using the new self-adhesive resin luting material, which was rated higher by the evaluators for ease of use (4.7 on a visual analogue scale where 5 represented easy to use and 1 represented difficult to use) than both the pre-trial resin-based and 'conventional' luting materials (rated 3.7 and 4.4 respectively on the same scale). The presentation, instructions, convenience of dispensing and handling and viscosity also received high ratings. CONCLUSION: The new material achieved ratings for ease of use superior to the pre-study resin-based and conventional luting materials in the dental practices of 13 UK dental practitioners.     

The elimination of cross-infection in dental practice--a 5-year follow-up

A survey in 1983 showed that 16% of general dental practitioners in the Lothian Region wore operating gloves when treating patients; 9% wore them continually and 7% only when performing dento-alveolar surgery. Twelve per cent replied that they would not consider wearing operating gloves and 72% stated that they might consider their use. A similar survey has now been completed 5 years later, involving practitioners in the Lothian and Borders regions. This shows that 163 (97%) of the 168 practitioners who replied now wear operating gloves; 51% restrict their use to the treatment of 'potentially infectious patients' and dento-alveolar surgery; 46% wear them continually. The main objections given to wearing gloves continually were loss of tactile sensation (67%) and cost (13%). The most difficult task to perform wearing gloves was root canal therapy (56%). The majority of practitioners (84%) believed that gloves reduced the dangers of cross-infection. The methods stated to be available for instrument sterilisation in 99.5% of practices were acceptable. This paper proposes that to eliminate cross-infection and protect the dental practitioner, operating gloves should be worn when treating all patients.     

The effects of fixed and removable implant-stabilised prostheses on posterior mandibular residual ridge resorption

Abstract: This study investigated the change over time in the area of the posterior mandibular residual ridge in patients wearing either i) mandibular overdentures stabilised by two implants (Brånemark System; Nobel Biocare, Göteborg, Sweden) connected by a bar, or ii) mandibular fixed cantilever prostheses stabilised on five or six implants. Proportional measurements were made in order to compare the area of the residual ridge with an area of bone uninfluenced by resorption. Measurements were made by digitising tracings of panoramic radiographs that were taken shortly after implant insertion and up to seven years later. With the use of overdentures, the posterior bone area index reduced by a mean of 1.1% per annum, while a mean bone area index increase of 1.6% per annum was demonstrated in association with fixed prostheses. A multiple linear regression model was fitted to predict the change in posterior area from type of prosthesis, gender, age, years of edentulism and initial height of the mandible. The model was only significant for initial height of mandible (P = 0.04) and type of prosthesis (P = 0.0001). In conclusion, patients rehabilitated with implant‐stabilised mandibular overdentures demonstrated low rates of posterior mandibular residual ridge resorption, while patients rehabilitated with implant‐stabilised mandibular fixed cantilever prostheses demonstrated bone apposition in the same area.     

Molecular mediators of Porphyromonas gingivalis‐induced T‐cell apoptosis

Porphyromonas gingivalis produces virulence factors which can modify the molecular and cellular components of the host immune response. In the present work we investigated the role of specific virulence factors from P. gingivalis in the induction of apoptosis in Jurkat T cells. P. gingivalis culture supernatants mimicked the effect of butyric acid on T‐cell apoptosis and this effect was associated with an increase in histone H4 acetylation. A role for proteases was excluded in experiments which demonstrated that neither protease inhibitors nor use of P. gingivalis mutants defective in protease synthesis had any effect on the stimulation of T‐cell apoptosis in this system.     

Effects of local cooling rate and processing variables on leucite in dental porcelain

PURPOSE: This research determined whether there is a measurable effect of local geometry factors on leucite content of dental porcelain in fixed partial dentures (FPD). MATERIALS AND METHODS: Four-unit FPD frameworks (n = 36) were fabricated using a nickel-chromium alloy (Rexillium III). Body porcelain (Crystar, shade A2) was applied in one increment and subjected to two simulated body firings, followed by a simulated glaze firing to achieve a thickness of 1.5 to 2.0 mm. The completed FPD specimens were randomly assigned to three groups of 12 specimens each: (1) simulated post-soldering, (2) multiple firing, and (3) control. The FPDs from each test group were sectioned into individual units: canine retainer, premolar pontic, molar pontic, and molar retainer. The porcelain was removed from each unit, and the leucite content was measured via quantitative x-ray diffraction. RESULTS: Porcelain cracking indicated that the soldering simulation had successfully reproduced conditions in the dental laboratory that result in porcelain cracking during soldering. The leucite content was not significantly different between the retainer and pontic units for either the soldering simulation or control FPDs, although the canine retainer units did have a slightly lower leucite content than the pooled values of the other units. Comparison of the pooled data for the three groups indicated statistically significant differences among the leucite contents. CONCLUSION: Compared to the control, the simulated post-soldering procedure produced a significant increase in leucite, and the multiple firing group exhibited a significant decrease in leucite. Increases in leucite weight fraction during post-soldering operations-and the larger thermally induced stresses that accompany these leucite increases-are responsible for the cracking that occurs.     

Alterations of surface hardness with gypsum die hardeners

STATEMENT OF PROBLEM: Die stones require abrasion resistance, dimensional stability with time, and high surface wettability material properties. PURPOSE: The purpose of this study was to compare the surface microhardness (Knoop) of 4 contemporary gypsum materials with and without surface die hardener. MATERIAL AND METHODS: Materials used were a Type III stone (Microstone) and 3 die stones (Die-Keen, Silky-Rock, and ResinRock). Die hardener was cyanoacrylate (Permabond 910) or Clear Coat. Specimens of stone were hand mixed with distilled room temperature water and vacuum spatulated according to manufacturer's directions. Five cylinders (15 x 15 mm) per group were poured, using vibration, into phenolic ring molds positioned on top of a glass slide. The face of each specimen was polished with 2400-grit Al2O sandpaper. One face of each of 5 specimens/material was coated with cyanoacrylate; 5 specimens/material were coated with Clear Coat, air thinned and dried; and 5 specimens/material had no treatment (control). Knoop hardness (kg/mm2) readings were made on each face (5 readings/time point) 3, 12, and 24 hours after pouring. An ANOVA procedure with post hoc Tukey tests were performed (alpha=.05). RESULTS: Microhardness did not vary between 3 and 24 hours for any material (P>.05). Microstone had significantly lower surface hardness (P<.0001) than the die stones. Specimens coated with die hardener had lower hardness values (P<.001 in all cases) CONCLUSIONS: The 3 types of die stones evaluated in this study did not differ significantly in surface microhardness. Under these conditions, die hardener coatings reduced the surface hardness of the gypsum material.