Keratocystic Odontogenic Tumour of the Mandible: a case report of decompression with a customised removable tube and review of literature.

Keratocystic odontogenic tumour (KOT or KCOT) is defined by the WHO to be 'a benign uni- or multicystic, intraosseous tumour of odontogenic origin'. In 2005, the World Health Organization renamed the lesion; previously known as an odontogenic keratocyst (OKC) as the KCOT. WHO recommends the term KCOT as it reflects its neoplastic nature. In this case report, a 21-year-old female with a histologically proven large parakeratinised KCOT of the right mandible underwent treatment that involved a 14-month period of decompression, followed by enucleation (with Carnoys application) of the residual cyst. During the period of decompression, a custom made removable mandibular chrome-cobalt appliance was used to hold the decompression tube in the oral cavity.

In vitro wear of new indirect resin composites.

This in vitro study evaluated the toothbrush abrasion wear, three-body Alabama wear and two-body pin-on-disc wear of four commercial indirect resin composites. Enamel shades of Radica (R), Sculpture Plus (S), Belleglass-NG (B) and Gradia Indirect (G) were used. For measuring wear due to toothbrush abrasion, six specimens of each group were fabricated, then brushed in a toothbrush abrasion machine for 20,000 cycles. Material loss was determined by weighing and conversion to volume loss. Three-body wear was measured on six samples for each group using an Alabama-type wear testing machine for 400,000 cycles. Wear depth was measured with a contact profilometer. For two-body wear, five disc specimens were prepared and tested in a two-body wear-testing machine against hydroxypatite sliders for 25,000 cycles. Data were analyzed with one-way analysis of variance (ANOVA) and Tukey test (alpha=0.05). Wear was the highest in Sculpture Plus by all three methods tested and the lowest wear was observed in Belleglass-NG. No statistical difference in wear was noted from Radica.

Mixed impact of Xpert(®) MTB/RIF on tuberculosis diagnosis in Cambodia.

SETTING: National Tuberculosis (TB) Program sites in northwest Cambodia. OBJECTIVE: To evaluate the impact of Xpert(®) MTB/RIF at point of care (POC) as compared to non-POC sites on the diagnostic evaluation of people living with the human immunodeficiency virus (PLHIV) with TB symptoms and patients with possible multidrug-resistant (MDR) TB. DESIGN: Observational cohort of patients undergoing routine diagnostic evaluation for TB following the rollout of Xpert. RESULTS: Between October 2011 and June 2013, 431 of 822 (52%) PLHIV with TB symptoms and 240/493 (49%) patients with possible MDR-TB underwent Xpert. Xpert was more likely to be performed when available as POC. A smaller proportion of PLHIV at POC sites were diagnosed with TB than at non-POC sites; however, at POC sites, a higher proportion of those diagnosed with TB were bacteriologically positive. There was poor agreement between Xpert and other tests such as smear microscopy and culture. Overall, the evaluation of patients with possible MDR-TB increased following Xpert rollout, yet for patients confirmed as having drug resistance on drug susceptibility testing, only 46% had rifampin resistance that would be identified with Xpert. CONCLUSION: Although utilization of Xpert was low, it may have contributed to an increase in evaluations for possible MDR-TB and a decline in empiric treatment for PLHIV when available as POC.

Contexte : Sites du Programme National contre la Tuberculose (TB) dans le nord-ouest du Cambodge.Objectif : Evaluer l'impact du Xpert® MTB/RIF dans des sites où il est réalisé sur place (POC) comparés aux autres sites sur le diagnostic des personnes vivant avec le VIH (PVVIH) et ayant des symptômes de TB ainsi que des patients présumées de TB multirésistante (MDR).Schéma : Cohorte d'observation de patients bénéficiant d'une évaluation diagnostique de routine pour la TB après le lancement de l'Xpert.Résultats : Entre octobre 2011 et juin 2013, 431/822 (52%) PVVIH ayant des symptômes de TB et 240/493 (49%) patients avec suspicion de TB-MDR ont eu un test Xpert. L'Xpert a été réalisé plus souvent lorsqu'il était disponible en POC. Une plus faible proportion de PVVIH a eu un diagnostic de TB dans les sites POC que dans les sites non-POC ; cependant, dans les sites POC, une proportion plus élevée des patients ayant eu un diagnostic de TB a eu une bactériologie positive. L'accord entre l'Xpert et les autres tests (par exemple la microscopie de frottis ou la culture) a été médiocre. Dans l'ensemble, l'évaluation des patients présumées de TB-MDR a augmenté après le lancement de l'Xpert, mais parmi les patients ayant eu une pharmacorésistance confirmée par test de pharmacosensibilité, seulement 46% ont eu une résistance à la rifampicine qui aurait été identifiée par Xpert.Conclusion : Même si l'utilisation de l'Xpert a été faible, l'Xpert pourrait avoir contribué à une augmentation de l'évaluation des suspicions de TB-MDR et à un déclin du traitement empirique des PVVIH quand il est disponible sur place.

