RESUMO
BACKGROUND: Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010. OBJECTIVES: To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We considered randomised and quasi-randomised controlled trials that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent front teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required. MAIN RESULTS: Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review.One study at high risk of bias with 69 participants (138 teeth) compared a 20-minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing.One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth.A third study at high risk of bias with 19 participants compared extra- or intra-oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing.The fourth study at high risk of bias with 73 participants compared a 10-minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival. AUTHORS' CONCLUSIONS: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well-designed randomised controlled trials.
Assuntos
Incisivo/lesões , Avulsão Dentária/cirurgia , Reimplante Dentário/métodos , Desenvolvimento Ósseo/fisiologia , Hidróxido de Cálcio/uso terapêutico , Demeclociclina/uso terapêutico , Combinação de Medicamentos , Humanos , Oxigenoterapia Hiperbárica , Ligamento Periodontal/crescimento & desenvolvimento , Cuidados Pré-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Irrigantes do Canal Radicular/uso terapêutico , Descoloração de Dente/induzido quimicamente , Triancinolona Acetonida/uso terapêuticoRESUMO
Hyponatremia is the most common electrolyte disorder. With the aging of the population and the greater propensity of the elderly to develop hyponatremia, this electrolyte disorder is of increasing importance to the practicing nephrologist. In this Attending Rounds, an illustrative patient with hyponatremia is presented. The reasons for the increased incidence and prevalence of hyponatremia in the elderly are discussed, with emphasis on the effects of aging on urinary dilution, the frequently multifactorial nature of hyponatremia in this population, and the absence of a definite cause for inappropriate and persistent vasopressin release in many such patients. The rationale for treating the hyponatremia, even when apparently asymptomatic, is discussed, with attention to cognitive function, gait, and bone structure disturbances that increase the risk for fractures. The various available treatment approaches, including water restriction, demeclocycline, loop diuretics with NaCl supplementation, urea, and vasopressin antagonists are summarized, with emphasis on the efficacy and limitations of each of these therapies.
Assuntos
Hiponatremia , Fatores Etários , Idoso , Antagonistas dos Receptores de Hormônios Antidiuréticos , Biomarcadores/sangue , Doença Crônica , Demeclociclina/uso terapêutico , Ingestão de Líquidos , Feminino , Antagonistas de Hormônios/uso terapêutico , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Valor Preditivo dos Testes , Fatores de Risco , Sódio/sangue , Cloreto de Sódio/uso terapêutico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Resultado do Tratamento , Ureia/uso terapêutico , Micção , Equilíbrio HidroeletrolíticoRESUMO
AIM: To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus. SUMMARY: A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues. KEY LEARNING POINTS: Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.
Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Dens in Dente/diagnóstico , Imageamento Tridimensional/métodos , Incisivo/anormalidades , Modelos Dentários , Plásticos/química , Adolescente , Compostos de Alumínio/uso terapêutico , Antibacterianos/uso terapêutico , Compostos de Cálcio/uso terapêutico , Desenho Assistido por Computador , Demeclociclina/uso terapêutico , Dens in Dente/classificação , Dens in Dente/terapia , Fístula Dentária/diagnóstico , Cavidade Pulpar/patologia , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Incisivo/patologia , Óxidos/uso terapêutico , Planejamento de Assistência ao Paciente , Abscesso Periapical/diagnóstico , Radiografia Interproximal , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Tratamento do Canal Radicular/métodos , Silicatos/uso terapêutico , Triancinolona Acetonida/uso terapêuticoRESUMO
Etiopathogenesis, diagnostics and therapy of hyponatremias are summarized for clinicians. Hyponatremia is the most common electrolyte abnormality. Mild to moderate hyponatremia and severe hyponatremia are found in 15-30% and 1-4% of hospitalized patients, respectively. Pathophysiologically, hyponatremias are classified into two groups: hyponatremia due to non-osmotic hypersecretion of vasopressin (hypovolemic, hypervolemic, euvolemic) and hyponatremia of non-hypervasopressinemic origin (pseudohyponatremia, water intoxication, cerebral salt wasting syndrome). Patients with mild hyponatremia are almost always asymptomatic. Severe hyponatremia is usually associated with central nervous system symptoms and can be life-threatening. Diagnostic evaluation of patients with hyponatremia is directed toward identifying the extracellular fluid volume status, the neurological symptoms and signs, the severity and duration of hyponatremia, the rate at which hyponatremia developed. The first step to determine the probable cause of hyponatremia is the differentiation of the hypervasopressinemic and non-hypervasopressinemic hyponatremias with measurement of plasma osmolality, glucose, lipids and proteins. For further differential diagnosis of hyponatremia, the determination of urine osmolality, the clinical assessment of extracellular fluid volume status and the measurement of urine sodium concentration provide important information. The most important representative of euvolemic hyponatremias is SIADH. The diagnosis of SIADH is based on the exclusion of other hyponatremic conditions; low plasma osmolality (<275 mosmol/kg) and inappropriate urine concentration (urine osmolality >100 mosmol/kg) are of pathognomic value. Acute (<48 hrs) severe hyponatremia (<120 mmol/l) necessitates emergency care with rapid restoration of normal osmotic milieu (1 mmol/l/hr increase rate of serum sodium). Patients with chronic symptomatic hyponatremia have a high risk of osmotic demyelination syndrome in brain if rapid correction of the plasma sodium occurs (maximal rate of correction of serum sodium should be 0.5 mmol/l/hr or less). The conventional treatments for chronic asymptomatic hyponatremia (except hypovolemic patients) include water restriction and/or the use of demeclocycline or lithium or furosemide and salt supplementation. Vasopressin receptor antagonists have opened a new forthcoming therapeutic era. V2 receptor antagonists, such as lixivaptan, tolvaptan, satavaptan and the V2+V1A receptor antagonist conivaptan promote the electrolyte-sparing excretion of free water and lead to increased serum sodium.
