Assessment of the Efficacy and Bond Strength of Different Dentin-bonding Agents with Adhesives on Primary Teeth: An In Vitro Study.

AIM: The purpose of this study was to evaluate the effectiveness and strength of three various dentin-bonding agents used with adhesives on primary teeth. MATERIALS AND METHODS: The study used 80 recently extracted, healthy human maxillary anterior primary teeth that had undergone physiologic resorption, or over-retention. Teeth were cut to expose a flat dentin surface at a depth of 1.5 mm. All samples were divided into four groups (20 samples in each group) as follows: Group I-Control group, Group II-Primary teeth bonding with 6th-generation bonding agent, Group III-Primary teeth bonding with 7th-generation bonding agent, Group IV-Primary teeth bonding with 8th-generation bonding agent. All of the samples' dentinal surfaces were covered with composite resin using a Teflon mold after adhesive had been applied. A universal testing machine (INSTRON) was used to assess the shear bond strength. Data were collected and statistically analyzed. RESULTS: The maximum mean shear bond strength was found in 8th-generation bonding agent (30.76 ± 0.16), followed by 7th-generation bonding agent (26.08 ± 0.21), 6th-generation bonding agent (25.32 ± 0.06), and control group (6.18 ± 0.09). Statistically significant difference was found between the three different bonding agents (p < 0.001). CONCLUSION: On conclusion, the 8th-generation bonding agent demonstrated a greater shear bond strength to dentin than the 7th and 6th-generation bonding agent. CLINICAL SIGNIFICANCE: The emergence of different bonding techniques to the market improves the durability and quality of restorations. An effective bonding to the tooth would also reduce bacterial penetration, marginal microleakage, possibility of pulpal inflammation preserve tooth structure, and postoperative sensitivity by allowing less cavity preparation. How to cite this article: Alqarni AS, Al Ghwainem A. Assessment of the Efficacy and Bond Strength of Different Dentin-bonding Agents with Adhesives on Primary Teeth: An In Vitro Study. J Contemp Dent Pract 2024;25(4):342-345.

Assessment of Two Different Obturation Systems in Primary Teeth: A Comparative Study.

Aim: The purpose of this study was to evaluate the efficacy of two distinct obturation techniques in primary teeth. Materials and Methods: For this investigation, 40 primary molar teeth were taken into consideration. Every sample underwent sample preparation. All teeth were evenly split into two groups: Group 1-obturation using the lentulospiral method and Group 2-obturation using the NaviTip method. The comparison between the two procedures was established through radiographic evaluation of the obturation quality and voids in the obturated canals. Results: In the lentulospiral method, 12 (60%) were optimal filling, 6 (30%) were underfilling, and 2 (10%) were overfilling. In the lentulo spiral method, 40% voids were present, and in the NaviTip method, 15% voids were present. Conclusion: The present study concluded that the NaviTip syringe method was sufficiently effective in regulating voids and yielded the best results for the apical seal, whereas the lentulo spiral approach generated the best results in terms of length of obturation.

Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study.

AIM: The aim of the current investigation was to evaluate the marginal microleakage of various esthetic restorative materials applied to primary teeth. MATERIALS AND METHODS: A total of 75 noncarious primary molars that were removed for orthodontic intervention and teeth nearing exfoliation were chosen. One millimeter (mm) above the cementoenamel junction, on the buccal surface of the teeth, Class V cavities were prepared. William's graded periodontal probe was used to standardize cavity preparation on all teeth. 3 mm was the cavity's length, 2 mm in width, and 2 mm in depth. The teeth were then divided into three groups (25 samples in each group) according to the type of esthetic restorative material used. Group I: Resin-modified glass ionomer cement, Group II: Ormocer, Group III: Giomer. The samples underwent 500 cycles of thermocycling, with an immersion time of 60 seconds and a well time of 15 seconds, between 5 and 55°C. The samples were submerged in methylene blue dye for 24 hours at room temperature and dried. The samples were then divided into sections and examined with a stereomicroscope. Data was recorded and statistically analyzed. RESULTS: The least marginal microleakage was found in the ormocer group (1.22 ± 0.01) followed by resin-modified glass ionomer cement group (1.31 ± 0.07) and the giomer group (1.78 ± 0.03). There was a highly statistically significant difference found between resin-modified glass ionomer cement group and the ormocer group, resin-modified glass ionomer cement group and giomer group. And no significant difference was found between the ormocer group and the giomer group. CONCLUSION: The present study concluded that there was some amount of microleakage in primary teeth in all restorative materials examined in this in-vitro investigation. However, the marginal sealing ability of ormocer was found highest compared to resin-modified glass ionomer cement and Giomer materials. CLINICAL SIGNIFICANCE: The primary reason dental restorations fail, particularly in Class V cavities, is microleakage since the margins of these restorations are typically found in the dentin or cementum. Assessing microleakage is a crucial step in determining the marginal integrity of restorative materials. Developing methods and resources that reduce the adverse effects caused by the restorative marginal seal failing would benefit from this. How to cite this article: Al Ghwainem A, Alqarni AS. Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study. J Contemp Dent Pract 2024;25(1):58-61.

The Pectoral (PECS) Regional Block: A Scoping Review.

Among the various surgical procedures, breast surgeries rank as a frequently conducted procedure. Interfacial blocks such as the Pectoral (PECS) block became possible with the currently available knowledge on innervations and ultrasound. Interfacial blocks target the deep fascial planes, which are potential spaces for injecting local anesthetics. The Pectoral I (PECS I) consists of the injection of local anesthetics in the plane between the pectoralis major and minor muscles. The PECS II block, a modified version of the block, is achieved by adding another, deeper injection in the plane between the pectoralis minor and the serratus anterior muscle. We conducted a scoping review using Arkesy and O'Malley's framework, as described by Levac. We identified our research question as the uses of the PECS regional block technique with the choice of local anesthetics, including adjuncts, and its effectiveness in intraoperative and postoperative analgesia in the first 24 hours and incidence of postoperative nausea and vomiting. Subsequently, we identified the relevant studies that met our inclusion criteria and charted the data. Lastly, we summarized and reported the results. The PECS block was used in various breast surgeries, among which radical mastectomies with/without lymph node dissection were the most common. It was found that the PECS block reduced intraoperative opioid consumption in 60% and 24-hour postoperative opioid consumption in 93.3% of the included papers. Various local anesthetics were used such as ropivacaine, bupivacaine, and levobupivacaine. Ultrasound-guided interfacial plane blocks, such as the PECS block, are a recent development in regional anesthesia that offers analgesia for patients undergoing breast surgeries. The authors conclude that PECS block can provide a decrease in intraoperative and postoperative opioid consumption, a decrease in the incidence of nausea and vomiting, and can lead to overall patient satisfaction in terms of lower pain scores compared to systemic analgesia.

Comparison of Cleaning Efficacy of Different Rotary Files in Primary Teeth-An In vitro Study.