Marco de referencia: Los centros del Programa Nacional contra la Tuberculosis en el noroeste de Camboya.Objetivo: Evaluar la repercusión de la práctica de la prueba Xpert® MTB/RIF en el lugar de la consulta, en comparación con la realización de la prueba en otro centro, sobre la evaluación diagnóstica de las personas aquejadas de infección por el virus de la inmunodeficiencia humana (PVVIH) que presentan síntomas de tuberculosis (TB) y de los pacientes con presunción de TB multidrogorresistente (TB-MDR).Método: Fue este un estudio observacional de cohortes de pacientes en curso de evaluación diagnóstica corriente de la TB, después de la introducción de la prueba Xpert.Resultados: De octubre del 2011 a junio del 2013 se practicó la prueba Xpert a 431 de los 822 PVVIH que presentaban síntomas de TB (52%) y a 240 de los 493 pacientes con presunción de TB-MDR (49%). La probabilidad de realizar la prueba Xpert fue mayor cuando esta se podía practicar en el lugar de la consulta. La proporción de PVVIH en quienes se diagnosticó TB en los centros que practicaban localmente la prueba Xpert fue menor que en los demás centros; sin embargo, en los centros que contaban con la prueba fue más alta la proporción de casos de TB confirmados bacteriológicamente. Se observó una baja concordancia entre los resultados de la prueba Xpert y las otras pruebas (la baciloscopia y el cultivo). En general, tras el despliegue de la prueba molecular se investigó un mayor número de pacientes con presunción de TB-MDR; sin embargo, de los pacientes en quienes se confirmó la farmacorresistencia mediante pruebas de sensibilidad solo un 46% presentaba resistencia a rifampicina, que podía detectar la prueba Xpert.Conclusión: Si bien la utilización de la prueba Xpert fue muy limitada, su disponibilidad contribuyó a la investigación de más casos con presunción de TB-MDR y a una disminución del tratamiento empírico de las PPVIH, cuando la prueba Xpert se practicaba en el lugar de la consulta.

Curing of pit & fissure sealants using Light Emitting Diode curing units.

Light Emitting Diode (LED) curing units are attractive to clinicians, because most are cordless and should create less heat within tooth structure. However, questions about polymerization efficacy have surrounded this technology. This research evaluated the adequacy of the depth of cure of pit & fissure sealants provided by LED curing units. Optilux (OP) and Elipar Highlight (HL) high intensity halogen and Astralis 5 (A5) conventional halogen lights were used for comparison. The Light Emitting Diode (LED) curing units were Allegro (AL), LE Demetron I (DM), FreeLight (FL), UltraLume 2(UL), UltraLume 5 (UL5) and VersaLux (VX). Sealants used in the study were UltraSeal XT plus Clear (Uclr), Opaque (Uopq) and Teethmate F-1 Natural (Kclr) and Opaque (Kopq). Specimens were fabricated in a brass mold (2 mm thick x 6 mm diameter) and placed between two glass slides (n=5). Each specimen was cured from the top surface only. One hour after curing, four Knoop Hardness readings were made for each top and bottom surface at least 1 mm from the edge. The bottom to top (B/T) KHN ratio was calculated. Groups were fabricated with 20 and 40-second exposure times. In addition, a group using a 1 mm-thick mold was fabricated using an exposure time of 20 seconds. Differences between lights for each material at each testing condition were determined using one-way ANOVA and Student-Newman-Keuls Post-hoc test (alpha=0.05). There was no statistical difference between light curing units for Uclr cured in a 1-mm thickness for 20 seconds or cured in a 2 mm-thickness for 40 seconds. All other materials and conditions showed differences between light curing units. Both opaque materials showed significant variations in B/T KHN ratios dependent upon the light-curing unit.

