Application of dental floss traction-assisted endoscopic submucosa dissection to rectal neuroendocrine neoplasm / 中华胃肠外科杂志

Objective@#To evaluate the safety and efficacy of dental floss traction-assisted endoscopic submucosal dissection (DFS-ESD) for rectal neuroendocrine neoplasm (NEN).@*Methods@#A retrospective cohort study was performed. Clinical data of rectal NEN patients undergoing ESD at Endoscopy Center of Zhongshan Hospital, Fudan University from January 2016 to December 2017 were retrospectively analyzed. Inclusion criteria: 1) age of 18 to 80 years old; 2) maximal diameter of lesions <1.5 cm; 3) tumor locating in the submucosa without invasion into the muscularis propria; 4) no enlarged lymph nodes around bowel and in abdominal cavity; 5) ESD requested actively by patients. A total of 37 patients were enrolled, including 23 male and 14 female cases with mean age of (56.0±11.3) years. All the lesions were single tumor of stage T1, and the mean size was 0.8±0.2(0.5-1.2) cm. Postoperative pathology revealed all samples as neuroendocrine tumors (NET). Seventeen patients received DFS-ESD treatment (DFS-ESD group) and 20 patient received conventional ESD treatment (conventional ESD group). In DFS-ESD group, after the mucosa was partly incised along the marker dots, the endoscopy was extracted, and the dental floss was tied to one arm of the metallic clip. When the endoscope was reinserted, the hemoclip was attached onto the incised mucosa; another hemoclip was attached onto normal mucosa opposite to the lesion in the same way. The submucosa was clearly exposed with the traction of dental floss and the resection could proceed. The conventional ESD group received the traditional ESD operation procedure. The operation time, modified operation time (remaining time after excluding the assembly time of dental floss traction in DFS-ESD group), en bloc resection rate, R0 resection rate, morbidity of operative complication, recurrence and metastasis were compared between two groups.@*Results@#The average tumor size was (0.8±0.2) cm in DFS-ESD group and (0.7±0.2) cm in conventional ESD group (t=0.425, P=0.673). According to postoperative pathological grading of rectal neuroendocrine neoplasm, 13 were G1 and 4 were G2 in DFS-ESD group, while 17 cases were G1 and 3 cases were G2 in conventional ESD group without significant difference (P=0.680). There were no significant differences in baseline data between in the two groups (all P>0.05). All the basal resection margins were negative, the en bloc resection rate was 100% and the R0 resection rate was 100%. Pathological results showed tumor tissue close to the burning margin in 5 cases of conventional ESD group and in 2 cases of DFS-ESD group (P=0.416). The operation time was (17.9±6.6) minutes in conventional ESD group and (14.7±3.3) minutes in DFS-ESD group (t=1.776, P=0.084). The modified operation time of DFS-ESD group was (11.9±2.8) minutes, which was significantly shorter than (17.9±6.6) minutes in conventional ESD group (t=3.425, P=0.002). The hospital stay was (2.3±0.6) days and (2.0±0.5) days in conventional ESD group and DFS-ESD group, respectively, without significant difference (t=1.436, P=0.160). No patient was transferred to surgery, and no delayed bleeding or perforation occurred in either group. There was no recurrence or primary tumor-related death, and all the patients recovered well during a follow-up period of 14(1-24) months.@*Conclusion@#Dental floss traction-assisted ESD for rectal neuroendocrine neoplasm can simplify operation and ensure negative basal margin.

Application of dental floss traction assisted technique in endoscopic submucosal dissection for early rectal cancer and precancerous lesions / 中国内镜杂志

Objective?To investigate the efficacy and safety of dental floss traction assisted technique in endoscopic submucosal dissection (ESD) of early rectal cancer and precancerous lesions.?Methods?57 patients recived ESD for early colorectal cancer and precancerous lesions from September 2014 to June 2017 were randomly divided into dental floss traction group (n = 28) and routine group (n = 29). To compare the average operation time, the amount of supplementary submucosal injection, and frequency of supplementary submucosal injection, complete resection rate, R0 resection rate, complications and follow-up results of the two groups.?Results?All 57 cases were treated with ESD successfully. The average operation time, the amount of supplementary submucosal injection and the frequency of injection were significantly less in the dental floss traction group than in the conventional group [(55.11 ± 10.44) vs (74.72 ± 14.47) min; (5.80 ± 1.80) vs (10.00 ± 5.70) ml; frequency (1.10 ± 0.90) vs (1.70 ± 0.90)]. The average operation time (P = 0.000), the amount of supplementary submucosal injection (P = 0.001) and the frequency of supplementary submucosal injection (P = 0.022) were significantly different between the two groups. The complete resection rate and R0 resection rate were 100.0% in both groups. There was no bleeding or perforation in the dental floss traction group, and 1 cases (3.4%) in the conventional group had delayed bleeding after operation, and 2 cases (6.9%) perforation occurred during the operation, and there was no significant difference between the two groups (P > 0.05). No recurrence was found in the two groups during follow-up period.?Conclusions?Dental floss traction assisted technique can significantly shorten the operation time of ESD, reduce the amount and frequency of supplementary submucosal injection and ensure good therapeutic effect for early colorectal cancer and precancerous lesions.

