Intentional replantation and dental autotransplantation of mandibular posterior teeth: Two case reports.

BACKGROUND: Intentional replantation and dental autotransplantation are 2 similar techniques both involving atraumatic tooth extraction, visualization of the root, and replantation. They are considered as the last resort for unsalvageable teeth. The author aims to describe 2 mandibular posterior teeth with serious periapical lesions which are resolved by intentional replantation and dental autotransplantation, respectively. CASE SUMMARY: In case 1, a 45-year-old male patient received root canal treatment because of a cracked mandible right first molar with periapical lesions. An endodontic file was separated in the apical third of the mesiolingual root canal. After conventional canal filling of the other root canals, the molar was atraumatically extracted. The separated instrument was removed, the mesiolingual root received a retrograde filling and the molar was replanted. At the 3-month follow up, the patient was asymptomatic and the X-ray picture showed no detectable root resorption and ankylosis. In case 2, a 29-year-old woman reported discomfort during occlusal loading after a root canal treatment and a coronal restoration of the mandibular right first molar. Radiographs showed a low-density shadow in the mesial apical and in the root furcation area of the mandibular first molar so the patient was diagnosed as chronic periapical periodontitis. After the removal of the affected tooth, the extraction socket was thoroughly debrided and irrigated. The intact mandibular right third molar with similar dimensions was extracted by minimally invasive procedure and transplanted. The donor tooth was fixed by a fiber-splint for 1 month and a root canal treatment was performed 2 weeks after surgery. After 1 year, clinical and radiographical examination revealed functional and periodontal healing. CONCLUSIONS: These 2 reports present the successful management of intentional replantation and dental autotransplantation. Both procedures are recommended after nonsurgical endodontic treatment, especially when apical microsurgery is not an option, for example because of difficult accessibility or patient preference.

The Bacterial Oral Microbiome in Children with Congenital Heart Disease: An Extensive Review.

Children with congenital heart disease have poorer oral health compared with healthy children. Oral diseases, such as dental caries and gingivitis, are associated with the oral microbiome. The objective of this review was to find evidence of differences in the bacterial colonization of the oral cavity of children with congenital heart disease (CHD) versus healthy children. A literature review was conducted according to predetermined criteria, including the need for controlled clinical trials. Half of the 14 studies that met the inclusion criteria reported significant differences in bacterial colonization in children with congenital heart disease. A variety of influencing factors were discussed. There is some evidence for alterations in the oral microflora as a result of physiopathological and treatment-related factors in children with CHD, but additional research is required to validate these findings.

Marginal Quality and Wear of Bulk-fill Materials for Class-II Restorations in Primary Molars.

PURPOSE: The aim of this in-vitro study was to evaluate the marginal integrity and wear of eight bulk-fill materials in comparison to a compomer in Class-II cavities in primary molars after thermomechanical loading (TML). MATERIALS AND METHODS: Prepared Class-II cavities in 72 extracted primary molars were filled with eight bulk-fill materials. A compomer served as the control group. After water storage (incubator, 28 days, 37°C), samples were subjected to TML (2500 thermal cycles 5°C/55°C; 100,000 load cycles, 50 N, 1.67 Hz). Before and after TML, replicas were made which were used for both SEM analysis of marginal integrity and 3-D wear analysis. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon tests (p < 0.05). RESULTS: A significant reduction in perfect margins was observed for all groups, while marginal gap formation increased (Wilcoxon test, p < 0.02) for all groups but the compomer. Significant interindividual differences were observed between the tested materials regarding marginal integrity (Kruskal-Wallis test, p < 0.05). Wear analysis revealed no significant differences between groups (Kruskal-Wallis test, p > 0.05). CONCLUSION: Some of the bulk-fill materials investigated here achieved better results than the compomer and should be further evaluated clinically.

Systematic application of multiplex PCR enhances the detection of bacteria, parasites, and viruses in stool samples.

OBJECTIVES: To determine whether systematic testing of faecal samples with a broad range multiplex PCR increases the diagnostic yield in patients with diarrhoea compared with conventional methods and a clinician initiated testing strategy. METHODS: 1758 faecal samples from 1516 patients with diarrhoea submitted to two diagnostic laboratories were tested for viral, bacterial, and parasitic pathogens by Fast-Track Diagnostics multiplex real-time PCR kits and conventional diagnostic tests. RESULTS: Multiplex PCR detected pathogens in 530 samples (30%): adenovirus (51, 3%), astrovirus (95, 5%), norovirus (172, 10%), rotavirus (3, 0.2%), Campylobacter jejuni/coli (85, 5%), Salmonella spp. (22, 1%), Clostridium difficile (72, 4%), entero-haemorrhagic Escherichia coli (21, 1%), Cryptosporidium spp. (3, 0.2%), Entamoeba histolytica (1, 0.1%), and Giardia lamblia (59, 3%). In contrast, conventional testing detected a pathogen in 324 (18%) samples. CONCLUSIONS: Using a systematic approach to the diagnosis of gastroenteritis improved diagnostic yield. This enhanced detection with PCR was achieved by a combination of improved detection of individual pathogens and detection of pathogens not requested or unable to be tested by conventional tests. This approach also allowed earlier identification for most pathogens and created a workflow which is likely to adapt well for many diagnostic laboratories.

