Effect of alpha-humulene incorporation on the properties of experimental light-cured periodontal dressings.

The objective of this study was to formulate an experimental light-cured periodontal dressing containing alpha-humulene and to compare its physical, antimicrobial, and cytotoxicity properties with commercial gold standards (Barricaid® and Periobond®). Two periodontal dressing formulations were developed (a and b). The formulations were divided into 5 groups according to the alpha-humulene concentration as follows: Ea - control group, Ea1 - 1%, Ea5 - 5%, Ea10 - 10%, and Ea20 - 20%; Eb - control group, Eb1 - 1%, Eb5 - 5%, Eb10 - 10%, and Eb20 - 20%. Materials characterization was performed using the degree of conversion, cohesive strength, sorption, and solubility assays. Antimicrobial assay was performed using the modified direct contact test against E. faecalis and S. aureus. Cytotoxicity was assessed by the cell viability experiment using L929 fibroblasts. In general, the cohesive strength values of materials decreased as the alpha-humulene concentration increased. All the experimental dressings showed antimicrobial activity against both bacteria tested. Cell viability results for the Ea, Ea1, Eb, and Eb1 groups showed moderate cytotoxic effect. The formulations containing alpha-humulene showed similar behavior to the commercial references. Thus, formulations containing alpha-humulene have potential to be used as periodontal dressing.

Biological and mechanical characterization of commercial and experimental periodontal surgical dressings.

The objective of this study was to evaluate the biocompatibility and mechanical properties of two commercially available and one experimental periodontal dressing materials. The cytotoxicity of Periobond ® , Barricaid ® and one experimental periodontal dressing based on Exothane ® 8 monomer was tested on 3T3/NIH mouse fibroblast. Genotoxicity was assessed by micronuclei formation, and cell alterations were analyzed using light microscopy. Both biological assays were performed using the eluate obtained from specimens after 24, 72, or 168 hours of incubation. Mechanical characterization was assessed through the ultimate tensile strength and the water sorption and solubility tests. The significance level of α = 0.05 was used for all statistical analyses. All the materials promoted a cell viability lower than 60% in all evaluated times. In general, the cell viability was significantly reduced after 72 and 168h of specimens' incubation. Considering the factor material, there were not statistical differences in the cell viability (p = 0.156). The genotoxicity was not statistically significant among the groups in the different periods of time (p > 0.05). Differences in the ultimate tensile strength values were not statistically significant different among the groups (p = 0.125). Periobond ® showed the higher water sorption values (p < 0.001). Regarding solubility, there were no statistical differences between the groups (p = 0.098). All the periodontal dressing materials evaluated in this study exerted a cytotoxic effect against mouse fibroblasts, and their toxicity became more evident over time. Among the materials evaluated, the experimental light-cure type has shown overall similar properties to the commercial references.

Intraoperative findings, complications, and short-term results after lumbar microdiscectomy with or without implantation of annular closure device.

BACKGROUND: Standard microscopic lumbar discectomy (MLD) is a short operation with minimal blood loss, and a low rate of peri- and intraoperative complications. The objective of this study was to evaluate intraoperative findings, complications, and early postoperative neurological outcome (< 105 days) in patients undergoing MLD with or without implantation of an annular closure device (ACD). METHODS: This study is based on data analysis of a post-marketing, prospective, multicenter RCT in Europe including patients undergoing standard MLD with or without implantation of an ACD (Barricaid®, Intrinsic Therapeutics, Inc., Woburn, MA). Enrollment of 554 patients in 21 centers in Europe (Germany, Switzerland, Austria, Belgium, The Netherlands, and France) started in 2010 and was completed in October 2014, with 276 patients randomized to the ACD group and 278 to the control group. RESULTS: Mean operation time was 70 min in the ACD group and 52 min in the control group (p < 0.0001). Intraoperative fluoroscopy time was 24 s in the ACD group and 7 s in the control group (p < 0.0001). Average blood loss was 94.2 ml in the ACD group and 64.7 ml in the control group (p = 0.0001). Serious device- or procedure-related adverse events occurred in 3.7% (10/272) of the ACD group and 7.9% (22/278) of the control group. Dural injuries occurred in 13 (4.8%) patients in the ACD group and 7 (2.5%) in the control group. There was one device-related nerve root injury resulting in a nerve root amputation. Surgical complications included 3 hematomas in the ACD group and 4 in the control group; 3 infections occurred in both groups. Device migrations were documented in 3 patients in the ACD group. Patients in the ACD group (n = 7, 2.6%) underwent fewer reoperations compared with that in the control group (n = 16, 5.8%, OR = 2.3 (0.9-5.7)). Mean VAS leg pain at 3 months was 11.9 in the ACD and 15.1 in the control group, respectively. CONCLUSION: Short-term outcome after MLD with or without implantation of ACD was similar in both groups. Patients included in the ACD group underwent fewer reoperations in the first 3 months after surgery. Nevertheless, longer operation time, higher amount of blood loss, and risk of nerve root lesion during device implantation should be considered additional risks in patients undergoing ACD implantation after MLD.

Biological and mechanical characterization of commercial and experimental periodontal surgical dressings

Abstract The objective of this study was to evaluate the biocompatibility and mechanical properties of two commercially available and one experimental periodontal dressing materials. The cytotoxicity of Periobond ® , Barricaid ® and one experimental periodontal dressing based on Exothane ® 8 monomer was tested on 3T3/NIH mouse fibroblast. Genotoxicity was assessed by micronuclei formation, and cell alterations were analyzed using light microscopy. Both biological assays were performed using the eluate obtained from specimens after 24, 72, or 168 hours of incubation. Mechanical characterization was assessed through the ultimate tensile strength and the water sorption and solubility tests. The significance level of α = 0.05 was used for all statistical analyses. All the materials promoted a cell viability lower than 60% in all evaluated times. In general, the cell viability was significantly reduced after 72 and 168h of specimens' incubation. Considering the factor material, there were not statistical differences in the cell viability (p = 0.156). The genotoxicity was not statistically significant among the groups in the different periods of time (p > 0.05). Differences in the ultimate tensile strength values were not statistically significant different among the groups (p = 0.125). Periobond ® showed the higher water sorption values (p < 0.001). Regarding solubility, there were no statistical differences between the groups (p = 0.098). All the periodontal dressing materials evaluated in this study exerted a cytotoxic effect against mouse fibroblasts, and their toxicity became more evident over time. Among the materials evaluated, the experimental light-cure type has shown overall similar properties to the commercial references.

Assessment of Clinical Efficacy of Different Periodontal Dressing Materials on Wound Healing: A Comparative Study.

AIM: The present study aims to assess the efficacy of different periodontal dressing materials on wound healing clinically. MATERIALS AND METHODS: A total of 45 patients between the age group of 30-45 years, with chronic generalized periodontitis with loss of attachment of 3-6 mm, who require periodontal flap surgery, were screened to include in the study. Out of 45 subjects, 24 were males and 21 were females. The subjects were randomized into 3 groups as 15 in each. Group I: a collagen dressing, group II: light-cure dressing, and group III: non-eugenol-based dressing. The clinical parameters such as plaque index, vertical probing depth, pain, gingival index, and patient satisfaction were documented for all the three groups on the 7th and the 14th day. Visual analog scale (VAS) was used to score the pain severity. The SPSS 20 software was used to analyze the data. The significance level was set at 5%. RESULTS: The mean gingival index score reduced from 1.40 ± 0.14 to 1.10 ± 0.30 in group I, from 1.48 ± 0.01 to 1.26 ± 0.22 in group II, and from 1.58 ± 0.16 to 1.33 ± 0.10 in group III. The mean plaque index score reduced from 1.48 ± 0.56 to 1.18 ± 0.40 in group I, from 1.46 ± 0.01 to 1.24 ± 0.48 in group II, and from 1.42 ± 0.12 to 1.20 ± 0.20 in group III. There was a statistical difference found in all the three groups and between the groups from the plaque and gingival index scores. The probing depth comparison shows a significant difference in group I. Patient satisfaction was almost similar in all the groups. The pain index showed the reduction in the pain severity from the 7th day to the 14th day in all the subjects from all the three groups. CONCLUSION: It can be concluded that the periodontal wound covered with a collagen dressing material showed significant evidence to provide symptomatic relief and better healing to the patients compared to that of light-cure and non-eugenol periodontal dressing material.

Annular closure device for disc herniation: meta-analysis of clinical outcome and complications.

BACKGROUND: Lumbar intervertebral disc herniation is a common cause of lower back and leg pain, with surgical intervention (e.g. discectomy to remove the herniated disc) recommended after an appropriate period of conservative management, however the existing or increased breach of the annulus fibrosus persists with the potential of reherniation. Several prosthesis and techniques to reduce re-herniation have been proposed including implantation of an annular closure device (ACD) - Barricaid™ and an annular tissue repair system (AR) - Anulex-Xclose™. The aim of this meta-analysis is to assist surgeons determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications. METHODS: Four electronic full-text databases were systematically searched through September 2017. Data including outcomes of annular closure device/annular repair were extracted. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics. RESULTS: Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P < 0.0001). Durotomies were lower among the ACD/AR patients with only 3 reported cases compared to 7 in the control group (OR: 0.54; 95% CI: 0.13, 2.23; I2 = 11%; P = 0.39). Similar outcomes for post-operative Oswestry Disability Index and visual analogue scale were obtained when both groups were compared. CONCLUSION: Early results showed the use of Barricaid and Anulex devices are beneficial for short term outcomes demonstrating reduction in symptomatic disc reherniation with low post-operative complication rates. Long-term studies are required to further investigate the efficacy of such devices.

Implantation of a bone-anchored annular closure device in conjunction with tubular minimally invasive discectomy for lumbar disc herniation: a retrospective study.

BACKGROUND: Minimally invasive techniques for lumbar discectomy have been recommended as superior to open techniques due to lower blood loss, lower rates of infection and shorter recovery. There are, however, concerns that this approach does not sufficiently remove the herniated nuclear material, thus leaving the patient susceptible to reherniation requiring reoperation. The purpose of this study was to examine the safety and viability of an annular closure device in limiting reherniation and reoperation in a cohort of patients undergoing minimally invasive lumbar discectomy with the assistance of an annular closure device. METHODS: We retrospectively analysed the results from patients treated by a single surgeon between March 2011 and December 2017. All patients had been diagnosed with a large (≥ 5 mm) defect and were treated via minimally invasive surgical techniques. Outcomes included demographic data, the procedural duration and the rates of symptomatic reherniation and reoperation. RESULTS: 60 patients were included in the study. The mean age was 42 years (range: 19-66); mean BMI was 24.1 (range: 16.7-36.3). Mean surgical duration was 29 min (range: 16-50). Reoperation was required in 5% (3/60) of patients, although only 3% (2/60) experienced symptomatic reherniation at the index level. No other complications were reported. CONCLUSIONS: In our study, the use of an annular closure device during minimally invasive lumbar discectomy in a population of patients with large herniations was associated with low rates of reherniation and reoperation at the index level. While more research is required, the results of this study demonstrate the safety and viability of the annular closure device as an adjunct to minimally invasive discectomy.

Symptomatic annulus-repair-device loosening due to a low-grade infection.

We report the unusual case of a young patient with reoperation after annuloplasty using the Barricaid® (Intrinsic Therapeutics, Woburn, MA, USA) closure device. Our patient, a 32-year-old man underwent lumbar discectomy and annuloplasty of the level L5-S1. Five years later, the patient presented with a new onset of low-back pain radiating into the right leg. Imaging revealed loosening of the annulus repair device. The device was removed surgically and the patient was pain free thereafter. Annular closure devices such as the Barricaid system aim to improve outcome after lumbar discectomy by reducing the risk of recurrent disc herniation of the same level. Data on long-term follow-up are missing. Here we present, to our knowledge, the first case of symptomatic device loosening.

Periodontal Dressing as an Adjunct after Scaling and Root Planing--A Useful Preventive Tool?

PURPOSE: To determine the preventive effect of a periodontal dressing containing colophony, zinc oxide and magnesium oxide applied after scaling and root planing on clinical variables, subgingival bacteria and local immune response in patients with chronic periodontitis. MATERIALS AND METHODS: In this randomised prospective clinical study, 28 volunteers with generalised moderate chronic periodontitis were treated with full-mouth scaling in a split-mouth design. In the test quadrants, the periodontal dressing was applied during the first three days. At baseline and after 6 and 12 weeks, probing pocket depth (PD), attachment level (AL) and bleeding on probing (BOP) were recorded, and subgingival plaque samples were taken for laboratory analysis. RESULTS: In both groups, PD, AL and BOP were significantly reduced (p=0.001). BOP was significantly lower in the control than the test group after 6 weeks (p=0.046). Significantly reduced bacterial counts of Porphyromonas gingivalis were found in the control group after 12 weeks (p=0.013). No differences were found for the microbiological results between the groups. After 12 weeks, interleukin (IL)-8 and matrix metalloproteinase (MMP)-8 were significantly higher in the test group (p=0.023 and p=0.003, respectively). CONCLUSION: The adjunctive application of a periodontal dressing had no additional preventive effect on clinical data 12 weeks after scaling and root planing.

Effect of periodontal dressing on non-surgical periodontal treatment outcomes: a systematic review.

BACKGROUND: Periodontal dressing has been advocated and showed some positive outcomes for placing over the surgical site after periodontal surgery. However, little is known about its effect on non-surgical therapy. PURPOSE: The aim of this review was to assess the clinical effect of periodontal dressing when used after non-surgical therapy. MATERIAL AND METHODS: Two examiners performed an electronic search in several databases for relevant articles published in English up to November 2013. Selected studies were randomized human clinical trials (prospective or retrospective trials) with the clear aim of investigating the effect of periodontal dressing placement upon periodontal non-surgical mechanical therapy. Data were extracted from the included articles for analysis. RESULTS: Three randomized clinical trials fulfilled the inclusion criteria and thus were included in the data analysis. Statistical analysis could not be carried out due to the lack of clear data of the included studies. However, descriptive analysis showed its effectiveness in improving clinical parameters such as gain of clinical attachment level and reduction of probing pocket depth. CONCLUSION: Placement of periodontal dressing right after non-surgical mechanical therapy can be beneficial in improving overall short-term clinical outcomes, although more controlled studies are still needed to validate this finding.

Pulp Revascularization of Immature Dog Teeth with Apical Periodontitis Using Triantibiotic Paste and Platelet-rich Plasma: A Radiographic Study.

INTRODUCTION: This study evaluates radiographically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP). METHODS: Forty double-rooted immature premolar teeth from 4 female beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP following different treatment protocols. Four teeth were left untreated and assigned to the positive control group, and the last 28 teeth were randomly assigned into 4 experimental groups of 8 teeth: A1, sodium hypochlorite (NaOCl) + a blood clot; A2, NaOCl + platelet-rich plasma (PRP); B1, NaOCl + modified triantibiotic paste (mTAP) + a blood clot; and B2, NaOCl + mTAP + PRP. Teeth were monitored radiographically for 6 months regarding healing of periapical radiolucencies, thickening of the dentinal walls, and apical closure of roots. RESULTS: Significant differences (P < .05) between the 4 groups were evident in the percentage of teeth showing improvement of periapical radiolucencies (62.5%), continued radiographic thickening of radicular walls (53.1%), radiographic apical closure (43.8%), and deposition of hard tissue on radicular dentin walls (53.1%). Group B2 showed maximal improvement in the 3 variables assessed (P < .05). Group A1 showed the minimum percentages in the 3 parameters assessed (P < .05). CONCLUSIONS: These results suggest that an intracanal dressing of mTAP and the use of PRP as scaffold improves the success rate of the revascularization procedure.

To pack or not to pack: the current status of periodontal dressings.

Surgical wound dressings have been employed over several centuries for the purpose of protection of surgical sites, to prevent postoperative infection and to accelerate healing. Periodontal dressings, also known as periodontal packs, provide similar benefits when applied after periodontal surgical procedures. They can broadly be categorized as eugenol-based dressings and noneugenol dressings. Over the years, many modifications have been made to the composition of such dressings to improve their physical and therapeutic properties. Controversies surrounding the rationale for their use, advantages and disadvantages of the most commonly employed periodontal dressings and their current status in clinical practice are described in this comprehensive review. From the evidence-based literature presented here, we have also attempted to answer the question of whether there is a universal need for the application of periodontal dressings.

Técnica de collage dentario con colgajo mucoperióstico: reporte de caso / Toot fragment reattachment with mucoperiosteal flap: report of case

La fractura dental coronaria es la injuria dental traumática más común de los dientes permanentes. El collage dentario es una alternativa restauradora que consiste en pegar fragmentos dentarios con un procedimiento semejante al que se utiliza para unir pedazos sueltos mediante pegamentos convencionales. El presente artículo describe el caso de un paciente con fracturas coronarias en las piezas 11 y 21 que fueron tratadas mediante un collage dentario. El paciente acudió a la consulta con los fragmentos fracturados procediéndose a realizar el tratamiento de conductos de dichas piezas y colocación de postes de fibras de vidrio. Posteriormente se procedió a la unión de los fragmentos previa realización de un colgajo mucoperióstico debido a la invasión del espacio biológico. A la evaluación clínica inmediata y a los tres años de seguimiento fue aceptable tanto funcional como estética

Dental crown fracture is the most common traumatic dental injury for permanent teeth. Tooth fragment reattachment is a restorative alternative which consists in adhering tooth fragments with a procedure suchlike the one used to join loose pieces by conventional adhesives. This article describes a clinical case of a patient with upper central incisors crowns fractured which were treated by tooth reattachment. Patient attended dental practice with the broken teeth and their fragments, and was immediately referred to receive root canal treatments and then the placement of fiberglass posts. Later, the fragments attachment was made after carrying a mucoperiosteal flap because of the biological space invasion. There were acceptable functional and esthetic results at the immediate clinical assessment and after three years of monitoring

Alveolitis seca: una revisión de la literatura / Dry socket: a literature review

La alveolitis seca es la complicación posoperatoria más frecuente como resultado de la alteración en la cicatrización de la herida alveolar después de una extracción dental. El manejo de esta afección tiene por objetivo el control del dolor durante el periodo de curación del cuadro, lo cual se logra fundamentalmente mediante medidas paliativas. El objetivo de esta revisión de la literatura es obtener suficiente información sobre las causas y otros factores que podrían estar involucrados en esta complicación postoperatoria, así como las opciones de tratamiento que existen actualmente (AU)

Dry socket is the most common postoperative complication, due to problems in alveolar wound healing after tooth extraction. The management of this condition aims to control pain during the healing period, and is mainly achieved with palliative drugs. The aim of this literature review is to obtain sufficient information on the causes and any other factors that could be involved in this post-operative complication, as well as the currently available treatment options (AU)

Periodontal dressing after surgical crown lengthening: a randomized clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the effect of periodontal dressing on post-operative pain and swelling after surgical crown lengthening. MATERIALS AND METHODS: A blind, randomized, clinical trial was carried out with 36 patients. Following surgical crown lengthening, the individuals were randomly allocated to the periodontal dressing group (PDG) and control group (CG, non-placement of periodontal dressing). Pain and discomfort were analyzed using a visual analog scale (VAS), verbal scale (VS) and the number of analgesics consumed in 7 days post-operatively. Post-operative infection, stability of the gingival margin and type of healing were also evaluated. RESULTS: The PDG had a significantly higher percentage of responses of 'strong pain' on the VS in the first day post-operatively (33.3% vs 5.3%, p = 0.03) and greater pain on the first and second days post-operatively based on the VAS. Moreover, a significant difference between groups was found regarding gingival swelling after 7 days. However, gingival recession was found in 57.8% of the sites in the CG and only 5.5% of sites in the PDG. No change in condition was found among individuals with conjunctive tissue/bone exposure in the CG in the immediate post-operative period and 80% of the patients in the PDG had healing by first intention after 7 days. CONCLUSION: The use of periodontal dressing seems to be preferable following surgical crown lengthening with connective tissue/bone exposure. However, adequate post-operative analgesic strategies should be employed due to the possibility of intense pain in the first 24 hours.

A simplified pocket reduction procedure around a stud attachment without suturing.

Plaque accumulation on the implant titanium surface plays a critical role in the initiation and progression of periimplant disease. Removing plaque and calculus deposits, and reducing the periimplant probing depth, therefore, are important. The reduction of the periimplant probing depth in periimplant disease by using a cord and a surgical dressing pack has not been previously reported. This procedure is useful for periimplant mucositis and mild periimplantitis before a surgical intervention and can maintain a narrow keratinized mucosa with less pain than surgical intervention.

A methodological approach to assessing alveolar ridge preservation procedures in humans: soft tissue profile.

INTRODUCTION: The aesthetic results of implant restoration in the anterior maxilla are particularly related to the soft tissue profile. Although socket preservation techniques appear to reduce bone remodelling after tooth extraction, there is still few investigations assessing the external soft tissue profile after such procedures. The goal of this study was to describe an accurate technique to evaluate soft tissue contour changes after performing socket preservation procedures. The secondary objective was to apply the newly developed measuring method to a specific socket preservation using a "saddled" connective tissue graft combined with the insertion of slowly resorbable biomaterials into the socket. MATERIALS AND METHODS: A total of 14 patients needing tooth replacement in the aesthetic region were included to receive a socket preservation procedure using a connective tissue graft. Impressions were taken before the tooth extraction (baseline) and at 2, 4, and 12 weeks after the procedure. The corresponding plaster casts were scanned, and the evolution of the soft tissue profile in relation to the baseline situation was assessed using imaging software. RESULTS: The measuring technique allowed assessing the soft tissue profiles accurately at different levels of the alveolar process. The insertion of a saddled connective tissue appeared to compensate for the horizontal and vertical bone remodelling after a socket preservation procedure in most regions of the alveolar crest. After 12 weeks, the only significant change was located in the more cervical and central region of the alveolar process and reached a median drop of 0.62 mm from baseline. CONCLUSION: Within the limitations of this study, we found that a saddled connective tissue graft combined with a socket preservation procedure could almost completely counteract the bone remodelling in terms of the external soft tissue profile. The minor changes found in the cervical region might disappear with the emergence profile of the prosthodontic components. The described technique might therefore enhance the aesthetic outcomes when a tooth has to be replaced in the aesthetic zone. The described protocol can be used to further compare the effectiveness of different extraction socket preservation protocols in randomised controlled trials.

One-stage full-mouth disinfection combined with a periodontal dressing: a randomized controlled clinical trial.

AIM: To compare the clinical benefit of a periodontal dressing applied after a one-stage full-mouth disinfection (OSFMD) in patients with chronic periodontitis up to 3 months after therapy. MATERIAL AND METHODS: This randomized, controlled split-mouth study included 24 patients. After OSFMD, a test and a control side were selected by means of a computer-generated randomization list. Test sides received a periodontal dressing (Coepak(®) ) for 7 days and the control sides received no periodontal dressing. After 7 days the periodontal dressing was removed and the pain experience was recorded. After 3 months, the clinical periodontal parameters were recorded. RESULTS: The periodontal dressing group showed a significant (p < 0.05) additional pocket depth reduction and additional clinical attachment gain for the moderate pockets of single- and multi-rooted teeth compared with the control group. A significant (p < 0.05) lower percentage of sites with probing pocket depth ≥5 mm were shown for the periodontal dressing group compared with the control group (2.7 ± 16.3% versus 4.8 ± 21.4%). The pain intensity was significantly reduced when using a periodontal dressing (5.13 ± 0.89 versus 3.42 ± 1.27). CONCLUSION: The use of a periodontal dressing for 7 days after a OSFMD offers an additional short-term clinical improvement and lowers the pain intensity.