Aim: The aim of the present study was to comparatively assess the cleansing efficiency of dissimilar rotary files in deciduous teeth. Materials and Methods: Forty-five deciduous anterior teeth that had been subjected to extraction were chosen for this research. The teeth were included if they had a minimum of 2/3rd undamaged root portions. Coronal entrée was completed using round diamond burs. All 45 samples were allocated at random to one of the following three groups: Group I: Control group in which the radicular canal was not subjected to any form of instrumentation, Group II: The radicular canal was subjected to instrumentation employing rotary ProTaper files, Group III: The radicular canal was subjected to instrumentation with rotary MTwo files. The samples were subjected to immersion in a succession of diluted ethyl alcohols to permit dehydration: With a change of solution every eight hours, the first 16 hours were spent in 70% alcohol, followed by eight hours in 80% alcohol, eight hours in 95% alcohol, and eight hours in 100% alcohol. The samples thus subjected to dehydration were cleared by immersion in methyl salicylate for six hours. Under a stereomicroscope with a 10x magnification, the root canals were examined by a person who was blinded to the groups in order to look for any traces of ink in the coronal, middle, and apical third of the canals. Results: In the control group, greater residual remains were present in the apical 3rd at 2.16 ± 0.08 followed by the coronal 3rd at 2.02 ± 0.14, and then in the middle 3rd at 1.88 ± 0.10. While using the ProTaper files, greater residual remains were present in the middle portion at 1.68 ± 0.16, followed by the coronal third at 0.94 ± 0.09, then the apical third at 0.98 ± 0.22. Greater residual remains were again noted with the MTwo files in the mid-portion at 1.44 ± 0.18, followed by the coronal part at 0.86 ± 0.10 and then the apical part at 0.82 ± 0.04. Differences among these groups were statistically significant with a P value < 0.001. Conclusion: The present study concluded that either of the file types used exhibited reasonably lower remnant score values in the apical third versus the middle/coronal thirds. Nonetheless, MTwo type files delineated superior capacity at removing debris versus the ProTaper file types at the apical level.

Evaluation of Microleakage of Stainless Steel Crowns and Pedo Jacket Crowns after Cementation With Different Luting Cements.

Aim: The present research was conducted to assess the microleakage of stainless steel crowns along with pedo jacket crowns following cementation with different luting cements. Materials and Methods: A total of 60 deciduous teeth subjected to extraction were employed in this in vitro research. These 60 specimens were randomly divided into two groups: Group I: Stainless steel crowns and Group II: Pedo Jacket crowns. Both crowns were subjected to cementation using self-cure resin-modified glass ionomer (RMGI) cement as well as by means of self-adhesive universal resin cement (RelyX luting cement). The specimens were subjected to storage in distilled water at 37°C for 24 h and were subjected to 500 thermal cycles between 5°C and 55°C using a dwell span of 30 s. Individual surfaces were assessed for the amount of dye infiltration at the boundaries by the side of the tooth-cement border beneath a stereomicroscope under 50× magnifying power. At the mesial and distal surfaces, the amount of microleakage was measured in micrometers (µm), and the mean value was computed for each sample. Results: Stainless steel crowns subject to cementation with RelyX luting cement exhibited the lowest microleakage (0.88 ± 0.78) versus self-cure RMGI cement (0.94 ± 0.78). There was no statistically significant difference found between the groups. Pedo Jacket crowns subject to cementation with RelyX luting cement exhibited the lowest microleakage (0.96. ± 0.32) while self-cure RMGI cement (1.83 ± 0.16) depicted the maximum microleakage. There was an extremely statistically noteworthy dissimilarity noted among the groups. Conclusion: The current research concluded that Pedo Jacket crowns subjected to cementation with RelyX luting cement can be regarded as an esthetically pleasing restorative alternative for numerous young patients. Applying RelyX luting cement to Pedo Jacket crowns provides a strong bolstering by composite materials that ensures the success of the therapy provided.

Evaluation of the Efficacy of Various Root Canal Irrigants on Removal of Smear Layer in Primary Teeth: A Comparative Study.