Epidemiology of drug-resistant tuberculosis among children and adolescents in South Africa, 2005-2010.

OBJECTIVE: To describe the demographic and clinical characteristics of children and adolescents diagnosed with resistance to any anti-tuberculosis drug (drug-resistant tuberculosis; DR-TB) in South Africa. DESIGN: We retrospectively reviewed medical records of all children (<13 years) and adolescents (13 to <18 years) with DR-TB at specialty hospitals in four South African provinces from 2005 to 2010. RESULTS: During the review period, 774 children and adolescents (median age 11.3 years) were diagnosed with DR-TB at selected facilities. A high proportion of patients had a history of previous TB treatment (285/631; 45.2%), human immunodeficiency virus (HIV) infection (375/685; 54.7%), contact with a TB case (347/454; 76.4%), and smear-positive (443/729; 60.8%), cavitary (253/680, 38.7%) disease. Eighty-two per cent of patients with HIV infection received antiretroviral therapy. Of 626 patients diagnosed with multidrug-resistant TB (MDR-TB), 561 (89.6%) received a regimen consistent with national guidelines; the median length of treatment was 22 months (IQR 16-25). Among 400 patients with any DR-TB and a known outcome, 20.3% died during treatment. CONCLUSION: Pediatric DR-TB in these provinces is characterized by complex clinical features at diagnosis, with one in five children dying during treatment. History of previous treatment and contact with a TB patient indicate opportunities for earlier diagnosis and treatment to improve outcomes.

Microhardness and anisotropy of the vital osseous interface and endosseous implant supporting bone.

Limited information is available on the mechanical properties of the rapidly remodeling bone that surrounds endosseous implants. Fifteen implant-bone blocks were obtained from the mid-femoral diaphyses of three mature male hounds 12 weeks after placement of the implants. To evaluate the microhardness and cortical anisotropy of bone, the implants were sectioned along their long axes. In this process, the femurs were sectioned transversely. Knoop microhardness measurements (HK) were made with a 50 g force on cortical bone and a 25 g force on periosteal callus, endocortical callus, and circumferential lamellar bone. The long diagonal of the indenter was placed parallel to the implant (in the radial bone direction). Measurements were made in cortical bone at 200, 400, 600, 800, 1,000, 1,500, 2,000, and 2,500 microm from both sides of the implant. To detect cortical anisotropy in the radial compared with the tangential direction, a second set of indentations was made perpendicular to the first. Microhardness of periosteal callus and endocortical callus and anisotropy of circumferential lamellar bone near the endocortical surfaces of the femur were also evaluated. Repeated measures analysis of variance showed significantly (p < 0.05) lower microhardness values (30.6 +/- 0.8 HK [mean +/- SEM]) for cortical bone at 200 microm than at any other location (range: 40.3-46.6 HK). Microhardness anisotropy was not detected in cortical bone. Furthermore, within 200 microm of the implant surface, the Knoop microhardness values were significantly lower for periosteal and endocortical calluses than for cortical bone. These data provide information about the mechanical properties of bone adjacent to endosseous implants at a microstructural level. The results are consistent with the high rate of remodeling seen adjacent to endosseous implants at 12 weeks after implantation.

Luminescence spectra of dental porcelains.

The luminescence spectra were obtained for a series of porcelain teeth and powders currently used in this country. Comparison was made between the spectra of these materials and the spectra of plastic teeth and natural tooth structures. It was found that many of the porcelain teeth and powders have strikingly different luminescence characteristics than those of natural teeth.

Rheology of luting cements.

A rheometer has been developed to simulate the extrusion of luting cement from beneath a full crown during seating using clinically realistic shear rates. Five luting cements were studied, and differences in rheological behavior were illustrated. These measurements demonstrate the importance of consideration of the effects of shear rate on viscosity when evaluating a cement for optimal clinical utilization.

Properties of microfilled composite resins as influenced by filler content.

