Effect of 0.2% Chitosan Associated with Different Final Irrigant Protocols on the Fiber Post Bond Strength to Root Canal Dentin of Bovine Teeth: An In-vitro Study

Objective:

This in-vitro study investigated the effect of 0.2% Chitosan associated with different final irrigant protocols on the bond strength of fiber posts (FP) to root canal dentin.

Methods:

Fifty bovine incisors roots were prepared using the ProTaper Universal system, irrigated with 2.5% sodium hypochlorite, and divided into one control group (n=10) with no final irrigant protocol and four experimental groups (n=10), which were defined according to the combination of chelating solution (17% EDTA and 0.2% Chitosan) and irrigant activation/delivery method [conventional irrigation (CI), and passive ultrasonic irrigation (PUI)]. Post spaces were prepared to a depth of 12 mm using #1-5 Largo drills, and the FP were cemented using self-adhesive resin cement. Two slices of 2 mm in thickness from each third were obtained and submitted to the micropush-out test. After testing the push-out strength, the slices were analyzed under a stereomicroscope at 40× magnification for bond failure patterns determination. Statistical analysis was performed using three-way ANOVA followed by Tukey’s test (α = 0.05).

Results:

The control and 17% EDTA + CI groups exhibited significantly lower bond strength than 0.2% Chitosan + CI, 17% EDTA + PUI, and 0.2% Chitosan + PUI groups in the cervical third (P = 0.00). The cervical third had higher values than the middle and apical thirds in control (P = 0.00), 17% EDTA + PUI (P = 0.00), and 0.2% Chitosan + PUI groups (P = 0.00). Adhesive cement-dentin failure type was predominant in all groups.

Conclusion:

The use of 0.2% chitosan did not affect the bond strength of FP to root dentin. Passive ultrasonic activation of chelating solutions resulted in an improvement in bonding strength.

Residual Dentin Thickness in Bifurcated Maxillary Premolars after Cervical Preflaring Preparation: A CBCT Analysis

Objective:

This study evaluated the residual dentin thickness (RDT) of maxillary premolars after the use of different cervical preflaring (PF) drills by using cone-beam computed tomography (CBCT).

Methods:

Eighty bifurcated maxillary premolars were accessed and randomly divided into 5 groups (n=16). PF was performed with Gates-Glidden #1, #2, and #3 (group 1), Largo #1 and #2 (group 2), and LA Axxess #20/.06 (group 3), #35/.06 (group 4), and #45/.06 (group 5). CBCT images were acquired before (preoperative) and after (postoperative) PF. Initial and final cervical dentin thickness was measured at the buccal, palatal, mesial, and distal aspects, 0.5 mm coronally to the furcation, on both buccal and palatal roots, using CBCT’s image analysis software. The percentage of removed dentin after PF preparation was also calculated. Data were analyzed using ANOVA followed by Tukey’s test at a significance level of P < 0.05.

Results:

No statistically significant differences were found among the groups for preoperative or postoperative RDT (P > 0.05). LA Axxess #20/.06 (group 3) removed significantly less cervical dentin at all root canal aspects on both buccal and palatal roots. The mesial aspect of the buccal root and distal aspect of the palatal root were significantly reduced after the use of LA Axxess #45/.06 (group 5) and Largo #1 and #2 drills (group 2), respectively (P < 0.05).

Conclusion:

PF in bifurcated maxillary premolars should be performed with LA Axxess instrument #20/.06. The use of Gates-Glidden #1, #2, and #3, Largo #1 and #2, and LA Axxess #45/.06 drills should be done with caution.

Physicomechanical Properties of Tertiary Monoblock in Endodontics: A Systematic Review and Meta-analysis

Introduction

A systematic review and meta-analysis were conducted to evaluate the physicomechanical properties of tertiary monoblock obturation with different obturation techniques.

Methods and Materials

PubMed (MEDLINE), Web of Science, Scopus, the Cochrane Library, LILACS, IBECS, and BBO were searched time. PICO question was: "In extracted human teeth (Population), does tertiary monoblock obturation (Intervention) have superior physicomechanical properties (Outcome) compared to conventional obturation systems (Comparison)?". Statistical analyses for push-out bond strength were performed with RevMan software by comparing the mean differences of each study, with a 95% confidence interval. Inverse variance was used as statistical method, random-effects models as analysis model, and heterogeneity between studies was assessed by Cochran's Q test and I² statistic (P <0.05).

Results

Of 2162 studies retrieved, 31 were included in this review for "Study Characteristics". Ten studies were included in the meta-analysis. Analysis demonstrated that conventional obturation had significantly higher push-out bond strength than tertiary monoblock obturation (P <0 .01), with a mean difference of -1.00 (95% CI, -1.41 to -0.58; I²=100%). Subgroups using single-cone and cold lateral condensation techniques showed significantly lower push-out bond strength for tertiary monoblock obturation (P <0.01), respectively with a mean difference of -0.09 (95% CI, -1.13 to -0.67; I²=97%) and of -1.97 (95% CI, -3.19 to -0.75; I²=100%). The warm vertical compaction subgroup showed no statistically significant difference between tertiary monoblock and conventional systems (P =0.13), with a mean difference of 0.49 (95% CI, -0.14 to 1.12; I²=10%).

Conclusion

Tertiary monoblock systems have a push-out bond strength similar to conventional systems when used with warm vertical compaction.

Effects of Brown and Green Propolis on Bond Strength of Fiberglass Posts to Root Canal Dentin

Introduction

The purpose of this study was to evaluate the effect of brown and green propolis on bond strength of the fiberglass posts to root canal dentin, and to compare it with conventional endodontic irrigants.

