Dejan Markovic

Factors related to treatment and outcomes of avulsed teeth

BACKGROUND The aim of this study was to examine factors associated with avulsion injury and to specify the association between these factors and the treatment, as well as the outcomes of avulsed permanent incisors in children. MATERIALS AND METHODS The sample consisted of 51 children with 62 avulsed permanent incisors, whose injuries had been managed in the period 1998-2006. The study was prospective, recording the history of the accident, concomitant injuries, age, gender, apical maturity of the root, replantation rate, storage media, extra-alveolar duration, endodontic treatment, compliance and recall appointments response. Factors were analysed in relation to postoperative outcomes, classified as functional healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). RESULTS The average age of patients was 10.7 years (range 7-19). In 16/51 patients, tooth avulsion was caused by a road traffic accident. Avulsion was accompanied by concomitant injuries in all cases. Thirty of 62 avulsed teeth were not replanted and 32 incisors were replanted after dry storage. Time until replantation ranged between 15 min and 9 h (median 60 min). The observation period ranged from 1 to 6 years (median 2 years). FH was observed in 5/32, IRR in 20/32 and RR in 7/32 incisors. Ten teeth were extracted during 5-years of observation. Immature incisors exhibited significantly more complications compared with mature teeth (P = 0.04). Storage media and extra-alveolar duration did not significantly affect the survival of replanted teeth (P = 0.253, P = 0.350). Teeth in which endodontic treatment was in temporary phase exhibited significantly more complications in comparison with teeth with completed endodontic treatment (P = 0.0l6). CONCLUSION The combination of delayed replantation and unphysiological storage is followed by low survival. Incisors with open apices exhibited lower survival compared with incisors with closed apices. Replanted incisors that required prolonged treatment with calcium hydroxide exhibited more complications compared with incisors with completed root canal treatment.

A retrospective study of intrusive injuries in primary dentition

OBJECTIVE The aim was to evaluate epidemiological aspects of intrusive injuries in primary teeth, extent and severity of injuries, provided treatment, and complications to the primary and permanent dentition. METHODS This was a retrospective study based on the clinical and radiographic data of 102 intruded teeth in 70 patients. Follow-up period varied from 6 months to 6 years, with the mean time of 2.7 +/- 1.5 years. Data were collected through dental files and dental trauma forms. The following parameters were analyzed at control examinations: rate of spontaneous re-eruption, presence of complications, time elapsed between the injury and complication, and possible sequels on permanent successors. RESULTS Mean age of the patients was 2.5 +/- 1.3 years. Fifty-six children were injured because of the fall while walking or running. Most of children had one intruded tooth. Maxillary central incisors were the most frequently injured teeth. Seventy injured teeth were <2 mm intruded. Mean time elapsed from the injury until the professional help was 45.0 +/- 67.3 h. Within 2 months after trauma, 48 intruded teeth re-erupted spontaneously. Crown discoloration occurred in 10 intruded teeth, pulp necrosis was diagnosed in nine cases and pathologic root resorption was found in five injured teeth. CONCLUSIONS The most common mechanism of injury was fall. Spontaneous re-eruption occurred in the majority of intruded primary teeth. In comparison with moderate or severe intrusions, mildly intruded teeth took less time to re-erupt. Mildly intruded teeth exhibited less complications in comparison with moderately and severely intruded teeth.

Clinical evaluation of a chemomechanical method for caries removal in children and adolescents

Objective. The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents. Material and Methods. The study comprised 120 patients aged 3–17 years randomized into two groups: caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments. The outcome variables were: clinically complete caries removal, pain during caries removal, need for local anesthesia, treatment time, preferences of patients, and clinical success of the restorations during the 12-month evaluation period. Results. Complete caries removal was achieved in 92% of chemomechanically treated teeth and in all teeth treated with rotary instruments (p>0.05). The chemomechanical method significantly reduced the need for local anesthesia (p<0.001). Eighty-five percent of patients treated with Carisolv and 47% treated with rotary instruments were satisfied with the treatment (p<0.05). The mean time for chemomechanical caries removal was 11.2±3.3 min and 5.2±2.8 min for caries removal with rotary instruments (p<0.001). At the end of the 12-month evaluation period, there was no observed influence of the caries removal method on the survival of the restorations. Conclusions. The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry.

Cervical plexus block versus general anesthesia in carotid surgery: single center experience.

