Ameen Khraisat

Antibiotic prescribing practices by dentists: a review

Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.

Immediate vs. early loading of dental implants: 3-year results of a randomized controlled clinical trial

OBJECTIVES The aim of the present study was to test whether or not immediately loaded implants exhibit the same survival rates as early loaded implants. MATERIAL AND METHODS Eleven patients with bilateral free end mandibles were randomly assigned to treatment either with immediately (test) or early loaded implants (control). Test implants received provisionals in occlusion on the day of surgery, control implants 6 weeks later. Parameters assessed included implant stability quotient (ISQ), plaque, prosthesis stability and radiographs at baseline (implant insertion), 1 and 3 years. The statistical analysis was performed by means of Students paired t-test and Wilcoxons signed-rank test. The level of significance was set at P<0.05. RESULTS After a mean observation period of 39.8 months (36.7-53.1), three test implants were lost in two patients resulting in a survival rate of 85% compared with 100% for control implants. At baseline, the mean marginal bone level was significantly higher at test implants (mean=0.36 mm, SD +/-0.5) compared with control implants (1.08+/-0.37 mm). For both test and control implants, the bone level significantly decreased from baseline to 3 years (test: 1.51+/-0.79 mm; control: 0.89+/-0.94 mm). The bone loss until 3 years was not significantly different between test and control group. There was no significant difference for ISQ both at test and control implants between baseline (test: 63.59+/-4.62 mm, control: 65.35+/-7.43 mm) and 3 years (test: 66.47+/-7.47 mm, control 68.80+/-8.75 mm). CONCLUSIONS Immediate loading was associated with a lower implant survival rate. Although the test implants were placed with increased sink depth compared with the control implants, the marginal bone levels were not different between test and control at 3 years.

Local tolerance and efficiency of two prototype collagen matrices to increase the width of keratinized tissue

AIM to evaluate the local tolerance and efficiency of two experimental collagen matrices to increase the width of keratinized tissue. METHODS in 12 pigs, two apically positioned flaps were prepared on both sides of the mandible. The denuded defect areas were randomly covered with one of two experimental porcine-derived collagen matrices (M1; M2). The other defect area was left untreated (control). At 1 and 6 months, clinical measurements for the width and thickness of the keratinized tissue were recorded. At 6 months, all animals were sacrificed. Descriptive and semi-quantitative histologic analyses were performed. For statistical analysis, the Kruskal-Wallis test and the Mac Nemar test were applied. RESULTS the collagen matrices integrated well into the surrounding tissue without any signs of inflammation. The thickness and width of the keratinized tissue increased significantly over 6 months in all the groups, resulting in slightly more favourable results for M1 (compared with M2) with respect to the thickness and for M2 (compared with M1) with respect to the width of keratinized tissue. No statistically significant differences were observed for any of the evaluated clinical and histologic parameters among the three treatment modalities. CONCLUSIONS within the limits of this animal study, the prototype collagen matrices can be used safely to increase the width of keratinized tissue.

Effects of Local Melatonin Application on Implant Osseointegration

PURPOSE The aim of this study was to assess the effect of local melatonin administration on bone osseointegration around implants in rabbit tibiae. MATERIAL AND METHODS Ten female, 6-month-old New Zealand rabbits were randomly divided into two groups: the experimental group, where five rabbits were treated with local application of melatonin (3 mg) to implant sites when placed into the rabbit tibia, and the control group, those who where without additive materials. Four weeks later, animals were sacrificed; tibiae were dissected from soft tissues and fixed in buffered formaldehyde, and then included in methacrylate. Histological sections were performed to be studied under light microscopy and analyzed morphometrically to evaluate the amount of bone to implant contact (BIC), trabecular area density, and cortical area density. One-way analysis of variance test was used for statistical evaluation. p < .05 was considered to be significant. RESULTS Histological evaluation showed more trabecular reaction in the melatonin group. Morphometrical analysis showed a statistically significant increase in trabecular BIC in the melatonin group when compared with the control group (24.61% ± 2.87 vs 13.62% ± 1.44; p < .01). Cortical BIC was decreased in the melatonin group, without statistical significance (71.08 ± 3.63 vs 76.28 ± 2.57; p = 0.31). Trabecular area density was increased significantly in the melatonin group (8.68 ± 1.61 vs 4.02 ± 0.36; p < .05). Cortical area density was decreased significantly in the melatonin group (91.31 ± 1.6 vs 95.7 ± 0.5; p < .05). CONCLUSION Within the limitation of this animal study, local melatonin application at the time of implant placement might induce more trabecular bone at implant contact and higher trabecular area density.

Risk indicators of postoperative complications following surgical extraction of lower third molars.

Objective: The aim of this prospective clinical trial was to evaluate the incidence of postoperative complications following surgical extraction of lower third molars (L8) and the risk factors and clinical variables associated with these complications. Subjects and Methods: Three-hundred and twenty-seven consecutive patients (128 men and 199 women, mean age = 23.1 ± 3.9 years, range: 18–40) were recruited to this study. The L8 of all the patients were surgically extracted. Immediate and late complications like pain, swelling, trismus, paresthesia, bleeding, dry socket, infection and fracture were assessed 3 and 7–14 days, respectively, following the surgery. Results: The most frequent immediate and late complications were slight pain, swelling, and trismus. Thirty-nine (11.9%) patients reported dry socket and 10 (0.3%) reversible sensory nerve complications. More immediate and late complications were experienced by females (p = 0.000 and 0.016, respectively). Older subjects reported more late complications. Frequent immediate and late complications were associated with preexisting pericoronitis, longer duration of operation, extraction of two molars, flaps with vertical incision, extractions with bone removal, extractions without tooth sectioning and distoangular impactions (p ≤ 0.05). Linear regression analysis showed that the above factors were able to predict postoperative complications. Conclusion: The most frequent immediate and late complications were slight pain, swelling, and trismus. Preoperative complaints, angulation of the impacted molars, duration of surgery, type of surgical flap, the need for bone removal and tooth sectioning could predict and had an impact on the incidence of postoperative complications following L8 removal. Females and older patients were likely to have more postoperative complications following surgical extraction of L8.

Effect of Solely Applied Platelet-Rich Plasma on Osseous Regeneration Compared to Bio-Oss®: A Morphometric and Densitometric Study on Rabbit Calvaria

BACKGROUND The use of platelet-rich plasma (PRP) in bone augmentation procedures is well documented; however, the exact benefit of this material is not yet established. PURPOSE This study aimed to evaluate the benefits of using PRP, when only used, and compare it to Bio-Oss (Geistlich Biomaterials, Wolhusen, Switzerland) in vertical bone augmentation capacity. MATERIALS AND METHODS The study was performed in calvaria of eight adult female New Zealand rabbits using titanium bone conduction cylinder. Two titanium cylinders were fixed into perforated slits made on the parietal bone of each rabbit. On each rabbit, one chamber was grafted with Bio-Oss, and the contralateral was filled with PRP. Animals were sacrificed 4 weeks after intervention and biopsies were taken. Densitometric, histological, and histomorphometric analyses were performed to evaluate bone mineral density, vertical bone augmentation, and remaining graft volume, respectively. Statistical analyses were performed with Mann-Whitney test, using a significance level of p < .05. RESULTS Densitometric and histomorphometric data analysis revealed that mean bone mineral densities and bone augmentation were significantly lower in the cylinders treated with PRP (p < .0001) 4 weeks after implantation. CONCLUSION This study showed no beneficial effect of using PRP on osseous regeneration. In addition, it was emphasized that Bio-Oss presents good osteoconductive properties by achieving suitable bone volume values.

An analysis of therapeutic, adult antibiotic prescriptions issued by dental practitioners in Jordan.

Objective: The aim of this study was to determine the therapeutic adult antibiotics prescribed by dental practitioners working in the Jordan University Hospital. Methods: Adult dental prescriptions for therapeutic antibiotics issued between 1 January 2003 and 31 May 2004 by dental specialists working in the Jordan University Hospital were included in this study. Data included the name of the antibiotic as well as the dose, quantity and presentation of the drug. Descriptive statistical analysis was carried out. Results: Amoxycillin and metronidazole were the most commonly prescribed antibiotics, with 60% of the prescriptions containing amoxycillin and 39.4% containing metronidazole. 20.4% of the prescriptions were combination prescriptions containing metronidazole. In this study, long courses were observed for amoxycillin (60.5%), cephalosporins (21%) and metronidazole (59.7%). Conclusions: It seems that in the sample studied, Jordanian dental specialists have a tendency towards overprescribing antibiotics both in quantity and duration. This may constitute a problem particularly when considering the remaining sectors of less well-educated dental practitioners. The results will be used to increase awareness among dental practitioners in the field of antibiotic prescribing throughout the University of Jordan and the Jordanian Dental Association.