Methods and Materials

Sixty bovine teeth were selected, decoronated and randomly distributed into six groups (n=10), according to the irrigation solution: 0.9% saline solution (Control); 2% chlorhexidine (CHX); 5% malic acid (MA); 0.5% ethanolic extract of brown propolis (BP); 0.25% ethanolic extract of green propolis (GP); 2.5% sodium hypochlorite (NaOCl). After root canal treatment, fiber posts were cemented into prepared root canals with a self-adhesive resin cement. The roots were cross-sectioned to obtain two discs from each third and submitted to the micro push-out test. Failure patterns were evaluated under optical microscopy. The influence of irrigants agents was analyzed using one-way ANOVA followed by Games-Howell's test (α=0.05). Failure modes were analyzed using Fischer's exact test (α=0.05).

Results

There were statistically significant differences among the groups (P<0.05). The control, NaOCl and BP groups showed the highest bond strength with no statistically significant difference between them (P>0.05). Adhesive failure type was the predominant in all groups.

Conclusion

Based on this in vitro study, the use of 0.5% brown propolis did not influence the bond strength of fiberglass posts to root canal dentin, while the use of 0.25% green propolis did affect it negatively.

Effect of post space preparation drills on the incidence of root dentin defects

Objectives

This study investigated the incidence of root dentin defects after the use of different post space preparation (PSP) drills.

Materials and Methods

Seventy-two bovine incisors were selected and obtained 14-mm-long root sections. Twelve roots served as controls with no intervention (G1). The 60 root canals remaining were instrumented using the crown-down technique with the ProTaper Next system and obturated using the lateral condensation technique. Specimens were randomly distributed into 5 groups (n = 12) according to the operative steps performed: G2, root canal instrumentation and filling (I+F); G3, I+F and PSP with Gates-Glidden drills; G4, I+F and PSP with Largo-Peeso reamers; G5, I+F and PSP with Exacto drill; and G6, I+F and PSP with WhitePost drill. Roots were sectioned at 3, 6, 9, and 12 mm from the apex, and digital images were captured. The presence of root dentin defects was recorded. Data were analyzed by the χ² test, with p < 0.05 considered to indicate statistical significance.

Results

Root dentin defects were observed in 39.6% of the root sections. No defects were observed in G1. G5 had significantly more cracks and craze lines than G1, G2, and G3 (p < 0.05), and more fractures than G1, G2, G3, and G4 (p < 0.05). When all root sections were analyzed together, significantly more defects were observed at the 12-mm level than at the 3-mm level (p < 0.05).

Conclusions

PSP drills caused defects in the root dentin. Gates-Glidden drills caused fewer root defects than Largo-Peeso reamers and Exacto drills.

Maxillofacial Fractures in a University Hospital in Central Brazil

Avaliou-se os aspectos epidemiológicos das fraturas oralmaxilofaciais em prontuários de pacientes atendidos em um Hospital Universitário do Brasil central. A amostra do estudo foi proveniente da revisão de prontuários de 346 pacientes atendidos no Serviço de Cirurgia e Traumatologia Oralmaxilofacial do Hospital Geral Universitário na cidade de Cuiabá, Mato Grosso, Brasil. Os seguintes dados foram coletados dos registros hospitalares de cada paciente: sexo, idade, fator etiológico, região anatômica afetada, procedência, distribuição sazonal e período de internação. O tratamento estatístico analisou os dados frente à distribuição de frequência e qui-quadrado. O nível de significância foi de p<0,05. Observou-se elevada frequência de fraturas oralmaxilofaciais em indivíduos do sexo masculino (n=290; 83,8%), com idade variando entre 21-30 anos (n=120; 34,5%) e provenientes de cidades do interior do estado do Mato Grosso (n=169; 48,8%). Os principais fatores etiológicos foram os acidentes de trânsito motorizados (n=169; 48,9%), violência (n=65; 18,8%) e quedas (n=25; 7,2%). A distribuição sazonal evidenciou elevado número de lesões no outono (n=89; 25,8%), inverno e primavera (n=77; 22,2%, cada um). O terço inferior da face foi a região mais comumente envolvida (n=276; 54,3%). A injúria mais comum foi a fratura do complexo zigomático (n=146; 28,7%), seguida da fratura do corpo da mandíbula (n=99; 19,4%). Os dados obtidos se assemelham aos encontrados na literatura, no que diz respeito à prevalência do sexo masculino, da faixa etária e dos acidentes de trânsito como principal agente etiológico.Palavras-chave: Traumatismod Dentários. Ossos Faciais. Epidemiologia. Cirurgia Bucal. AbstractThe objective of this study was to evaluate epidemiological aspects of maxillofacial fractures in 346 hospitalized patients treated at the Department of Oral and Maxillofacial Surgery of the University General Hospital, Mato Grosso, Brazil. The following information was collected from the patients’ medical records: gender, age, etiologic factor, type of injury, patient origin, seasonal distribution and hospital stay period. The statistical treatment analyzed data from frequency distribution and chi-squared test. The level of significance was set at 5% for all analyses. The highest incidence of maxillofacial fractures was found among males (n=290; 83.8%), with 21-30 years-old (n=120; 34.5%) and from inner cities of Mato Grosso (n=169; 48.9%). The main etiologic factor were vehicle traffic accidents (n=169; 48.9%), violence (n=65; 18.8%) and falls (n=25; 7.2%). The seasonal distribution showed that most of the cases occurred in the fall (n=89; 25.8%), winter and spring (n=77; 22.2% each). The lower third of the face was the most commonly involved region  (n=276; 54.3%). The most frequently observed fracture involved the zygomatic complex (n=146; 28.7%), followed by the mandible body (n=99; 19.4%). The epidemiological aspects of maxillofacial fractures in this study were similar to those observed in other studies, regarding the prevalence of the male, age group and traffic accidents as the main etiological factor.Keywords: Tooth Injuries. Facial Bones. Epidemiology. Surgery, Oral. 

