Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF).

PURPOSE: Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls. CASE SERIES RESULTS: Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening. CONCLUSION: REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.

Mandibular block success rate in relation to needle insertion and position: a self-report survey.

AIM: To evaluate possible associations between successful mandibular block injection and location of penetrating the oral mucosa, location of injection on the ramus and the needle insertion length. STUDY DESIGN: The study consisted of 101 dentists, of whom, 33 were oral surgeons, 33 certified paediatric dentists and 35 general dental practitioners. The dentists were asked to estimate their rate of success in mandibular block injections, defined as the proportion of their patients for whom only a single carpule was necessary, and to indicate the needle insertion length and the location of the injection on a photograph of a ramus and on a photograph of the oral mucosa. RESULTS: Injecting a single carpule for achieving full anaesthesia in 90% or more of their patients was reported by 79.3 and 57.8% of the dentists treating children and adults, respectively. Of practitioners treating children, experienced dentists (>5 years in occupation) reported higher success rates than did inexperienced ones (p = 0.05). A positive correlation was found between failure rate reported in children, shorter length of the inserted needle (R = 0.356, p = 0.001) and injecting at the central (superior inferior dimension) most anterior quarters of the ramus (p = 0.006; odd ratio = 3.9375). Routine waiting period of more than 5 min after the injection and before operative treatment was associated with higher rates of failure (p = 0.042, χ(2) = 6.335). No correlation was found between the success rates of mandibular block injection and the location of penetrating the oral mucosa in children (p = 0.94), adults (p = 0.57), or between success rates and the target location on the ramus in adults (p = 0.42). STATISTICS: χ(2) test was used to determine the significance of differences among proportions and t test for continuous variables. Pearson's correlation analysis was used to analyse the correlation between the length of the needle inserted in children and adults by the same dentist. CONCLUSIONS: Shorter needle insertion lengths and targeting the injecting to the most anterior quarters of the ramus were positively correlated with failure of anaesthesia in children, according to dentists' reports. A routine waiting period of over 5 min did not increase the success rates of mandibular block injection.

Quality of bitewing radiographs in children in relation to the type of film holder used.

AIM: To assess the frequency of use with young uncooperative children of the bitewing radiograph film holders: KWIK-BITE, Snap-a-ray, and a Sticky tape, and to compare the quality of bitewing radiographs achieved with these types of film holders. STUDY DESIGN: This retrospective study assessed 298 pairs of bitewing radiographs of children aged 3-14 years. The radiographs were evaluated according to age, type of behavioural management approach used, extent and degree of overlapping surfaces, visibility of the alveolar bone, and the presence of folds, cone-cut and elongated teeth. RESULTS: Snap-a-ray was used more frequently in younger children (p < 0.001), less cooperative children (p < 0.001), and in those who were treated under sedation (p < 0.001). The KWIK-BITE holder was used more frequently in older children (p < 0.001), cooperative children (p = 0.001), and in those under general anaesthesia (p < 0.001). About 76.5 % of the radiographs contained technical errors. The degree of overlapping surfaces in radiographs was not correlated with the type of film holder used, but rather with the degree of children's cooperation. CONCLUSIONS: The Snap-a-ray film holder was used more frequently in young uncooperative children; nevertheless, its use was not associated with an increased frequency or degree of overlapping surfaces.

[Decoronation: treatment protocol for ankylotic root resorption as a consequence of dental trauma].

