Maturogenesis of an Early Erupted Immature Permanent Tooth: A Case Report With 7-Year Follow-Up.

The main objective of treatment of an undeveloped tooth (immature) is to provide vital pulp therapy to allow continued development of root dentin. A case report is presented that demonstrates the use of calcium hydroxide (CaOH2) as an indirect pulp-copping material for the purpose of continued maturogenesis of an early-erupted permanent tooth with severe mobility and almost-begun root formation. Seven-year radiographic and clinical follow-up demonstrated a vital pulp and physiologic root development without any endodontic failure clinically or radiographicaly.

Treatment of pilonidal disease by combination of pit excision and phenol application.

AIM: To examine the results of our minimal invasive treatment for pilonidal disease. METHODS: Total 83 patients treated by pit excision and consecutive phenol applications on an outpatient setting. All procedures were performed under local anesthesia, without any preoperative testing, colon cleansing, prophylactic antibiotics or sedation. A pit excision (mean length 1.3 ± 0.5 cm) including several close midline orifices was done. Separated pit excisions were done to the remaining midline and lateral orifices. Sinus cavity was cleared of hair and debris, and the walls of the cavity were sclerosed using a cotton bud dipped in 80% liquid phenol. Phenolization was repeated twice on day one and seven. RESULTS: Mean procedure time was 22.2 ± 7.4 min. Rates of patients who did not required analgesics at first, second, third and fourth days after surgery were 58, 85, 91 and 100%, respectively. All the patients returned to work/school after 3 days. Mean wound closure time was 28.5 ± 14.9 days. Total 86.7% of the patients were asymptomatic after a mean 25.7 ± 8.5 months follow-up. CONCLUSION: Simple pit excision and sclerosing the pilonidal sinus cavity consecutively was an effective and minimal invasive method for relief of pilonidal symptoms.

Incidental appendectomy in donors undergoing hepatectomy for living-donor liver transplantation.

BACKGROUND: The aim of this study was to investigate the morbidity associated with appendectomy in living liver donors undergoing hepatectomy. METHODS: The medical records of 338 donors who underwent hepatectomies for living-donor liver transplantation between 2008 and 2010 were reviewed retrospectively. The patients were divided into 2 groups on the basis of appendectomy: patients in group A (n = 126) received incidental appendectomies in conjunction with donor hepatectomy, and those in group B (n = 212) underwent hepatectomy alone. RESULTS: No significant difference in age, gender, or body mass index was found between groups. The wound infection rate (P = .037) and length of hospital stay (P = .0038) were higher in group A than in group B. Intraoperative findings in 126 donors in group A were subserosal (n = 4), retrocecal (n = 6), or hard nodular (n = 11) appendix; hyperemic appendix with edema (n = 9); appendix length ≥ 8 cm (n = 18); and palpable fecalith (n = 78). Histopathologic examination of appendix specimens revealed lymphoid hyperplasia with a fecalith (n = 32), fecalith only (n = 32), acute appendicitis (n = 20), normal anatomy (n = 18), fibrous obliteration (n = 9), lymphoid hyperplasia (n = 9), Enterobius vermicularis (n = 3), appendiceal neuroma (n = 1), carcinoid tumor (n = 1), and mucoceles (n = 1). CONCLUSION: Although incidental appendectomy increased the wound infection rate and length of hospital stay, this procedure is necessary for the prevention of potential complications due to appendicitis when the exploration of the ileocecal region in patients undergoing donor hepatectomy reveals one or more of the following: appendix length ≥ 8 cm; dropsical, hyperemic, subserosal, nodular, and/or retrocecal appendix; and/or palpable fecaloma.

Comparison of harmonic scalpel versus conventional knot tying for transection of short hepatic veins at liver transplantation: prospective randomized study.