Aim: The aim of the current research was to appraise the effectiveness of different radicular canal irrigant solutions on the elimination of the smear layer in deciduous teeth. Materials and Methods: A total of 60 fit deciduous teeth that were subjected to extraction for a variety of curative reasons were employed in this research. Every sample tooth was subjected to decoronation at the CEJ employing a carborundum disk. A number 10 K-file (Dentsply Maillefer) was utilized to estimate the working length of the radicular canal using a manual technique by a sole operator in the step-back method. The specimens were allocated at random to one of the following three groups: Group 1: Irrigation using Saline, Group 2: Irrigation using 6% Citric acid, and Group 3: Irrigation using sodium hypochlorite. Following 24 h of storage, the sample teeth were subjected to vertical grooving using diamond suctioning discs beneath a high-power suction. All sections were subjected to staining using 1% methylene blue for 2 min before rinsing with 0.9% saline and allowed to bench dry. Rendering scores for the existence of a smear layer for the two halves of the split sample tooth were performed by visual inspection for the cervical, middle, plus apical one-third via a light stereomicroscope at 40× magnifying power. Results: With saline irrigation, the smear coat elimination at coronal one-third scored at 2.16 ± 0.11, 1.84 ± 0.06 at middle one-third, along with 1.92 ± 0.26 at the apical one-third. When 6% citric acid was employed as an irrigant, the scores were 0.72 ± 0.14 at coronal one-third, 0.84 ± 0.03 at middle one-third, and 0.90 ± 0.23 at apical one-third. When sodium hypochlorite was used as an irrigant, the mean score was 0.78 ± 0.12 at the coronal one-third, 0.92 ± 0.06 at the middle one-third, as well as 0.96 ± 0.18 at the apical one-third. The differences between the groups were statistically significant. Conclusion: The current in-vitro research arrived at a conclusion that 6% citric acid has the potential to eliminate smear coats in deciduous radicular canals when employed as a closing irrigant following instrumentation.

Assessment of Erosive Effect of Various Beverages on Esthetic Restorative Materials Used in Primary Teeth: An In Vitro Study.

AIM: The purpose of the current study was to evaluate the erosive impact of various beverages on the esthetic restorative materials utilized in primary teeth. MATERIALS AND METHODS: One hundred and twenty primary molars indicated for serial extraction or over-retention reason with sound buccal surfaces were collected. One millimeter above the cemento-enamel junction, standard Class V cavities were prepared. Following cavity preparation, all teeth were randomly assigned (20 samples per group for each beverage) to one of the three experimental groups based on the type of filling materials: group I: resin-modified glass ionomer cement (GC), group II: nanocomposite resin and group III nanohybrid ormocer-based composite. The samples were kept suspended in various containers containing 250 mL of each orange juice and cola at a temperature of 37°C for three hours per day and rest of day in distilled water. This procedure was repeated for 15 days. Using a 3D optical profilometer, a profilometric reading was recorded for each specimen. RESULTS: The minimum surface roughness was found in nanohybrid ormocer­based composite (1.816 ± 0.16 and 1.302 ± 0.08) followed by resin-modified glass ionomer cement (3.101 ± 0.12 and 2.946 ± 0.09) and nanocomposite resin (5.242 ± 0.20 and 4.488 ± 0.16) after immersed in the cola and orange juice, respectively. And there was a statistically significant difference found between the different esthetic restorative materials in both media. CONCLUSION: On conclusion, the current investigation demonstrates that when exposed to both beverages, the erosive effect was much lesser in nanohybrid ormocer-based composite, followed by resin-modified glass ionomer cement and nanocomposite resin. CLINICAL SIGNIFICANCE: Consuming high-calorie, low pH acidic foods and beverages such as carbonated beverages and fruit juices can lead to erosion, a frequent condition that results in irreparable damage to dental hard tissues and early deterioration of dental restorations.

Buprenorphine for acute post-surgical pain: A systematic review and meta-analysis.

Our study was designed to evaluate the efficacy of buprenorphine for the management of acute post-surgical pain reported in published studies in the years 2015-2022. Comprehensive research was performed by using online resources like PUBMED and the Wiley Library database to gather the relevant literature. Two authors were assigned to independently collect the information. Cochran's Q-test and I square statistic were used to determine the heterogeneity across the studies. Publication bias was estimated by using the Egger regression analysis and found to be significantly present once the P value <0.05. In this review, 15 studies were included. The pooled ratio of pain reduction after 12 hours of surgery was reported as 11.2% with 97% heterogeneity. Day one shows 5.9 reductions in pain with 98% heterogeneity. The 3% more pain was reduced on day 2. The day 3 pooled pain reduction score was observed as 1.9%. The overall pool prevalence of pain reduction was noted as 6.2% at different time duration with significant heterogeneity of 100%. Buprenorphine transdermal and sublingual both have significant pain relief scores. The analgesic drug consumption was reduced at the end of the follow-up duration.