Two series of composite resins were prepared with a light-cured urethane dimethacrylate matrix to which varying amounts of two types of silanated silica particles were added. One series contained volume fractions ranging from 15.8 to 28.8% silica particles of 20 nm in diameter (Type I filler) and the other series volume fractions of from 24 to 49.4% of an agglomerated silica particle of 40 nm in diameter (Type II filler). Tests were conducted to determine the effect of filler level on: depth of cure as determined by hardness measurements; color stability in both UV light and water; water sorption with time; hardness; compressive strength; strain behavior in slow compression; and resistance to toothbrush abrasion and wear by hydroxyapatite. Analysis of the data obtained for these two microfilled series indicate that increased filler levels result in trends for increased depth of cure, color stability, hardness, compressive strength, and stiffness, while water sorption and resistance to both toothbrush abrasion and wear by hydroxyapatite were reduced. These trends were more pronounced for the Type II filler series than for the Type I filler series. However, there was a greater differential in filler levels within the Type II series than within the Type I series.

Use of the Munsell system to compute color differences in composite resins.

Color changes resulting from immersion of four composite resins in hot distilled water, coffee and tea were measured by a tristimulus colorimeter. Changes are shown as CIE deltaE values and converted to Munsell deltaH, deltaV and deltaC values.

Effect of filler content and size on properties of composites.

Two series of dental composites, along with the unfilled resin matrix, were examined to determine the effects of filler level and size on selected properties. Both series were prepared by incorporating a silanated barium borosilicate filler into a visible-light-activated polyphenylene polymethacrylate resin matrix. One series had a filler particle size of 2 microns, with filler levels of 20, 40, 45, 50, and 53% (vol). The second series contained a 15-microns filler in amounts of 20, 40, 50, 60, and 65% (vol). Tests conducted included: depth of cure as evaluated by hardness, water sorption, compressive strength, stress-strain behavior under slow compression, toothbrush abrasion, and wear by hydroxyapatite. Analysis of the data indicated that increased filler levels resulted in increased hardness, compressive strength and stiffness, and decreased water sorption. Also, there was a slight trend toward improved depth of cure. Incorporation of the 2-microns filler decreased the abrasion resistance of the resins to toothbrushing as compared with the unfilled resin, while addition of the 15-microns filler improved resistance. All filled resins exhibited a significant improvement in resistance to wear by hydroxyapatite as compared with the unfilled resin. There was a trend for increased wear with increased filler level. The particle size of the filler appeared to have a moderate influence on the properties. When compared with 15-microns filled resins of the same filler levels, the 2-micron filled series appeared to have inferior properties in terms of depth of cure, compressive strength, water sorption, and resistance to toothbrush abrasion. Properties which were less affected by particle size were hardness, stiffness, and wear resistance to hydroxyapatite.

Computerized prediction of optical density for diagnostic radiology.

A computer program was formulated and verified experimentally to predict the optical density on an image receptor for any given set of radiographic variables including tube kilovoltage, milliamperage, and wave form; x-ray beam filtration; nature of filters and absorbers, and type of x-ray film.

Evaluation of an apatite cement as a root end filling material.

A self-setting apatite cement, EBA cement, and amalgam with varnish were tested for root end sealing ability using a fluid filtration and dye technique. Single-rooted human teeth were prepared in vitro to receive root end fillings. Experimental groups were amalgam with two layers of varnish, EBA cement with dry cavity, EBA cement within a wet cavity, apatite cement within a dry cavity, and apatite cement within a wet cavity. Fluid filtration measurements were made at 6, 24, and 7 days, and 1 and 3 months. Each specimen was also subjected to a dye leakage test using Procion Green dye at 3 months. Results indicated that apatite cement provided a comparable seal to amalgam and EBA cement. This finding, in conjunction with its excellent biocompatibility, suggests that apatite cement is an acceptable alternative to present-day root end filling materials.

An in vitro study of apical extrusion of sodium hypochlorite during endodontic canal preparation.

