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1.
Polymers (Basel) ; 13(10)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064954

RESUMO

This study investigated the antibacterial activity, bond strength to dentin (SBS), and ultra-morphology of the polymer-dentin interface of experimental adhesive systems doped with pyrogallol (PY), which is a ubiquitous phenolic moiety that is present in flavonoids and polyphenols. A universal adhesive containing 4-META and 10-MDP was used in this study. PY behaves as an antioxidant and anti-cancerogenic agent and it was incorporated into the adhesive at different concentrations (0.5 and 1 wt.%). The antibacterial activity and SBS were analyzed and the results were statistically analyzed. The ultra-morphology of the polymer-dentin interface was assessed using scanning electron microscopy (SEM). At 24 h, a lower antibacterial activity was observed for the control adhesive compared to those with 0.5% and 1% PY. No difference was seen in SBS between the three groups at 24 h. After 6 months, the SBS of the 0.5% PY adhesive was significantly lower than the other tested adhesives. The specimens created with 1% PY adhesive presented a higher bond strength at six months compared with that found at 24 h. No morphological differences were found at the polymer-dentin interfaces of the tested adhesives. Pyrogallol may be incorporated into modern universal adhesive systems to preserve the polymer-dentin bonding interface and confer a certain degree of antibacterial activity.

2.
J Endod ; 47(6): 873-882, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33811981

RESUMO

INTRODUCTION: Regenerative endodontic procedures (REPs) are intended to repair and regenerate part of the pulp-dentin complex. The aim of this study was to systematically appraise the existing evidence on the effectiveness of REPs on mature teeth with pulp necrosis and apical periodontitis. METHODS: Electronic database and hand searches were performed on 8 databases of published and unpublished literature from inception to January 3, 2021, for the identification of randomized controlled trials (RCTs) or prospective clinical trials. The related key words included "regenerative," "pulp revascularization," "revitalization procedure," and "necrotic mature teeth." A random effects meta-analysis was conducted assessing success as the main outcome treatment. Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool, and the quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of the 337 initial hits, 4 RCTs were eligible for inclusion, whereas 3 were included in the quantitative synthesis. Overall, there was no difference in the relative risk for a successful/unsuccessful treatment outcome between REPs or conventional treatment (3 studies, relative risk = 1.03; 95% confidence interval, 0.92-1.15; P = .61; heterogeneity I2 = 0.0%, P = .53; prediction interval = 0.51-2.09). Risk of bias ranged from low to raising some concerns, whereas the quality of the evidence was graded as moderate. CONCLUSIONS: Based on moderate-quality evidence, REPs appear as a viable treatment alternative for mature necrotic teeth with periapical lesions at present. Furthermore, well-designed RCTs might also provide confirmatory evidence in this respect while also framing a backbone for standardization of the therapeutic protocol of REPs.


Assuntos
Periodontite Periapical , Endodontia Regenerativa , Necrose da Polpa Dentária/terapia , Humanos , Periodontite Periapical/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tratamento do Canal Radicular
3.
J Clin Med ; 10(6)2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33803893

RESUMO

BACKGROUND: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in curved root canals filled with Thermafil, GuttaCore, GuttaFusion and lateral compaction with AH Plus and EndoSequence BC sealer, by means of percentage of gutta-percha and sealer filled area. METHODS: 200 curved canals of mandibular molars were divided in five groups (n = 40). Each specimen was evaluated at 3, 6 and 9 mm from the apex. A total of 600 samples were analyzed. Obturation was performed with either Thermafil (TH), GuttaCore (GC), GuttaFusion (GF) or lateral compaction (LC), using AH Plus as sealer. In another group EndoSequence BC sealer (BC) was used. Subgroups (n = 20) were made depending on the use of sonic activation during the placement of the sealer. The percentage of total obturation material was analyzed as an indirect measurement of percentage of voids. RESULTS: GF showed a better performance at the apical level, while GC showed the higher percentage of total obturation at the coronal area. No differences were observed for the activation of sealers in any of the groups. Statistical analysis was performed by using two-way ANOVA. Statistical significance was set at CI: 95% (p < 0.05). CONCLUSIONS: Sonic activation of sealers did not show any benefit to avoid the presence of voids within obturation of curved canals. Following the manufacturer recommendations, we found that TH did not show benefits when applied to curved canals.

