Decision making in the treatment of class III furcation: resective therapy? Extraction? Implant?

The presence of furcation lesions is associated with bone resorption and lack of insertion in the inter-radicular space, and is a condition that considerably increases the risk of dental loss, particularly in the absence of adequate treatment. In this context, the object of some of the therapies is to keep teeth with furcation lesions that are important to dental planning, to re-establish an anatomy that enables the patient to remove dental biofilm from the compromised area. However, the long term maintenance and treatment of molars with Class III furcation lesions continues to be a challenge to dentists during periodontal therapy, since the anatomy of the inter-radicular region makes it difficult for both professionals and patients to gain access to perform adequate and efficient control of dental biofilm. The impossibility of obtaining appropriate decontamination of the area involved during the root scraping process, including by means of surgical access, demands thatdentists have adequate knowledge to determine the correct therapeutic approach during the treatment of teeth with advance inter-radicularbone loss. The aim of the present study was to discuss the treatments available for Class III furcation lesions and relate clinical procedures that could be performed for the treatment of this type of defect

Effectiveness of 4 Pulpotomy Techniques—Randomized Controlled Trial

Pulpotomy is the accepted therapy for the management of cariously exposed pulps in symptom-free primary molars; however, evidence is lacking about the most appropriate technique. The aim of this study was to compare the relative effectiveness of the Er:YAG laser, calcium hydroxide, and ferric sulfate techniques with that of dilute formocresol in retaining such molars symptom-free. Two hundred primary molars in 107 healthy children were included and randomly allocated to one of the techniques. The treated teeth were blindly re-evaluated after 6, 12, 18, and 24 months. Descriptive data analysis and logistic regression analysis, accounting for each patient's effect by a generalized estimating equation (GEE), were used. After 24 months, the following total and clinical success rates were determined (%): formocresol 85 (96), laser 78 (93), calcium hydroxide 53 (87), and ferric sulfate 86 (100). Only calcium hydroxide performed significantly worse than formocresol (p = 0.001, odds ratio = 5.6, 95% confidence interval 2.0-15.5). In conclusion, calcium hydroxide is less appropriate for pulpotomies than is formocresol

Treatment of Abscessed Primary Molars Utilizing Lesion Sterilization and Tissue Repair: Literature Review and Report of Three Cases

Purpose: The purpose of this report was to review an emerging alternative treatment to pulpectomies and extractions for nonvital primary teeth called lesion sterilization and tissue repair (LSTR) and provide the results of three clinical case applications. LSTR is a noninstrumentation endodontic treatment that involves a triantibiotic mixture in a propylene glycol vehicle, which is used to disinfect root canal systems. This concept was developed by the cariology research unit of the School of Dentistry, Niigata University, Niigata, Niigata Prefecture, Japan. This article reviews the development of the technique, clinical procedures required for the technique, three clinical applications and radiographic documentation and follow-up, and a short literature review of the current evidence supporting its application in clinical practice

The nurse of the Mediterranean

During the First World War Malta did not take an active part in the fighting. Britain was joined in an ‘entente’ a friendship agreement with France since 1904 and later with Russia in 1907. On the other hand Germany was allied to the Austrian- Hungerian Empire, hence when the Great War started in July 1914 there were France, Britain and Russia on one side and Germany and Austria-Hungary on the other. The British fleet “ruled the waves”, hence with France and Britain as allies, to be joined later by Italy, the Mediterranean was more or less an allied lake, with Malta in the centre.peer-reviewe

Clinical application of ceramics in anterior cervical discectomy and fusion: A review and update

Study Design: Narrative review. Objectives: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure, commonly used for cervical degenerative disc disease. For interbody fusions, autograft was the gold standard for decades; however, limited availability and donor site morbidities have led to a constant search for new materials. Clinically, it has been shown that calcium phosphate ceramics, including hydroxyapatite (HA) and tricalcium phosphate (TCP), are effective as osteoconductive materials and bone grafts. In this review, we present the current findings regarding the use of ceramics in ACDF. Methods: A review of the relevant literature examining the clinical use of ceramics in anterior cervical discectomy and fusion procedures was conducted using PubMed, OVID and Cochrane. Result: HA, coralline HA, sandwiched HA, TCP, and biphasic calcium phosphate ceramics were used in combination with osteoinductive materials such as bone marrow aspirate and various cages composed of poly-ether-ether-ketone (PEEK), fiber carbon, and titanium. Stand-alone ceramic spacers have been associated with fracture and cracks. Metallic cages such as titanium endure the risk of subsidence and migration. PEEK cages in combination with ceramics were shown to be a suitable substitute for autograft. Conclusion: None of the discussed options has demonstrated clear superiority over others, although direct comparisons are often difficult due to discrepancies in data collection and study methodologies. Future randomized clinical trials are warranted before definitive conclusions can be drawn. © The Author(s) 2017

Radiculopathy as Delayed Presentations of Retained Spinal Bullet.

Bullet injuries to the spine may cause injury to the anatomical structures with or without neurologic deterioration. Most bullet injuries are acute, resulting from direct injury. However, in rare cases, delayed injury may occur, resulting in claudication. We report a case of intradural bullet at the L3-4 level with radiculopathy in a 30-year-old male. After surgical removal, radicular and claudicating pain were improved significantly, and motor power of the right leg also improved. We report the case of intradural bullet, which resulted in delayed radiculopathy

Classification of impacted mandibular third molars on cone-beam CT images

Background: Neurological involvement is a serious complication associated to the surgical removal of impacted mandibular third molars and the radiological investigation is the first mandatory step to assess the risk of a possible post-operative injury to the inferior alveolar nerve (IAN). The aim of this study was to introduce a new radiological classification that could be normally used in clinical practice to assess the relationship between an impacted third molar and mandibular canal on cone beam CT (CBCT) images. Material and Methods: CBCT images of 80 patients (133 mandibular third molars) were independently studied by three members of the surgical team to draw a classification that could describe all the possible relationships between third molar and IAN on the cross-sectional images. Subsequently, the study population was subdivided according to this classification. The SPSS software, version 15.0 (SPSS® Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results: Eight different classes were proposed (classes 0-7) and six of them (classes 1-6) were subdivided in two subtypes (subtypes A-B). The distribution of classes showed a prevalence of buccal or apical course of the mandibular canal followed by lingual position and inter-radicular one. No differences have resulted in terms of anatomic relationship between males and females apart from a higher risk of real contact without corticalization of the canal when the IAN had a lingual course for female group. Younger patients showed an increased rate of direct contact with a reduced calibre of the canal and/or without corticalization. Conclusions: The use of this classification could be a valid support in clinical practice to obtain a common language among operators in order to define the possible relationships between an impacted third molar and the mandibular canal on CBCT image

Lumbar spinal stenosis: the reliability, sensitivity and specificity of the nerve root sedimentation sign

Introduction: Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves at the level of the lumbar vertebra. The sedimentation sign is evaluated from standard lumbar MRIs and easy to apply. MRI finding of positive sedimentation sign is a reliable sign to diagnose lumbar spinal stenosis with high sensitivity and specificity. The objective of this study is to identify the nerve root sedimentation sign in patients with degenerative LSS and to evaluate its reliability, sensitivity and specificity. Methodology: This study is a retrospetive record review study to determine the socio-demographic and clinical presentation of LSS. It is also to determine the reliability, sensitivity and specificity of the nerve root sedimentation sign and to evaluate the inter and intra observer reliability, sensitivity and specificity. 82 subjects were enrolled in this study to determine the socio-demographic, clinical presentation of LSS, reliability, sensitivity and specificity of the nerve root sedimentation sign. 56 subjects were included in determining the inter and intra observer reliability, sensitivity and specificity. Two observers which were a radiologist and an orthopaedic surgeon were assigned to independently elicit the sign. Results: There were 43 patients in LSS group and 39 patients for control (non LSS group). There was significant association between spinal claudication and leg numbness with LSS (p <0.001). Leg weakness, buttock pain and thigh pain also showed significant association with LSS (p = 0.037, 0.019 and 0.011 respectively). There were significant association ofmotor weakness and sensory changes with LSS (p <0.001). The nerve root sedimentation sign were 100% sensitive in diagnosed LSS with specificity of 82.1%. The sensitivity of the nerve root sedimentation by Observer 1 was 84.8% and Observer 2 was 78.8% while the specificity by both observers was 95.7%. For the intra observer reliability, both observers showed good reliability. The intra observer reliability for Observer 1 was Kappa of 0.785, (p value < 0.001) 95% CI (0.62, 0.95) and the intra observer reliability for Observer 2 was Kappa of 0.857, (p value < 0.001) 95% CI (0.72, 0.99). The inter observer reliability for two observers was found to be good with Kappa of 0.610, (p value < 0.001) 95% CI (0.62, 0.95). Conclusion: The results showed that the nerve root sedimentation sign had high sensitivity and specificity for diagnosing LSS. For the intra rater reliability, both observers showed good reliability. This showed that this sign can be identified accurately and it gives reliable additional information in diagnosing LSS