Severe dental traumatic injuries, such as the complete displacement of a tooth from its socket (Avulsion) or the displacement of a tooth within its socket (Intrusive Luxation), may result in extensive injury to the root surface. As a result, the root surface injury heals without cementum and there is fusion between the alveolar bone and the exposed dentin or anorganic exposed cementum, without any attachment apparatus between them. This phenomenon is known as "dento-alveolar ankylosis" and is accompanied by ankylotic resorption of the root. In a process that results subsequent to the ankylosis, the root surface resorbs, and this is part of the remodeling of the alveolar bone (ankylotic resorption). When the traumatic injury occurs at a young age, lateral and apical growth of the alveolar bone continues without continued physiological eruption of the tooth. As a result, the position of the ankylotic tooth does not change, and with time thetooth appears infra-occluded resulting in severe esthetic and functional consequences. Extraction of the ankylotic tooth is difficult and sometimes even impossible due to the rigid fusion between the bone and the tooth. In addition, attempted extraction of the ankylotic tooth may lead to fracture of the buccal plate and resorption of the alveolar bone. Retention of the ankylotic tooth may lead to damage in bone deposition in the verticaldimension, leading to difficulties in future prosthodonticrehabilitation, research-based information has been incorporated

Effect of non-functional teeth on accumulation of supra-gingival calculus in children.

AIM: To evaluate the occurrence of supra-gingival calculus in children aged 6-9 years with disuse conditions such as: presence of dental pain, open-bite or erupting teeth. METHODS: A cohort of 327 children aged 7.64±2.12 (range: 6-9) years (45% girls) were screened for presence of supra-gingival calculus in relation to open bite, erupting teeth and dental pain. Presence of dental calculus was evaluated dichotomically in the buccal, palatinal/lingual and occlusal surfaces. Plaque index (PI) and gingival index (GI) were also evaluated. RESULTS: Supra-gingival calculus was found in 15.9% of the children mainly in the mandibular incisors. Children aged 6-7 years had a higher prevalence of calculus as compared to children aged 7-8 years (23% vs. 13.5%, p=0.057) or 8-9 years (23% vs. 12.4%, p=0.078), respectively. No statistical relation was found between plaque and gingival indices and presence of calculus. The prevalence of calculus among children with openbite was significantly higher than that of children without open-bite (29.4% vs. 10.7%, p=0.0006, OR=3.489). The prevalence of calculus among children with erupting teeth in their oral cavity was higher than that of children without erupting teeth (17.7% vs. 9%, respectively, p=0.119). No statistical correlation was found between presence of dental pain and calculus (15.4% vs. 15.9%; p=0.738). CONCLUSION: Accumulation of calculus in children aged 6-10 years was found mainly in the mandibular incisors, decreased with age and was correlated with open-bite.

Awareness of orthodontists regarding oral hygiene performance during active orthodontic treatment.

AIM: The aim of the present study was orthodontist's awareness for maintenance of several home and professional prevention measures during active orthodontic treatment according to patients' report. MATERIALS AND METHODS: A structured questionnaire was distributed to 122 patients undergoing active orthodontic treatment with fixed appliances. Patients were treated by 38 different orthodontists. The questionnaire accessed information regarding instructions patients received from their orthodontist concerning maintenance of their oral hygiene during orthodontic treatment. RESULTS: Most of the patients (94%) reported that their orthodontists informed them at least once about the importance of tooth-brushing, and 74.5% received instructions for correct performance of tooth brushing or alternatively were referred to dental hygienist. However, only 24.5% of the patients reported that their orthodontist instructed them to use the correct fluoride concentration in their toothpaste, to use daily fluoride mouthwash (31.5%) and to brush their teeth once a week with high concentration of fluoride gel (Elmex gel; 10.2%). Only 13.8% received application of high concentration of fluoride gel or varnish at the dental office, and 52% of the patients reported that their orthodontist verified that they attend regular check-ups by their dentist. A significant positive correlation was found between explaining the patients the importance of tooth brushing and the following variables: instructing them on how to brush their teeth correctly (p<0.0001), explaining them which type of toothbrush is recommended for orthodontic patients (p=0.002), recommending to perform daily fluoride oral rinse (p=0.036) and referring them to periodic check-ups (p=0.024). CONCLUSION: Orthodontists should increase their awareness and commitment for instructing their patient on how to maintain good oral hygiene in order to prevent caries and periodontal disease during orthodontic treatment.

Postoperative pain after root canal treatment: a prospective cohort study.

Aim. To evaluate the incidence and severity of postendodontic treatment pain (PEP) subsequent to root canal treatment (RCT) in vital and necrotic pulps and after retreatment. Methodology. A prospective study. Participants were all patients (n = 274) who underwent RCT in teeth with vital pulp, necrotic pulp, or vital pulp that had been treated for symptomatic irreversible pulpitis or who received root canal retreatment, by one clinician, during an eight-month period. Exclusion criteria were swelling, purulence, and antibiotic use during initial treatment. A structured questionnaire accessed age, gender, tooth location, and pulpal diagnosis. Within 24 h of treatment, patients were asked to grade their pain at 6 and 18 hours posttreatment, using a 1-5 point scale. Results. RCT of teeth with vital pulp induced a significantly higher incidence and severity of PEP (63.8%; 2.46 ± 1.4, resp.) than RCT of teeth with necrotic pulp (38.5%; 1.78 ± 1.2, resp.) or of retreated teeth (48.8%; 1.89 ± 1.1, resp.). No statistical relation was found between type of pain (spontaneous or stimulated) and pulp condition. Conclusion. RCT of teeth with vital pulp induced a significantly higher incidence and intensity of PEP compared to teeth with necrotic pulp or retreated teeth.

Common mistakes, negligence and legal offences in paediatric dentistry: a self-report.

AIM: To identify the type and relative prevalence of mistakes, negligence and legal offences (MNLOs) performed or nearly performed by paediatric dentists during their entire career. METHODS: The population consisted of 25 (29.4%) certified and 48 (56.5%) non-certified paediatric dentists, and 12 (14.1%) residents in paediatric dentistry. A structured anonymous questionnaire accessed occupational characteristics and frequencies of MNLOs (0, 1-4, 5-10, >10). RESULTS: The most prevalent MNLOs related to the performance of radiographs: bite-wings with overlapping teeth (90%), overturned film (30%), film over-exposure (48%), faulty film development (84%) and exposure of the same side of film twice (32%). Other MNLOs were drilling an intact tooth (37%), misdiagnosing existing radiographic caries (63%), anaesthetising the wrong tooth (49%), accidental incision of the cheek/lips during treatment (73%), administering an incorrect dose of antibiotic (49%) or analgesics (24%), extracting the wrong tooth (15%), documenting the wrong tooth in the patient's file (63%), and a child swallowing an instrument (33%) or clasp (15%). Prevalent MNLOs included administering sedation to a child who had not fasted (32%), sedating without monitoring (9%), treating children without receiving signed parental consent (15%) and losing a radiograph (64%). CONCLUSIONS: MNLOs occur commonly during various operative dental treatments. Means to raise awareness and to implement regulations should be addressed to limit these mistakes.

Seroepidemiology of hepatitis C antibodies among dentists and their self-reported use of infection control measures.

OBJECTIVES: To determine the prevalence of hepatitis C virus (HCV) antibodies among dentists graduated from various countries and assess the use of infection control measures in their dental practice. RESEARCH DESIGN: The study included 301 Israeli dentists who attended an annual dental conference. Participants filled out a structured questionnaire regarding demographic (age, gender, number of siblings, number of children) and occupational characteristics. Venous blood was examined for presence of HCV antibodies by enzyme immunoassay and confirmed by a third generation line immunoassay, which assesses antibodies to HCV-core antigens (INN-LIA HCV Ab III update, 100% sensitivity, 100% specificity). RESULTS: The prevalence of HCV antibodies among Israeli dentists was 1/301 (0.33%), similar to the prevalence range (0.1-0.5%) among the general Israeli population. The studied population included dentists (30.6%) who immigrated from Asia, Eastern Europe and the former USSR, where HCV prevalence ranges from 3.1% to 26.5%. Dentists routinely used gloves (99.6%), gown (93.3%), autoclaves (90.3%), dry heat (29.1%) and mask (81%). Dentists who graduated after 1985 used a mask or gown significantly more often than dentists who graduated before 1985 (p < 0.001 and p = 0.004, respectively). CONCLUSION: It seems that dentists who usually adhere to basic infection control measures are not at an increased risk for HCV.

Post-operative pain and use of analgesic agents in children following intrasulcular anaesthesia and various operative procedures.

AIM: To characterise post-operative pain (PDP) and use of analgesic agents in children. METHODS: The study consisted of 472 children, who received routine dental treatment. Teeth were anaesthetised by a computerised delivery system, either intrasulculary (CDS-IS) or by local infiltration (CDS-IF). Information regarding post-operative pain and use of analgesic agents was obtained by a telephone call within 24 hours after treatment. RESULTS: The overall incidence of PDP was 38%. 60.9% of the children who experienced PDP were given an analgesic agent. Incidence and severity of pain were significantly associated with type of dental procedure. The highest incidence was found after root canal treatment (62.5%) and preformed crowns (60.8%). A higher incidence of PDP was found in teeth with history of pain or abscess as compared to teeth with restoration or caries (p <0.01). Incidence of pain was not associated with restoration material, extension, depth or type (occlusal vs proximal) of restoration, multiple restoration, gender, mode of CDS anaesthesia, or effectiveness of anaesthesia during dental treatment. Analgesic drugs were given mainly after preformed crowns, root canal filling and extractions. CONCLUSIONS: PDP and analgesic use in children is common, especially after root canal filling, preformed crowns and extractions. CDS-IS is not associated with increased PDP.

[Dental trauma protocol--treatment of avulsion and luxation injury].

The goal of this protocol is to provide clear instructions which simplify the process of decision making and treatment of Luxation and Avulsion. In teeth with a closed apex, one should perform root canal therapy at the second appointment in teeth with injuries of luxation and avulsion (except for injuries of subluxation and concussion). The tooth should be reimplanted at site of accident if it possible. For avulsed teeth, the preferred storage medium is milk. One should condition the roots of teeth which have been avulsed. In teeth which have not finished development, the preferred treatment is to allow the continued development of the root.

[Preservation of alveolar bone of un-restorable traumatized maxillary incisors for future].

UNLABELLED: Anterior maxillary implantation is a challenging treatment for both the surgeon and prosthodontist due to high esthetic demands in this area. However, it is the most traumatized and most exposed region to habits. Prompt and appropriate management can significantly improve prognosis of many dentoalveolar injuries, especially in young patients. Unfortunately, many traumatized teeth are overtreated or left untreated, which lead to a much more complicated treatment at the time of permanent restoration at adulthood. The facial cortical plate over the roots of the maxillary teeth is thin and porous. Periapical infections, as well as prolonged and stubborn surgical treatments (repeated root end surgeries) can cause resorption of the labial plate, migrate to a more palatal position, and may later require an augmentation procedure prior to implant placement. The treatment-options of traumatized, anterior maxillary, un-restorable fractured root and ankylosed infraocluded teeth, in relation to preservation of the adjacent alveolar bone for future use of dental implantation will be discussed. The recommended treatment of crown-root fracture of permanent incisor includes removal of the coronal fragment and supragingival restoration of the fractured root. In severe cases in which the fracture line positions deeply under the gingival margin, this treatment may be supplemented by gingivectomy and/or osteotomy, as well as surgical or orthodontic extrusion of the root. In young patients, use of these treatment options as temporary treatment to preserve the facial cortical plate is important. Preservation of alveolar dimension will enable implantation after the completion of growth and development. Dento-alveolar ankylosis accompanied by replacement resorption is a serious complication following severe injury to the periodontal membrane. This complication develops mainly following avulsion and intrusion but also following lateral luxation and root fracture. Replacement resorption develops after severe damage to the periodontal ligament cells that cover the root surface. As a result of this damage, the periodontal ligament is replaced by bone tissue, causing ankylosis between bone and tooth. Following ankylosis, resorption of cementum and root dentin occurs. These processes eventually result in replacement of the entire root by bone. In young children it could arrest the growth of the alveolar process and create an infra-occluded tooth, resulting in a severe bony defect that is difficult to correct. In addition, loss of the maxillary incisor leads to serious esthetic and restorative problems, particularly when the trauma occurs at a young age. Therefore, ankylosed teeth should be treated as soon as diagnosed. Alternative treatments include intentional extraction and immediate replantation of the ankylosed tooth to its socket after embedding the tooth and the socket in Emdogain. This treatment is indicated only when the ankylosis or the replacement resorption is diagnosed at an early stage or has affected only a small area of the root. When the resorption is diagnosed at a later stage, auto transplantation of first lower pre-molar to the anterior region or decoronation of the ankylosed tooth may be considered. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It should be considered as a treatment option for teeth affected by replacement resorption. The alternative treatment of surgical extraction of an ankylosed tooth often leads to considerable bone loss and reduced bone volume in the oro-facial dimension. This may later necessitate an augmentation procedure. CONCLUSION: Scrupulous diagnosis of teeth and the alveolar bone after a traumatic injury is necessary. Treatment is multidisciplinary, requiring endodontic, surgical, orthodontic, operative and prosthetic compliance. An individual treatment plan for each patient is necessary. General rule do not apply. Periodic check-up is essential.

[Judicious use of antibiotics in dental practice].

With the discovery of penicillin and entrance into the antibiotic era, the capability of dentists to treat dental infections have changed dramatically. Many antibacterial agents have developed since, but bacterial resistance using diverse mechanisms, have increased concomitantly. Since antimicrobial agents are frequently needed in dentistry, their judicious use is of prime importance. Dental infections can be divided to two main groups according to the origin of the infection. First, odontogenic infections (acute dento-alveolar abscess) originating from the dental pulp are most commonly caused by gram-positive anaerobic or facultative bacteria. Systemic antibiotic should be given concomitantly with drainage of the dento-alveolar abscess, debridment of the root canal of the infected tooth, and placement of inta-canal antimicrobial medication such as calcium hydroxide. Penicillin G, penicillin V (Rafapen) or amoxycillin (moxypen) are the first line systemic antimicrobial agents. In case of no improvement within 2-3 days, second line regimens such as amoxycillin-clavulanate (augmentin), cefuroxime (zinnat) or penicillin and metronidazole are recommended. In patients allergic to penicillin, clindamycinn (dalacin) is preferred over macrolides. The second group of infections originates from the periodontal apparatus, and is caused usually by gram-negative anaerobes bacilli, sometimes with Actinobacillus actinomycetemcomitance (Aa). Systemic antibiotics are only infrequently indicated in this situation, and always accompanied by scaling, root planning and curettage of the infected root and gingiva. In regenerative or post surgical periodontitis, augmentin, metronidazole or metronidazole in combination with penicillin or amoxycillin augmentin are recommended. In aggressive periodontitis the most common pathogen is Aa and therefore tetracycline, augmentin, or metronidazole and amoxicillin are recommended. In necrotizing ulcerative gingivitis, which is caused usually by fusiform bacilli and spirochetes, metronidazole or augmentin are appropriate. In patients with periodontal disease who are allergic to penicillin can be treated with a macrolides.

Lymphoid elements and apoptosis-related proteins (Fas, Fas ligand, p53 and bcl-2) in lichen sclerosus and carcinoma of the vulva.

