Edina Lempel

Retrospective evaluation of posterior direct composite restorations: 10-Year findings

OBJECTIVES This 10-year retrospective study investigated the differences in the changes and the longevity of Class II restorations using 4 similar microhybrid resin composites (Filtek Z250, Herculite XR, Gradia Direct Posterior, Renew). METHODS Data were collected from patient records. Those patients who received posterior restoration between 2001 and 2003, and who still visited the clinical practice for regular check-up visits were selected. A total of 225 adult patients (86 males, 139 females) with 701 restorations were evaluated by 2 operators using the USPHS criteria. Data were analyzed with Fishers Exact Test, Pearsons Chi-Square Test and Kaplan-Meier analysis (p<0.05). RESULTS A failure rate of 2.1% was detected. The reasons of failures included restoration fracture, secondary caries and endodontic treatment. Similar survival rates for Gradia Direct Posterior (91.25%) and Renew (92.19%) were observed; better performance was observed with the Filtek Z250 (99.1%) and Herculite XR (98.64%). There was a higher probability of failure in 3 surface (n=10) than in 2 surface (n=5) restorations (p<0.001), and this rate was similar when molars (n=8) and premolars (n=7) were compared. The most frequent but clinically acceptable deficiency was the marginal discoloration. SIGNIFICANCE All four microhybrid resin composites showed acceptable clinical durability in Class II restorations during the 10-year follow-up period, with an overall survival rate of >97.8%. Higher rates of failures and deficiencies were observed with the Renew (fracture) and Gradia Direct Posterior (color match), respectively.

Degree of conversion and BisGMA, TEGDMA, UDMA Elution from flowable bulk fill composites

The degree of conversion (DC) and the released bisphenol A diglycidyl ether dimethacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA) monomers of bulk-fill composites compared to that of conventional flowable ones were assessed using micro-Raman spectroscopy and high performance liquid chromatography (HPLC). Four millimeter-thick samples were prepared from SureFil SDR Flow (SDR), X-tra Base (XB), Filtek Bulk Fill (FBF) and two and four millimeter samples from Filtek Ultimate Flow (FUF). They were measured with micro-Raman spectroscopy to determine the DC% of the top and the bottom surfaces. The amount of released monomers in 75% ethanol extraction media was measured with HPLC. The differences between the top and bottom DC% were significant for each material. The mean DC values were in the following order for the bottom surfaces: SDR_4mm_20s > FUF_2mm_20s > XB_4mm_20s > FBF_4mm_20s > XB_4mm_10s > FBF_4mm_10s > FUF_4mm_20s. The highest rate in the amount of released BisGMA and TEGDMA was found from the 4 mm-thick conventional flowable FUF. Among bulk-fills, FBF showed a twenty times higher amount of eluted UDMA and twice more BisGMA; meanwhile, SDR released a significantly higher amount of TEGDMA. SDR bulk-fill showed significantly higher DC%; meanwhile XB, FBF did not reach the same level DC, as that of the 2 mm-thick conventional composite at the bottom surface. Conventional flowable composites showed a higher rate of monomer elution compared to the bulk-fills, except FBF, which showed a high amount of UDMA release.

Digital versus conventional panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar removal.

AbstractThe aim of the study was to compare the accuracy of conventional and digital panoramic radiography (OPG) in relation to 4 specific high-risk signs (interruption of the superior cortical line, diversion, narrowing of the canal, and dark band of the root), which would indicate a close anatomic relationship between third molar roots and the inferior alveolar canal.Four hundred mandibular third molar surgical removals after conventional and 272 after digital radiographs were evaluated in the study. The association between postoperative inferior alveolar nerve (IAN) paresthesia and the presence of any preoperative high-risk signs in the OPG was investigated. Bivariate and multivariate logistic regression analyses were completed to compare the accuracy of conventional and digital radiographic techniques detecting high-risk signs predicting possible IAN paresthesia.Digital OPG results showed significantly higher sensitivity in diversion (P = 0.014) and narrowing (P < 0.002) of the canal, whereas the specificity of these signs was significantly lower (P < 0.001 and P = 0.035). The likelihood ratio analysis and multivariate logistic regression analysis did not prove the significant difference between digital and conventional imaging according to the examined high-risk signs. Positive predictive values of the signs were found in conventional radiography between 3.6% and 10.9%, whereas in the digital images, it ranged from 2.9% to 7.9%.The results of this study failed to prove significant difference between the accuracy of digital and conventional OPG for predicting IAN paresthesia, whereas low positive predictive values indicate both imaging techniques as inadequate screening methods for predicting IAN paresthesia after mandibular third molar removal.

