Presence or severity of Hashimoto's thyroiditis does not influence basal calcitonin levels: observations from CROHT biobank.

PURPOSE: The influence of Hashimoto's thyroiditis (HT) on calcitonin (Ct) production is unresolved question. The aim of this study was to explore if basal Ct levels are influenced by the presence/severity of HT or correlated with clinical phenotypes of HT patients. METHODS: We included 467 HT patients and 184 control participants, from Croatian Biobank of HT patients (CROHT), in this retrospective study. Calcitonin levels between HT patients and controls were compared using Mann-Whitney test. Ct levels between two subgroups of HT patients, divided by intake of levothyroxine (LT4) therapy, were additionally tested to take into account the illness severity. Spearman rank correlation test was used to analyze correlations between Ct levels and 14 relevant phenotypes. RESULTS: We have not detected significant differences in median Ct levels between HT patients and controls (2.2 vs 2.35 pg/mL, respectively, P = 0.717) nor in-between two subgroups of HT patients (P = 0.347). We have not detected statistically significant correlations between Ct levels and clinical phenotypes, although we identified three weak nominal correlations: negative correlation of Ct with TgAb in all HT patients (r = - 0.1, P = 0.04); negative correlation of Ct with age in subgroup of HT patients without LT4 therapy (r = - 0.13, P = 0.04); positive correlation of Ct with BSA in subgroup of HT patients on LT4 therapy (r = 0.16, P = 0.042). CONCLUSION: Our results suggest that HT patients of all disease stages preserve Ct production as healthy individuals and there is no need for Ct measurements in the absence of a nodule. Additional confirmation and clarification of observed nominal correlations are needed due to potential clinical relevance of TgAb and age-dependent Ct decrease in HT women.

Relationship between vitamin D, IFN-γ, and E2 levels in systemic lupus erythematosus.

In this study, we investigated the relationship between vitamin D, interferon-gamma (IFN-γ), and estradiol (E2) in females of childbearing age with inactive systemic lupus erythematosus (SLE). The study included 22 SLE patients, and 21 age- and gender-matched healthy individuals. Serum concentrations of 25-hydroxyvitamin D3 (25(OH)D3), E2, and IFN-γ were measured by radioimmunoassay using the gamma-counter and ELISA. Patients and control subjects were divided into two groups based on their vitamin D levels (25(OH)D3 ≤ 20 ng/mL; 25(OH)D3 > 20 ng/mL). The median values of IFN-γ and E2 were higher in SLE patients compared to the controls, irrespective of vitamin D level (p = 0.001, p = 0.009, p = 0.003, and p = 0.003, respectively). In SLE patients, there was a negative correlation between IFN-γ and 25(OH)D3 (rs = -0.330; p = 0.03) and a positive correlation between IFN-γ and E2 (rs = 0.404; p = 0.007). This study demonstrates an interesting interplay between vitamin D, INF-γ, and E2 in SLE patients with inactive disease.

Electrorheological behavior of iron(ii) oxalate micro-rods.

Electrorheological (ER) fluids represent smart materials with extensive application potential due to their rheological properties which can be readily changed under an external electric field. In this study, the iron(ii) oxalate particles with rod-like morphology were successfully synthesized by the co-precipitation method using sulphate heptahydrate and oxalic acid dihydrate. The characterization of particles was performed via X-ray diffractometry and scanning electron microscopy. Subsequently, the ER fluids were prepared by dispersing the synthesized particles in silicone oil. The optical microscopy demonstrated the formation of chain-like particle structures upon the application of an electric field. Rheological properties were determined by means of rotational rheometry including creep-recovery experiments. The viscoelastic behavior of systems under investigation in the presence of the electric field was confirmed by the presence of recoverable strain of the system.

Hard tissue barrier formation in pulpotomized monkey teeth capped with cyanoacrylate or calcium hydroxide for 10 and 60 minutes.