4.
J Clin Med ; 9(11)2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33218015

RESUMO

BACKGROUND: Infections of the root canal space involve polymicrobial biofilms and lead to chronic, low grade inflammatory responses arising from the seeding of microbes and by-products. Acute exacerbation and/or disseminating infections occur when established microbial communities undergo sudden changes in phenotypic behaviour. METHODS: Within clinical endodontic infections, we assessedcategorical determinants comprising, and changing microbial composition of, chronic polymicrobial infections and their association with amoebae. After standardised assessment, primary or secondary infections underwent sampling and DNA processing, targeting bacteria, fungi and amoebae, including 16S high-throughput sequencing. After taxonomic assignment, community composition was correlated with clinical signs and symptoms. Diversity and abundance analyses were carried out in relation to the presence of non-bacterial amplicons. RESULTS: Clinical specimens revealed two distinct community clusters, where specific changes correlated with clinical signs. An association between the compositions of microbiomes was found between these groups and the presence of Entamoeba gingivalis in 44% of cases. When amoebae were present in endodontic infections, we demonstrate changes in microbial community structure that mirror those observed in treatment-resistant or recurrent infections. CONCLUSIONS: Amoeba are present in endodontic infections at a high prevalence, and may promote increased virulence by enrichment for phagocytosis-resistant bacteria.

5.
Imaging Sci Dent ; 50(3): 183-192, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33005575

RESUMO

Purpose: This study was performed to assess the accuracy of preoperative cone-beam computed tomography (CBCT), when justified for other reasons, in locating the apical foramen and establishing the working length. Materials and Methods: Six electronic databases were searched for studies on this subject. All studies, of any type, were included if they compared measurements of working length with preoperative CBCT to measurements using an electronic apex locator (EAL) or histological reference standard. Due to the high levels of heterogeneity, an inverse-variance random-effects model was chosen, and weighted mean differences were obtained with 95% confidence intervals and P values. Results: Nine studies were included. Compared to a histological reference standard, CBCT indicated that the apical foramen was on average 0.40 mm coronal of its histological position, with a mean absolute difference of 0.48 mm. Comparisons were also performed to an EAL reference standard, but the conclusions could not be considered robust due to high levels of heterogeneity in the results. Conclusion: A low level of evidence is produced suggesting that preoperative CBCT shows the apical foramen to be on average 0.40 mm coronal to its histological position, with a mean absolute difference of 0.48 mm.

6.
J Clin Med ; 9(9)2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32846942

RESUMO

PURPOSE: This study compared the antimicrobial efficacy of calcium silicate sealers (BioRoot RCS and Total Fill BC) and conventional sealers (AH Plus and Tubli-seal) against planktonic bacteria and a nutrient-stressed multispecies biofilm. METHODS: Antimicrobial properties of freshly mixed sealers were investigated using the direct contact test (DCT) and a nutrient-stressed multispecies biofilm comprised of five endodontic strains. Antimicrobial activity was determined using quantitative viable counts and confocal laser scanning microscopy (CLSM) analysis with live/dead staining. The pH of the sealers was analysed over a period of 28 days in Hanks Balanced Salt Solution (HBSS). Analysis of variance (ANOVA) with Tukey tests and the Kruskal-Wallis test were used for data analysis with a significance of 5%. RESULTS: All endodontic sealers exhibited significant antimicrobial activity against planktonic bacteria (p < 0.05). BioRoot RCS caused a significant reduction in viable counts of the biofilms compared to AH Plus and the control (p < 0.05), while no significant difference could be observed compared to TotalFill BC and Tubli-seal (p > 0.05). CLSM analysis showed that BioRoot RCS and TotalFill BC exhibited significant biofilm inhibition compared to Tubli-seal, AH Plus and the control (p < 0.05). BioRoot RCS presented with the highest microbial killing, followed by TotalFill BC and Tubli-seal. Alkalizing activity was seen from the onset by BioRoot RCS, TotalFill BC and AH Plus. After 28 days, BioRoot RCS demonstrated the highest pH in HBSS (pH > 12). CONCLUSIONS: Calcium silicate sealers exhibited effective antimicrobial properties. This was demonstrated by superior biofilm inhibition capacity and microbial killing, with strong alkalizing activity compared to epoxy-based and zinc oxide-eugenol-based sealers.

