Long-term survival of different deep dentin caries treatments: A 5-year clinical study.

OBJECTIVE: The aim of this in-vivo study was to evaluate the long-term clinical survival of different deep dentin caries treatment options. MATERIALS AND METHODS: : In total, 391 patients with at least one permanent tooth with clinically diagnosed deep dentin caries were inspected. Two hundred and fourteen patients were examined at recall visits. Inclusion criteria were teeth with deep caries lesions with pulp vitality but absence of spontaneous pain and periapical alterations. The subjects received either stepwise removal (SWR), complete caries removal (CCR), or direct pulp capping (DPC). The radiological and clinical exams were performed after a mean observation time of 62 months. Success was defined as pulp sensitivity to vitality test and absence of periapical lesions as well as a clinical symptom. Data were statistically analyzed using Kaplan-Meier and log-rank (Mantel-Cox) tests (α = 0.05). RESULTS: Of the total 214 patients evaluated, 126 received SWR, 88 received CCR, and 67 received DPC treatment. One hundred and twenty-seven restorations were amalgam and 141 were composite. The mean observation period was 62 months. Survival rates were 85.7%, 90.9%, and 59.7% for SWR, CCR, and DPC, respectively (P = 0.001). Success rates of amalgam restorations (86.6%) were similar to composite restorations (83%), and both were found to be successful (P = 0.401). CONCLUSION: SWR treatment should be considered to preserve pulp vitality of deep dentin lesions instead of CCR or DPC. CLINICAL RELEVANCE: SWR method for deep dentin caries management had acceptable results over 5 years.

Comparative Evaluation of Marginal Adaptation and Fracture Strength of Different Ceramic Inlays Produced by CEREC Omnicam and Heat-Pressed Technique.

OBJECTIVE: The aim of this in vitro study was to evaluate marginal adaptation and fracture strength of inlays produced by CEREC Omnicam using different types of blocs and heat-pressed technique. Methods: Seventy-five extracted human mandibular molars were divided randomly into 5 groups (n=15). 60 molars in four groups received MOD inlay preparations. Experimental groups were CO: Intact teeth, EC: IPS e.max CAD and CEREC, LU: Lava Ultimate and CEREC, EL: IPS Empress CAD and CEREC, EP: IPS Empress Esthetic ingots and heat-pressed technique. Marginal gap measurements were taken with a stereomicroscope. Restorations were cemented with Variolink N and stored in distilled water at 37°C for 24 hours. All samples were subjected to thermocycling. The fracture strength of specimens was determined at a 0.5 mm/min crosshead speed until fracture. Fracture modes were determined. Statistical analyses were performed using one-way analysis of variance for fracture strength data and Kruskal-Wallis for marginal gap data (p=0.05). RESULTS: The mean marginal gap size of EC, LU, EL, and EP were 33.54 µm, 33.77 µm, 34.23 µm, and 85.34 µm, respectively. EP had statistically higher values than other groups. The fracture strength values were significantly higher in the intact teeth group (3959,00 ± 1279,79 N) than those of restored groups EC (2408,00 ± 607,97 N), LU (2206,73 ± 675,16), EL (2573.27 ± 644,73) ve EP (2879,53 ± 897,30). CONCLUSION: Inlays fabricated using CEREC Omnicam demonstrated better marginal adaptation than inlays produced with heat-pressed technique, whereas fracture strength values of inlays fabricated with different type of blocks using CEREC Omnicam exhibited similarity to those fabricated with heat-pressed technique.

High cefepime plasma concentrations and neurological toxicity in febrile neutropenic patients with mild impairment of renal function.

High-dose cefepime therapy is recommended for febrile neutropenia. Safety issues have been raised in a recent meta-analysis reporting an increased risk of mortality during cefepime therapy. Cefepime-related neurological toxicity has been associated with overdosing due to severe renal dysfunction. This study aimed to investigate the association between cefepime plasma concentrations and neurological toxicity in febrile neutropenic patients. Cefepime trough concentrations (by high-performance liquid chromatography) were retrospectively analyzed for 30 adult febrile neutropenic patients receiving the recommended high-dose regimen (6 g/day for a glomerular filtration rate [GFR] of >50 ml/min). The dose adjustment to renal function was evaluated by the ratio of the cefepime daily dose per 100 ml/min of glomerular filtration. The association between cefepime plasma concentrations and neurological toxicity was assessed on the basis of consistent neurological symptoms and/or signs (by NCI criteria). The median cefepime concentration was 8.7 mg/liter (range, 2.1 to 38 mg/liter) at a median of 4 days (range, 2 to 15 days) after the start of therapy. Neurological toxicity (altered mental status, hallucinations, or myoclonia) was attributed to cefepime in 6/30 (20%) patients (median GFR, 45 ml/min; range, 41 to 65 ml/min) receiving a median dose of 13.2 g/day per 100 ml/min GFR (range, 9.2 to 14.3 g/day per 100 ml/min GFR). Cefepime discontinuation resulted in complete neurological recovery for five patients and improvement for one patient. A multivariate logistic regression model confirmed high cefepime concentrations as an independent predictor of neurological toxicity, with a 50% probability threshold at ≥22 mg/liter (P = 0.05). High cefepime plasma concentrations are associated with neurological toxicity in febrile neutropenic patients with mild renal dysfunction. Careful adherence to normalized dosing per 100 ml/min GFR is crucial. Monitoring of plasma concentrations may contribute to preventing neurological toxicity of high-dose therapy for this life-threatening condition.

