Charles B Hermesch

Perioperative use of 0.12% chlorhexidine gluconate for the prevention of alveolar osteitis: Efficacy and risk factor analysis

OBJECTIVES The purposes of this study were to evaluate the use of 0.12% chlorhexidine gluconate as a prophylactic therapy for the prevention of alveolar osteitis and to further examine subject-based risk factors associated with alveolar osteitis. STUDY DESIGN The trial was a randomized, double-blind, placebo-controlled, parallel-group study conducted among 279 subjects, each of whom required oral surgery for the removal of a minimum of one impacted mandibular third molar. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine or placebo mouthrinse for 30 seconds for 1 week before and 1 week after the surgical extractions. This regimen included a supervised presurgical rinse. Alveolar osteitis diagnosis was based on the subjective finding of increasing postoperative pain at the surgical site that was not relieved with mild analgesics, supported by clinical evidence of one or more of the following: loss of blood clot, necrosis of blood clot, and exposed alveolar bone. RESULTS In comparison with use of the placebo mouthrinse, prophylactic use of the chlorhexidine mouthrinse resulted in statistically significant (p < 0.05) reductions in the incidence of alveolar osteitis. With chlorhexidine therapy, the subject- and extraction-based incidences of alveolar osteitis in the evaluable subset (271 subjects) were reduced, relative to placebo, by 38% and 44%, respectively. The corresponding odds ratios that describe the increased odds of experiencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject- and extraction-based analyses, respectively. In comparison with nonuse of oral contraceptives, the use of oral contraceptives in female subjects was related to a statistically significant increase in the incidence of alveolar osteitis (odds ratio = 1.92, p = 0.035). Relative to male subjects, the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically significant (odds ratio = 1.18, p = 0.64). Smoking did not increase the incidence of alveolar osteitis relative to not smoking (odds ratio = 1.20, p = 0.33). CONCLUSIONS These data confirm that the prophylactic use of 0.12% chlorhexidine gluconate mouthrinse results in a significant reduction in the incidence of alveolar osteitis after the extraction of impacted mandibular third molars. In addition, oral contraceptive use in females was confirmed to be a risk factor for the development of alveolar osteitis.

Ceramic bracket bonding: A comparison of shear, tensile, and torsional bond strengths of ceramic brackets†

The purpose of this study was to evaluate whether shear, tensile, or torsional forces were best suited for debonding ceramic brackets. Four commercially available ceramic brackets were evaluated. The brackets included both polycrystalline and monocrystalline types with either chemical or mechanical retention in the bracket bases. The ceramic brackets were bonded to one hundred and twenty bovine teeth, using Concise. The brackets were stressed until bond or bracket failure occurred with either shear, tensile, or torsional forces on the Instron machine. The maximum bond strength and the site of bond failure was recorded. Starfire TMB brackets fractured 30% of the time during shear debonding, whereas, Quasar 1000, Lumina, and Transcend 2000 brackets exhibited no bracket fractures. The shear bond strengths of Quasar 1000 brackets were significantly higher than Starfire TMB brackets. Starfire TMB was the only bracket type that exhibited no bracket fractures with tensile force. Tensile bond strengths were not significantly different between the four bracket types. In torsion, Lumina was the only bracket type that did not exhibit any bracket failures. Shear and tensile bond strengths of chemically retained brackets were not significantly different than mechanically retained brackets. Torsional bond strength of chemically retained brackets was significantly higher than mechanically retained brackets. The results suggest Quasar 1000, Lumina, and Transcend 2000 are best removed with shear or tensile forces. Starfire TMB is best removed with tensile forces.

A perceptibility curve comparison of Ultra-speed and Ektaspeed Plus films

OBJECTIVE The purpose of this study was to evaluate the subjectively assessed contrast difference between Kodaks Ultra-speed and Ektaspeed Plus dental radiography films (Eastman Kodak, Rochester, N.Y.) through the use of perceptibility curves. DESIGN Four series of 22 radiographs were exposed at 70 and 90 kVp with each film type by means of a Gendex 1000 dental radiography unit (Gendex Corp., Milwaukee, Wis.) for times ranging from 0.05 to 5 seconds at 10 ma. The test object consisted of a 7-mm-thick rectangular aluminum block with 10 circular depth cuts, each 2 mm in diameter, which created wells varying in depth from 50 to 500 microns. The corresponding films were processed concurrently (for 4.5 minutes) in total darkness with fresh Kodak Readymatic solutions (Eastman Kodak) held at a constant temperature of 28 degrees C. The resulting radiographs were viewed in a predetermined random order under ideal conditions by 10 dentists. The evaluators recorded the maximum number of perceptible images on each film. A pair of perceptibility curves were generated at 70 and 90 kVp by plotting the log relative exposure versus the mean number of perceptible images. RESULTS There was no statistical difference between the two film types with respect to the mean number of perceptible images, as analyzed by Wilcoxons signed rank test (p = 0.22; p = 0.44). CONCLUSIONS There is no subjectively assessed contrast difference between Kodak s Ultra-speed and Ektaspeed Plus films at 70 and 90 kVp.