One hundred fifty-three single rooted teeth were divided into four groups. Canals were cleaned and shaped using the balanced forces technique. In one group of 50 teeth, irrigation was delivered with the irrigation needle deep within the root canal. In the other group of 51 teeth, the needle was placed passively in the coronal access cavity and the irrigation carried into the root canal during filing. The remaining 52 teeth in the control groups were treated in the same manner using distilled water as the irrigation solution. The concentration of sodium extruded apically was measured by means of atomic emission spectrophotometry, and the volume of sodium hypochlorite extruded was calculated. Significantly more sodium hypochlorite was extruded apically during deep delivery of the irrigation (p<0.05). It is concluded that the use of a reservoir of irrigation in the coronal access cavity results in significantly less apical extrusion of irrigation solution than with deep delivery.

Anodic polarization behavior and microstructure of a gallium-based alloy.

A gallium-based alloy (GA) that was developed as a substitute for dental amalgam was investigated for anodic polarization behavior in deoxygenated Ringers solution, 37 degrees C. The related microstructures were examined and microanalyses were conducted. Four polarization tests were conducted by scanning from -300mV to +1,000 mV (vs. SCE) at 2 mV/s. Polarization of the first sample (GA-1) was stopped after the first anodic dissolution peak (-100 mV, 1.5-2.0 x 10(-3) A/cm2). The fourth sample (GA-4) was interrupted at the secondary peak (+1000 mV, 0.3 A/cm2). It was found that (1) the early stage of the first peak is related to selective dissolution of divalent tin ions, followed by a dissolution of Ga. Transmission electron diffraction (TED) identified the brown corrosion product as Ga2O3; (2) the GA-4 sample was covered with the white corrosion product of mainly Sn+4, identified as SnO2. In addition, the current density of the GA sample when coupled with a high-copper dental amalgam was 0.03 A/cm2 (with +1,000 mV) at the second peak which was about a ten times lower value than for the uncoupled sample; (3) the uncoupled gallium alloy and gallium alloy coupled with a high-copper dental amalgam showed 10(3)-10(4) times higher anodic current density than that of an uncoupled high-copper dental amalgam, suggesting that the gallium alloy is more corrosion prone.

Correlation of bond strength with surface roughness using a new roughness measurement technique.

OBJECTIVES: The correlation between shear bond strength and surface roughness was investigated using new surface measurement methods. METHODS: Bonding agents and associated resin composites were applied to set amalgam after mechanically roughening its surface. Surface treatments were noe (as set against glass), 80 grit, and 600 grit abrasive paper. Surface roughness (R(a) as measured parallel and perpendicular (+) to the direction of the polishing scratches and true profile length were measured. A knife-edge was applied (rate = 2.54 mm/min) at the bonding agent/amalgam interface of each sample until failure. RESULTS: Coefficients of determination for mean bond strength vs either roughness (R(a), of profile length were significantly higher for measurements in parallel directions than for those measurements in (+) directions. The shear bond strength to set amalgam for a PENTA-containing adhesives system (L.D. Caulk Division) was not significantly different from that of a PENTA-free adhesive (3M Dental Products Division), even though PENTA has been reported to increase bond strength to nonprecious metals. SIGNIFICANCE: The shear bond strength of resin composite to amalgam is correlated to surface roughness when it is measured parallel to the polishing scratches. This correlation is significantly lower when surface roughness is measured in the typical manner, perpendicular to the polishing scratches.

Analysis of the dentin-resin interface by use of laser Raman spectroscopy.

OBJECTIVES: Adhesion of resin-bonding agents to dentin is currently believed to result from impregnation of adhesive resin into superficially demineralized dentin. The purpose of this study was to investigate the chemical composition of the resin-impregnated dentin (hybrid) layer using a micro-Raman spectroscopy. METHODS: Resin composites were bonded to bovine dentin with the two-step bonding systems, and specimens were sectioned parallel to dentinal tubules. These surfaces were then polished down to 1 microm diamond pastes. Raman spectra were successively recorded along a line perpendicular to the dentin-adhesive interface by steps of 0.2 microm on a computer controlled X-Y stage. The relative amounts of hydroxyapatite (960 cm(-1), P-O), adhesive resin (640 cm(-1), aromatic ring), and organic substrate (1450 cm(-1), C-H) in the dentin-adhesive bonding area were calculated. RESULTS: From the Raman spectroscopy results, the hybrid layer represents a gradual transition in the relative amount of adhesive from the resin side to dentin side. Evidence of poor saturation of the adhesive resin in the demineralized dentin with the one-bottle adhesive system was detected. SIGNIFICANCE: From the results of this study, inhomogeneity of the hybrid layer composition was detected, and the degree of resin impregnation was found to be different between the bonding systems tested.