Introduction Carotid endarterectomy may be performed under general (GA) or regional anesthesia (RA). The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing carotid surgery. Material and methods This prospective study included 1098 consecutive patients operated on between 2003 and 2009 (773 underwent cervical plexus block and 325 underwent general anesthesia). Results There were 6 deaths, 3 (0.9%) after GA and 3 (0.4%) after RA (p = 0.272). Neurological complication rates were not significantly different (GA 2.1% vs. RA 1.1%, p = 0.212). Incidence of myocardial infarction was similar (GA 0.31% vs. LA 0.39%, p = 0.840). Shunt placement rate was the same in both groups, 11.1%. Total operating time and carotid clamping time were significantly shorter in RA patients (RA: 92 min vs. GA: 106 min; p < 0.001 and RA: 18 min vs. GA: 19 min; p = 0.040). There was no significant difference in number of reinterventions (RA: 1.0% vs. GA: 0.6%; p = 0.504). Pulmonary complications were common in the GA group (RA: 0 vs. GA 0.9%; p = 0.007). Time to first postoperative analgesic was significantly shorter in the GA group (RA: 226 min vs. GA: 139 min; p < 0.001). Conclusions Type of anesthesia does not affect the outcome of surgical treatment of carotid disease. However, it should be stressed that fewer respiratory complications, later requirement for first postoperative analgesic, and an awake patient who can continue oral therapy early after surgery, give priority to regional techniques of anesthesia.

A novel technique for treatment of mitral valve prolapse/flail

References 1. Leal-Noval SR, Rincon-Ferrari MD, Garcia-Curiel A, et al. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest. 2001;119:1461-8. 2. Rogers MA, Blumberg N, Saint SK, et al. Allogenic blood transfusions explain increased mortality in woman after coronary artery bypass graft surgery. Am Heart J. 2006;152:1028-34. 3. Lacroix J, Hebert PC, Hutchinson JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356:1609-19. 4. Boettcher W, Merkle F, Huebler M, et al. Transfusion-free cardiopulmonary bypass in Jehovah’s Witness patients weighing less than 5 kg. J Extra Corpor Technol. 2005;37:282-5. 5. Redlin M, Koster A, Huebler M, et al. Regional differences in tissue oxygenation during cardiopulmonary bypass for correction of congenital heart disease in neonates and small infants: relevance of near-infrared spectroscopy. J Thorac Cardiovasc Surg. 2008;136:962-7. 6. Golab HD, Takkenberg JJM, Gerner-Weelink GL, et al. Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogenic transfusion requirements in infants undergoing cardiac surgery. Interact Cardiovasc Thorac Surg. 2007;6:335-9. 7. Kotani O, Honjo O, Nakakura M, et al. Impact of miniaturization of cardiopulmonary bypass on blood transfusion requirements in neonatal open heart surgery. ASAIO J. 2007;53:662-5. Brief Communications

The impact of fissure depth and enamel conditioning protocols on glass-ionomer and resin-based fissure sealant penetration.

PURPOSE To evaluate the effect that fissure depth and enamel conditioning protocols have on penetration abilities of resin-based and glass-ionomer fissure sealants. MATERIALS AND METHODS Fifty extracted human molars were randomized into 10 experimental groups. Conditioning was performed as follows: groups I and VI, no pretreatment; groups II and VII, 10% polyacrylic acid and 37% phosphoric acid, respectively; groups III and VIII, self-etching adhesive; groups IV and IX, Er:YAG laser; groups V and X, Er:YAG laser/10% polyacrylic acid and laser/37% phosphoric acid, respectively. In groups I to V, teeth were sealed with a glass-ionomer material, and in groups VI to X a resin-based sealant was used. The sealed teeth were sectioned and the penetration ability was evaluated using scanning electron microscopy (SEM). RESULTS Pretreatment with a suitable acid resulted in superior penetration of glass-ionomer and resin-based sealant when compared with other conditioning protocols (p < 0.0001), except for the teeth treated with both Er:YAG laser and acid. Both conditioning protocol and fissure depth significantly affected the sealant penetration (p < 0.0001), but fissure depth had a greater impact on fissure penetration than did conditioning protocol. CONCLUSION Resin-based and glass-ionomer sealing materials show similar potential for pit-and-fissure penetration. Penetration of a fissure sealant is largely influenced by the fissure depth. Regarding the conditioning protocol, a pretreatment with a suitable acid is essential to obtain an adequate penetration of a sealing material.

Evaluating the population with intellectual disability unable to comply with routine dental treatment using the International Classification of Functioning, Disability and Health

Purpose. The aim of this study was to investigate the use of general anaesthesia (GA) among patients with intellectual disability (ID) in relation to the International Classification of Functioning (ICF). Method. Twenty-seven ICF codes related to the tolerance of the dental treatment were chosen. The sample consisted of 100 children with ID divided into two groups (50 patients in whom routine dental treatment had been accomplished and 50 patients who had been treated under GA). Differences between the groups were analysed using the chi-square test, bivariate correlation and multiple logistic regression analysis. Results. The GA group showed higher levels with regard to the following codes: b117 – intellectual function, b2801 – pain in head and neck, d310 – communication, d530 – toileting, d540 – dressing, e310 – immediate family, e5400 – transportation services and e5850 – education and training services. The severity of ID significantly correlated with the ‘Activities and Participation’ codes. Three predictors of GA treatment were identified: ‘Pain in head and neck’ (p  <  0.001), ‘Transportation services, systems and policies’ (p  <  0.05) and ‘Education and training services, systems and policies’ (p  <  0.05). Conclusions. The use of GA increases with the severity of ID. Acute and painful conditions result in more frequent use of GA. Unfavourable environmental factors present barrier to routine dental management.

Histological evaluation of platelet rich plasma and hydroxiapatite in apexogenesis: Study on experimental animals

BACKGROUND/AIM There are very few data about the effects of endogenous growth factors in vital pulp therapy, and still they are often controversial. The aim of the study was to evaluate the effects of platelet rich plasma (PRP) in conjugation with hydroxyapatite (HAP), as pulp capping materials, to root and periodontium formation. METHODS Eight young monkeys (Cercopithecus Aethiops) with permanent dentition and incomplete root formation were involved in this study. After pulpotomy, the pulp lesion was capped with calcium hydroxide (control), hydroxyapatite (experimental group I) or hydroxyapatite in conjugation with PRP (experimental group II). Six months later, the animals were sacrificed, the tissue was removed en block, and prepared for the histological analysis in a routine way. RESULTS The results of the histological analysis revealed that healing process was characterised by dentin bridge formation, maintained morphological and functional integrity of dental pulp and complete formation of dental root and surrounding periodontium. The inflammatory reaction was scored as mild to moderate, in almost all the samples in all groups, suggesting the biocompatibility of the used materials. CONCLUSION Materials used in this study are convenient as capping agents, contributing maintaining the integrity of the pulp tissue and facilitating root and periodontium forma tion. According to histological data it could be suggested that hydroxyapatite in conjugation with endogenous growth factors, represents superior alternative to other materials used in this study.

Risk factors for intraoperative hypotension during thyroid surgery

Background Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension. Material/Methods The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH. Results IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000). Conclusions IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.

Screening of antimicrobial and antioxidant activity of commercial Melaleuca alternifolia (tea tree) essential oils

The paper deals with the investigation of the chemical composition, antimicrobial and antioxidant activity of four commercial products of Melaleuca alternifolia essential (TTO). The chemical composition was determined using gas chromatography mass spectrometry (GC/MS) analysis. The broth-microdilution method was used to test antimicrobial activity. The antioxidant activity was tested by stable free radical of the 2,2-diphenyl-1-picrylhydrazyl (DPPH). Results of the chemical analysis identified over 30 components. The composition of the four samples varied and the major components included the following: terpinen-4-ol, γ-terpinene and α-terpinene, respectively. The samples were compliant to the ISO Standard 4730. All TTOs presented similar degrees of antimicrobial activity. A slightly higher activity was shown by TTO 4 , having a balanced level of the three main components: terpinen-4-ol (34.58%) γ γ γ γ-terpinene (9.89%) and α-terpinene (12.59%). Fungi were more sensitive than bacteria and yeast. All TTOs tested possessed the concentration-dependent antioxidant activity. Antioxidant activity was based on a balanced chemical composition between terpinen-4-ol and terpenic compounds. Biological testing confirmed the TTO antimicrobial activity against a wide range of the Gram-positive and Gram-negative bacteria, and fungi and yeasts. The correlation between the chemical composition and biological activity was quite evident. In conclusion, this study’s results reveal not only the biological activity of TTO, but also its potential as an antioxidative agent.