CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol.

BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.

Effect of acid-etching on the enamel bond of two self-etching systems.

PURPOSE: To evaluate enamel bond strengths of self-etching primer systems with and without the use of phosphoric acid etching. MATERIALS AND METHODS: The enamel of sixteen bovine incisors was ground with wet 600-grit SiC paper, and specimens were divided into seven groups. Group SE and group ABF were bonded with Clearfil SE Bond (Kuraray) and an experimental self-etching primer system ABF (Kuraray) in accordance with the manufacturer's instructions. The enamel of groups SE+AC and ABF+AC was acid-etched (AC) prior to application of the primers. The enamel of groups AC+SE-P and AC+ABF-P was acid-etched and the bonding resin was applied without primer. All of these groups were restored with Clearfil AP-X (Kuraray). For the control group (SB), enamel was etched and bonded with Single Bond (3M) according to manufacturer's instructions and restored with Z-250 (3M). After 24 h of water storage, the teeth were sectioned into 0.7-mm-thick slabs, trimmed for microtensile bond testing and subjected to tensile forces at a cross-head speed of 1 mm/min. After testing, all samples were analyzed with SEM. Data were evaluated by one-way ANOVA and Fisher's PLSD (alpha = 0.05). RESULTS: Acid etching prior to application of the self-etching primer produced higher bond strengths to enamel than self-etching priming only. Omission of the primer step provided bond strengths similar to the other acid-etched groups. SEM analysis revealed that when the acid was applied prior to the self-etching primers, an increase in failure within enamel occurred. CONCLUSION: Since high bond strength to enamel is critical for good margins and seal of the restorations, applying the etching step should be considered in case of restorations that rely mainly on enamel bonding.

Targeted delivery of SiRNA to CD33-positive tumor cells with liposomal carrier systems.

SiRNA molecules represent promising therapeutic molecules, e.g. for cancer therapy. However, efficient delivery into tumor cells remains a major obstacle for treatment. Here, we describe a liposomal siRNA carrier system for targeted delivery of siRNA to CD33-positive acute myeloid leukemia cells. The siRNA is directed against the t(8;21) translocation resulting in the AML1/MTG8 fusion protein. The siRNA was encapsulated in free or polyethylene imine (PEI)-complexed form into PEGylated liposomes endowed subsequently with an anti-CD33 single-chain Fv fragment (scFv) for targeted delivery. The resulting siRNA-loaded immunoliposomes (IL) and immunolipoplexes (ILP) showed specific binding and internalization by CD33-expressing myeloid leukemia cell lines (SKNO-1, Kasumi-1). Targeted delivery of AML1/MTG8 siRNA, but not of mismatch control siRNA, reduced AML1/MTG8 mRNA and protein levels and decreased leukemic clonogenicity, a hallmark of leukemic self-renewal. Although this study revealed that further modifications are necessary to increase efficacy of siRNA delivery and silencing, we were able to establish a targeted liposomal siRNA delivery system combining recombinant antibody fragments for targeted delivery with tumor cell-specific siRNA molecules as therapeutic agents.

Artrografía ATM

Se presenta una revisión de la artrografía de la articulación temporo-mandibular (A.T.M.) y se revisa la fisiopatología de la articulación. Se analiza la experiencia en 225 casos, concluyéndose la utilidad de la artrografía en el diagnóstico de disfunción de la A.T.M. encontrándose que el estudio debe incluir valoración dinámica (grabación en video) y cortes tomográficos lineales