A clinical comparative study of rubber ring versus dental floss combined with hemoclipping assisted endoscopic submucosal dissection on gastrointestinal tumor / 上海交通大学学报（医学版）

Objective·To investigate and compare the curative effect of rubber ring and dental floss combined with hemoclipping assisted endoscopic submucosal dissection(ESD) on gastrointestinal tumors.Methods·A total of 54 patients with gastrointestinal tumors were collected.Twenty-seven patients in rubber ring group accepted ESD assisted by rubber ring with hemoclipping,and the other 27 patients in dental floss group accepted ESD assisted by dental floss.with hemoclipping.Duration of the operation,installation time of the traction device,detachment frequency of hemoclipping,injury of mucosa,one-time complete resection rate,and complication rate were analyzed as key indicators.Results·The detachment frequency of hemoclipping in rubber ring group was significantly less than that in dental floss group (t=4.418,P＜0.05).There was no injury of mucosa in rubber ring group,while,three patients had mucosa injury in dental floss group.There was no statistically significant difference on duration of operation,installation time of traction device,one-time complete resection rate,and complication rate between two groups.After 2 ～ 12 months of follow-up,the wound healed well in all patients in rubber ring group.No evidence of tumor recurrence was noted.Conclusion·Compared with dental floss,rubber ring combined with hemoclipping is superior in assisted ESD,especially in the right half colon.It is an effective assist device with little trauma and adjustable direction.

Levantamento transversal da relação do índice de placa com o grau de escolaridade, idade e frequência do uso do fio dental e escova em pacientes de 31 a 69 anos de idade / The relationship of plaque index, educational degree, age, and frequency of dental fl oss in patients from 31 to 69 years-old ­ a cross-sectional study

Objetivo: estudar o índice de placa e a sua correlação com a técnica de higiene empregada, com o grau de escolaridade, idade, frequência e o conhecimento sobre a higiene oral. Material e métodos: em uma amostra da população da cidadede Divinópolis/MG, foi aplicado um questionário específico sobre os hábitos de higiene oral. O exame clínico foi realizado com sonda milimetrada, e a placa evidenciada pelo corante. Todos os pacientes foram divididos em quatro faixas etárias e receberam reforço na higiene oral. As possíveis associações entre os critérios foram investigadas com o teste Qui-quadrado. Resultados: 216 pacientes (86 homens, 130 mulheres) foram incluídos. No total, 5.853 dentes e 23.412 faces foram analisados. O nível de placa variou de 54,29% (60-69 anos) a 60,10% (40-49 anos), e as faces interproximais foram as mais coradas (83,27%). Um total de 140 pacientes não tinha realizado tratamento periodontal prévio; dos 76 pacientes com tratamento prévio, 34 não haviam sido instruídos sobre a higiene oral. Metade dos pacientes relatou usar a escova dental três vezes ao dia; 1/3 dos pacientes usavam o fio dental duas vezes e estavam no ensino médio. Conclusão: 1) há necessidade de uma campanha maciça sobre a importância da escova dental e do fio dental, e como usá-los; 2) os menores índices de placa estão nos indivíduos de grau superior; 3) as faces proximais coradas confirmam a falta de uso do fio dental, principalmente nos pacientes que foram submetidos ao tratamento periodontal, por ausência de informação profissional.