The objective of this study was to compare harmonic scalpel for short hepatic vein transection with conventional ligation during recipient hepatectomy with caval preservation. Sixteen patients undergoing elective living donor liver transplantation were randomized into 2 groups. We recorded number, diameter, and location of each short hepatic vein, procedure time, central venous pressure, and degree of liver failure (Child-Pugh and Model for End stage Liver Disease scores). As an end point, we observed the intraoperative and postoperative bleeding rates of the transected veins. We transected 144 veins of mean diameter of 2.6 ± 1.8 mm (range, 1-12 mm). Mean number of short hepatic veins in each person was 9 (range, 5-16). Harmonic scalpel was safe for veins with a diameter ≤ 2 mm; these veins were more prone to bleeding with conventional ligation. Bleeding rate was higher after ligation of veins in the upper half than the lower half of the cava (37% vs 21%; P = .04). Both total and per vessel procedure time did not differ between the groups. No postoperative bleeding complications occurred. Transection of veins with a diameter ≤ 2 mm by harmonic scalpel was as safe as conventional ligation. Harmonic scalpel transection of small hepatic veins (≤ 2 mm) can be even safer than conventional control by knot tying, particularly in narrow areas.

Replacement of the vena cava with aortic graft for living donor liver transplantation in Budd-Chiari syndrome associated with hydatid cyst surgery: a case report.

A 12-year-old girl, operated because of a hydatid cyst of the liver, with Budd-Chiari syndrome was evaluated for postoperative development of ascites and paraumbilical varicose veins. A vena caval stent was placed for the relief of inferior vena caval obstruction. The patient was admitted because of progressive deterioration in ascites and liver functions. Imaging techniques showed degeneration adjacent to the right hepatic vein in liver segments 7 to 8, a partially calcified 5-cm hydatid cyst, and a thrombosis in the inferior vena cava was that addressed with a 10-cm metal stent. A living donor segments 2 to 3 liver transplantation was obtained from the patient's mother. After completion of the donor operation without complications, the vena caval stent was removed following the recipient hepatectomy. Suprarenal flow continued after resection of the fibrotic vena cava and placement of a cadaveric cryopreserved aortic graft for the vena cava, anastomosed between the suprarenal and subdiaphragmatic segments of the vena cava. An end-to-side anastomosis was performed between the left hepatic vein of the donor liver and the aortic graft. There was no complication and the patient was discharged on postoperative day 19. Follow-up Doppler ultrasonography showed the aortic vena caval graft to be open, along with the hepatic/portal vein and hepatic artery. This case demonstrated that operations for liver hydatid cyst surgeries can iatrogenically induce Budd-Chiari syndrome; a cryopreserved aortic graft can be an alternative to ensure the continuity of the vena cava in living donor liver transplantation.

Living donor liver transplantation in the absence of inferior vena cava: a case report.

Because of difficulties in the supply of cadaveric organs, of living donor liver transplantations are performed in increasing numbers. Congenital hepatic fibrosis associated with fibrosis and atrophy of the inferior vena cava were present in a potential recipient of living donor liver transplantation. This case report documented living donor liver transplantation as a treatment modality for a patient with absence of the inferior vena cava due to chronic liver failure.

Clinical long-term evaluation of MTA as a direct pulp capping material in primary teeth.

AIM: To evaluate the effectiveness of mineral trioxide aggregate (MTA) when used as a pulp capping material in primary teeth. METHODOLOGY: Clinical follow-up was performed on 25 symmetrical pairs of primary molars with deep occlusal caries, in 25 patients between the ages of 5 and 8 years. Pulps exposed during cavity preparation were treated by direct pulp capping with MTA or calcium hydroxide, based with resin-bonded zinc oxide eugenol cement and restored with amalgam. Clinical and radiographic examinations were carried out at 1, 3, 6, 9, 12, 18 and 24 months. RESULTS: Twenty-four-month clinical and radiographic follow-ups were carried out on 22 patients. One patient failed to return for evaluation after 1 month, one after 9 months and another after 12 months. During follow-up, none of the MTA and calcium hydroxide groups exhibited clinical or radiographic failure. CONCLUSIONS: Mineral trioxide aggregate was found to be as successful as calcium hydroxide when used for direct pulp capping in primary teeth. Further histological investigations are needed to support these findings.

Further clinical and genetic characterization of SPG11: hereditary spastic paraplegia with thin corpus callosum.

Hereditary spastic paraplegias (HSPs) are a heterogeneous group of neurodegenerative disorders leading to progressive spasticity of the lower limbs. Clinically, HSPs are divided into "pure" and "complicated" forms. In pure HSP, the spasticity of the lower limbs is the sole symptom, whereas in complicated forms additional neurological and non-neurological features are observed. Genetically, HSPs are divided into autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) forms. Up to date, 30 different HSPs are linked to different chromosomal loci and 11 genes could be defined for AR-HSP, AD-HSP and XL-HSP. SPG11, an AR-HSP (synonym: HSP11), is a complicated HSP associated with a slowly progressive spastic paraparesis, mental impairment and the development of a thin corpus callosum (TCC) during the course of the disease. SPG11 has been previously linked to chromosomal region 15q13 - 15. First, we applied rigid diagnostic criteria to systematically examine 20 Turkish families with autosomal recessive HSP for characteristic features of SPG11. We detected four large Turkish families with AR-HSP and TCC consistent with SPG11. Subsequent genetic linkage analysis of those 4 families refines the SPG11 locus further down to a small region of 2.93 cM with a maximum lod score of 11.84 at marker D15S659 and will guide further candidate gene analysis.

Novel truncating and missense mutations of the KCC3 gene associated with Andermann syndrome.

BACKGROUND: Andermann syndrome (OMIM 218000) is an autosomal recessive motor-sensory neuropathy associated with developmental and neurodegenerative defects. The cerebral MRI reveals a variable degree of agenesis of the corpus callosum. Recently, truncating mutations of the KCC3 gene (also known as SLC12A6) have been associated with Andermann syndrome. METHODS: The authors assessed clinically and genetically three isolated cases from Germany and Turkey with symptoms consistent with Andermann syndrome. RESULTS: The authors detected four novel mutations within the KCC3 gene in their patients: two different truncating mutations in the first patient, a homozygous truncating mutation in the second, and a homozygous missense mutation in the third patient. In contrast to the classic phenotype of the Andermann syndrome linked to truncating KCC3 mutations the phenotype and the course of the disease linked to the missense mutation appeared to be different (i.e., showing additional features like diffuse and widespread white matter abnormalities). CONCLUSIONS: Not only truncating but also missense mutations of the KCC3 gene are associated with Andermann syndrome. Different types of KCC3 mutations may determine different clinical phenotypes.

Congenital hydrocephalus as a rare association with ligneous conjunctivitis and type I plasminogen deficiency.

Severe type I plasminogen deficiency is the underlying cause of ligneous conjunctivitis (LC). Furthermore, pseudomembranes may also be found on other mucous membranes (gastrointestinal tract, bronchial system, genital tract). In very rare cases, congenital hydrocephalus has been associated with the more severe forms of the disease and may even precede LC. The pathophysiological mechanism is unclear at present. It is advisable to look for plasminogen deficiency in patients with congenital hydrocephalus, because obstruction of ventriculoperitoneal shunts is possible when such a condition is overlooked. Here, we report a case of LC with hydrocephalus. This report reemphasizes the association of LC with hydrocephalus which is not well known.

Effect of LED and halogen light curing on polymerization of resin-based composites.

The clinical performance of light polymerized resin-based composites (RBCs) is greatly influenced by the quality of the light curing unit (LCU). A commonly used unit for polymerization of RBC material is the halogen LCUs. However, they have some drawbacks. Development of new blue superbright light emitting diodes (LED LCU) of 470 nm wavelengths with high light irradiance offers an alternative to standard halogen LCU. The aim of this study is compared the effectiveness of LED LCU and halogen LCU on the degree of conversion (DC) of different resin composites [two hybrid (Esthet-X, Filtek Z 250), four packable (Filtek P60, Prodigy Condensable, Surefil, Solitaire), one ormocer-based resin composite (Admira)]. The DC values of RBCs polymerized by LED LCU and halogen LCU ranged approximately from 61.1 +/- 0.4 to 50.6 +/- 0.6% and from 55.6 +/- 0.7 to 47.4 +/- 0.5%, respectively. Significantly higher DC of RBCs except Surefil and Filtek Z 250 was obtained for LED LCU compared with halogen LCU (P < 0.05). Surefil and Filtek Z 250 exhibited no statistically significant difference values between LED LCU and halogen LCU (P > 0.05). As a result, it was observed that the performance of LED LCU used in the study was satisfactory clinically and had sufficient irradiance to polymerize RBCs (hybrid, packable and ormocer based) at 2 mm depth with a curing time of 40 s.