A 3-year clinical evaluation of a gallium restorative alloy.

Several alternative materials have been suggested to take the place of amalgam, because of the environmental toxic effects of its mercury component. One such material is gallium-based alloy restoratives. The aim of this in vivo study was to compare the long-term clinical performance of a commercial gallium alloy with an admixed high copper amalgam alloy. For this purpose, 32 gallium and 32 amalgam restorations were placed in molar teeth in 14 human subjects. All the selected patients had at least two molar teeth that required restoration. In this way both restoratives were used in the same oral cavity. The restorations were examined at baseline, 6 months, 1, 2 and 3 years. At baseline, six teeth restored with gallium alloy showed post-operative sensitivity, whereas none of the amalgams were sensitive. At the end of 3 years, only a few amalgam restorations showed slight surface tarnish and marginal integrity loss. None of them needed replacement. Of the 32 gallium restorations placed, five had to be removed because of sensitivity, corrosion and tooth fracture. Also dramatic surface roughness and corrosion were noticed in 12 gallium restoration. According to the results of this clinical study, gallium-based restoratives should not be used before their physical properties are improved.

Effect of disinfectant application methods on the bond strength of composite to dentin.

The use of cavity disinfectants with composite resins has raised important questions regarding their potential adverse effects on bond strength. The purpose of this study was to evaluate the effect of cavity disinfection on the bond strength of composite resin to dentin. Buccal surfaces of 64 caries-free extracted human third molars were ground flat by diamond flat-end cylinder bur, polished with a series of silicon carbide abrasive papers and mounted in autopolymerizing acrylic resin. They were randomly distributed into four groups (of 16). In group 1 (control group), dentin surfaces were treated with 35% phosphoric acid, Permagen primer and Permagen bonding resin and no disinfectant was used. In group 2, cavity disinfectant was applied and acid etching, priming and bonding procedures were performed as in group 1. In group 3, cavity disinfectant was applied after acid etching. In group 4, cavity disinfectant was applied as in group 3, but it was rinsed off before priming and bonding procedures. Then a Teflon mould 3 mm thick and 4 mm in diameter was attached to the dentin surfaces, filled with composite resin and light polymerized. After the specimens had been thermocycled, shear bond strengths were determined. Application of the disinfectant before or after acid etching significantly reduced the shear bond strength of composite to dentin (P<0.05). Rinsing off the cavity disinfectant before the bonding procedure did not affect the bond strength (P>0.05). The use of cavity disinfectant with composite resin restorations can influence the dentin bond strength.

Two-year performance of glass-ceramic insert-resin composite restorations: clinical and scanning electron microscopic evaluation.

OBJECTIVE: This study evaluated the 2-year clinical performance of beta-quartz-resin composite restorations. METHOD AND MATERIALS: Twenty-two glass insert-resin composite restorations were placed. Restorations were placed in 6 molars, 12 premolars, and 4 incisors. After 2 years, clinical assessment of the restorations was made by three operators according to the US Public Health Service criteria. Scanning electron microscopic evaluations were made by replica technique. RESULTS: Nineteen restorations were graded Alfa and three restorations were graded Bravo for color match. Twenty-one restorations were graded Alfa and one restoration Charlie for proximal contact, marginal integrity, and anatomic form. None of the restorations showed marginal discoloration, tooth sensitivity, or caries. CONCLUSION: Glass-ceramic insert-resin composite restorations exhibited excellent performance after 2 years of clinical service.

In vitro adherence of bacteria to bleached or unbleached enamel surfaces.

The purpose of this in vitro study was to evaluate the effects of three 10% carbamide peroxide bleaching agents on adherence of bacteria to tooth enamel surface. Enamel specimens were subjected to one of three carbamide peroxide solutions for 8 h per day for 30 days. Control specimens were kept in saline solution. Profilometer evaluation of surface roughness was performed on all specimens. The adherence of Streptococcus mutans was determined bacteriologically. There was no significant difference in surface roughness between the untreated and treated enamel specimens but a statistically significant difference was found in the adherence of S. mutans to bleached and unbleached enamel specimens. Specimens treated with Opalescence showed the highest adherence.

Antibacterial activity of 10% carbamide peroxide bleaching agents.

The antibacterial activity of three commercial 10% carbamide peroxide bleaching agents (Nite White, Karisma, and Opalescence) on Streptococcus mutans, Streptococcus mitis, Streptococcus sanguis, Lactobacillus casei, and Lactobacillus acidophilus was examined. Chlorhexidine (0.2%) was used as a positive control. Test materials and control solution were inserted in wells punched on the surface of disk sensitivity agars seeded with bacteria. After incubation of 24 to 48 h, zones of inhibition were measured. All three of the test materials displayed greater inhibition than the control. The pH of the solutions did not effect the bacterial inhibition.