[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Hebrew edition].

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented. The Hebrew Edition is part of the IADT global effort to provide accessibility to these guidelines worldwide.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Hebrew edition].

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This scond part of the guidelines will focus on avulsion of permanent teeth.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Hebrew edition].

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition.

A parallel approach to post source decay MALDI-TOF analysis.

We present a novel enhancement to matrix-assisted laser desorption ionization (MALDI) post-source decay (PSD) analysis whereby fragment ions from multiple precursor ions are acquired into the same spectrum without employing a timed ion gate to preselect each parent ion. Fragment ions are matched to their corresponding precursor ions by comparing spectra acquired at slightly different reflectron electric fields. By measuring the difference in time-of-flight (TOF) between the two spectra for each fragment, it is possible to calculate the mass of the fragment ion and its parent. This new "parallel PSD" technique reduces analysis time and consumes less sample than conventional PSD, which requires an ion gate for serial preselection of precursor ions.

Buccal and lingual activity during mastication and swallowing in typical adults.

A non-invasive protocol was developed to assess tongue and cheek movements during mastication and to evaluate the temporal relationship between mastication and the initiation of pharyngeal swallowing. Typical adults (three males and three females) were monitored during chewing. Miniature pressure transducers were bonded unilaterally to the buccal and lingual surfaces of the first mandibular molar and the buccal surface of the first maxillary molar on each subject's preferred chewing side. Surface electromyography of the ipsilateral masseter muscle was recorded as an indicator of jaw-closing activity. Pressure and electromyography (EMG) recordings were time-linked to simultaneous B-mode ultrasound imaging of the oral cavity using a submental, coronal view aligned with the first mandibular molar. The intervals between peak pressure recorded at each pressure transducer and peak jaw-closing activity for each masticatory cycle were not statistically different [analysis of variance (anova), P=0.9856] and displayed large statistical variation. These intervals were not different at the beginning of the trials (hard biscuit) than they were at the completion of mastication when the cookie had been broken down to a paste/puree consistency bolus. The interval between the last chewing stroke and the initiation of swallowing was 0.92 +/- 0.34 s). No significant difference existed among subjects for this time interval (anova, P=0.382).

Replantation of avulsed primary incisors: a risk benefit assessment.

Parents of preschool children with avulsed primary incisors may request replantation. Although dental textbooks uniformly recommend that primary teeth not be replanted, some case reports advocate the procedure. This review of case reports identifies a number of pathological outcomes of replantation and provides information for clinicians and parents on the risks that may accompany replantation.

Pre-replantation storage of avulsed teeth: fact and fiction.

Recent laboratory and clinical studies have proven that there is a rapid decrease in the regenerative potential of normal periodontal ligament the longer an avulsed tooth is out of the socket. These findings make some guidelines for the management of avulsed teeth inaccurate. This paper will review the effects of pre-replantation storage on periodontal ligament healing. In addition, current management recommendations are reviewed and suggestions for change presented.

Clinical management of avulsed permanent incisors using Emdogain: initial report of an investigation.

The enamel matrix derivative Emdogain was recently approved for clinical use in a number of countries, including Canada. It has been shown to stimulate regeneration of periodontal ligament following periodontal surgery in adults. This paper reviews pertinent clinical and laboratory studies of Emdogain and describes the protocol and methods used for a longitudinal outcome study of replantation of avulsed permanent incisors in children and adolescents. Application of these methods is described in an illustrative case report of Emdogain use. This paper is meant to inform clinicians and guide those who are instituting similar investigations.

Comparison of efficacy of ciprofloxacin and doxycycline against experimental melioidosis and glanders.

Melioidosis and glanders are caused by the closely related species Burkholderia pseudomallei and Burkholderia mallei, respectively. Whereas melioidosis is a significant cause of morbidity in south-east Asia, glanders is extremely rare. The efficacies of ciprofloxacin and doxycycline were assessed against a strain of B. pseudomallei and a strain of B. mallei which were susceptible to both antimicrobials in vitro. Porton outbred mice and Syrian hamsters were given 40 mg/kg of either doxycycline or ciprofloxacin twice daily by sc injection according to one of three regimens: dosing starting 48 h before challenge and continuing for 5 days postchallenge; 5 days' therapy starting immediately after challenge; 5 days' therapy starting 24 h after challenge. Mice were challenged ip with B. pseudomallei 4845 and hamsters were challenged ip with B. mallei 23344. Antimicrobial efficacy was determined by the shift in the median lethal dose (MLD). Ciprofloxacin prophylaxis and immediate therapy both raised the MLD of B. pseudomallei to 4 x 10(6) cfu from 19 cfu in untreated animals, but therapeutic ciprofloxacin only raised the MLD to 180 cfu. The results for doxycycline were similar. Ciprofloxacin prophylaxis raised the MLD of B. mallei 23344 to 4.6 x 10(5) cfu compared with 4 cfu in untreated controls. Immediate therapy raised the MLD to 7.0 x 10(4) cfu and therapy raised the MLD to 1.6 x 10(3) cfu. All regimens of doxycycline protected hamsters against challenges of up to 2 x 10(7) cfu. Despite using a susceptible strain of B. pseudomallei, neither antimicrobial was effective when used therapeutically. The timely administration of either antimicrobial, however, was effective in preventing symptomatic infection. Doxycycline was the superior of the two antimicrobials against experimental glanders although relapse did occur in treated animals approximately 4-5 weeks after challenge.