Technical quality of root canal treatment of posterior teeth after rotary or hand preparation by fifth year undergraduate students, The University of Jordan

The aim of this study was to investigate the technical quality of root canal treatment provided by the undergraduate students as their first experience in molar endodontics using nickel-titanium (NiTi) files in a crown-down approach compared with stainless steel standard technique. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training programme, using two different questionnaires to assess the overall technical quality and potential problems regarding endodontic complications after root canal preparation with these two techniques. The overall results indicated a statistically significant difference in the performance of the two instrument techniques in difficult cases showing better performance of the NiTi system and mean rotary preparation time (P < 0.001). Under the conditions of this study, novice dental students, using NiTi ProTaper rotary files, were able to prepare root canals faster with more preparation accuracy compared with canals of same teeth prepared with hand instruments.

Shear bond strength of self-adhesive resin cements to base metal alloy

STATEMENT OF PROBLEM Many self-adhesive cements have been introduced in the past few years, with little or no data regarding their clinical performance. This study investigated the shear bond strength of some recently introduced self-adhesive resin cements. PURPOSE The purpose of this study was to evaluate the shear bond strength of self-adhesive and conventional resin-based cements to a base metal alloy. MATERIAL AND METHODS Four groups (10-12 each) that comprised 3 self-adhesive cements (SmartCem2; RelyX Unicem; seT SDI) and a conventional resin-based cement (RelyX ARC) were tested. Cylindrical cement specimens (diameter, 3 mm; height, 3 mm) were applied to nickel-free base metal alloy (Sheradent) disks with a diameter of 12 mm, and the surface was treated with airborne-particle abrasion of 50 μm aluminum oxide. The metal disks were fixed in brass molds specifically designed for the shear bond test device. Test specimens were incubated at 37°C for 24 hours and then the shear bond was tested with a Zwick Roll testing machine at a 0.8 mm/min cross-head speed. In addition, bond failures were investigated and categorized as adhesive, cohesive, or mixed. Shear bond strengths were calculated by dividing the maximum debonding force over the cross-sectional area of each specimen. One-way ANOVA and the Tukey (honestly significant difference) post hoc test were used to test statistical significant differences among the groups (α=.05). RESULTS Statistical analysis showed significant differences among different resin cements (F=14.34, P<.001). The highest mean shear bond strength was observed for SmartCem2 (14.18 MPa), and the lowest was reported for seT (3.52 MPa). The observed failure mode in all the materials was adhesive in nature, which occurred at the resin-metal interface. CONCLUSIONS The early bond strength of self-adhesive resin cements varied significantly among the tested materials. SmartCem2 showed the highest bond strength, which was 4 times the strength observed for seT SDI.

Cholesterol Granuloma of the Maxillary Sinus Encountered during Floor Augmentation Procedure: A Case Report

BACKGROUND Cholesterol granuloma (CG) is a foreign-body reaction to the deposition of cholesterol crystals. Its occurrence in the paranasal sinuses is very rare. PURPOSE This report describes a new case of maxillary sinus CG discovered incidentally during sinus-floor augmentation for dental implant placement in a 60-year-old female patient. MATERIALS AND METHODS The preoperative clinical and radiological examinations revealed a normal maxillary antrum with no evidence of sinus pathology. After lateral osteotomy, a dark-green, viscous soft tissue mass appeared through the thin mucous membrane inside the sinus. Enucleation and curettage of the sinus contents including the sinus membrane were performed for histopathologic analysis. The augmentation and implant placement procedures were postponed. RESULTS Histopathologic analysis showed several fragments of granulation tissue containing diffuse cholesterol clefts surrounded by mixed chronic inflammatory cell infiltrate including plasma cells and lymphocytes. These features were compatible with the diagnosis of CG. The patient was followed up for 3 months after the first procedure, and a second attempt of sinus augmentation and dental implant insertion was then carried out. The inserted dental implants were followed up for 6 months without any complications. CONCLUSIONS CG of maxillary sinus can be an incidental finding. For this reason, the final diagnosis can only be achieved after examination of the material under the microscope.