Epidemiological Profile of Patients with Hematological Neoplasms in an Oncological Hospital of Mato Grosso

O objetivo do estudo foi analisar os aspectos epidemiológicos de pacientes adultos com diagnóstico de neoplasia hematológica, no período de 2004 a 2014, em um Hospital Oncológico em Mato Grosso. A coleta de dados foi realizada através de busca e análise de 590 prontuários. Entre os pacientes, 335 (56,8%) eram do sexo masculino (p<0,05). A maioria possuía mais de 50 anos (p<0,05), com idade média de 53,97±16,55 anos. Quanto ao local de procedência, 257 pacientes eram provenientes da região metropolitana de Cuiabá (43,6%) e 333 (56,4%) de outros locais (p<0,05). A maioria eram pacientes não brancos (p<0,05) e solteiros 342 (58%) (p<0,05). Em relação ao tratamento, 537 (91%) pacientes utilizavam quimioterapia (p<0,05), 57 (9,7%) fizeram uso da radioterapia (p<0,05). Cinquenta e quatro (9,2%) pacientes fizeram uso de ambas as terapias de forma associada (p<0,05) e 50 pacientes (8,4%) não fizeram uso  de radioterapia e nem de quimioterapia. Referente aos tipos de neoplasia, os diagnósticos mais encontrados na análise foram de: leucemia mielóide crônica 131 (22,2%); linfoma não Hodking 119 (20,2%); mieloma múltiplo 93 (15,8%); trombocitemia essencial 49 (8,3%); linfoma de Hodking 39 (6,6%); leucemia linfocítica crônica 38 (6,4%); policetemia vera 34 (5,8%); leucemia mielóide aguda 27 (4,6%); síndrome mielodisplasica 21 (3,6); leucemia linfocítica aguda 13 (2,2%) e síndrome mieloproliferativa 10 (1,7%) (p<0,05). A partir dos resultados deste estudo, pode-se concluir que, em geral, os pacientes mais acometidos pelas neoplasias hematológicas tinham mais de 50 anos, eram homens, provenientes do interior do Estado, não brancos e solteiros.Palavras-chave: Doenças Hematológicas. Epidemiologia. Leucemia.AbstractThe objective of this study was to analyze the epidemiological aspects of adult patients diagnosed with hematologic neoplasia, from 2004 to 2014, at a Cancer Hospital in Mato Grosso. Data collection was performed through the search and analysis of 590 patient records. Among the patients, 335 (56.8%) were male (p <0.05). The majority was  older than 50 years (p <0.05), with a mean age of 53.97 ± 14.95 years. Regarding origin, 257 patients came from the metropolitan region of Cuiabá (43.6%) and 333 (56.4%) from other sites (p <0.05). The majority was non-white patients (p <0.05) and unmarried 342 (58%) (p <0.05). About treatment, 537 (91%) patients used chemotherapy (p <0.05), 57 (9.7%) used radiotherapy (p <0.05). Fifty-four (9.2%) patients used both therapies in an associated way (p <0.05) and 50 patients (8.4%) did not use either radiotherapy or chemotherapy at any time of their treatment. Regarding the types of neoplasia, the diagnoses most found in the analysis were: chronic myelogenous leukemia 131 (22.2%); non Hodking lymphoma 119 (20.2%); multiple myeloma 93 (15.8%); essential thrombocythemia 49 (8.3%); Hodgkin's lymphoma 39 (6.6%); chronic lymphocytic leukemia 38 (6.4%); policetemia vera 34 (5.8%); acute myeloid leukemia 27 (4.6%); myelodysplastic syndrome 21 (3,6); acute lymphocytic leukemia 13 (2.2%) and myeloproliferative syndrome 10 (1.7%) (p <0.05). From the results of this study, it can be concluded that, in general, the  most affected patients by hematological malignancies were older than 50 years, were men from the interior of the State, non-white and unmarried.Keywords: Hematologic Diseases. Epidemiology. Hodgkin Lymphoma. Leukemia.

Immediate Rehabilitation of Elderly Patient with Large Proportion Residual Cyst

Abstract Residual cyst is consequence of a radicular cyst incomplete removal. This paper presents the case of a patient with residual cyst of unusual size located in the pre-maxilla causing large bone defect rehabilitated by titanium mesh. A 78-year-old male patient with good general health sought treatment reporting maladjustment of the upper dental prosthesis due to a volumetric increase with one year of evolution. Patient history and clinical and complementary exams led to diagnosis of residual cyst. Due to the cyst size and bone resorption, after the lesionremoval, a titanium mesh was fixed and a membrane positioned, in an attempt to reduce bone deformity and induce tissue repair to avoid functional and aesthetic sequelae. The treatment restored maxillary sinus health and provided satisfactory aesthetic contours to the patient’s face, enabling a proper prosthetic rehabilitation and proved to be a viable alternative for the treatment of similar cases.Keywords: Maxillary Sinus. Odontogenic Cysts. Surgical Mesh.ResumoO cisto residual é consequência da remoção incompleta de um cisto radicular. Este artigo apresenta o caso de um paciente com cisto residual de tamanho incomum localizado na região pré-maxilar causando grande defeito ósseo reabilitado com uso de tela de titânio. Paciente do sexo masculino, 78 anos, com boa saúde geral procurou tratamento com desajuste da prótese dentária superior, devido a um aumento volumétrico com um ano de evolução. A história do paciente e exames clínicos e complementares levaram ao diagnóstico de cisto residual. Devido ao tamanho do cisto e à reabsorção óssea, após a remoção da lesão, uma tela de titânio foi fixada e uma membrana posicionada, na tentativa de reduzir a deformidade óssea e induzir a reparação tecidual para evitar sequelas funcionais e estéticas. O tratamento restaurou a saúde do seio maxilar e forneceu contornos estéticos satisfatórios para a face do paciente, permitindo uma reabilitação protética adequada e provou ser uma alternativa viável para o tratamento de casos semelhantes.Palavras-chave: Cistos Odontogênicos, Seio Maxilar, Telas Cirúrgicas

HIV infection is independently associated with a higher concentration of alpha-1 antitrypsin

OBJECTIVES

Alpha-1 antitrypsin (AAT) deficiency is associated with an increased risk of chronic obstructive pulmonary disease and has been related to CD4 T-cell count decline in people living with HIV (PLWH). We determined whether HIV status is associated with AAT concentrations and assessed associations between AAT concentration, pulmonary function and immunological status.

