Dentistry Review最新文献

OBJECTIVES

The purpose of this abstract is to describe how the use of phage therapy can be used to effectively target oral bacteria such as Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Enterococcus faecalis with minimal side effects to patients. These particular bacteria are important components in the process of caries formation, periodontal disease, and failed endodontic treatment.

METHODS

A search of Pubmed was conducted for peer-reviewed randomized control trials, clinical trials, and studies that were less than five years old. The keywords used to find relevant articles were: bacteria, oral bacteria, phage therapy, bacteriophage therapy, pathogenic bacteria, and dental bacteria.

RESULTS

The studies that were reviewed demonstrated phage therapy to be effective in reducing oral bacteria commonly responsible for dental caries, periodontal disease, and failed endodontic treatment. The first study showed the isolated phage, SMHBZ8, targeted S. mutans and reduced both biofilm formation and demineralization of enamel. The second study demonstrated the ability of a lysogenic bacteriophage, S1249, to be induced into the lytic cycle in human serum and effectively eliminate A. actinomycetemcomitans, a bacteria implicated in aggressive periodontal disease and known to be resistant to serum. The third study found a phage, PEf771, targeting E. faecalis in endodontically treated teeth with refractory periapical periodontitis was found to have greater substantivity and antibiotic properties than traditional medicaments used in root canal treatment.

CONCLUSIONS

These studies prove the viability of phage therapy as a treatment modality in targeting pathogens that contribute to major oral diseases. Benefits of phage therapy include low toxicity, high specificity, biofilm penetrating capabilities, and the ability to continuously replicate in the presence of target bacteria.

IMPLICATIONS

With more research to include human trials, phage therapy could prove to be a cost-effective alternative to conventional treatments in dentistry with fewer side effects to patients. Current treatment options for these oral diseases carry risks such as antibiotic resistance, staining, and toxicity. The ability of bacteriophage to target caries-causing bacteria such as S. mutans while sparing commensal bacteria is promising for preventive dentistry while the specificity and replicating abilities are desirable for eliminating periodontal and endodontic pathogens. The use of bacteriophage in dentistry could be adapted for delivery as a rinse, dentifrice, varnish, or targeted delivery system.

Essix trays are commonly used within dentistry for the temporary replacement of missing teeth following extraction of dental alveolar trauma. Typically, this procedure is performed easily with the use of an impression of existing arch, denture tooth, and Essix Tray material. This following report is unique due to the complexity of his existing maxillary dentition being restored with a combination of removable and fixed prosthodontics and the location of the fracture occurring within the esthetic zone. Furthermore, the patient's complex medical history and severe gag reflex added additional factors to the rehabilitation of this patient.

A 64-year-old Caucasian male presented to the General Practice Residency with fracture of his fixed partial denture (#9-11). Patient's maxillary arch was restored previously using FPD #6-8 and #9-11 with a Kennedy Class I removable partial denture. Opposing dentition was restored with all ceramic zirconia crowns. Secondary caries noted on fractured #11 deemed non-restorable and #9 fractured equigingival with fair prognosis for restoring via NSRCT, post, core and crown. History of Myocardial Infarction within past year and severe gag reflex. Impressions for this patient required the use of intravenous moderate procedural sedation. Consultation with PCP and cardiologist for medical clearance for moderate sedation were obtained and patient was appointed for impressions, records, and extraction of #9 and #11. Patient was offered plans including traditional denture fabrication, implant retained, or implant fixated prosthesis. Patient requested a temporary prosthesis to allow time to make decision on the final plans due to financial considerations.

This case report illustrates a unique application of the Essix Appliance for the temporization of this patient. Additionally, this case report shows a proof of concept for using Essix appliances in temporization of patients already restored with removable prosthesis. The final esthetics, function, and retention of the prosthesis were evaluated as adequate and acceptable to the patient. Pt was able to function with this temporary appliance for 3 months and was restored with an immediate maxillary denture. Patient is being seen for follow up to evaluate patient adaptation to the denture.

OBJECTIVES

To test the effectiveness of EGCG palmitate (EC16), a lipophilic derivative of (-)-epigallocatechin-3-gallate (EGCG, an anti-oxidant catechin component found in green tea), in reducing the neurological complications of persistent SARS CoV-2 infection particularly in the Human Olfactory Epithelium. The goal of this project was to evaluate the in vitro properties and antiviral activity of a prototype aqueous EC16 nanoformulation.

METHODS

Nanoparticles of EC16 were obtained by a natural-forming method. Nanoparticle size and Zeta potential were measured by the ZetaView Nanoparticle Tracking Analysis (NTA) system. The pH and viscosity of the formulations were measured. Contact suspension antiviral activity of EC16 nanoformulations against OC43 β-coronavirus was determined by TCID50 assay in human respiratory fibroblast cells (MRC-5). Post-infection antiviral activity of the EC16 nanoformulation was assessed using human nasal primary epithelial cells (HNpECs). Cytotoxicity tests were conducted by MTT assay in HNpECs and HCT-8 cells.

RESULTS

A nanoformulation containing 0.1% w/v EC16 inactivated 99.9999% of OC43 on direct contact within 1 minute. After a single 10-minute incubation of HNpECs with formulation EC16m (EGCG-4’ monopalmitate) nanoformulation, OC43 viral replication was inhibited by 99%. Cytotoxicity tests showed that EC16 nanoformulations were comparable to normal saline commonly used in nasal irrigations.]

