One-year clinical performance of self-etch adhesives in posterior restorations

Purpose: To evaluate the 1-year clinical performance of three self-etching adhesives (Adper Prompt L-Pop, Clearfil S-3 Bond, iBond) in posterior composite restorations using one etch&rinse adhesive (One-Step Plus) as control. Methods: Upon approval by the Institutional Review Board, 121 restorations were inserted in 38 subjects. The adhesives were applied as per manufacturers' instructions. Preparations were restored with a nanofilled resin composite (Filtek Supreme) and evaluated at baseline, 6 months, and 1 year. Statistical analyses included the Chi-square distribution with the McNemar non-parametric test (P< 0.05). Results: At 1 year, 111 restorations in 35 subjects were evaluated using the USPHS modified criteria. No significant changes were observed for the etch&rinse adhesive One-Step Plus. At 1 year the number of Alfa ratings decreased significantly for Clearfil S-3 Bond and for iBond in the categories color match, marginal staining, and marginal adaptation. For Adper Prompt L-Pop, marginal adaptation at 1 year was significantly worse than at baseline. Postoperative sensitivity to air improved significantly for Adper Prompt L-Pop, Clearfil S-3 Bond, and iBond. When the evaluation criteria were paired at 1 year, iBond resulted in a significantly lower number of Alfa ratings than any of the other adhesives for color match, marginal staining, and marginal adaptation. One-Step Plus resulted in a greater number of Alfa ratings for marginal adaptation than either Adper Prompt L-Pop or Clearfil S-3 Bond. Marginal adaptation was significantly better for Clearfil S-3 Bond than for Adper Prompt L-Pop. The post-operative sensitivity measured at 1 year for Adper Prompt L-Pop was statistically better than that for One-Step Plus.

Effect of the clinical application of the GaAlAs laser in the treatment of dentine hypersensitivity

Objective: the aim of this study was to evaluate the effectiveness of the clinical use of the gallium-aluminum-arsenium (GaAlAs) laser at the maximum and minimum energies recommended by the manufacturer for the treatment of dentine hypersensitivity.Background Data: Dentine hypersensitivity (DH) is a response to a stimulus that would not usually cause pain in a healthy tooth. It is characterized by sharp pain of short duration from the denuded dentin. Its etiology is unknown. The dentin only begins to show sensitivity when exposed to the buccal environment. This exposure can result after removal of the enamel and/or dental cement, or after root denudation. Different treatments are proposed for this disorder.Materials and Methods: In this study, 25 patients, with a total number of 106 cases of DH, were treated with GaAlAs low-level laser therapy (LLLT). 65% of the teeth were premolars; 14% were incisors and molars; 6.6% were canines. The teeth were irradiated with 3 and 5 J/cm(2) for up to six sessions, with an interval of 72 It between each application, and they were evaluated initially, after each application, and at 15 and 60 days follow-up post-treatment.Results: the treatment was effective in 86.53% and 88.88% of the irradiated teeth, respectively, with the minimum and maximum energy recommended by the manufacturer. There was a statistically significant difference between DH and after a follow-up of 60 days for both groups. The difference among the energy maximum and minimum was not significant.Conclusion: the GaAlAs low-level laser was effective in reducing initial DH. A significant difference was found between initial values of hypersensitivity and after 60 days follow-up post-treatment. No significant difference was found between minimum (3 J/cm(2)) and maximum (5 J/cm(2)) applied energy.

Genotypes of the mannan-binding lectin gene and susceptibility to visceral leishmaniasis and clinical complications

Background. Visceral leishmaniasis (VL) is almost always lethal if not treated, but most infections with the causative agents are clinically silent. Mannan-binding lectin (MBL), an opsonin, is a candidate molecule for modifying progression to VL because it may enhance infection with intracellular pathogens. Mutations in the MBL2 gene decrease levels of MBL and may protect against development of VL. This case-control study examines genotypes of MBL2 and levels of MBL in individuals presenting with different outcomes of infection with Leishmania chagasi.Methods. Genotypes for MBL2 and levels of serum MBL were determined in uninfected control subjects (n=76) and in individuals presenting with asymptomatic infection (n=90) or VL (n=69).Results. Genotypes resulting in high levels of MBL were more frequent (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.3-5.0]; P=.006) among individuals with VL than among those with asymptomatic infections and were even more frequent (OR, 3.97 [95% CI, 1.10-14.38];P=.043) among cases of VL presenting with clinical complications than among those with uneventful courses. Serum levels of MBL were higher (P=.011) in individuals with VL than in asymptomatic infections.Conclusions. Genotypes of the MBL2 gene predict the risk for developing VL and clinical complications in infections with L. chagasi.

