Clinical evidence and literature to compare two different therapeutic protocols in tooth avulsion. Thymosin alpha 1 provides short-term and long-term benefits in the reimplantation of avulsed teeth: a double-blind randomized control pilot study. Endodontic complications after plastic restorations in general practice. [Clinical studies on the use of hyperbaric oxygen in replantation of young permanent teeth]. Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: effects of hyperbaric oxygen therapy. Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions. Comparison of the effect of the linseed extract Salinum and a methyl cellulose preparation on the symptoms of dry mouth. Clinical and microbiologic effects of chemical versus mechanical cleansing in professional supportive implant therapy. A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth.
This is to assess the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament. The objective is to establish a univocal protocol by analysing and comparing the various components of these therapeutic procedures.
                Study design: 20 patients were selected and divided into 2 groups: in group A we focused our attention on the rapidity of replantation, in group B we focused on the elimination of the necrotic pulp and every possible irritating stimulus that might lead to root resorption of inflammatory nature.
                Clinically, dental mobility seems to be greater in the first group. However after 15 days teeth have a comparable mobility and after one month they all show a mobility degree 1. Radiographically a greater incidence of resorption can be observed in group A compared to group B as in the first one a higher number of replanted teeth undergo resorption. Such lesions have the tendency to remain constant or even increase.
                The results of this study seem to take only one direction: extraoral endodontic therapy. This study investigates the short-term and long-term effects of thymosin alpha 1 (Talpha1) on reimplantation of avulsed teeth.
                Seventy-three patients with avulsed teeth were double-blind randomly assigned to a control group and group that used Talpha1. The teeth were reimplanted after treatment with Talpha1 or saline. Patients were monitored for both short-term and long-term parameters.
                The thymosin group demonstrated a lower interferon, tumor necrosis factor alpha and interleukin-6 levels (P < .05) and higher white blood cell levels than the control group (P < .05). The thymosin group demonstrated greater periodontal healing (P < .05), less ankylosis (P < .05), less tooth movement, and greater lifetime of the replanted teeth.
                The use of Talpha1 has both short-term and long-term beneficial effects during reimplantation of avulsed teeth. To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining.
                A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05).
                A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92).
                Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams. To investigate the treatment effects of hyperbaric oxygen(HBO) in replantation of young permanent teeth.
                A total of 138 luxation injuries to young permanent teeth undergoing treatment. The teeth were replanted and then divided into 2 groups. The HBO group was exposed to 0.25 MPa pure oxygen 40 x 2 minutes each day for 10 days continuously while the control group were compared.
                The total effective rates of the HBO group and the control group were 97.26% and 70.77% respectively, and showed significant difference (P < 0.05); respective frequencies of missing tooth after 1 year were 1.37% and 18.46%, and provided a statistical significance (P < 0.001).
                HBO used in replantation of luxated young permanent teeth could promote the recovery of periodontal membrane, pulp, and prevent resorption of root. Surgical treatment of malignancies in the oral cavity and subsequent radiotherapy often result in an anatomic and physiological oral condition unfavorable for prosthodontic rehabilitation. The objective of this prospective study was to assess the effect of hyperbaric oxygen therapy on treatment outcome (condition of peri-implant tissues, implant survival, oral functioning and quality of life) of prosthodontic rehabilitation with implant-retained lower dentures in radiated head and neck cancer patients 6 weeks and 1 year after placing the new dentures. The treatment outcome was assessed in a group of 26 head neck cancer patients who were subjected to radiotherapy after tumour surgery. Standardized questionnaires were completed and clinical and radiographic assessments were performed. After randomization, endosseous Brånemark implants were placed in the anterior part of the mandible either under antibiotic prophylaxis (13 patients) or under antibiotic prophylaxis combined with pre and postsurgery hyperbaric oxygen (HBO) treatment (13 patients). In the HBO and non-HBO group eight implants (implant survival 85.2%) and three implants (implant survival 93.9%) were lost, respectively. Peri-implant tissues had a healthy appearance in both groups. Osteoradionecrosis developed in one patient in the HBO group. All patients functioned well with their implant-retained lower denture. The quality of life related to oral functioning and denture satisfaction were improved to a comparable extent in the HBO and non-HBO group. Implant-retained lower dentures can improve the quality of life related to oral functioning and denture satisfaction in head and neck cancer patients. Adjuvant hyperbaric oxygen therapy could not be shown to enhance implant survival in radiated mandibular jaw bone. This prospective clinical study explored the influence of calcium hydroxide as an interappointment dressing on the healing of periapical lesions associated with pulpless teeth that had not been endodontically treated previously. This was achieved by comparing the prognosis after a two-visit root canal treatment with that following a one-visit treatment.
                Seventy-three patients were recruited having one tooth with an endodontically induced lesion. Of these patients, 67 could be re-examined. Calcium hydroxide was placed in the instrumented root canals of 31 teeth for at least one week and the treatment finished at the second visit. Thirty-six teeth were root canal treated at one visit. The criteria for success were the absence of signs and symptoms indicating an acute phase of periapical periodontitis and radiographically a periodontal ligament space of normal width. Methods for event time analysis were used to evaluate and compare the prognosis of both treatment approaches.
                The probability that complete periapical healing will take place increased continuously with the length of the observation period. In both treatment groups the likelihood that the root canal treatment yields a success within an observation time of five years exceeded 90%. A statistically significant difference between the two treatment groups could not be detected.
                From a microbiological perspective, one-visit root canal treatment created favourable environmental conditions for periapical repair similar to the two-visit therapy when calcium hydroxide was used as antimicrobial dressing. One-visit root canal treatment is an acceptable alternative to two-visit treatment for pulpless teeth associated with an endodontically induced lesion. The effect of a linseed extract Salinum and a sodium carboxymethyl cellulose preparation called MAS-84 was compared with regard to its effect on the symptoms of dry mouth. Twenty patients with xerostomia, who had been treated for cancer in the head and neck by radiation were recruited from the clinic for maxillofacial surgery, Malmo University Hospital. Following radiation treatment the salivation was severely reduced. The symptoms of a general feeling of a dry mouth, difficulties in chewing and swallowing, taste disturbances, problems with speech and mouth burning were registered on a subjective verbal rating scale. In addition plaque index and gingival bleeding were determined. The study design was crossover and performed single blind. The experimental period was 7 weeks. The patients were randomly divided into 2 groups. One group used Salinum and the other MAS-84 for 3 weeks. The fourth week was a wash out period and for the next three weeks the patients shifted preparation. Each of the preparations was used ad libitum. Registrations of the various parameters were undertaken on days 0, 7 and 21 of the respective period. At the initial examination all patients reported considerable disturbances from mouth-dryness. These symptoms were reduced in 15 patients during the Salinum period and in 9 during the MAS-84 period. The relief was significantly more pronounced during the use of Salinum compared to that during the use of the methyl cellulose preparation. On day 21 plaque and gingival bleeding were significantly reduced during the Salinum period but not during the MAS-84 period. The results of the present study confirm those of a previous pilot study and indicate that the linseed mucilage significantly reduced the symptoms of dry mouth. This effect increased with increasing time of saliva substitute use. The linseed mucilage Salinum appeared to be a suitable saliva replacement in mouth dry patients. The aim of the present study was to compare the cleansing properties of mechanical supportive care for dental implants with the use of an etching gel. Sixteen patients underwent a 5-month clinical trial with monthly recalls. These patients, wearing maxillary complete dentures and mandibular overdentures supported by a bar device on 4 implants, were treated in a split-mouth study design. Test and control therapy were randomly assigned to left and right sides of the mandible. At the test side, 35% phosphoric etching gel (pH 1) was applied in the peri-implant sulcus. After 1 minute, the sulcus was thoroughly rinsed with a water spray for approximately 15 seconds per implants. Control therapy consisted of supra- and subgingival debridement using carbon fiber curettes and a rubber cup. Plaque, calculus, probing pocket depth, and modified Gingival Index were determined before each treatment. Microbiologic evaluation was performed at baseline, 1 month later, and 5 months later, just before and immediately after each treatment. Per treatment and per assessment, the mean scores of all clinical parameters were calculated for each patient. The number of colony-forming units was used as the primary efficacy variable in the analysis of microbiologic data. At baseline, no differences between test and control sites were observed for any of the clinical parameters. The mean Gingival Index and the mean probing pocket depth were reduced over the 5-month period. The mean reduction in Gingival Index at the test sites proved to be significantly larger at the control sites (P = .03). Both treatment modalities resulted in an instant reduction of the number of colony-forming units, where the reduction by chemical cleaning was larger (P < .05). This short-term study employing a high recall frequency indicates that local application of 35% phosphoric acid gel can be as effective as conventional mechanical supportive therapy. The purpose of this project was to evaluate the performance of a dentin adhesive system on carious and noncarious primary dentin in vivo.
                Forty-eight primary molars with carious lesions were randomly assigned to 2 different treatments: group 1 (control, n = 24)--All identifiable, irreversibly infected dentin was removed prior to the application of the bonding agent and restorative material; group 2 (experimental, n = 24)--Irreversibly infected dentin was partially removed prior to the application of the bonding agent and restorative material. The control and experimental teeth were clinically monitored every 3 months and evaluated 12 months after restoration. The teeth were extracted around the time of exfoliation and processed for scanning electron microscopy.
                Retention rate, marginal integrity, and pulpal symptoms were identical in both groups. Radiographically, the radiolucent area associated with the experimental restorations did not increase with time in 75% of the cases. For the control group, the adhesive system formed a hybrid layer. In the experimental group, there was morphologic evidence of the formation of an acid-resistant "altered hybrid layer." An acid-resistant tissue, resulting from the interdiffusion of adhesive resin within the area of carious dentin, was observed adjacent to and under the altered hybrid layer.
                Application of an adhesive restorative system to irreversibly infected dentin did not affect the clinical performance of the restoration.
The available evidence suggests that extra-oral endodontics is not detrimental for teeth replanted after more than 60 minutes dry time. Studies with moderate/high risk of bias indicate that soaking in thymosin alpha 1 and gentamycin sulphate followed by hyperbaric oxygen may be advantageous however, they have not previously been reported as interventions for avulsed teeth and need further validation. More evidence with low risk of bias is required and, with the low incidence of avulsed teeth, collaborative multicentre trials are indicated.