Periodontal Health in Women With Early-Stage Postmenopausal Breast Cancer Newly on Aromatase Inhibitors: A Pilot Study.

BACKGROUND: Aromatase inhibitor (AI) use results in low estrogen levels, which in turn affect bone mineral density (BMD). Periodontitis, alveolar bone loss, and tooth loss are associated with low BMD. The goal of this study is to assess the prevalence of periodontitis and perceived oral health and evaluate salivary biomarkers in postmenopausal women who are survivors of early-stage (I to IIIA) breast cancer (BCa) and receive adjuvant AI therapy. METHODS: Participants included 58 postmenopausal women: 29 with BCa on AIs and 29 controls without BCa diagnoses. Baseline periodontal status was assessed with: 1) periodontal probing depth (PD); 2) bleeding on probing (BOP); and 3) attachment loss (AL). Demographic and dental utilization information was gathered by questionnaire. Linear regression modeling was used to analyze the outcomes. RESULTS: No differences were found in mean PD or number of teeth. The AI group had significantly more sites with BOP (27.8 versus 16.7; P = 0.02), higher worst-site AL (5.2 versus 4.0 mm; P <0.01), and more sites with dental calculus (18.2 versus 6.4; P <0.001) than controls. Linear regression adjusted for income, tobacco use, dental insurance, and previous radiation and chemotherapy exposure demonstrated that AI use increased AL by >2 mm (95% confidence interval, 0.46 to 3.92). Median salivary osteocalcin and tumor necrosis factor-α levels were significantly higher in the AI group than the control group. CONCLUSION: This first investigation of the periodontal status of women initiating adjuvant AI therapy identifies this population as having an increased risk for periodontitis.

Efficacy of laser-driven irrigation versus ultrasonic in removing an airlock from the apical third of a narrow root canal.

The purpose of the study was to test the hypothesis that air entrapment occurs in the apical third of a root canal during irrigation. A second objective was to test the null hypothesis that there is no difference between laser-driven irrigation (an erbium, chromium:yttrium-scandium-gallium-garnet laser) and passive ultrasonic irrigation in removing an airlock from the apical third. One hundred twenty extracted human teeth with single narrow root canals were randomised into two experimental groups (n = 40) and two control groups (n = 20). The specimens were shaped using hand instruments up to a size 30/0.02 file. The teeth were irrigated with a mixture of saline, radiopaque contrast and ink in solution. In the passive ultrasonic irrigation group, the irrigant was activated with an ultrasonic device for 60 s. In the laser group, the irrigant was activated with a laser for 60 s. It was concluded that if the insertion of irrigation needle is shorter than the working length, air entrapment may develop in the apical third, but the use of laser-driven irrigation is completely effective in removing it.

The role of glass ionomer cement on the remineralization of infected dentin: an in vivo study.

PURPOSE: This study's purpose was to investigate the effect of a glass ionomer cement as a liner over infected unexcavated dentin after 60 days and at 10 to 15 months. METHODS: Forty-five permanent molars with deep carious lesions were selected. Fragments of carious dentin were removed prior to lining the cavity (baseline sample) with glass ionomer cement (G1) or an inert wax material (G2). Cavities were restored with composite resin and reopened 60 days later, when other fragments were removed (60-day sample). The dentin morphology (scanning electron microscopy) and mineral content of calcium, phosphorus, and fluorine were assessed. During the follow-up periods (60 days and 10 to 15 months), restorations were evaluated and standardized radiographs were taken. A postprocessing routine was used to identify changes in the radiographic density between periods. RESULTS: After 60 days, the dentin exhibited a better organization, fewer bacteria, and signs of remineralization. The weight percents of calcium and phosphorus were higher 60 days after the cavity sealing, regardless of the group. Higher gray levels of carious and sound dentin were seen on the 10- to 15-month radiographs, irrespective of the group. The success rates of G1 and G2 were 89 percent and 88 percent, respectively. CONCLUSIONS: The lining material isn't fundamental for caries arrestment. Early (60-day) and late (10 to 15 months) dentin changes occurred, indicating the remineralization of dentin carious tissue.

Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols.

INTRODUCTION: Regenerative endodontics is a promising alternative treatment for immature teeth with necrotic pulps. The present study was performed to assess the regenerative potential of young permanent immature teeth with necrotic pulp after the following treatment protocols: (1) a mineral trioxide aggregate (MTA) apical plug, (2) the regenerative endodontic protocol (blood clot scaffold), and (3) the regenerative endodontic protocol with a blood clot and an injectable scaffold impregnated with basic fibroblast growth factor. METHODS: Immature necrotic permanent maxillary central incisors (n = 36) of patients 9-13 years old were divided into 3 groups according to the treatment protocol: the MTA group (MTA apical plug), the REG group (regenerative endodontic protocol [blood clot]), and the FGF group (regenerative endodontic protocol [blood clot + injectable scaffold]). Follow-up was done up to 18 months. Standardized radiographs were digitally evaluated for an increase in root length and thickness, a decrease in the apical diameter, and a change in periapical bone density. RESULTS: After a follow-up period of 18 months, most of the cases showed radiographic evidence of periapical healing. Groups 2 and 3 showed a progressive increase in root length and width and a decrease in apical diameter. CONCLUSIONS: The regenerative endodontic procedure allowed the continued development of roots in teeth with necrotic pulps. The use of artificial hydrogel scaffold and basic fibroblast growth factor was not essential for repair.

Comparison of orange oil and chloroform as gutta- percha solvents in endodontic retreatment.

