Complications following an accidental sodium hypochlorite extrusion: A report of two cases

Sodium hypochlorite (NaOCl) is the most commonly used solution in root canal treatments, as it is a low-cost method that displays a very effective antimicrobial activity against microbiota of infected root canals. However, this solution can cause complications especially due to its cytotoxic features. When this solution is injected into the adjacent tissues, the patient usually experiences intense pain, and an urgent treatment should be implemented in order to prevent a long-term sequelae. This paper describes the clinical features of two patients that experienced an accidental extrusion of NaOCl after endodontic treatment of varying severity and with different treatments. Furthermore, it shows the long-term neurologic injuries that this type of accidents may cause and a treatment protocol for these situations will be suggested.

Tensile strength characteristics of polypropylene composites reinforced with stone groundwood fibers from softwood

The behavior of stone groundwood / polypropylene injection-molded composites was evaluated with and without coupling agent. Stone groundwood (SGW) is a fibrous material commonly prepared in a high yield process and mainly used for papermaking applications. In this work, the use of SGW fibers was explored as a reinforcing element of polypropylene (PP) composites. The surface charge density of the composite components was evaluated, as well as the fiber’s length and diameter inside the composite material. Two mixing extrusion processes were evaluated, and the use of a kinetic mixer, instead of an internal mixer, resulted in longer mean fiber lengths of the reinforcing fibers. On the other hand, the accessibility of surface hydroxyl groups of stone groundwood fibers was improved by treating the fibers with 5% of sodium hydroxide, resulting in a noticeable increase of the tensile strength of the composites, for a similar percentage of coupling agent. A new parameter called Fiber Tensile Strength Factor is defined and used as a baseline for the comparison of the properties of the different composite materials. Finally the competitiveness of stone groundwood / polypropylene / polypropylene-co-maleic anhydride system, which compared favorably to sized glass-fiber / polypropylene GF/PP and glass-fiber / polypropylene / polypropylene-co-maleic anhydride composite formulations, was quantified by means of the fiber tensile strength factor

Structural and magnetic characterization of the lithiated iron oxide LixFe3O4

The Rietveld profile‐analysis method is used to investigate the x‐ray diffraction pattern of lithiated Fe3O4. It is shown that, after exposure to air, pure magnetite coexists with a lithium‐inserted LixFe3O4 phase. The Mössbauer spectra at 300 and 4.2 K have been used to estimate the lithium content of the sample, the pure magnetite concentration, and the iron distribution over the available 16c and 16d sites of the spinel structure. Magnetization measurements from 4.2 to 120 K with an external magnetic field up to 150 kOe have been used to obtain the saturation magnetic moment, the magnetic anisotropy constants, and the susceptibility. It is concluded that a noncollinear spin structure should be present in Li0.5Fe3O4. These results indicate that there is no room‐temperature extrusion of iron even for x→2.0, but that on exposure to air LixFe3O4 samples with x>0.5 are oxidized at room temperature by delithiation.

Evidence of an efflux pump in Serratia marcescens

Spontaneous mutants resistant to fluoroquinolones were obtained by exposing Serratia marcescens NIMA (wild-type strain) to increasing concentrations of ciprofloxacin both in liquid and on solid media. Frequencies of mutation ranged from 10-7 to 10-9. Active expulsion of antibiotic was explored as a possible mechanism of resistance in mutants as well as changes in topoisomerase target genes. The role of extrusion mechanisms in determining the emergence of multidrug-resistant bacteria was also examined. Mutants resistant to high concentrations of fluoroquinolones had a single mutation in their gyrA QRDR sequences, whereas the moderate resistance in the rest of mutants was due to extrusion of the drug

Evidence of an efflux pump in Serratia marcescens

Spontaneous mutants resistant to fluoroquinolones were obtained by exposing Serratia marcescens NIMA (wild-type strain) to increasing concentrations of ciprofloxacin both in liquid and on solid media. Frequencies of mutation ranged from 10-7 to 10-9. Active expulsion of antibiotic was explored as a possible mechanism of resistance in mutants as well as changes in topoisomerase target genes. The role of extrusion mechanisms in determining the emergence of multidrug-resistant bacteria was also examined. Mutants resistant to high concentrations of fluoroquinolones had a single mutation in their gyrA QRDR sequences, whereas the moderate resistance in the rest of mutants was due to extrusion of the drug

Lower incisor dentoalveolar compensation and symphysis dimensions among Class I and III malocclusion patients with different facial vertical skeletal patterns

Objective: To compare lower incisor dentoalveolar compensation and mandible symphysis morphology among Class I and Class III malocclusion patients with different facial vertical skeletal patterns. Materials and Methods: Lower incisor extrusion and inclination, as well as buccal (LA) and lingual (LP) cortex depth, and mandibular symphysis height (LH) were measured in 107 lateral cephalometric x-rays of adult patients without prior orthodontic treatment. In addition, malocclusion type (Class I or III) and facial vertical skeletal pattern were considered. Through a principal component analysis (PCA) related variables were reduced. Simple regression equation and multivariate analyses of variance were also used. Results: Incisor mandibular plane angle (P < .001) and extrusion (P  =  .03) values showed significant differences between the sagittal malocclusion groups. Variations in the mandibular plane have a negative correlation with LA (Class I P  =  .03 and Class III P  =  .01) and a positive correlation with LH (Class I P  =  .01 and Class III P  =  .02) in both groups. Within the Class III group, there was a negative correlation between the mandibular plane and LP (P  =  .02). PCA showed that the tendency toward a long face causes the symphysis to elongate and narrow. In Class III, alveolar narrowing is also found in normal faces. Conclusions: Vertical facial pattern is a significant factor in mandibular symphysis alveolar morphology and lower incisor positioning, both for Class I and Class III patients. Short-faced Class III patients have a widened alveolar bone. However, for long-faced and normal-faced Class III, natural compensation elongates the symphysis and influences lower incisor position.

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion