Effect of Multilayering Incremental Technique on the Microleakage of High-viscosity Bulk-fill Composite Restorations in Endodontically Treated Teeth.

AIM: The aim of this study is to evaluate the effect of multilayering incremental technique on the microleakage of high-viscosity bulk-fill composite restorations in endodontically treated teeth. MATERIALS AND METHODS: A total of 60 human mandibular premolar teeth were divided into four groups after standardized access preparation with a protaper technique followed by single-cone obturation to receive the following restorations for the access preparations. Group I (n = 20): bulk-fill composite (Filtek™ Bulk fill) using a bulk technique, group II (n = 20): bulk-fill composite (Filtek™ Bulk fill) using an incremental layering technique, group III (negative control) (n = 10): gutta-percha was kept intact at the access orifice and covered with a nail polish, and group IV (positive control) (n = 10): gutta-percha was kept intact at the orifice. The samples were thermocycled at 5°C and 55°C for 500 cycles followed by dye penetration with 2% methylene blue and then the scoring was done under a stereomicroscope at 10× magnification. The data so obtained were compared for microleakage using a Chi-square test. There was a significant difference among all the groups except groups II and III. RESULTS: Bulk-fill composites used with an incremental layering technique sealed significantly better than the other groups followed by bulk-fill composite in the bulk technique. CONCLUSION: Within the limitations of the present study, it can be concluded that the incremental layering technique with bulk-fill composites significantly decreases microleakage in the restored access preparations of endodontically treated teeth.

Adalimumab for the treatment of Japanese patients with intestinal Behçet's disease.

BACKGROUND & AIMS: Behçet's disease is a chronic, relapsing inflammatory disease that can involve the mouth, skin, eyes, genitals, and intestines. Active intestinal Behçet's disease can be complicated by gastrointestinal (GI) bleeding and perforation. We performed a multicenter, open-label, uncontrolled study to evaluate the efficacy and safety of adalimumab, a fully human monoclonal antibody against tumor necrosis factor α, in patients with intestinal Behçet's disease who were refractory to corticosteroid and/or immunomodulator therapies. METHODS: The study was conducted at 12 sites in Japan, from November 2010 through October 2012. Twenty patients were given 160 mg adalimumab at the start of the study and 80 mg 2 weeks later, followed by 40 mg every other week for 52 weeks; for some patients, the dose was increased to 80 mg every other week. A composite efficacy index, combining GI symptom and endoscopic assessments, was used to evaluate efficacy. The primary efficacy end point was the percentage of patients with scores of 1 or lower for GI symptom and endoscopic assessments at week 24. Secondary end points included complete remission and resolution of non-GI Behçet's-related symptoms. RESULTS: Nine patients (45%) had GI symptom and endoscopic assessment scores of 1 or lower at week 24 of treatment, and 12 patients (60%) had these scores by week 52. Four patients (20%) achieved complete remission at weeks 24 and 52. Individual global GI symptom and endoscopic scores improved for most patients at weeks 24 and 52. Two thirds of patients with oral aphthous ulcers, skin symptoms, and genital ulcers, and 88% of patients with erythema nodosum had complete resolution of these conditions at week 52. A total of 9 of 13 patients (69%) taking steroids at baseline were able to taper (n = 1) or completely discontinue steroids (n = 8) during the study. No new safety signals were observed. CONCLUSIONS: Adalimumab is a potentially effective treatment for intestinal Behçet's disease in Japanese patients who are refractory to conventional treatments. ClinicalTrials.gov number: NCT01243671.

Ablation of TRPV1+ Afferent Terminals by Capsaicin Mediates Long-Lasting Analgesia for Trigeminal Neuropathic Pain.