7.
J Clin Med ; 9(9)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32854206

RESUMO

BACKGROUND: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. METHODS: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). RESULTS: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively with a statistically significant difference (z score = 2.3, p = 0.021). Of teeth with severe and mild symptoms at T0, 42.9% and 36.7% respectively failed at T24 (p > 0.05). Within the self-limiting group, there was a lower success in premolars compared to molars (p < 0.05). CONCLUSION: after 2 years, there was a statistically significant higher pulp survival rate of teeth with deep carious lesions excavated using self-limiting protocols in patients with reversible pulpitis. Molars showed higher success than premolars in teeth excavated using the self-limiting protocol. There was no statistically significant association between the outcome and the severity of symptoms at T0 (ClinicalTrials.gov NCT03071588).

8.
J Clin Med ; 9(7)2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32635158

RESUMO

BACKGROUND: The aim of this longitudinal, one-year cohort study was to explore the hypothesis that fluorescence sampling of the root canal space prior to obturation could predict the outcome of root canal treatment (RCT). METHODS: Sixty-five teeth underwent primary RCT and were followed up clinically and radiographically. The outcome was determined radiographically with periapical radiographs (PR) and cone beam computed tomography (CBCT) scans. RESULTS: Success at 12 months was predictable based on the fluorescence score. When the fluorescence score (defined as the percentage of signal over total signal including background) was lower than 67, there was a 4.5 times (Odds ratio (OR) = 0.028; 95% confidence interval (CI): 0.003, 0.291, p = 0.001) greater chance of success (90% overall). When the readings were above this threshold, the success rate was 20%. CONCLUSION: A chairside sampling method is able to predict the outcome of RCT, through the use of paper point sampling and fluorescence staining. This has reduced the prevalence of persistent infections by guiding the optimum time for obturation. ClinicalTrials.gov trial NCT03660163.

9.
Sci Rep ; 10(1): 8194, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32424172

RESUMO

Antibiotic resistance is increasing worldwide. The implementation of antibiotic stewardship programmes (ASPs) is of utmost importance to optimize antibiotic use in order to prevent resistance development without harming patients. The emergency department (ED), cornerstone between hospital and community, represents a crucial setting for addressing ASP implementation; however, evidence data on ASP in ED are poor. In this study, a 4-year, non-restrictive, multi-faceted ASP was implemented in a general ED with the aim to evaluate its impact on antibiotic use and costs. Secondly, the study focused on assessing the impact on length of hospital stay (LOS), Clostridioides difficile infection (CDI) incidence rate, and mortality in the patients' group admitted from ED to medical wards. The ASP implementation was associated with a reduction of antibiotic use and costs. A mild but sustained LOS decrease in all medical wards and a significant downward trend of CDI incidence rate were observed, while mortality did not significantly change. In conclusion, the implementation of our ED-based ASP has demonstrated to be feasible and safe and might clinically benefit the hospital admitted patients' group. Further research is needed to identify the most suitable ASP design for ED and the key outcome measures to reliably assess its effectiveness.


Assuntos
Gestão de Antimicrobianos/métodos , Serviço Hospitalar de Emergência , Infecções por Clostridium/tratamento farmacológico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Admissão do Paciente , Estudos Prospectivos
10.
BMC Oral Health ; 20(1): 133, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375759