Assuntos
Hiponatremia/etiologia , Hiponatremia/terapia , Sódio/sangue , Vasopressinas/metabolismo , Antagonistas dos Receptores de Hormônios Antidiuréticos , Azepinas/uso terapêutico , Benzamidas/uso terapêutico , Benzazepinas/uso terapêutico , Volume Sanguíneo , Encefalopatias/etiologia , Sistema Nervoso Central/metabolismo , Doença Crônica , Demeclociclina/uso terapêutico , Doenças Desmielinizantes/etiologia , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Líquido Extracelular/metabolismo , Furosemida/uso terapêutico , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/urina , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/diagnóstico , Compostos de Lítio/uso terapêutico , Morfolinas/uso terapêutico , Concentração Osmolar , Osmose , Pirróis , Índice de Gravidade de Doença , Compostos de Espiro/uso terapêutico , Fatores de Tempo , Tolvaptan , Vasopressinas/sangueRESUMO
The prognosis of replanted teeth depends on several factors, the most important being the length of extra-oral dry time. Studies show that after 60 min dry time, root resorption is predicted. Immediate intracanal placement of Ledermix, a paste containing triamcinolone (corticosteroid) and demeclocycline (tetracycline) has been shown to inhibit root resorption after extended dry time. However, discoloration is possible from the tetracycline in Ledermix. To evaluate the individual influence of corticosteroid and tetracycline on external root resorption after extended extra-oral dry time. Sixty-nine premolar roots of four beagle dogs were extracted and instrumented with NiTi files. Group 1 (negative control) was immediately replanted after root filling with GP and sealer; Group 2 (positive control) was root filled with GP and sealer and replanted after 60 min dry time; In groups 3-5, the canals were filled with Ledermix, Triamcinolone, and Demeclocycline, respectively, and replanted after 60 min dry time. After 4 months, the dogs were sacrificed and the roots were examined histologically for type of healing (favorable or unfavorable) and remaining root diameter. The groups treated with Ledermix, Triamcinolone and Demeclocycline had statistically significantly more favorable healing (75.8%; 69.8%; 52.4%) and more remaining root structure (5.59; 5.48; 5.09) than the group filled with GP and sealer (positive control) (0; 1.15). Corticosteroids were as effective as Ledermix at inhibiting external root resorption.
Assuntos
Anti-Inflamatórios/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Reabsorção da Raiz/prevenção & controle , Avulsão Dentária/terapia , Reimplante Dentário , Animais , Demeclociclina/uso terapêutico , Ligas Dentárias , Dessecação , Modelos Animais de Doenças , Cães , Combinação de Medicamentos , Ácido Edético/uso terapêutico , Resinas Epóxi/uso terapêutico , Glucocorticoides/uso terapêutico , Guta-Percha/uso terapêutico , Níquel , Materiais Restauradores do Canal Radicular , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Fatores de Tempo , Titânio , Avulsão Dentária/fisiopatologia , Triancinolona Acetonida/uso terapêutico , Cicatrização/efeitos dos fármacosRESUMO
The aim of this study was to evaluate the time required by four different root canal medications coupled with the temporary filling material Cavit (ESPE, Seefeld, Germany) to prevent penetration of bacteria into the root canal. There were 145 roots prepared in a standardized manner. Four groups with 15 samples each were dressed with calcium hydroxide (Ca(OH)(2)), a 5% chlorhexidine gel (CHX), a chloromono-campherphenolic compound (ChKM), and Ledermix (LM), respectively, and sealed with Cavit. Four control groups contained identical medications but the roots were left unsealed. The 25 remaining roots served as additional controls. A standard setup for bacterial leakage studies was chosen with Staphylococcus epidermidis as test strain. Cavit application resulted in a significantly better seal compared with the unsealed groups. In the Cavit-sealed groups, all groups differed significantly from one another except for the CHX and the ChKM groups. The Ca(OH)(2) medicated roots provided the longest protection (median of 36 days), followed by the Ledermix-group (27 days) and the CHX (18 days) or ChKM groups (19 days). It may be concluded that Cavit-sealed and medicated root canals do not provide adequate protection against bacterial leakage for more than 1 month.
