Assessment and management of halitosis.

Halitosis is an unpleasant condition that may be the origin of concern not only for a possible health condition but also for frequent psychological alterations which may lead to social and personal isolation. The most frequent sources of halitosis that exist in the oral cavity include bacterial reservoirs such as the dorsum of the tongue, saliva and periodontal pockets. Volatile sulphur compounds (VSCs) are the prominent elements of oral malodour. Genuine halitosis and pseudo-halitosis should be in the treatment realm of dental practitioners. Clinical Relevance: Halitosis can be a symptom of underlying systemic disease, therefore the exact diagnosis and its source (oral or non-oral) is important in the proper approach to its management.

Mineral trioxide aggregate: a review of physical properties.

The purpose of this two-part series is to review the composition, properties, products, and clinical aspects of mineral trioxide aggregate (MTA) materials. Electronic search of scientific papers from January 1991 to May 2010 was accomplished using PubMed and MedLine search engines to include relevant scientific citations from the peer-reviewed journals published in English. MTA is a refined form of the parent compound, Portland cement (PC). It demonstrates a strong biocompatible nature owing to the high pH and its ability to form hydroxyapatite. MTA materials provide a better seal than traditional endodontic materials as observed in dye leakage, fluid filtration, protein leakage, and bacterial penetration leakage studies, and it has been recognized as a bioactive material. Currently a variety of MTA commercial products are available, including Proroot Gray MTA and White MTA both from DENTSPLY Tulsa Dental Specialties (www.DENTSPLY.com), and MTA Angelus (Angelus,www.angelus.ind.br). Although these materials are indicated for various dental uses/applications, long-term in-vivo clinical studies are still needed to claim the same. This first of this series highlights and discusses the composition, physical, and/or chemical properties of MTA. A subsequent article will offer an overview of the material aspect (commercial products) and clinical considerations for MTA materials.

Self-adhesive resin cements: a new perspective in luting technology.

UNLABELLED: Many materials are available for the fabrication of indirect restorations such as, metal alloys, resin-based composites and ceramics. Resin cements have long been valued as luting agents for indirect restorations because of their high retentive strength, resistance to wear, and low solubility. However, one of the common discouraging factors regarding their chairside use is the need of multiple-steps (etching, drying, priming and luting) for bonding. Thus the current impetus is towards the use of self-adhesive cements that require no etching, priming or bonding agents to bond to the tooth surface. Their increased popularity can be judged by the commercial availability of more than a dozen self-adhesive resin products/brands, in a short span of time. This article reviews the composition, physical and biological properties, adhesion characteristics and clinical performance of self-adhesive (resin) cements. CLINICAL RELEVANCE: Self-adhesive resin cements are dual-cured and adhere to tooth structure without the requirement of a separate etching step and application of an adhesive/bonding agent.

Calcific metamorphosis. Literature review and clinical strategies.

UNLABELLED: Calcific metamorphosis (CM) is a commonly observed phenomenon following traumatic injuries like concussion, subluxation and luxation. Depending on the severity of the injury and the developmental stage of the tooth, there can be either complete or partial obliteration of root canals. However, histologically, there is always persistence of fine residual filaments of pulp tissue or tracts of organic material without the presence of any inflammatory component. A periodic clinical and radiographic follow-up examination is preferred and usually, for cosmetic reasons, only a conservative aesthetic treatment is required. Endodontic treatment is only advocated if there is development of apical periodontitis and, if executed properly, can be highly successful. CLINICAL RELEVANCE: Appropriate management of calcific metamorphosis can present a clinical dilemma to the clinician. Thus a judicious and prudent decision should be made between endodontic intervention for the involved tooth and other available restorative (and/or aesthetic) treatment options.

EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION.

Introduction: Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods: A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results: The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant. Conclusion: Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.

Introdução: O fechamento adequado da ferida é um passo importante no manejo da fratura distal do fêmur a fim de evitar infecção e permitir uma rápida reabilitação. Suturas farpadas sem nós podem poupar tempo e distribuir uniformemente a tensão da ferida. Entretanto, seu papel em termos de resultado funcional, tempo de fechamento e complicações pós-operatórias não tem sido analisado em casos de fratura distal do fêmur. Material e métodos: Um total de 47 pacientes com mais de 18 anos de idade com fratura distal do fêmur tratados com placa de fixação distal do fêmur foram aleatorizados em grupos de sutura farpada ou tradicional. No grupo de farpados, o fechamento da ferida capsular foi feito com suturas sem nós farpados bidirecionais 2-0 (Quill SRS® PDO, Angiotech, Vancouver, BC, Canadá). Em pacientes designados para o grupo B, o fechamento capsular foi feito com Vicryl®1-0 (Ethicon inc. Somerville, NJ) e Ethibond® 5-0 respectivamente. Resultados: A flexão média na articulação do joelho foi de 105,7±15,6 graus no grupo de estudo e 110,4±13,7 no grupo controle (p= 0,2133). O tempo médio estimado de fechamento foi significativamente menor no grupo de estudo em comparação com o grupo controle (p<0,05). Os casos de ferimento por perfuração da agulha foram maiores no grupo de sutura tradicional. Os pacientes desenvolveram abscesso de pontos e infecção superficial em ambos os grupos. Entretanto, a diferença na incidência entre os dois não foi estatisticamente significative. Conclusão: A sutura farpada é um método eficiente para o fechamento de feridas. Ele reduz o tempo de fechamento das feridas com uma taxa de complicação semelhante à utilização de suturas convencionais. Evidência Nível II; Ensaio Clínico Randomizado.

Comparison of Three Suture Materials in Capsular Closure Closure Time and Wound Complications Following Knee Arthroplasty.

BACKGROUND: Watertight capsular closure in knee arthro- plasty is desirable in order to achieve a good functional outcome. Barbed knotless sutures are being increasingly used in wound closure following knee arthroplasty. The prior studies have compared barbed sutures with either VICRYL® or Ethibond for closure, while none had compared all the three in a single setting in terms of closure time, needle stick injuries, postoperative complications, and functional outcome. PATIENTS AND METHODS: One hundred and forty-three subjects of unilateral knee arthroplasty were screened for eligibility in the prospective randomized controlled trial. One hundred and twenty patients fulfilled the inclusion criteria and were randomized into three groups to undergo capsular closure with barbed sutures, VICRYL, or Ethibond. RESULTS: The wound closure was fastest with barbed su- tures followed by VICRYL and Ethibond (10.4 ± 4.1; 15.4 ± 4.7; 17.2 ± 3.8 minutes; p < 0.001). There were seven needle stick injuries in the Ethibond group followed by three in the VICRYL group and none in the barbed suture group. The Knee Society Scores and wound related complications were comparable in all the three groups. CONCLUSION: Barbed suture, VICRYL, and Ethibond are equally good in the capsular closure following knee arthro- plasty. The faster wound closure time achieved may not be clinically relevant in the short term.

Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians.

Objective The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures. Methods The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living. Results There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels. Conclusion In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I.

Comparison Between Vancomycin and Gentamicin for Intraoperative Presoaking of Hamstring Graft in Primary Anterior Cruciate Ligament Reconstruction.

Introduction Postoperative infection is an uncommon complication with grave consequences following anterior cruciate ligament reconstruction (ACLR). Presoaking of the hamstring graft with antibiotics results in a lower rate of infection. The purpose of the current study was to compare the efficacy of two commonly used antibiotics, vancomycin and gentamicin, in reducing infection rates following anterior cruciate ligament reconstruction. Methods The retrospective study included a total of 578 patients who underwent arthroscopic anterior cruciate ligament reconstruction between June 2015 and October 2021. The timeline was categorized as the period between June 2015 to October 2018 (Vancomycin presoaking of hamstring graft) and November 2018 to October 2021 (Gentamicin presoaking of hamstring graft). All patients were examined for the development of infection, causative organism, and treatment received. Patients with intravenous drug abuse, alcoholism, steroid use, revision cases, and a prior history of infection in the knee were excluded from the study. Fisher's exact test was used for comparison of categorical data, and Poisson regression analysis was carried out to calculate incidence rate ratios after adjusting for confounding variables. Results Presoaking of hamstring grafts with vancomycin was carried out in 224 patients, and gentamicin was used in 354 patients. In total, three patients in the vancomycin and four patients in the gentamicin groups developed an intraarticular infection, and the difference in infection rate between the two groups was not statistically significant (p=0.919). Coagulase-negative Staphylococcus aureus was isolated in four cases, Enterobacter cloacae in one, and no organism was seen in two cases. The groups were comparable in terms of age (p=0.563), smoking (p=0.84), sex (p=0.359), and operative time (p=0.09). Conclusion Presoaking of hamstring autografts with gentamicin intraoperatively is a good alternative to vancomycin in the prevention of infection following arthroscopic anterior cruciate ligament reconstruction.