RESUMO

BACKGROUND: To assess the change of the Schneider membrane thickness measured by CBCT before and after root canal treatment, retreatment and pulp capping procedures. METHODS: This retrospective study was conducted on CBCT scans of a patient population of Guy's Hospital NHS Foundation Trust, London. Three groups of patients were studied: Group 1 consisted of patients referred for primary endodontic treatment; Group 2 for endodontic retreatment; Group 3 for indirect pulp capping procedures (serving as a control group). Follow up scans were carried out 1 year after treatment. Measurements were carried out on CBCT scans and data were analysed statistically by Wilcoxon Signed Rank Test. Linear regression was used to assess predictive parameters for membrane thickness. RESULTS: A statistically significant reduction of the Schneider membrane thickness was observed one year after endodontic treatment and retreatment (P < 0.05) but no significant reduction was observed after pulp capping procedures. Linear regression showed that age and gender were significant predictors influencing the Schneider membrane thickness. CONCLUSIONS: Within the limitations of this retrospective study, following root canal treatment and re-treatment a Schneiderian membrane thickness reduction occurred at 1-year follow-up. The removal of odontogenic infection following endodontic treatment may help reducing the thickness of the Schneider membrane.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Capeamento da Polpa Dentária , Cavidade Pulpar/diagnóstico por imagem , Mucosa Nasal/diagnóstico por imagem , Tratamento do Canal Radicular , Feminino , Humanos , Londres , Masculino , Mucosa Nasal/anatomia & histologia , Retratamento , Estudos Retrospectivos
11.
J Clin Med ; 9(4)2020 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-32325751

RESUMO

BACKGROUND: The objective was to evaluate the efficiency of ProTaper Gold (PTG) and Reciproc Blue (RB) NiTi files in obturation material removal from straight root canals assessed by micro-computed tomography. METHODS: Fifty-two anterior human teeth were shaped with a PTG rotary system until F2 (25/.08). Specimens were obturated with a continuous wave of condensation technique. For retreatment, specimens were randomly distributed in two experimental groups: PTG group (F4 file) and RB (R40 file). Micro-CT scans were performed before and after retreatment procedures. The percentage of the remaining obturation material compared to the original volume was calculated, as well as the retreatment time. The presence of separated files was recorded. A descriptive analysis was carried out, and nonparametric tests were employed. RESULTS: The mean percentages of remaining obturation material in the PTG group and the RB group were 4.14 ± 4.30% and 4.18 ± 4.29%, respectively. The mean retreatment times for the PTG and RB groups were 144 ± 51 and 163 ± 88 s, respectively. There were no statistically significant differences, neither in removal efficiency (p > 0.05) nor in retreatment time (p > 0.05), between the two groups. The coronal and middle thirds presented significantly more remaining obturation material than the apical third (p < 0.05). No file separation occurred. CONCLUSIONS: ProTaper Gold and Reciproc Blue present with comparable efficiency in removing the obturation material, with a similar mean retreatment time.

12.
J Clin Med ; 9(3)2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32183124

RESUMO

BACKGROUND: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. METHODS: 150 necrotic or pulpitic teeth were treated. (REC: 08/H0804/79). Following standardized root canal chemo-debridement. The canals were obturated using warm vertical condensation of gutta-percha and epoxy-based sealer (AH plus) or a calcium silicate sealer (BioRootTM RCS) with a single cone technique. Follow-up assessment was conducted at 12 months using Cone Beam Computed Tomography (CBCT). RESULTS: At 1-year recall, 104 teeth were assessed (51 AH plus, 53 BioRootTM RCS). The success rate using loose criteria for the CBCT images and PA radiographs was respectively 80% and 89% in the AH plus/warm vertical condensation group, 84% and 90% in the BioRootTM RCS/single cone group. There was no statistically significant difference between the two groups (Fisher exact test p value 0.6099 for the CBCT images). CONCLUSION: Within the limitations of this non-randomized trial, a calcium silicate cement in combination with single cone resulted in a similar proportion of successful cases compared to warm vertical condensation and epoxy-based sealer.

13.
Eur J Dent ; 14(1): 1-7, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32018281

RESUMO

OBJECTIVE: The purpose of this research was to investigate the effect per se of two shaping and cleaning techniques on the reduction of an in vitro multispecies biofilm. MATERIALS AND METHODS: A total of 39 freshly extracted monoradicular teeth for periodontal reason were decoronated. Roots were sectioned longitudinally. After autoclaving, a specific stressed biofilm was grown on the root halves that were subsequently reassembled in a silicone index. Two treatments (n = 9 each)-RaCe (Schottlander; Letchworth Garden City, United Kingdom) and ProTaper Gold ( PTG; Dentsply Maillefer, Baillagues, Switzerland)-were tested; three noninstrumented samples served as a control group and three were rinsed with saline. Posttreatment samples were taken at three different levels of the root. Colony-forming units were counted after incubations. Additionally, three treatments (n = 5 each)-RaCe, PTG, and saline only-were evaluated under a confocal laser scanning microscope (CLSM). STATISTICAL ANALYSIS: Statistical analysis was conducted using Tukey's test and analysis of variance to evaluate the post-instrumentation bioburden. RESULTS: Both instrumentations were able to reduce the biofilm; however, differences were not present between them (p > 0.05). CLSM showed biofilm killing and disruption through mechanical shaping alone. CONCLUSIONS: Intraradicular biofilm is reduced with mechanical shaping. There was no difference between RaCe and PTG systems in biofilm reduction despite differences in design, file sequence, and rotational speed.

14.
Materials (Basel) ; 12(5)2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30832247

RESUMO

This study aimed at evaluating the microtensile bond strength (MTBS) and fractographic features of dentine-bonded specimens created using universal adhesives applied in etch-and-rinse (ER) or self-etching (SE) mode in combination with modern ion-releasing resin-modified glass-ionomer cement (RMGIC)-based materials after load cycling and artificial saliva aging. Two universal adhesives (FTB: Futurabond M+, VOCO, Germany; SCU: Scotchbond Universal, 3M Oral Care, USA) were used. Composite build-ups were made with conventional nano-filled composite (AURA, SDI, Australia), conventional resin-modified glass ionomer cement (Ionolux VOCO, Germany), or a (RMGIC)-based composite (ACTIVA, Pulpdent, USA). The specimens were divided in three groups and immersed in deionized water for 24 h, load-cycled (350,000 cycles; 3 Hz; 70 N), or load-cycled and cut into matchsticks and finally immersed for 8 months in artificial saliva (AS). The specimens were cut into matchsticks and tested for microtensile bond strength. The results were analyzed statistically using three-way ANOVA and Fisher's LSD post hoc test (p < 0.05). Fractographic analysis was performed through stereomicroscope and FE-SEM. FTB showed no significant drop in bond strength after aging. Unlike the conventional composite, the two RMGIC-based materials caused no bond strength reduction in SCU after load-cycle aging and after prolonged aging (8 months). The SEM fractographic analysis showed severe degradation, especially with composite applied on dentine bonded with SCU in ER mode; such degradation was less evident with the two GIC-based materials. The dentine-bond longevity may be influenced by the composition rather than the mode of application (ER vs. SE) of the universal adhesives. Moreover, the choice of the restorative material may play an important role on the longevity of the finalrestoration. Indeed, bioactive GIC-based materials may contribute to maintain the bonding performance of simplified universal adhesives over time, especially when these bonding systems are applied in ER mode.

15.
J Endod ; 45(4): 406-413, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30770279

RESUMO

INTRODUCTION: The purpose of this study was firstly to compare the impact of radiographs, cone-beam computed tomographic (CBCT) imaging, and 3D Endo software (Dentsply Sirona, Ballaigues, Switzerland) on the assessment of root canal anatomy and radiographic quality of endodontic treatment and secondly to assess stress levels in the same cohort of residents performing endodontic treatment. METHODS: Sixty patients requiring primary molar endodontic treatment were allocated randomly into 3 groups: group 1 (n = 20), conventional radiographs (periapical radiography [PR]) only; group 2 (n = 20), PR and CBCT imaging; and group 3 (n = 20), PR, CBCT imaging, and 3D Endo software. All treatment was performed using a standardized protocol. Residents completed a questionnaire to assess their stress levels and usefulness of the imaging modality used. The radiographic quality of completed cases was assessed by 2 experienced endodontists who were not involved in the supervision of the cases being assessed. RESULTS: Groups 2 (CBCT imaging) and 3 (PR, CBCT imaging, and 3D Endo) proved significantly better than group 1 (PR) (P < .001) for assessing the number of root canals and anatomy and estimating the working lengths. Group 3 provided a significantly more accurate determination of the working level (P = .002). There were significantly more cases with obturation short of the apex (<2 mm) and voids in group 1 compared with group 3 (P < .05) and a significantly higher number of cases with voids in group 1 compared with group 3 (P < .01). Clinicians found treatment to be moderately or very stressful in 75%, 5%, and 0% in groups 1, 2, and 3, respectively. CONCLUSIONS: 3D Endo software followed by CBCT imaging were found to be more desirable for the evaluation of root canal anatomy and working lengths and reducing the residents' stress levels.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar/diagnóstico por imagem , Endodontia/educação , Endodontistas/psicologia , Imageamento Tridimensional , Internato e Residência , Dente Molar/cirurgia , Radiografia Dentária , Tratamento do Canal Radicular , Estresse Psicológico , Estudos de Coortes , Humanos , Software , Inquéritos e Questionários
16.
Case Rep Med ; 2018: 8613948, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30254678

RESUMO

Lactobacillus species are Gram-positive, facultative anaerobic, rod-shaped bacteria. They belong to the lactic acid bacteria group and are also known as a usual part of the normal flora of the gastrointestinal tract as well as of the urinary and genital tracts. They are an infrequent human pathogen but can induce several infections such as bacteremia and infectious endocarditis. We report the case of an 81-year-old woman with Lactobacillus bacteremia and mitral valve endocarditis as well as splenic abscesses.

17.
Eur J Dent ; 12(3): 369-374, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30147401

RESUMO

Objective: The aim of this study is to investigate the microleakage attained with three resin-based material used to restore deep Class II cavities. A null hypothesis was chosen: there is no difference in microleakage among the tested materials. Materials and Methods: A total of 30 Class II cavities were prepared in freshly extracted molars with the proximal mesial and distal margins located, respectively, 1.5 mm apically and 1.5 mm coronally to the cementum-enamel junction. Restorations were completed using a three-step enamel-dentin adhesive system "Etch and Rinse," margins were relocated using a micro-hybrid, preheated, or flowable composite and restorations were then completed using a conventional composite. All samples were coated with nail varnish with the exception of an area along the margins and apex was sealed using epoxide cement and then thermocycled (30-s dwell time, 5°C/55°C, 1000 cycles). A 50% ammoniac AgNO3 solution was used as tracer according to Tay's protocol. The microleakage analysis was performed using a microtomography system Sky-scan 1072 (SKYSCAN, Kartuizersweg 3B 2550, Konitch, Belgium). Results: The mean microleakage of all the tested materials showed greater leakage in the cementum margins; flowable composite exhibit greater leakage among the groups. Significant differences (P < 5%) within groups in both enamel and dentin margins were present. None of the tested materials eliminated marginal microleakage. Preheated composite showed significantly lesser microleakage. Conclusion: Tested materials showed statistical differences in microleakage; thus, the null hypothesis has been rejected. Within the limitations of the present experimental procedure, it can be concluded that flowable resin composite should be avoided at the dentin/cementum margin.

18.
Int Ophthalmol ; 38(1): 353-361, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28039672

RESUMO

PURPOSE: To report two cases of primary vitreoretinal lymphoma (PVRL), which presented as intermediate and posterior uveitis. METHODS: Combined clinical assessment, multimodal imaging with spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, brain magnetic resonance imaging and vitreous and retinal biopsy. Case 1 was a 48-year-old woman who complained of visual loss in her right eye secondary to a diffuse vitreous opacification and multiple chorioretinal lesions. Case 2, a 74-year-old man, presented with low vision in his right eye due to a wide chorioretinal lesion at the posterior pole, vitreous opacification and posterior uveitis in both eyes. RESULTS: Diffuse large B cell lymphoma was histologically diagnosed in the cerebellum in the first case and in chorioretinal tissue in the second patient. Atypical lymphoid cells were detected and allowed to make a diagnosis of primary central nervous system lymphoma in case 1 and PVRL in case 2. CONCLUSION: PVRL often masquerades ad intermediate or posterior uveitis. The management of the patients needed a team of pathologists, haematologists and ophthalmologists to achieve the correct diagnosis and choose the more appropriate therapy. Some peculiar characteristics on multimodal imaging, even in atypical cases of PVRL, should raise suspicious for PVRL and lead to a diagnostic vitrectomy and/or retinal biopsy.


Assuntos
Angiofluoresceinografia/métodos , Linfoma Difuso de Grandes Células B/diagnóstico , Imagem Multimodal/métodos , Retina/patologia , Neoplasias da Retina/diagnóstico , Uveíte Posterior/etiologia , Corpo Vítreo/patologia , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Seguimentos , Fundo de Olho , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias da Retina/complicações , Neoplasias da Retina/cirurgia , Tomografia de Coerência Óptica , Uveíte Posterior/diagnóstico , Uveíte Posterior/cirurgia , Acuidade Visual , Vitrectomia
19.
J Endod ; 43(11): 1852-1856, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28951029

RESUMO

INTRODUCTION: The aim of this study was to evaluate the bacterial contamination in endodontic consumables (gutta-percha points, rubber dams, paper mixing pads, caulking agents, and endodontic instrument sponges [EISs]) before and after clinical use and storage. METHODS: Materials were randomly sampled in triplicates at 3 time points (t0, at package opening; t1, at 7 days; and t2, at 14 days) during their clinical usage. The gutta-percha points and caulking agent (25 mg) were added to 1 mL phosphate-buffered saline (PBS). The rubber dam, paper mixing pad, and EIS were added to 25 mL PBS. After vortexing, centrifuging, and removing the supernatant, the pellet was resuspended in 1 mL PBS, plated on fastidious anaerobic agar, and incubated aerobically and anaerobically. The grown colonies were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The total bacterial load was calculated in the remaining volume (800 µL) from each sample by quantitative polymerase chain reaction after DNA extraction. RESULTS: All tested materials showed a varied number of contaminated samples at the 3 time points (except EIS at t0) using MALDI-TOF MS. The most isolated genera were Propionibacterium (42%) and Staphylococcus (32%). By using non-culture-based approaches, all tested materials at the 3 time points (except gutta-percha at t0 and the caulking agent at t0, t1, and t2) carried bacterial DNA. CONCLUSIONS: The majority of the tested materials harbored bacteria in their samples before and after clinical storage. Nosocomial infection derived from commonly used consumables could have an impact on the outcome of endodontic treatment.


Assuntos
Materiais Dentários/efeitos adversos , Endodontia/métodos , Contaminação de Equipamentos , Bactérias/genética , DNA Bacteriano/genética , Contaminação de Equipamentos/estatística & dados numéricos , Humanos , Reação em Cadeia da Polimerase , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
20.
Lancet Infect Dis ; 17(9): 990-1001, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28629876

RESUMO

BACKGROUND: Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria. METHODS: For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I2 method. FINDINGS: We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; p<0·0001), extended-spectrum ß-lactamase-producing Gram-negative bacteria (48%; 0·52, 0·27-0·98; p=0·0428), and meticillin-resistant Staphylococcus aureus (37%; 0·63, 0·45-0·88; p=0·0065), as well as the incidence of C difficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; p<0·0001), than when implemented alone. Antibiotic stewardship did not affect the IRs of vancomycin-resistant enterococci and quinolone-resistant and aminoglycoside-resistant Gram-negative bacteria. Significant heterogeneity between studies was detected, which was partly explained by the type of interventions and co-resistance patterns of the target bacteria. INTERPRETATION: Antibiotic stewardship programmes significantly reduce the incidence of infections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria. FUNDING: German Center for Infection Research.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/epidemiologia , Farmacorresistência Bacteriana , Padrões de Prática Médica , Infecções Bacterianas/prevenção & controle , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/prevenção & controle , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Bactérias Gram-Negativas , Humanos , Incidência , Staphylococcus aureus Resistente à Meticilina , beta-Lactamases
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