Two case examples of pelvic fractures in medieval populations from central Europe.

Pelvic fractures are considered to be uncommon and difficult to treat, even in the modern medical literature. Serious and eventually life-threatening associated injuries may occur, requiring emergency abdominal, vascular or neurologic surgery. Pelvic fractures can also be managed non-operatively; however, a considerable dispute exists on the suitable management strategy. The treatment and healing of such injuries in the bioarchaeological record, is therefore of great interest for anthropological and medico-historical studies. Fractures of the pelvis are rarely reported in the anthropological literature either due to poor preservation of the innominate bone or lack of adequate examination. Here we present two cases of pelvic fractures observed on two adult male individuals from two European medieval sites. They differ in severity and in the pattern of healing. They are both adequately healed and probably had no acute life-threatening consequences, which gives us some insight into the medical knowledge and means of management of past populations.

Preservation of cell structures in a medieval infant brain: a paleohistological, paleogenetic, radiological and physico-chemical study.

Cerebral tissues from archaeological human remains are extremely rare findings. Hereby, we report a multidisciplinary study of a unique case of a left cerebral hemisphere from a 13th century AD child, found in north-western France. The cerebral tissue-reduced by ca. 80% of its original weight-had been fixed in formalin since its discovery. However, it fully retained its gross anatomical characteristics such as sulci, and gyri; the frontal, temporal and occipital lobe as well as grey and white matter could be readily recognised. Neuronal remains near the hippocampus area and Nissl bodies from the motor cortex area were observed (Nissl, Klüver-Barrera staining). Also, computed tomography (CT) and magnetic resonance imaging (T1, proton density, ultra short echo time sequences) were feasible. They produced high quality morpho-diagnostic images. Both histological and radiological examinations could not confirm the pathologist's previously suggested diagnosis of cerebral haemorrhage as the cause of death. Reproducible cloned mtDNA sequences were recovered from the skeleton but not from the brain itself. This was most likely due to the combined effect of formaldehyde driven DNA-DNA and/or DNA-protein cross-linking, plus hydrolytic fragmentation of the DNA. The chemical profile of the brain tissue, from gas-chromatography/mass-spectroscopy analysis, suggested adipocerous formation as the main aetiology of the mummification process. The hereby presented child brain is a unique paleo-case of well-preserved neuronal cellular tissue, which is a conditio sine qua non for any subsequent study addressing wider perspectives in neuroscience research, such as the evolution of brain morphology and pathology.

Paleopathologies of the vertebral column in medieval skeletons.

Paleopathological data provide valuable information about health, longevity and mortality in earlier human populations. We investigated the incidence of spinal pathologies on 54 individuals (1045 vertebrae and 18 sacral bones) that belong to a medieval skeletal series discovered in the Dalheim monastery (Northwest Germany) and compared them with contemporary and recent populations. The skeletons were analyzed with anthropological methods (sex and age determination), by macroscopic inspection, and, if pathologies of the spine and the sacrum were visible, also by X-ray. We investigated evidence of trauma, specific and nonspecific infectious diseases, joint diseases, tumors, and congenital as well as metabolic disorders. Radiocarbon determination of four samples of different specimens was also undertaken revealing a historic dating of ca. 1050 AD. The most common pathological findings were degenerative changes of the spine found in 29 individuals (53.3%). Examples of infections of the spine were rare (0.8% of all vertebrae). There were no cases of traumatic injuries of the spine. The prevalence of spondylosis deformans, the most commonly found type of pathology was found to be higher in the lumbar region, in males as well as in individuals of low stature.

Radiographic evaluation of neonatal skeletal development in Callimico goeldii reveals closer similarity to Callithrix jacchus than to Saguinus oedipus.

The phylogenetic affinities of the neotropical Goeldi's monkey (Callimico goeldii) have long been a matter of debate. Whereas most morphological evidence appears to place Callimico in a sister group position relative to the Callitrichidae, genetic studies place C. goeldii within the Callitrichidae and suggest that it is more closely related to marmosets than to tamarins. The present study presents the first radiographic analysis comparing the secondary limb bone ossification of newborn C. goeldii with representatives of the marmosets (Callithrix jacchus) and tamarins (Saguinus oedipus). The state of secondary ossification of the epiphysis and short bones is classified into three different ontogenetic stages. Our results reveal that in terms of the number of ossification centers, C. goeldii is significantly closer to C. jacchus than to S. oedipus. This is the first morphological study to support the findings of molecular studies, and the results suggest that C. goeldii is more closely related to marmosets than to tamarins.