Sorin Teich

Facial arthralgia and myalgia: can they be differentiated by trigeminal sensory assessment?

Heat and electrical detection thresholds were assessed in 72 patients suffering from painful temporomandibular disorder. Employing widely accepted criteria, 44 patients were classified as suffering from temporomandibular joint (TMJ) arthralgia (i.e. pain originating from the TMJ) and 28 from myalgia (i.e. pain originating from the muscles of mastication). Electrical stimulation was employed to assess thresholds in large myelinated nerve fibers (A&bgr;) and heat application to assess thresholds in unmyelinated nerve fibers (C). The sensory tests were performed bilaterally in three trigeminal nerve sites: the auriculotemporal nerve territory (AUT), buccal nerve territory (BUC) and the mental nerve territory (MNT). In addition, 22 healthy asymptomatic controls were examined. A subset of ten arthralgia patients underwent arthrocentesis and electrical detection thresholds were additionally assessed following the procedure. Electrical detection threshold ratios were calculated by dividing the affected side by the control side, thus reduced ratios indicate hypersensitivity of the affected side. In control patients, ratios obtained at all sites did not vary significantly from the expected value of ‘one’ (mean with 95% confidence intervals; AUT, 1:0.95–1.06; BUC, 1.01:0.93–1.11; MNT, 0.97:0.88–1.05, all areas one sample analysis P>0.05). In arthralgia patients mean ratios (±SEM) obtained for the AUT territory (0.63±0.03) were significantly lower compared to ratios for the MNT (1.02±0.03) and BUC (0.96±0.04) territories (repeated measures analysis of variance (RANOVA), P<0.0001) and compared to the AUT ratios in myalgia (1.27±0.09) and control subjects (1±0.06, ANOVA, P<0.0001). In the myalgia group the electrical detection threshold ratios in the AUT territory were significantly elevated compared to the AUT ratios in control subjects (Dunnett test, P<0.05), but only approached statistical significance compared to the MNT (1.07±0.04) and BUC (1.11±0.06) territories (RANOVA, F2,27=3.12, P=0.052). There were no significant differences between and within the groups for electrical detection threshold ratios in the BUC and MNT nerve territories, and for the heat detection thresholds in all tested sites. Following arthrocentesis, mean electrical detection threshold ratios in the AUT territory were significantly elevated from 0.64±0.06 to 0.99±0.04 indicating resolution of the hypersensitivity (paired t‐test, P=0.001). In conclusion, large myelinated fiber hypersensitivity is found in the skin overlying TMJs with clinical pain and pathology but is not found in controls. In patients with muscle‐related facial pain there was significant elevation of the electrical detection threshold in the AUT region.

Lean management-the journey from toyota to healthcare.

The evolution of production systems is tightly linked to the story of Toyota Motor Company (TMC) that has its roots around 1918. The term “lean” was coined in 1990 following the exploration of the Toyota model that led to the “transference” thesis sustaining the concept that manufacturing problems and technologies are universal problems faced by management and that these concepts can be emulated in non-Japanese enterprises. Lean is a multi-faceted concept and requires organizations to exert effort along several dimensions simultaneously; some consider a successful implementation either achieving major strategic components of lean, implementing practices to support operational aspects, or providing evidence that the improvements are sustainable in the long term. The article explores challenges and opportunities faced by organizations that intend incorporating lean management principles and presents the specific context of the healthcare industry. Finally, the concepts of “essential few” and customer value are illustrated through a simple example of process change following lean principles, which was implemented in a dental school in the United States.

The role of sensory input of the chorda tympani nerve and the number of fungiform papillae in burning mouth syndrome

OBJECTIVE The aim of this study was to evaluate patients suffering from burning mouth syndrome (BMS) and control subjects by means of sensory testing and fungiform papillae count. STUDY DESIGN The left and right anterior two-thirds of the tongue of of 25 BMS subjects and 20 healthy control subjects were evaluated for electric taste and electric detection threshold. The number of fungiform papillae/cm(2) was evaluated by using close-up digital photography. RESULTS The electric taste/tingling detection threshold ratio was significantly higher in BMS compared with control subjects (P = .041). No difference was found between the number of fungiform papillae/cm(2) in the BMS compared with the control subjects (P = .277). Patients suffering from BMS for a prolonged period of time presented with a significantly elevated electric taste/tingling detection threshold ratio (P = .031). CONCLUSIONS BMS may be a neurodegenerative process with chorda tympani nerve hypofunction potentially playing a role in the pathophysiology of this disorder.