Phenotypic methods and commercial systems for the discrimination between C-albicans and C-dubliniensis

Candida dubliniensis is a recently described Candida species associated with oral candidosis that exhibits a high degree of phenotypic similarity to Candida albicans. However, these species show differences in levels of resistance to antimycotic agents and ability to cause infections. Therefore, accurate clinical identification of C. dubliniensis and C. albicans species is important in order to treat oral candidal infections. Phenotypic identification methods are easy-to-use procedures for routine discrimination of oral isolates in the clinical microbiology laboratory. However, C. dubliniensis may be so far underreported in clinical samples because most currently used identification methods fail to recognize this yeast. Phenotypic methods depend on growth temperature, carbon source assimilation, chlamydospore and hyphal growth production, positive or negative growth on special media and intracellular enzyme production, among others. In this review, some phenotypic methods are presented with a special emphasis on the discrimination of C. dubliniensis and C. albicans.

Clinical comparison between conventional suture and vaporization with carbon dioxide laser in rat's skin

Objective: This study compares wound healing efficiency on a rat's skin when the incision was closed with a conventional suture versus vaporized with a CO2 laser. Materials and Methods: In this study, 24 rats were used, and two longitudinal incisions were made with a conventional scalpel in the dorsum of each rat. The left incision was sutured with nylon thread, and the right incision was closed by vaporization with a defocused CO2 laser in continuous mode with an 8-watt power density. Clinical photographs were taken immediately after the procedure, 24 h later, and after 3, 7, 14, and 21 days, documenting the healing of the incision. Results: the results showed that there was an initial delay in wound repair in the vaporized incision as compared to the scalpel incision, but after 21 days, both incisions showed the same clinical characteristics. However, the vaporized incision showed no trauma of the tissue, as opposed to the sutured incision, and no hemorrhagic complications. Conclusion: These results suggest that the CO2 laser can eventually replace the use of sutures.

A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation

Introduction Oral mucositis (OM) is a significant early complication of hematopoietic cell transplantation (HCT). This phase III randomized double-blind placebo-controlled study was designed to compare the ability of 2 different low level GaAlAs diode lasers (650 nm and 780 nm) to prevent oral mucositis in HCT patients conditioned with chemotherapy or chemoradiotherapy.Materials and methods Seventy patients were enrolled and randomized into 1 of 3 treatment groups: 650 nm laser, 780 nm laser or placebo. All active laser treatment patients received daily direct laser treatment to the lower labial mucosa, right and left buccal mucosa, lateral and ventral surfaces of the tongue, and floor of mouth with energy densities of 2 J/cm(2). Study treatment began on the first day of conditioning and continued through day +2 post HCT. Mucositis and oral pain was measured on days 0, 4, 7, 11, 14, 18, and 21 post HCT.Results the 650 nm wavelength reduced the severity of oral mucositis and pain scores. Low level laser therapy was well-tolerated and no adverse events were noted.Discussion While these results are encouraging, further study is needed to truly establish the efficacy of this mucositis prevention strategy. Future research needs to determine the effects of modification of laser parameters (e.g., wavelength, fluence, repetition rate of energy delivery, etc.) on the effectiveness of LLE laser to prevent OM.

Periodontal status in smokers and never-smokers: Clinical findings and real-time polymerase chain reaction quantification of putative periodontal pathogens

