Multi-institutional and multi-disciplinary care: A successfully managed aortic dissection in the third trimester of pregnancy.

Multi-disciplinary collaborative care for pregnant women with complex and emergent conditions is essential. Logistical planning, clear communication and human factor awareness are all non-clinical skills which need to be utilised in order to maximise outcomes. We describe the case of a proximal aortic dissection in the late third trimester of pregnancy diagnosed in a peripheral hospital that was transferred to a cardiothoracic centre for successful operative management 160 km away. This required the time-sensitive mobilisation and liaison of a receiving cardiothoracic, anaesthesiology and perfusionist team in conjunction with obstetric and midwifery support from an affiliated maternity hospital, as well as the national neonatal transport team. We emphasise the importance of multidisciplinary team management in complex cases and how imperative good inter-disciplinary communication is to ensure safe inter-hospital transfer.

Circulating pro- and anticoagulant levels in normal and complicated primigravid pregnancies and their relationship to placental pathology.

We aimed to compare the changes in factor VIII:C, antithrombin, protein C, protein S and fibrinogen in a cohort of low-risk primigravida who developed maternal or fetal complications to those who had uncomplicated pregnancies and to correlate these findings with placental pathology. This is a case-control study of 170 cases and 122 controls selected from a prospective cohort of 1,011 low-risk primigravida. Significantly elevated levels of factor VIII:C and significantly decreased levels of antithrombin were seen in women who developed pre-eclampsia (p <0.001), placental infarction (p < 0.001) or had infants with a birth weight < 3rd centile (p < 0.001). Placental villous dysmaturity was significantly associated with raised factor VIII:C (p < 0.001). Women who developed pre-eclampsia showed elevated fibrinogen at 14 weeks (p = 0.03). Significantly higher than normal pregnancy levels of factor VIII:C, in tandem with significantly lower antithrombin levels associated with certain adverse pregnancy outcomes, may be related to underlying placental insufficiency. This is supported by associated placental findings.

Ponderal index (PI) vs birth weight centiles in the low-risk primigravid population: which is the better predictor of fetal wellbeing?

Our objective was to compare Ponderal index (PI) with birth weight centiles as predictors of perinatal morbidity and to determine which best reflects the presence of placental disease. We prospectively recruited 1,011 low-risk primigravidas and calculated PI and birth weight centiles following delivery. Perinatal morbidity was defined as: pre-term birth (PTB); fetal acidosis; an Apgar score <7 at 5 min or neonatal resuscitation. Placental disease was defined as chronic uteroplacental insufficiency (CUPI); villous dysmaturity; infection or vascular pathology. Ponderal index was statistically reduced (25.33 vs 27.79 p =0.001) and the incidence of infant birth weight <9th centile was statistically higher (11.1% vs 5.1%; p =0.004) in cases with PTB and in CUPI (26.23 vs 27.84; p =0.001 and 28.2.1% vs 10.4%; p =0.002). Both PI and infant birth weight centile <9th centile for gestational age correlate with PTB, however overall, both are poor predictors of neonatal and placental disease.

The relationship between body mass index and mid-arm circumference in a pregnant population.

Our objective was to correlate body mass index (BMI) with mid-arm circumference (MAC) and also to ascertain whether maternal BMI could be calculated from MAC at booking. We approached all Caucasian women who met the inclusion criteria attending the University College Hospital, London between 1 April 1996 and 30 June 1997 and the Rotunda Hospital, Dublin, Ireland between 15 April 2003 and 19 May 2004. A total of 2,912 women agreed to participate in the research. The participants' maternal height and weight were measured. Their BMI was calculated using the formula: BMI = weight (kg) ÷ height (m(2)). The MAC was measured in cm. Statistical analysis was performed using SPSS for Windows version 11 with p < 0.05 as significant. We found that BMI is directly correlated with MAC (r = 0.836) and estimates of BMI may be calculated from the simple equation BMI = MAC ± 2. Alternatively, a MAC of ≥ 27 cm allowed for a detection rate for overweight patients of 75%, with a false positive rate of 15%.

Pheochromocytoma, sickle cell disease and pregnancy: a case report.

