Quality of cross-infection control in dental laboratories. A critical systematic review.

PURPOSE: To identify reported practices for cross-infection control in dental laboratories and to quantify the importance of the flaws encountered. DATA SOURCES: Systematic search (cross-infection AND dental laboratory) at EMBASE, PubMed, SciELO and Scopus databases. STUDY SELECTION: Papers reporting on cross-sectional studies providing original data about cross-infection knowledge, practices and attitudes of dental technicians. Papers reporting on a single laboratory or institution were excluded. DATA EXTRACTION: Data extraction was undertaken independently by three reviewers using a purpose made form. The outcome of this study was analyzed in five aspects, namely process organization, disinfection, working environment, use of individual protective equipment and vaccination policy. RESULTS OF DATA SYNTHESIS: The systematic search output was 1651 references and 11 papers were finally selected. Flaws were more frequently identified in terms of vaccination policy, biological safety of the working environment and use of individual protective equipment (100%). Slightly better results were found in terms of organization of the cross-infection control process (89.47%) and disinfection practices (85.71%). The application of the formula for disclosing the relative importance of the flaws identified in the literature prioritizes the need for interventions aimed at improving the organization of the cross-infection control procedures, followed by training in item disinfection. The control of the working environment together with the use of individual protective equipments rank closely in importance, followed by the existence of a vaccination policy. CONCLUSIONS: Sub-standard cross-contamination practices seem to be a common finding in dental laboratories, which may well compromise the quality of certain dental treatments.

Relationship between the cranial base and the mandible in artificially deformed skulls.

OBJECTIVES: There is controversy regarding the relationship between mandibular position and alterations of the cranial base that provoke a more anterior location of the glenoid fossa. Artificially deformed skulls display marked alterations of the cranial base. This study evaluates mandibular changes as function of the morphology of the cranial base in these skulls. MATERIAL AND METHODS: A geometric morphometric study was performed on lateral cephalometric X-rays of three groups of skulls: 32 with anteroposterior deformity, 17 with circumferential deformity and 39 with no apparent deformity. RESULTS: In artificially deformed skulls, the cranial base was deformed causing the mandibular condyle to be in a more anterior position. There was a complete remodelling of the mandible involving narrowing and elongation of the mandibular ramus, rotation of the corpus of the mandible and increased vertical height of the symphysis. Forward displacement did not occur. Integration between mandible and cranial base is not altered by deformation of the skull. CONCLUSIONS: Deformity of the cranial vault exerts an influence on the mandible, supporting the theory of modular units in complete integration. This also supports the theory that mandibular prognathism is a multifactorial result and not a direct effect of displacement of the cranial base.

Radiographic evaluation of marginal bone maintenance around tissue level implant and bone level implant: a randomised controlled trial. A 1-year follow-up.

The etiologic factors associated with crestal bone loss have not been comprehensively clarified. Several theories exist as to the reason for the observed changes in crestal bone height following implant restoration. In the 1990s, the wide-diameter implants were commercially introduced. Initially, the implants were restored with standard-diameter abutments because of lack of matching prosthetic components. Long-term radiographic follow-up of these 'platform-switched' restored wide-diameter dental implants has demonstrated a smaller-than-expected vertical change in the crestal bone height around these implants that is typically observed around implants restored conventionally with prosthetic components of matching diameters. The aim of this randomised controlled study was to assess radiographically marginal bone level alterations in implants restored according to the platform-switching concept compared with traditionally restored implants. Fifty-four subjects to participate in this randomised controlled study were selected. Two groups were assigned at random: control group (56 implants were restored with standard matching-diameter abutments) and test group (58 implants were restored with medialised abutments). X-ray explorations were taken for peri-implant bone level at the minute the last cementing of the prosthesis and at 1-year follow-up. NHI Image was used to digitally process and manipulate the radiographic images and perform the measurements. Mean of bone loss with platform-switching implants was -0·01 mm, and the mean of bone loss with standard platform implant was 0·42 mm. Outcomes of this study indicated that the platform-switching design could preserve the crestal bone levels to 1-year follow-up. There was a statistically significant difference in marginal bone loss.

Distance of the contact glide in the closing masticatory stroke during mastication of three types of food.

This study was designed to characterize the distance of the contact glide in the closing masticatory stroke in healthy adult subjects, during chewing of three types of food (crustless bread, chewing gum and peanuts). Mandibular movements (masticatory movements and laterality movements with dental contact) were registered using a gnathograph (MK-6I Diagnostic System) on the right and left side during unilateral chewing of the three food types. Length of dental contact was measured in masticatory cycle, which is defined as where the terminal part of the chewing cycles could be superimposed on the pathways taken by the mandible during lateral excursions with occlusal contacts. The length of dental contact during mastication of chewing gum is 1.46 +/- 1 mm, during chewing of soft bread is 1.38 +/- 0.7 mm and during chewing of peanuts is 1.45 +/- 0.9 mm. There is no significant difference in the lengths of dental contact during mastication of three types of foods that enable direct tooth gliding.