Transcervical migration of a broken dental needle: a case report and literature review.

Although needle breakage is a rare event in dentistry, the occurrence can cause significant distress to the patient and the clinician. Taking appropriate measures to prevent this mishap is best. However, when this event occurs, appropriate planning and retrieval of the needle can lessen the detrimental effects. In this report, we document the migration and retrieval of a broken dental needle that traveled from the medial ramus of the mandible to the posterior cervical space. This report emphasizes the importance of proper local anesthesia techniques, as well as preventive measures, localization methods, and the principles of surgical approaches for the removal of broken needles.

Anti-nociceptive effect of IL-12p40 in a rat model of neuropathic pain

IL-12p70 is a proinflammatory cytokine secreted by dendritic cells, monocytes and macrophages. It plays a crucial role in cell-mediated immunity by inducing proliferation of T cell and natural killer cells, and enhancing their cytotoxic activity. In adaptive immune response, it acts on naive T cells to differentiate into Th1-type cells. It is composed of two subunits, p35 and p40. The latter can be secreted in the form of monodimer or heterodimer, which is also referred as IL-12p80. Recently IL-12p70 has been proven to locally provoke nociceptive effect in naïve rats. This study investigated pain response following systemic administration of IL-12p70 and IL-12p40 homodimer in chronic neuropathic pain model, induced by chronic constriction injury. The doses tested were IL-12p40 homodimer or IL12p70 at 15, 150 and 1500ng/kg, respectively. Pain was assessed at 1, 4, 7 and 24h after injection, in the form of tactile allodynia and mechanical hyperalgesia. The side effect of sensory motor disability was measured by rotarod performance. By all behavioral measures, IL-12p70 of any dosage, at any time point, had no significant effect on tactile allodynia and mechanical hyperalgesia. A high dose of IL-12p40 homodimer induced significant analgesic effect by the measure of hind paw tactile allodynia from 1h to 4h after injection. Medium and low doses of IL-12p40 homodimer exerted their analgesic effect 4h post injection. Mechanical hyperalgesia, following high and medium doses of IL-12p40 administration, was significantly reduced at 4h after application. Also, no significant sensory motor dysfunction was detected for all dosage for both homodimers. These findings suggest that systemic application of IL-12p40 homodimer induces time-dependent analgesia to mechanical stimulation in rats exposed to neuropathic pain.

Measurement of J-integral in CAD/CAM dental ceramics and composite resin by digital image correlation

Ceramic and composite resin blocks for CAD/CAM machining of dental restorations are becoming more common. The sample sizes affordable by these blocks are smaller than ideal for stress intensity factor (SIF) based tests. The J-integral measurement calls for full field strain measurement, making it challenging to conduct. Accordingly, the J-integral values of dental restoration materials used in CAD/CAM restorations have not been reported to date. Digital image correlation (DIC) provides full field strain maps, making it possible to calculate the J-integral value. The aim of this study was to measure the J-integral value for CAD/CAM restorative materials. Four types of materials (sintered IPS E-MAX CAD, non-sintered IPS E-MAX CAD, Vita Mark II and Paradigm MZ100) were used to prepare beam samples for three-point bending tests. J-integrals were calculated for different integral path size and locations with respect to the crack tip. J-integral at path 1 for each material was 1.26±0.31×10(-4)MPam for MZ 100, 0.59±0.28×10(-4)MPam for sintered E-MAX, 0.19±0.07×10(-4)MPam for VM II, and 0.21±0.05×10(-4)MPam for non-sintered E-MAX. There were no significant differences between different integral path size, except for the non-sintered E-MAX group. J-integral paths of non-sintered E-MAX located within 42% of the height of the sample provided consistent values whereas outside this range resulted in lower J-integral values. Moreover, no significant difference was found among different integral path locations. The critical SIF was calculated from J-integral (KJ) along with geometry derived SIF values (KI). KI values were comparable with KJ and geometry based SIF values obtained from literature. Therefore, DIC derived J-integral is a reliable way to assess the fracture toughness of small sized specimens for dental CAD/CAM restorative materials; however, with caution applied to the selection of J-integral path.

Painful Traumatic Trigeminal Neuropathy

This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions.

Effect of different adhesive strategies on microtensile bond strength of computer aided design/computer aided manufacturing blocks bonded to dentin.