OBJECTIVE: To compare the efficacy of gutta-percha removal achieved with simple mechanical technique using two different solvents. MATERIALS AND METHODS: It was an in vitro experimental study conducted at the Aga Khan University Hospital, Karachi, Pakistan on 27 extracted human molars divided into two groups by alternate sampling technique. The teeth were prepared by manual filing and obturated with gutta-percha and calcium hydroxide sealer. Two drops of the assigned solvent were placed on the orifice of the obturated canal and Gates Glidden drills #1, 2 and 3 were used for removal of coronal gutta-percha. Manual filing was done for removal of remaining gutta-percha and the solvent was used in drops until needed. Postoperative periapical radiographs were taken to visualize the remaining gutta-percha left in the canals. Descriptive statistics (mean and SD) of the variables such as tooth type, obturation length and canal curvatures were determined. Chi-square and independent sample t-tests were applied and level of significance was set at 0.05. RESULTS: There was 5.19 (3.8) mm of remaining gutta-percha in the orange oil group and 5.37 (4.2) mm in the chloroform group (p=0.90). CONCLUSION: There is no statistically significant difference between the orange oil and chloroform when used as solvent for removing gutta-percha.

Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial.

INTRODUCTION: The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant. METHODS: Single-rooted teeth with radiographic evidence of periapical bone loss were randomly assigned to 2 treatment groups. In both groups syringe irrigation was performed, and in one group the irrigant was also activated by ultrasound. Ten to 19 months after treatment, the teeth were examined by using periapical radiography (PA) and cone-beam computed tomography (CBCT). Area and volume of the periapical lesions were measured, and the outcome was presented in 4 categories: absence, reduction or enlargement of the radiolucency, or uncertain. Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20% or more. RESULTS: The recall rate was 82%, and 84 teeth were analyzed. CBCT detected significantly more post-treatment lesions than PA (P = .038), but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar (P = .383). The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth (19%) and reduction of the radiolucency in 61 of 84 teeth (72.6%), but there was no significant difference between the results of the 2 groups (P = .470). Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth (95.1%) and in the syringe group in 38 of 43 teeth (88.4%). CONCLUSIONS: Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing.

Impact of three radiographic methods in the outcome of nonsurgical endodontic treatment: a five-year follow-up.

INTRODUCTION: The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success. METHODS: A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05. RESULTS: CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration. CONCLUSIONS: The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT.

Retrieval of extensive gutta-percha extruded into the maxillary sinus: use of 3-dimensional cone-beam computed tomography.

INTRODUCTION: Close proximity of the maxillary sinus to the roots of maxillary teeth can predispose to the inadvertent deposition of endodontic products into the maxillary sinus. One such material is thermoplasticized injectable gutta-percha, which has gained popularity of late. As a consequence of overfilling, some patients warrant surgical retrieval. METHODS: A case report of extreme overextension of gutta-percha within the maxillary sinus after endodontic retreatment on tooth #14 was provided. The distobuccal and palatal canals had been obturated with gutta-percha master cones and backfilled with thermoplasticized injectable warm gutta-percha. The mesiobuccal canal had only been filled with thermoplasticized injectable warm gutta-percha, the origin of the extrusion. Imagery with 3-dimensional cone-beam computed tomography was performed for localization of the gutta-percha. RESULTS: The patient underwent a Caldwell-Luc approach for removal of the extruded material. The gutta-percha was successfully removed intact, and the patient had an unremarkable postoperative course. However, the patient continues to have mild tenderness in the sinus region. CONCLUSIONS: The featured case exemplified the consequence of overinstrumentation and ensuing inadequate apical stop. In these situations, the obturation of a maxillary tooth with thermoplasticized injectable gutta-percha, without master cones, can potentially result in overfilling and deposition into the antrum. Use of 3-dimensional cone-beam computed tomography could enhance endodontic diagnosis, serve as an aid for visualization of foreign materials within the sinus and contiguous soft tissue structures, and improve clinical outcome.

Metodología del análisis diagnóstico para la operatoria dental clínica / A methodology of diagnostic analysis for clinical operative dentistry

El diagnóstico en operatoria dental clínica es un tópico de difícil resolución en la práctica diaria y más aún en el proceso de enseñanza aprendizaje. Arribar a un correcto diagnóstico presupone un proceso ordenado, meticuloso y responsable. En el presente informe se describe el "diseño diagnóstico" utilizado en la Cátedra de Operatoria II "A" de la Facultad de Odontología de la Universidad Nacional de Córdoba, el cual comprende: 1. Relevamiento de datos con la H. CL. 2. Confección de un odontograma general. 3. Confección de un foto-odontograma individualizado. 4. Utilización de la radio-anatomía aplicada a la radiografía bitewing

Metodología del análisis diagnóstico para la operatoria dental clínica / A methodology of diagnostic analysis for clinical operative dentistry

El diagnóstico en operatoria dental clínica es un tópico de difícil resolución en la práctica diaria y más aún en el proceso de enseñanza aprendizaje. Arribar a un correcto diagnóstico presupone un proceso ordenado, meticuloso y responsable. En el presente informe se describe el "diseño diagnóstico" utilizado en la Cátedra de Operatoria II "A" de la Facultad de Odontología de la Universidad Nacional de Córdoba, el cual comprende: 1. Relevamiento de datos con la H. CL. 2. Confección de un odontograma general. 3. Confección de un foto-odontograma individualizado. 4. Utilización de la radio-anatomía aplicada a la radiografía bitewing (AU)