Eficacia de la hidroterapia frente al tratamiento en gimnasio en prótesis total primaria de rodilla por osteoartritis: ensayo controlado y aleatorizado / Efficacy of hydrotherapy versus gym treatment in primary total knee prosthesis due to osteoarthritis: a randomized controlled trial

Fundamento: La fisioterapia se postula como un tratamiento eficaz tras la intervención de prótesis total derodilla (PTR) por osteoartritis. El objetivo fue valorarla eficacia de la hidroterapia frente a la cinesiterapia engimnasio durante la segunda fase de la rehabilitación depacientes intervenidos de PTR en relación a la mejora deltest de la marcha, el dolor, la rigidez, el balance articular,la fuerza muscular y la inflamación. Método: Se realizó un ensayo controlado y aleatorizado.Los pacientes intervenidos de PTR recibieron una primerafase rehabilitadora (15 sesiones de 60 minutos) en el gimnasio. En la segunda fase (15 sesiones de 40 minutos), ungrupo realizó fisioterapia en gimnasio y otro en piscina.Se valoraron (basal, tras 15 y tras 30 sesiones): capacidadfuncional, dolor y rigidez con índice WOMAC, balance articular con goniómetro, fuerza muscular con escala Lovett,y test de la marcha de 6 minutos. Resultados: Participaron 115 pacientes, 59 (51,3 %) en grupo sala y 56 (48,7 %) en grupo piscina. Tras la segunda fasede rehabilitación se observaron mejoras clínicas superiores en el grupo piscina, siendo las diferencias estadísticamente significativas respecto al dolor (p = 0,005), rigidez(p = 0,010), balance articular flexión (p = 0,027) y fuerzamuscular (p = 0,049) en la rodilla intervenida, y en el testde la marcha de 6 minutos (p = 0,002). Conclusiones: En pacientes intervenidos de PTR, la hidroterapia durante la segunda fase del tratamiento rehabilitador fue más eficaz que la fisioterapia en gimnasio enrelación a la mejora del dolor, rigidez, balance articular,fuerza muscular y resultado del test de la marcha.(AU)

Background: Physiotherapy is postulated as an effective treatment after total knee arthroplasty (TKA) due toosteoarthritis. The aim was to assess the efficacy of hydrotherapy versus gym kinesitherapy during the secondphase of treatment in TKA patients, with regard to theimproved gait test, pain, stiffness, joint balance, musclestrength and inflammation. Methods: A controlled and randomized trial was carriedout. TKA patients received a first rehabilitative phase (1560-minutes sessions) at the gym. In the second phase (1540-minute sessions), one group performed physiotherapyin a gym and another in a swimming pool. Different variables were assessed (basal, after 15 and after 30 sessions):functional capacity, pain and stiffness with WOMAC index, joint balance with goniometer; muscle strength withLovett scale, and result of 6-minute gait test. Results: A total of 115 patients participated, 59 (51.3%)in the gym group and 56 (48.7 %) in the pool group. After the second phase of rehabilitation, higher clinical improvements were observed in the pool group, with statistically significant differences in pain (p = 0.005), stiffness(p = 0.010), joint balance (p = 0.027) and muscle strength(p = 0.049) in the operated knee, and in the result of the6-minute gait test (p = 0.002). Conclusions: In TKA patients, hydrotherapy during thesecond phase of rehabilitative treatment was more effective than gym physiotherapy in terms of improved pain,stiffness, joint balance, muscle strength and gait testing.(AU)

[Efficacy of hydrotherapy versus gym treatment in primary total knee prosthesis due to osteoarthritis: a randomized controlled trial].

BACKGROUND: Physiotherapy is postulated as an effective treatment after total knee arthroplasty (TKA). The objective of the study was to assess the efficacy of hydrotherapy versus gym kinesitherapy during the second phase of treatment in TKA patients, with regard to the improved gait test, pain, stiffness, joint balance, muscle strength and inflammation. METHODS: A controlled and randomized trial was carried out. TKA patients received a first rehabilitative phase (15 60-minutes sessions) at the gym. In the second phase (15 40-minute sessions), one group performed physiotherapy in a gym and another in a swimming pool. Different variables were assessed (basal, after 15 and after 30 ses-sions): functional capacity, pain and stiffness with WOMAC index, joint balance with goniometer; muscle strength with Lovett scale, and result of 6-minute gait test. RESULTS: A total of 115 patients participated, 59 (51.3%) in the gym group and 56 (48.7?%) in the pool group. After the second phase of re-habilitation, higher clinical improvements were observed in the pool group, with statistically significant differences in pain (p?=?0.005), stiffness (p?=?0.010), joint balance (p?=?0.027) and muscle strength (p?=?0.049) in the operated knee, and in the result of the 6-minute gait test (p?=?0.002). CONCLUSIONS: In TKA patients, hydrotherapy during the second phase of rehabilitative treatment was more effective than gym physiother-apy in terms of improved pain, stiffness, joint balance, muscle strength and gait testing.