Background: Smoking is a well-known risk factor for destructive periodontal disease, but its relationship with periodontal status and subgingival microbiota remains unclear. Inherent limitations of microbiological methods previously used may partly explain these mixed results, and real-time polymerase chain reaction (PCR) has been presented as a valid alternative. The aim of the present study was to investigate the clinical condition and microbiological profile of patients with chronic periodontitis as related to the habit of smoking.Methods: Fifty patients (33 to 59 years old), 25 smokers and 25 never-smokers, constituted the sample. The visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PD), clinical attachment loss (CAL), and gingival crevicular fluid (GCF) volume were recorded. Real-time PCR quantified Porphyromonas gingivalis, Micromonas micros, Dialister pneumosintes, Actinobacillus actinomycetemcomitans and total bacteria in subgingival samples.Results: Smokers and never-smokers showed similar values for VPI, GBI, and BOP. Smokers had deeper PD in buccal/lingual sites and higher CAL independently of the tooth surface. The GCF volume was smaller in smokers, independent of the PD. Similar amounts of total bacteria and P. gingivalis were observed for both groups. Significantly higher numbers of D. pneumosintes and M. micros were present in smokers and associated with moderate and deep pockets. When heavy smokers were considered, higher counts of total bacteria, M. micros, and D. pneumosintes were observed.Conclusions: Smoking seems to have a detrimental impact on the periodontal status and microbiological profile of patients with periodontitis. Compared to never-smokers, smokers had deeper pockets, greater periodontal destruction, and higher counts of some putative periodontal pathogens.

The treatment of painful temporomandibular joint clicking with oral splints: A randomized clinical trial

Background. The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial.Methods. The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a XI test to test the hypothesis.Results. The type of guidance used did not influence the pain reduction; yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left; lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort.Conclusion. The type of lateral guidance did not influence the subjects'; improvement: All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.

The Use of Etoricoxib and Celecoxib for Pain Prevention After Periodontal Surgery: A Double-Masked, Parallel-Group, Placebo-Controlled, Randomized Clinical Trial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evaluation of Different Methods of Optical Impression Making on the Marginal Gap of Onlays Created with CEREC 3D

Objectives: This study evaluated the marginal gaps on several surfaces of onlays created with the Cerec 3D system using one intraoral and two extraoral optical impression methods. Methods: A human molar (#19) was mounted with its adjacent teeth on a typodont (Frasaco) and prepared for a MODL onlay. The typodont was assembled in the mannequin head in order to simulate clinical conditions. The same operator took 36 individual optical impressions using a CEREC 3D camera. For group 1 (IP), a thin layer of titanium dioxide powder (CEREC powder-VITA) was applied directly onto the surface of the preparation for imaging (n=12). For group 2 (EP), a sectional impression was taken with hydrocolloid Identic Syringable (Dux Dental), a die made with polyvinylsiloxane KwikkModel Scan (R-dental Dentalerzeugnisse GmbH) and powdered with titanium dioxide for imaging (n=12). For group 3 (ES), a sectional impression was taken with PVS and a sectional stock tray, a die fabricated in stone (Diamond die- HI-TEC Dental Products) and the die being imaged without powdering (n=12). One operator designed and machined the onlays in Vita Blocks Mark II for Cerec (VITA) using a CEREC 3D. The marginal gaps (pm) were measured with an optical microscope (50x) at 12 points, three on each surface of the MODL. The results were analyzed by two-way ANOVA/Tukey's (p=0.05). Results: The overall mean marginal gaps (mu m) for the three methods were: IP=111.6 (+/- 34.0); EP=161.4 (+/- 37.6) and ES=116.8 (+/- 42.3). IP and ES were equal, but both were significantly less than EP. The pooled mean marginal gaps (mu m) for the occlusal = 110.5 (+/- 39) and lingual = 111.5 (+/- 30.5) surfaces were equivalent and significantly less than the distal = 136.5 (+/- 42.5) and mesial = 161.1 (+/- 43.3). Conclusion: The marginal gap of CEREC 3D onlay restorations was not different when the optical impression was taken intraorally vs extraorally using a stone cast that does not require powdering. The lingual and occlusal surfaces showed the lowest gaps.

The Combination of Amoxicillin and Metronidazole Improves Clinical and Microbiologic Results of One-Stage, Full-Mouth, Ultrasonic Debridement in Aggressive Periodontitis Treatment

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

CLINICAL STUDY of NATURAL INFECTION BY Trypanosoma cruzi IN DOGS RESIDING IN A RURAL AREA IN MATO GROSSO do SUL STATE, BRAZIL