[Assessing quality in the process of using hazardous drugs-prescription and preparation]. / Evaluación de la calidad en el proceso de utilización de fármacos peligrosos: prescripción y preparación.

OBJECTIVE: To evaluate the quality of cytotoxic drug prescription based on the results of an interventional pharmaceutical program and the quality of the final product based on quality-control prior to preparation. STUDY PERIOD: July 2002-March 2003. Hazardous drug prescription was evaluated through an analysis of pharmaceutical interventions during therapeutical monitoring. Depending on repercussion in patients, they were classified in three categories (treatment optimization, resource optimization or criteria unification). Data obtained from manual quality control programs prior to hazardous drug preparation were evaluated. RESULTS: Sixty-four interventions were made (9 interventions per 100 prescriptions): 55% were classified as treatment optimization, 28% as resource optimization and 17% as criteria unification. A total of 66% of the interventions focused on treatment optimization were caused by prescription errors. Ninety-seven per cent were accepted. Out of 2,074 preparations, 1,951 were evaluated (94.9%). A 5.1% of non-evaluated preparations were due to a lack of registration and 0.8% to violations in the established protocol. CONCLUSIONS: Results of the interventional Pharmaceutical program show that an assisted prescription system is necessary, not only to detect prescription errors but also to prevent them. Manual controls in different stages of the process are useful and they should be complementary to other more reliable dosification controls.

The Málaga flap for vaginoplasty in the Mayer-Rokitansky-Kuster-Hauser syndrome: experience and early-term results.

We report our experience in vaginoplasty for the treatment of six cases of the Mayer-Rokitansky syndrome using bilateral vulvoperineal fasciocutaneous flaps measuring 8 to 9 X 3 cm. We consider a detailed description of the operative technique, noting the modifications that we have introduced as our experience increased, in addition to the cosmetic and functional results. On the other hand, the indications for using this vaginoplasty are presented. On the basis of our clinical results, the actual anatomy of the blood vessels leading to the pedicle of the flap, and the geometric design of the vulvoperineal flap, the following technical points can be made: (1) It is a secure and reliable technique because of well-established vascularization beneath the lateral border of the labia majora. (2) It is a straightforward method because the transposition and rotation of a vertical flap is easier than the use of more distant flaps. (3) There is a minor risk of injury to the superficial perineal neurovascular pedicle and Bartholin's gland. (4) Innervation extends into the external two-thirds of the artificial vagina. And (5) an acceptable cosmetic and functional result is achieved without the need to use dilators, obturators, or molds.

Anatomic study of the superficial perineal neurovascular pedicle: implications in vulvoperineal flap design.

Thirty superficial perineal neurovascular pedicles from 15 formaldehyde-fixed female cadavers were dissected and analyzed with the purpose of establishing the anatomic basis for the design and elevation of vulvoperineal fasciocutaneous flaps based on their anatomic elements. The average internal diameter of the superficial perineal artery was 0.53 +/- 0.2 mm, determined by means of an image analysis system. Three distinct anatomic patterns of cutaneous arterial vascularization were seen bilaterally, and two types of vulvoperineal fasciocutaneous flaps are described.

[Orchiectomy and buserelin in combination with flutamide: comparative results in metastatic prostatic carcinoma]. / Orquiectomía y buserelin asociados a flutamida: resultados comparativos en el carcinoma prostático metastásico.

In a prospective, non-randomized study in 44 patients with metastatic prostate carcinoma (D2), without previous hormone therapy, two alternative therapeutic courses to achieve complete androgenic blockade were compared. A first group (n = 29) was assigned to received Flutamide plus Buserelin, whereas the second group (n = 15) underwent orchidectomy, also in association to Flutamide. Both regimes were sustained without interruption, except when progression was evident, and both achieved castration levels of testosterone plasma titres. Mean follow-up duration was 13 months and 7 days, ranging between 2 and 36 months. There were no significant differences between both groups with regard to therapy objective responses and survival. Whereas the responses (CR + PR + E) were 93% in the LHRH analogues group and 86% in the orchidectomy group, overall survival was 66% and 67%, respectively. There were no secondary complications related to the surgical procedure nor adverse effects to drug therapy which required its cessation.

[Renal cholesteatoma: keratin accumulation tumor]. / Colesteatoma renal: tumor por acúmulo de queratina.

Presentation of 6 cases of renal cholesteatoma in 4 male and 2 female patients ranging between 30 and 67 years of age. The most consistent clinical data was a history of relapsing nephritic colic of long-evolution. The average time to diagnose was 19 years. In 50% cases an association to malignant neoplastic pathology was found. The clinical diagnosis was based on the urography and the histopathological examination of the material passed with the urine. Renal exeresis was performed in 5 cases. One was treated in a conservative fashion. Also the etiology causes, diagnostic procedure and other therapeutic possibilities were reviewed.