Validation and Cross-Cultural Adaptation of the Hindi Version of the Oxford Knee Score in Patients With Knee Osteoarthritis.

INTRODUCTION: Cases of knee osteoarthritis are on the rise in India with an increasingly ageing population. A large number among them shall undergo total knee replacement, so there is a requirement for validated patient-reported outcome measures in the Hindi language. Oxford Knee Score (OKS) is one of the most commonly used patient-reported outcome measure scoring systems. The current study was designed to test and validate cross-cultural adaptation and translate the Hindi version of the Oxford Knee Score (OKS-H).  Material and Methods: The OKS-H was formulated as per recommendations for cross-cultural adaptation and translation. The OKS was tested on 162 patients with knee osteoarthritis who underwent a total knee replacement. Reliability of the OKS-H was tested using the intraclass correlation coefficient (ICC) and internal consistency was assessed using Cronbach's alpha. The construct validity was assessed using OKS-H, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form Survey (SF-36) questionnaire.  Results: The translation was performed with no major difficulty. The OKS was completed by 158 (97.5%) and 157 (96.9%) patients at test and retest, respectively, after one week. With an ICC of 0.87, OKS had shown good reliability. The construct validity obtained against the WOMAC and SF-36 scores was strong (ICC between 0.49 to 0.86). CONCLUSION: The translated OKS-H is a reliable and valid instrument for patient-reported outcome measures in cases of knee osteoarthritis opting for total knee arthroplasty.

Effect of three indigenous food stains on resin-based, microhybrid-, and nanocomposites.

PURPOSE: This study investigated the effects of three indigenous food stains (tea, tobacco, turmeric) on a nanocomposite (Ceram-X-Mono, Dentsply DeTery, Konstanz, Germany), a microhybrid posterior (P60, 3M ESPE, St. Paul, MN, USA), and a universal microhybrid (Z100, 3M ESPE) resin-based composite (RBC). MATERIALS AND METHODS: Thirty-six disk-shaped specimens were fabricated (10 × 2 mm) for each type of RBC material, using a polytetraflouroethylene (PTFE) sheet. Specimens from each group were randomly distributed into three subgroups for each of the used stains. The baseline color values were measured using a spectrophotometer. The specimens were immersed in the staining solutions for a period of 3 hours per day for 15 days (3 hours/day × 15 days). Following this, the color change value (ΔE) was calculated. RESULTS AND CONCLUSION: All the tested groups showed a clinically perceptible color change (ΔE values = 3.3 or >3.3), except for tea-stained P60 (ΔE = 3.15) and Z100 (ΔE = 1.63) groups. Turmeric caused the most significant color change for all the tested RBCs. The least amount of color change was observed with the Z100 (tea, ΔE = 1.63; tobacco, ΔE = 13.59; turmeric, ΔE = 38.77) group that was statistically significant from P60 (tea, ΔE = 3.15; tobacco, ΔE = 18.83; turmeric, ΔE = 57.72), and Ceram-X-Mono (tea, ΔE = 3.32; tobacco, ΔE = 18.83; turmeric, ΔE = 53.95) groups.

Comparative in vitro evaluation of efficacy of mouthrinses against Streptococcus mutans, Lactobacilli and Candida albicans.

PURPOSE: The present study was undertaken to compare the relative antimicrobial efficacy of two commercially available mouthrinses, Hexidine (0.12% chlorhexidine mouthrinse) and S-Flo (0.2% sodium fluoride), and a laboratory-manufactured propolis mouthrinse (10%) tincture with a dilution of 1:5 with water and their combinations against Streptococcus mutans, lactobacilli and Candida albicans. MATERIALS AND METHODS: Unstimulated saliva samples were obtained from the patients using the spitting method and the isolates of Streptococcus mutans, Lactobacillus and Candida albicans were obtained. The agar diffusion method was used to evaluate the antimicrobial activity of these test solutions and their combinations. RESULTS: Hexidine (0.12% chlorhexidine gluconate mouthrinse) showed the best antimicrobial efficacy against all the tested microorganisms. The laboratory manufactured propolis mouthrinse showed an effective antimicrobial action only against Streptococcus mutans. The antimicrobial efficacy of propolis (P) against Streptococcus mutans was similar to that of chlorhexidine (CHX) and the combination of propolis with chlorhexidine (CHX+P). S-Flo mouthrinse (0.2% sodium fluoride) showed the least efficacy against Streptococcus mutans among all tested solutions, but had better efficacy than propolis against lactobacilli and Candida albicans. The antimicrobial efficacy of the combination of chlorhexidine and fluoride mouthrinse and the combination of chlorhexidine and propolis mouthrinse was less than chlorhexidine mouthwash alone. Among all the tested combinations, the combination of fluoride and propolis showed the least efficacy against all the tested microorganisms. CONCLUSION: The results of the study indicate that 0.12% chlorhexidine gluconate mouthrinse (Hexidine) has the best anti-microbial efficacy against all the tested microorganisms, with laboratory-manufactured propolis mouthrinse showing an equivalent efficacy against Streptococcus mutans only. No added advantage of using the tested mouthrinse combinations was observed.

The role of remineralizing agents in dentistry: a review.

Minimal intervention is a key phrase in today's dental practice. Minimal intervention dentistry (MID) focuses on the least invasive treatment options possible in order to minimize tissue loss and patient discomfort. Concentrating mainly on prevention and early intervention of caries, MID's first basic principle is the remineralization of early carious lesions, advocating a biological or therapeutic approach rather than the traditional surgical approach for early surface lesions. One of the key elements of a biological approach is the usage and application of remineralizing agents to tooth structure (enamel and dentin lesions). These agents are part of a new era of dentistry aimed at controlling the demineralization/ remineralization cycle, depending upon the microenvironment around the tooth. This article details the various agents that enhance and/or promote remineralization and discusses their clinical implications.

Resin-based composite as a direct esthetic restorative material.

The search for an ideal esthetic material for tooth restoration has resulted in significant improvements in both materials and the techniques for using them. Various resin-based composite (RBC) materials have recently been introduced into the market that offer improved esthetic and physical properties. This article reviews RBCs, including their compositions, advantages, and disadvantages, that are contemporary to today's clinical practice as well as those that are under research consideration and/ or in clinical trial phase.

A review of root fractures: diagnosis, treatment and prognosis.

UNLABELLED: Tooth fractures (crown or root fractures) are commonly encountered emergencies in a dental clinic. Root fractures are defined as fractures involving the dentine, cementum and pulp. They are broadly classified as horizontal and vertical root fractures. They may be clinically challenging cases to treat as, usually, treatment of such cases requires an interdisciplinary/multidisciplinary approach for complete rehabilitation of teeth. For a successful outcome, it is imperative to arrive at an appropriate diagnosis and design a treatment plan accordingly as soon as possible.This review article discusses the various types of root fractures, their diagnosis and treatment, along with the factors affecting their healing and prognosis. CLINICAL RELEVANCE: Treatment of root fractures depends on a number of factors such as, position of fracture line, mobility of tooth and pulpal status. Thus clinicians must have thorough knowledge and adequate clinical experience to treat them properly.

Light-curing considerations for resin-based composite materials: a review. Part I.

