Synthesis of a PVA drug delivery system for controlled release of a Tramadol-Dexketoprofen combination.

The local administration of analgesic combinations by means of degradable polymeric drug delivery systems is an alternative for the management of postoperative pain. We formulated a Tramadol-Dexketoprofen combination (TDC) loaded in poly(vinyl alcohol) (PVA) film. Films were prepared by the solvent casting method using three different molecular weights of PVA and crosslinking those films with citric acid, with the objective of controlling the drug release rate, which was evaluated by UV-vis spectrometry. Non-crosslinked PVA films were also evaluated in the experiments. Differential scanning calorimetry (DSC) analysis of samples corroborated the crosslinking of PVA by the citric acid. Blank and loaded PVA films were tested in vitro for its impact on blood coagulation prothrombin time (PT) and partial thromboplastin time (PTT). The swelling capacity was also evaluated. Crosslinked PVA films of higher-molecular weight showed a prolonged release rate compared with that of the lower-molecular-weight films tested. Non-crosslinked PVA films released 11-14% of TDC. Crosslinked PVA films released 80% of the TDC loaded (p < 0.05). This suggests that crosslinking films can modify the drug release rate. The blank and loaded PVA films induced PT and PTT in the normal range. The results showed that the polymeric films evaluated here have the appropriate properties to allow films to be placed directly on surgical wounds and have the capacity for controlled drug release to promote local analgesia for the control of postoperative pain.

Evaluation of Surgical Bur Deformation and Bone Surface Roughness After Multiple Uses.

PURPOSE: The aim of the present in vitro study was to microscopically evaluate and describe the deformation of Lindeman surgical burs and the bone surface roughness after repeated osteotomies and sterilization cycles. MATERIALS AND METHODS: Twenty-one Lindeman surgical burs were analyzed under scanning electron microscopy (SEM) to evaluate the damage of the bur's integrity after 0, 1, 3, 5, 7, or 9 osteotomies on bovine ribs. Eighteen bone specimens were obtained after osteotomy for roughness analysis using profilometry. One-way analysis of variance was used to compare the mean roughness values across the experimental groups, and P ≤ .05 was considered to indicate statistical significance. RESULTS: Representative SEM images illustrated that all analyzed burs presented with some type of deformation at both the tip and the body, even after their first use. The mean roughness values were independent of the number of uses (P > .05); however, the standard deviation increased with the number of uses of the burs. CONCLUSIONS: These results suggest that even after their first use, rotatory surgical burs will have some type of deformation and that their cutting efficiency on the bone will vary and will be difficult to predict.

Local Ketamine Improves Postoperative Analgesia After Third Molar Surgery.

PURPOSE: Evidence exists to support the peripheral analgesic effect of local administration of ketamine (LAK) after third molar surgery. The aim of the present systematic review and meta-analysis was to determine the efficacy of LAK in the control of pain, swelling, and trismus after third molar surgery. MATERIALS AND METHODS: The study design was a systematic review with a meta-analysis of the effect of LAK after third molar surgery. A search in electronic databases was performed from September 2017 to February 2019. Only prospective clinical trials and randomized controlled trials that had evaluated LAK after third molar surgery were included. The meta-analysis was based on the random effects model. The outcome measures evaluated were postoperative acute pain, swelling, and trismus. The estimated overall effect size was a standardized mean difference (SMD). RESULTS: A total of 110 study subjects (men and women aged 18 to 50 years) were evaluated for the analgesic effect. The SMD showed a significant analgesic effect (postoperative pain control) favoring LAK (SMD, -1.7403; 95% confidence interval [CI], -2.45 to -1.04). Evaluation of the anti-inflammatory effect of LAK included 105 study subjects and resulted in significantly less swelling in the first postoperative day (SMD, -0.6169; 95% CI, -1.1654 to -0.0683). However, LAK did not reduce the incidence of trismus after third molar surgery (SMD, -0.7241; 95% CI, -2.2765 to 0.8284). CONCLUSIONS: The use of LAK can reduce the incidence and severity of postoperative pain after third molar surgery and had an anti-inflammatory effect, although only in the first postoperative day. However, LAK had no effect on trismus reduction after third molar surgery.

Analgesic efficacy of preoperative dexketoprofen trometamol: A systematic review and meta-analysis.

Post-Market Research Clinical evidence supports the use of dexketoprofen trometamol (DEX) to manage acute postoperative pain. However, controversies surround the impact of the use of this drug in preoperative analgesic protocols. The aim of the present meta-analysis was to evaluate the effectiveness of the preoperative administration of DEX under postoperative pain conditions. Electronic and manual searches were conducted through diverse electronic databases. A systematic review and meta-analysis to evaluate the analgesic efficacy of the preoperative administration of DEX was performed including Randomized Clinical Trials (RCTs) published between 2002 and 2017. Suitable individual studies were evaluated through a quality system, and the data were extracted and analyzed. Fourteen RTCs were included (12 parallel trials and 2 cross-over trials), published in the English and Turkish languages. Follow-up periods ranged from 4, 6, 8, 24, and 48 hr. All trials measured the outcome result as Acute Pain Level (APL) (VAS, NRS, VRS), time to requiring a second dose of DEX or analgesic emergency and consumption of opioids via patient-controlled analgesia. When the comparators were other drugs - paracetamol, Lornoxicam or placebo during the preoperative time, preoperative administration of DEX was superior. When the comparison comprised preoperative and postoperative DEX, both alternatives exhibited comparable analgesic effects. The analgesic efficacy of the preoperative administration of DEX when compared to placebo, lornoxicam, and paracetamol on postoperative pain was evident. Preoperative administration of DEX compared to its immediate postoperative administration showed a similar analgesic effect.

Sustained release of calcium hydroxide from poly(DL-lactide-co-glycolide) acid microspheres for apexification.

Calcium hydroxide (CH) loaded poly(DL-lactide-co-glycolide) acid (PLGA) microspheres (MS) might be used for apexification requiring a sustained release of Ca(2+). The aim of this study was to formulate and characterize CH-PLGA-MS. The CH-loaded MS were prepared by either oil-in-water (O/W) or water-in-oil/in-water (W/O/W) emulsion solvent evaporation technique. MS produced by the O/W technique exhibited a larger diameter (18.63 ± 7.23 µm) than the MS produced by the W/O/W technique (15.25 ± 7.37 µm) (Mann-Whitney U test P < 0.001). The CH encapsulation efficiency (E e) and Ca(2+) release were calculated from data obtained by absorption techniques. Ca(2+) release profile was evaluated for 30 days. To know the E e, the CH-loaded MS were dissolved in 1 M NaOH to release all its content and a Ca(2+) colorimetric marker was added to this solution. The reagent marked the Ca(2+) in blue color, which was then measured by a UV-Vis system (650 nm). The percentage of E e was calculated on the basis of the theoretical loading. The E e of the O/W-produced MS was higher (24 %) than the corresponding percentage of the W/O/W-produced MS (11 %). O/W- and W/O/W-produced MS released slower and lower Ca(2+) than a control CH paste with polyethylene glycol 400 (Kruskal-Wallis test). O/W-produced MS released higher Ca(2+) than W/O/W-produced MS (statistically significant differences; P < 0.05). In conclusion, the CH-PLGA-MS were successfully formulated; the technique of formulation influenced the size, encapsulation efficiency and release profile. The MS were better sustained release system than the CH paste.

Sensory Neuropeptides and Endogenous Opioids Expression in Human Dental Pulp with Asymptomatic Inflammation: In Vivo Study.

PURPOSE: This study quantified the expression of substance P (SP), calcitonin gene-related peptide (CGRP), ß-endorphins (ß-End), and methionine-enkephalin (Met-Enk) in human dental pulp following orthodontic intrusion. METHODS: Eight patients were selected according to preestablished inclusion criteria. From each patient, two premolars (indicated for extraction due to orthodontic reasons) were randomly assigned to two different groups: the asymptomatic inflammation group (EXPg), which would undergo controlled intrusive force for seven days, and the control group (CTRg), which was used to determine the basal levels of each substance. Once extracted, dental pulp tissue was prepared to determine the expression levels of both neuropeptides and endogenous opioids by radioimmunoassay (RIA). RESULTS: All samples from the CTRg exhibited basal levels of both neuropeptides and endogenous opioids. By day seven, all patients were asymptomatic, even when all orthodontic-intrusive devices were still active. In the EXPg, the SP and CGRP exhibited statistically significant different levels. Although none of the endogenous opioids showed statistically significant differences, they all expressed increasing trends in the EXPg. CONCLUSIONS: SP and CGRP were identified in dental pulp after seven days of controlled orthodontic intrusion movement, even in the absence of pain.

Peripheral synergism between tramadol and ibuprofen in the formalin test.

Preclinical Research Analgesics with different mechanisms of action can be combined in order to obtain pharmacological synergism, employing lower doses of each agent, thus diminishing side effects. For instance, an atypical dual analgesic such as tramadol (TMD) and a nonsteroidal anti-inflammatory drug such as ibuprofen (IBU) are good candidates to be evaluated when combined and applied peripherally. The present study was conducted to evaluate possible local synergism between TMD and IBU when combined peripherally using the formalin test in rats. The effects of the individual analgesics and their combinations were evaluated simultaneously using a 5% formalin dilution. Dose-effect curves were determined for TMD (50-400 µg/paw) and IBU (1-100 µg/paw). Experimental effective doses were evaluated and isobolographic analyses were constructed to evaluate TMD-IBU combination synergism. Both drugs produced a dose-dependent analgesic effect when applied separately. Isobolographic analysis showed synergism during phase 1 (0-10 min) and phase 2 (15-60 min) when compared with theoretical doses (P < 0.05), with interaction indexes of 0.06 and 0.09, respectively. The present information supports the peripheral analgesic effect of TMD and IBU, especially when combined at appropriate doses.

Involvement of nitric oxide and ATP-sensitive potassium channels in the peripheral antinoceptive action of a tramadol-dexketoprofen combination in the formalin test.

Systemic coadministration of tramadol and dexketoprofen can produce antinociceptive synergism in animals. There has been only limited evaluation of this drug combination in the peripheral nervous system in terms of the antinociceptive interaction and its mechanisms. The aim of the present study was to evaluate the peripheral antinociceptive interaction between tramadol and dexketoprofen in the formalin test and the involvement of the nitric oxide (NO)-cyclic guanosine monophosphate pathway and ATP-sensitive K(+) channels. Different doses of tramadol or dexketoprofen were administered locally to the formalin-injured mouse paw and the antinociceptive effect evaluated. ED50 values were calculated for both drugs alone and in combination. Coadministration of tramadol and dexketoprofen produced an antinociceptive synergistic interaction during the second phase of the formalin test. Pretreatment with NO antagonists, including l-NG-nitroarginine methyl ester and 1H-[1,2,4]-oxadiazolo-[4,3-a]-quinoxalin-1-one, or the ATP-sensitive K(+) channel antagonist glibenclamide reversed the antinociceptive synergistic effect of the tramadol-dexketoprofen combination, suggesting that NO and ATP-sensitive K(+) channels were involved.

Evaluation of the Local Synergistic Effect of a Dexketoprofen and Chlorhexidine Combination in the Formalin Test.

OBJECTIVE: Evidence supports the local application of non-steroidal antiinflammatory drugs such as dexketoprofen trometamol (DXT) for pain management, but little is known about the potential antinociceptive effect of chlorhexidine gluconate (CHX) and its possible synergistic effect when combined with DXT. The aim of this study was to evaluate the local effect of a DXT-CHX combination using isobolographic analysis in a formalin pain model in rats. MATERIALS AND METHODS: Briefly, 60 female Wistar rats were used for the formalin test. Individual dose effect curves were obtained using linear regression. For each drug, the percentage of antinociception and median effective dose (ED50; 50% of antinociception) were calculated, and drug combinations were prepared using the ED50s for DXT (phase 2) and CHX (phase 1). The ED50 of the DXT-CHX combination was determined, and an isobolographic analysis was performed for both phases. RESULTS: The ED50 of local DXT was 5.3867 mg/mL in phase 2 and for CHX was 3.9233 mg/mL in phase 1. When the combination was evaluated, phase 1 showed an interaction index (II) of less than 1, indicating synergism but without statistical significance. For phase 2, the II was 0.3112, with a reduction of 68.88% in the amounts of both drugs to obtain the ED50; this interaction was statistically significant (P < .05). CONCLUSION: DXT and CHX had a local antinociceptive effect and exhibited synergistic behavior when combined in phase 2 of the formalin model.

3D-Printed Tubular Scaffolds Decorated with Air-Jet-Spun Fibers for Bone Tissue Applications.

The fabrication of instructive materials to engineer bone substitute scaffolds is still a relevant challenge. Current advances in additive manufacturing techniques make possible the fabrication of 3D scaffolds with even more controlled architecture at micro- and submicrometric levels, satisfying the relevant biological and mechanical requirements for tissue engineering. In this view, integrated use of additive manufacturing techniques is proposed, by combining 3D printing and air-jet spinning techniques, to optimize the fabrication of PLA tubes with nanostructured fibrous coatings for long bone defects. The physicochemical characterization of the 3D tubular scaffolds was performed by scanning electron microscopy, thermogravimetric analysis, differential scanning calorimetry, profilometry, and mechanical properties. In vitro biocompatibility was evaluated in terms of cell adhesion, proliferation, and cell-material interactions, by using human fetal osteoblasts to validate their use as a bone growth guide. The results showed that 3D-printed scaffolds provide a 3D architecture with highly reproducible properties in terms of mechanical and thermal properties. Moreover, nanofibers are collected onto the surface, which allows forming an intricate and interconnected network that provides microretentive cues able to improve adhesion and cell growth response. Therefore, the proposed approach could be suggested to design innovative scaffolds with improved interface properties to support regeneration mechanisms in long bone treatment.

Effects of heat on seven endodontic sealers.

PURPOSE: To examine the microscopic surface features, chemical composition, and thermodynamic profile of seven endodontic sealers (AH Plus, Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, GuttaFlow BioSeal, and EndoRez) exposed to high-temperature changes using an endodontic obturation device. METHODS: The thermal properties were examined using scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Then, six disc-shaped specimens of each sealer were prepared and divided into two groups - a room temperature group and a heat exposure group - for analysis of surface and chemical changes using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). RESULTS: DSC analysis showed that AH Plus had the highest exothermal signal (122.9°C), while TGA analysis showed that MTA-Fillapex was most affected by increased temperature (32.4% mass loss at 230ºC). SEM analysis showed that while AH Plus and GuttaFlow BioSeal maintained their surface integrity after heat exposure, the EDS profiles demonstrated changes in the chemical composition of the sealers after heat exposure for 5 s. High-temperature exposure had a negative impact on the properties of five of the sealers (Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, and EndoRez). CONCLUSION: AH Plus and GuttaFlow BioSeal showed minimal changes upon high-temperature exposure, suggesting their suitability for thermal endodontic obturation techniques.

Management of dental caries lesions in Latin American and Caribbean countries.

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

Rehabilitation of anterior maxilla with a novel hyperbolic profile transmucosal implant in elderly patients.

BACKGROUND: This study aims to evaluate soft and hard tissues response of a two-piece implant placed nonsubmerged in elderly patients' anterior maxilla. Marginal bone level and Pink Esthetic Score (PES) were evaluated up to 24 months. METHODS: Twelve healthy consecutive patients (mean age 65.8±5 years; 65.5 median) were included in the study. Implants were inserted with flapless technique after 3 months or immediately after extraction. The smooth machined neck of the implant was characterized by a hyperbolic neck which follows biologically oriented preparation technique (BOPT) principles. A customized abutment and a provisional resin crown was positioned with care to avoid excessive soft tissue compression after 3 months, according with BOPT technique. A definitive ceramic crown was positioned after approx. 4 months. RESULTS: After 24 months all implants were stable and osseointegrated. PES improved at 6 and 12 months recalls, remaining stable at 24 months, indicating a healthy soft and hard tissue response. No complications were observed. Impression procedures and provisional/definitive crown cementation resulted simple and free from complications. The hyperbolic profile allowed the preparation of prosthetic crown free from any gingival tissue pressure to create the adequate soft tissue contour. CONCLUSIONS: The use of hyperbolic profile implant associated with the transmucosal (not-submerged) technique is a safe procedure that allow the preservation of soft and hard tissue also in elderly patients.

Physico-Chemical comparison of four commercially available mineral trioxide aggregates / Comparación fisicoquímica de cuatro mineral trióxido agregados disponibles comercialmente

Abstract To compare the physicochemical composition of 4 MTAs commercially available in Latin America. ProRoot MTA (Dentsply, USA), MTA Angelus (Angelus, Brazil), MTA Flow (Ultradent, USA), and MTA Viarden (Viarden, Mexico) were physically and chemically compared. Scanning electron microscopy (SEM) images were obtained from the MTA powder and the prepared presentations. Energy Dispersive X-Ray Spectroscopy (EDS) analyses were performed by triplicate, to calculate the mass proportion of calcium (Ca), silicon (Si), the Ca/Si proportion among the 4 brands. Thermogravimetric analyses (TGA) were conducted (50ºC-1000ºC), and mass loss and inflection points were calculated for each material. Statistical differences for Ca and Si content were determined by ANOVA (p<0.05). SEM images showed evident differences in the appearance of both the powder and the prepared MTAs among brands. Angelus MTA showed cubic prisms not observed in the other 3 brands. ProRoot MTA and MTA Flow showed similar homogeneous structures. MTA Viarden was the less homogeneous, with random structures (>15um). When comparing the mass proportions of Ca and Si between the 4 powder samples, MTA Viarden showed a significantly lower proportions of both elements when compared with the other brands (p<0.005). TGA análisis showed a similar behavior for ProRoot MTA, MTA Angelus and MTA Flow, with less than 2% mass loss when the 1000C temperature was reached. MTA Viarden showed a mass loss of 9,94% before the 700C, indicating the presence of different content sensible to temperature degradation. The analyzed MTAs demonstrated to vary significantly in their chemical composition and physical characteristics. Clinicians must be aware of the differences between different brands of a same material, and future research should focus on the clinical implications of these differences.

Resumen Comparar la composición fisicoquímica de 4 MTA disponibles comercialmente en América Latina. Se compararon física y químicamente ProRoot MTA (Dentsply, EE. UU.), MTA Angelus (Angelus, Brasil), MTA Flow (Ultradent, EE. UU.) y MTA Viarden (Viarden, México). Se obtuvieron imágenes de microscopía electrónica de barrido (SEM) del polvo de MTA y de las presentaciones preparadas. Los análisis de espectroscopía de dispersión de energía de rayos X (EDS) se realizaron por triplicado para calcular la proporción de masa de calcio (Ca), silicio (Si), la proporción Ca/Si entre las 4 marcas. Se realizaron análisis termogravimétricos (TGA) (50ºC-1000ºC), y se calcularon las pérdidas de masa y los puntos de inflexión para cada material. Las diferencias estadísticas para el contenido de Ca y Si se determinaron mediante ANOVA (p<0,05). Los análisis SEM mostraron diferencias evidentes en la apariencia tanto del polvo como las preparaciones de los MTA, entre las diferentes marcas. MTA Angelus mostró prismas cúbicos no observados en las otras 3 marcas. ProRoot MTA y MTA Flow mostraron estructuras homogéneas similares. MTA Viarden fue el menos homogéneo, con estructuras aleatorias (>15um). Al comparar las proporciones de masa de Ca y Si entre las 4 muestras de polvo, MTA Viarden mostró proporciones significativamente más bajas de ambos elementos en comparación con las otras marcas (p<0,005). El análisis TGA mostró un comportamiento similar para ProRoot MTA, MTA Angelus y MTA Flow, con menos del 2 % de pérdida de masa al alcanzar los 1000 °C de temperatura. El MTA Viarden mostró una pérdida de masa de 9,94% antes de los 700 °C, indicando la presencia de diferentes contenidos sensibles a la degradación por temperatura. Los MTA analizados demostraron diferencias significativas en su composición química y características físicas. Los clínicos deben ser conscientes de las diferencias entre las diferentes marcas de un mismo material, y futuras investigaciones deben enfocarse en las implicaciones clínicas de estas diferencias.

Comparison of two obturation techniques on adhesion and proliferation of human periodontal ligament fibroblasts / Comparación de la adhesión y proliferación de fibroblastos periodontales humanos en dos técnicas de obturación endodóntica

The present study aimed to compare the adhesion and proliferation of human periodontal ligament fibroblasts (hPDL) in transverse sections of the teeth sealed with two different obturation techniques, BioRoot RCS/hydraulic obturation (HO) and AH-Plus/continuous-wave condensation (CWC). The techniques were tested using an in vitro model to simulate the interaction between periodontal tissues and the materials. The root canals were instrumented and sterilized. A total of 15 samples were obturated with BioRoot RCS/HO and 15 samples with AH-Plus/CWC. Then, roots were sectioned to obtain obturated teeth slices, and hPDL cells were seeded onto the root slices. The results were obtained at intervals of 4 and 24h for cell adhesion; and at 3,7,14, and 21 days for cell proliferation. Empty cell culture plates were use as controls. The cell adhesion was increased at 4 and 24h for both groups, with an increased response observed in the BioRoot RCS/HO group (p<0.05). The difference in cell proliferation was also found between experimental groups. After 14 days of culture, BioRoot RCS/HO group showed an increase response than control and AH-Plus/CWC groups (p<0.05), and after 21 days both groups behaved better than control group, with an increased response observed in the BioRoot RCS/HO group. This study demonstrated that both root canal sealers allow the attach and growth of periodontal ligament fibroblasts, with an increased biological response in the BioRoot RCS/HO group.

El presente estudio se enfocó en comparar la adhesión y proliferación de fibroblastos de ligamento periodontal humano (hPDL) en secciones transversales de raíces previamente obturadas con dos técnicas de obturación diferentes: obturación hidráulica empleando cono único de gutapercha y BioRoot RCS como sellador (HO), y obturación de condensación de onda continua y AH-Plus como sellador (CWC). Los selladores se usaron en un modelo in vitro que simula la interacción entre los tejidos periodontales y los materiales de obturación. Los conductos radiculares fueron instrumentados, esterilizados y obturados. La muestra se compuso de un total de 15 raíces con la técnica BioRoot RCS/HO y 15 raíces con la técnica AH-Plus/CWC. Las células de hPDL fueron sembradas en condiciones estándar de cultivo sobre las raíces seccionadas. Los resultados fueron obtenidos a intervalos de 4 y 24h para adhesión celular, y a los 3,5,7,14 y 21 días de cultivo para proliferación celular. La adhesión celular a las 4 y 24 horas mostró ser diferente para ambas técnicas en comparación con el grupo control, siendo más importante en el grupo BioRoot RCS/HO. La diferencia en la proliferación entre grupos se observó a los 14 días de cultivo, únicamente para el grupo BioRoot RCS/HO; Sin embargo para el día 21 ambas técnicas mostraron mayor proliferación celular que el grupo control, con mejor respuesta para el grupo BioRoot RCS/HO. Este estudio ha demostrado que ambos selladores de conductos permiten la adhesión y crecimiento de fibroblastos de ligamento periodontal, siendo el grupo BioRoot RCS/HO el que mostró mayor biocompatibilidad.

2020: Renewing the paradigms for orofacial pain / 2020: renovando los paradigmas para el dolor orofacial

Abstract In 2020, two important changes were adapted by the international health community: a new definition of pain and a new classification for orofacial pain conditions. With these changes new tasks and challenges also emerged, and clinicians from several disciplines begun to adopt and reconsidered classic paradigms, and the policies derived from them. This new perspective article, examine the new definition of pain proposed by the International Association for the Study of Pain, and the new International Classification of Orofacial Pain; analyzing the positive impact and further perspectives of these.

Resumen En 2020, dos importantes cambios fueron adaptados por la comunidad internacional en salud: una nueva definición de dolor y una nueva clasificación para las condiciones de dolor orofacial. Con estos cambios, también emergieron nuevos retos y tareas, y los clínicos de diversas disciplinas empezaron adaptar y reconsiderar los paradigmas clásicos; y las políticas derivadas de estos. En este artículo de nueva perspectiva, examinaremos nueva definición de dolor propuesta por la Asociación Internacional para el Estudio del Dolor, y la nueva Clasificación Internacional de Dolor Orofacial; analizando el impacto positivo y las próximas perspectivas de estos cambios.

Antibacterial and antifungal capacity of three commercially available mouthwashes with different concentrations of chlorhexidine / Efecto antibacteriano y antifúngico de tres enjuagues bucales comerciales con diferentes concentraciones de clorhexidina

Abstract Chlorhexidine was introduced almost seven decades ago and has a myriad of applications in dentistry. Few studies have evaluated the antimicrobial and antifungal capacity of different concentrations of chlorhexidine mouthwashes. Therefore, the aim of this study, was to evaluate in vitro, the antibacterial and antifungal capacity of three commercially available mouthwashes in Costa Rica, with different concentrations of chlorhexidine, 0.12%, 0.06%, and 0.03%. The experimental method selected was the Kirby-Bauer method to evaluate the antibacterial and antifungal effect of each compound by measuring the inhibitory effect on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Candida albicans strains, exposed to the antiseptic solutions. All samples showed some degree of antibacterial and antifungal effect. Even though we provide in vitro results, our findings are of relevance since all the species used in our experiment are microorganisms that may be present in dental plaque. Our results further support evidence that oral hygiene regimens may include mouthwashes with low doses of chlorhexidine and maintain reasonable antibacterial and antifungal efficacy.

Resumen La clorhexidina se introdujo hace casi siete décadas y tiene una gran variedad de aplicaciones en odontología. Pocos estudios han evaluado la capacidad antimicrobiana y antifúngica de diferentes concentraciones de enjuagues bucales con clorhexidina. Por lo tanto, el objetivo de este estudio fue evaluar in vitro, la capacidad antibacteriana y antifúngica de tres enjuagues bucales disponibles comercialmente en Costa Rica, con diferentes concentraciones de clorhexidina, 0.12%, 0.06% y 0.03%. El método experimental seleccionado fue el método Kirby-Bauer para evaluar el efecto antibacteriano y antifúngico de cada compuesto midiendo el efecto inhibidor sobre Staphylococcus aureus, Enterococcus faecalis, Escherichia coli y Candida albicans, expuestos a la solución antiséptica. Todas las muestras mostraron algún grado de efecto antibacteriano y antifúngico. Aunque proporcionamos resultados in vitro, nuestros hallazgos son de relevancia, ya que todas las especies utilizadas en nuestro experimento son microorganismos que pueden estar presentes en la placa dental. Nuestros resultados respaldan aún más la evidencia de que los regímenes de higiene bucal pueden incluir enjuagues bucales con dosis bajas de clorhexidina y mantener una eficacia antibacteriana y antifúngica razonable.

Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis.

INTRODUCTION: The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). METHODOLOGY: A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. RESULTS: IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). CONCLUSION: None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.

Evaluation of dentin microroughness and composite bond strength after multiple uses of diamond burs / Evaluación de la micro rugosidad dentinaria y la resistencia adhesiva de composites tras múltiples usos de fresas de diamante

Abstract Using a bur multiple times to prepare dental structure may produce a smoother final surface on dentin than a new one. This superficial roughness may affect adhesion with resin-based materials by modifying the substrates' characteristics. The aim of this study was to evaluate the effect of multiple uses of diamond burs on dentin's superficial microroughness and bond strength with resin composite when using a self-etch adhesive. Diamond dental burs were used to simulate a preparation (dentin flat surface) on extracted third molars. Samples were distributed into groups according to burs' number of previous uses as follows: 0, 1, 5 and 10. Scanning electron microscopy images at 70x, 350x, and 1000x were used to illustrate burs' deformation. Each specimen's dentin microroughness was measured three times to compare between experimental groups and the micro-shear bond strength test (n=15) was performed for the 0 and 10 uses groups using a universal adhesive in a self- etching mode. Diamond crystals wear and dislodgements were evident among groups where the burs were used more times. As the number of uses increased the mean microroughness of the dentin surface decreased with significant differences between the 0 and 10 uses groups. No statistical differences between experimental groups resulted from bond strength tests. When using a universal adhesive in a self-etching mode, the number of previous uses of a diamond bur seems to have no significant effect on dentin/resin composite bond strength.

Resumen El uso de una fresa múltiples veces para preparar la estructura dental puede producir una superficie final más lisa en la dentina que una fresa nueva. Esta rugosidad superficial modifica las características del sustrato y puede afectar la adhesión con materiales resinosos. El objetivo de este estudio fue evaluar el efecto de los múltiples usos de las fresas de diamante sobre la micro rugosidad superficial de la dentina y la resistencia adhesiva con la resina compuesta cuando se utiliza un adhesivo de autograbado. Se utilizaron fresas dentales de diamante para simular una preparación (superficie plana de la dentina) en terceros molares extraídos. Las muestras se distribuyeron en grupos según el número de usos previos de las fresas de la siguiente manera: 0, 1, 5 y 10. Se utilizaron imágenes de microscopía electrónica de barrido a ×70, ×350 y ×1000 para ilustrar la deformación de las fresas. Se midió la micro rugosidad de la dentina de cada espécimen tres veces para comparar entre los grupos experimentales y se realizó la prueba de resistencia a la adhesión por micro cizallamiento (n=15) para los grupos de 0 y 10 usos utilizando un adhesivo universal en modo de autograbado. El desgaste de los cristales de diamante y los desprendimientos fueron evidentes entre los grupos en los que las fresas se utilizaron más veces. A medida que aumentaba el número de usos, la micro rugosidad media de la superficie de la dentina disminuyó, con diferencias significativas entre los grupos de 0 y 10 usos. En las pruebas de resistencia adhesiva no se observaron diferencias estadísticas entre los grupos experimentales. Cuando se utiliza un adhesivo universal en modo de autograbado, el número de usos previos de una fresa de diamante no parece tener un efecto significativo en la resistencia de la unión dentina/resina del composite.

Management of dental caries lesions in Latin American and Caribbean countries

Abstract Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.