Fracture Resistance of Endodontically Treated Teeth Restored with Biodentine, Resin Modified GIC and Hybrid Composite Resin as a Core Material.

INTRODUCTION: The restoration of a severely damaged tooth usually needs a post and core as a part of treatment procedure to provide a corono - radicular stabilization. Biodentine is a class of dental material which possess high mechanical properties with excellent biocompatibility and bioactive behaviour. The sealing ability coupled with optimum physical properties could make Biodentine an excellent option as a core material. AIM: The aim of the study was to determine the fracture resistance of Biodentine as a core material in comparison with resin modified glass ionomer and composite resin. MATERIALS AND METHODS: Freshly extracted 30 human permanent maxillary central incisors were selected. After endodontic treatment followed by post space preparation and luting of Glass fibre post (Reforpost, Angelus), the samples were divided in to three groups based on the type of core material. The core build-up used in Group I was Biodentine (Septodont, France), Group II was Resin-Modified Glass Ionomer Cement (GC, Japan) and Group III was Hybrid Composite Resin (TeEconom plus, Ivoclar vivadent). The specimens were subjected to fracture toughness using Universal testing machine (1474, Zwick/Roell, Germany) and results were compared using One-way analysis of variance with Tukey's Post hoc test. RESULTS: The results showed that there was significant difference between groups in terms of fracture load. Also, composite resin exhibited highest mean fracture load (1039.9 N), whereas teeth restored with Biodentine demonstrated the lowest mean fracture load (176.66 N). Resin modified glass ionomer exhibited intermediate fracture load (612.07 N). The primary mode of failure in Group I and Group II was favourable (100%) while unfavourable fracture was seen in Group III (30%). CONCLUSION: Biodentine, does not satisfy the requirements to be used as an ideal core material. The uses of RMGIC's as a core build-up material should be limited to non-stress bearing areas. Composite resin is still the best core build-up material owing to its high fracture resistance and bonding to tooth.

Revitalization of an Immature Permanent Mandibular Molar with a Necrotic Pulp Using Platelet-Rich Fibrin: A Case Report.

Any insult to the pulp during its development causes cessation of dentin formation and root growth. Pulpal status and degree of root development are the decisive factors in the treatment approach. Various treatment options have been tried like surgery with root-end sealing, calcium hydroxide-apexification, placement of apical plug and regenerative endodontic procedures to induce apexogenesis. An ideal scenario for a necrosed tooth with immature root would be continued root development coupled with regeneration of pulp tissue. We report a case, where revitalization was done using Platelet-Rich Fibrin (PRF) as a scaffold in immature mandibular molar tooth.

Follow-up of erlotinib related uveitis.

The authors report the follow-up of a 68-year-old lady with bilateral anterior uveitis secondary to erlotinib. Erlotinib was started and stopped after symptoms and signs suggestive of severe bilateral anterior uveitis were noted. The patient developed signs of a non-ST elevation myocardial infarction, 12 days after stopping the erlotinib, and recovered without major problems. The patient also reported intermittent low-grade fever since starting erlotinib which resolved after stopping this drug. No further symptoms of uveitis were noted up to 6 month follow-up. The patient reported improved well being, resolution of ocular symptoms and intermittent low-grade fever at last follow-up (6 months after stopping erlotinib).

Erlotinib-related bilateral anterior uveitis.

The authors report the case of a 68-year-old woman with secondary adenocarcinoma of the lungs from an unknown primary. Erlotinib was started which produced symptoms suggestive of uveitis. Erlotinib was stopped and restarted a month later at a lower dose, which resulted in severe bilateral anterior uveitis. The uveitis settled after stopping erlotinib and treatment with topical steroids and cycloplegics. To the best of the authors' knowledge, this is the first case of erlotinib-related anterior uveitis.

Botulinum toxin injection for postoperative diplopia testing in adult strabismus.

PURPOSE: To investigate the use of botulinum toxin type A in identifying adult patients with constant strabismus who are at high risk of developing intractable diplopia after surgery. METHODS: A retrospective review of adult patients with constant horizontal strabismus who had botulinum toxin injection to evaluate their risk of postoperative diplopia. These patients reported diplopia when prisms were used to neutralize the deviation. RESULTS: One hundred ninety-five adults were studied; their mean age was 40.3 +/- 14 years (range, 16 to 73 years). One hundred thirty-three (68%) had botulinum toxin injected into a lateral rectus muscle; 62 (32%) had injections in a medial rectus muscle. Only 14 (7%) developed diplopia; 9 (4.6%) of these had troublesome diplopia but 5 (2.6%) could cope with the double vision and elected to have surgery. Surgical correction was recommended to the remaining 181 (93%) who did not experience diplopia. Complications of botulinum toxin injection were ptosis (10 patients, 5.1%) and superior oblique muscle weakness (3 patients, 1.5%). Twenty-six patients (13.3%) had a poor response to the first injection and required a second injection with a double dose. Surgery did not result in intractable diplopia after 6 weeks in any patient with a negative botulinum toxin diplopia test. CONCLUSIONS: Botulinum toxin is a useful diagnostic tool for identifying patients with a low risk or no risk of postoperative diplopia despite a positive prism diplopia test.

Can the sequential use of conventional silicone oil and heavy oil be a strategy for the management of proliferative vitreoretinopathy?

INTRODUCTION: Densiron is a novel long-term tamponade. Its specific gravity is 1.06 g/mL and as such it is heavier than water and provides support for the inferior retina. As proliferative vitreoretinopathy (PVR) has a propensity for the inferior retina, we used Densiron on a consecutive series of 97 cases with inferior pathology. We hypothesised that the sequential use of conventional and heavy silicone oil is a strategy for the management of PVR. MATERIALS AND METHODS: A consecutive interventional case series involving the use of Densiron for PVR cases was studied. Patients were selected if conventional silicone oil and Densiron were used sequentially. Anatomical success was defined as total re-attachment in the absence of any tamponade agent for at least 3 months post oil removal. RESULTS: Of the 97 patients, 10 patients fulfilled the criteria. Surgery involving Densiron was successful in re-attaching the retina in 7 of 10 cases, with one sequence of alternating light then heavy oil operation, and with one further surgery using silicone oil in the remaining 3 cases. The mean LogMAR preoperative vision was 1.57 and the postoperative vision was 0.82. In 8 of 10 patients, the final vision was 20/200 or better; in 5 of 10 patients, 20/80 or better. The mean follow-up was 19.5 months (range, 9 to 45). CONCLUSIONS: The sequential use of conventional silicone oil and Densiron may be a strategy in reducing the number of re-operations. Our case series shows that despite multiple surgical procedures, favourable visual outcome can be achieved.