Application of Platysma-Based Transpositional Flap for Through-and-Through Facial Defect When the Facial Artery Circulation Is Blocked or Compromised

PURPOSE A novel use of site-limited platysma-based transpositional flap is demonstrated and discussed for the reconstruction of facial defects. MATERIALS AND METHODS Between January 1985 and January 2001, 342 patients were operated on for advanced oral-oropharyngeal and orofacial cancers. In 6 cases, a platysma-based transpositional flap was used for external closure of facial through-and-through defects. Internally, the saved oral mucosa was used in 4 patients and fasciocutaneous forearm free flaps in 2 patients. The facial artery was blocked in all cases. RESULTS The postoperative course was uneventful except in 1 case, when partial loss of the flap was observed intraorally. The externally used transpositional platysma-based flap showed cosmetic and functional advantages: its consistency, color, and texture were similar to those of the original facial tissues, the area of operation was the same, and the donor site was closed primarily. CONCLUSION The site-limited platysma-based myocutaneous transpositional flap is usable and safe even in those cases in which circulation of the facial artery is damaged or local vascular compromise has occurred and the facial through-and-through defect is extended. The facial reconstruction described is one of several applicable reconstructive methods that may be chosen for special facial defects. The method is not applicable when the neck is radically operated on (radical neck dissection) and/or irradiated. No similar use of platysma-based transpositional flaps has been reported thus far.

Direct resin composite restorations for fractured maxillary teeth and diastema closure: A 7 years retrospective evaluation of survival and influencing factors

OBJECTIVES This retrospective study evaluated the survival rate of anterior direct resin based composite (RBC) build-ups in vital teeth made of microhybrid and nanofill RBC materials and the influence of bruxism, beverage consumption and smoking on the long-term performance of restorations. METHODS Patients receiving anterior restoration between 2006 and 2011, with the diagnosis of fracture or diastema, were selected. A total of 65 adult patients (mean age: 25.2) with 163 restorations (78 Filtek Supreme XT and 85 Enamel Plus HFO) were evaluated using the USPHS criteria. Data were analyzed with Fishers Exact Test, Extended Cox-regression analysis and Kaplan-Meier method. RESULTS Mean observation period was 7.2 (±1.4) years and the mean annual failure rate for this period was 1.43%. The reasons of failures included restoration fracture and color mismatch. Nanofill restorations had significantly higher rate of color mismatch (p=0.002), microhybrids more frequently failed in fracture of restoration (p=0.034). The overall difference in potential hazard of using Enamel Plus HFO or Filtek Supreme XT was not significant (p=0.704). Chipping or fracture of the restoration was more frequent in the first year after placement (p=0.036), while beverage consumption was significantly correlated with discoloration of the restorations (p=0.005). SIGNIFICANCE The application of direct RBC restorations provides an excellent treatment option for fractured teeth and for closing diastemas. The overall survival rate was 88.34% up to 10 years. Microhybrid and nanofill RBC restorations showed similar survival rates, however nanofills discolored at a higher rate, meanwhile chipping of the restoration occurred frequently with microhybrids.

A nervus alveolaris inferior védelmében: alsó bölcsességfogak coronectomiája. Irodalmi áttekintés

Absztrakt: Az also bolcsessegfogak coronectomiaja a bolcsessegfog reszleges eltavolitasaval hivatott az esetleges nervus alveolaris inferior seruleseit kikuszobolni. Az eljarasnak van nehany sarkalatos pontja, ugymint a fog pulpalis, periapicalis preoperativ allapota, a koronai sectio es koronaeltavolitas, illetve a sebzaras mikentje, valamint a paciens posztoperativ kovetese es az esetlegesen felmerulő szovődmenyek ismerete es kezelese. Szakirodalmi adatok szerint a coronectomia kevesebb szovődmennyel bir, mint a hagyomanyos, teljes fogeltavolitasok, es a nervus alveolaris inferior serulesek szempontjabol a coronectomia egyertelműen es kifejezetten a biztonsagosabb eljaras. A szerzők celja volt a szakirodalmat attekintve, az eljaras indikacioirol es kontraindikacioirol, korrekt kivitelezeseről es az esetleges sikertelensegenek okairol, gyakorisagairol atfogo kepet adni, előmozditva az eljaras hazai nepszerűsiteset. Orv Hetil. 2017; 158(45): 1787–1793.

Proteomic and scanning electron microscopic analysis of submandibular sialoliths

ObjectivesSeveral theories have been proposed regarding the genesis of sialoliths, including the organic core theory, which suggests epithelial or bacterial etiology originating in the central core. Our aim was to use novel methodologies to analyze central areas (the core) of calculi from sialolithiasis patients.Materials and methodsThe structures of the halves of six submandibular salivary stones were analyzed by scanning electron microscopy (SEM). After structural analysis, from the other six halves, samples from the central parts of the core and peripheral parts of the core were digested with trypsin and analyzed by matrix-assisted laser desorption ionization–time of flight mass spectrometry. The peptide mass fingerprints were compared with the results of in silico digestion.ResultsSEM analysis of the sialoliths showed that organic structures (collagen/fibrous-like structures, bacterial fragments) were visible only outside of the core in the concentric layers of external areas, but not in the core area. The mass spectrometry (MS)/MS post-source decay experiments were completed from the four, most intense signals observed in the MS spectrum and human defensin was proven to be present in three of the examined samples, originated from the peripheral region of three cores.ConclusionsAlthough proteomic analysis demonstrated defensin protein in the peripheral region of the core in three sialoliths, SEM failed to prove organic structures in the core.Clinical relevanceNew investigation modalities still cannot prove organic structures in the core, henceforward challenging the organic core theory.

Effect of pre-drilling on intraosseous temperature during self-drilling mini-implant placement in a porcine mandible model.

This in vitro study investigated intraos seous heat production during insertion, with and without pre-drilling, of a self-drilling orthodontic mini-implant. To measure temperature changes and drilling times in pig ribs, a special testing apparatus was used to examine new and worn pre-drills at different speeds. Temperatures were measured during mini-implant placement with and without pre-drilling. The average intraosseous temperature increase during manual mini-implant insertion was similar with and without pre-drilling (11.8 ± 2.1°C vs. 11.3 ± 2.4°C, respectively; P = 0.707). During pre-drilling the mean temperature increase for new drills was 2.1°C at 100 rpm, 2.3°C at 200 rpm, and 7.6°C at 1,200 rpm. Temperature increases were significantly higher for worn drills at the same speeds (2.98°C, 3.0°C, and 12.3°C, respectively), while bone temperatures at 100 and 200 rpm were similar for new and worn drills (P = 0.345 and 0.736, respectively). Baseline bone temperature was approximated within 30 s after drilling in most specimens. Drilling time at 100 rpm was 2.1 ± 0.9 s, but was significantly shorter at 200 rpm (1.1 ± 0.2 s) and 1,200 rpm (0.1 ± 0.03 s). Pre-drilling did not decrease intraosseous temperatures. In patients for whom pre-drilling is indicated, speeds of 100 or 200 rpm are recommended, at least 30 s after pilot drilling.