Nevin Manimala

J Contemp Dent Pract. 2022 Dec 1;23(12):1237-1244. doi: 10.5005/jp-journals-10024-3442.

ABSTRACT

AIM: The aim of this study was to evaluate the efficacy of grape seed extract (GSE) on remineralization of surface and subsurface enamel lesions compared to that of sodium fluoride (NaF).

MATERIALS AND METHODS: A total of 20 intact bovine incisor crowns were separated from their roots and immersed in a demineralizing solution for 96 hours at 37°C to create artificial enamel lesions. The specimens were randomly divided into two groups (n = 10): 6.5% GSE solution and 1000 ppm NaF solution. The specimens were subjected to six daily pH cycles for 8 days. The microhardness test was carried out at three different stages: baseline, after artificial caries formation, and after pH cycling. Raman spectroscopy was used to evaluate the depth of enamel remineralization. Surface morphology and elemental analysis were assessed using a scanning electron microscope (SEM) and an energy dispersive X-ray (EDX) spectroscope, respectively. Statistical analysis was performed using SPSS 22.0 at a significance level of p ≤ 0.05.

RESULTS: There was a significant increase in the mean values of enamel surface microhardness after pH cycles in the two groups compared to after artificial caries formation, but there was no significant difference between both groups. The B-type carbonate/phosphate (Ca/P) ratio at 10 and 40 µm depth revealed no significant difference between the two groups. Scanning electron microscope micrograph revealed occlusion of porosities and particle precipitation on the enamel surface of the two groups, while EDX results for the Ca/P ratio of the GSE and NaF groups were 1.59 and 1.60, respectively.

CONCLUSION: Grape seed extract and NaF are equally effective in remineralizing surface and subsurface artificial enamel lesions.

CLINICAL SIGNIFICANCE: Grape seed extract can be considered a promising herbal material and a safe alternative to traditional NaF for the noninvasive treatment of enamel lesions.

PMID:37125522 | DOI:10.5005/jp-journals-10024-3442

J Contemp Dent Pract. 2022 Dec 1;23(12):1211-1217. doi: 10.5005/jp-journals-10024-3443.

ABSTRACT

AIM: This randomized controlled trial evaluated the efficacy of platelet-rich fibrin (PRF) and concentrated growth factor (CGF) as scaffolds in the regenerative endodontic procedure (REP) using clinical and radiographic parameters along with cone-beam computed tomographic (CBCT) analysis.

MATERIALS AND METHODS: The apexogenesis procedure was performed in 16 teeth. They were randomly divided into two groups of eight teeth each: group I and group II. In group I PRF was used as the scaffold and in group II CGF was used as the scaffold. They were evaluated for pain, pulpal vitality, tenderness on percussion, and mobility, and also evaluated using digital radiographs at 3, 6, 12, and 18 months interval. The response of the teeth was graded using Chen and Chen criteria. Increase in root length, reduction in the apical foramen dimension, and reduction in periapical lesion volume were evaluated using CBCT scans taken preoperatively and at 18 months.

RESULTS: At the end of 3 months, 50% of teeth without periapical pathology were found to be vital in both groups. At the end of 18 months, 60% of the teeth in both groups showed increase in root length, all teeth showed closure of apical foramen, and reduction in the volume of periapical lesion. However, there was no statistically significant difference between the groups (p < 0.05).

CONCLUSION: The clinical and radiographic features reported in this study revealed that both PRF and CGF act as effective scaffolds in REP for regeneration of pulp-dentin complex with promising results.

CLINICAL SIGNIFICANCE: Apexogenesis by revascularization has not been used regularly for the treatment of nonvital teeth with open apex because the results are not reliable. Since platelet concentrates like PRF and CGF are rich in growth factors; when apexogenesis is performed by REP using these platelet concentrates, desirable results can be achieved in a short duration of time. They also accelerate the healing of periapical lesions present in such cases. With the increased success rate of apexogenesis with REP, many clinicians would prefer to use REPs as a treatment option for teeth with open apex.

PMID:37125518 | DOI:10.5005/jp-journals-10024-3443

J Contemp Dent Pract. 2022 Dec 1;23(12):1199-1202. doi: 10.5005/jp-journals-10024-3449.

ABSTRACT

AIM: To evaluate the effectiveness of gelatin sponge [Abgel] with injectable platelet-rich fibrin (i-PRF) in the surgical treatment of mandibular Grade II furcation defects in endodontically involved teeth.

