A Novel Self-Mineralizing Antibacterial Tissue Repair Varnish to Condition Root-end Dentin in Endodontic Microsurgery.

INTRODUCTION: A novel 2-part varnish system containing chitosan nanoparticles (part 1) and chitosan-grafted hydroxyapatite precursor nanocomplex (part 2) was developed to condition the root-end dentin using the principle of biomineralization while rendering both antimicrobial efficacy and bioactivity. This in vitro study aimed to characterize and assess the effectiveness of the chitosan nanoparticles and chitosan-grafted hydroxyapatite precursor nanocomplex containing self-mineralizing antibacterial tissue repair varnish to condition as well as seal root-end dentin during endodontic microsurgery. METHODS: In phase 1, the antibacterial properties and cellular response of the varnish were characterized. The antibacterial activity and cellular responses were evaluated using Enterococcus faecalis and periodontal ligament (PDL) fibroblasts, respectively. In phase 2, a resected root-end model was used to apply the 2-part varnish and examine the dentin-varnish interface using transmission electron microscopy. The percentage of root end sealed with time was determined using scanning electron microscopy (n = 6/time point). Statistical analysis was performed using 1-way analysis of variance where applicable. RESULTS: The part 1 and 2 of the varnish displayed significant antibacterial activity and reduced bacterial adherence/survival (P < .01). The attachment and spreading of PDL fibroblasts on the varnish-conditioned dentin was enhanced compared with unconditioned dentin (P < .01). In the resected root-end model, the 2-part varnish displayed a biomineralized varnish layer with close interaction with the subsurface dentin. Root-end coverage with the biomineralized layer increased with incubation time (P < .01), reaching approximately 95% coverage after 24 hours. CONCLUSIONS: The 2-part varnish system effectively conditioned/sealed the root end with a biomineralized layer while reducing bacterial load and promoting PDL fibroblast attachment. This therapeutic modification of root-end dentin could provide optimal conditions to enhance healing and improve prognosis in teeth with root-end cracks after endodontic microsurgery.

Temporomandibular disorders and whiplash injury: a narrative review.

OBJECTIVES: The objective of this study was to conduct a review investigating the relationship between temporomandibular disorders (TMDs) and whiplash injuries (WIs). STUDY DESIGN: The authors conducted a search of PubMed/Medline, Cochrane Database, and EMBASE for studies discussing the prevalence, incidence, severity, treatment, and prognosis of TMDs following WIs. English language studies published between January 2010 and March 2016 were included. Study quality was assessed by using the Ottawa-Newcastle scale. RESULTS: Eight studies investigating TMDs in patients with histories of WI were included. These studies reported associations between WIs and TMDs and an increase in symptom severity among patients with TMDs and a history of WIs. Additionally, patients with TMD and trauma histories display more severe subjective, objective, and psychological dysfunction compared with typical patients with TMDs. This results in poorer treatment outcomes. CONCLUSIONS: These findings highlight the need for early evaluation of patients with WI for TMDs and for a multidisciplinary approach to their management.