Storage conditions of avulsed teeth affect the phenotype of cultured human periodontal ligament cells.

After severe injury to the periodontal ligament (PL), the phenotypes of cells recolonizing root surfaces influence the extent and type of repair processes. In teeth that are replanted following avulsion injury, recolonization of the PL space by osteogenic cells instead of by PL fibroblasts may favor bone formation (i.e. ankylosis) instead of PL regeneration. We consider here that recolonization processes depend in part on the storage conditions of the teeth following avulsion. We used an in vitro cell culture model to assess the effect of storage conditions on immunohistochemical staining of several marker proteins that are expressed by osteogenic cells (osteopontin and alkaline phosphatase) and fibroblasts (alpha-smooth muscle actin, type III and XII collagens). Prior to cell culture, extracted human premolar teeth were stored in air ("dry") or in alpha-MEM ("wet") for either 30 or 120 min as surrogate conditions for the variations of extra-alveolar tooth storage that may occur following avulsion. Collagenase/trypsin-digested suspensions of PL cells were prepared from the tissue adherent to the extracted root surface. Passage #2 or #3 cultures were immunostained and examined by fluorescence microscopy. For type XII collagen, cells from wet samples displayed perinuclear staining while cells from 30-min dry samples showed only isolated foci. The staining for 120-min dry samples was weak and non-specific. alpha-Smooth muscle actin was not incorporated into stress fibers in wet samples, whereas dry samples demonstrated prominent stress fibers stained for alpha-smooth muscle actin. Detached cytoplasmic fragments resembling cell processes that stained for alpha-smooth muscle actin were abundant in dry samples, indicating the presence of highly contractile cells. The staining for osteopontin was mainly perinuclear but was more intense in dry samples. The focal adhesion pattern of osteopontin staining in 120-min dry samples resembled that of migrating osteogenic cells. The pattern of staining did not vary for type III collagen or alkaline phosphatase, although staining for alkaline phosphatase was more intense in samples stored under dry conditions. We conclude that prolonged extra-alveolar dry storage favors increased in vitro growth of contractile cells expressing osteogenic cell markers while storage in cell culture medium favors growth of cells with the classical phenotype of PL fibroblasts.

In vitro susceptibilities of Burkholderia mallei in comparison to those of other pathogenic Burkholderia spp.

The in vitro antimicrobial susceptibilities of isolates of Burkholderia mallei to 16 antibiotics were assessed and compared with the susceptibilities of Burkholderia pseudomallei and Burkholderia cepacia. The antibiotic susceptibility profile of B. mallei resembled that of B. pseudomallei more closely than that of B. cepacia, which corresponds to their similarities in terms of biochemistry, antigenicity, and pathogenicity. Ceftazidime, imipenem, doxycycline, and ciprofloxacin were active against both B. mallei and B. pseudomallei. Gentamicin was active against B. mallei but not against B. pseudomallei. Antibiotics clinically proven to be effective in the treatment of melioidosis may therefore be effective for treating glanders.

The development of ISO 9002 quality management standards for Canadian dental practices.

The department of dentistry of the Hospital for Sick Children has actively maintained a quality assurance system since the early 1980s. In addition, members of the department have taught courses and published articles on risk management and quality assurance for over a decade. The decision to achieve ISO 9002 registration led to an intensive 10-month process to adapt ISO systems and standards to Canadian institutional dental practice. This article describes the ISO registration system and the changes required for an existing quality assurance program to conform to ISO standards.

Evaluation of a laser Doppler flowmeter to assess blood flow in human primary incisor teeth.