Objective: to study the plaque index and possible correlations with oral hygiene, educational levels, age, and frequency of dental flossing. Material and methods: a patient sample from Divinopolis/MG received an appropriate questionnaire survey regarding their oral hygiene habits. The clinical exam was made with a periodontal probe and a disclosing agent. All patients were divided according to 4 age conditions and receive further oral instructions. Possible associations were investigated with the Chi-square method. Results: 216 patients (86 men, 130 women) were included. Overall, 5,852 teeth and 23,412 surfaces were examined. Plaque levels varied from 54.29% (60-69 years) to 60.10% (40-49 years), being most prevalent at the proximal surfaces (83.27%). 140 patients did not have previous periodontal treatment; from 76 patients under active periodontal treatment, 34 had no oral hygiene instructions. Half of the patients reported the use of toothbrushing 3 times a day; 1/3 of patients reported flossing twice a day. Conclusion: 1) a massive campaign is needed to underscore the importance of oral hygiene and dental floss, 2) the lowest plaque scores were observed in people with higher education, 3) the proximal surfaces confirmed the lack of dental floss, particularly in patients under periodontal treatment due to the lack of professional information.

Clinical Evaluation of Residual Tetrasodium Pyrophosphate Released from Two Different Anticalculus Flosses

The aim of this study was to compare the residual content of tetrasodium pyrophosphate released by two different anticalculus dental flosses (Reach PP(r) - entangled polypropylene floss and Reach NT(r) - texturized nylon) in the oral cavity. Ten healthy individuals (aged between 18 and 30 years) were enrolled in this randomized crossover clinical investigation. Participants received instructions on daily dental flossing and the interventions were randomly performed in 2 different groups (NT or PP) of five individuals each according to the dental flosses. Individuals were instructed to use each dental floss with a total of six slides on the two interproximal aspects of target teeth (3 slides on each interproximal aspect). A washout period of one week was used before start flossing interventions and after each type of dental floss to prevent any bias related to the exposure to any product that contained the active ingredient. Samples were collected by #35 sterilized absorbent paper points from interdental fluid after flossing and assessed by ion chromatography. The levels of residual tetrasodium pyrophosphate were evaluated by means of binomial generalized linear model proportions and canonical link function. Both dental flosses were effective in tetrasodium pyrophosphate release at therapeutic levels in the interdental gingival crevicular fluid for a period of up to 2 h after use. No significant differences were found between both groups (p>0.05). It may be concluded that both material composition and physical structure of the new dental floss did not affect the release or the maintenance of anticalculus agent at therapeutic levels for a period of up to 2 h after single use.

O objetivo deste estudo foi comparar o teor residual de pirofosfato de tetrasodio liberado por dois tipos diferentes de fio dental anti-cálculo (Reach PP(r) - polipropileno entrelaçado e Reach NT(r) - nylon texturizado) na cavidade oral. Dez indivíduos saudáveis (com idade entre 18 e 30 anos) foram selecionados para este estudo clínico em modelo crossover. Os participantes receberam instruções sobre como utilizarem os fios dentais e as intervenções foram randomicamente realizadas em 2 grupos de 5 participantes de acordo com o tipo de fio avaliado. O participantes foram instruídos a passarem cada fio dental em um total de 6 passadas ao redor dos 2 espaços interproximais dos dentes selecionados (3 passadas em cada face interproximal). Um período de washout de 1 semana foi utilizado antes do início do estudo e após cada intervenção com o objetivo de prevenir a ocorrência de viés relacionado à exposição de algum agente terapêutico. Amostras do fluido interdental após as intervenções foram avaliadas por meio de cromatografia de íons. A porcentagem residual de pirofosfato tetrassódico foi verificada empregando-se o método da cromatografia de íons, pela colheita do fluido interdental com cones de papel absorvente esterilizados. Os teores de pirofosfato tetrassódico residual foram comparados para cada fio dental e para cada tempo de colheita do fluido interdental. Não foram observadas diferenças significantes entre os grupos avaliados (p>0,05). Conclui-se que a composição do material e a estrutura física dos fios dentais não exerceram influência na liberação e na permanência do agente anti-tártaro, que permaneceu em níveis terapêuticos por um período de até 2 h após o uso único.

Fio dental: da dificuldade ao êxito na remoção do biofilme interproximal / Dental floss: from difficulty to success in the removal of interproximal biofilms

A higiene bucal é um importante meio de prevenção das doenças cárie e periodontal. Em relação às superfícies proximais, o fio dental é considerado um excelente instrumento para a remoção do biofilme localizado nesses locais. Verifica-se, entretanto, que a frequência de uso do fio dental ainda é baixa na população em geral. Desse modo, o presente estudo objetivou realizar uma revisão de literatura referente aos fatores relacionados à utilização do fio dental, a sua eficiência na redução do biofilme interproximal e as técnicas educativas utilizadas para orientar e motivar as pessoas quanto ao seu uso. Os estudos analisados sugerem que uma pequena parcela da população utiliza o fio dental. Verificou-se a presença de dificuldades na auto-remoção eficiente do biofilme interproximal. Quando as pessoas são estimuladas e orientadas de forma adequada, melhoram muito a qualidade de sua higiene bucal. Normalmente isso é conseguido através de técnicas educacionais específicas.(AU)

