Cochlear Implantation Via the Middle Fossa Approach: Surgical and Programming Considerations

Objectives: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases. Study Design: Retrospective case review. Setting: Tertiary-care referral center with a well-established cochlear implant program. Patients: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation. Interventions: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients. Main Outcome Measures: Complications, hearing thresholds, and speech perception outcomes were evaluated. Results: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP. Conclusion: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.

Effect of different root caries treatments on the sealing ability of conventional glass ionomer cement restorations

In this study we compared the microleakage of conventional glass ionomer cement (GIC) restorations following the use of different methods of root caries removal. In vitro root caries were induced in 75 human root dentin samples that were divided in five groups of 15 each according to the method used for caries removal: in group 1 spherical carbide burs at low speed were used, in group 2 a hand-held excavator was used, and in groups 3 to 5 an Er,Cr:YSGG laser was used at 2.25 W, 40.18 J/cm(2) (group 3), 2.50 W, 44.64 J/cm(2) (group 4) and 2.75 W, 49.11 J/cm(2) (group 5). The air/water cooling during irradiation was set to 55%/65% respectively. All cavities were filled with GIC. Five samples from each group were evaluated by scanning electron microscopy (SEM) and the other ten samples were thermocycled and submitted to a microleakage test. The data obtained were compared by ANOVA followed by Fisher's test (pa parts per thousand currency sign0.05). Group 4 showed the lowest microleakage index (56.65 6.30; p < 0.05). There were no significant differences among the other groups. On SEM images samples of groups 1 and 2 showed a more regular interface than the irradiated samples. Demineralized dentin below the restoration was observed, that was probably affected dentin. Group 4 showed the lowest microleakage values compared to the other experimental groups, so under the conditions of the present study the method that provided the lowest microleakage was the Er,Cr:YSGG laser with a power output of 2.5 W yielding an energy density of 44.64 J/cm(2).

Degradation of the resin-dentin bonds after simulated and inhibited cariogenic challenge in an in situ model

The aim of this study was to evaluate the resindentin bonds of two simplified etch-and-rinse adhesive after simulated cariogenic and inhibited cariogenic challenge in situ. Dental cavities (4 mm wide, 4 mm long, and 1.5 mm deep) were prepared in 60 bovine teeth with enamel margins. Restorations were bonded with either adhesive Adper Single Bond 2 (3MESPE) or Optibond Solo Plus (Kerr). Forty restorations were included in an intra-oral palatal appliance that was used for 10 adult volunteers while the remaining 20 dental blocks were not submitted to any cariogenic challenge [NC group] and tested immediately. For the simulated cariogenic challenge [C+DA], each volunteer dropped 20% sucrose solution onto all blocks four times a day during 14 days and distilled water twice a day. In the inhibited cariogenic challenge group [C + FA], the same procedure was done, but slurry of fluoride dentifrice (1.100 ppm) was applied instead of water. The restored bovine blocks were sectioned to obtain a slice for cross-sectional Vickers microhardness evaluation and resindentin bonded sticks (0.8 mm2) for resindentin microtensile evaluation. Data were evaluated by two-way ANOVA and Tukey's tests (a = 0.05). Statistically lower microhardness values and degradation of the resindentin bonds were only found in the C + DW group for both adhesives. The in situ model seems to be a suitable short-term methodology to investigate the degradation of the resindentin bonds under a more realistic condition. (c) 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 100B: 14661471, 2012.