Assuntos
Infiltração Dentária/prevenção & controle , Irrigantes do Canal Radicular/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Sulfato de Cálcio , Cânfora/uso terapêutico , Clorofenóis/uso terapêutico , Dente Canino , Demeclociclina/uso terapêutico , Cimentos Dentários , Infiltração Dentária/microbiologia , Combinação de Medicamentos , Humanos , Polivinil , Materiais Restauradores do Canal Radicular , Staphylococcus epidermidis , Triancinolona Acetonida/uso terapêutico , Óxido de ZincoRESUMO
AIM: To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain. METHODOLOGY: Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study. Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis. All teeth underwent conventional root canal treatment, which involved the instrumentation to the apices of each canal at the first visit. Canals were instrumented using a stepback technique and hand-files along with irrigants using Milton's (1% sodium hypochlorite) solution followed by 15% EDTAC. The canals were dried and one of the following three medicaments was inserted into the canal in random sequence: Group 1: Ledermix paste (Lederle Pharmaceuticals, Division of Cyanamid, Wolfratshausen, Germany); Group 2: calcium hydroxide paste (Calcipulpe, Septodont, France); and Group 3: no dressing. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days. RESULTS: The mean score pain for all three groups was between 42 and 48 prior to treatment being commenced. After 4 days, the pain score for Group 2 was 10, for Group 3 was 7 and for Group 1 was 4. Mean preoperative pain level was 44.4 (of a maximum 100) for all groups, and declined by 50% (to 22.1) after 24 h. Patients in Group 1 (Ledermix) experienced significantly less (P = 0.04) postoperative pain than those in the other two groups. There was no significant difference between Group 2 (calcium hydroxide) and Group 3 (no dressing). CONCLUSION: Under the conditions of this study, painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all. Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis, with a rapid onset of pain reduction.
Assuntos
Demeclociclina/uso terapêutico , Necrose da Polpa Dentária/terapia , Glucocorticoides/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Periodontite Periapical/terapia , Irrigantes do Canal Radicular/uso terapêutico , Odontalgia/prevenção & controle , Triancinolona Acetonida/uso terapêutico , Antibacterianos/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Sulfato de Cálcio , Cimentos Dentários , Combinação de Medicamentos , Tratamento de Emergência , Humanos , Metilmetacrilatos , Medição da Dor , Polivinil , Estudos Prospectivos , Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular , Método Simples-Cego , Óxido de Zinco , Cimento de Óxido de Zinco e EugenolRESUMO
Carbamazepine (CBZ)-induced water intoxication occasionally limits its usefulness in refractory seizures and trigeminal neuralgia. Fluid restriction, CBZ dose reduction, or concomitant phenytoin therapy may be impractical or ineffective. Demeclocycline (7-chloro-6 demethyl tetracycline) (DMC) corrected the CBZ-induced water intoxication in a 51-year-old man with refractory complex partial seizures and a normal antidiuretic hormone (ADH) level. DMC inhibits ADH-sensitive adenylate cyclase activity in the renal collecting duct and may be useful in correcting the ADH-like or renal antidiuretic effect of CBZ.