Influence of Spectroscopic Techniques on the Estimation of the Degree of Conversion of Bulk-fill Composites.

OBJECTIVES: To compare the degree of conversion (DC) of different flowable and sculptable bulk-fill composites (BFC), at 0- and 4-mm depths from the surface, by Fourier transform infrared (FTIR), attenuated total reflection FTIR (ATR-FTIR), and FT-Raman spectroscopic techniques. METHODS AND MATERIALS: Six BFC were investigated, including three sculptable composites (Admira Fusion [Voco], Aura Bulk Fill [SDI], and X-tra Fill [Voco]) and three flowable composites (Venus Bulk Fill [Heraeus], Filtek [3M], and X-tra Base [Voco]). Three molds of each composite were light cured as specified by the manufacturer. For each mold, slices corresponding to 0-mm (surface) and 4-mm depth were analyzed by spectroscopic techniques: ATR-FTIR, FTIR, and FT-Raman. The spectra of uncured composite material were used as an analytical control for background subtraction of the treated composite. The area and amplitude of the reference peaks (1607 and 1637 cm-1) were obtained to calculate the DC percentage at 0- and 4-mm depth. A Kruskal-Wallis nonparametric test was used for materials, and paired comparisons were made using Mann-Whitney nonparametric test. Wilcoxon's rank test was used for comparison between spectroscopic methods and between 0- and 4-mm depth in each composite. Significance was accepted at p<0.05. RESULTS: FTIR showed significantly lower DC values, both in areas and amplitudes of the peaks, when compared with the results reported by different BFC. Differences between the surface and 4-mm depth were detected more precisely by FT-Raman. ATR-FTIR obtained DC values significantly higher than those obtained by FTIR. CONCLUSIONS: The vibrational spectroscopy method significantly influenced DC measurements of the flowable and sculptable BFC explored.

[Video-assisted thoracoscopic treatment for two ports for idiopathic palmar and axillary hyperhidrosis in children]. / Tratamiento videotoracoscópico por dos puertos para la hiperhidrosis palmar y axilar idiopática en el niño.

JUSTIFICATION: Primary hyperhidrosis is a benign disease that consists in the excessive production of sweat, mainly in the hands, axillas and feet. It may to interfere with the social and work life of the sufferer. It affects up to 3% of the population. In Cuba there are no epidemiological studies on its prevalence. One of the treatment modalities is videothoracoscopic sympathicotomy. OBJECTIVES: To describe the results of the videothoracoscopic sympathicotomy technique for two ports using apneic oxygenation to achieve lung collapse. METHOD: Descriptive, retrospective study of 27 cases operated by primary hyperhidrosis in the period from May 2015 to June 2018. Demographic and clinical characteristics of operated patients, results of the endoscopic surgical technique, postoperative complications and satisfaction were described. RESULTS: The 27 patients were adolescents with ages ranging from 11 to 19 years old, it was more frequent in the female sex. All patients had total solution of the symptoms in the intraoperative period, demonstrated by the cessation of sweat in the palms or axillas and by the verification of the increase of the palmar temperature in the monitor. No patient had intraoperative complications. Compensatory sweating occurred in four patients and one had intercostal neuritis. 100% of the patients were satisfied with the result at 30 days of treatment. CONCLUSIONS: It is a safe technique, with few complications, high satisfaction with the results and feasible to perform in pediatric hospitals with basic resources of minimal access surgery.