[Renal fungal infection: presentation forms and therapeutic advances]. / Infeccion fúngica renal: formas de presentación y avances terapéuticos.

Fluconazole is a broad spectrum anti-fungal agent which combines good tolerance, efficacy and low toxicity, and offers useful advantages in the treatment of certain forms of mycosis. Three cases of renal fungal disease treated with surgery (nephrectomy in two cases and pyelolitectomy plus partial nephrectomy in the third one) and fluconazole or amphotericin B are presented. In all three cases there was at least one predisposing factor (diabetes, urolithiasis, urinary catheter, previous therapy with antibiotics, or AIDS), and the causing pathogens were Candida and Mucor. Administration of fluconazole 100 mg b.i.d. for 4 weeks in the two candida infected patients accomplished a complete cure of the disease. Incidence, etiopathology, presentation forms and diagnostic techniques of urinary mycosis are analyzed together with the current therapeutical options, making special reference to fluconazole.

[Detection and classification of medication errors at Joan XXIII University Hospital]. / Detección y clasificación de errores de medicación en el Hospital Universitari Joan XXIII.

INTRODUCTION: Medication errors are multifactorial and multidisciplinary, and may originate in processes such as drug prescription, transcription, dispensation, preparation and administration. The goal of this work was to measure the incidence of detectable medication errors that arise within a unit dose drug distribution and control system, from drug prescription to drug administration, by means of an observational method confined to the Pharmacy Department, as well as a voluntary, anonymous report system. The acceptance of this voluntary report system's implementation was also assessed. MATERIAL AND METHODS: A prospective descriptive study was conducted. Data collection was performed at the Pharmacy Department from a review of prescribed medical orders, a review of pharmaceutical transcriptions, a review of dispensed medication and a review of medication returned in unit dose medication carts. A voluntary, anonymous report system centralized in the Pharmacy Department was also set up to detect medication errors. RESULTS: Prescription errors were the most frequent (1.12%), closely followed by dispensation errors (1.04%). Transcription errors (0.42%) and administration errors (0.69%) had the lowest overall incidence. Voluntary report involved only 4.25% of all detected errors, whereas unit dose medication cart review contributed the most to error detection. CONCLUSIONS: Recognizing the incidence and types of medication errors that occur in a health-care setting allows us to analyze their causes and effect changes in different stages of the process in order to ensure maximal patient safety.

[Thickness variation of the dural sac]. / Variación del espesor del saco dural.

OBJECTIVE: To measure carefully the thickness of the dural sac and evaluate possible variation in recently removed human specimens that had not yet undergone postmortem change. The thickness of the dural membrane is of interest because of its function as a barrier during diffusion processes and during closure of spinal lesions. MATERIAL AND METHODS: After receiving the consent of our hospital's ethics committee and the family of the deceased, and immediately after extraction of organs for transplantation, we removed the dural sac and nerves contained therein from the cadaver of 56-year-old patient diagnosed of brain death. The membrane was dissected and 240 measurements of thickness were made over the entire surface of the sample. A micrometer was used, controlled through a surgical microscope. To analyze variations in thickness, the specimen was divided into 48 zones. RESULTS: The dural sac open on its anterior side was treated as a rectangular membrane measuring 130 x 54 mm. Mean thickness of the sample was 0.322 mm. Mean thickness of anterior zones was 0.353 mm, with no significant differences among them. Posterior zones measured a mean 0.295 mm with significant differences among them (p < 0.001). Up to the second lumbar root, anterior and posterior zone thicknesses presented no significant differences. However, after the space between the second and third lumbar roots, the posterior side was significantly thinner. Where the first, second and third lumbar roots emerged, we measured thicknesses of 0.315, 0.361 and 0.322 mm, with no significant differences among anterior, posterior and side zones on any level. At the fourth lumbar root and in the spaces of the dura mater between the emergence of the first and second, the second and third, the third and fourth and fourth and fifth lumbar roots, we observed significant differences. The measurements were 0.298 mm (p < 0.01); 0.348 mm (p < 0.01); 0.337 mm (p < 0.001), 0.306 mm (p < 0.01); 0.289 mm (p < 0.001), respectively. CONCLUSION: Possible inter- or intra-individual variation in dural sac thickness is an unpredictable variable affecting the management of dural lesions. The data we report on thickness allow for future objective assessment of the maximum sizes recommended for the lateral orifices of bevelled, pencil-point needles in order to avoid straddling the membrane when subarachnoid anesthesia is given. The data also contributes to the study of substance diffusion through this membrane.

