Are healthcare workers immunized after receiving hepatitis B vaccination according to recommended guidelines? A systematic review and meta-analysis.

OBJECTIVES: Nowadays, it is believed that more than 240 million people worldwide are infected with the hepatitis B virus (HBV), associated with irreversible health-related consequences, represented by hepatic failure, cirrhosis, and hepatocellular carcinoma, and already are ranked as 15th cause of human death around the world. METHODS: A systematic review and a meta-analysis were performed to evaluate the effectiveness of vaccination and immunization on health professionals against HBV. The review was registered at the PROSPERO database (CRD42017075643). A search for cross-sectional studies was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. The Effective Public Health Practice Project Modified Scale was used to evaluate the internal quality of the studies included. RESULTS: A total of 1865 articles were identified after the removal of duplicates. Of these, 790 studies remained after screening the titles and abstracts. Finally, ten studies remained after full-text reading for qualitative analysis, all of which were used in the meta-analysis. A significant difference was found in the vaccine protocol for health professionals immunized against hepatitis B, compared to those not immunized. The risk ratio was 7.37 (95% confidence interval = 3.92-13.83; P < 0.00001). CONCLUSION: This study showed that the vaccine protocol is effective in immunizing health professionals against hepatitis B.

Bond strength of fiber-reinforced posts to deproteinized root canal dentin.

AIM: This study evaluated the push-out bond strength of cemented fiber posts after deproteinization of root canal dentin walls with NaOCl. The effect of the application of an antioxidant solution (sodium ascorbate) was also evaluated. MATERIALS AND METHODS: A three-step etch-and-rinse (Scotch-bond - 3M Espe) and a one-step self-etching adhesive (Xeno III - Dentsply Caulk) were evaluated. Thirty bovine incisor roots were divided into 3 groups: a. Irrigation with physiologic solution (control). b. Deproteinization with 10 minutes irrigation of 5% NaOCl. c. Deproteinization with NaOCl followed by 10 minutes irrigation with 10% ascorbic acid. Fiber posts were cemented with a dual-cured cement (Rely X ARC - 3M ESPE). The push-out bond strength was evaluated after 24 hours of storage in distilled water. The data were analyzed with three-way ANOVA, one-way ANOVA and Tukey's test (α = 0.05). RESULTS: There were significant differences between groups (p < 0.05). The bond strength of Scotchbond was not influenced by the deproteinization. Xeno III showed a decrease in bond strength when deproteinized with 5% NaOCl (p < 0.05). For Xeno III, the subsequent irrigation with ascorbic acid was able to reverse the effect of the deproteinization. Considering the radicular thirds, the bond strength varied in the sequence-apical < middle < coronal. CONCLUSION: Only the all-in-one adhesive was influenced by the deproteinization. Considering the respective control groups, both systems showed similar bond strength results. CLINICAL SIGNIFICANCE: The decreased bond strength of the self-etching adhesive following deproteinization seams to be related to the oxidant effect of the NaOCl solution and the subsequent irrigation with ascorbic acid was able to reverse the effect of the deproteinization.

The challenges of treating a fused tooth.

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.

The challenges of treating a fused tooth

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.

Este caso descreve o tratamento multidisciplinar de um incisivo lateral superior permanente fusionado a um dente supranumerário, ambos apresentando necrose pulpar e lesão periapical. Paciente compareceu ao consultório se queixando de dor, edema e mobilidade do incisivo lateral superior. O preparo endodôntico foi realizado no sentido coroa-ápice e foi colocada pasta de hidróxido de cálcio como medicação intra-canal por 15 dias. A seguir, a obturação foi realizada pela termoplastificação da guta-percha. Após 18 meses, foram realizados exames clínicos e radiográficos indicando ausência de dor e edema. Dois anos após o tratamento endodôntico, o paciente retornou para o tratamento periodontal e estético. Nove meses depois, foi realizada tomografia computadorizada e observou-se presença de defeito periodontal e lesão periapical. Foi então indicada e planejada a cirurgia paraendodôntica. O dente supranumerário foi removido e a área de comunicação com o canal radicular do incisivo lateral foi preenchida; a loja cirúrgica foi preenchida com vidro bioativo e osso orgânico bovino desmineralizado. O tecido patológico da lesão periapical foi submetido à análise histopatológica sendo diagnosticado como cisto periapical. Um ano após a cirurgia parendodôntica, uma nova tomografia computadorizada mostrou neoformação óssea na região periapical do dente em questão. Doi anos após a cirurgia, a restauração foi trocada devido à motivos estéticos e uma radiografia periapical mostrou sucesso do tratamento (5 anos após o tratamento inicial). Um correto diagnóstico e plano de tratamento multidisciplinar é essencial para o sucesso do tratamento de dentes fusionados à dentes supranumerários.