Maturation of the middle phalanx of the third finger and cervical vertebrae: a comparative and diagnostic agreement study.

OBJECTIVE: Diagnostic agreement on individual basis between the third middle phalanx maturation (MPM) method and the cervical vertebral maturation (CVM) method has conjecturally been based mainly on overall correlation analyses. Herein, the true agreement between methods according to stage and sex has been evaluated through a comprehensive diagnostic performance analysis. SUBJECTS AND METHODS: Four hundred and fifty-one Caucasian subjects were included in the study, 231 females and 220 males (mean age, 12.2 ± 2.5 years; range, 7.0-17.9 years). The X-rays of the middle phalanx of the third finger and the lateral cephalograms were examined for staging by blinded operators, blinded for MPM stages and subjects' age. The MPM and CVM methods based on six stages, two pre-pubertal (1 and 2), two pubertal (3 and 4), and two post-pubertal (5 and 6), were considered. Specifically, for each MPM stage, the diagnostic performance in the identification of the corresponding CVM stage was described by Bayesian statistics. RESULTS: For both sexes, overall agreement was 77.6%. Most of the disagreement was due to 1 stage apart. Slight disagreement was seen for the stages 5 and 6, where the third middle phalanx shows an earlier maturation. CONCLUSIONS: The two maturational methods show an overall satisfactorily diagnostic agreement. However, at post-pubertal stages, the middle phalanx of the third finger appears to mature earlier than the cervical vertebrae. Post-pubertal growth phase should thus be based on the presence of stage 6 in MPM.

Epidemiology and variables involved in dental abscess: survey of dental emergency unit in Trieste.

OBJECTIVES: The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. SUBJECTS AND METHODS: Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. Case histories of all patients were collected to investigate the clinical course and healing time of dental abscess according to anamnestic and diagnostic data and therapeutic management. A multiple logistic regression model was performed to evaluate the association of each variable with the healing time required for dental abscess. RESULTS: Variables associated with increased healing time were spring seasonality at admission, pyretic state, trismus, involvement of multiple anatomic spaces, and spontaneous drainage. Moreover, administration of some, but not all, classes of antibiotics was also associated with an increased healing time. CONCLUSIONS: The knowledge of variables involved in healing time for dental abscess is crucial in the optimization of managing such infections in terms of cost-benefit ratio. This would represent a valuable way to ensure a shortened and more effective healing.

Is gingival crevicular fluid volume sensitive to orthodontic tooth movement? A systematic review of split-mouth longitudinal studies.

To assess the scientific evidence for detectable volume changes of gingival crevicular fluid (GCF) incident to orthodontic tooth movement (OTM). A literature survey of longitudinal split-mouth studies was performed searching PubMed, SCOPUS and the Cochrane Library, with the last access in 15 April 2012. After selection, 13 articles qualified for the final analysis. One study was judged to be of medium/high quality, six were of medium quality and the rest of low quality. Across all studies, there was very little or no statistically significant change in GCF volume incident to OTM. The changes seen were generally ascribed to the clinical or subclinical inflammation consequent to placement of the fixed orthodontic appliance. A reappraisal of the data provided in these studies was performed by comparing the GCF volume from the test (moved) and control (non-moved) teeth, in terms of effects-size (ES) coefficients and variations, as percentages. Generally, the ES coefficients and the variations were below 1.0 and 20%, respectively. Therefore, when using current methods to collect and measure GCF volume, there was no meaningful diagnostic potential for the GCF volume as an index of tissue remodelling incident to OTM. The GCF volume is not a reliable index for tissue remodelling incident to OTM.

Repeatability of gingival crevicular fluid collection and quantification, as determined through its alkaline phosphatase activity: implications for diagnostic use.

BACKGROUND AND OBJECTIVE: In spite of four decades of studies on gingival crevicular fluid, no data have been reported on the repeatability of gingival crevicular fluid collection and the subsequent quantification procedures. The present study reports, for the first time, on the repeatability and method error of gingival crevicular fluid collection and quantification, as determined through its alkaline phosphatase (ALP) activity. Diagnostic considerations are then explored. MATERIAL AND METHODS: Twenty-seven healthy subjects (17 women and 10 men; mean age ± SD, 21.2 ± 4.8 years) with optimal periodontal status were enrolled according to a blind prospective design. The gingival crevicular fluid was collected at baseline, and after 1 d, 1 wk and 3 mo. At each clinical session, two consecutive rounds of gingival crevicular fluid collection were made from each of the four maxillary incisors, allowing the recovery of resting and flow gingival crevicular fluid. The total ALP activities were determined spectrophotometrically, and repeatability and method errors for the resting, flow and overall (resting + flow) gingival crevicular fluid ALP activities were calculated, relative to the corresponding baseline levels. RESULTS: No significant differences were seen over time, although the flow gingival crevicular fluid ALP activity was generally lower than that for the resting gingival crevicular fluid. The method errors ranged from 40 to 58%, with the flow and overall gingival crevicular fluid activities showing the highest and lowest errors, respectively. CONCLUSION: Reliable use of the gingival crevicular fluid ALP collection and quantification, both in research and diagnosis on an individual basis, should take into account relevant errors, and variations are to be considered as true only above relevant thresholds.

