Revista clínica de periodoncia, implantología y rehabilitación oral最新文献

Loosening is the most common failure of fiber posts, mainly due to complex adhesion within the root canal. The main objective of this study was to determine if significant differences in adhesive resistance, using the push-out test, in the cementation of fiber posts with RelyX U-200^® (U200) and Core Paste XP^® (CPX) in different root regions.

Material and methods

A selection of 40 premolars were sectioned 15 mm from the apex, treated endodontically and then randomly divided in two groups of 20, using an Exacto translucent fiber post with U200 and CPX, respectively. After 24 hours, each sample was sectioned into cervical, middle and apical. The test push-out test was performed using a Tinius Olsen HK5-S machine to quantify the adhesive strength in Mega Pascals. The test Shapiro-Wilk, two-factor Anova and Tukey tests were used with a significance level of 95%

Results

There were no significant differences between the cements (P = .457) but if there was difference when comparing the type of cement and region. CPX showed a value significantly higher in the cervical third (P < .05), while U200 presented a value significantly higher in the apical third (P < .05).

Conclusions

There was no significant difference in the value of the adhesive strength in the comparison between U200 and CXP, however there was a higher value of CXP at cervical and U200 at apical level.

Background

Payment mechanisms for health care providers have been used as a strategy to improve management, health indicators, cost containment, equity and efficiency. Among the mechanisms implemented in the past decade is pay-for-performance (P4P). In Chile, it was incorporated since 2003 in primary care in addition to the salary by seniority and training.

Objectives

To assess the impact of P4P on the efficiency of primary oral health care providers in Chile.

Methods

We performed a retrospective cohort study to compare the performance of oral healthcare practices belonging to primary health providers measured by the rate of dental discharge in 6 year-old children between years in which P4P was used and years in which P4P was not used, in the 52 municipalities of the Metropolitan Region of Chile. We also explored whether rurality, and the human development index (HDI) had an association with the efficiency of health care teams. We calculated the rate of discharge per 1000 patients, and its adjusted and unadjusted association with the predictors of interest, using a Random-effects Poisson regression.

Results

We found statistically significant differences in the rate of dental discharges when comparing P4P versus no P4P (822.59/1000 and 662.59/1000, respectively, p < 0.0001) and high versus low HDI (692.23/1000 and 832.85/1000, respectively, p = 0.01). Rurality was not statistically associated with P4P (727.24/1000 in rural and 770.19/1000 in urban municipalities, p = 0.553). Unadjusted and adjusted rate ratios were very similar.

Conclusions

P4P financial incentives can improve the performance of primary care dental practices, and seem to be useful interventions to improve the performance of oral health care providers.

Cavities and periodontal diseases have a very high prevalence worldwide. Similarly, osteoporosis, another disease affecting bones, will continue to increasing because of the so called «reversal of the demographic pyramid».

Bone and teeth are both anatomical and functional related. Therefore, it is worth determining, among many other aspects, whether osteoporosis also affects the maxilla and mandibular bones, in the same way as in the long bones, especially those of post-menopausal women.

If so, the pharmacological therapy most widely used in the world, bisphosphonates, could also work in maxilla and mandibular bones and then would allow dentists to focus not only on reporting epidemiological and etiopathogenic data on its potential adverse effect: «bisphosphonate-related osteonecrosis of the jaw» (BRONJ).

Consequently, Osteology and Odontology could share more than one common issue, as well in the physiological as in the pathophysiological field.

Almost two-thirds (63.2%) of the Chilean population aged 65 and above use removable prosthesis. When they cease to be functional, injuries may occur in the oral mucosa, with denture stomatitis being the most prevalent. This is an inflammatory process of the supportive mucosa of varying extension and severity, with its main etiologic factor being infection by Candida spp. The aim of this investigation was to determine the quantity and species of yeast of the genus Candida and their association with denture stomatitis in carriers of removable prosthesis, before and after the rehabilitation treatment. A descriptive quantitative study was conducted on 34 patients, with a mean age of 69 years, and carriers of a non-functional removable prosthesis, with and without prosthetic stomatitis. Saliva samples were taken before and after the treatment for the counting and identification of genus Candida yeast. The variables were statistically analyzed. The results showed a diagnosis of prosthetic stomatitis in 55.9% of the subjects, of which 29.4% were Type I and 26.5% were Type II. The Candida spp count was higher in the subjects with prosthetic stomatitis both before and after the treatment. The count decreased significantly after installing a functional prosthesis. However, it remained high in those with prosthetic stomatitis. The most frequently identified species was Candida albicans.

Objective

To determine, using in vitro pH measurements, the buffering capacity of saliva when added to different energy drinks sold in Chile.

Method

The participation of 3 young and systemically healthy patients, with no diseases of the saliva glands, was obtained. Samples of stimulated saliva where obtained from each patient and then mixed and stored as one sample. The study used 13 energy drinks sold nationwide, with 5 mL of each one being distributed into 4 Falcon tubes. The pH of each of the energy drinks, the saliva sample, and drinking water was measured. 1 mL of drinking water was added into Falcon tube number 1, and 1 mL of saliva into the 3 remaining every 3 min until completing 13 mL of solution in each one (38% vol./vol.). The pH measurements where performed upon adding each 1 mL (saliva/water) to allow the pH meter to correctly register the data.

Results

The pH levels for energy drinks range between pH 2.42 ± 0.008 (Battery Gingered®), to pH 3.44 ± 0.005 (Battery Sugar Free®). The saliva had a mean pH value of 7.99, and 7.05 for drinkable water. The energy drink that achieved a higher increase in pH level was Speed®, reaching a value of pH 4.38, while the energy drink that increased the pH level the least was Quick Energy®, only reaching a pH of 3.37.

Conclusion

The buffering capacity of saliva managed to increase the pH level of energy drinks analyzed in this study between 17 and 54%. However, saliva was unable to neutralize further than 4.38 the low levels of pH in these drinks, thus being critical to dental structure.

The tooth anomalies of size and shape are common anatomical alterations involving the aesthetics of the anterior sector. There are different approaches to address this morphological alteration. The procedure most in demand is restoration with veneers, with the materials of choice in this case being indirect ceramic restorations and direct composite resin restorations. The ceramic preserves physical and aesthetic properties that make it the first choice, but composite resins are becoming a reliable alternative. The case of a patient is presented who consulted with aesthetic anomalies. In the intraoral examination 2 pin-shaped dental organs 12 and 22 are observed, as well as diastemas in the maxilla, in the anterior sector. A proposed treatment plan was cosmetic restoration of anterior-superior sector with composite resin veneers using plastic preforms. The aim of the present case is to describe the aesthetic restorative treatment performed using composite resin copings.

We describe a case report of a patient with lip incompetence and a healthy carrier of a dental implant in the tooth 1.2, which was performed using a connective tissue graft technique for improving an existing slight cosmetic defect. The graft necrosis was possibly due to the dehydration that the tissues are subjected to in these patients with mouth breathing and labial incompetence. The surgical resolution of the case by a second connective tissue graft, and its clinical management to prevent the occurrence of this complication is presented.

Objective

The aim of this study is the evaluation of a new removal method of osseointegrated implants under a minimally invasive technique.

Material and methods

The study was conducted on a group of 66 osseointegrated internal and external connection implants that were considered unsuccesful. The surgical removal was indicated after radiologically confirming peri-implant bone loss, and poor positioning which made the prosthetic rehabilitation impossible, or would damage the prosthetic implant retainer. The surgical procedure was developed in an operating room under local anesthesia. As first surgical removal option, the procedure consisted of the use of a removal instrument that works against torque and which does not need a full thickness flap to reach the surgical site; and as a second surgical removal option a trephine bur was used. For this option, a full thickness flap was performed in order to expose the surgical site.

Results

A total of 66 osseointegrated implants were removed under the first mode, with no full thickness flaps or Trephine burs required.

Conclusions

Within the limitations of this preliminary study, we propose that the use of this new, against torque, removal instrument of osseointegrated implants in failure is seen as a very good alternative to invasive surgical removal techniques, reducing surgical risks.

Objective

Apical destructive periodontal processes are largely mediated by specific proteases. Evidence supports that the levels of extracellular matrix metalloproteinase-9 (MMP-9) could reflect the presence of asymptomatic apical periodontitis (AAP) in gingival crevicular fluid (GCF). The aim of this study was to evaluate the activity of MMP-9 during reparative response in periapical post endodontic controls between 1 week and 6 months later and in healthy controls.

Materials and methods

A prospective study was performed on 28 patients with a diagnosis of AAP. GCF samples were taken from AAP teeth at baseline and post-endodontic controls at 1 week, 1, 3 and 6 months. Additional healthy contralateral controls were obtained, and samples were eluted and analyzed by densitometric scanning and gelatin zymography.

Results

In patients with asymptomatic apical periodontitis, both the pro form and the active form of MMP-9 were identified. These showed significant increases in post-endodontic controls at three and six months, with signs of periapical repairing.

Conclusions

MMP-9 levels significantly increased in teeth diagnosed with AAP during the reparative phase. These results suggest that MMP-9 might be involved in the healing of apical tissues that might be reflected in GCF.