Referral letters in oral medicine: an approach for the general dental practitioner

The aim of this study was to analyze the contents of referral letters related to clinical history and reason for consultation. A total of 236 consecutive referral letters were evaluated. Analysis of the referral letters was based on key items concerning patient identification. chief complaint, previous consultation. laboratory investigation and use of drugs for the chief complaint. A database was organized (Epinfo 6.04) and the chi (2) test (a = 0.05) was applied to the results. of the 800 files examined. only 30%, (236) had a referral letter. of the 236 referral letters. 67% were from dentists, 22% from physicians and 11% from unidentified professionals. Patient age did not appear in 70%, of the letters and the chief complaint was mentioned only in 55%. The letters had no details such as description of the oral lesion (80%), anatomical site (34%), size (99%), symptoms (83%), or period of evolution (92%). Clinical diagnosis was not included in 84% of the letters. Less than 5% of the referral letters contained information about previous consultation and laboratory investigation. The chi (2) test showed significant differences for ail items of the referral letter. Referral letters did not satisfy minimal requirements about clinical history or reason for consultation. leading to failed communication among professionals. Based on this study, we suggest that standard letters are important to improve the quality of the letters, reducing the rate of omission of relevant items.

Influence of fluoride-containing solutions on the translucency of flowable composite resins

The aim of this study was to evaluate the influence of fluoride-containing solutions on the translucency of flowable composite resins, with respect the immersion time. Flow-It! (FI) and Natural Flow (NF) composite resins and three commercial brands of fluoride-containing solutions (Fluordent, Fluorgard and Oral B) were used. Specimens were prepared and stored in the solutions at 37degreesC, until the measurements were made after the following treatments: T1 - after 1 hour in relative humidity; T2 - after 1 h in solution; T3 - 24 h; T4 - 48 h; T5 - after a week; from T9, the measurements were accomplished weekly, up to 30-day immersion. To obtain translucency values an electrophoresis equipment was employed. Data were submitted to ANOVA and Tukey tests. The results disclosed that NF showed highest values of translucency and was statistically different from FI (p < 0.001). As regards the solutions, Fluordent and Oral B presented similar values and were statistically superior to Fluorgard (p < 0.05). Concerning the immersion time, similar results were observed for the different evaluation periods. It may be concluded that the fluoride-containing solutions affected the translucency of the composite resins, independently of the materials used. Among the tested resins, NF presented the best performance. (C) 2003 Kluwer Academic Publishers.

Cytotoxicity of denture base acrylic resins: A literature review

Acrylic resins are widely used in the fabrication of denture bases and have been shown to be cytotoxic as a result of substances that leach from the resin. The primary eluate is residual monomer. Numerous reports suggest that residual monomer may be responsible for mucosal irritation and sensitization of tissues. This information is important, not only to assess the biologic effects of such materials, but also to enable a comparison among the different polymerization methods, thus assisting the clinician in selecting a material with minimal cytotoxicity. This article reviews the literature published from 1973 to 2000, selected by use of a Medline search, associated with cytotoxic effects usually ascribed to acrylic denture base materials.

Influence of different dentin etching times and concentrations and air-abrasion technique on dentin microtensile bond strength

Purpose: To determine the influence of different dentin treatments on the microtensile bond strengths of adhesive resins to dentin. Methods: Fifteen human molars were ground to 600-grit to obtain flat root-dentin surfaces. Five different dentin treatments were evaluated: Group 1 - 10% phosphoric acid for 30 seconds; Group 2 - 37% phosphoric acid for 15 seconds; Group 3 - air-abrasion for 10 seconds followed by 10% phosphoric acid for 30 seconds; Group 4 - air-abasion for 10 seconds followed by 37% phosphoric acid for 15 seconds. The dental adhesive (OptiBond Solo Plus) was applied according to manufacturer's instructions and followed by composite (Z100) application to provide sufficient bulk for microtensile bond testing. All samples were placed in distilled water for 24 hours at 37degreesC, thermocycled for 500 cycles in distilled water at 10degreesC and 50degreesC, and serially sliced perpendicular to the adhesive surface and subjected to tensile forces (0.5 mm/minute). Additional samples were prepared for SEM to observe the adhesive interface. Results: Group 2 exhibited significantly (P< 0.05) lower bond strength values than all other treatments. The bond strengths of the different conditions were (in MPa): Group 1: 43.0 +/- 16.1; Group 2: 29.2 +/- 8.3; Group 3: 48.1 +/- 14.2; Group 4: 41.0 +/- 9.3. The dentin treated with phosphoric acid 37% for 15 seconds showed the lowest values of microtensile bond strength. The results obtained with Groups 1, 3 and 4 were statistically similar.