Surface corrosion and fracture resistance of two nickel-titanium-based archwires induced by fluoride, pH, and thermocycling. An in vitro comparative study.

The present comparative study aimed to evaluate the surface corrosion and fracture resistance of two commercially available nickel-titanium (NiTi)-based archwires, as induced by a combination of fluoride, pH, and thermocycling. One hundred and ten rectangular section NiTi-based archwires were used, 55 of each of the following: thermally activated Thermaloy® and super-elastic NeoSentalloy® 100 g. Each of these was divided into five equal subgroups. One of these five subgroups did not undergo any treatment and served as the control, while the other four were subjected to 30 days of incubation at 37°C under fluoridated artificial saliva (FS) at 1500 ppm fluoride treatment alone (two subgroups) or combined with a session of thermocycling (FS + Th) treatment at the end of incubation (two subgroups). Within each of the Thermaloy® and NeoSentalloy® groups, the FS and FS + Th treatments were performed under two different pH conditions: 5.5 and 3.5 (each with one subgroup per treatment). Analysis of the surface topography and tensile properties by means of scanning electron microscopy (a single sample per subgroup), atomic force microscopy, and a universal testing machine for ultimate tensile strength were carried out once in each of the control subgroups or immediately after the treatments in the other subgroups for 10 of the archwires. Non-parametric tests were used in the data analysis. Significant effects in terms of surface corrosion, but not fracture resistance, were seen mainly for the Thermaloy® group at the lowest pH, with no effects of Th irrespective of the group or pH condition. Different NiTi-based archwires can have different corrosion resistance, even though the effects of surface corrosion and fracture resistance appear not to be significant in clinical situations, especially considering that thermocycling had no effect on these parameters.

Diagnostic performance of dental maturity for identification of skeletal maturation phase.

The objective of this study is to analyse the diagnostic performance of the circumpubertal dental maturation phases for the identification of individual-specific skeletal maturation phases. A total of 354 healthy subjects, 208 females and 146 males (mean age, 11.1 ± 2.4 years; range, 6.8-17.1 years), were enrolled in the study. Dental maturity was assessed through the calcification stages from panoramic radiographs of the mandibular canine, the first and second premolars, and the second molar. Determination of skeletal maturity was according to the cervical vertebra maturation (CVM) method on lateral cephalograms. Diagnostic performances were evaluated according to the dental maturation stages for each tooth for the identification of the CVM stages and growth phases (as pre-pubertal, pubertal, and post-pubertal) using positive likelihood ratios (LHRs). A positive LHR threshold of 10 or more was considered for satisfactory reliability of any dental maturation stage for the identification of any of the CVM stages or growth phases. The positive LHRs were generally less than 2.0, with a few exceptions. These four teeth showed positive LHRs greater than 10 only for the identification of the pre-pubertal growth phase, with values from 10.8 for the second molar (stage E) to 39.3 for the first premolar (stage E). Dental maturation assessment is only useful for diagnosis of the pre-pubertal growth phase, and thus, precise information in relation to the timing of the onset of the growth spurt is not provided by these indices.

Gingival crevicular fluid alkaline phosphatase activity as a non-invasive biomarker of skeletal maturation.

OBJECTIVES: To evaluate the gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity in growing subjects in relation to the stages of individual skeletal maturation. SETTING AND SAMPLE POPULATION: The Department of Biomedicine, University of Trieste. Seventy-two healthy growing subjects (45 women and 27 men; range, 7.8-17.7 years). MATERIALS AND METHODS: Double-blind, prospective, cross-sectional design. Samples of GCF were collected from each subject at the mesial and distal sites of both of the central incisors, in the maxilla and mandible. Skeletal maturation phase was assessed through the cervical vertebral maturation (CVM) method. Enzymatic activity was determined spectrophotometrically. RESULTS: The relationship between GCF ALP activity and CVM stages was significant. In particular, a twofold peak in enzyme activity was seen at the CS3 and CS4 pubertal stages, compared to the pre-pubertal stages (CS1 and CS2) and post-pubertal stages (CS5 and CS6), at both the maxillary and mandibular sites. No differences were seen between the maxillary and mandibular sites, or between the sexes. CONCLUSIONS: As an adjunct to standard methods based upon radiographic parameters, the GCF ALP may be a candidate as a non-invasive clinical biomarker for the identification of the pubertal growth spurt in periodontally healthy subjects scheduled for orthodontic treatment.