FUNDAMENTACION: La hiperhidrosis primaria es una enfermedad benigna que consiste en la excesiva producción de sudor, principalmente en manos, axilas y pies, y por ello puede llegar a condicionar la vida social y laboral de quien la padece. Afecta hasta el 3% de la población. En Cuba no hay estudios epidemiológicos sobre su prevalencia. Una de las modalidades de tratamiento es la simpaticotomía videotoracoscópica. OBJETIVOS: Describir los resultados de la técnica de simpaticotomía videotoracoscópica por dos puertos usando oxigenación apneica para lograr el colapso pulmonar. METODO: Estudio descriptivo, retrospectivo, de una serie de 27 casos operados por hiperhidrosis primaria en el periodo de mayo de 2015 a junio de 2018. Se describen características demográficas y clínicas de pacientes operados, resultados de la técnica quirúrgica endoscópica, complicaciones postoperatorias y satisfacción. RESULTADOS: Los 27 pacientes eran adolescentes con edades comprendidas entre 11 y 19 años, siendo más frecuente en el sexo femenino. Todos los pacientes tuvieron solución total de los síntomas en el periodo intraoperatorio, demostrados por el cese del sudor en palmas o axilas y por la comprobación del aumento de la temperatura palmar en el monitor. Ningún paciente tuvo complicaciones intraoperatorias. El sudor compensatorio se presentó en cuatro pacientes y un paciente tuvo neuritis intercostal. El 100% de los pacientes estuvieron satisfechos con el resultado a los 30 días del tratamiento. CONCLUSIONES: Es una técnica segura, con pocas complicaciones, elevada satisfacción con los resultados y factible de realizar en hospitales pediátricos con recursos básicos de cirugía de mínimo acceso.

Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine.

AIM: To evaluate and compare ex vivo the decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. METHODOLOGY: Two 2-mm-thick slices were cut from the coronal third of the root of 10 human incisors. Each slice was sectioned into two equal parts. Specimens were assigned to one of four groups (n = 10) for immersion in 20 mL of either 15% EDTA, or 15% citric acid, 5% phosphoric acid or 2.5% NaOCl, for three time periods (5, 10 and 15 min). The concentration of Ca(2+) extracted from the dentine was measured by atomic absorption spectrophometry. The amount of calcium extracted was analysed using the Kruskal-Wallis test for global comparisons and the Mann-Whitney U-test for pairwise comparisons. RESULTS: In the three time periods, 15% EDTA and 15% citric acid extracted the largest amount of calcium, with no significant differences between them. The 2.5% NaOCl solution extracted insignificant amounts of calcium, whereas 15% EDTA extracted 86.72% of the calcium in the first 5 min, and 15% citric acid and 5% phosphoric acid had a similar pattern of calcium removal (77.03% and 67.08% in first 5 min, respectively). CONCLUSIONS: Solutions of 15% EDTA, 15% citric acid and 5% phosphoric acid decalcify root dentine, with most calcium extracted during the first 5 min of action. The efficacy of 15% citric acid and 15% EDTA solutions was significantly greater than that of 5% phosphoric acid solution at each time period (5, 10 and 15 min).

Effect of CHX on the decalcifying effect of 10% citric acid, 20% citric acid, or 17% EDTA.

The objective of this study was to measure the demineralization capacity of 10% and 20% citric acid and 17% EDTA after three time periods and to determine whether it was modified by the addition of 1% of commercial chlorhexidine (CHX). Three slices of 2-mm thickness were cut from the cervical third of the root of ten bovine incisors and sectioned into two equal parts, obtaining six specimens per tooth. Specimens were assigned to one of six groups (n = 10) for immersion in 25 ml of the above mentioned solutions or 25 ml of these same solutions plus 1% CHX (Hibimax). At 3, 10, and 15 min of immersion, the concentration of Ca2+ was measured by atomic absorption spectrophometry. The demineralization effect of all solutions was time-dependent (F = 158,448; p < 0.001), without significant differences among them (p = 0.783). Addition of 1% CHX did not modify the demineralizing capacity of these solutions. In the first three minutes, significantly more [Ca2+] was obtained when 17% EDTA was used in comparison with the other solutions.

Individualized wedge.

The preparation of an individualized wedge in the gingival embrasure before cavity preparation using photo-cured resin permits rehabilitation of the interproximal space and the original contact point position. Because the individualized wedge completely fills the embrasure, the adaptation to the gingival and proximal walls of the molar to be restored is perfect, avoiding any overextension of obturation material during insertion. Furthermore, the original position of the contact point is preserved.

An in vitro study of coronal leakage after intraradicular preparation of cast-dowel space.

STATEMENT OF PROBLEM: Coronal leakage can produce contamination of periapical tissues, resulting in endodontic failure. PURPOSE: The purpose of this in vitro study was to evaluate the ability of 2 sealers to prevent coronal leakage in canals filled with gutta-percha and prepared for cast dowels but without coronal sealing. MATERIAL AND METHODS: The crowns of 60 extracted single-rooted teeth were amputated. The root canals were prepared corono-apically and filled with gutta-percha cones and 1 of 2 different endodontic sealers: a resin-based sealer (AH Plus) and a calcium hydroxide-based sealer (Sealapex). Specimens were then stored in water for 7 days to allow the sealers to set. The specimens were prepared in 1 of 2 ways: no preparation for cast dowel or preparation of cast-dowel space (n=15). External surfaces of the roots were sealed with cyanoacrylate cement. The teeth were thermal cycled at 5 degrees and 55 degrees C in water baths (dwell time=30 seconds) for 500 cycles. Specimens were then submerged in 2% methylene blue colorant for 24 hours. Microleakage was measured according to the percentage of area stained with the colorant. Effects of each factor (cast-dowel preparation and type of sealant) on microleakage were analyzed by the Student t test (alpha=.05). RESULTS: The AH Plus and Sealapex sealers with cast-dowel preparation resulted in significantly (P<.001) more leakage compared to sealers with no dowel preparation. CONCLUSION: Cast dowel-space preparation had a negative influence on the sealing ability of the remnant root-canal filling material.

Decalcification of root canal dentine by citric acid, EDTA and sodium citrate.

AIM: To measure the demineralization capability of 1 and 10% citric acid, 10% sodium citrate and 17% EDTA during immersions of 5, 10 and 15 min on root canal dentine. METHODOLOGY: Crowns were sectioned from eight maxillary canines. The cementum was removed from the cervical third of the roots to expose the dentine. Canals were prepared using a handpiece-mounted Largo Peeso reamer. A 3-mm thick cross-sectional slice was obtained from the cervical third of each root. Each slice was sectioned into four equal parts. These specimens were assigned to one of four groups (n = 8) for the application of 1% citric acid, 10% citric acid, 10% sodium citrate or 17% EDTA. Each specimen underwent three successive 5-min immersions in each solution at room temperature. The solutions were not renewed between immersions. Two millimetres of solution were collected from the extracts and lanthanum oxide was added for the calcium reading by spectrophotometry. To compare the amounts of calcium removed by each solution, the Friedman test was used for the global comparison and the Wilcoxon test for paired comparisons. Differences between groups were evaluated using the Kruskal-Wallis test for the global comparison and Mann-Whitney test for paired comparisons. RESULTS: Overall, 1 and 10% citric acid were more effective than EDTA or sodium citrate at the three immersion times (P < 0.001); 10% citric acid was more effective than 1% citric acid (P < 0.001). EDTA and 1 and 10% citric acid showed decreasing effectiveness with time, and the decrease was significant for citric acid at both concentrations (P < 0.001). Although sodium citrate removed little calcium during the three time periods, the small increase recorded was significant (P < 0.01). CONCLUSIONS: Citric acid at 10% was the most effective decalcifying agent, followed by 1% citric acid, 17% EDTA and 10% sodium citrate.

Influence of different composite restoration techniques on cuspal deflection: an in vitro study.

Cuspal deflection produced by polymerization shrinkage was measured after using different composite restoration techniques. This study included 30 healthy premolars embedded in acrylic resin connected to a system that simulated intrapulpal pressure. A small ball was attached to each cuspal vertex as a reference point for intercuspal distance measurements. A large mesio-occlusal cavity was cut in each premolar. All premolars were treated with the same adhesive (ScotchBond) and composite (Tetric Ceram). The teeth were randomly distributed among three study groups: Group 1, filled with two horizontal increments; Group 2, filled with two horizontal increments, the first up to half the cavity height and light cured using a transparent plastic cone (Cerana), and the second filling the remainder of the cavity and Group 3, filled in the same way as Group 2, except that the first increment only filled one-third of the cavity height. The intercuspal distance was measured before beginning the restoration and immediately after polymerization of the first and second increments. Under the experimental conditions used, none of the filling techniques utilized avoided the cuspal deflection phenomenon. Polymerization of the final increment, which binds occlusal enamel in the buccal-lingual plane, was the main cause of cuspal deflection and produced a statistically significant reduction in intercuspal distance vs the baseline measurement in the three study groups. The global deflection ranged from 4 microm to 6 microm, depending on the filling technique used, although the differences among techniques did not reach statistical significance (p<0.05).

The effect of various surface treatments and bonding agents on the repaired strength of heat-treated composites.

STATEMENT OF PROBLEM: Some clinical situations may require the repair of a secondary polymerized or aged composite. The higher indirect resin conversion rate may prove to be a disadvantage if a repair procedure based on covalent bonding from unreacted methacrylate groups is attempted. PURPOSE: This study evaluated the effectiveness of different combinations of surface treatments and 2 bonding agents used to enhance heat-polymerized and aged composite repairs. MATERIAL AND METHODS: Ninety Herculite XRV and 90 Heliomolar Radiopaque specimens were prepared and then postpolymerized and stored for 4 weeks. All composites were subjected to 1 of 9 treatment regimens that involved adding fresh composite onto a corresponding postpolymerized composite (Herculite/Herculite or Heliomolar/Heliomolar). The surfaces were treated with different combinations of air abrasion, phosphoric acid, hydrofluoric acid, acetone, Special Bond II, Heliobond, and Prime & Bond 2.0. RESULTS: Surface treatment with air abrasion resulted in the strongest repairs; surface treatment with phosphoric acid resulted in the weakest repairs. CONCLUSION: The use of air abrasion and Prime & Bond 2.0 adhesive consistently improved the shear bond strength for both composites tested.

[The area of dentinal diffusion at the time of the manual preparation of root canals]. / Aire de diffusion dentinaire lors de la préparation manuelle des conduits radiculaires.

In this current piece of work we study the area of dentinal diffusion obtained with various irrigating agents which eliminate the smear layer: critic acid at concentrations of 10, 25 and 50%, 15% ethylene-diamino-tetraacetic acid (EDTA), and REDTA (compound of EDTA). All the agents proved their efficiency in eliminating the smear layer, which was corroborated by use of the sweep electron microscope and objectified using computerized image analysis, thus obtaining different diffusion areas with the various irrigating solutions used.

[Mechanical instrumentation of the root canals. A study using SEM and computerized image analysis]. / Instrumentation mécanique des conduits radiculaires. Une étude à l'aide du M.E.B. et analyse informatisée d'image.

The effectiveness of ultrasonic and sonic instrumentation in eliminating the smear layer from instrumented root channels. The results were examined with S.E.M. and the effective areas of dental diffusion were calculated using the computerized image analyzer. The agents used: citric acid at concentrations of 10, 25 and 50% as well as 15% EDTA, proved their efficiency with both types of mechanical instrumentation. However, the area of diffusion found was always greater using the ultrasonic instrumentation technique as opposed to the sonic instrumentation technique. 1, 2.5 and 5.25% sodium hypochlorite, as well as 10 volume hydrogen peroxide were not effective in eliminating the smear layer using both types of instrumentation.

[Bonding of glass ionomer cement to dentin. An in vitro study]. / La unión del cemento de vidrio ionómero a la dentina. Un estudio "in vitro".

It's been studied "in vitro" the influence of the "Smear Layer" on the cement adhesión of the glass ionomer to the dentin. Using phosphoric acid at 37% and poliacrylic in the dentin during short periods of time, the adhesion between the cement and the dentin is improved because the Smear Layer is removed totally in the case of phosphoric acid and partially in the case of polyacrylic acid.

[Optical and scanning electron microscope study of gingival microleakage in Class II composite restorations]. / Estudio con microscopia optica y electrónica de barrido de la microfiltración gingival en restauraciones de Clase II con composites.

It has been studied the gingival microleakage and the polymerization contraction gap in composites class II restorations. The influence of two different composites, a microparticle [Heliomolar (Vivadent)] and a high filled one [P-50 (3M)], has been compared with different adhesion systems: a) gingival enamel acid-etch technique. b) Dentinal adhesives [Gluma (Bayer) and Scotchbond 2 (3M)]. c) A adhesive varnish [Dentin Protector (Vivadent)]. The gingival microleakage is only prevented when a microparticle composite [Heliomolar (Vivadent)] and a adhesive varnish [Dentin Protector (Vivadent)] are used together.