Effect of light exposure on fracture toughness and flexural strength of light-cured composites.

OBJECTIVES: This study was conducted to investigate the curing characteristics of light-cured composites and their related mechanical properties. METHODS: Single-edge notch specimens [25 mm x 2.5 mm x 5 mm with a 5 mm notch (a/W = 0.5)] were prepared for fracture toughness measurements. For flexural strength testing, a stainless steel mold (25 mm x 2 mm x 2 mm) was used. Light-cured composites were condensed into the mold, and the middle third of the specimen was first activated for 30 s with 400 mW/cm2, for 60 s with 200 mW/cm2, or for 120 s with 100 mW/cm2. Then the remaining thirds were activated at the same intensity and curing time as the middle third. After 24 h storage in 37 degrees C water, three-point bending tests were performed with a span length of 20 mm at a crosshead speed of 0.5 mm/min. A one-way ANOVA, followed by a Newman-Keuls test (p < 0.05), were used to compare the data obtained from each group to test the effect of the curing conditions. RESULTS: Fracture toughness, flexural strength, and flexural modulus varied with resin composites. Among the three curing conditions for each material, there were no significant differences in fracture toughness, flexural strength, or flexural modulus. SIGNIFICANCE: The fracture toughness and the flexural strength were the same when irradiations with the same amount of energy (light intensity multiplied by curing time) were used. It was found that, at lower light intensity, longer curing was required to provide comparable mechanical properties. An accumulated irradiation energy obtained through a product of the light intensity and curing time may serve as a guideline to produce samples exhibiting equivalent fracture toughness as well as flexural strengths.

Influence of filler addition to bonding agents on shear bond strength to bovine dentin.

OBJECTIVES: The purpose of this study was to investigate the influence of adding filler particles to a bonding agent on dentin bond strength and of the temperature change during curing in order to determine the optimum filler level for an experimental bonding agent. METHODS: Experimental light-cured bonding agents with microfiller (average size: 0.05 micrometers) content of 0, 10, 20, 30, 40, 50, 60, and 70 wt% were used with the Imperva Bond / Lite-Fil II A (Shofu) restorative material. Bovine incisors were mounted in self-cured resin, and the facial surfaces were prepared with 600-grit SiC paper. After dentin surface pretreatment with dentin primer, experimental bonding agents were applied to the dentin surface and bonded with resin composite. Ten samples per test group were stored in 37 degrees C water for 24 h, then shear tested at 1.0 mm/min. The temperature change of the bonding agent was monitored during the exthothermic polymerization reaction according to the method of ISO standard #4049. The peak temperature and the time required to reach peak temperature were recorded. RESULTS: Bond strength to dentin and the temperature change were greatly affected by the filler level. Maximum dentin bond strength (14.3 +/- 2.3 MPa) was obtained with a filler level of 10 wt% and decreased with filler level higher than 30 wt% (10.4 +/- 1.7 MPa - 5.3 +/- 2.6 MPa). Peak temperature decreased and the time required to reach peak temperature increased with the higher filler levels. There were strong correlations between the bond strength and temperature change of experimental bonding agents. SIGNIFICANCE: The initial setting behavior of bonding agents containing filler particles may be one of the important factors influencing dentin bond strength. When bonding agents with filler particles are used, it is important to determine if optimum filler levels exist in order to optimize the dentin bond strength.

Influence of selected variables on adhesion testing.

Three variables associated with adhesion testing were examined: (1) the test mode, shear and tension; (2) design of the tensile apparatus; and (3) tooth substrate, human and bovine. Findings revealed no significant differences in bond strength by one tensile test and a shear test. However, the shear test produced more true adhesive failures; thus it may be preferable to use a shear test for adhesion testing. Bond strengths with some adhesive systems differed significantly when tested by two different tensile apparatus. Design of the test apparatus appeared to affect values. Bond strength measurements obtained with human and bovine enamel were essentially comparable. Values with dentin varied. There appeared to be a trend for higher bond strength values with bovine than with human dentin.