A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients.

ABSTRACT: Although dental treatment with sedation is performed increasingly in special needs patients, data on adding midazolam to intravenous propofol sedation are very limited for this group. The purpose of this study was to identify the factors and procedure time associated with the use of intravenous sedation with propofol alone or propofol combined with midazolam in dental patients with special needs.This was a retrospective data analysis. The sedation medications and relevant covariates, including demographic parameters, disability levels, oral health conditions, dental procedures, treatment time, and side effects, of 718 patients with special needs were collected between April 2013 and September 2014. The unfavorable side effects by sedation types were reported. Factors associated with procedure time and the sedation medications were assessed with multiple logistic regression analyses.Of 718 patients, 8 patients experienced unfavorable side effects (vomiting, sleepiness, or emotional disturbance) after the dental procedures; the rate was 0.6% in the 509 patients who received propofol only. In 209 patients who received propofol and midazolam, 2.4% experienced the side effects. Sedation time was associated with body mass index (BMI) < 25 (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.04-2.04) and the performance of multiple dental procedures (aOR = 1.44, 95% CI: 1.06-1.97) but not associated with the sedation types. A significant odds ratio for the combined use of propofol and midazolam was shown for adolescents (aOR = 2.22, 95% CI: 1.28-3.86), men (aOR = 2.05, 95% CI: 1.41-2.98), patients with cognitive impairment (aOR = 1.99, 95% CI: 1.21-3.29), and patients undergoing scaling procedures (aOR = 1.64, 95% CI: 1.13-2.39).With the acceptable side effects of the use of propofol alone and propofol combined with midazolam, multiple dental procedures increase the sedation time and the factors associated with the combined use of propofol and midazolam are younger age, male sex, recognition problems, and the type dental procedure in the dental treatment of patients with special needs.

Cellular response of calcium phosphate bone substitute containing hydroxyapatite and tricalcium phosphate.

PURPOSE: This study developed calcium phosphate bone substitutes and their microstucture and in vitro cell response were evaluated in comparison with commercial hydroxyapatite (HA). MATERIALS: HA powder was ball-milled and then sintered to transfer into the calcium phosphate bulks (CPB). The density, hardness, and microstructure of the CPB were investigated. The viability and proliferation of MG63 osteoblast-like cells on the commercial HA and the CPB were evaluated. RESULTS: The x-ray diffraction confirmed that the CPB consisted of α-tricalcium phosphate (α-TCP), CaO, and HA. The hardness, density, and α-TCP-to-HA ratio of the CPB decreased when increasing the sintering duration. Cell tests demonstrated that the CPB exhibited an earlier cell-spread response than the commercial HA. CONCLUSIONS: This study demonstrated that a phase transformation of HA into α-TCP and CaO was achieved by sintering. The cell tests indicated that the CPB has favorable in vitro cellular performance, which implied that it presented potential as bone substitute.