This study was carried out to describe the clinical characteristics of natural infection caused by Trypanosoma cruzi in dogs that reside in a rural area of Mato Grosso do Sul State, Brazil. Conventional and nonconventional diagnostic methods were used for screening T. cruzi infection in 75 dogs that lived in the area. Cardiovascular tests and biochemical examination of sera were also performed in four confirmed positive dogs. The following techniques were employed: indirect immunofluorescence test (IFAT), enzyme-linked immunosorbent assay with T. cruzi epimastigote antigens (EAE-ELISA) and enzyme-linked immunosorbent assay with T. cruzi excreted-secreted trypomastigote antigens (TESA-ELISA) with antibodies detected in 45.33% (n = 34), 24.0% (n = 18) and 12.0% (n = 9) of the dogs, respectively. The current prevalence of the infection was confirmed as 10.7% (n = 8) by immunoblotting test with T. cruzi excreted-secreted antigens (TESA-blot). The test that showed the best concordance index (Kappa; 0.93), sensitivity (100%) and specificity (98.5%) was TESA-ELISA, that when associated with IFAT had the same results as those obtained by TESA-blot (10.7%). Three out of the four chagasic animals showed enlarged cardiac silhouette on X-ray and an increase of the P-wave duration and QRS complex in electrocardiogram. Two dogs presented conduction disturbances, right bundle branch block in one dog and first-degree atrioventricular block and sinus arrest in another. The ecodopplercardiography presented left-ventricular-wall thickness increased during diastole, decrease of the shortening fraction and inversion in the speed peaks of the E and A waves, indicating the presence of systolic and diastolic disorders. The four animals showed enzymatic activities of creatine kinase (221-404 U/L), MB fraction of creatine kinase (189-304 U/L), elevated total proteins (7.6-10.2 g/dL) and total globulins (4.6-7.7g/dL) and reduction of albumin/globulin ratio, which suggested a myocardial injury and continuous antigenic stimulus.

Effect of posture-control insoles on function in children with cerebral palsy: Randomized controlled clinical trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Heparin, heparin plus ASA and dipyridamole, and arteriovenous fistula as adjuvant methods to prevent rethrombosis after venous thrombectomy. Experimental study in rabbits

Venous rethrombosis following thrombectomy is a common event. The aim of the present study was to verify the action of heparin, heparin plus acetyl salicylic acid (ASA) and dipyridamole, and of an arteriovenous fistula (AVF) in the prevention of this complication. Thrombosis was induced in 48 male rabbits by the injection of thrombin in a segment of the left jugular vein, in which the blood flow was arrested for 10 minutes. After 48 hours, the animals were randomly allocated into one of 4 groups of treatment: (1) control, (2) subcutaneous heparin (600 S.I. Units/kg - 8/8 hours), (3) heparin, in the same dose, plus ASA (10 mg/kg/once a day), and dipyridamole (0.5 mg/kg thrice a day), (4) an AVF was surgically constructed between the left carotid after and the left maxillar vein. After 30 minutes, thrombectomy was performed. The venous blood flow, the hematocrit, activated partial thromboplastin time and thrombin time tests were performed before, right after the thrombectomy and 48 hours after thrombectomy. Venography was performed after thrombectomy and at the end of the experiment. The animals were killed 48 hours after thrombectomy and the veins were examined macroscopically. Venous rethrombosis was significantly prevented only in the AVF group (9/12), when compared to control group (0/12), heparin group (1/12) and heparin plus antiaggregating agents group (2/12). These results validate further clinical and experimental investigations with the use of AVF to prevent rethrombosis after venous thrombectomy, when a reduction of venous flow is present.

Comparison between histochemical and immunohistochemical methods for diagnosis of sporotrichosis

Aims: To compare the efficacy of histochemical and immunohistochemical methods in detecting forms of Sporothrix schenckii in tissue. Methods: Thirty five cutaneous biopsy specimens from 27 patients with sporotrichosis were stained by histochemical haemotoxylin and eosin, periodic acid Schiff, and Gomori's methenamine silver methods and an immunohistochemical (avidin-biotin complex immunoperoxidase) (ABC) technique associated with a newly produced rabbit polyclonal antibody anti-Sporothrix schenckii. Results: A total of 29 (83%) cases were positive by the ABC method used in association with anti-Sporothrix schenckii rabbit polyclonal antibodies. Histochemical methods, using silver staining, periodic acid Schiff, and conventional haematoxylin and eosin detected 37%, 23%, and 23% of forms of S schenckii, respectively. The ABC technique was significantly more reliable than periodic acid Schiff and silver staining techniques. Conclusions: It is concluded that immunostaining is an easy and rapid method which can efficiently increase the accuracy of the diagnosis of sporotrichosis in human tissue.