Oral hygiene is important in preventing caries and periodontal disease. Regarding interproximal surfaces, dental floss is considered an excellent instrument for the removal of plaque from these locations; however, it has been proven that its frequency of use is still quite low in the general population. As such, the present study aimed to carry out a literature review referent to the factors related to the use of dental floss, its efficiency in reducing interproximal plaque, and the educational techniques that can be used to advise and motivate patients. It was concluded that only a small percentage of the population actually uses dental floss. Moreover, difficulties also arise in the efficient self-removal of interproximal biofilms. However when patients are properly advised and motivated, the quality of their hygiene habits also increases proportionally. This is commonly achieved through specific educational techniques.(AU)

Valor comercial y eficacia de la cinta de politetrafluoretileno (PTFE) para la remoción de la biopelícula dental interproximal comparado con la seda dental de nylon en adolescentes y adultos jóvenes / Price and the efficacy of the polytetrafluoroethylene (PTFE) tape for the removal of the proximal dental biofilm compared to the common nylon dental floss in adolescents and young adults

Objetivo: Identificar el valor comercial y la eficacia de la cinta de politetrafluoretileno (PTFE) como método de higiene oral para la remoción de la biopelícula dental interproximal, comparado con la seda dental de nylon en adolescentes y adultos jóvenes. Métodos: Se utilizó la cinta de PTFE para remover la biopelícula dental interproximal. Por muestreo aleatorio simple el tamaño de la muestra fue de 87 (31 hombres y 56 mujeres) con un rango de edades entre 16 y 28 años. A los participantes se les suspendió toda clase de higiene oral durante un período de 12 horas, posteriormente se realizó una tinción con revelador de placa bacteriana y se llevó a cabo la remoción tanto con la cinta de PTFE como con la seda dental mediante la misma técnica y por el mismo operador. La recolección de datos se hizo con base en la división coronal (por tercios) del índice de higiene de Greene y Vermillion, pero se modificó para evaluar solamente las caras interproximales. Resultados: En el grupo de seda dental la presencia de la biopelícula dental interproximal fue 72.6% antes y 11.2% después de la remoción y en el grupo de PTFE fue 72.9% antes y 11% después; al comparar la remoción de la biopelícula con los dos métodos no hubo diferencias estadísticamente significativas (p>0.05). El valor comercial del PTFE es en promedio 2.7 veces más económico que el de la seda dental de nylon. Conclusiones: La similitud en la remoción de la bio-película interproximal de la cinta de PTFE frente a la seda dental fue significativa. Gracias a su buena bio-compatibilidad, tolerancia y bajo costo, la cinta de PTFE sirve como un método alternativo para retirar la bio-película interproximal. Los resultados de este estudio abren una puerta para investigar técnicas poco ortodoxas, pero eficaces, en el mantenimiento de la salud bucal con el único propósito de mejorar la calidad de vida en las poblaciones menos favorecidas.

Objective: To identify the price and the efficacy of the polytetrafluoroethylene PTFE tape as an oral hygiene method for the removal of the proximal dental biofilm, compared to the common nylon dental floss in adolescents and young adults. Methods: The polytetrafluoroethylene tape was used as a method for the removal of the proximal dental biofilm. By a randomized procedure the sample size was of 87 (31 men and 56 women) between 16 and 28 years old. The oral hygiene of the participants was suspended during a period of 12 hours. A suitable disclosing solution was used to paint the dental surfaces. The removal of the biofilm was made by the same operator who used the same technique with the two materials (polytetrafluoroethylene tape and nylon dental floss). The information was collected using the coronal division (in thirds) of the Greene and Vermillion Oral Hygiene Index. This index was modified to evaluate proximal surfaces only. Results: In the group of dental floss the presence of the proximal biofilm was 72.6% before and 11.2% after its removal. In the group of PTFE was 72.9% before and 11% after. After the comparison of the two methods the differences are not significant. PTFE price is 2.7 times lower than common nylon dental floss. Conclusions: The similarity in the removal of the proximal biofilm of the PTFE tape when compared to the nylon floss was significant. Thanks to its biocompatibility, tolerance and its low price, the PTFE tape is an alternative method for the removal of the biofilm in these proximal areas. Results of this study open a way for the investigation on non orthodox techniques, but effective, for the maintenance of the oral health with the only purpose of improving life quality of poor populations.