Trigeminal neuropathic pain (TNP) is often resistant to current pharmacotherapy, and there is a pressing need to develop more efficacious treatments. Capsaicin is a pungent ingredient of chili peppers and specifically activates transient receptor potential vanilloid subtype 1 (TRPV1), a Ca2+-permeable ion channel. Topical capsaicin invariably induces burning pain. Paradoxically, the transient pain is often followed by prolonged attenuation of the preexisting pathologic pain from the same region. However, the mechanisms underlying capsaicin-induced analgesia are not well understood. Although the reports of the involvement of TRPV1 and TRPV1+ afferents in neuropathic pain are controversial, we recently demonstrated that TRPV1 and TRPV1+ afferents are involved in mechanical hyperalgesia in mice with chronic constriction injury of the infraorbital nerve (ION-CCI). Consistently, chemogenetic inhibition of TRPV1-lineage (TRPV1-LN) afferents attenuated mechanical hyperalgesia and ongoing pain. In mice with ION-CCI, we found that a single focal injection of capsaicin into facial skin led to attenuation of mechanical hyperalgesia over two weeks. Capsaicin treatment also attenuated secondary hyperalgesia in extraterritorial mandibular skin. Furthermore, capsaicin treatment decreased ongoing pain. Longitudinal in vivo two-photon imaging of cutaneous nerve fibers showed that such capsaicin-induced analgesia is correlated with cutaneous nerve terminal density. Furthermore, preventing capsaicin-induced ablation of afferent terminals by co-administration of capsaicin with MDL28170, an inhibitor of calpain, abolished capsaicin-induced analgesia. These results suggest that a single focal injection of capsaicin induces long-lasting analgesia for neuropathic pain via selective ablation of TRPV1+ afferent terminals and that TRPV1+ afferents contribute to the maintenance of TNP.

Banking stem cells from human exfoliated deciduous teeth (SHED): saving for the future.

Tooth derived cells are readily accessible and provide an easy and minimally invasive way to obtain and store stem cells for future use. Banking ones own tooth-derived stem cells is a reasonable and simple alternative to harvesting stem cells from other tissues. Obtaining stem cells from human exfoliated deciduous teeth (SHED) is simple and convenient, with little or no trauma. Every child loses primary teeth, which creates the perfect opportunity to recover and store this convenient source of stem cells--should they be needed to treat future injuries or ailments and presents a far better alternative to simply discarding the teeth or storing them as mementos from the past. Furthermore, using ones own stem cells poses few, if any, risks for developing immune reactions or rejection following transplantation and also eliminates the potential of contracting disease from donor cells. Stem cells can also be recovered from developing wisdom teeth and permanent teeth. Individuals have different opportunities at different stages of their life to bank these valuable cells. It is best to recover stem cells when a child is young and healthy and the cells are strong and proliferative. The purpose of this review is to discuss the present scenario as well as the technical details of tooth banking as related to SHED cells.

An in vitro comparative evaluation of different intraorifice barriers on the fracture resistance of endodontically treated roots obturated with gutta-percha.

AIM: To compare and evaluate the root reinforcement potential of four different intraorifice barriers: Mineral trioxide aggregate (MTA), resin-modified glass ionomer cement (RMGIC), fiber-reinforced composite (FRC), and nanohybrid composite (NC). MATERIALS AND METHODS: Seventy-five mandibular premolars were decoronated to a standardized length, and prepared and obturated with gutta-percha and AH Plus sealer. Except for control specimens, the coronal 3-mm gutta-percha was removed and filled with different materials. The specimens (75) were divided into five groups (n = 15) on the basis of the intraorifice barrier material used. Group 1: MTA, Group 2: RMGIC, Group 3: FRC, Group 4: NC, Group 5: no barrier (control). Fracture resistance of the specimens was tested. RESULTS: Fracture resistance of roots was significantly affected by the type of intraorifice barrier used and the following pattern was observed: RMGIC > FRC > NC > MTA. CONCLUSION: Intraorifice barriers can be regarded as a viable choice to reduce the occurrence of postendodontic root fractures. Among the four tested materials, RMGIC showed the maximum reinforcement.

Juvenile ossifying fibroma diagnosed on fine needle aspiration cytology: a diagnostic challenge.

Preoperative diagnosis of jaw lesions is not always possible on the basis of clinico-radiological findings alone and needs to be confirmed before attempting any surgical intervention. Fibro-osseous lesions of the jaw comprise a spectrum of diseases which include cement-osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The cytomorphological distinction between these individual entities is difficult. We present a case of maxillary fibro-osseous lesion in an adolescent girl diagnosed and categorized as juvenile ossifying fibroma preoperatively on cytology and confirmed on histopathology. Although aspirates are usually paucicellular in fibro-osseous lesions, certain cytological features if present in cellular cytosmears can offer further categorization and a definitive diagnosis may be possible in light of clinico-radiological correlation.

