Delayed endodontic and orthodontic treatment of cross-bite occurring after luxation injury in permanent incisor teeth

A case is presented in which combined endodontic and orthodontic therapy was performed in traumatically injured teeth 12 months after an accident. Calcium hydroxide treatment was used to halt any possible resorption during orthodontic treatment. The teeth were repositioned in a desirable manner without any complication by orthodontic treatment. Root canal obturation was accomplished after the completion of active orthodontic treatment. Recall examination 12 months after completion of root canal treatment showed clinical and radiographic evidence of healing.     

Postoperative complications after Mainz pouch construction--with emphasis on measures to deal with narrowing of the duct aperture

Cutaneous sinus tracts in the face and neck region are often dental in origin. The purpose of this study was to characterize the clinical features and treatment of 37 consecutive cases of odontogenic cutaneous sinus tracts, collected and reviewed in a 15-year period. More than half of the patients (21 cases, 57%) were referred from medical doctors, particularly plastic surgeons and dermatologists. The sinus tracts were associated with caries (26 cases), incomplete endodontic treatment (7), crown fracture (2), vertical root fracture (1) and impacted mandibular third molar (1). They occurred most often in adolescents and adults (30 cases, 81%). The most common causative teeth were mandibular teeth (34 teeth, 85%). The chin, submental, and cheek areas were the most common sites of sinus tracts (30 cases, 81%). The majority of causative teeth (32 teeth, 80%) were treated endodontically. All fistulas healed uneventfully after proper dental treatment, without cosmetic surgery. In 63% (20 cases) of the recorded cases, complete resolution occurred within 8 weeks. Half of the patients had had fistulas for more than 6 months before receiving dental treatment, demonstrating that delays in proper diagnosis and treatment were common. As most patients suffered from unnecessary medication or surgery due to the delay of dental treatment, early dental consultation and treatment is important. Conventional endodontic treatment should be the treatment of choice if the tooth is salvageable. The increasing incidence of incomplete endodontic treatment in association with the occurrence of sinus tracts indicates that standardized endodontic therapy should be emphasized for prevention.     

Long-term evaluation of endodontic and periodontal treatment

One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodontal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive supportive periodontal treatment.     

Cholesterol 7 alpha-hydroxylase activity in hypothyroidism and hyperthyroidism in humans

The effects of three root-end filling materials on healing following endodontic surgery were assessed radiologically and correlated with histological findings reported elsewhere. The materials compared were a light-cured glass ionomer cement (Vitrebond), a reinforced zinc oxide-eugenol cement (Kalzinol) and amalgam. The root canals of 27 two-rooted mandibular premolar teeth of six beagle dogs were inoculated with endodontic pathogenic bacteria to induce periradicular lesions. The roots were apicected and root-end cavities filled with the tested filling materials. The teeth and surrounding jaw were removed after 4 weeks (30 roots) or 8 weeks (24 roots). Radiographs were taken of each jaw section and subjected to image analysis. Healing was evaluated based on measurements of the size of the periradicular radiolucent areas. ANOVA disclosed no statistically significant differences in the size of the periradicular areas either between time periods or between materials. These results did not correlate with the tissue responses in the same material as assessed histologically and previously reported. The use of radiographs alone to assess healing after endodontic surgery in the dog mandible is unsatisfactory, and should not be regarded as a substitute for histological examination for the determination of healing.     

Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.     

Factors associated with endodontic flare-ups: a prospective study

The purpose of this prospective study was to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment by the two authors in their respective practices during a period of one year, and also to examine the correlation with pre-operative and operative variables. The results showed an incidence of 1.58% for flare-ups from 1012 endodontically treated teeth. Statistical analysis using the chi-square test (P<0.05) indicated that flare-ups were found to be positively correlated with multiple appointments, retreatment cases, periradicular pain prior to treatment, presence of radiolucent lesions, and patients taking analgesic or anti-inflammatory drugs. In contrast, there was no correlation between flare-up, and age, sex, different arch/tooth groups and the status of the pulp.     

Effects of CO2 laser in treatment of cervical dentinal hypersensitivity

The effectiveness of CO2 laser therapy in the reduction and elimination of dentinal hypersensitivity in vivo and its thermal effects on tooth surfaces in vitro were investigated. Twenty-three patients with 91 sensitive teeth participated in this study and were followed for 3 months. The parameters used with CO2 laser were 1 W in a continuous wave mode and irradiation time ranging from 5 to 10 s. Hypersensitivity was assessed by thermal stimulus (a blast of air from a dental syringe). Thermal effects were measured by thermography using 10 extracted human teeth. After laser treatment, all patients were immediately free from sensitive pain. Over 3 months, the CO2 laser treatment reduced dentinal hypersensitivity to air stimulus by 50%. All teeth remained vital with no adverse effects. Thermography revealed no temperature increase on irradiated tooth surfaces subjected to water coolant. These results show that the CO2 laser is useful in the treatment of cervical dentinal hypersensitivity without thermal damage to pulp.     

Effects of resorbable membrane placement and human osteogenic protein-1 on hard tissue healing after periradicular surgery in cats

Periradicular surgeries were performed on the maxillary cuspid teeth of twelve cats. Before reapproximation of the surgical flaps, eight of the osteotomies were covered with a resorbable membrane and eight were filled with human osteogenic protein-1 (hOP-1) on a collagen carrier. The remaining eight sites received no further treatment and served as controls. The animals were euthanized after 12 wk, and the specimens were examined histomorphometrically for the presence or absence of osseous regeneration, inflammation, and cementum formation on the root ends. The results showed that the sites treated with the membrane exhibited significantly more inflammation adjacent to the resected root ends (p < 0.05), and that the use of the membrane had no statistically significant effect on osseous healing or new cementum formation. The use of hOP-1 was associated with a significant decrease in the thickness of new cementum formed on the resected root ends (p < 0.05), but had no statistically significant effect on osseous healing or degree of inflammation. Based on these results, it seems that neither the use of hOP-1 nor resorbable membranes have a positive effect on periradicular tissue healing in endodontic surgery.     

Solution structure of the thermostable sweet-tasting protein brazzein

The purpose of this study was to determine whether a nanosecond-pulsed, frequency-doubled Nd:YAG laser emitting at 532 nm can be used as an alternative to mechanical methods of root canal treatment or as an adjunct to conventional endodontic preparation. Laser parameters whose thermal effects did not exceed safety thresholds for adjacent periodontal tissues were selected in a preliminary study. In 27 extracted human teeth, root canals were irradiated for 30 to 60 s at fluences of 2 to 2.2 J/cm2, and 10 Hz. Samples were observed using SEM. Laser irradiation could achieve smear layer removal after minimal manual preparation. However, results were inhomogeneous, and at higher energy densities thermal damage was observed, especially in the fully manually prepared samples. Nanosecond-pulsed irradiation at 532 nm can achieve complete smear layer removal. However, mechanisms must be developed to monitor laser effects and avoid potential damage to collateral structures.     

Conservative treatment of a case of periapical lesion with complications. Report of a case and calcium hydroxide therapy

A case and treatment of extraoral fistula on the chin-caused by necrotic pulp of lower left canine--is being presented. In this case an endodontic origin should always be considered from the aspect of differential diagnosis. Nonsurgical endodontic therapy, sometimes complimented by surgery, or extraction are the treatment modalities of these cases. For the treatment calcium hydroxide powder mixed with chlorhexidin gluckonat (0.1%) was used. Usage of calcium hydroxide paste was leaded to rapid and successful healing of extraoral lesions communicating with necrotic tooth.     