Applicant Selection for Anesthesiology Residency Programs in Saudi Arabia.

Background Anesthesiology is a medical specialty that involves pre, intra, and postoperative surgical and medical procedures; it is a profession shaped by the clinician's medical knowledge and manual dexterity. To date, very few studies have addressed the selection criteria and factors associated with the applicant selection process for anesthesia residency programs in Saudi Arabia. Objectives We aimed to define the criteria, factors, and guidelines for candidate selection in anesthesia residency programs in Saudi Arabia. Methodology This was a cross-sectional study conducted using electronic questionnaires that were distributed to anesthesiology program directors in Saudi Arabia via email. The questionnaire was divided into six sections, and each section included various parameters such as demographic data, cognitive/academic activities, non-cognitive/non-academic activities, individual qualities, and red flags or negative factors of the individual. The participants rated each parameter, and the collected data were analyzed for statistical significance (p≤0.05). Results A total of 28 programs were included in this survey. All 14 parameters associated with individual qualities were found to be significantly important for applicant selection (p≤0.05). Except for delayed entry into residency after graduation, all 12 parameters associated with red flags or negative characteristics of individuals were significant for candidate selection (p≤0.05). Conclusion The results showed that academic/cognitive factors and non-academic/non-cognitive factors, along with the individual characteristics of the applicant, were given priority when selecting candidates for anesthesiology residency programs in Saudi Arabia.

The efficacy of sphenopalatine ganglion block for the treatment of postdural puncture headache among obstetric population.

Background: Postdural puncture headache (PDPH) is a common complication among parturients who had undergone obstetric neuraxial block. Epidural blood patch is the current gold standard treatment for PDPH, although it is an invasive procedure. We conducted this systematic review to assess the efficacy of sphenopalatine ganglion block (SPGB) as a noninvasive treatment of PDPH. Methods: Relevant reports were searched from Google Scholar, PubMed, Science Direct, and Scopus from the inception of the databases to November 30, 2020. A total of 10 reports found to be related to SPGB for the treatment of PDPH in the obstetric population were enrolled. Significant relief of headache with no further intervention and initial relief of headache that requires further interventions were considered as the primary outcomes. The secondary outcome was the complications after SPGB. Results: A total of 68 patients were identified. We found that 41 of 68 patients (60.3%) had effective management with significant relief of headache with no further interventions needed. Moreover, a total of 27 of 68 patients (39.7%) had initially effective management that needed further interventions. The use of 2% lidocaine was found to be the most effective among all used local anesthetics with 85.7% effective management. Furthermore, parturients who developed PDPH after spinal anesthesia responded to SPGB better than other obstetric neuraxial techniques. Conclusions: This systematic review showed that SPGB is a promising treatment modality for the management of PDPH with no reported complications. Before recommending this technique for treating PDPH, we are calling for randomized clinical trials to prove its efficacy.

Efficacy of regional anesthesia using ankle block in ankle and foot surgeries: a systematic review.

Ankle blocks are commonly used as surgical anesthetics and for postoperative analgesia during foot surgeries. It is chiefly an infiltration block which utilizes a localized anesthetic approach for providing surgical anaesthesia for a variety of foot procedures. Thus, in this systematic review, we focus primarily on the use, effectiveness, success and failures of regional ankle blocks in outpatient surgeries and hereby compare them with other anesthetic techniques and agents commonly used. Literature search was carried out using PubMed, Medline, Embase, Scopus and Cochrane Library for the studies existing till April 2021. Search was conducted by two independent reviewers separately keeping in view the structured format of the review. Data were thoroughly read and were extracted manually into a structured data extraction form. After going through the databases, 252 relevant articles were identified as per the search strategy. Among those 99 duplicate records were taken away. Among the remaining one hundred fifty-three records, one hundred thirty-eight records were excluded majorly going through their titles and abstracts. Next matching our inclusion criteria and going through the full texts, fifteen studies were excluded. Lastly, after excluding the reviews and case studies we included relevant 11 studies that compared the efficacy of ankle block in outpatient foot and ankle surgery in the present analysis. Seven studies used anatomic landmark guided (ALG) approach, three studies used ultrasound guided (USG) approach, while one study included both approaches. The results showed a significantly lower VAS score postoperatively at 24 hrs. It was observed that in general, immediately after surgery the VAS pain scores are low due to the continued analgesic effect provided by the ankle block. 0.25%-0.5% bupivacaine was the most common single long-acting local anesthetics used. Patient satisfaction ranged from 66%-95.8%. Major complications included block failure and consequent requirement of general anesthesia and few cases of transient nerve injuries. Therefore, this systematic review supports the fact that ankle block has advantages like excellent success rates with minimal side effects, high levels of patient satisfaction and decreased hospital expenses. Thus, it proves to be a safe and highly effective means of regional anesthesia for the majority of foot and ankle surgeries in outpatient settings.

Zoledronate Extends Health Span and Survival via the Mevalonate Pathway in a FOXO-dependent Manner.

Over recent decades, increased longevity has not been paralleled by extended health span, resulting in more years spent with multiple diseases in older age. As such, interventions to improve health span are urgently required. Zoledronate (Zol) is a nitrogen-containing bisphosphonate, which inhibits the farnesyl pyrophosphate synthase enzyme, central to the mevalonate pathway. It is already used clinically to prevent fractures in osteoporotic patients, who have been reported to derive unexpected and unexplained survival benefits. Using Drosophila as a model we determined the effects of Zol on life span, parameters of health span (climbing ability and intestinal dysplasia), and the ability to confer resistance to oxidative stress using a combination of genetically manipulated Drosophila strains and Western blotting. Our study shows that Zol extended life span, improved climbing activity, and reduced intestinal epithelial dysplasia and permeability with age. Mechanistic studies showed that Zol conferred resistance to oxidative stress and reduced accumulation of X-ray-induced DNA damage via inhibition of farnesyl pyrophosphate synthase. Moreover, Zol was associated with inhibition of phosphorylated AKT in the mammalian traget of rapamycin pathway downstream of the mevalonate pathway and required dFOXO for its action, both molecules associated with increased longevity. Taken together, our work indicates that Zol, a drug already widely used to prevent osteoporosis and dosed only once a year, modulates important mechanisms of aging. Its repurposing holds great promise as a treatment to improve health span.

Impact of Intraoperative Dexmedetomidine versus Remifentanil on Recovery Characteristics following Laparoscopic Sleeve Gastrectomy.

OBJECTIVE: To evaluate the impact of intraoperative dexmedetomidine versus remifentanil on postoperative pain; and enhanced recovery profile in patients scheduled for laparoscopic sleeve gastrectomy (LSG). STUDY DESIGN: Clinical observational double-blind pilot study. PLACE AND DURATION OF STUDY: King Khalid University Hospital, affiliated with King Saud University, Riyadh, Saudi Arabia, from December 2019 to March 2020. METHODOLOGY: Forty adult patients with body mass index (BMI) >35 Kg/m2 were divided into two equal groups: group dexmedetomidine (D) and group remifentanil (R). In the post-anaesthesia care unit (PACU) and for 24 hours in the ward, the patients were assessed for pain score and other recovery characteristics. RESULTS: In the PACU, the mean values of numerical rating scale (NRS) were 4.26±1.97 vs. 4.15±1.9 and morphine consumption median values were 4 vs. 1 mg in groups D and R, respectively (p >0.05). The number of patients who developed shivering were 0 vs. 6 in groups D and R, respectively (p <0.05). Sedation agitation scale (SAS) median values were 4 vs. 4 (p <0.05), postoperative nausea and vomiting (PONV) frequency was 1 vs. 6 (p >0.05) in groups D and R, respectively. The length of hospital stay (LOS) median values were 1 vs. 1 day in groups D and R, respectively (p >0.05). CONCLUSION: Better enhanced recovery profile after LSG supports the use of intraoperative infusion of dexmedetomidine as an anaesthetic adjuvant versus remifentanil. Key Words: Dexmedetomidine, Remifentanil, Enhanced recovery after surgery (ERAS); Bariatric surgery.

How does methotrexate work?

Developed over 70 years ago as an anti-folate chemotherapy agent, methotrexate (MTX) is a WHO 'essential medicine' that is now widely employed as a first-line treatment in auto-immune, inflammatory diseases such as rheumatoid arthritis (RA), psoriasis and Crone's disease. When used for these diseases patients typically take a once weekly low-dose of MTX - a therapy which provides effective inflammatory control to tens of millions of people worldwide. While undoubtedly effective, our understanding of the anti-inflammatory mechanism-of-action of low-dose MTX is incomplete. In particular, the long-held dogma that this disease-modifying anti-rheumatic drug (DMARD) acts via the folate pathway does not appear to hold up to scrutiny. Recently, MTX has been identified as an inhibitor of JAK/STAT pathway activity, a suggestion supported by many independent threads of evidence. Intriguingly, the JAK/STAT pathway is central to both the inflammatory and immune systems and is a pathway already targeted by other RA treatments. We suggest that the DMARD activity of MTX is likely to be largely mediated by its inhibition of JAK/STAT pathway signalling while many of its side effects are likely associated with the folate pathway. This insight into the mechanism-of-action of MTX opens the possibility for repurposing this low cost, safe and effective drug for the treatment of other JAK/STAT pathway-associated diseases.

Effects of Gingival Retraction Paste and Subsequent Cleaning with Hydrogen Peroxide on the Polymerization of Three Elastomeric Impression Materials: An In Vitro Study.

PURPOSE: It has been hypothesized that there are no effects of Expasyl and subsequent cleaning with hydrogen peroxide on polymerization of selected commonly used impression materials. Therefore, the aim of this study was to evaluate the effect of Expasyl paste on the polymerization of three impression materials with and without subsequent cleaning using 3% hydrogen peroxide (H2 O2 ). MATERIALS AND METHODS: Nine standardized stainless steel specimens were fabricated. One hundred and eighty impressions were made using 3 materials (60 each) as follows: group I: poly(vinyl siloxane) (PVS) (Virtual); group II: polyether (Monophase); group III: polyether (Impregum). Groups were subdivided into 3 categories: control without intervention (n = 20), pre-application of Expasyl and subsequent 1-minute washing with water and air-drying (n = 20), and pre-application of Expasyl and subsequent cleaning with 3% H2 O2 for 10 seconds (n = 20). All impressions were made by one operator using auto-mixing cartridges under standardized conditions at room temperature. Evaluation of the polymerization inhibition was blindly and independently performed by three practitioners with comparable experience using a visual scale. The observation was subjectively categorized as noninhibited or inhibited. Data were tabulated and analyzed using Fisher's exact test with significance level set at p ˂ 0.05. RESULTS: Significant differences were found between the control group and the impressions made after contamination with Expasyl (p < 0.001). Polymerization inhibition of PVS and Impregum was similar (in 85% and 90% of the specimens, respectively) when washed with water. There was a statistically significant reduction in polymerization inhibition in both upon cleaning with H2 O2 (p < 0.001); however, polymerization inhibition occurred in 100% of Monophase specimens when contaminated with Expasyl despite the washing technique used. CONCLUSIONS: Under these in vitro conditions, it can be concluded that the remnants of Expasyl on specimens caused a significant polymerization inhibition of the 3 impression materials tested. Subsequent cleaning with 3% H2 O2 significantly reduced this inhibitory effect on polymerization. Expasyl should not be used with Monophase polyether material.

Clinical characteristics and prognosis of bacteraemia during postoperative intra-abdominal infections.

BACKGROUND: Bloodstream infections of abdominal origin are usually associated with poor prognosis. We assessed the clinical and microbiological characteristics of critically ill patients admitted to the intensive care unit (ICU) for postoperative intra-abdominal infection (PIAI) and analysed the influence of bacteraemia on their outcome. METHODS: All consecutive PIAI patients admitted to the ICU between 1999 and 2014 were prospectively analysed. Bacteraemic patients (at least one positive blood culture in the 24 h preceding/following surgery) were compared with non-bacteraemic patients. Demographic characteristics, underlying disease, severity scores at the time of reoperation, microbiological results, therapeutic management, outcome, and survival were recorded. Results are expressed as median (interquartile range (IQR)) or proportions. RESULTS: Overall, 343 patients (54% male, 62 (49-73) years old) with PIAI were analysed, including 64 (19%) bacteraemic patients. Immunosuppression and cancer were more frequent in bacteraemic patients (p < 0.001 in both cases). No difference between groups was observed for the characteristics of initial surgery. Time to reoperation, site, and cause of PIAI were similar in both groups. At the time of reoperation, Sequential Organ Failure Assessment (SOFA) score was higher in bacteraemic patients (8 (6-10) versus 7 (4-10); p < 0.05). A predominance of Gram-positive (34%) and Gram-negative (47%) bacteria were recovered from blood cultures (polymicrobial bacteraemia in 9 (14%) patients and bacteraemia involving multidrug-resistant organisms in 14 (22%) patients). In multivariate analysis, risk factors for bacteraemia were immunosuppression or cancer, high SOFA score, and E. coli in peritoneal samples. Bacteraemia did not impact the management (with similar results for the adequacy of antibiotic therapy, anti-infective agents used, de-escalation or duration of therapy in both groups). Neither hospital mortality nor morbidity criteria differed between groups. Risk factors for mortality in multivariate analysis were urgent initial surgery, high Simplified Acute Physiology Score (SAPS) II score and documented antifungal therapy, but not perioperative bacteraemia. CONCLUSIONS: In this ICU population, bacteraemia did not change the overall management of patients with PIAI. Our data suggest that bacteraemic patients do not require a specific management.

Papillon-Lefèvre syndrome: a series of five cases among siblings.

BACKGROUND: Papillon-Lefèvre syndrome is a rare autosomal recessive disorder characterized by palmoplantar hyperkeratosis and aggressively progressing periodontitis leading to premature loss of deciduous and permanent dentition. The etiopathogenesis of the syndrome is relatively obscure, and immunologic, genetic, or possible bacterial etiologies have been proposed. CASE PRESENTATION: A series of five cases of Papillon-Lefèvre syndrome among the siblings in a family is presented here: a 3-year-old Arab girl, a 4-year-old Arab boy, a 11-year-old Arab boy, a 12-year-old Arab boy, and a 14-year-old Arab boy. The patients presented with severe gingival inflammation and mobility of teeth. The clinical manifestations were typical of Papillon-Lefèvre syndrome and the degree of involvement of the oral and skin conditions varied among them. CONCLUSIONS: This case series stresses the consanguinity in the family as an etiologic factor. All siblings in the family were affected with Papillon-Lefèvre syndrome which makes this a rare case. A multidisciplinary approach with the active participation of a dental surgeon, dermatologist, and pediatrician is essential for the management of cases of Papillon-Lefèvre syndrome.