We studied some of the morphological and immunohistochemical parameters of lichen sclerosus (LS) and carcinomas of the vulva in order to verify some characteristics in LS related to neoplasm transformation. Parameters such as proliferating index, rate of proliferation of lymphoid elements into a tumor and types of such elements were studied. In parallel, the number of cells positive to apoptosis-related proteins such as Fas, Fas ligand, p53 and bcl-2 were evaluated. Biopsy material from patients with different vulvar disorders--22 samples with LS and 23 samples with vulvar squamous cell carcinoma (VSCC)--was studied by the methods of morphometry and immunohistochemistry. In LS, the number of T cells is a few times higher than those of B cells. Among the T cells, the number of killers is significantly higher than the number of helpers. Carcinomas, especially those with lymphoid depletion, are characterized by a further significant increase in some parameters such as the rate of lymphoid proliferation and the number of T helpers and killers. The progression in to tumorigenesis was accompanied with a significant increase in the number of Fas+ and FasL+ lymphocytes. In tumor epithelial cells the proliferative index increased in carcinomas with lymphoid depletion. The number of p53+ epithelial cells increased whereas the number of bcl-2+ cells showed a distinct tendency to decrease with progression in to tumorigenesis. Development of a tumor is manifested in deep changes in relationships between different lymphoid components. Only two lymphoid markers are significantly different in VSCC compared to LS: the number of T killers and macrophages. The other parameters studied (rate of proliferative activity, the total number of T cells and T helpers, B cells, IL-2-connective cells) already showed high expression in LS as the first signs of transformation of this inflammation into neoplasia.

In vitro viability, mitogenicity and clonogenic capacities of periodontal ligament fibroblasts after storage in four media supplemented with growth factors.

The choice of storage medium for preserving traumatically avulsed teeth is important for the success of future replantation. The objective of this study was to evaluate the effectiveness of growth factors (IGF-1 and PDGF-BB) when added to storage media in preserving the functional abilities of cultured periodontal ligament fibroblasts (PDLF). The evaluated storage media were: ViaSpan, Hanks' balanced salt solution (HBSS), alpha minimal essential medium (alpha MEM), and alpha MEM supplemented with FCS and antibiotic (alpha MEM-S). PDLF were obtained from explants of human healthy extracted teeth. Plates with confluent PDLF were soaked in the various media supplemented with IGF-1 (10 ng/ml) and PDGF-BB (4 ng/ml) for 2, 8 and 24 h at room temperature (24 degrees C). The control group was incubated with the examined storage media without growth factors at 24 degrees C. An additional control group was incubated with culture medium at 37 degrees C without growth factors. After incubation, the viability of the cells was determined by Trypan blue exclusion test. Viable cells were then analyzed for mitogenic (with thymidine) and clonogenic (by culturing one cell/well) capacities. Storage of PDLF with growth factors (GF) for 2, 8 and 24 h decreased their vitality by only 3% (not statistically significant). The mitogenicity of PDLF stored for 2, 8 and 24 h in various media with GF was statistically comparable to that of the control group. Generally, the highest mitogenic capacity of PDLF stored with or without GF was found after 8 h of storage. Increasing the storage period to 24 h decreased the mitogenic capacity of the cells stored with GF by only 10-40% compared to the control group. In contrast, the clonogenic capacity of PDLF stored with GF increased with increasing storage periods by 100-300%, and the highest clonogenic capacity was found in most storage media after 24 h of storage with GF. The highest clonogenic and mitogenic capacities were found in cells stored in HBSS followed by alpha MEM-S. The mitogenic and clonogenic capacities of PDLF stored in various media supplemented with GF for 2-8 h were generally lower than without GF supplementation. The mitogenic and clonogenic effects of GF-supplementation was observed only after 24 h of storage. After 24 h of storage with GF, the clonogenic capacity increased by 8-224% and the mitogenicity by 20-37%, except in cells stored in alpha MEM (-1%). However, these differences were generally not statistically significant. In conclusion, the mitogenic and clonogenic effects of GF were observed only after 24 h of storage at room temperature. HBSS and alpha MEM-S supplemented with GF were the most effective media for preserving the viability, mitogenicity and clonogenic capacity of PDLF stored for 24 h at room temperature. For short periods of storage (2 and 8 h), HBSS and alpha MEM-S without GF were preferable.