PURPOSE: This study determined whether the portable Advance Laser Flowmeter Model 21, a clinical instrument, would indicate significant values when pulpal blood flow was present or absent; whether the analog output of the flowmeter was time-linked to the heart rate; and whether labial and lingual crown surfaces produced different flow values. METHODS: Teeth were tested under two conditions: with the teeth in situ and extracted, or with the pulp present and removed. RESULTS: Values before and after the teeth were extracted, and those before and after pulpectomy with the tooth in situ were significantly different. These findings verified that the flowmeter measured the presence of bloodflow. Peaks of the electrocardiogram waves and the regular signal fluctuations of the flowmeter were time-linked and verified the measurement of the heart rate from the dental pulp. Differences in the values for the lingual and labial surfaces of individual teeth were not significant. CONCLUSIONS: This instrument proved a valid means of determining the presence of pulpal blood flow in primary incisors.

The influence of storage conditions on the clonogenic capacity of periodontal ligament cells: implications for tooth replantation.

Viable periodontal ligament (PL) cells are required for PL healing of avulsed teeth following replantation. If immediate replantation cannot be accomplished, the ability of PL progenitor cells to reproduce (clonogenic capacity) and recolonize the wound may be extended by prevention of desiccation and storage in physiological media. This investigation examined the effects of storage in saliva, milk, Hank's balanced salt solution (HBSS) and Eagle's medium (alpha MEM) on the clonogenic capacity of human PL progenitor cells at 30 and 60 min extra-alveolar time. Twenty erupted human premolar teeth extracted as atraumatically as possible for orthodontic purposes were used in the present study. Fifteen premolars were placed immediately in freshly collected autologous saliva at room temperature, (+ 23 degrees C) for 15 min. These 15 premolars were next divided into three groups of five and stored in either saliva, milk or HBSS at + 4 degrees C in plastic cups surrounded by ice. The remaining five teeth served as positive controls and were immediately placed in alpha MEM at + 4 degrees C. PL tissue was scraped from one-half of the root surface with a scalpel at 30 and 60 min total extra-alveolar duration. Cells were released from the tissue sample with a 30 min enzymatic digestion procedure and the cells from the tissue samples analyzed for clonogenic capacity. There was a reduction in clonogenic capacity with time for all protocols. Periodontal ligament cells stored in alpha MEM showed the least reduction between 30 and 60 min and the greatest reduction was observed for PL cells stored in saliva. The difference in clonogenic capacity following transfer from saliva to milk or HBSS was not significant at 30 min. At 60 min, cells transferred from saliva to HBSS had a statistically higher percentage of clonogenic cells than those transferred to milk (5.9% vs. 3.5%; P < 0.05). We conclude that immediate storage of avulsed teeth in autologous saliva, followed by transfer to chilled milk, preserves the presence of sufficient progenitor cells in the PL to warrant replantation and the possibility of PL healing at 60 min extra-alveolar duration.

Interim storage of avulsed permanent teeth.

This literature review examines the effects of extra-alveolar duration and storage conditions on the healing of the periodontal ligament (PL) of avulsed teeth following replantation. A critical assessment of the so-called "reconstitution theory" for PL cells is also presented. The ideal treatment for an avulsed tooth is immediate replantation (i.e. less than five minutes). Unfortunately, immediate replantation is not the norm, and most avulsed teeth experience delayed replantation. The greatest risk to the vitality of the PL cells attached to the root of an avulsed tooth is desiccation. Not surprisingly, storage media affect PL healing. Storing avulsed teeth in an isotonic liquid is superior to dry storage. Numerous studies support the use of Modified Eagle's Medium, Hank's Balanced Salt Solution (HBSS), ViaSpan, saline, milk, and saliva as storage media. A recent study has suggested that chicken egg white may also prove to be a suitable storage medium for avulsed teeth. Of these media, only saliva is always present at the scene of an accident, however. Milk can usually be obtained on short notice, but even 10 minutes of desiccation can affect the outcome of replantation. From a practical standpoint, milk packed in ice seems to be the best alternative for the temporary storage of avulsed teeth, due to its wide availability and the minimal detrimental effects it has on PL cells. There is no evidence to support the suggestion that HBSS or any other media will "reconstitute" the PL cells when the extra-alveolar duration of avulsed teeth is greater than 30 minutes.

Avulsed permanent teeth: a review of the literature and treatment guidelines.

Dental trauma represents one of the few situations where dentists are called upon to make unscheduled diagnostic and treatment decisions in an area that is outside their routine experience. Since patients who sustain an avulsion present infrequently, except in child-oriented or emergency-based practices, clinicians often make diagnostic and management decisions based upon their previous rare treatment experiences. Clinicians also rely on published guidelines for this aspect of their practice and expect these standards to be up-to-date and based on current research information. None of the current protocols has been tested by a prospective longitudinal outcome study in humans. Nevertheless, current guidelines have become the standard for clinical practice around the world. An effort must be made to develop treatment protocols that are based upon the biological mechanisms that underlie periodontal wound healing.