Retrograde root filling with dentin-bonded modified resin composite

A retrograde root-end cover with a special resin composite (Retroplast) combined with the dentin bonding agent Gluma (Bayer AG) has been used since 1984 by the authors. Its content of silver, added to promote radiopacity, has been found to lower the working time and storage stability of the composite and might cause discolorations. Since 1990, silver has therefore been replaced with ytterbium trifluoride, which eliminates these side effects. The purpose of this study was to compare the clinical results obtained with these two resin composites and to evaluate the healing results after several years in function. Apical fillings (351) with the modified Retroplast showed the following radiographic healing pattern 1 yr after surgery: 80% complete healing, 2% scar tissue, 12% uncertain healing, and 6% failure. No significant difference in this healing pattern was found, compared with that obtained with the silver-containing Retroplast. Cases with ytterbium trifluoride classified as scar tissue and uncertain healing at 1 yr when examined at 2 to 4 yr postoperatively showed 89% complete healing. 0% scar tissue, 1% uncertain healing, and 9% failure. This result is significantly different from that obtained 1 yr after surgery. Based on calculations, it was predicted that with time 90% will become complete healing, whereas 10% will become failure.     

Expression and immunogenicity in rats of recombinant adenovirus 5 DNA plasmids and vaccinia virus containing the HTLV-I env gene

PURPOSE: To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachytherapy (HDRB) and external beam radiotherapy (EBRT) for patients found to have isolated vaginal recurrences from early-stage endometrial adenocarcinoma following total abdominal hysterectomy and bisalpingo-oophorectomy (TAH BSO). MATERIALS AND METHODS: Twenty patients originally diagnosed with early-stage endometrial adenocarcinoma (FIGO stage I or II) following TAH BSO developed isolated vaginal recurrences and were referred to our radiation oncology department for definitive treatment. The median time between TAH BSO and vaginal recurrence was 24 months. Thirteen patients received combined modality treatment (EBRT + HDRB) and seven patients received HDRB only. Median prescribed dose was 4400 cGy by EBRT and 2400 cGy to the vagina mucosa surface by HDRB in the combined modality group. Median prescribed dose was 3500 cGy to the vagina mucosa surface for the HDRB only group. These patients were followed for a median duration of 47.5 months following treatment for isolated vaginal recurrence. RESULTS: Eighteen of 20 patients (90%) achieved a complete response to therapy and the remaining 2 achieved a partial response. Four of 18 complete responders developed a second recurrence within 30 months following radiotherapy. Ten-year cumulative local control rate was 74%. Ten-year cumulative cause specific and disease-free survival rate was 71 and 46%. Overall late complication rate was 15%; there were no grade 3 or 4 late complications. Three patients developed grade 2 late complications from treatment; all 3 were from the combined modality group (HDRB + EBRT). CONCLUSION: The use of HDRB resulted in high complete response rates and durable long-term disease-specific survival in a substantial percentage of patients. To our knowledge, this study represents the first published results on treatment of vaginal recurrences with HDRB. Although the number of patients in this study is small, treatment results compare favorably to those obtained from patients treated with low-dose-rate brachytherapy +/- EBRT from other studies.     

The combined treatment of peptic ulcer with the differentiated use of nontraditional physiotherapeutic methods

Efficiency was studied of multimodality treatment of 586 patients with ulcer disease. Of these, 110 had gastric ulcer, 460 patients had duodenal ulcer, sixteen were suffering from both gastric and duodenal ulcer. 275 patients (46.8%) had various concurrent chronic disorders involving cardiovascular system and alimentary canal. Three groups of patients were identified: those receiving magnetoresonance therapy apart from conventional antiulcer therapy (n = 89), those undergoing laser therapy (n = 170), those exposed to hyperbaric oxygenation (HBO), variable magnetic field (VMF) and acupuncture (AP) according to generally accepted techniques. In the control group, drug therapy promoted ulcer healing in 73.3% of patients, whereas multimodality treatment involving MRT induced healing in 80.6% that of incorporating computer-aided laser therapy led to healing in 85.7 to 89.4%. HBO, VMF and AP group demonstrated healing in 92.4 to 93.7%.     

Mice deficient in Mac-1 (CD11b/CD18) are less susceptible to cerebral ischemia/reperfusion injury

Many children with esophagitis demonstrate histological changes without gross evidence of esophagitis by esophagoscopy. The effect of omeprazole on the histological healing of esophagitis in children is unknown. Therefore, the aim of this study was to determine the effect of omeprazole on refractory histological esophagitis in pediatric patients. Eighteen patients with histological evidence of esophagitis and recurrent symptoms despite therapy with H2-receptor antagonists and prokinetic agents were prospectively treated with omeprazole. Dosing was adjusted by monitoring intragastric pH, and esophagoscopy was repeated after 8-12 weeks of omeprazole treatment. Two patients did not complete the study due to either worsening symptoms or hypergastrinemia. Of the remaining patients, 76% were asymptomatic with omeprazole treatment and 24% reported improvement in their symptoms. Approximately 40% demonstrated complete histological healing of their esophagitis. Three patients (17%) had persistent elevations in serum gastrin levels while on omeprazole treatment, which was associated with both younger patient age and higher omeprazole dosing; however, all elevated gastrin levels returned to normal after discontinuation of the medication. All patients had recurrence of their symptoms after completing a course of omeprazole, even patients with complete histological healing. Omeprazole is efficacious in treating children with esophagitis refractory to H2-receptor antagonist and prokinetic agents. However, none of the patients were able to discontinue acid suppressive therapy even after documented healing of their esophagitis.     

Endoscopic resection of large colorectal adenomas: a combination of snare and laser ablation

BACKGROUND AND STUDY AIMS: Endoscopic resection of large colorectal adenomas is still not a standard procedure, treatment with a high diathermic snare is considered as difficult and risky, and the main disadvantage of laser vaporization is the unavailability of histological evaluation. We studied a combined technique that enjoys the benefits of both techniques and avoids the disadvantages and risks of each. PATIENTS AND METHODS: In a prospective study, we combined the techniques of high-frequency snare resection as a preparatory method and Nd: YAG laser vaporisation as a second-stage treatment. In 72 patients, we resected 79 adenomas, most of them in the rectum (81.0%) and with a tubulovillous histology (69.6%), with a mean volume of 9.4 cm3 (1.5-29.0 cm3) and a base diameter ranging from 20 mm to 80 mm. RESULTS: After using the combined technique of preparatory mucosectomy as a first step and laser vaporization as the second step, follow-up evaluation was possible in 50 out of 72 patients (69.4%). Fourteen patients had a local relapse of adenoma (28.0%), with dysplasia histologically of the same grade or a lower one compared to the original grade, after a mean of 1.4 years. Since these local recurrences were diagnosed at a size of a few millimeters (less than 3 mm), a further session of laser treatment eliminated the material completely without complications. No colorectal carcinomas were observed. CONCLUSIONS: The high clinical long-term success of our combined electro-laser resection is not only a result of complete endoscopic adenoma resection, but also of a strong control regimen. This technique is applicable to the treatment of large colorectal adenomas with curative intent.     

Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment

This retrospective study compared one-visit versus two-visit endodontic treatment. The same technique and materials were used before and after making the sole change to one-visit endodontic treatment in 1991. Treatment records of 402 consecutive patients with pulpally necrotic first and second molars were compared. In 201 patients, treatment was provided by debridement and instrumentation, followed by obturation at a second visit; whereas the second group received single visit therapy. Flare-ups were defined as either patient reports of pain not controlled with over-the-counter medication or as increasing swelling. Sixteen flare-ups (8%) occurred in the two-visit group versus six flare-ups (3%) for the one-visit group. This showed an advantage for one-visit treatment at a 95% confidence level. In a second comparison, one-visit patients who had previously received two-visit treatment for a different pulpally necrotic molar served as their own control. No significant differences were present in this subgroup of 17 patients.     

Risk of renal cell carcinoma after kidney transplantation

Dental trauma occurs very often in children and its consequences vary from tiny fractures to the complete avulsion of the tooth. According to Andreasen, 86.5% of incidents of dental trauma suffered by preschool children cause injury to maxillary primary incisors, whereas only 0.5% cause injury to primary molars. This case report is of a male patient aged 7 years who had fallen down a month before, struck his chin against a step, and fractured the maxillary and mandibular left primary second molars (65 and 75) and the mandibular right primary second molar (85). The 65 required only smoothing of sharp edges, 75 received endodontic treatment and a stainless steel crown, and 85 was extracted and a space maintainer fitted. The early diagnosis of fractures of posterior teeth is very important; a thorough examination of all posterior teeth should be made, especially when child suffers trauma to the chin region.     