There has been a continual advent of improved technologies in dentistry. Among these are the material sciences of resin-based composites (RBCs). Since the introduction of light-cured RBCs, the problem of polymerization shrinkage and the methods used to overcome this have concerned clinicians and researchers. Types of curing light and modes of curing have been shown to affect the degree of polymerization and related shrinkage of RBCs. This review, which is divided into two parts, discusses the contemporary light-curing units. Part I explores the evolution in light-curing units and different curing modes. Part II highlights the clinical considerations regarding light curing of RBCs that are important for achieving optimal curing and maximum polymerization of RBCs in a clinical setting.

Light-curing considerations for resin-based composite materials: a review. Part II.

As discussed in Part I, the type of curing light and curing mode impact the polymerization kinetics of resin-based composite (RBC) materials. Major changes in light-curing units and curing modes have occurred. The type of curing light and mode employed affects the polymerization shrinkage and associated stresses, microhardness, depth of cure, degree of conversion, and color change of RBCs. These factors also may influence the microleakage in an RBC restoration. Apart from the type of unit and mode used, the polymerization of RBCs is also affected by how a light-curing unit is used and handled, as well as the aspects associated with RBCs and the environment. Part II discusses the various clinical issues that should be considered while curing RBC restorations in order to achieve the best possible outcome.

Strategies to overcome polymerization shrinkage--materials and techniques. A review.

UNLABELLED: Stress generation at tissue/resin composite interfaces is one of the important reasons for failure of resin-based composite (RBC) restorations owing to the inherent property of polymerization shrinkage. Unrelieved stresses can weaken the bond between the tooth structure and the restoration, eventually producing a gap at the restoration margins. This can lead to postoperative sensitivity, secondary caries, fracture of the restorations, marginal deterioration and discoloration. As polymerization shrinkage cannot be eliminated completely, various techniques and protocols have been suggested in the manipulation of, and restorative procedures for, RBCs to minimize the shrinkage and associated stresses. Introduction of various newer monomer systems (siloranes) may also overcome this problem of shrinkage stress. This review emphasizes the various material science advances and techniques advocated that are currently available or under trial/testing phase to deal with polymerization shrinkage in a clinical environment. CLINICAL RELEVANCE: Minimizing the shrinkage stresses in RBC restorations may lead to improvement in the success rate and survival of restorations. Thus, it is important for dental practitioners to be aware of various techniques and materials available to reduce these shrinkage stresses and be updated with the current knowledge available to deal with this issue.

Current strategies and applications of tissue engineering in dentistry--a review Part 2.

UNLABELLED: The three main key elements used in tissue engineering are the stem cells, morphogens and the scaffolds that, under a conductive external influence (environment) combine in the engineering of tissues. Part 1 of this two-part review article described in detail the various stem cells, morphogens and scaffolds that can be used in tissue engineering. This second article describes the various ways in which these three key elements can be used to engineer biological tissues. A number of strategies and technologies (Figure 1) such as, stem cell therapy, gene therapy, guided tissue regeneration, self-assembling systems, etc have been proposed. CLINICAL RELEVANCE: The field of tissue engineering has recently shown promising results and good future prospects in dentistry for the development of restorations to replace lost tooth structure with a functional replacement.

Current strategies and applications of tissue engineering in dentistry--a review part 1.

UNLABELLED: A new direction in the field of vital pulp therapy is given by the introduction of tissue engineering as an emerging science. It aims to regenerate a functional tooth-tissue structure by the interplay of three basic key elements: stem cells, morphogens and scaffolds. It is a multidisciplinary approach that combines the principles of biology, medicine, and engineering to repair and/or regenerate a damaged tissue and/or organ. This two part article reviews and discusses the basic concept and strategies so far studied and researched for the engineering of basic dental tissues, to restore a functional tooth anatomy. This first part focuses on a detailed description of key elements used in tissue engineering and their applied clinical applications in dentistry. The second part will deal with the strategies that are being used and/or developed to regenerate the tooth tissues with the help of this scientific principle. CLINICAL RELEVANCE: The field of tissue engineering has recently shown promising results and a good prospect in dentistry for the development of the most ideal restorations to replace the lost tooth structure with a functional replacement.