Influence of Irrigant,Dowel Type,and Root‐Reinforcing Material on Fracture Resistance of Thin‐Walled Endodontically Treated Teeth

Purpose: Unresolved controversy exists concerning the optimum restorative material to reinforce the thin‐walled roots of endodontically treated teeth to improve their fracture resistance under occlusal load. This study evaluated the effectiveness of irrigant, dowel type, and root‐reinforcing material on the fracture resistance of thin‐walled endodontically treated teeth. Materials and Methods: The root canals of 140 maxillary central incisors were enlarged and equally divided into seven groups according to the canal irrigant: no irrigant (control), 5% hydrogen peroxide, 5% sodium hypochlorite, a combination of 5% hydrogen peroxide and sodium hypochlorite, 15% ethylenediaminotetraacetic acid (EDTA), 10% lactic acid, or 20% lactic acid. Within each group, root canals were lined with composite resin (PermaFlo) or glass ionomer cement (Fuji II LC). A light‐transmitting plastic dowel (Luminex) was used to create space for a quartz fiber‐reinforced dowel (Aestheti Post) or a titanium alloy dowel (ParaPost XH) and to cure the restorative materials. Following dowel cementation and restoration of the roots with composite core, the teeth were submitted to fracture resistance testing, and data were analyzed with 3‐way ANOVA followed by Ryan‐Einot‐Gabriel‐Welsch Multiple Range Test (α= 0.05). Results: Fracture resistance values were significantly different among irrigants, restorative materials, and their interaction (p < 0.001); however, the dowel type was not significantly different (p= 0.51). Conclusions: Thin‐walled roots that had the smear layer removed with lactic acid and that were then lined with composite resin had a higher fracture resistance.     

Maxillary and mandibular complete-arch implant rehabilitation using a complete digital workflow: A case report

This article summarizes the clinical steps involved in maxillary and mandibular complete-arch implant rehabilitation using a complete digital workflow. The maxillary arch was recorded using the double digital scan technique, and the mandibular arch using the triple digital scan technique. The digital protocol used in this case report allowed the recording of implant positions via scan bodies, soft tissues, and, most importantly, the interocclusal relationship in the same visit. A new technique for mandibular digital scan was described that uses soft tissue landmarks by creating windows in the patient's provisional prostheses to superimpose the three digital scans and consequently fabricate and verify the maxillary and mandibular prototype prostheses and definitive complete-arch zirconia prostheses.     

Clinical features and induction outcome of childhood acute lymphoblastic leukemia in a lower/middle income population: A multi‐institutional report from Pakistan

Background

Acute lymphoblastic leukemia (ALL) is the most common cancer of childhood. Some evidence suggests differences in clinical and cytogenetic characteristics of ALL based on geographic and ethnic variations. However, data on ALL characteristics and early outcome of therapy from low/middle‐income countries such as Pakistan are scanty.

Procedure

A prospective, multi‐institutional cohort study in Karachi enrolled 646 newly diagnosed children with ALL over 3 years. Standard forms were used to collect demographic, clinical, and laboratory data at presentation and at the end of induction.

Results

Of the total, 66.1% (n = 427) were males. Median age was 6 (mean ± SE 6.87 ± 0.16; range 0.16–18) years. The most common clinical presentation was fever (88.7%). BPC‐ALL was diagnosed in 78.5%, while 17.5% had T‐ALL; 28.8% had a WBC >50 × 10⁹/L. With 316 patients karyotyped, hypodiploidy and hyperdiploidy were seen in 5.1% and 10.7%, respectively. Of those tested, ETV6‐RUNX1 translocation was detected in 13.2%, while BCR‐ABL1 translocation and MLL gene rearrangements were seen in 7.3% and 4.6%, respectively. The cumulative loss to follow up before and during induction was 12.8% (n = 83) and 11.5% (n = 74) died before or during this phase. Induction was successfully completed by only 75.6% (n = 489) of the entire cohort and 69.6% (n = 450) achieved remission.

Conclusion

These patients had ALL with higher risk features than that reported from developed countries. One quarter failed to complete induction chemotherapy. This suboptimal result requires further study and development of innovative interventions, particularly focusing on the causes and solutions for late referral, abandonment, and infections. Pediatr Blood Cancer 2015;62:1700–1708. © 2015 Wiley Periodicals, Inc.     

Vaccination guidelines for children with cancer and hematopoietic stem cell transplantation living in resource‐poor countries

There is no consensus on the immunization guidelines for immunocompromised children. Some recommendations are, however, available for children living in developed countries. The spectrum of infectious diseases is different in resource‐poor countries. Vaccinations against some of these infections are not a part of the immunization schedule for children living in developed countries. We have tried to include vaccinations against diseases, which are still prevalent and a major cause of morbidity and mortality in resource‐poor countries. In these guidelines, the focus has been on the vaccine‐preventable diseases prevalent in Pakistan but the same can be applied to other resource‐poor countries. Pediatr Blood Cancer 2010; 54:3–7. © 2009 Wiley‐Liss, Inc.     

Fracture resistance of endodontically treated mandibular first molars with conservative access cavity and different restorative techniques: An in vitro study

The aim was to investigate in vitro the fracture resistance (FR) of endodontically treated teeth (ETT) with conservative access cavity restored using various direct and indirect restorative materials and techniques. Seventy‐two mandibular first molars were equally divided into six groups. Teeth in Group 1 were untreated (controls). In Groups 2, 3, 4, 5 and 6, teeth were restored with amalgam, composite resin, ceramic inlay, ceramic onlay and zirconium crown, respectively. A fracture test was performed on all teeth using a static load. Compared with other groups, teeth in Groups 3 (P < 0.05) and 6 (P < 0.05) had the highest FR values with no significant difference in‐between them. Teeth in Group 4 had the lowest FR than other groups (P < 0.05). All restorative techniques tested led to a significant reduction in FR. It is necessary to consider type of fracture when evaluating fracture resistance of endodontically treated teeth. Crowned molars had the highest favourable fractures among the five treatment groups. Although the results of this in vitro study showed variations between tested techniques in ETT with a conservative access cavity, further long‐term controlled clinical trials are required to confirm these in vitro findings.