Implant biomaterials: A comprehensive review.

Appropriate selection of the implant biomaterial is a key factor for long term success of implants. The biologic environment does not accept completely any material so to optimize biologic performance, implants should be selected to reduce the negative biologic response while maintaining adequate function. Every clinician should always gain a thorough knowledge about the different biomaterials used for the dental implants. This article makes an effort to summarize various dental bio-materials which were used in the past and as well as the latest material used now.

Comparative evaluation of microleakage in Class II restorations using open vs. closed centripetal build-up techniques with different lining materials.

BACKGROUND: Evaluation of microleakage is important for assessing the success of new restorative materials and methods. AIM AND OBJECTIVES: Comparative evaluation of microleakage in Class II restorations using open vs. closed centripetal build-up techniques with different lining materials. MATERIALS AND METHODS: Standardized mesi-occlusal (MO) and distoocclusal (DO) Class II tooth preparations were preparedon 53 molars and samples were randomly divided into six experimental groups and one control group for restorations. Group 1: Open-Sandwich technique (OST) with flowable composite at the gingival seat. Group 2: OST with resin-modified glass ionomer cement (RMGIC) at the gingival seat. Group 3: Closed-Sandwich technique (CST) with flowable composite at the pulpal floor and axial wall. Group 4: CST with RMGIC at the pulpal floor and axial wall. Group 5: OST with flowable composite at the pulpal floor, axial wall, and gingival seat. Group 6: OST with RMGIC at the pulpal floor, axial wall, and gingival seat. Group 7: Control - no lining material, centripetal technique only. After restorations and thermocycling, apices were sealed and samples were immersed in 0.5% basic fuchsin dye. Sectioning was followed by stereomicroscopic evaluation. RESULTS: Results were analyzed using Post Hoc Bonferroni test (statistics is not a form of tabulation). Cervical scores of control were more than the exprimental groups (P < 0.05). Less microleakage was observed in CST than OST in all experimental groups (P < 0.05). However, insignificant differences were observed among occlusal scores of different groups (P > 0.05). CONCLUSION: Class II composite restorations with centripetal build-up alone or when placed with CST reduces the cervical microleakage when compared to OST.

Light-cured resin "Barricaid" - An aesthetic and biocompatible dressing: A step ahead.

BACKGROUND: Periodontal dressings have been used for several years as a protection over injured tissue to shield the area from further insult. Several dressings are commercially available. A recently introduced light-cured resin, claimed to be more biocompatible and esthetic, needs critical evaluation. AIM: To compare this dressing with most widely used non-eugenol pack in the perspective of esthetics, acceptance, and healing following periodontal flap surgery. MATERIALS AND METHODS: Twenty patients suffering from generalized chronic periodontitis, requiring periodontal flap surgery on contralateral sides of the arch, were selected and divided randomly into Group I (control) and Group II (test). In Group I, a non-eugenol dressing and in Group II light-cured dressing were applied after flap surgery. Pain and discomfort scores were recorded on day 1, 2, and 3 while plaque scores, gingival index, and bleeding index were recorded on day 7. Patient's subjective evaluation and preference for the dressing material were recorded. The data was collected and statistically analyzed. RESULTS: Group II showed better results than Group I when plaque scores, bleeding scores, modified gingival index scores, and pain and discomfort scores were compared though the differences were not statistically significant. Subjects found no unpleasant taste/smell and perceived the light-cured dressing to be better. A significantly higher number of patients preferred light-cured resin as a post-surgical dressing over Coe-pak. CONCLUSION: The light-cured dressing showed better patient acceptability and proves to be a better alternative to Coe-pak as a dressing material.

Perio-esthetic surgery: Using LPF with frenectomy for prevention of scar.

An aberrant frenum is postulated to create functional and aesthetic problems. Archer's 'classical frenectomy' is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edward's frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented.