Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted (Review)

Background: Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010. Objectives: To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: We considered randomised and quasi‐randomised controlled trials that included a minimum follow‐up period of 12 months, for interventions for avulsed and replanted permanent front teeth. Data collection and analysis: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required. Main results: Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review. One study at high risk of bias with 69 participants (138 teeth) compared a 20‐minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing. One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth. A third study at high risk of bias with 19 participants compared extra‐ or intra‐oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing. The fourth study at high risk of bias with 73 participants compared a 10‐minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival. Authors' conclusions: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well‐designed randomised controlled trials

Ferric sulphate and formocresol pulpotomies in baboon primary molars: histological responses

Aim: To compare pulpal reactions to ferric sulphate and formocresol pulpotomies in primary molar teeth with inflamed pulps. Study design: An experimental study in 15 juvenile baboons (Papio ursinus). Materials and methods: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 57 primary molars; after 14 days a pulpotomy was performed on the same primary molars with the two pulp medicaments randomly allocated; the pulp was covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. Results: Reaction frequencies in the ferric sulphate-treated and formocresol-treated teeth were: recognisable pulp 52% and 50%, dentine bridges 16% and 12%, internal root resorption 12% and 4%, external resorption 28% and 31%, bacteria 12% and 23%, peri-apical abscesses 32% and 38%. Statistics: Fisher’s exact probability test showed no statistically significant differences between reaction frequencies in the two treatment groups. Conclusion: A pulpotomy in a primary tooth may be clinically successful in the presence of adverse histological reactions.TS2016.http://www.ejpd.eu/bibliografia_elenco.asp?data_da=01/01/2002&data_a=31/12/200

Pulpitis induction in baboon primary teeth using carious dentine Streptococcus mutans

KIMThe objective of this equivalency study was to see if a colony of Streptococcus mutans placed into cavities in primary molar teeth produced pulpitis similar to an established pulpitis induction method using carious dentine. In two juvenile baboons (Papio ursinus), occlusal cavities were cut in all 16 primary molar teeth, followed by making a small pulpal exposure after which the cavity was swabbed with 37 per cent phosphoric acid. In one half of the teeth, fresh soft human carious dentine was placed over the pulpal exposure; in the remaining teeth the exposure was covered with a colony of Streptococcus mutans in agar. All the cavities were restored with unlined light-cured composite resin. After 14 days specimens were harvested and examined under the light microscope with the examiner blind to the induction method. In both groups of teeth there was recognisable pulp, hyperaemia, micro-abscesses in the pulp and peri-apical abscesses. Reactions to soft caries were more severe than to Streptococcus mutans. The results show that Streptococcus mutans placed in a cavity with an exposure produces comparable pulpitis to fresh soft human carious dentine in the same type of cavity and that both methods produce pulpitis suitable for testing pulpotomy or pulpectomy treatments

Zinc oxide-eugenol and calcium hydroxide pulpectomies in baboon primary molars: histological responses

AIM: To compare histological responses to zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pulpectomies in primary molar teeth with inflamed pulps. STUDY DESIGN:This was an experimental study in 17 juvenile baboons (Papio ursinus). METHODS: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 78 primary molars; after 14 days a pulpectomy was performed on the same primary molars with the two root fillings randomly allocated. The root canal openings were then covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. RESULTS:Reaction frequencies in the ZOE-treated versus CH-treated teeth were: no recognisable pulp 89% and 82%, internal root resorption 0% and 1%, external root resorption 11% and 24%, presence of bacteria 5% and 18%, periapical abscesses 24% and 52%. STATISTICS:Fisher's exact probability test showed a statistically significant higher prevalence of periapical abscesses in the CH-treated group (P=0.03, relative risk 2.2). CONCLUSIONS: ZOE pulpectomy is preferred to CH for the treatment of infected pulps in primary molarsKIMhttp://www.ejpd.eu

Low-temperature, in-bin drying : Shelled corn in southwest, central, and north Missouri

"This guide sheet tells how to manage low-temperature in-bin drying of shelled corn."--First page.Robert M. George, Donald Brooker, Anil Duggal, and Neil F. Meador (Department of Agricultural Engineering, College of Agriculture)New 6/84/10

Conformal Ricci collineations of static spherically symmetric spacetimes

Conformal Ricci collineations of static spherically symmetric spacetimes are studied. The general form of the vector fields generating conformal Ricci collineations is found when the Ricci tensor is non-degenerate, in which case the number of independent conformal Ricci collineations is \emph{fifteen}; the maximum number for 4-dimensional manifolds. In the degenerate case it is found that the static spherically symmetric spacetimes always have an infinite number of conformal Ricci collineations. Some examples are provided which admit non-trivial conformal Ricci collineations, and perfect fluid source of the matter

