Immediate Surgical Repositioning Following Intrusive Luxation: A Case Report and Review of the Literature

This report presents a case of severe intrusive luxation of mature maxillary lateral incisor in a 10-year-old boy. The intruded tooth was immediately repositioned (surgical extrusion) and splinted within 2 h following injury. Tetracycline therapy was initiated at the time of repositioning and maintained for 10 days. Pulp removal and calcium hydroxide treatment of the root canal was carried out after repositioning. Splint was removed 1 month later. Definitive root canal treatment with gutta percha was accomplished at the second month recall. Clinical and radiographic examination 28 months after the surgical extrusion revealed satisfactory apical and periodontal healing

An evaluation of the effect of non-setting calcium hydroxide on human dentine: a pilot study.

AIM: To evaluate the effect of non-setting calcium hydroxide (NSCH) on the hardness and elastic modulus of dentine from extracted permanent premolar human teeth. METHODS: 30 freshly extracted single rooted human premolar teeth were decoronated and the roots then sectioned longitudinally into equal halves. In the experimental group a thin layer of NSCH was applied whilst the control group had no medicament. After 1, 3 and 6 months, nanoindentation was used to assess dentine hardness and the modulus of elasticity. Scanning Electron Microscopy (SEM) was used to visualize the depth of penetration of NSCH into the dentinal tubules. RESULTS: SEM images showed that there were no structural changes in the dentine slabs that had NSCH application after 1, 3 or even 6 months. However, penetration of NSCH into the dentine tubules was seen at both 3 and 6 months with a significant reduction in the hardness of dentine observed at 3 (p<0.02) and 6 months (p<0.01). The modulus of elasticity was significantly lower (p<0.01) at 6 months. CONCLUSION: It appears that there is a significant reduction in the hardness of dentine with increasing periods of calcium hydroxide application. Prolonged application of NSCH could have a detrimental effect on dentine, making the dentine more prone to fracture

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty

Intrathecal (IT) morphine provides excellent postoperative analgesia but may result in many side effects, including postoperative nausea and vomiting, pruritus, and respiratory depression, particularly at larger doses. Older patients may be at particular risk. The optimal dose of spinal morphine in older patients undergoing hip arthroplasty is not known. We designed this prospective, randomized, controlled, double-blinded study to evaluate the analgesic efficacy and side effect profile of 50-200 mug of IT morphine in older patients undergoing elective hip arthroplasty. Sixty patients older than 65 years undergoing elective hip arthroplasty were enrolled. Patients were randomized to receive spinal anesthesia with 15 mg of bupivacaine and IT morphine in four groups: 1) 0 mug, 2) 50 mug, 3) 100 mug, and 4) 200 mug. IT morphine 100 and 200 mug produced effective pain relief and decreased the postoperative requirement for morphine compared with control. IT morphine 50 mug did not provide effective pain relief. Both 100 and 200 mug of IT morphine provided comparable levels of postoperative analgesia. There were no between-group differences in postoperative nausea and vomiting, sedation, respiratory depression, or urinary retention. Pruritus was significantly more frequent with 200 mug of IT morphine. In conclusion, 100 jig of IT morphine provided the best balance between analgesic efficacy and side effect profile in older patients undergoing hip arthroplasty