Candida albicans Isolation from Buccal Mucosa of Patients with HIV Wearing Removable Dental Prostheses

Purpose: The aim of this study was to evaluate the influence of complete or partial removable dental prostheses (RDPs) on the frequency of Candida albicans isolated from the mouth and the presence of oral candidiasis in human immunodeficiency virus positive (HIV+) patients correlated with CD4 levels. Materials and Methods: One hundred ninety-three HIV+ patients were evaluated; 68 had RDPs and 125 did not. CD4 cell count was obtained after blood sampling and performed on the day of clinical examination. The material was collected from the buccal mucosa for isolation of yeasts with a sterile swab and seeded onto Sabouraud dextrose agar with chloramphenicol. C albicans strains were identified by testing germ tubes and chlamydospore formation and biochemical (zymogram, auxanogram) characteristics. The results were subjected to the Fischer exact test and chi-square tests. Results: C albicans were isolated from 45(66.17%) patients who had RDPs and 48 (38.4%) who did not (P = .0003). The presence of oral candidiasis was observed in 14 patients (7.25%), and 10 of the 14 (71.43%) were RDP users. The absence of candidiasis occurred in 121 (67.59%) nonusers and 58 (32.40%) users of RDPs (P = .0065). The mean CD4 cell count was lower in patients with oral candidiasis regardless of the use of RDPs. Conclusion: The use of RDPs was an important factor in the isolation of C albicans among HIV+ patients, and CD4 level seems to play a role in the presence of oral candidiasis. Int J Prosthodont 2012;25:127-131.

Influence of ultrasound or halogen light on microleakage and hardness of enamel adjacent to glass ionomer cement

Background. The use of external sources of energy may accelerate the setting rate of glass ionomer cements (GICs) allowing better initial mechanical properties. Aim. To investigate the influence of ultrasound and halogen light on the microleakage and hardness of enamel adjacent to GIC restorations, after artificial caries challenge. Design. Cavities were prepared in 60 primary canines, restored with GIC, and randomly distributed into three groups: control group (CG), light group (LG) - irradiation with a halogen lightcuring unit for 60 s, and ultrasonic group (UG) application of ultrasonic scaler device for 15 s. All specimens were then submitted to a cariogenic challenge in a pH cycling model. Half of sample in each group were immersed in methylene blue for 4 h and sectioned for dye penetration analysis. The remaining specimens were submitted to Knoop cross-sectional microhardness assessments, and mineral changes were calculated for adjacent enamel. Results. Data were compared using Kruskal-Wallis test and two- way ANOVA with 5% significance. Higher dye penetration was observed for the UG (P < 0.01). No significant mineral changes were observed between groups (P = 0.844). Conclusion. The use of halogen light- curing unit does not seem to interfere with the properties of GICs, whereas the use of ultrasound can affect its marginal sealing.

Effect of alveolex on the bone defects repair stimulated by rhBMP-2: Histomorphometric study

OBJECTIVE: The aim of this study was to evaluate histomorphometrically the effect of alveolex (Propolis 10%) on the repair of bone cavities in the calvaria of rats. MATERIALS AND METHODS: A 5 mm diameter bone defect was made in the calvaria of male Wistar rats using the drill-type trephine. The defects were filled with rhBMP-21Alveolex, rhBMP-2, Alveolex, or coagulum. Twenty-eight animals with seven subjects on each were sacrificed 30 days after surgery and samples were fixed and embedded in paraffin. Histological sections stained by HE (hematoxylin and eosin) were obtained from the calvaria bone defect and analyzed by a differential point-counting method. RESULTS: Group I and II, rhBMP-21Alveolex and rhBMP-2, respectively, presented higher levels of newly formed bone than other groups (P < 0.001). There were not significant differences between groups I and II (P > 0.05). In addition, there was not significant difference between groups III and IV, Control-Coagulum and Alveolex, respectively (P > 0.05). CONCLUSION: Alveolex has increased the bone repair in calvaria defects of rats when associated to rhBMP-2, however without significant differences for rhBMP-2 isolated group; Alveolex isolated group showed the lowest levels of newly formed bone with no significant differences to coagulum group (control). Microsc. Res. Tech. 75: 36-41, 2012. (C) 2011 Wiley Periodicals, Inc.

Using AMS combined with mineral shape preferred orientation analysis to understand the emplacement fabrics of the Apiai gabbro-norite (Ribeira Belt, SE Brazil)

The Apiai gabbro-norite is a massive fine-grained Neoproterozoic intrusion emplaced in a core of synformal structure that deforms low-grade marine metasedimentary rocks of the Ribeira Belt of south-eastern Brazil. The lack of visible magmatic layering or any internal fabric has been a major limitation in deciding whether the emplacement occurred before or after the regional folding. To assist in the tectonic interpretations, we combine low-field anisotropy of magnetic susceptibility (AMS) and silicate shape preferred orientation (SPO) to reveal the internal structure of the mafic intrusion. Magnetic data indicate a mean susceptibility of about 10(-2) SI and a mean anisotropy degree (P) of about 1.08, essentially yielded by titanomagnetite. The magnetic and silicate foliations for P >= 1.10 are parallel to each other, while the lineations tend to scatter on the foliation plane, in agreement with the dominant oblate symmetry of the AMS and SPO ellipsoids. For lower P values, the magnetic and silicate fabrics vary from coaxial to oblique, and for P <= 1.05, their shapes and orientations can be quite distinct. The crystal size distribution (CSD) of plagioclase for P > 1.05 is log linear, in agreement with a bulk simple crystallisation history. These results combined show that for a strong SPO, corresponding to a magnetic anisotropy above 1.10, AMS is a reliable indicator of the magmatic fabric. They indicate that the Apiai gabbro-norite consists of sill-like body that was inclined gently to the north by the regional folding.

Virulence Genes and Antimicrobial Resistance Profiles of Pasteurella multocida Strains Isolated from Rabbits in Brazil

Pasteurella multocida is responsible for a wide range of diseases in domestic animals. In rabbits, the agent is related to nasal discharge, pneumonia, otitis media, pyometra, orchitis, abscess, and septicemia. One hundred and forty rabbits with respiratory diseases from four rabbitries in Sao Paulo State, Brazil were evaluated for the detection of P. multocida in their nasal cavities. A total of twenty-nine animals were positive to P. multocida isolation, and 46 strains were selected and characterized by means of biochemical tests and PCR. P. multocida strains were tested for capsular type, virulence genes, and resistance profile. A total of 45.6% (21/46) of isolates belonged to capsular type A, and 54.34% (25/46) of the isolates were untypeable. None of the strains harboured toxA or pfhA genes. The frequency of the other twenty genes tested was variable, and the data generated was used to build a dendrogram, showing the relatedness of strains, which were clustered according to origin. Resistance revealed to be more common against sulfonamides and cotrimoxazole, followed by erythromycin, penicillin, and amoxicillin.

Double-chambered right ventricle in an adult patient diagnosed by transthoracic echocardiography

Abstract Background Double-chambered right ventricle is a rare congenital disease frequently misdiagnosed in the adult patient. An anomalous muscle band divides the right ventricle in two cavities causing variable degree of obstruction. Although echocardiography is considered a useful method for the diagnosis of this pathology in children, it has been recognized the transthoracic scanning limitation in adults. Case presentation A 29 year-old patient with double-chambered right ventricle presenting mild exercise intolerance referred for follow up of a known ventricular septal defect in whom a complete diagnosis was obtained based only on transthoracic two dimensional echocardiography without the needing of cardiac catheterization. Conclusion Based on non invasive echocardiographic diagnosis, patient was referred to surgical correction, which was completely successful.

Conservative approach to restore the first molar with extensive destruction: a 30-month follow-up

The available options for restoring multiple surface cavities are: amalgam, composite resin, or indirect restorations. Adhesive system and intradentinal pin-retained composite resin restorations should have a similar performance to pin-retained amalgam, regarding resistance to support occlusal forces. Polymerization shrinkage is a major concern when performing direct posterior composite resin restorations and the incremental insertion technique can provide less stress and outstanding margin behavior. Intradentinal pins can potentially enhance composite resin's retention, while reducing gaps caused by polymerization shrinkage. This article reports a clinical case involving an extensive restoration on a posterior tooth with cusp loss that was successfully treated using an intradentinal pin and direct nano-hybrid composite resin restoration.

Micro-structural and compositional variations of hydrothermal epidote-group minerals from a peralkaline granite, Corupá Pluton, Graciosa Province, South Brazil, and their petrological implications

Epidote-group minerals, together with albite, quartz, fluorite, Al-poor and Fe-rich phyllosilicates, zircon, and minor oxides and sulphides, are typical hydrothermal phases in peralkaline alkali-feldspar granites from the Corupá Pluton, Graciosa Province, South Brazil. The epidote-group minerals occur as single crystals and as aggregates filling in rock interstices and miarolitic cavities. They display complex recurrent zoning patterns with an internal zone of ferriallanite-(Ce), followed by allanite-(Ce), then epidote-ferriepidote, and an external zone with allanite-(Ce), with sharp limits, as shown in BSE and X-ray images. REE patterns show decreasing fractionation degrees of LREE over HREE from ferriallanite to epidote. The most external allanite is enriched in MREE. LA-ICP-MS data indicate that ferriallanite is enriched (>10-fold) in Ti, Sr and Ga, and depleted in Mg, Rb, Th and Zr relative to the host granite. Allanite has lower Ga and Mn and higher Zr, Nb and U contents as compared to ferriallanite, while epidote is enriched in Sr, U and depleted in Pb, Zr, Hf, Ti and Ga. The formation of these minerals is related to the variable concentrations of HFSE, Ca, Al, Fe and F in fluids remaining from magmatic crystallization, in an oxidizing environment, close to the HM buffer. L-MREE were in part released by the alteration of chevkinite, their main primary repository in the host rocks.

Influence of radiopacifying agents on the solubility, pH and antimicrobial activity of portland cement

The aim of this study was to evaluate the interference of the radiopacifiers bismuth oxide (BO), bismuth carbonate (BC), bismuth subnitrate (BS), and zirconiun oxide (ZO) on the solubility, alkalinity and antimicrobial properties of white Portland cement (WPC). The substances were incorporated to PC, at a ratio of 1:4 (v/v) and subjected to a solubility test. To evaluate the pH, the cements were inserted into retrograde cavities prepared in simulated acrylic teeth and immediately immersed in deionized water. The pH of the solution was measured at 3, 24, 72 and 168 h. The antimicrobial activity was evaluated by a radial diffusion method against the microorganisms S. aureus (ATCC 25923), P. aeruginosa (ATCC 27853), E. faecalis (ATCC 29212) and C. albicans (ATCC 10231). The zone of microbial growth inhibition was measured after 24 h. The addition of BS and BC increased the solubility of the cement. The pH values demonstrated that all materials produced alkaline levels. At 3 h, BS showed lower pH than WPC (p<0.05). At 168 h, all materials showed similar pHs (p>0.05). The materials did not present antimicrobial activity for S. aureus, P. aeruginosas and E. faecalis (p>0.05). With regards to C. albicans, all materials formed an inhibition zone, mainly the mixture of WPC with ZO (p<0.05). The type of radiopacifier incorporated into WPC interfered with its physical and antimicrobial properties. ZO was found to be a viable radiopacifier that can be used with WPC.