MATERIALS AND METHODS: The present study was a single-center clinical trial wherein 20 mandibular grade II furcation defects were treated with gelatin sponge combined with i-PRF results were compared both clinically and radiographically at baseline, 3, and 6 months postoperatively. Statistical analysis was done using Statistical package for social sciences (SPSS) we software. For pre and post comparison, paired t-test, analysis of variance (ANOVA) and Wilcoxon test were used.

RESULTS: There was a statistically highly significant improvement seen in all the clinical parameters vertical clinical attachment level (V-CAL), horizontal clinical attachment level (H-CAL) and probing pocket depth (PPD) and radiographic parameters at baseline and 6 months postoperatively p < 0.01.

CONCLUSION: Open flap debridement along with Abgel combined with i-PRF is an effective treatment modality in reducing the horizontal and vertical component of grade II furcation defects.

CLINICAL SIGNIFICANCE: Gelatin sponge with i-PRF is a cost-effective treatment modality in achieving periodontal regeneration.

PMID:37125516 | DOI:10.5005/jp-journals-10024-3449

J Contemp Dent Pract. 2022 Dec 1;23(12):1190-1194. doi: 10.5005/jp-journals-10024-3452.

ABSTRACT

AIM: The aim of the present study was to assess the occlusal stress on the implant-abutment junction and implant-bone interface of a long-span implant-supported prosthesis made of two different prosthetic materials.

MATERIALS AND METHODS: A computerized tomography of the mandible was used to get the finite element model of the bone. The comparative groups were made as follows: S1 and S2 – 3.7 × 11 mm (44 region) and 4.5 × 11 mm (47 region), S1A and S2A – screw-retained porcelain-fused-to-metal prosthesis, S1B and S2B – cement-retained porcelain-fused-to-metal prosthesis, S1C and S2C – screw-retained zirconia prosthesis, and S1D – cement-retained zirconia prosthesis. Maximum stress generated on the implant-abutment interface of all the prostheses under vertical and oblique load was assessed.

RESULTS: For all the comparative groups, maximum level of stress was generated at the cervical level of the implant-bone interface in comparison to the apical and middle-third level under both vertical and oblique load. No statistically significant difference between zirconia and porcelain-fused-to-metal prosthesis was seen at the implant-abutment interface and the cervical third of the implant-bone interface. A significant difference was found between all screw-retained and cement-retained groups.

CONCLUSION: The present study concluded that the short implants in combination with standard-length implants using either porcelain-fused-to-metal or zirconia as prosthetic material in the form of long-span implant-supported prosthesis can be a viable treatment option in the posterior mandible.

CLINICAL SIGNIFICANCE: The accuracy of the diagnosis, examination, and knowledge of the site where the implant must be inserted, and the choice of superstructure is important for the stability and lifespan of the implant prosthesis.

PMID:37125514 | DOI:10.5005/jp-journals-10024-3452

Clin Infect Dis. 2023 May 1;76(Supplement_2):S210-S214. doi: 10.1093/cid/ciad097.

ABSTRACT

There is a crucial need for novel antibiotics to stem the tide of antimicrobial resistance, particularly against difficult to treat gram-negative pathogens like Acinetobacter baumannii-calcoaceticus complex (ABC). An innovative approach to addressing antimicrobial resistance may be pathogen-targeted development programs. Sulbactam-durlobactam (SUL-DUR) is a β-lactam/β-lactamase inhibitor combination antibiotic that is being developed to specifically target drug-resistant ABC. The development of SUL-DUR culminated with the Acinetobacter Treatment Trial Against Colistin (ATTACK) trial, a global, randomized, active-controlled phase 3 clinical trial that compared SUL-DUR with colistin for treating serious infections due to carbapenem-resistant ABC. SUL-DUR met the primary noninferiority endpoint of 28-day all-cause mortality. Furthermore, SUL-DUR had a favorable safety profile with a statistically significant lower incidence of nephrotoxicity compared with colistin. If approved, SUL-DUR could be an important treatment option for infections caused by ABC, including carbapenem-resistant and multidrug-resistant strains. The development program and the ATTACK trial highlight the potential for pathogen-targeted development programs to address the challenge of antimicrobial resistance.

PMID:37125468 | DOI:10.1093/cid/ciad097

J Neurotrauma. 2023 Apr 26. doi: 10.1089/neu.2022.0419. Online ahead of print.

ABSTRACT

Hyperventilation (HV) therapy uses vasoconstriction to reduce intracranial pressure (ICP) by reducing cerebral blood volume. However, as HV also lowers cerebral blood flow (CBF), it may provoke misery perfusion (MP) where the decrease in CBF is coupled with increased oxygen extraction fraction (OEF). MP may rapidly lead to the exhaustion of brain energy metabolites, making it vulnerable to ischemia. MP is difficult to detect at the bedside, which is where transcranial hybrid, near-infrared spectroscopies are promising since they noninvasively measure OEF and CBF. We have tested this technology during HV (∼30 minutes) with bilateral, frontal lobe monitoring to assess MP in twenty-seven sessions in eighteen patients with traumatic brain injury. In this study, HV did not lead to MP at a group level (p>0.05). However, a statistical approach yielded eighty-nine events with a high probability of MP in nineteen sessions. We have characterized each statistically significant event in detail and their possible relation with clinical and radiological status (decompressive craniectomy and presence of a cerebral lesion), without detecting any statistically significant difference (p>0.05). However, MP detection stresses the need for personalized, real-time assessment in future clinical trials with HV, in order to provide an optimal evaluation of the risk-benefit balance of HV. Our study provides pilot data demonstrating that bedside transcranial hybrid near-infrared spectroscopies could be utilized to assess potential MP.

PMID:37125452 | DOI:10.1089/neu.2022.0419

J Neurotrauma. 2023 Apr 26. doi: 10.1089/neu.2022.0507. Online ahead of print.

ABSTRACT

Data supporting the benefits of early surgical intervention in acute spinal cord injury (SCI) is growing. For early surgery to be accomplished, understanding the causes of variabilities that effect the timing of surgery is needed to achieve this goal. The purpose of this analysis is to determine factors that affect the timing of surgery for acute cervical SCI within the North American Clinical Trials Network (NACTN) for SCI registry. Patients in the NACTN SCI registry from 2005 to 2019 with a cervical SCI, excluding Acute Traumatic Central Cord Syndrome, were analyzed for time elapsed from injury to arrival to the hospital, and time to surgery. Two categories were defined: 1) Early Arrival with Early Surgery commenced within 24 hours of injury (EAES) and 2) Early Arrival but Delayed Surgery (EADS) with surgery occurring between 24 to 72 hours post-injury. Patients’ demographic features, initial clinical evaluation, medical comorbidities, neurological status, surgical intervention, complications, and outcome data were correlated with respect to the two arrival groups. Of the 222 acute cervical SCI patients undergoing surgery, 163 (73.4%) were EAES, and 59 (26.6%) were EADS. There was no statistical difference in arrival time between the EAES and EADS groups. There was a statistical difference in the median arrival time to surgery between the EAES group (9 hours) compared to the EADS group (31 hours) (p<0.05). There was no statistical difference in race, sex, age, mechanism of injury, APACHE II scores, or medical comorbidities between the two groups but the EAES group did present with a significantly lower systolic blood pressure (p<0.05). EADS patients were more likely to present as an AIS D than EAES (p<0.05). Early surgery was statistically more likely to occur if the injury occurred over the weekend (p<0.05). There were variations in the rates of early surgery between the 8 NACTN sites within the study, ranging from 57% to 100%. Of the 114 patients with 6-month outcome data, there was no significant change between the two groups regarding AIS grade change and motor/pin prick/light touch score recovery. A trend towards improved motor scores with early surgery was not statistically significant (p=0.21). Although there is data that surgery within 24 hours of injury improves outcomes and can be performed safely, there remain variations in care outside of clinical trials. In the present study of cervical SCI, NACTN achieved its goal of early surgery in 73.4% of patients from 2005-2019 who arrived within 24 hours of their injury. Variability in achieving this goal was related to severity of neurological injury, the day of the week, and the treating NACTN center. Evaluating variations within our network improves understanding of potential systemic limitations and our decision-making process to accomplish the goal of early surgery.

PMID:37125447 | DOI:10.1089/neu.2022.0507

Dent Mater J. 2023 Apr 28. doi: 10.4012/dmj.2022-273. Online ahead of print.

ABSTRACT

This study investigated the effect of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) in methyl methacrylate (MMA) monomer on the adhesion of tri-n-butylborane (TBB)-initiated resins (MDP/MMA-TBB resins) to human enamel. Enamel surface conditions were either polished only or phosphatized surfaces. The 1.0, 1.7, and 2.0 mol% MDP/MMA-TBB resins, 4-methacryloxyethyl trimellitate anhydride (4-META)/MMA-TBB resin and MMA-TBB resin were prepared as luting materials. The shear bond strength was determined before and after thermocycles, and the results were compared using non-parametric statistical analyses (each, n=15). The MDP/MMA-TBB resins showed significantly better bond durability to enamel than other resins with or without etching. The 1.7 and 2.0 mol% MDP/MMA-TBB resins were suggested to be the optimum MDP concentrations from pre- and post-thermocycling results for the non-etched specimens. The TBB initiator resin including MDP was shown to be effective in bonding to human enamel, and this effect was enhanced in combination with phosphate treatment.

PMID:37121735 | DOI:10.4012/dmj.2022-273

J Clin Exp Hematop. 2023 Apr 28. doi: 10.3960/jslrt.23001. Online ahead of print.

ABSTRACT

We retrospectively evaluated long-term outcomes of high dose chemotherapy followed by autologous stem cell transplant (HDC/ASCT) in patients with diffuse large B-cell lymphoma (DLBCL). Between 2004 and 2020, 46 DLBCL patients received HDC/ASCT in our institution, including 12 patients (26.1%), who received as an upfront setting (UFS). At a median follow-up time of 69 months (range, 2-169 months), the 5-year progression-free survival (PFS) rates were 82.5% (95%CI, 46.1-95.3%) in the UFS, and 57.8% (95%CI, 38.1-73.2%) in the relapsed or refractory (R/R) patients (n=34), respectively. The 5-year PFS rates were 62.3% (95%CI, 34.0-81.3%) in primary resistant (n=13) or early relapsing (within 1 year from the initial diagnosis) patients (n=4), and 53.3% (95%CI, 25.9-74.6%) in those relapsing >1 year after the initial diagnosis (n=17), with no statistically significant difference (p=0.498). In R/R patients, multivariate analysis showed that the remission status before HDC/ASCT was an independent poor prognostic factor for progression-free survival (hazard ratio [HR], 17.0; 95%CI, 3.35-86.6; p=0.000630) and high-risk category in the international prognostic index for OS (HR, 9.39; 95%CI, 1.71-51.6; p=0.0100). The incidence of non-relapse mortality by 5 years, and 10 years were 12.2%, and 15.2%, respectively. Eleven patients (23.9%) developed second malignancies, which was the most frequent late complication after HDC/ASCT, with 5-year, and 10-year cumulative incidence of 16.9%, 22.5%, respectively. In conclusion, HDC/ASCT is effective for chemo-sensitive R/R DLBCL regardless of the timing and lines of therapy. However, careful observation is required, considering the long-term complications such as secondary malignancies.

PMID:37121716 | DOI:10.3960/jslrt.23001

J Wound Care. 2023 May 1;32(Sup5):S6-S10. doi: 10.12968/jowc.2023.32.Sup5.S6.

ABSTRACT

OBJECTIVE: The objective of the current study was to evaluate outcomes of elective knee arthroscopy portal closure comparing two skin closure techniques.

METHOD: This was a randomised controlled trial including healthy volunteers aged ≥18 years undergoing elective knee arthroscopy that used two portals. At the time of surgery, each patient’s two arthroscopy portal closures were randomised to one of two closure techniques; the first technique used approximation of the skin with a micro-anchor skin dressing (BandGrip Inc., US), while the second closure technique used an absorbable suture (Biosyn Monofilament, Medtronic) and a liquid bonding agent skin closure (Dermabond, Ethicon Inc., US). Postoperative complications and patient-reported outcomes were evaluated at the first visit after knee arthroscopy and at six weeks postoperatively.

RESULTS: A total of 38 patients (76 portals) were enrolled in this study. No patients reported wound complications of either portal; thus, there was no significant difference (p>0.05) in wound complication rates between the skin closure techniques. Survey questions regarding any difference in appearance and cosmesis between the closure techniques’ portal sites were responded to by 15 patients, all of whom indicated no difference in appearance between the portal sites. There was also no statistically significant difference between the two closure techniques with regards to appearance.

CONCLUSION: There was no significant difference in presence of wound complications or appearance between skin closure with the micro-anchor skin dressing and the absorbable suture/liquid bonding agent skin closure.

PMID:37121665 | DOI:10.12968/jowc.2023.32.Sup5.S6