Monkey incisor teeth were pulpotomized in groups of 10. After physiological hemostasis, the pulps of group I were covered with isobutyl cyanoacrylate, and those of groups II and III with calcium hydroxide for 10 and 60 minutes, respectively, whereafter this compound was washed away and the wound surfaces covered with Teflon. In group IV, calcium hydroxide was used as a positive control, and Teflon as a negative control in group V. The animals were killed after 12 weeks and the teeth removed in tissue blocks. The material was processed and evaluated histologically with respect to location and continuity of a hard tissue barrier, type of newly formed hard tissue, state of the pulp, and presence of stainable bacteria in the coronal cavity. Seven of nine teeth in group I showed a hard tissue barrier. The corresponding figure for group II was eight out of 10 teeth. All teeth in groups III and IV had a barrier. The incidence of a continuous barrier increased from group I through group IV, as did the incidence of its location below the level of the original wound surface. The condition of the pulp was related to the presence of bacteria and the continuity of the barrier to the presence of inflammation. There was no bridging in group V. The results support the theory that a low-grade irritation is responsible for the formation of a hard tissue barrier in exposed pulps.

Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study.

A material of 885 luxated, non-vital incisors was evaluated radiographically with respect to healing of periodontal tissues including inflammatory root resorption and occurrence of ankylosis and cervical root fractures. The results were assessed after completion of calcium hydroxide treatment and 4 years after filling of the root canal with gutta-percha. After treatment with calcium hydroxide, periapical healing occurred in 95% of the teeth. Four years after filling with gutta-percha, periapical healing was present in 91% of the teeth. In the remaining teeth, recurrent or persistent periapical radiolucency was more frequent in overfilled than adequately filled teeth (P = 0.0001). There was no difference between immature and mature teeth. Inflammatory root resorption healed in 192 of 197 teeth (97%); in 5 teeth it developed into ankylosis. Ankylosis occurred in 13 teeth, all of which were intruded into the alveolar bone at the time of injury. The frequency of cervical root fractures was markedly higher in immature than mature teeth (P greater than 0.0001). Among immature teeth, the frequency of fractures was dependent on the stage of root development (chi 2 = 31.6) and ranged from 77% in teeth with the least to 28% in teeth with the most developed roots. The frequency of fractures was also related to the defects after healing of inflammatory root resorption in the cervical area of the root, significant at P less than 0.0001.

[Calcium hydroxide in the treatment of traumatized teeth]. / L'hydroxyde de calcium dans le traitement des dents traumatisées.

Calcium hydroxide is used in the treatment of different traumatized teeth. New concepts about the effects of calcium hydroxide on vital pulps and immature non vital teeth are developed. Some clinical techniques and their results are described.

A light microscopy study of pulps from traumatized permanent incisors with reduced pulpal lumen.

The pulps from 20 traumatized permanent maxillary incisors treated endodontically because progressive hard-tissue formation diminished the pulpal lumen, were studied with light microscopy. The tissue changes were characterized by a varied increase in collagen content. A marked increase in collagen content was associated with a marked decrease in number of cells. Areas of mineralized tissue resembling dystrophic mineralization were present in nine pulps. Osteoidlike tissue with included and lining cells was found adjacent to these mineralized areas in three pulps. In one pulp a moderate infiltration of inflammatory cells was noted, mostly lymphocytes. With the exception of the latter tooth, tissue changes in the pulps in no case warranted endodontic treatment.

Partial pulpotomy in young permanent teeth with deep carious lesions.

The material comprised 37 young posterior teeth with deep carious lesions and exposed pulps, treated with partial pulpotomy and dressed with calcium hydroxide. The teeth were divided into two groups. Group 1 consisted of 31 teeth with no clinical or radiographic symptoms before treatment, Group 2 of 6 teeth with temporary pain, widened periodontal space periapically and/or productive osteitis, i.e. increased density of the surrounding alveolar bone. After an observation time of 24 to 140 months (mean = 56 months), healing had occurred in 29 of 31 teeth in Group 1 (93.5%) and in 4 of 6 teeth in Group 2. It was concluded that the present, as well as previously reported results indicate that partial pulpotomy may be an adequate treatment for young permanent molars with a carious exposure, although more studies are needed before the treatment can be recommended for routine clinical use.

Failures and healing in endodontically treated non-vital anterior teeth with posttraumatically reduced pulpal lumen.

The aim of the present investigation was to assess the frequency of technical failures as well as the 4-year results of endodontic treatment in non-vital incisors with post-traumatically reduced pulpal lumen. In 54 teeth the smallest width of the root canal was measured and classified as 0. less than or equal 0.1, greater than 0.1- less than or equal to 0.2 or greater than 0.2 mm. The total frequency of failures was 20%. In upper incisors it was 15-17% in the classes up to a root canal width of 0.2 mm. In lower incisors with no or only partially visible root canal it was 71% and in the class up to 0.1 mm 10%, the difference being significant at the 5% level. The total frequency of healing after 4 years was 80%, while in teeth with a technical failure at the time of treatment the frequency was 50%. The difference between the group without and that with technical failures was statistically significant at the 5% level.

Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents.

A method for preserving the alveolar ridge of ankylosed and infrapositioned incisors and improving conditions for a subsequent prosthetic therapy is described and evaluated clinically and radiographically. The method involves removal of the crown and root filling from the root, which is retained and covered with a mucoperiosteal flap. Clinically, there were no postoperative complications and after the follow-up a satisfactory prosthetic restoration was performed in all cases, regardless of the degree of infraposition before treatment. Radiographically, no pathologic changes were observed apart from a continuous resorption and replacement of lost root substance by bone. Alveolar bone level shifted only slightly between postoperative and 12-month follow-up radiographs, in a majority of cases in a coronal direction.

Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth.

The aim was to assess the prevalence of pulp exposure after stepwise versus direct complete excavation of permanent posterior teeth with deep carious lesions. The material, representing 116 patients aged 6-16 yrs (mean = 10.2 yrs), consisted of 127 teeth with radiographs revealing carious lesions to such a depth that pulp exposure could be expected if direct complete excavation was performed. Teeth with clinical symptoms, other than transient pain shortly before treatment, were not accepted. The teeth were randomly selected for either treatment procedure. Stepwise excavation implied removal of the bulk of carious tissue and application of calcium hydroxide, followed by sealing of the cavity with zinc-oxide eugenol cement. After a period of 8-24 weeks the rest of the carious dentin was removed and the cavity sealed with calcium hydroxide, zinc-oxide-eugenol (ZOE) and a restorative material. Direct complete excavation entailed removal of all carious dentin followed by sealing as mentioned above. In case of pulp exposure, pulp treatment was performed. The pulp was exposed in 40 of the teeth treated by direct complete excavation. The corresponding figure for those treated by stepwise excavation was 17.5%. The difference was statistically significant. The teeth with no pulp exposure after direct or stepwise excavation showed normal clinical and radiographic conditions at the last check-up (mean = 43 months).

Antimicrobial effect of root canal débridement in teeth with immature root. A clinical and microbiologic study.

The aim of present investigation was to compare the antibacterial effect of biochemical root canal cleansing in permanent non-vital upper incisors with immature with those with mature root. The material comprised three groups made up of 34, 46 and 28 teeth in which the mechanical cleansing was accompanied by flushing with sterile saline and sodium hypochlorite solutions giving 0.5 or 5.0% active chloride, respectively. Samples were taken in root canals initially after removal of necrotic tissue and after completed cleansing, transferred to solid and liquid media for aerobically and anaerobically and incubated until growth appeared or up to 10 days. The microorganisms were identified by biochemical tests and gas-chromatographic analysis. The antibacterial effect of mechanical cleansing with sterile saline was very low (9%) and limited to the teeth with mature root. The flushing with sodium hypochlorite increased the antibacterial effect to about 25%. No statistical difference was found in the antibacterial effect between flushing with 0.5 % or 5.0% sodium hypochlorite solutions. The antibacterial effect was, however, irrespective of the sodium hypochlorite concentrations, less good in teeth with immature root at the statistically significant 5% level. It was concluded that mechanical cleansing of root canals in teeth with immature root with the instruments now available is inadequate. This inadequacy cannot be compensated for by use of highly concentrated solution, with dissolving effect on necrotic tissue, for flushing. The use of such substances which also have toxic effect on the tissue should be avoided.

Treatment of non-vital permanent incisors with calcium hydroxide. VI. A clinical, microbiological and radiological evaluation of treatment in one sitting of teeth with mature or immature root.

The purpose of the investigation was clinically, microbiologically and radiologically to assess the effect of calcium hydroxide as a temporary root-filling inserted in the same sitting as root canal debridement in non-vital permanent incisors with mature and immature root, infected or uninfected root canal and with or without radiologically demonstrated periapical bone changes. The material consisted of 141 teeth divided in 3 groups in which mechanical cleansing was accompanied by flushing with sterile saline and sodium hypochlorite solutions giving 0.5% or 5.0% active chlorine, respectively. Microbiological samples were taken from root canals after extirpation of necrotic pulp tissue, after completed cleansing of the root canal and 3 and 6 month after treatment. Results of treatment were evaluated from the radiographs taken before treatment and at the 3 and 6 month follow-ups. Complication, pain and an abscess, occurred in 2 cases, 2 and 5 days, respectively, after treatment. No statistical correlation between occurrence of samples that gave growth, taken from the root canals at 3 (8%) or 6-month control (9%) and 1) bacteriological status of the root canal prior to filling with calcium hydroxide, 2) the development of the root or 3) periapical healing at 3 or 6 month follow-up could be ascertained. Periapical bone healing at the end of 6-months observation period was noted in 61 teeth (46%), regression of periapical bone lesions in 64 (49%) and no periapical healing in 6 (5%). The only difference in healing pattern, statistically significant on 0.1% level, was found in the group of teeth flushed with 5.0% sodium hypochlorite. At 3 month control they showed percentually less cases with regression and more cases with no healing of periapical bone lesions than the teeth in the other two groups. It was concluded that treatment in one sitting can be done routinely, irrespective of the initial status, in all those cases where no other treatment is possible. If the periodontium or the periapical bone are injured during cleansing procedures or if necrotic rests are not pressed out through the apical foramen, no complications after treatment need to be feared.

Healing of 208 intra-alveolar root fractures in patients aged 7-17 years.

This retrospective study consisted of 208 root-fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7-17 years) treated in the period 1959-1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non-healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long-term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies.

Conservative endodontic treatment of teeth fractured in the middle or apical part of the root.

According to treatment type, root-fractured teeth with pulp necrosis or exposed pulps were divided into five groups, group 1: 17 teeth in which the root canal of the coronal fragment only was filled with gutta-percha (GP); group 2: seven teeth in which the root canals of the coronal and apical fragments were both filled with GP; group 3: 19 teeth in which the coronal fragment was filled with GP and the apical fragment was surgically removed; group 4: 68 teeth where the root canal of the coronal fragment was treated with calcium hydroxide and subsequently filled with GP; and group 5: five vital teeth with root and concomitant crown fractures in which the exposed pulps were treated by partial pulpotomy. The frequency of periodontal healing was 76% in group 1, zero in group 2, 68% in group 3 and 86% in group 4. Compared with groups 1 and 2 combined, healing in group 4 was significantly more frequent. In groups 1, 2 and 4, failures occurred significantly more often in teeth showing overfilling, i.e. protrusion of GP into the space between the fragments, compared with teeth without overfilling. All five teeth in group 5 showed healing. It was concluded that root canal filling with GP of the coronal fragment only, with or without surgical removal of the apical fragment, can be successful in selected cases. Treatment of the root canal with calcium hydroxide followed by GP filling appears to be the treatment of choice in root-fractured non-vital teeth. Partial pulpotomy of exposed pulps in five teeth showed results similar to root-unfractured teeth with pulp exposure treated with this technique.

Pulp revascularization in reimplanted immature monkey incisors--predictability and the effect of antibiotic systemic prophylaxis.

In 32 monkeys 105 immature maxillary incisors were extracted and reimplanted either immediately or after 30 or 60 min wet or dry storage. Of the monkeys, 17 (group I) did not receive and 15 (group II) received prophylactic treatment with 4 mg/kg doxycycline before extraction and 2 mg/kg for 5 d after reimplantation. The observation time varied from 6 to 8 weeks. After being histologically processed, the material was evaluated with respect to the amount of vital tissue and presence of micro-organisms in the pulpal lumen. A comparison revealed no difference in the results between the groups. The results were therefore pooled and statistically analysed with respect to the significance of apical foramen width, extra-alveolar time, wet or dry storage and presence of micro-organisms in the pulpal lumen for the occurrence of complete pulp revascularization (CPR). The overall frequency of CPR was 18%. Log-linear analyses (SAS, 1985) of the material as a whole or of separate parameters consistently revealed a relationship between presence of micro-organisms and absence of CPR (P = 0.0001). A higher frequency of CPR and a lower frequency of micro-organisms (P = 0.05) was found only for the group of immediately reimplanted teeth. The presence of micro-organisms could be explained for 61 teeth. In 27 of these, blood clots containing bacteria in the apical portion of pulpal lumen indicated contamination during the extra-alveolar time, while in 34, the micro-organisms originated from plaque covered mechanical damage in the cervical part of the root surface.