Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study.

AIM: This study aims to compare the caries removal efficacy of three minimally invasive techniques and to analyze qualitatively under stereomicroscopy and quantitatively using Vickers hardness test. MATERIALS AND METHODS: Thirty non-carious anterior primary teeth were selected and subjected to demineralization and the same was confirmed using RadioVisioGraphy (RVG). Samples were divided into three groups: Bromelain gel, smart bur, and atraumatic restorative technique (ART). Caries removal was carried out for a time period of 2 minutes. The remaining demineralized dentin was measured using stereomicroscopy. Random dentin blocks were prepared and a microhardness test was conducted. STATISTICAL ANALYSIS: Data were subjected to statistical analysis by one-way analysis of variance (ANOVA) test. RESULTS: Stereomicroscopic analysis revealed bromelain gel and smart burs to be superior to ART. Bromelain gel was found to have comparable microhardness levels as healthy dentin. Statistically significant (p < 0.001) results were obtained. CONCLUSION: In terms of caries removal and microhardness, bromelain gel was highly efficient when compared to other groups. CLINICAL SIGNIFICANCE: Fear and anxiety of children and parents about conventional drills led to the emerging trends of minimally invasive restorative dentistry. This research indicated the use of bromelain gel and smart bur in the process of caries removal and that bromelain was more efficient when compared to other groups. HOW TO CITE THIS ARTICLE: Abinaya R, Nagar P, Urs Pallavi, et al. Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(6):585-589.

Coronary artery bypass grafting in a predominately black group of patients.

The preoperative profiles of a predominately non-white group of patients undergoing coronary artery bypass grafting were reviewed. Data were obtained from a retrospective analysis of medical records of 163 patients operated on at Howard University Hospital between July 1983 and July 1986. The analysis was carried out primarily to determine whether patients requiring myocardial revascularization were somehow different from their non-black counterparts. Ninety-one percent of the patients were black, 5 percent white, 0.5 percent Hispanic, and 3.5 percent others (Iranian, Filipino, etc).The study was not designed to review the prevalence of coronary disease in blacks, or to determine the natural history following coronary artery bypass grafting, but to determine whether those with established coronary disease of such a severity as to warrant revascularization had the usual clustering of risk factors. Patient records were reviewed to determine the prevalence of hypertension, diabetes, obesity, cigarette smoking, previous myocardial injury, and total serum cholesterol. Because of the well-recognized increased incidence of hypertension in black patients, and its role as a major risk factor in coronary heart disease, the sequelae of hypertension were considered in relation to results of surgical therapy.The study population included 93 men (57 percent) and 70 women (43 percent); mean age was 59 years (fourth to ninth decade). Seventy-four percent of the patients were hypertensive, 35 percent were diabetic, and 77 percent had a smoking history. Obesity was prevalent among the female patients in general, with 36 percent of the diabetics and 21 percent of the nondiabetics being greater than 50 percent over ideal body weight. Ninety percent of the female patients and 80 percent of the male patients presented with New York Heart Association class III or IV angina. Left ventricular function was, on the average, well preserved. The immediate surgical mortality (following exclusion of patients in extremis) was 4 percent. The surgical mortalities were related to easily identifiable factors. Peri-operative infarctions were profoundly influenced by the presence of diabetes.Although this group was distinguished from most reported groups of patients undergoing aortocoronary bypass grafting by the presence of advanced age, the large percentage of women and diabetics and the marked prevalence of hypertension, and the usual risk factors for coronary artery disease reported in the majority population, the study reconfirms previous epidemiologic findings. It appears that racial "clumping" of a heterogeneous non-white population has minimal usefulness, except as it may be related to socioeconomic status and access to quality health care.

Bypass grafts for recurrent or complex coarctations of the aorta.

Twenty-three patients aged 5 to 53 years with recurrent or complex coarctations of the aorta were successfully operated upon using bypass grafts. This technique of repair was selected for 5 patients with recurrent coarctation, 11 with long-segment coarctation with or without hypoplasia of the transverse aortic arch, and 7 with inadequate collateral circulation. Nineteen patients had bypass grafts from the left subclavian artery to the distal descending thoracic aorta. The other 4 had a combined approach through a left thoractomy and median sternotomy with grafts between the ascending and descending thoracic aorta. All patients survived the operative procedure. One patient were reexplored for a hemothorax and 5 developed transient postoperative hypertension. There were no instances of abdominal vasculitis or lower extremity paralysis. These patients have been followed from 3 months to 11 years postoperatively, and all but 1 are alive and well. Twenty-two are normotensive, and none have the sequelae of hypertensive disease. Gradients up to only 15 mm Hg exist between upper and lower extremity blood pressures. Five patients have undergone postoperative catheterization and aortography, and all have patent grafts. This procedure is a useful and adjunct in difficult coarctations of the aorta and can be safely performed with excellent reproducible long-term results.