The influence of cyclosporin a on mechanical retention of dental implants previously integrated to the bone: A study in rabbits

Background: Immunosuppressive agents may induce severe changes on bone metabolism and may impair the osseointegration process during the implant healing. No data are available concerning the influence of cyclosporin A on dental implants previously integrated to the bone. The aim of this study was to evaluate the influence of cyclosporin A administration on the mechanical retention of bone previously integrated to dental implants.Methods: Eighteen female New Zealand rabbits were submitted to an implant surgery. Each animal received one commercial dental implant of 10 x 3.75 mm. After 12 weeks of an undisturbed healing period, six animals were randomly sacrificed and the removal torque test was performed (group A). In addition, six animals were submitted to a daily injection of cyclosporin A in a dosage of 10 mg/kg (group C), and six animals received saline solution as a control (group B). After 12 weeks of cyclosporin A administration, groups B and C were sacrificed and submitted to a removal torque test in which higher values can be interpreted as higher mechanical bone retention to the implant surface or higher osseointegration.Results: the removal torque results were 30.5 (+/- 9.8) Ncm for group A, 50.17 (+/- 17.5) Ncm for group B, and 26 (+/- 7.8) Ncm for group C. The statistical analysis showed significant differences between groups A and B (P < 0.05) and groups B and C (P < 0.01).Conclusion: Cyclosporin A administration may impair the mechanical retention of dental implants previously integrated to the bone.

Comparative investigation of the cleavage step in the synthesis of model peptide resins: Implications for N-alpha-9-fluorenylmethyloxycarbonyl-solid phase peptide synthesis

Based on our studies of the stability of model peptide-resin linkage in acid media, we previously proposed a rule for resin selection and a final cleavage protocol applicable to the N-alpha-tert-butyloxycarbonyl (Boc)-peptide synthesis strategy. We found that incorrect choices resulted in decreases in the final synthesis yield, which is highly dependent on the peptide sequence, of as high as 30%. The present paper continues along this line of research but examines the N-alpha-9-fluorenylmethyloxycarbonyl (Fmoc)-synthesis strategy. The vasoactive peptide angiotensin II (All, DRVYIHPF) and its [Gly(8)]-All analogue were selected as model peptide resins. Variations in parameters such as the type of spacer group (linker) between the peptide backbone and the resin, as well as in the final acid cleavage protocol, were evaluated. The same methodology employed for the Boc strategy was used in order to establish rules for selection of the most appropriate linker-resin conjugate or of the peptide cleavage method, depending on the sequence to be assembled. The results obtained after treatment with four cleavage solutions and with four types of linker groups indicate that, irrespective of the circumstance, it is not possible to achieve complete removal of the peptide chains from the resin. Moreover, the Phe-attaching peptide at the C-terminal yielded far less cleavage (50-60%.) than that observed with the Gly-bearing sequences at the same position (70-90%). Lastly, the fastest cleavage occurred with reagent K acid treatment and when the peptide was attached to the Wang resin.

Infrared laser photobiomodulation (lambda 830 nm) on bone tissue around dental implants: A Raman spectroscopy and scanning electronic microscopy study in rabbits

Objective: the aim of this study was to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA; similar to 960 cm(-1)), and scanning electron microscopy (SEM), the bone quality on the healing bone around dental implants after laser photobiomodulation ( lambda 830 nm). Background Data: Laser photobiomodulation has been successfully used to improve bone quality around dental implants, allowing early wearing of prostheses. Methods: Fourteen rabbits received a titanium implant on the tibia; eight of them were irradiated with lambda 830 nm laser ( seven sessions at 48-h intervals, 21.5 J/cm(2) per point, 10 mW, phi similar to 0.0028 cm(2), 86 J per session), and six acted as control. The animals were sacrificed 15, 30, and 45 days after surgery. Specimens were routinely prepared for Raman spectroscopy and SEM. Eight readings were taken on the bone around the implant. Results: the results showed significant differences on the concentration of CHA on irradiated and control specimens at both 30 and 45 days after surgery ( p < 0.001). Conclusion: It is concluded that infrared laser photobiomodulation does improve bone healing, and this may be safely assessed by Raman spectroscopy or SEM.

