The role of intercostal nerve preservation in acute pain control after thoracotomy

OBJECTIVE:

To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures (dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure).

METHODS:

We selected 40 patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of São Paulo/Paulista School of Medicine, in the city of São Paulo, Brazil. The patients were randomized into two groups: conventional thoracotomy (CT, n = 20) and neurovascular bundle preservation (NBP, n = 20). All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring patient requests for/consumption of analgesics.

RESULTS:

On postoperative day 5, the self-reported pain intensity was significantly lower in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p = 0.04). No significant differences were found between the groups regarding the number of requests for/consumption of analgesics.

CONCLUSIONS:

In patients undergoing thoracotomy, protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery.     

Immediate occlusal loading of extrasinus zygomatic implants: A prospective cohort study with a follow-up period of 8 years

The aim of this study was to evaluate the long-term success rate of immediate occlusal loading of extrasinus zygomatic implants after an 8-year follow-up. From 62 patients who needed implant treatment in 2003, 25 patients who presented with maxillary atrophy met the inclusion criteria and agreed to participate in the study. All patients received fixed dentures under immediate occlusal loading supported by extrasinus zygomatic implants associated with anterior standard implants. No bone grafting procedures were performed. During the 8-year follow-up period, 21 patients underwent clinical evaluation and radiographic examinations every 6 months. This study conforms to the STROBE guidelines regarding prospective cohort studies. 40 extrasinus zygomatic and 74 anterior standard implants were evaluated. All patients were clinically free of signs and symptoms of sinus disturbance at all follow-up appointments. After 8 years, the success rates of extrasinus zygomatic implants, standard anterior implants and definitive prostheses were 97.5%, 95.9% and 95.2%, respectively. Within the limits of this study, immediate occlusal loading of extrasinus zygomatic implants presents a predictable treatment option for the atrophic maxilla.     

In vitro Candida colonization on acrylic resins and denture liners: influence of surface free energy, roughness, saliva, and adhering bacteria

This study aimed to determine the influence of surface roughness (Ra), surface free energy (SFE), saliva, and bacteria on Candida adhesion to denture materials. The Ra and SFE of 2 acrylic resin specimens and 2 denture liner specimens were measured and assayed in a flow chamber for bacteria culture perfusion plus Candida albicans or C glabrata cultures. Adhesion was determined by counting under light microscopy. Candida adhesion showed significant differences depending on the factors involved. The overall colonization was significantly decreased by saliva and influenced by bacteria. Candida adhesion was strongly affected by Ra, saliva, and bacteria, but not by SFE.     

Low‐fluoride toothpaste and deciduous enamel demineralization under biofilm accumulation and sucrose exposure

Cury JA, do Amaral RC, Tenuta LMA, Del Bel Cury AA, Tabchoury CPM. Low‐fluoride toothpaste and deciduous enamel demineralization under biofilm accumulation and sucrose exposure. Eur J Oral Sci 2010; 118: 370–375. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci Because low‐fluoride toothpaste (500 p.p.m. F) has not clearly been shown to be effective for controlling caries in caries‐active children, this experimental in situ study was conducted to evaluate whether its effect, when compared with a conventional toothpaste (1,000–1,500 p.p.m. F), would depend on the cariogenic challenge. During four phases of 14 d each, 14 volunteers used 500 or 1,100 p.p.m. F toothpaste and wore palatal appliances containing deciduous enamel slabs, on which biofilm was accumulated and exposed to 20% sucrose solution at frequencies increasing from two to eight times per day. The F concentration was determined in the biofilm formed, and enamel demineralization was assessed by surface hardness loss (%SHL) and integrated area of hardness × lesion depth (ΔS). The F uptake by enamel was also determined. Fluoride in biofilm fluid and solids was statistically higher when conventional F toothpaste was used. The toothpastes did not differ statistically in terms of %SHL, ΔS, and F in enamel, but only the conventional F toothpaste significantly reduced caries‐lesion progression according to the frequency of sucrose exposure. The findings suggest that the high‐F availability in biofilm, resulting from the use of conventional toothpaste compared with low‐F toothpaste, may be important for reducing caries‐lesion progression in conjunction with a high frequency of sucrose exposure.     

Strength of Denture Base Resins Repaired with Auto- and Visible Light-Polymerized Materials

Purpose: Clinicians are still confused about the choice of repair method, which depends on factors such as the length of time required for processing, the mechanical strength of the repaired material, and the effect of stress concentration in the acrylic resins before the repair. The aim was to determine the impact and flexural strength characteristics, such as stress at yield, Young's modulus, and displacement at yield of denture base resins fractured and repaired by three methods using heat‐, auto‐, and visible light‐polymerized acrylic resins. Material and Methods: For impact and flexural strength tests, 18 rectangular specimens measuring 50 × 6 × 4 mm³ and 64 × 10 × 3.3 mm³, respectively, were processed using Impact 2000, Lucitone 550, Impact 1500, and QC‐20 acrylic resins. Fracture tests were performed according to ISO1567:1999. Afterward, all fractured specimens were stored in distilled water at 37°C for 7 days, and then repaired with (1) the same acrylic resin used for specimen fabrication (n = 6), (2) an autopolymerized acrylic resin (TruRepair, n = 6), and (3) a visible light acrylic resin (Versyo.com, n = 6). The repaired specimens were again submitted to the same fracture tests, and the failures were classified as adhesive or cohesive. Data from all mechanical tests after repair by the different methods were submitted to two‐way ANOVA, and mean values were compared by the Tukey test. Results: All acrylic resins showed adhesive fractures after impact and flexural strength tests. Differences (p < 0.05) were found among repair methods for all acrylic resins studied, with the exception of displacement at yield, which showed similar values for repairs with auto‐ and visible light‐polymerized acrylic resins. The highest values for impact strength, stress, and displacement at yield were obtained when the repair was made with the same resin the specimen was made of. Conclusion: Denture base acrylic resins repaired with the same resin they were made of showed greater fracture strength.     

Effect of starch on the cariogenic potential of sucrose

Since in vitro and animal studies suggest that the combination of starch with sucrose may be more cariogenic than sucrose alone, the study assessed in situ the effects of this association applied in vitro on the acidogenicity, biochemical and microbiological composition of dental biofilm, as well as on enamel demineralization. During two phases of 14 d each, fifteen volunteers wore palatal appliances containing blocks of human deciduous enamel, which were extra-orally submitted to four groups of treatments: water (negative control, T1); 2 % starch (T2); 10 % sucrose (T3); and 2 % starch+10 % sucrose (T4). The solutions were dripped onto the blocks eight times per day. The biofilm formed on the blocks was analysed with regard to amylase activity, acidogenicity, and biochemical and microbiological composition. Demineralization was determined on enamel by cross-sectional microhardness. The greatest mineral loss was observed for the association starch+sucrose (P<0.05). Also, this association resulted in the highest lactobacillus count in the biofilm formed (P<0.05). In conclusion, the findings suggest that a small amount of added starch increases the cariogenic potential of sucrose.