Influence of cervical preflaring on determination of apical file size in the palatal roots of maxillary molars

PURPOSE: The aim of this study was to investigate the influence of cervical preflaring in determining the initial apical file (IAF) in the palatal roots of maxillary molars, and to determine the morphologic shape of the canal 1 mm short of the apex. METHODS: After preparing standard access cavities the group 1 received the IAF without cervical preflaring (WCP). In groups 2 to 5, preflaring was performed with Gates-Glidden (GG), Anatomic Endodontics Technology (AET), GT Rotary Files (GT) and LA Axxes (LA), respectively. Each canal was sized using manual K-files, starting with size 08 files, and making passive movements until the WL was reached. File sizes were increased until a binding sensation was felt at the WL. The IAF area and the area of the root canal were measured to verify the percentage occupied by the IAF inside the canal in each sample by SEM. The morphologic shape of the root canal was classified as circular, oval or flattened. Statistical analysis was performed by ANOVA/Tukey test (P < 0.05). RESULTS: The decreasing percentages occupied by the IAF inside the canal were: LA>GT=AET>GG>WCP. The morphologic shape was predominantly oval. CONCLUSION: The type of cervical preflaring used interferes in the determination of IAF.

Quantitative detection of Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa in human oral epithelial cells from subjects with periodontitis and periodontal health

Epithelial cells in oral cavities can be considered reservoirs for a variety of bacterial species. A polymicrobial intracellular flora associated with periodontal disease has been demonstrated in buccal cells. Important aetiological agents of systemic and nosocomial infections have been detected in the microbiota of subgingival biofilm, especially in individuals with periodontal disease. However, non-oral pathogens internalized in oral epithelial cells and their relationship with periodontal status are poorly understood. The purpose of this study was to detect opportunistic species within buccal and gingival crevice epithelial cells collected from subjects with periodontitis or individuals with good periodontal health, and to associate their prevalence with periodontal clinical status. Quantitative detection of total bacteria and Staphylococcus aureus, Pseudomonas aeruginosa and Enterococcus faecalis in oral epithelial cells was determined by quantitative real-time PCR using universal and species-specific primer sets. Intracellular bacteria were visualized by confocal microscopy and fluorescence in situ hybridization. Overall, 33 % of cell samples from patients with periodontitis contained at least one opportunistic species, compared with 15 % of samples from healthy individuals. E. faecalis was the most prevalent species found in oral epithelial cells (detected in 20.6 % of patients with periodontitis, P = 0.03 versus healthy individuals) and was detected only in cells from patients with periodontitis. Quantitative real-time PCR showed that high levels of P. aeruginosa and S. aureus were present in both the periodontitis and healthy groups. However, the proportion of these species was significantly higher in epithelial cells of subjects with periodontitis compared with healthy individuals (P = 0.016 for P. aeruginosa and P = 0.047 for S. aureus). Although E. faecalis and P. aeruginosa were detected in 57 % and 50 % of patients, respectively, with probing depth and clinical attachment level ≥6 mm, no correlation was found with age, sex, bleeding on probing or the presence of supragingival biofilm. The prevalence of these pathogens in epithelial cells is correlated with the state of periodontal disease.

Efficient 1535 nm light emission from an all-Si-based optical micro-cavity containing Er3+ and Yb3+ ions

This work reports on the construction and spectroscopic analyses of optical micro-cavities (OMCs) that efficiently emit at ~1535 nm. The emission wavelength matches the third transmission window of commercial optical fibers and the OMCs were entirely based on silicon. The sputtering deposition method was adopted in the preparation of the OMCs, which comprised two Bragg reflectors and one spacer layer made of either Er- or ErYb-doped amorphous silicon nitride. The luminescence signal extracted from the OMCs originated from the 4I13/2→4I15/2 transition (due to Er3+ ions) and its intensity showed to be highly dependent on the presence of Yb3+ ions.According to the results, the Er3+-related light emission was improved by a factor of 48 when combined with Yb3+ ions and inserted in the spacer layer of the OMC. The results also showed the effectiveness of the present experimental approach in producing Si-based light-emitting structures in which the main characteristics are: (a) compatibility with the actual microelectronics industry, (b) the deposition of optical quality layers with accurate composition control, and (c) no need of uncommon elements-compounds nor extensive thermal treatments. Along with the fundamental characteristics of the OMCs, this work also discusses the impact of the Er3+-Yb3+ ion interaction on the emission intensity as well as the potential of the present findings.