Analysis of procedures used in tooth avulsion by 100 dental surgeons

Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion, because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth. The aim of this study was to analyze the procedures used in the management of tooth avulsion by 100 dental surgeons (DSs). Thus, by means of a descriptive questionnaire, information was obtained about the profile of the professionals interviewed, procedures used in cases of tooth avulsion, and patient orientation and education. One hundred properly filled questionnaires were obtained. Descriptive statistics was used for the data, and the chi-squared statistics was employed (EPI-INFO 3.2 software). According to the results, this type of trauma is part of the routine of 15 DSs, although 71 have reported some experience with avulsed,teeth. Great deficiencies were found regarding root surface treatment and occlusal adjustment. Positive findings were related to socket treatment, adjunctive therapy, and patient education and orientation (extra-alveolar period, storage medium, manipulation of the avulsed tooth, replantation by the own patient). It was possible to conclude that 47.5% of the procedures reported by, 100 professionals interviewed are adequate, and patient education is favorable in 87.7% of cases, a fact that can positively interfere with the prognosis of tooth replantation.

Biocompatibility of denture base acrylic resins evaluated M culture of L929 cells. Effect of polymerisation cycle and postpoymerisation treatments

Objective: the purpose of this study was to evaluate the effect of two post-polymerisation treatments and different cycles of polymerisation on the cytotoxicity of two denture base resins.Materials and methods: the resins tested were Lucitone 550 and QC 20. Discs of resins were fabricated following the manufacturer's instructions. Lucitone 550 was processed by long cycle or short cycle. The resin QC 20 was processed by reverse cycle or normal cycle. The specimens were divided into groups: (i) post-polymerised in microwave for 3 min at 500 W; (ii) post-polymerised in water-bath at 55 degrees C for 60 min and (iii) without post-polymerisation. Eluates were prepared by placing three discs into a sterile glass vial with 9 ml of Eagle's medium and incubated at 37 degrees C for 24 hours. L929 cells were seeded into 96 3 well culture plates and DNA synthesis was assessed by H-thymidine incorporation assay.Results: the results were submitted to two-way ANOVA and Tukey HSD test. QC 20 specimens polymerised by the normal cycle and submitted to microwave post-polymerisation were graded as moderately cytotoxic. Similar results were observed for Lucitone 550 processed by long cycle without post-polymerisation. The other experimental groups were graded as not cytotoxic. After water-bath post-polymerisation, specimens of Lucitone 550 processed by long cycle produced significantly lower inhibition of DNA synthesis than the other groups.Conclusion: the long cycle increased the cytotoxicity of Lucitone 550 and water-bath post-polymerisation reduced the cytotoxicity of Lucitone 550 processed by long cycle.

Localized mechanics of dentin self-etching adhesive system

The bond strength of composite resins (CRs) to dentin is influenced by the interfacial microstructure of the hybrid layer (HL) and the resin tags (TAG). The contemporary self-etching primer adhesive systems overcame the inconvenient of the etch-and-rinse protocol. Studies, however, have demonstrated that HL thickness and TAG length vary according to the wetting time and additional use of acid-etching prior to self-etching primers. This study investigated the localized stress distribution in the HL and the dentin/adhesive interface. Two HL thicknesses (3 or 6 mu m), two TAG lengths (13 or 17 mu m) and two loading conditions (perpendicular and oblique-25 degrees) were investigated by the finite element (FE) analysis. Five two-dimensional FE models (M) of a dentin specimen restored with CR (38 x 64 mu m) were constructed: M1 - no HL and no TAG; M2 - 3 mu m of HL and 13 mu m of TAG; M3 - 3 mu m of HL and 17 mu m of TAG; M4 - 6 mu m of HL and 13 mu m of TAG; and M5 - 6 mu m of HL and 17 mu m of TAG. Two distributed loadings (L) (20N) were applied on CR surface: L1 - perpendicular, and L2 - oblique (25 degrees). Fixed interfacial conditions were assigned on the border of the dentin specimen. Ansys 10.0 (Ansys (R), Houston, PA, USA) software was used to calculate the stress fields. The peak of von Mises (sigma(vM)) and maximum principal stress (sigma(max)) was higher in L2 than in L1. Microstructures (HL and TAG) had no effect on local stresses for L1. Decreasing HL decreased sigma(vM) and sigma(max) in all structures for L2, but the TAG length had influence only on the peributular dentin. The thickness of HL had more influence on the sigma(vM) and sigma(max) than TAG length. The peritubular dentin and its adjacent structures showed the highest sigma(vM) and sigma(max), mainly in the oblique loading.