Efficacy of pamidronate in children with chronic non-bacterial osteitis using whole body MRI as a marker of disease activity.

BACKGROUND: To study the response to pamidronate using whole body magnetic resonance imaging (WB-MRI) in children with chronic non-bacterial osteitis (CNO) in a tertiary health centre. METHODS: The medical records of children under the age of sixteen with a diagnosis of chronic non-bacterial osteitis between 2005 and 2018 were reviewed. All those who were treated with pamidronate were included and relevant data was collected. Response to therapy was determined based on the status of lesions on WB- MRI. RESULTS: Forty six patients were included in the study. Pre- and post-treatment WB-MRI was available in forty patients. Cumulative lesions pre-treatment were 150 and reduced to 45 (30%) post-treatment. Seventeen patients (42.5%) had a good response with complete resolution of all lesions and nine patients (22.5%) worsened during or following treatment with pamidronate. Vertebral disease had a good response and 82.3% of the lesions resolved completely. CONCLUSION: Our study describes the experience with pamidronate in a tertiary health centre using WB-MRI as a marker of disease activity. Pamidronate was well tolerated in our cohort and treatment response was fairly good. SIGNIFICANCE AND INNOVATION: 1. Bisphosphonates can be used in the treatment of CNO when response to NSAIDs is suboptimal. 2. In the presence of spinal or mandibular lesions bisphosphonates were used as first line. 3. Treatment was escalated to a TNF blocker when response to bisphosphonates was suboptimal.

Comparison of shear bond strength of metal brackets bonded to porcelain surface using different surface conditioning methods: an in vitro study.

AIM: To evaluate and compare the shear bond strength of metal brackets bonded to ceramic surfaces using different conditioning methods and to assess the site of bond failure after debonding. MATERIALS AND METHODS: A total of 70 ceramic surfaces were produced with uniform shape, size and composition. The samples were divided into 7 groups (each of 10 samples). Group 1 was the control group (untreated surface); in group 2 the surface were roughened with a diamond bur; in group 3 the surface were etched with hydrofluoric acid; in group 4 the surfaces were sandblasted; in group 5 the surfaces roughened with bur and silane applied; in group 6 the surfaces were etched with hydrofluoric acid and silane applied and in group 7 the surfaces were sandblasted and silane applied. To all the above groups, metal orthodontic brackets were bonded with light cure adhesive. The brackets were later stored in artificial saliva and incubated at 37°C (24 hours). The samples were then subjected to shear bond strength test using an Instron universal testing machine. The debonded porcelain surfaces were then studied under stereomicroscope to assess site of bond failure. RESULTS: Sandblasting the ceramic surface and silane application showed the highest bond strength. Stereomicroscope examination after debonding showed that the bond failure is at bracket-adhesive interface in four groups namely hydrofluoric acid, sandblasting, hydrofluoric acid with silane and sandblasting with silane. CONCLUSION: Sandblasting with silane combination produced the highest shear bond strength, so it is a clinically suitable method for bonding orthodontic metal brackets onto ceramic surface. CLINICAL RELEVANCE: Bonding orthodontic brackets to ceramic crowns of patients has been a tough task. In this study, different conditioning methods were used to treat the ceramic surfaces before bonding. The results showed that sandblasting the ceramic surface prior to application of silane produced the highest shear bond strength which is clinically suitable to reduce bond failures.