Effects of carbamide peroxide containing bleaching agents on the morphology and subsurface hardness of enamel.

The purpose of this study is to evaluate the effects of nightguard bleaching agents (Karisma and Yotuel) on the enamel surface of forty anterior teeth. Ten teeth of each group were evaluated with SEM and ten teeth of each group were tested with a microhardness tester Morphologic alterations were observed on the enamel surfaces with SEM. Karisma group showed a significant decrease in enamel hardness (p<0.05) and microhardness values of enamel were increased significantly in Yotuel group (p<0.05).

Comparison of the resin-dentin interface in primary and permanent teeth.

The purpose of the present study was to compare primary and permanent teeth in terms of the thickness of the hybrid layer developed with two bonding systems: Syntac (multi step) and Syntac Single Component. Fourteen sound primary first molars and 14 sound permanent first bicuspids, were removed for orthodontic reasons, and divided into 4 groups: 7 primary and 7 permanent teeth were restored with Syntac adhesive resin system (multi step); and 7 primary and 7 permanent teeth were restored with Syntac Single Component adhesive resin system. Measurements of hybrid layer thickness were performed by means of SEM and two teeth in each group were evaluated on TEM for further confirmation of resin-dentin interface. The result of this study indicated that the hybrid layer was significantly thicker in primary than in permanent teeth (p < 0.05). No difference was observed in the hybrid layers produced by two dentin bonding systems (p < 0.05).

The effect of cavity disinfectants on microleakage in dentin bonding systems.

The purpose of this study was to determine the effect on microleakage of two disinfectants, one a chlorhexidine based and the other alcohol based, used as cavity washes prior to the application of one step dentin bonding systems Syntac and Prime & Bond in Class V composite restorations. Children between 10-12 years old, with noncarious second primary molars about to exfoliate, were selected for this study. Cavity preparations were treated with either Syntac or Prime & Bond, combinations of one of the two disinfectants washes with Syntac or Prime & Bond or with one of the disinfectants only and filled with Tetric composite resin. All teeth were extracted one month later, stained and sectioned to evaluate dye penetration. As a result, focal dry disinfectant when used as a cavity wash prior to the use of Prime & Bond did not effect the ability of dentin bonding agents to prevent microleakage. Chlorhexidine solution had an adverse effect on Syntac and Prime & Bond and produced significantly higher microleakage when used with these bonding systems. The use of cavity disinfectants with composite resin restorations appears to be material specific regarding the interactions with various dentin bonding systems and the ability to seal dentin.

Effect of an alum-containing mouthrinse in children for plaque and salivary levels of selected oral microflora.

The purpose of the study was to assess the effect of daily supervised rinsing with a specially formulated, alum-containing mouthrinse on plaque and salivary levels of S. mutans, S. mitis and S. salivarius in caries susceptible children (12-14 years old) and to monitor the effect on the oral tissues and acceptability to subjects. Forty-five subjects were divided into 3 groups (n = 15). Group I received an experimental group with a mouthrinse containing hydrated aluminum potassium sulfate (alum). Group 2 received a vehicle control group containing the same mouthrinse, but without alum and Group 3 had a treatment control with distilled water. All subjects continued normal oral hygiene habits during the study. Salivary and plaque levels were obtained at base line, 2 weeks and 4 weeks and evaluated for microbiologic procedures. Also, potential adverse effects on oral tissues were performed during every visit. The mean plaque and salivary levels of oral Streptococcus (S. mutans, S. mitis, S. salivarius) for the experimental group were significantly reduced after 2 weeks and 4 weeks compared with baseline. The plaque and salivary levels of oral Streptococcus of experimental and vehicle control group differed statistically from each other after 4 weeks, with the strongest reduction in the experimental group and there was statistically difference between treatment control and vehicle control or experimental groups at each time interval. No evidence of deleterious effects to the oral tissues was observed. Daily use of an alum-containing mouthrinse was safe and produced significant reduction effect on plaque and salivary levels of oral Streptococcus and can be used in children for the preventive dentistry.