Do malocclusion and Helkimo Index ≥ 5 correlate with body posture?

Whether there are correlations between the stomatognathic system and body posture remains controversial. Here, we have investigated whether malocclusal traits and having a Helkimo Index ≥ 5 show detectable correlations with body-posture alterations in children and young adults. A total of 1178 11- to 19-year-old subjects were divided into four groups: (i) controls; (ii) malocclusion; (iii) Helkimo Index ≥ 5 and (iv) malocclusion + Helkimo Index ≥ 5. Dental occlusion assessment included the following: overbite, overjet, posterior crossbite, scissorbite, mandibular crowding and dental class. Subsequently, body-posture assessments were performed through static analyses of body inclination and trunk asymmetry, and according to the dynamic Fukuda stepping test. Univariate and multivariate statistical analyses were performed. Although at the univariate level both the trunk asymmetry and Fukuda stepping test showed significant differences among the groups, the multivariate level revealed that age and gender were mostly responsible for this. The only significant correlation that was seen was for the malocclusion + Helkimo Index ≥ 5 group: these subjects had a positive (worse) trunk asymmetry and a negative (better) Fukuda stepping test performance. At the further multivariate analyses of each single malocclusal trait /Helkimo Index ≥ 5 (irrespective of the groups), only an increased overbite showed a statistically significant association with a slightly better Fukuda stepping test performance. Given the small number of significant associations seen and their limited entities, this study does not support the existence of clinically relevant correlations for malocclusal traits and Helkimo Index ≥ 5 with body posture in children and young adults.

Posturography as a diagnostic aid in dentistry: a systematic review.

The aim of this systematic review of the literature was to assess the scientific evidence for detectable correlations between the stomatognathic system and whole-body posture and to provide information on the relevance of posturography as a diagnostic aid in dentistry. A literature survey was performed using the Medline database, covering the period from January 1966 to May 2009, and using the medical subject headings. After selection, 21 articles qualified for the final analysis. Only one study was judged to be of medium/high quality, with all of the rest classified as of low quality design. Only two studies included follow-up of 28 days and 1 year. Overall, 14 of the studies reported detectable correlations between the stomatognathic system and body posture in at least one of the parameters used, although in four of these studies the authors suggested caution in the interpretation of their data. After a reappraisal of the data provided in 13 of the studies, a weak correlation that reaches biological, but not clinical, relevance is apparent. With limitations because of the poor methodological quality of the present published studies, conclusions are that a correlation between the stomatognathic system and whole-body posture can be detected, at least under experimental conditions; although posturography has little relevance in the monitoring of body posture responses to changes in the stomatognathic system (including temporomandibular disorders). While more investigations with improved levels of scientific evidence are needed, the current evidence does not support the usefulness of posturography as a diagnostic aid in dentistry.

Influence of calcium hydroxide debris on the quality of endodontic apical seal.

AIM: The aim of the study was to study investigate the influence of calcium hydroxide used as intermediate medication on the quality of apical seal of a silicon based and an experimental resin based endodontic sealer. METHODS: Eighty endodontic canals were prepared and divided in four groups. Calcium hydroxide was applied in groups 2 and 4. After 7 days, medication was removed and canals were filled with gutta-percha and RoekoSeal Automix (groups 1 and 2) or Scotchbond MP+C&B cement B (groups 3 and 4). Specimens were placed into India ink, cleared and analyzed under a stereomicroscope to investigate apical leakage. RESULTS: Specimens that received calcium hydroxide medication showed leakage means higher than the corresponding untreated ones (i.e. group 1< group 2 and group 3< group 4; P<0.001). CONCLUSIONS: Calcium hydroxide interferes with the sealing ability of silicon based sealer, since it frequently remains entrapped within the endodontic space even after careful removal procedures.

