Survival of composite restorations after selective or total caries removal in primary teeth and predictors of failures: A 36-months randomized controlled trial.

OBJECTIVES: The aim of this study was to assess the survival of composite restorations after selective (SCR) or total caries removal (TCR) and determine predictors of failures after 36 months. METHODS: 120 teeth with deep occlusal or occlusal-proximal carious lesions were randomly divided into control (TCR; n = 54; 69% Class II) and test (SCR; n = 66; 63% Class II) groups. Clinical evaluation was applied using the USPHS criteria, and the presence of Charlie or Delta scores at the marginal integrity were considered as a failure. RESULTS: The overall survival rate of restorations was 68% after 36 months, 81% for TCR and 57% for SCR (p = 0.004). The multivariable Cox Regression model demonstrated that restorations performed after SCR had 3.44 times greater probability of failure compared to TCR (p = 0.006). The other two predictors for failure of restorations were teeth with Class II cavities (hazard ratio = 3.3) and children with gingival bleeding over 20% (hazard ratio = 2.5). CONCLUSIONS: Performing composite restorations after SCR in primary teeth had success rate significantly lower than restorations performed after TCR. Complex cavities and worst patient´s oral hygiene were found to be predictors of failure of restorations. CLINICAL SIGNIFICANCE: Although SCR has been demonstrating high rates of pulp preservation, clinicians should consider that composite restorations fail in a higher frequency compared to TCR in primary teeth and, in some circumstances, may be preferable in terms of restoration longevity.

Invasive Fungal Disease in Renal Transplant Recipients at a Brazilian Center: Local Epidemiology Matters.

INTRODUCTION: Invasive fungal disease (IFD) is an important complication after solid organ transplantation (SOT). A marked geographic variation in the epidemiology of IFD after kidney transplantation (KT) has been suggested by the results of previous studies. Nevertheless, data from Latin American centers are scarce. OBJECTIVE: This study sought to describe the epidemiology of IFD at a Brazilian KT center. METHODS: This study was a retrospective single-center cohort study that included patients who underwent KT between 1998 and 2009 and were followed up until July 2015. Cases of simultaneous kidney-pancreas transplantation were excluded. The primary study outcome was the occurrence of proven or probable IFD. RESULTS: Among 908 KT recipients, 44 cases of IFD occurred in 42 patients (4.6%). Cryptococcus spp. infection, diagnosed in 16 cases (36.3%), was the leading cause of IFD, followed by histoplasmosis in 10 cases (22.7%) and invasive candidiasis in 10 (22.7%). Sporotrichosis, mucormycosis, invasive aspergillosis, pulmonary Cladophialophora sp. infection, trichosporonosis and Saccharomyces cerevisiae fungemia occurred in 1 recipient each (2.3%). Two additional (4.5%) cases of unspecified mold infections were identified by histopathological analysis. Most cases of IFD (67%) occurred later than 6 months after transplantation. Previous use of antilymphocyte antibodies (P = .008) and corticosteroid pulse therapy (P < .001) were more frequent among cases of IFD occurring within the first 6 months after transplantation. CONCLUSIONS: The epidemiology of IFD in this Brazilian cohort was characterized by a large predominance of late infections and a high proportion of cases of cryptococcosis and histoplasmosis. These results highlight the considerable geographic variability of IFD epidemiology after KT.

Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth.

OBJECTIVE: This randomized clinical trial aimed to compare the 24-months survival of composite restorations in primary molars after partial caries removal (PCR) and total caries removal (TCR). METHODS: Forty-eight children aged 3-8 years with at least one molar with a deep carious lesion were included (PCR; n=66; TCR; n=54). For PCR, excavation was stopped when dentine with a leathery consistency was achieved; in the TCR group, total absence of carious tissue was confirmed using a blunt-tipped probe. Pulpotomy was performed in cases of pulp exposure. Success was assessed by modified USPHS criteria with Alpha and Bravo scores recorded as success. RESULTS: Pulp exposure occurred in 1 and 15 of the teeth treated with PCR and TCR respectively (p<0.01). The restorations survival rate after 24 months was 66% (PCR) and 86% (TCR) (p=0.03). When teeth that received pulpotomy were analyzed separately, the survival rate was 92% (p=0.09). PCR performed in occlusoproximal restorations demonstrated the lowest success rate (p=0.002). PCR increases 2.90 times the probability of having a restorative failure compared to TCR (p=0.03), after adjusting for cavity type. When pulp exposure and restoration failure were considered as the outcome, there was no significant difference between the two groups (p=0.10) with success rates of 64% (PCR) and 61% (TCR). CONCLUSION: Collectively, deciduous teeth submitted to PCR prevented pulp exposure and, consequently, more invasive treatments; otherwise, PCR yielded lower longevity for composite restoration compared to TCR, suggesting that PCR restorations need to be followed over time, especially when multi-surface restorations are involved. CLINICAL SIGNIFICANCE: Composite restorations on carious remaining tissue require monitoring over time, especially those performed in more than one surface. Even if the restorations present shortcomings over the time, the majority of them are subject to repair, allowing more conservative approaches for teeth with deep caries lesions.

Assessment of biochemical and hematological parameters in rats injected with Tityus serrulatus scorpion venom.