[Periorbital hematoma as a complication of posterior peribulbar anesthesia]. / Hematoma periorbitario como complicación de la anestesia peribulbar posterior.

We report a case of a large periorbital hematoma which furtherly extended to the ipsilateral orbit and appeared after posterior peribulbar blockade in a 70-year-old woman undergoing cataract extraction and intraocular implant. Peribulbar blockade was carried out with a 23-gauge blunt bevel Atkinson's needle introduced at the level of nasal or internal angle of the upper lid without loosing contact with the ceiling of the orbit. Anesthetic solution was bupicavaine at 0.75% with 10 U/ml of hyaluronidase, 3 ml. Usual blockade of lower lid was not carried out as with the first blockade, an almost complete paresis of extraocular muscles together with discrete conjunctival ecchymosis occurred. Ocular compression was conducted with Homan's balloon at 30 mmHg gor 30 minutes. Then, the eyeball was decompressed and a progressive increase of edema with conjunctival hemorrhage becoming bilateral was observed. Coagulation tests were normal. The incidence of conjunctival ecchymosis and palpebral hematoma with such technique ranges from 2% to 9%; it does not represent any intraoperative problem but may difficult surgery.

A paralleling technique modification to determine the bone crest level around dental implants.

The aim of this report is two-fold. First it analyses the precision of a modification of the parallel technique that can be used in those cases with anatomical limitations. Second, it checks the influence of the reference points' definition of objects to be measured by using both the original and the modified radiographic techniques. 2 intraoral radiographs were taken of 28 implants with 2 different methods: a standard paralleling technique and a modified technique that used a smaller film and a silicone spacer to ensure parallelism. Measurements of peri-implant bone levels and implant width were made in triplicate on digitized film radiographs. The results of the peri-implant bone levels were that with the parallel method the mean was 0.44 mm and the precision was 0.43 mm, and with the modified method the mean was 0.73 mm and the precision was 0.66 mm. In addition to the correct localization of the point of reference in this study, the precision with the parallel method was 0.08 mm and with the modified method was 0.13 mm. Although it was greater with the gold standard technique than with the modified technique, precision was very high for both methods and accurate enough for clinical use.

Biowaiver monographs for immediate release solid oral dosage forms: furosemide.

Literature and new experimental data relevant to the decision to allow a waiver of in vivo bioequivalence (BE) testing for the approval of immediate release (IR) solid oral dosage forms containing furosemide are reviewed. The available data on solubility, oral absorption, and permeability are sufficiently conclusive to classify furosemide into Class IV of the Biopharmaceutics Classification System (BCS). Furosemide's therapeutic use and therapeutic index, its pharmacokinetic properties, data related to the possibility of excipient interactions and reported BE/bioavailability (BA) problems are also taken into consideration. In view of the data available, it is concluded that the biowaiver procedure cannot be justified for either the registration of new multisource drug products or major postapproval changes (variations) to existing drug products.

A hollow-bulb interim obturator for maxillary resection. A case report.

The treatment of hemimaxillectomy patients include the construction of an interim obturator in the wound healing period. With the aim of simplifying this process, we describe construction of an obturator in a short single visit, in the dental chair with no need for impressions or for laboratory services. The obturator comprises: (i) the surgical obturator and (ii) a hollow light-cured resin bulb built onto the base, and providing a large surface for bonding of the soft reline material. The advantages of this approach are rapid construction and ease of ongoing adjustment during the healing process.

Electromyographic analysis of the masticatory muscles of patients after complete rehabilitation of occlusion with protection by non-working side contacts.

Surface electromyography was used to study the function of the anterior temporal, surface masseter, deep masseter and anterior digastric muscles of 14 patients after complete rehabilitation of occlusion with fixed prostheses and/or removable partial prostheses. All patients had a balanced occlusion with protection by non-working side contacts during lateral excursion. Mean resting myoelectric activity was 2.5-3.8 microV, showing no hypertonia or muscular spasm. When patients clenched their teeth (i.e. exerted maximum voluntary occlusal force in centric occlusion), the anterior temporal muscles were the most active, followed by the surface masseters; the digastrics were significantly less active. During lateral displacements, the muscles exhibiting significantly higher potentials than the other muscles monitored were the working side anterior temporal muscle and the contralateral surface masseter. During mastication, the muscle that was most active in relation to its contralateral homologue was the working side surface masseter, the difference between the two being statistically significant.

An esthetically attractive twin-flex clasp for removable partial dentures.

The cosmetic appearance of a removable partial denture is of great importance to both the patient and the dentist. Traditional facial clasp arms are usually unsightly. Other options are expensive and/or technically difficult, and may require time-consuming maintenance. Furthermore, when these clasps are broken, replacement of the entire removable partial denture may be required. This article describes a procedure for making a simple but effective twin-flex clasp. The clasp has excellent esthetics and can be readily adjusted or replaced.