Development of depressive symptoms post hip fracture is associated with altered immunosuppressive phenotype in regulatory T and B lymphocytes

Hip fracture is a common physical trauma in older adults that is also associated with a high incidence of new onset depression. The immune system declines with age and is also compromised by physical and psychological stress. This study examined whether hip fracture and depressive symptoms had additive effects upon the aged immune system that might contribute to poor health outcomes after hip fracture. We assessed the frequency of regulatory T cells, Tregs (CD4+ CD25+ Foxp3+) and IL10 production by CD4 T cells, and the frequency and IL10 production by regulatory B cells, Bregs (CD19+ CD24hi CD38hi) in 101 hip fracture patients (81 female) 6 weeks after injury and 43 healthy age-matched controls (28 female). 38 hip fracture patients (37 %) developed depressive symptoms. Hip fracture did not have an effect on circulating Tregs frequency but a significant reduction in the frequency of Bregs was observed in patients who developed depression compared with non-depressed patients (p = 0.001) or healthy controls (p < 0.001). Bregs also showed a significant decline in IL10 production in depressed hip fracture patients compared with controls (p = 0.04) and non-depressed patients (p = 0.01). In contrast, there was an increase in IL10 production by CD4 T cells in hip fracture patients with new onset depression compared to hip fracture patients without depression (p = .04) and healthy controls (p = .02). We conclude that the reduced immunity associated with new onset depression post hip fracture could include a contribution by heightened Tregs function

Competing mechanisms and scaling laws for carbon nanotube scission by ultrasonication

Dispersion of carbon nanotubes (CNTs) into liquids typically requires ultrasonication to exfoliate individuals CNTs from bundles. Experiments show that CNT length drops with sonication time (or energy) as a power law t?m. Yet the breakage mechanism is not well understood, and the experimentally reported power law exponent m ranges from approximately 0.2 to 0.5. Here we simulate the motion of CNTs around cavitating bubbles by coupling Brownian dynamics with the Rayleigh-Plesset equation. We observe that, during bubble growth, CNTs align tangentially to the bubble surface. Surprisingly, we find two dynamical regimes during the collapse: shorter CNTs align radially, longer ones buckle.We compute the phase diagram for CNT collapse dynamics as a function of CNT length, stiffness, and initial distance from the bubble nuclei and determine the transition from aligning to buckling. We conclude that, depending on their length, CNTs can break due to either buckling or stretching. These two mechanisms yield different power laws for the length decay (0.25 and 0.5, respectively), reconciling the apparent discrepancy in the experimental data

Establishing an adjusted p-value threshold to control the family-wide type 1 error in genome wide association studies

<p>Abstract</p> <p>Background</p> <p>By assaying hundreds of thousands of single nucleotide polymorphisms, genome wide association studies (GWAS) allow for a powerful, unbiased review of the entire genome to localize common genetic variants that influence health and disease. Although it is widely recognized that some correction for multiple testing is necessary, in order to control the family-wide Type 1 Error in genetic association studies, it is not clear which method to utilize. One simple approach is to perform a Bonferroni correction using all <it>n single nucleotide polymorphisms (</it>SNPs) across the genome; however this approach is highly conservative and would "overcorrect" for SNPs that are not truly independent. Many SNPs fall within regions of strong linkage disequilibrium (LD) ("blocks") and should not be considered "independent".</p> <p>Results</p> <p>We proposed to approximate the number of "independent" SNPs by counting 1 SNP per LD block, plus all SNPs outside of blocks (interblock SNPs). We examined the <it>effective </it>number of independent SNPs for Genome Wide Association Study (GWAS) panels. In the CEPH Utah (CEU) population, by considering the interdependence of SNPs, we could reduce the total number of effective tests within the Affymetrix and Illumina SNP panels from 500,000 and 317,000 to 67,000 and 82,000 "independent" SNPs, respectively. For the Affymetrix 500 K and Illumina 317 K GWAS SNP panels we recommend using 10^-5, 10^-7and 10^-8and for the Phase II HapMap CEPH Utah and Yoruba populations we recommend using 10^-6, 10^-7and 10^-9as "suggestive", "significant" and "highly significant" p-value thresholds to properly control the family-wide Type 1 error.</p> <p>Conclusion</p> <p>By approximating the effective number of independent SNPs across the genome we are able to 'correct' for a more accurate number of tests and therefore develop 'LD adjusted' Bonferroni corrected p-value thresholds that account for the interdepdendence of SNPs on well-utilized commercially available SNP "chips". These thresholds will serve as guides to researchers trying to decide which regions of the genome should be studied further.</p