Extracciones dentarias en pacientes en tratamiento con anticoagulantes: revisión de la literatura / Dental extractions in patients under anticoagulant therapy: a literature review

Objetivo del trabajo. En pacientes en terapia con anticoagulantes orales, una simple extracción puede provocar hemorragias importantes. En la literatura se describen dos enfoques terapéuticos en casos de intervenciones quirúrgicas en esta categoría de pacientes. Uno propone la reducción de la dosis terapéutica del fármaco, mientras que el segundo sugiere la sustitución con heparina. El objetivo de este trabajo es revisar la literatura que tratar este tema con el fin de obtener un protocolo ideal. Conclusiones. En caso de extracciones simples es suficiente usar anestesia con vasoconstrictor (en el caso de que no haya otras contraindicaciones), realizar suturas bien tensadas, aplicar coadyuvantes hemostáticos locales y ácido tranexámico tópico. Solo en casos de intervenciones más complejas, o con valores de INR mayores a 3,5, será necesario reducir la dosis del fármaco y consecuente sustitución con heparina de acuerdo a las instrucciones del hematólogo y del cardiólogo (AU)

Aim of the work. In patients treated with oral anticoagulants, even simple tooth extractions can produce large hemorrhages. There are two main therapeutic outlines suggested in literature in case of little oral surgery. The first one is based on the reduction of the therapeutic dose of the drug, and the second one on the substitution with heparin. The aim of this paper was to review the. Literature on the management of patients treated with anticoagulants in order to obtain univocal guidelines. Conclusion. In case of simple tooth extractions generally a vasoconstrictive anaesthetic (if there are no other contraindications), tight sutures, the application of hemostats and tronexamic acid are enough. Only in case of more complex surgery or of INR values higher than 3,5 it is necessory to reduce the anticoagulant dose or to change the therapy with heparin, if agreed by the hoemotologist and/ or the cardiologist (AU)

Surface roughness of three resin restorative materials after finishing and polishing.

AIM: The surface roughness of 3 different resin restorative materials polymerized with a halogen and a plasma arc curing light, following finishing and polishing was evaluated in vitro. METHODS: Using a metal mold, 10 block specimens were prepared from each material. A Mylar strip was placed on both sides of the mold. Five specimens from each material were cured with the halogen lamp, while the other 5 were polymerized with the plasma arc lamp. In both groups the surface exposed to curing light was finished and polished with the Enhance system (Dentsply). The opposite surface was not treated and served as a control. Both surfaces of each specimen were analyzed with a laser profilometer: the roughness average (R(a)) was evaluated. The Vickers microhardness of the polished surfaces was also calculated. All data were statistically analyzed with the Mann-Whitney test. A regression test was carried out to evaluate the possible correlation between roughness and microhardness. RESULTS: The smoothest surfaces were obtained when composites were cured against a Mylar strip. Roughness was significantly increased in both groups in the treated surfaces. A significant correlation between roughness and microhardness could not be demonstrated. CONCLUSIONS: This study demonstrated that the surface polymerized against a Mylar strip was the smoothest surface produced, while the roughness of the Mylar-formed surface was significantly increased by finishing and polishing. Surface roughness following polishing is material-dependent.

Clinical evaluation of antibiotic prophylaxis before endodontic treatment of necrotic teeth.

AIM: The efficacy of antibiotic prophylaxis before endodontic treatment of necrotic teeth in the prevention of post-treatment flare-up pain and swelling was evaluated. METHODS: A total of 47 teeth with diagnosis of pulpal necrosis were selected in 39 patients, independently from the pre-operative symptomatology (painful or asymptomatic). Teeth were randomly divided into 2 groups. The first group (n=23) was given an antibiotic prophylaxis with 2 g amoxicillin 1 h before every appointment; the second group (n=24) did not receive any treatment (control group). The endodontic therapy was performed by shaping canals using the crown-down technique with hand devices, 5% sodium hypochlorite irrigations and 2 intermediate medications with Ca(OH)(2). Obturation was performed using randomly the vertical obturation technique or the no-stop wave technique. At the end of each appointment a questionnaire was given to each patient. The patient had to indicate if pain (absent, light, mild, severe) or swelling were present at 4, 8, 12, 24 h after every appointment. Data were statistically analysed with the Mann-Whitney, Wilcoxon and chi2 test. RESULTS: Only a case of flare-up pain and swelling was found in a patient of the study group. The statistical analysis showed that there were no significant differences between the 2 groups. CONCLUSIONS: An accurate endodontic treatment of necrotic canals is sufficient to guarantee an adequate control of post-treatment pain, with no need of antibiotic prophylaxis.

Allylglucosinolate and herbivorous caterpillars: a contrast in toxicity and tolerance.

Allylglucosinolate, found in many cruciferous plants, is acutely toxic to Papilio polyxenes larvae, which do not normally attack crucifers. By contrast, larval growth of Pieris rapae, a crucifer specialist, is not affected even by artificially high concentrations of allylglucosinolate. Larval growth of Spodoptera eridania, a generalist feeder, is inhibited by high but not by low concentrations of the compound.