Comparison of wound healing process using Argon and Krypton lasers

OBJECTIVE: We compared the wound healing process on Sprague-Dawley rats between Argon Laser and Krypton Laser, and calculated the laser actual doses after correction on wound healing on rats and estimated the clinical doses on wound healing for human skin. SUMMARY BACKGROUND DATA: Laboratory work provided some support for the use of low-intensity laser radiation in wound healing. Some studies found that laser irradiation may either enhance, inhibit, or has no effect on the function of a variety of microorganisms and cells. Animal studies also offered some basis for treatment. Improvements, particularly in the earliest phases of wound healing, have been reported following laser irradiation. METHODS: We used Argon Laser (488-514 nm) and Krypton Laser (670 nm) in the study. The laser beam was delivered through a system of fiber optic in Argon Laser and reflector in Krypton Laser. The rats treated were restrained in a Plexiglas cage without anesthesia during the laser irradiation period. The percentage of the wound healing acceleration in days and size, actual doses, and estimated clinical doses were calculated as follows: AccD = (1-TD/CD) x 100%, AccS = (1-TA/CA) x 100%, AD = D(in) - D(gl) - D(SR) and ECD = AD = D(sr), respectively. RESULTS: The acceleration effects of wound healing in days (AccD) were 22.93% and 14.54%, size reductions (AccS) were 41.93% and 30.41% at the optimal stimulative incident dose of 20 J/cm2. Zero bioactivation shown at the incident doses of 80 J/cm2 and 100 J/cm2. The inhibitory effects of wound healing in days were -7.72% and -3.37%, in size reduction were -13.35% and -12.88% at the maximal inhibitory incident dose of 140 J/cm2 for Argon and Krypton Lasers, respectively. The actual doses were 5.21 J/cm2 and 4.03 J/cm2, the estimated clinical doses were 5.50 J/cm2 and 4.25 J/cm2 at optimal stimulative incident dose 20 J/cm2 for Argon and Krypton Lasers, respectively. CONCLUSIONS: Low power laser therapy at the appropriate dosimetric parameters can provide the acceleration effects of wound healing on rats. The effects were dependent with the doses and laser wavelengths used. In this experiment, the optimum stimulative dose was 20 J/cm2 and the Argon Laser with 488 nm was more effective than the Krypton Laser with 670 nm. The zero bioactivation and inhibition effect of wound healing on rats occurred in Argon Laser and Krypton Laser.     

Catecholaminergic innervation of the human dura mater involved in headache

The effects of pulsed Nd:YAG laser irradiation with different laser initiators on the permeability and ultrastructure of the root canal wall dentin were investigated in vitro. Forty extracted human single-rooted teeth were randomly assigned to four groups. Group 1 teeth were not lased as a control. Group 2 specimens received four 10-s duration laser exposures for a total exposure of 40 s/canal. In group 3 specimens, the root canals were painted with black ink and then lased by the same method as group 2 teeth. In group 4 specimens, root canals were treated with 38% Ag(NH3)2F and then lased by the same method as group 2 teeth. Laser parameters were set at 2 W, 20 pps. After being placed in 0.6% rhodamine B solution for 48 h, the teeth were sectioned for study by stereoscope and scanning electron microscopy. Statistical analysis showed there were significant differences (p < 0.05) in dentin permeability in the apical areas between groups 3 and 1, 4 and 1, and 4 and 2. Scanning electron microscopic examination showed that laser treatment alone had no obvious effects on the root canal wall. The root canal surfaces prepared for by laser irradiation with black ink or 38% Ag(NH3)2F revealed melting, smear layer evaporation, and open dentinal tubules. Black ink was more effective than 38% Ag(NH3)2F as a Nd:YAG laser initiator.