The presence of hepatitis A antibodies in dental workers. A seroepidemiologic study.

BACKGROUND: The licensing of hepatitis A vaccine in the United States and other countries in the 1990s raised the question of vaccine candidates. The authors undertook a study to evaluate the presence of antibodies against hepatitis A virus, or HAV, in dental workers. METHODS: The authors recruited 115 members of the dental staff of Tel Aviv University: 82 dentists, 21 dental assistants, eight dental hygienists and four laboratory technicians. The subjects completed a structured questionnaire regarding demographic information (such as age, sex, number of siblings, number of children) and occupational characteristics. Venous blood was obtained and examined for presence of immunoglobulin G antibodies to HAV by microparticle enzyme immunoassay. RESULTS: Univariant analysis (chi 2 and Student t test) and multivariate stepwise logistic regression analysis were used to identify variables that were associated with seropositivity. Greater number of years of occupation in dentistry were independently and significantly (P = .0004) associated with seropositivity to HAV. The calculated odds ratio showed that each year of work increased the likelihood of being seropositive by 1.06 (6 percent). Subjects tended to have higher seropositive rates if they were older, had a greater number of children, had a greater number of siblings, had worked in hospitals and worked with children (pediatric dentists and orthodontists). CONCLUSIONS: This study suggests that HAV can be considered a hazard to dental workers, with risk increasing as the number of years in dentistry increases. More studies with larger sample sizes are needed. CLINICAL IMPLICATIONS: As HAV infection is associated with morbidity and mortality, dentists--especially those working in areas of endemic HAV (such as Africa, Asia and Latin America)--are encouraged to consider receiving the active vaccine to prevent HAV infection.

The bright edge of the endometrial polyp.

OBJECTIVE: To evaluate the accuracy of sonographic detection of endometrial polyps using a new ultrasound marker denoted 'the bright edge of the polyp'. METHODS: The ultrasound scans of the uterus were examined for the presence of the bright edge in two groups of women. The first, a retrospective group, included 40 women in whom both a histological diagnosis of endometrial polyps and sonographic scans were available for evaluation. The second, a prospective group, included 80 women scheduled for operative hysteroscopy because of endometrial irregularities detected by sonography. In this group the hysteroscopical and histological results of the removed endometrial tissue were correlated with the sonographic diagnosis. RESULTS: In the retrospective group, the bright edge marker, indicative of the presence of a polyp, was detected in 30 out of 40 scans available for evaluation. In the prospective group this marker was detected in 60 women out of 80. Endometrial polyps were confirmed in 56 of these 60 women. In three cases a submucosal myoma was found and in one case the histology showed simple cystic hyperplasia. Two polyps were found in 20 cases where the bright edge had not been detected. This marker has a sensitivity of 96%, specificity of 82%, positive predictive value of 93%, and negative predictive value of 90% in this group at high risk for endometrial abnormalities. CONCLUSION: The bright edge of the polyp is an accurate sonographic marker for the detection of endometrial polyps in women with endometrial irregularities demonstrated on ultrasound.

Microabrasion of teeth with discoloration resembling hypomaturation enamel defects: four-year follow up.

Microabrasion with 18% HCl and pumice to remove enamel dysmineralization and improve esthetics is an accepted and effective treatment. This technique can probably be extended even to generalized defects resembling hypomaturation amelogenesis imperfecta that appear on all erupted teeth. Five children aged 9 to 11 with two types of enamel-hypomaturation probably due to developmental defects were treated successfully by microabrasion, with marked improvement of the discoloration. The patients were followed for up to four years. During this period, no tooth-sensitivity or staining was noted. The teeth looked healthier and shinier.

In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in four media at room temperature.