CONCLUSIONS

The prototype of a nasal nanoformulation containing EC16 showed potential capabilities to rapidly inactivate SARS-CoV-2 virus in the olfactory epithelium. The results indicated that these novel nanoformulations could be the basis for a nasal drug for treatment of Long- COVID associated anosmia and other associated neurological symptoms, pending future clinical studies.

IMPLICATION

EC16, a food-grade compound derive from natural materials, has the potential to be a novel intranasal drug for the treatment of Long COVID, pending safety studies and optimization of a specific nasal spray formulation. Additionally, future studies will determine the antiviral effectiveness of EC16 for pathogens besides SARS-CoV-2, such as norovirus, herpes simplex virus, and influenza viruses, etc…

OBJECTIVES

Evaluate the role oral hygiene plays in decreasing the risk of contracting Ventilator-Associated Pneumonia (VAP) for patients on life-support.

METHODS

Five different research studies were used to measure the effectiveness of various mouthwashes ability to prevent VAP. The mouthwashes evaluated were Clove mouthwash, Ozonated Water (OZW), Chlorohexidine Gluconate (CHG), and Povidone Iodine. For each study, the patients were split into a control and experimental group. All patients were treated with the designated mouthwash, using a mouth swab for application. There was a variation of the duration of each study, as well as the time intervals of mouthwash application. The studies were conducted over the course of anywhere from a few hours to several days. There were numerous data collection instruments used throughout each study to measure the incidence of VAP contraction, such as Acute Physiology and Chronic Health Evaluation II (APACHEII), The Beck Oral Assessment Scale (BOAS), and Modified Clinical Pulmonary Infection Score (MCPIS).

RESULTS

• Study One: 40% participants in Chlorohexidine group contracted VAP; double that of the Clove Extract group • Study Two: 9 out of 36 patients in OZW group contracted VAP; 17 out of 37 patients in CHG group contracted VAP • Study Three: Experimental group showed an overall reduction in bacterial growth • Study Four: 0% VAP contraction in experimental group; 10.58% contraction in control group • Study Five: 10 patients in CHG group contracted VAP; 17 patients in placebo group contracted VAP

CONCLUSIONS

Overall, this literature review confirms that mouthwash solutions do have a positive effect in the reduction of VAP in critically ill patients. However, research has not consistently shown one solution to be more triumphant than another, when compared.

IMPLICATIONS

In a hospital setting the findings influence clinical dentistry by showing the importance of providing professional cleanings within 24 hours of mechanical ventilation, providing oral care using an antibacterial mouthwash 3 times a day, and ensuring that patients teeth are brushed twice a day. In a private practice setting the findings show the importance/need of advocating for patients receiving proper oral care while in a critically ill state and spreading awareness on the effect that oral hygiene has on preventing VAP.

OBJECTIVES

To examine the level of distortion of 3D printed surgical guides after steam sterilization and disinfection by immersion in 70% isopropyl alcohol. The results will provide a basis for developing a protocol for the sterilization of surgical guides.

METHODS

A maxillary stone model was scanned with Prime Scan optical scanner (Dentsply Sirona, Charlotte, NC) and the standard tessellation language (STL) file of the model was exported and uploaded to Blue Sky Bio® software. The model was modified to extract tooth #8 digitally in the Blue Sky Bio® software. Surgical guides were designed to extend from tooth number 6 to 10. Forty guides were printed with Formlabs Form 3B+ printer and Formlabs surgical guide resin following manufacturer's instructions. Each guide was scanned with Prime Scan optical scanner before disinfection and sterilization. Twenty guides were individually packaged, and autoclave sterilized at manufacturer's recommendation of 134°C for 20 minutes. The remaining twenty guides were soaked in 70% isopropyl alcohol for fifteen minutes. After sterilization and disinfection, the guides were scanned and STL files from pre- and post-sterilization were compared in GeoMagic Control X software to examine dimensional changes. A paired T-test was done to evaluate distortion of the guide before and after sterilization and disinfection. An unpaired T-test was done to compare the disinfection and sterilization test groups.

RESULTS

The average deviation at the lingual, incisal, buccal, combined surfaces, and the entire guide of the sterilized group was 6.28μm, -2.4μm, -20.6μm, 5.6μm, and 12.6μm respectively. The average deviation at the lingual, incisal, buccal, combined surfaces and the entire guide of the chemically disinfected group was -0.43μm, 2.6μm, -0.78μm, 0. μm, and 5.5μm respectively. Paired T-test of the sterilized group showed a significant difference before and after sterilization at all surfaces with p-values <0.05. Paired Ttest of the disinfection group showed no significant difference before and after chemical disinfection at any surface. Unpaired T-test between the sterilized and disinfected group showed a non-significant difference between the incisal and total averages. There was a statistically significant difference between the average deviation of the lingual surfaces with a p-value of 6.31763E-06, the buccal surface with a pvalue of 3.83055E-13, and the combined surfaces with a p-value of .0001.

CONCLUSIONS

Results indicate that there is distortion after sterilization and minimal distortion with chemical disinfection. However, the amount of distortion will likely not cause a clinically significant effect on the seating of the surgical guides. This is an indication that surgical guides can be either sterilized or disinfected prior to implant placement.

IMPLICATIONS

The results will provide a basis for d