Pheochromocytomas are rare catecholamine-secreting tumors with a 2-4% maternal morbidity rate and a fetal loss rate of 11%. Sickle cell disease is also associated with increased maternal and fetal mortality. We report the first case of a primigravid woman with both conditions and a successful pregnancy outcome.

An in vitro comparison of apical microleakage after obturation with JS Quick-Fill or lateral condensation.

Thirty extracted human single-root teeth were instrumented to #45 file size while creating a continuous coronal taper. Canals were obturated with Roth 801 sealer and either JS Quick-Fill or lateral condensation of gutta-percha. Mean apical linear microleakage of India Ink was evaluated in cleared teeth using a stereomicroscope. Significantly less leakage (p < 0.1) occurred with lateral condensation than with JS Quick-Fill.

Reeruption and extrusion of a traumatically intruded immature permanent incisor: case report.

A case report of treatment for a traumatically intruded maxillary central incisor is described. An attempt at accelerating eruption via surgical exposure of the embedded tooth was only partially successful. Orthodontic extrusion of the partially erupted tooth brought the tooth into correct position.

Proposed criteria for classifying potential dental emergencies in Department of Defense military personnel.

Dental emergencies have been well documented and evaluated. The results of dental emergencies have been lost duty time, decreased unit effectiveness, disruption of routine care, and hindrance to the military mission. The potential of dental emergencies to reduce combat effectiveness is still a major concern. The current U.S. Army and Department of Defense (DOD) military personnel dental classification system, as regulated by DOD Instruction 6410.1, places certain patients broadly into the potential emergency, class 3 category. Changes are needed to make this system more effective and predictive. In addition to various acute conditions, more emphasis should be focused on caries- and surgery-related problems to identify the majority of individuals at high risk for emergencies. Based on an extensive literature review, changes in the current system of classification are proposed.

Thermafil obturation: a literature review.

A review of the literature pertaining to the use of Thermafil Endodontic Obturators is presented in this article. Addressed are such concerns as apical microleakage, biocompatibility, coronal leakage, post space considerations, retreatment issues, surgical factors, and clinical evaluations of Thermafil; included are the authors' conclusions concerning its clinical use.

An in vitro evaluation of coronal microleakage in obturated root canals without coronal restorations.

A study was conducted to evaluate coronal microleakage of Super EBA and Ketac-Endo when used as sealers with single-cone gutta-percha (GP) root canal obturation. The root canals of 24 extracted human teeth were instrumented with flared preparations to a minimum #40 master apical file size. Ten teeth were obturated with a single GP cone and Super EBA as the sealer and ten teeth were obturated with a single GP cone and Ketac-Endo as the sealer. Four teeth were used as controls. Salivary bacterial microleakage studies were conducted to determine whether these sealers could prevent coronal microleakage through the root canal in the absence of a coronal tooth restoration. There was no bacterial penetration through the apical foramen for either sealer tested during the 60-day test period.

Effect of dowel lubrication on resistance to dislodgment of dowels cemented with a 4-META resinous cement.

Dentatus stainless steel dowels were cemented 5 mm into prepared canals of extracted human teeth with C&B Metabond cement. One half the dowels were lubricated before cementation to ensure easy subsequent retrieval. Significantly less tensile force was required to dislodge the lubricated dowels (p = 0.0209). Retrievable lubricated dowels could provide dentists the option of nonsurgical endodontic retreatment in lieu of endodontic surgery. However, lubrication cannot be recommended for clinical use at this time because of the potential for the dowel to unscrew during normal oral function. Further studies are required to determine the effects of rotational forces on the lubricated dowel, surface design of the dowel on retention, and chemical interaction of the lubricant on the resinous cement. Long-term effects of the lubricant on the cement are unknown.

An in vitro evaluation of the sealing ability of Super-EBA cement used as a root canal sealer.

Forty-six extracted human teeth, 26 maxillary central incisors, and 20 mandibular incisors were instrumented with flared preparations. The maxillary and mandibular incisors were prepared to #50 and #30 master apical file sizes, respectively. Ten maxillary and mandibular teeth were obturated with a single gutta-percha (GP) cone and Super-EBA cement. Ten maxillary and mandibular incisors were obturated with laterally condensed GP and Roth 801 sealer. Six maxillary incisors were used as controls. Apical leakage of India ink was measured using a stereomicroscope after clearing the teeth. Results showed significantly less leakage in the mandibular incisors filled with GP and Super-EBA (p<0.05). There was no significant difference in leakage when comparing the maxillary central incisors (p>0.05). In this in vitro study, root canal obturation with a single GP cone and Super-EBA showed promise as an effective way to eliminate or reduce apical microleakage. Further studies are needed to test the ability to use this obturation method clinically.

In vitro evaluation of the accuracy of several electronic apex locators.

This study describes two tests of the in vitro accuracy of several models of electronic canal length measuring devices (ECLMDs) using a gelatin test model and extracted human teeth with fully formed apices. In part 1, four previously untested ECLMDs were used in dry canals after access and pulpectomy. File lengths with wth file tip just visible at the foramen were compared to ECLMD lengths. Clinically significant ECLMD measurements of > or + 0.5 mm than visual length were noted with two ECLMDs 16.6% and 10% of the time. The other two ECLMDs had no measurements >0.5 mm than the visual measurement. The gelatin test model proved highly accurate with 4 of 6 ECLMDs tested thus far. Part 2 compared the accuracy of a previously tested ECLMD using the gelatin model when taking length measurements with canals both dry and wet with distilled water in them. There was no difference between measurements in wet or dry canals. Irrigation with distilled water may be a clinical aid when using resistance ECLMDs.

A comparison of maintenance of canal curvature using balanced-force instrumentation with three different file types.

Forty-five extracted human molar teeth with curved facial or mesial canals were instrumented to a #45 file with three different file types using balanced-force (BF) instrumentation. Pre- and postoperative X-rays were taken, projected, and file location traced to determine the canal curvature according to the method of Schneider. Results showed statistically less reduction in canal curvature with nickel-titanium (NT) files compared with either Flex-R (FR) (p < 0.05) or K-Flex (KF) files (p < 0.0021). There was no significant difference comparing FR with KF files (p > 0.05). Under the conditions of this study, NT files used with the BF technique were significantly less likely to change canal curvature than either FR or KF files when instrumenting curved root canals.

An in vitro test of a simplified model to demonstrate the operation of electronic root canal measuring devices.

This article describes an in vitro test of the accuracy of a model for demonstrating the operation of electronic canal length measuring devices (ECLMDs). The model is made from commercially available gelatin which is mixed with sterile saline solution. Extracted human canine and anterior teeth with fully formed apices had access preparations and complete pulpectomies before drying the canals with paper points. The tooth length was determined with an Exact-A-Pex using the gelatin test model. When the apex locator green light-emitting diode indicated 1.5 mm from the apex, the file length to the nearest 0.5 mm was measured with a rubber stop. This length was compared with the length determined by visualization of the tip of a #10 K-Flex file at the foramen. This method was repeated with the Foramatron IV using the instrument's digital reading of zero as the apex location and root canal length. There was complete agreement as to canal length between electronic root canal measuring devices and visual observations. This indicates that the gelatin test model is an accurate in vitro method of determining canal length.

The effect of dowel lubrication on retention of resin-cemented dowels.

Threaded dowels were cemented into prepared canals of extracted human teeth by use of unfilled Bis-GMA resin cement. One half the dowels were lubricated before cementation, unscrewed partially, and reseated to original length after cement had set, to assure retrievability. There was no significant difference in mean tensile force required to dislodge the dowels cemented with or without prior lubrication. Lubrication of dowels makes them predictably and easily retrievable with no short-term effect on tensile strength of the cemented lubricated dowels. Long-term effects of the lubricant on the resin are unknown.

A simplified model to demonstrate the operation of electronic root canal measuring devices.

This article describes how to construct and use a simplified model to demonstrate the operation of electronic root canal measuring devices. The model is effective, more economical than those previously described, and uses readily available materials.

Using a 1-ml syringe for the chloroform dip root canal filling technique.

This article describes using a 1-ml syringe as an alternative to a dappen dish to hold chloroform during the chloroform dip root canal filling technique. The syringe effectively holds chloroform while limiting its exposure to the endodontic operatory air.