METHODS

Alpha-1 antitrypsin was measured and spirometry performed in 1011 PLWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) study and in 11 962 age- and sex-matched uninfected controls. We studied associations between AAT concentration, HIV status, pulmonary function, and current and nadir CD4 T-cell counts using multivariate linear regression analyses.

RESULTS

The mean age of PLWH was 50.7 [standard deviation (SD) 11.3] years and 98.6% were receiving combination antiretroviral therapy (cART). The mean current CD4 T-cell count was 718 (SD 284) cells/μL. PLWH had a higher median AAT concentration than uninfected controls [1.4 (interquartile range (IQR) 1.3-1.6) versus 1.3 (IQR 1.2-1.4) g/L; P < 0.0001] and HIV infection was independently associated with higher AAT concentration [adjusted β = 0.10 g/L; 95% confidence interval (CI) 0.08; 0.11 g/L; P < 0.001]. Low AAT concentration (< 1.0 g/L) was not more common in PLWH with airflow limitation (defined as forced expiratory volume in 1 second/forced vital capacity (FEV₁ /FVC) < 0.7 with FEV₁ -predicted < 80%) compared with uninfected controls with airflow limitation, and the effect of AAT on FEV₁ %-predicted was comparable to that in uninfected controls (P-interaction = 0.66). AAT concentration was not associated with current or nadir CD4 T-cell count.

CONCLUSIONS

HIV infection was independently associated with a higher concentration of AAT through unknown mechanisms. However, AAT does not seem to contribute to lower pulmonary function or to low CD4 T-cell counts in PLWH.

Oral Changes in Patients with Sickle Cell Anemia of Dentistry Interest

AbstractSickle cell anemia is determined by the presence of S hemoglobin in homozygous, autosomal recessive and characterized by the presence of red cells with abnormal shape (sickle shape). The clinical manifestations may vary from one individual to another, and it may appear in the first year of the patient’s life, which emphasizes the importance of early diagnosis as the main measure of positive effect in the care of people with the disease. The aim of this study was to conduct a review of the literature on oral alterations of dental surgeon’s interest in patients with sickle cell anemia. The search for the key words “sickle cell anemia” and “oral manifestations” was carried out in the Scientific Electronic Library Online database (SciELO), linked to the Virtual Health Library (VHL). The oral manifestations described in the literature were: paleness of the oral mucosa, smooth, bleached and despapilated tongue or jaundice, delays in dental eruption, periodontal disease, hypo mineralization of the enamel, pulp calcifications, hypercementose, aseptic pulp necrosis, mandibular nerve neuropathy, osteomyelitis and orofacial pain. People with the disease may also exhibit mouth ulcers, particularly in the gums. Anemia causes a high degree of suffering for patients, who deserve special attention from all the multiprofessional team that attends them. Therefore, it is important that the dental surgeon understands and knows the symptoms of the disease, as well as its implications for oral health, as well as the best treatment. The adoption of constant care, with prevention measures in oral care and health, is important to inhibit the occurrence of dental infections.Keywords: Anemia, Sickle Cell. Dental Care. Oral Manifestations.ResumoA anemia falciforme é determinada pela presença da hemoglobina S em homozigose, de caráter autossômico recessivo e caracterizada pela presença de células vermelhas com formato anormal (forma de foice). As manifestações clínicas variam de acordo com o indivíduo e ao longo do percurso da doença, pois pode surgir no primeiro ano de vida do paciente, o que enfatiza a importância do diagnóstico precoce como principal medida de efeito positivo na assistência às pessoas com a doença. O objetivo deste trabalho foi realizar uma revisão de literatura sobre as alterações bucais de interesse do cirurgião-dentista em pacientes com anemia falciforme. A busca pelas palavras chaves “anemia falciforme” e “manifestações bucais” foi realizada na base de dados Scientific Electronic Library Online - SciELO, vinculada à Biblioteca Virtual em Saúde - BVS. As manifestações bucais descritas na literatura foram: palidez da mucosa oral, língua lisa, descorada e despapilada ou icterícia, atrasos na erupção dentária, doença periodontal, hipomineralização do esmalte, calcificações pulpares, hipercementose, necrose pulpar asséptica, neuropatia do nervo mandibular, osteomielite e dor orofacial. Os portadores também podem exibir úlceras bucais, particularmente na gengiva. A anemia provoca alto grau de sofrimento aos pacientes que merecem atenção especial de toda a equipe multiprofissional que os assiste. Desta forma, é importante que o cirurgião-dentista conheça a doença, assim como suas implicações para a saúde bucal e a condução do melhor tratamento. A adoção de cuidados, com medidas de promoção e prevenção em saúde bucal, é importante para evitar a ocorrência de infecções dentárias.Palavras-chave: Anemia Falciforme. Assistência Odontológica. Manifestações Bucais.

Multidimensional Analysis of Curved Root Canal Preparation Using Continuous or Reciprocating Nickel-titanium Instruments

Objective:

To evaluate transportation (T) and centering ability (CA) of root canal preparations using continuous or reciprocating nickel-titanium endodontic files.

Materials and Methods:

Ninety-six mesiobuccal root canals of mandibular first and second molars were randomly divided into 6 groups (n=16) according to the rotary file used: 1. ProTaper Next; 2. ProTaper Gold; 3. Mtwo; 4. BioRaCe; 5. WaveOne Gold; 6. Reciproc. Root canals were prepared according to manufacturer’s instructions. Cone beam computed tomography scans were obtained before and after root canal preparation. Measurements were made at six different reference points: 2, 3 and 4 mm from the apex and 2, 3 and 4 mm below furcation in different directions.

Results:

The greatest Mesiodistal (MD) Transportation (T) was found for Reciproc files (p<0.05), and the greatest buccolingual (BL) T, for Reciproc, ProTaper Gold and ProTaper Next files (p<0.05). The greatest Mesiodistal (MD) Centering Ability (CA) was found for BioRaCe files (p<0.05), and the greatest Buccolingual (BL) CA, for BioRaCe and Mtwo files (p<0.05).