Background: The aim of this study was to determine the microtensile bond strength (μTBS) of ceramic and composite computer aided design-computer aided manufacturing (CAD-CAM) blocks bonded to dentin using different adhesive strategies. Materials and Methods: In this in vitro study, 30 crowns of sound freshly extracted human molars were sectioned horizontally 3 mm above the cementoenamel junction to produce flat dentin surfaces. Ceramic and composite CAD/CAM blocks, size 14, were sectioned into slices of 3 mm thick. Before bonding, CAD/CAM block surfaces were treated according to the manufacturers instructions. Groups were created based on the adhesive strategy used: Group 1 (GI) - conventional resin cement + total-etch adhesive system, Group 2 (GII) - conventional resin cement + self-etch adhesive system, and Group 3 (GIII) - self-adhesive resin cement with no adhesive. Bonded specimens were stored in 100% humidity for 24h at 37΀C, and then sectioned with a slow-speed diamond saw to obtain 1 mm × 1 mm × 6 mm microsticks. Microtensile testing was then conducted using a microtensile tester. μTBS values were expressed in MPa and analyzed by one-way ANOVA with post hoc (Tukey) test at the 5% significance level. Results: Mean values and standard deviations of μTBS (MPa) were 17.68 (±2.71) for GI/ceramic; 17.62 (±3.99) for GI/composite; 13.61 (±6.92) for GII/composite; 12.22 (±4.24) for GII/ceramic; 7.47 (±2.29) for GIII/composite; and 6.48 (±3.10) for GIII/ceramic; ANOVA indicated significant differences among the adhesive modality and block interaction (P < 0.05), and no significant differences among blocks only, except between GI and GII/ceramic. Bond strength of GIII was consistently lower (P < 0.05) than GI and GII groups, regardless the block used. Conclusion: Cementation of CAD/CAM restorations, either composite or ceramic, can be significantly affected by different adhesive strategies used.

Are different generations of CAD/CAM milling machines capable to produce restorations with similar quality?

Background Different CAD/CAM machines’ generation may impact the restoration overall quality. The present study evaluated the marginal fit of CAD/CAM restorations manufactured with different generations of CEREC milling unit systems. Material and Methods Sixteen typodont teeth were divided into two groups (n=8) according to the machine’s generation assigned. These are control group (G1): Cerec AC with Bluecam/Cerec 3 milling unit and (G2): Cerec AC with Bluecam/MC XL Premium Package milling unit. Scanning of the preparation were performed and crowns were milled using the Vita Mark II blocks. Blocks were cemented using epoxy glue on the pulpal floor only and finger pressure applied for 1 min. Upon completion of the cementation step, misfits between the restoration and abutment were measured by microphotography and the silicone replica technique using light body silicon material on Mesial (M) and Distal (D) surfaces. Results Mean and SDs of marginal gaps in micrometers were: G1/M: 94.90 (±38.52), G1/D: 88.53 (±44.87), G2/M: 85.65 (±29.89), G2/D: 95.28 (±28.13). Two-way ANOVA indicated no significant differences among different groups (P>0.05); surface area (P>0.05) and the interaction (P>0.05). Overall, G2 had greater margin gaps than G1, however, without statistical difference (P>0.05). Conclusions Difference in milling unit generation did not significantly affect the marginal fit. Marginal gap means were in the range of the clinical acceptance levels for both generations of Cerec milling units, regardless the teeth site area. Key words:CAD/CAM, margin, ceramics.

Treatment of noncarious cervical lesions by a subepithelial connective tissue graft versus a composite resin restoration.

This study compared two treatments for mild noncarious cervical lesions (NCCLs): a subepithelial connective tissue graft (CTG) versus a Class V composite resin restoration (CRR). Twenty-six sites with NCCLs were randomly assigned to be treated by CTG or CRR. Periodontal health parameters and dentinal hypersensitivity (DH) were recorded at baseline and 3 months postoperatively. Esthetics was also evaluated at 3 months. Results showed a significant improvement in all periodontal health parameters in the CTG treatment. The CTG treatment attained a mean 82% defect coverage with 75% of sites achieving complete coverage. Patients rated the CTG treatment to be significantly more esthetic (P = .03), while a clinician panel did not see an esthetic difference (P = .86). There was no difference in DH reduction between the two treatments (P = .81). In conclusion, the CTG treatment is superior to the CRR treatment for NCCLs based on periodontal health parameters. From a patient point of view, the CTG is the more esthetic treatment.