A histopathologic study of direct pulp-capping with adhesive resins.

OBJECTIVE: The purpose of this study was to evaluate the histologic pulp responses of Optibond and Syntac adhesive resin systems placed directly on exposed pulp tissues. STUDY DESIGN: Class V facial cavities with pulpal exposures were prepared in dogs. After acid etching of enamel margins, the cavities were restored with a composite resin after pulp-capping with one of the dentin bonding agents. The remaining exposures were capped with calcium hydroxide and amalgam as controls. The animals were killed after 7, 21, and 90 days and the pulps were evaluated histologically. Statistical analysis was carried out with the chi-square test. RESULTS: There was no statistically significant difference with respect to inflammatory cell response, fibrosis, bleeding, or bacterial staining criteria over the time intervals of evaluation among the Optibond, Syntac, and calcium hydroxide groups. New dentin formation was also observed for all of the groups at the end of 90 days. CONCLUSION: The results of direct pulp-capping with a dentinal adhesive and composite resin appear promising but further in vivo studies are recommended.

Microleakage of resin composite restorations with glass-ceramic inserts.

OBJECTIVE: The purpose of this study was to evaluate the effects of glass-ceramic inserts and different application techniques of resin composites on marginal leakage. METHOD AND MATERIALS: Three groups of 10 standardized, round, Class V cavities were prepared on the buccal surface of 30 extracted human molar teeth. Group 1 received resin composite restorations, placed in one increment (bulk). Group 2 received resin composite restorations that were placed in two increments, and group 3 received resin composite restorations with beta-quartz ceramic inserts. After the teeth were thermocycled and placed in 0.5% basic fuchsin for 24 hours, they were sectioned and examined for microleakage. RESULTS: On the occlusal margins, there was no statistically significant difference between the restorations placed with the incremental technique and the restorations with beta-quartz inserts. The restorations placed with the bulk technique had significantly more microleakage than did the others. On the gingival margins, the restorations with beta-quartz inserts exhibited significantly less microleakage than did the other groups. The restorations placed with the bulk technique showed significantly more dye penetration than did the others. CONCLUSION: The use of a glass-ceramic insert reduced the marginal leakage of Class V resin composite restorations.

Clinical evaluation of transcutaneous electronic nerve stimulation for pain control during tooth preparation.

The purpose of this study was to evaluate the effectiveness of a transcutaneous electrical nerve stimulation unit. The effects of electronic dental anesthesia and local anesthesia for deep cavity preparations in primary molars were compared in children aged 7 to 9 years by using the Eland Color Scale. The patients had symmetric teeth requiring Class I cavity preparation. One of the teeth was treated with electronic anesthesia and the other with local anesthesia. The tooth and method were selected randomly. Both restorations were finished at the same visit. There was no statistically significant difference between the groups in the perception of pain. Fifty-six percent of the children preferred transcutaneous electrical nerve stimulation, while 36% of them preferred local anesthesia.

Clinical evaluation and marginal leakage of Amalgambond Plus: three-year results.

Amalgambond Plus with a high-performance additive was evaluated for its ability to bond a resin composite or an amalgam alloy to deep dentin in primary teeth with nonretentive cavity preparations. The clinical performance of amalgam and resin composite mesio-occlusodistal restorations bonded with Amalgambond Plus was evaluated at 15 months and 2 and 3 years. There was no statistically significant difference in the retention, marginal adaptation, secondary caries, and post-operative sensitivity over the times of the evaluation or between amalgam and resin composite restorations. After 3 years, most of the teeth were extracted because it was their exfoliation time, and 29 restorations limited within buccal and lingual cusps were evaluated for marginal leakage. There were no significant differences in microleakage between amalgam and resin composite restorations lined with Amalgambond Plus. Amalgambond Plus has the potential for serving successfully as a cavity liner with either amalgam or resin composite restorations.