Conclusion:

All systems produced root canal transportation. No file system achieved perfect CA of root preparation. Reciproc files had the greatest MD T and BL T. BioRaCe files had the greatest MD CA, whereas BL CA was similar for BioRaCe and Mtwo files.

The extent of B-cell activation and dysfunction preceding lymphoma development in HIV-positive people

OBJECTIVES

B-cell dysfunction and activation are thought to contribute to lymphoma development in HIV-positive people; however, the mechanisms are not well understood. We investigated levels of several markers of B-cell dysfunction [free light chain (FLC)-κ, FLC-λ, immunoglobulin G (IgG), IgA, IgM and IgD] prior to lymphoma diagnosis in HIV-positive people.

METHODS

A nested matched case-control study was carried out within the EuroSIDA cohort, including 73 HIV-positive people with lymphoma and 143 HIV-positive lymphoma-free controls. Markers of B-cell dysfunction were measured in prospectively stored serial plasma samples collected before the diagnosis of lymphoma (or selection date in controls). Marker levels ≤ 2 and > 2 years prior to diagnosis were investigated.

RESULTS

Two-fold higher levels of FLC-κ [odds ratio (OR) 1.84; 95% confidence interval (CI) 1.19, 2.84], FLC-λ (OR 2.15; 95% CI 1.34, 3.46), IgG (OR 3.05; 95% CI 1.41, 6.59) and IgM (OR 1.46; 95% CI 1.01, 2.11) were associated with increased risk of lymphoma > 2 years prior to diagnosis, but not ≤ 2 years prior. Despite significant associations > 2 years prior to diagnosis, the predictive accuracy of each marker was poor, with FLC-λ emerging as the strongest candidate with a c-statistic of 0.67 (95% CI 0.58, 0.76).

CONCLUSIONS

FLC-κ, FLC-λ and IgG levels were higher > 2 years before lymphoma diagnosis, suggesting that B-cell dysfunction occurs many years prior to lymphoma development. However, the predictive value of each marker was low and they are unlikely candidates for risk assessment for targeted intervention.

Avaliação da Saúde Gengival de Pacientes em Uso de Anticoagulantes

Na atualidade, as questões que envolvem o uso de anticoagulantes com o sangramento gengival aumentado ainda não são bem esclarecidas, havendo necessidade de avaliação se realmente estes medicamentos podem condicionar a mudança na inflamação gengival. Buscou-se neste estudo questionar e avaliar a saúde gengival de indivíduos cardiopatas, que utilizam anticoagulantes em período de internação. Foram aplicados questionários para coleta de dados socioeconômicos dos pacientes cardiopatas internados e realizou-se exame dos índices de placa visível (IPV) e sangramento gengival (ISG). Os pacientes participantes deste estudo eram > 18 anos, com 10 ou mais dentes em boca, cardiopatas internados e usuários de anticoagulantes. Participaram deste estudo 58 pacientes, a média de idade foi 55+12,92 anos; 69% eram homens; 62,1% leucodermas; 20,7% tabagistas e 46,6% diabéticos. O tempo da cardiopatia foi de 57,18+85,69 meses. O retorno ao Dentista ocorreu em média de 83,20 meses; 53,5%, 43,1% e 3,4% pertencem, respectivamente, as classes C, D e B. A maioria dos pacientes (87,9%) teve presença de IPV e 46,6% apresentou ISG. Na análise de risco houve uma relação entre o IPV e tabagismo -1,31 (1,12-1,53); >30 anos 1,085 (1,002-1,176), >40 anos; 1,244 (1,084 – 1,424). Cardiopatas que usam anticoagulantes apresentam necessidades de cuidados em relação à cavidade oral.Palavras-chave: Doença das Coronárias. Boca. Equipe Hospitalar de Odontologia. Gengivite.AbstractNowadays, the issues surrounding the use of anticoagulants such as increased bleeding gums are not well understood yet, there is need to assess whether these drugs actually may make the change in gingival inflammation. We sought to study this question and assess the gingival health of cardiac patients using anticoagulants in hospitalization. Questionnaires were used to collect socioeconomic data from hospitalizedpatients and examination of visible plaque index (VPI) and gingival bleeding (GBI) were carried out. The patients participating in the study were ≥18 years, with 10 or more teeth in their mouth, hospitalized cardiac patients and anticoagulants user. The study included 58 patients, mean age was 55+12,92; 69% were men; 62.1% Caucasian; 20.7% were smokers and 46.6% diabetics. The time of disease was 57,18+85,69 months. The return to the dentist was an average of 83.20 months; 53.5%, 43.1% and 3.4% are respectively the classes C, D and B. Most patients (87.9%) had the presence of IPV and 46.6% had ISG. The risk analysis there was a relationship between VPI and smoking -1.31 (1.12 to 1.53); > 30 years 1.085 (1.002 to 1.176), > 40; 1.244 (1.084 to 1.424).Keywords: Coronary Disease. Mouth. Dental Staff Hospital. Gingivitis.

Caries Experience and Periodontal Status in Children and Adolescents with Cleft Lip and Palate

PURPOSE

The purpose of this study was to examine the rate of dental caries and the periodontal status of children and adolescents with cleft lip and palate (CLP) and to compare them with gender- and age-matched control subjects.

METHODS

A total of 156 five- to 18-year-olds, with or without CLP, were examined for dental caries (decayed, missing and filled permanent teeth and primary surfaces [DMFT and dmfs, respectively] indices), plaque index (PI), the gingival bleeding index (BI), clinical attachment level (CAL), and probing pocket depth (PPD). Diagnoses of gingivitis (localized and generalized) and periodontitis (mild, moderate, and advanced) were performed. Characteristics such as gender, age group, cleft type, socioeconomic status, dental occlusion, and the use of orthodontic appliance were analyzed.

RESULTS

DMFT and dmfs scores were significantly higher in the control group. The PI, BI, and PPD indices were higher in the CLP group. Respectively, in individuals with and without CLP, 49 percent and 75 percent, had good gingival health, 22 percent and 24 percent had localized gingivitis, and 29 percent and one percent had generalized gingivitis.

CONCLUSIONS

The results demonstrate that caries experience in both dentitions was higher for CLP patients, and the presence of CLP is a determining factor for higher risk of gingival inflammation.

Avaliação do conhecimento da saúde bucal entre pacientes cardiopatas antes da realização de cirurgia cardíaca em um hospital Universitário

<p>Objetivou-se avaliar o conhecimento da saúde bucal de pacientes cardiopatas no aguardo de cirurgia cardíaca. Inicialmente os autores se dirigiram a enfermaria em que os pacientes estavam internados e aplicaram um questionário composto por anamnese, condição socioeconômica e perguntas relacionadas à higiene bucal: escovação, aparatos de higiene, frequência de troca, ida ao dentista e presença de próteses dentais, (Qui-quadrado, p&lt;0,05). Como critério de inclusão para o estudo o indivíduo deveria ser cardiopata, estar internado e no aguardo de cirurgia cardíaca. No total entrevistaram-se 62 pacientes; a maioria era do sexo masculino (64,5%), de cor branca (51,6%) e negra (48,4%), com idade média de 60,35+11,73. A maioria era não fumante (91,9%) e não diabético (75,8%). Para os hábitos de higiene, 87,1% escovavam os dentes duas ou três vezes ao dia, destes 98,4% utilizavam escova e creme dental, entretanto 69,4% não utilizam o fio dental. No total de 56,5% pacientes estava a mais de um ano sem ir ao dentista; destes 33,9% tinham procurado este profissional em busca de exodontia. Quanto ao questionamento de como os pacientes consideravam sua saúde bucal, 37,1% disseram ser boa, 43,5% e 19,4% respectivamente para regular e ruim. No total de 48,4% dos pacientes perderam todos os dentes superiores e outros 30,6% todos os inferiores. Conclui-se que a maioria dos pacientes tem conhecimento sobre a importância de se escovar os dentes pelo menos duas vezes ao dia para a manutenção da saúde bucal, entretanto os indicadores avaliados demonstram que no geral o estado de saúde é insatisfatório.</p>

Prevalence of Elongated Styloid Process in a Central Brazilian Population

BACKGROUND

Eagle's syndrome comprises a rare disorder caused by compression of an elongated or deformed styloid process or ossified/calcified stylohyoid ligament on neural and vascular structures. It is characterized by facial and neck pain and can be confused with a wide variety of facial neuralgias, oral and dental diseases and temporomandibular disorders. An imaging evaluation associated with a careful clinical examination, are mandatory in structuring a correct differential diagnosis and in the establishment of a proper therapeutic protocol.

AIM

To investigate the prevalence of the elongated styloid process in a Central Brazilian population and its relation to gender, age and side.

MATERIALS AND METHODS

Digital panoramic radiographs of 736 patients (412 female and 324 male, with a mean age of 35.03 years) were consecutively selected from a private radiology clinic's secondary database. The apparent length of the styloid process was measured from the point where the styloid left the tympanic plate to the tip of the process by two specialists in dental radiology, with the help of the measuring tools on the accompanying software. Styloid process measuring more than 30 mm was considered elongated. The statistical analysis included frequency distribution and cross tabulation. The data were analysed by using Chi-squared tests. The level of significance was set at 5% for all analyses.

RESULTS

A total of 323 (43.89%) radiographic images were suggestive of elongated styloid process. No statistically significant difference was found between the genders, although a higher prevalence was noticed in female participants. Approximately, 31% of the elongated styloid process was observed in 18-53-year-old participants (p < 0.05). Two hundred and sixty seven styloid processes (36.28%) were elongated on both right and left sides.

CONCLUSION

The prevalence of elongated styloid process was high and no statistically significant correlation was found between the presence of elongated styloid process and the studied variables with the exception of the age.

In vitro effectiveness of Brazilian brown propolis against Enterococcus faecalis

The aim of this study was to evaluate the in vitro antimicrobial activity of Brazilian brown propolis as an intracanal medication against Enterococcus faecalis. Thirty dentin discs prepared from intact freshly extracted bovine maxillary central incisors were infected with E. faecalis for 21 days. The specimens were distributed into six groups according to the medicament used as follows: G1- calcium hydroxide paste; G2- Carbowax 400 (control group); G3- 20% brown propolis paste; G4- 40% brown propolis paste; G5- 20% brown propolis paste + calcium hydroxide paste; and G6- 40% brown propolis paste + calcium hydroxide paste. The experimental pastes were placed into the canal lumen and left for 14 days. After each period, irrigation was performed with sterile saline to remove the medicament, and the canals were dried with sterile paper points. The dentin chips were removed from the canals with sequential sterile round burs at low speed and were immediately collected in separate test tubes containing BHI broth. The tubes were incubated at 37°C, and microbial growth was analyzed by spectrophotometry after 15 days. All the experimental medications significantly reduced the number of viable bacteria. The G4 and G5 pastes were more effective than the G1 paste, with 35.8%, 41%, and 21.3% antibacterial activity, respectively. Brazilian brown propolis shows antibacterial capacity against E. faecalis.

Frequency of Maxillary Sinus Mucous Retention Cysts in a Central Brazilian Population

STATEMENT OF THE PROBLEM

Mucous retention cysts (MRCs) of the maxillary sinus are lesions with undefined pathogenesis. In recent researches, geographical and climatic aspects have been related as risk factors.

PURPOSE

The purpose of this study was to determine the frequency of MRCs of the maxillary sinus using panoramic radiographs.

MATERIALS AND METHOD

A total of 631 panoramic radiographs were selected from a secondary database from a private radiology clinic and analyzed by two specialists in dental radiology according to gender, age, month, relative air humidity, and mean temperature.

RESULTS

A total of 87 (6.89%) radiographic images were suggestive of MRCs. Thirty-five MRCs (40.22%) were detected on the right side, 10 (11.49%) on the left side and 42 (48.29%) on both sides. A high frequency was detected in female participants (n=45; 51, 72%), those aged 18-35 years (n=31; 35, 63%) and those from August (n=24; 27.59%) and July (n=22; 25.29%).

CONCLUSION

The frequency of MRCs was low, and no statistically significant correlation was found between the prevalence of MRCs and the studied variables with the exception of the mean temperature.

Effect of repeated sterilization cycles on the physical properties of scaling instruments: a scanning electron microscopy study

BACKGROUND

Repeated sterilizations cycles cause undesirable alterations in the material properties of the instruments, such as corrosion, alterations in the hardness of the metal and the loss of the cutting sharpness of the instrument. This research examined the effect of repeated dry heat sterilization and autoclaves cycles on carbon steel (CS) and stainless steel (SS) curettes during the scaling and root planning.

MATERIALS AND METHODS

A total of 77 Gracey curettes were used in this study. Of these, 35 were SS and 42 were CS curettes submitted in different process: Dry heat, autoclave, inhibition of corrosion and autoclave, scaling, root planning and dry heat, scaling, root planning, inhibition of corrosion and autoclave. The inhibition of corrosion used on the carbon curettes (prior to sterilization in the autoclave) was sodium nitrite at 2%. The curettes received 10 consecutive cycles of sterilization and after that the cutting edges were examined in the electronic microscope, at 60 and 100 magnification times.

RESULTS

The images were evaluated by three independent examiners, who compared the photographs of each group with the control group.

CONCLUSION

The surface corrosion products and a deterioration of the edges were observed and the results showed that the SS curettes suffered little alteration with sterilization, scaling, root planning whereas the CS curettes were visibly affected by sterilization in the autoclave, but when the inhibition of corrosion was used prior to the sterilization, the oxidation was considerably reduced.

Sealing ability of root-end filling materials

BACKGROUND

The aim of this research was to compare the apical sealing ability of different root-end filling materials (SuperEBA(®), ProRoot MTA(®), thermoplasticized gutta-percha + AH-Plus(®), thermoplasticized RealSeal(®)), by means of microbial indicators.

MATERIALS AND METHODS

Thus, 50 human single-rooted teeth were employed, which were shaped until size 5 0, retro - prepared with ultrasonic tips and assigned to 4 groups, retro-filled with each material or controls. A platform was employed, which was split in two halves: upper chamber-where the microbial suspension containing the biological indicators was introduced (E. faecalis + S. aureus + P. aeruginosa + B. subtilis + C. albicans); and a lower chamber containing the culture medium brain, heart influsion, where 3 mm of the apical region of teeth were kept immersed. Lectures were made daily for 60 days, using the turbidity of the culture medium as indicative of microbial contamination. Statistical analyses were carried out at 5% level of significance.

RESULTS

The results showed microbial leakage at least in some specimens in all of the groups. RealSeal(®) has more microbial leakage, statistically significant, compared to ProRoot(®) MTA and SuperEBA(®). No significant differences were observed when compared ProRoot(®) MTA and SuperEBA(®). The gutta-percha + AH Plus results showed no statistically significant differences when compared with the other groups.

CONCLUSIONS

All the tested materials showed microbial leakage. Root-end fillings with Super-EBA or MTA had the lowest bacterial filtration and RealSeal shows highest bacterial filtration.

Detection of Procedural Errors during Root Canal Instrumentation using Cone Beam Computed Tomography

BACKGROUND

This study investigated procedural errors made during root canal preparation with nickel-titanium (NiTi) instruments, using cone beam computed tomography (CBCT) imaging method.

MATERIALS AND METHODS

A total of 100 human mandibular molars were divided into five groups (n = 20) according to the NiTi system used for root canal preparation: Group 1 - BioRaCe, Group 2 - K3, Group 3 - ProTaper, Group 4 - Mtwo and Group 5 - Hero Shaper. CBCT images were obtained to detect procedural errors made during root canal preparation. Two examiners evaluated the presence or absence of fractured instruments, perforations, and canal transportations. Chi-square test was used for statistical analyzes. The significance level was set at a=5%.

RESULTS

In a total of 300 prepared root canals, 43 (14.33%) procedural errors were detected. Perforation was the procedural errors most commonly observed (58.14%). Most of the procedural errors were observed in the mesiobuccal root canal (48.84%). In the analysis of procedural errors, there was a significant difference (P < 0.05) between the groups of NiTi instruments. The root canals instrumented with BioRaCe had significantly less procedural errors.

CONCLUSIONS

CBCT permitted the detection of procedural errors during root canal preparation. The frequency of procedural errors was low when root canals preparation was accomplished with BioRaCe system.

Chemical and structural characterization of glass ionomer cements indicated for atraumatic restorative treatment

Glass ionomer cements (GICs) are restorative materials, which clinical use has increased significantly during the last decade. The aim of the present study was to analyze the chemical constitution and surface morphology of four glass ionomer cements: Maxxion R, VitroFill, Vidrion R and Vitremer. Twelve polyethylene tubes with an internal diameter of 3 and 3 mm in length were prepared, filled and then transferred to a chamber with 95% relative humidity and a temperature of 37°C. The surface morphology of the tested materials was examined by scanning electron microscopy (SEM) and main components were investigated by energy-dispersive X-ray microanalysis (EDX). Scanning electron microscopy revealed irregular and rough external surface. Cracking was not observed. The main constituents were found to be aluminum, silicon, calcium, sodium and fluoride. Phosphorus, sulfur and barium were only observed in Vidrion R, while chlorine were only observed in Maxxion R. Elemental mapping of the outer surface revealed high concentration of aluminum and silicon. Significant irregularities on the surface of the tested materials were observed. The chemical constitution of all GIC was similar.

Effect of chronic stress on ligature-induced periodontitis in inbred and noninbred rats: a radiographic study

AIM

The aim was to compare the effect of chronic stress on ligature-induced periodontitis in inbred and noninbred female rats by means of a radiographic study.

MATERIALS AND METHODS

Adult Lewis (inbred) and Wistar (non-inbred) rats were used and divided into the following groups: Ligature/Stress Lewis Group (LSLG, n = 8); Ligature/Stress Wistar Group (LSWG, n = 8); Ligature Lewis Group (LLG, n = 8) and Ligature Wistar Group (LWG, n = 8). The animals were anesthetized and a silk thread was continuously kept around their second upper right molar. Then, groups LSLG and LSWG were subjected to physical stress test (physical restraint for 12 hours). After 15 days of ligature placement, the animals were euthanized. The right hemimaxilla was kept in formalin solution for 48 hours. Radiographs of the hemimaxillae were obtained using the parallelism technique and subsequently submitted to a standardized radiographic processing. The examiner was blinded to the groups and calibrated. The bone height level was measured and the data were subjected to statistical analysis (ANOVA, Tukey, p < 0.05).

RESULTS

LSWG showed bone destruction significantly higher than that of LSLG (32.1 ± 1.45 mm and 23.6 mm ± 2.13, respectively). Similarly, LWG showed bone destruction significantly higher than that of LLG (28.6 ± 1.18 mm and 25.2 ± 2.76 mm, respectively).

CONCLUSION

Inbred rats (Lewis) are less susceptible to the effects of chronic stress than are noninbred rats (Wistar) in relation to ligature-induced periodontitis.

CLINICAL SIGNIFICANCE

Epidemiological studies have shown a relationship between stress and periodontitis. One of the major difficulties of this type of research is the bias of the exact diagnosis of the patient's emotional state. Inbred lines animals have standards-specific neuroendocrine, this allows answers about the susceptibility of periodontal disease, making knowledge applicable in future clinical trials.

Marginal adaptation of class V restorations with current-generation dentin-bonding agents: effect of different dentin surface treatments

This study sought to assess the use of chlorhexidine with several excipients as a dentin surface treatment and its effect on marginal adaptation of class V restorations with current-generation dentin bonding agents. A total of 120 human third molars were selected and allocated into 12 groups, with standardized buccal class V restorations randomly divided into preconditioned dentin rinsed with: water; water + chlorhexidine; ethanol; or ethanol + chlorhexidine. After rinsing of dentin (previously conditioned with 35% phosphoric acid) with the test solutions, the Adper single bond 2, prime and bond 2.1, and Excite bonding systems were applied randomly. Restorations were performed with Filtek™ Z350 XT composite resin. The resulting specimens were subjected to thermal and mechanical load cycling. Quantitative analysis of marginal adaptation was performed on epoxy replicas by means of scanning electron microscopy. Results were assessed by means of the Kruskal-Wallis test (percentages of continuous margins) and Wilcoxon test (differences between percentages of continuous margins before and after thermal cycling and mechanical loading), at a significance level of p < 0.05. Outcomes in the chlorhexidine-treated groups were not superior to those obtained with other treatments.

Tecidual reaction of calcium hydroxide front chronic stress histological study in rats

BACKGROUND

The Calcium Hydroxide has been widely used as an intracanal dressing and in combination with restorative and endodontic materials and its main goal is the tissue reparation. However, when the patient has chronic stress, the immunological response and tissue repair decreases in both the epithelial and connective tissue. Therefore, the aim was to analyze the effect of chronic stress on the tissue response in rats exposed to calcium hydroxide (CH).

MATERIALS AND METHODS

A total of 60 wistar rats were anesthetized, and a polyethylene tube containing CH was inserted under the skin. After 24 h, they were divided into two groups: Calcium hydroxide + stress (CHSG) n = 30 and calcium hydroxide (CHG) n = 30. They were stressed by physical restraint, for 12 h each day for periods of 7, 15 and 30 days when 10 animals from each group were euthanized. The tissues surrounding the polyethylene tubes were removed, and slides were prepared and stained with hematoxylin and eosin. The analysis was performed with an optical microscope with magnification of 4-400 times by a blinded senior examiner. The sample slides were classified according to the following scores 0 - absent/1 - present/2 - infiltrate to: Inflammatory infiltrate containing fibrous condensation, lymphocytes, plasmacytes, macrophages, neutrophils, and eosinophils. The data were statistically analyzed using the Student's t-test (P < 0.05) for paired samples.

RESULTS

The exposure time of 7 days elicited no statistical difference between groups (P > 0.05). The 15 days exposure group had higher averages for CHG to eosinophils and inflammatory infiltrate (P < 0.05). In 30 days, CHG showed higher averages to inflammatory infiltrate and lower averages to FC (P < 0.05).

CONCLUSIONS

Some modified patterns of responses in the CHSG were observed at 15 days and 30 days.

The influence of chronic stress imposed on pregnant rats on the induced bone loss in their adult offspring

BACKGROUND AND OBJECTIVE

Stress during pregnancy may alter offspring susceptibility to diseases during adulthood. In the present study, female Lewis rats were subjected to chronic stress during the gestational period, and the effect of this stress was evaluated histometrically on the progression of ligature-induced bone loss in their adult offspring.

MATERIAL AND METHODS

After confirming pregnancy, half of the pregnant rats were randomly designated as control animals (no stress regimen was imposed), and the other half was submitted to a chronic stress model (immobilization at cold temperature) between the 7th and the 18th gestational day. After birth, 12 male rats delivered by stressed mothers - Group 1 (G1) - and 12 male rats delivered by non-stressed mothers - Group 2 (G2) - were selected. When birthed rats reached 250 g of body weight, a silk ligature was placed around their maxillary right second molar in order to induce bone loss. The non-ligated left side served as a control. Sixty days later, these animals were sacrificed by anaesthetic overdose. After routine laboratorial processing, images of the histological sections were digitized and submitted for histometric measurement using two parameters: histological attachment loss and bone loss.

RESULTS

On the ligated side, G1 presented with greater histological attachment and bone loss than G2 (p<0.05). On the non-ligated control side, neither of the groups presented with alterations in these parameters (p>0.05).

CONCLUSION

The chronic stress regimen imposed on pregnant rats produced a greater progression of ligature-induced bone loss in their adult offspring.