The choice of storage medium for preserving traumatically avulsed teeth is important for the success of future replantation. The objective of this study was to compare the effectiveness of four recommended storage media (Hank's balanced salt solution [HBSS], culture medium, alpha minimal essential medium [alpha-MEM], and ViaSpan) to preserve cultured periodontal ligament fibroblasts (PDLF) at room temperature (22 degrees C). PDLF were obtained from explants of extracted healthy human teeth. Plates with confluent PDLF were soaked in the various media for 2, 8 and 24 h at room temperature. A control group was incubated with culture medium at 37 degrees C. After incubation, viability of the cells was determined by trypan blue exclusion test. Viable cells were then analyzed for mitogenic (with thymidine) and clonogenic capacity (by culturing one cell/well). Viability of PDLF stored up to 24 h was comparable in all tested media, and the differences were limited to 1%-3%. PDLF stored for up to 24 h in various media had statistically comparable mitogenicity to the control group. After 8 h of storage, the differences were limited to 2%-9%, except for the alpha-MEM group which had 23%-29% lower mitogenic capacity compared to the control group. Increasing the storage time up to 24 h further decreased the mitogenicity of the cells by 22%-47%. The highest mitogenicity after 24 h of storage was found in PDLF stored in culture medium or HBSS, and the lowest in alpha-MEM. PDLF stored for 2-8 h in various media had a comparable clonogenic capacity to the control group. However, after 24 h, the cells' clonogenic ability dropped by 14%-66%. A similar trend of reduction was noted in the mitogenic and clonogenic capacity, although it was statistically significant only in the clonogenic capacity. Culture medium and ViaSpan, followed by HBSS, were the most effective in preserving the clonogenic capacity of PDLF after 24 h of storage. The lowest clonogenic capacity after 24 h of storage was in the alpha-MEM group (66%, P < 0.0025). In conclusion, culture medium, followed by HBSS and ViaSpan, was the most effective media for preserving the viability, mitogenicity and clonogenic capacity of PDLF stored for up to 24 h at room temperature. The lowest functional abilities were found in PDLF stored in alpha-MEM.

In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in six different media.

The choice of storage medium for preserving traumatically avulsed teeth is important for the success of future replantation. The objectives of this study were to evaluate the effectiveness of six different media: culture medium, alpha minimal essential medium (alpha-MEM), milk, Hank's balanced salt solution (HBSS), ViaSpan and conditioned medium (CM) to preserve cultured periodontal ligament fibroblasts (PDLF). Periodontal ligament fibroblasts were obtained from explants of human healthy extracted teeth. Plates with confluent PDLF were soaked in the various media for 2, 8 and 24 h at 4 degrees C. A control group was incubated with culture medium at 37 degrees C. After incubation, cell viability was determined by trypan blue exclusion test. Viable cells were then analyzed for mitogenic (with thymidine) and clonogenic capacity (by culturing one cell/well). Storage of PDLF up to 24 h decreased their vitality by only 2%-14%. Vitality of the PDLF after 2, 8 and 24 h was highest when stored in milk or HBSS (91%-97%) and lowest when stored in ViaSpan or CM (82%-93%). PDLF stored for 2-8 h in various media had a mitogenic capacity comparable to the control. However, increasing the storage period to 24 h decreased the mitogenicity of the cells by 3%-39%. The highest mitogenicity was found in PDLF stored in milk or HBSS and the lowest in CM or ViaSpan. The clonogenic capacity of the cells dropped by 38%-71% after 24 h and was the best indicator of the deteriorating effect of long storage. Milk and HBSS were the most effective in preserving the clonogenic capacity. Nevertheless, reduction in the viability, mitogenicity or clonogenic capacity was statistically significant in nearly all the tested media only after 24 h of incubation. In conclusion, HBSS and milk were the most effective media for preserving the viability, mitogenicity and clonogenic capacity after storage for up to 24 h at 4 degrees C.