The aim of this work was to evaluate the hematological changes induced by Tityus serrulatus venom (TsV). Blood of Wistar rats was collected 0.5, 2, 6 and 24 h after i.p. injection of TsV (0.5 mg/kg) or saline (controls). Two additional groups were injected with 0.67 mg/kg and 0.25 mg/kg of TsV and the blood was collected after 0.5 and 2 h, respectively. The results showed an increase on hematocrit (Ht), red blood cells (RBC) count, hemoglobin concentration (Hb), albumin and total protein, mainly 2-6 h after envenoming. Increase in serum activities of amylase, creatine kinase and aspartate aminotransferase were also observed, indicating tecidual damages. Hyperglycemia was observed at all times analyzed, as a consequence of catecholamine release. No significant changes were detected in the urea, [Na(+)] and [Ca(2+)], but an increase of [Mg(2+)], [K(+)] and conductivity was observed. TsV induced a reduction of erythrocytes osmotic fragility as consequence of dehydration and increase in plasma electrolytes concentration, as evidenced by its higher conductivity. This study demonstrated that TsV is able to induce severe hematological changes, that appear within the first hours after envenoming, justifying the seeking of medical attention as soon as possible to avoid worsening of clinical symptoms.

Solvent action of sodium hypochlorite on bovine pulp and physico-chemical properties of resulting liquid.

The solvent effect of 4 concentrations of sodium hypochlorite (0.5, 1.0, 2.5, and 5.0%) on bovine pulp tissue and the level of residual chlorine, pH and surface tension before and after dissolution were studied in vitro. A fragment of bovine pulp was submersed in sodium hypochlorite that circulated in an apparatus with a peristaltic pump and Luer Lok syringe. The higher the concentration of sodium hypochlorite the faster the dissolution of the pulp tissue. All concentrations of sodium hypochlorite reduced the pH and the surface tension and the higher concentrations of the solution had the least consumption of chlorine during tissue dissolution. Thus this study indicated that residual chlorine was directly proportional to concentration in the process of pulp tissue dissolution and that there was residual chlorine at all concentrations used.

Site I on human albumin: differences in the binding of (R)- and (S)-warfarin.

The binding of drugs known to interact with area I on human serum albumin (HSA) was investigated using a chiral stationary phase obtained by anchoring HSA to a silica matrix. In particular, this high-pressure affinity chromatography selector was employed to study the binding properties of the individual enantiomers of warfarin. The pH and composition of the mobile phase modulate the enantioselective binding of warfarin. Displacement chromatography experiments evidenced significant differences in the binding of the warfarin enantiomers to site I. The (S)-enantiomer was shown to be a direct competitor for (R)-warfarin, while (R)-warfarin was an indirect competitor for the (S)-enantiomer. Salicylate directly competed with (R)-warfarin and indirectly with (S)-warfarin. This behavior was confirmed by difference CD experiments, carried out with the same [HSA]/[drug] system in solution.

Effect of different grades of gum rosins and hydrogenated resins on the solubility, disintegration, and dimensional alterations of Grossman cement.

In the present study, we investigated the effect of the addition of different grades of gum rosins and hydrogenated resins to Grossman cement on dimensional stability, solubility and disintegration. pH and conductivity, which may affect these properties, were also determined. The experiments were performed according to Specification 57 of the American Dental Association for root canal cements using Grossman cements containing three gum rosins (grades X, WW, and WG) and two hydrogenated resins (Staybelite and Staybelite ester 10). The results showed that the solubility, disintegration, and dimensional stability of Grossman cement containing Staybelite and Staybelite ester 10 were inferior to the values considered acceptable by the American Dental Association Specification 57.

The influence of different grades of rosins and hydrogenated resins on the powder-liquid ratio of Grossman cements.

In this study, the effect of different grades of rosin and hydrogenated resin on the setting time of Grossman cement was evaluated. The experiments were carried following the American Dental Association Specification number 57 for root canal sealers. For this analysis, different Grossman cement powders were prepared using different grades of rosin (X,WW and WG) and hydrogenated resin (Staybelite and Staybelite ester 10). The pH and electrical conductance of the different grades of rosin and hydrogenated resin were evaluated. The physicochemical properties of the Grossman cements obtained with the different grades of rosin and hydrogenated resins interfere in the powder-liquid ratio of the cements. The sealers obtained with the hydrogenated resin showed a higher powder-liquid ratio.

Calcium hydroxide root canal sealers: evaluation of pH, calcium ion concentration and conductivity.

The calcium hydroxide ionization of four root canal sealers (Sealapex, CRCS, Sealer 26, and Apexit) was studied by measuring conductivity and pH and by conducting atomic absorption spectrophotometry. Samples 6 mm in diameter and 15 mm long were prepared from these sealers. After setting and 48 h storage in a desiccator, five samples of each material were placed in 50 mL distilled water and analysed after 0,1,2,4,6 and 24 h and 5, 15 and 30 days. The results showed that Sealapex was the root canal sealer showing the highest pH, ionic calcium and total calcium values (P < 0.05) throughout the experimental period, followed by CRCS, Apexit and Sealer 26.

Surface tension of several drugs used in endodontics.

Surface tension of various drugs used in endodontic therapy was studied by the capillary method. Drugs of the phenol group--eugenol, paramonochlorophenol, tricresol-formalin and phenol--presented very low surface tension. The association of a detergent to the solution of calcium hydroxide reduced its surface tension by half.