Assuntos
Carbamazepina/efeitos adversos , Demeclociclina/uso terapêutico , Intoxicação por Água/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Vasopressinas/metabolismo , Intoxicação por Água/induzido quimicamente , Intoxicação por Água/metabolismoAssuntos
Mycoplasma pneumoniae/efeitos dos fármacos , Pneumonia por Mycoplasma/tratamento farmacológico , Adolescente , Adulto , Animais , Criança , Cricetinae , Demeclociclina/uso terapêutico , Modelos Animais de Doenças , Eritromicina/uso terapêutico , Humanos , Testes de Sensibilidade Microbiana , Pneumonia por Mycoplasma/prevenção & controle , Tetraciclina/uso terapêuticoRESUMO
The success of lithium in the treatment of manic-depressive illness has highlighted the problems posed by the minority of bipolar patients who are lithium nonresponders or who suffer severe adverse effects. A number of possible alternative treatments have been proposed, and the evidence in support of their clinical efficacy is evaluated. At this time, only the anticonvulsant carbamazepine can be regarded as a clinically applicable potential alternative to lithium. Further controlled studies are needed before the antimanic and prophylactic efficacy of carbamazepine can be regarded as conclusively established. Other treatment approaches are of considerable theoretical interest and of potential value clinically but need to be more thoroughly evaluated.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Ácido Ascórbico/uso terapêutico , Bupropiona , Carbamazepina/uso terapêutico , Colina/uso terapêutico , Clonazepam/uso terapêutico , Clonidina/uso terapêutico , Clorgilina/uso terapêutico , Demeclociclina/uso terapêutico , Fenfluramina/uso terapêutico , Humanos , Azul de Metileno/uso terapêutico , Fosfatidilcolinas/uso terapêutico , Fisostigmina/uso terapêutico , Propiofenonas/uso terapêutico , Propranolol/uso terapêutico , Espironolactona/uso terapêutico , Tiroxina/uso terapêutico , Triptofano/uso terapêutico , Ácido Valproico/uso terapêuticoRESUMO
The anti-diuretic action of carbamazepine, before and after concurrent treatment with demeclocycline, has been studied in a single epileptic subject, in whom two episodes of status epilepticus had been associated with excessive fluid intake and hyponatraemia. After addition of demeclocyline, free water clearance, plasma arginine vasopressin concentration and serum osmolality (all appreciably reduced after carbamazepine alone) increased but did not revert to normal. The findings are consistent with direct antagonism by demeclocycline of the enhancing effect of carbamazepine on endogenous ADH activity.
Assuntos
Carbamazepina/efeitos adversos , Demeclociclina/uso terapêutico , Intoxicação por Água/tratamento farmacológico , Adulto , Carbamazepina/antagonistas & inibidores , Feminino , Humanos , Vasopressinas/metabolismo , Intoxicação por Água/induzido quimicamenteRESUMO
Demeclocycline, a competitive inhibitor of antidiuretic hormone at renal tubules, was studied in a patient with the syndrome of psychosis, psychogenic polydipsia, and episodic water intoxication. Under double-blind, placebo-controlled conditions, demeclocycline substantially reduced the severity and frequency of hyponatremic episodes.
Assuntos
Demeclociclina/uso terapêutico , Esquizofrenia/complicações , Intoxicação por Água/prevenção & controle , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Hiponatremia/prevenção & controle , Hiponatremia/psicologia , Síndrome de Secreção Inadequada de HAD/tratamento farmacológico , Psicologia do Esquizofrênico , Intoxicação por Água/psicologiaRESUMO
Comparative studies on the blood schizontocidal activity of antibiotics against Plasmodium gallinaceum infection of chicks have shown that doxycycline, minocycline, demeclocycline, tetracycline and oxytetracycline possess high antimalarial activity as judged by suppression of parasitaemia and extension of survival period. Of these, demeclocycline, tetracycline and oxytetracycline were effective only at high dose level. Chloramphenicol, erythromycin and gentamicin were relatively inactive. Treatment in 5- to 6-day-old established infection of chicks has shown that doxycycline and minocycline are relatively more effective than oxytetracycline and tetracycline in controlling acute infection.
Assuntos
Antibacterianos/uso terapêutico , Antimaláricos , Malária Aviária/tratamento farmacológico , Administração Oral , Animais , Antibacterianos/administração & dosagem , Galinhas , Cloranfenicol/uso terapêutico , Demeclociclina/uso terapêutico , Relação Dose-Resposta a Droga , Doxiciclina/uso terapêutico , Avaliação de Medicamentos , Eritromicina/uso terapêutico , Gentamicinas/uso terapêutico , Injeções Intraperitoneais , Malária Aviária/mortalidade , Minociclina/uso terapêutico , Oxitetraciclina/uso terapêutico , Tetraciclina/uso terapêuticoRESUMO
The therapeutic value of various ultraviolet treatments was assessed in patients with moderately severe papulopustular acne. The results did not verify the common belief that ultraviolet radiation is highly beneficial. In no instance was the comedo count appreciably reduced. Modest improvement was observed with sunburn rays (UV-B) and slightly more with the combination of long ultraviolet radiation (UV-A) and UV-B. UV-A alone had the least effect. Photosensitization with coal tar and UV-A greatly aggravated acne and was notably comedogenic. Photosensitization with methoxsalen (8-methoxypsoralen) applied topically was neither harmful nor helpful.