Regenerative Endodontic Technique using a combination of Amoxicillin and Metronidazole. A review and report of two cases

The management of non vital anterior permanent teeth in children is a challenge for the clinicians. Once the tooth becomes non vital, the root development ceases, which renders the tooth weak and unable to withstand the physiological forces of mastication. This results in a high fracture rate, and therefore a poor prognosis in the medium to long term. Recently there has been a paradigm shift in the approach to this clinical problem through the use of regenerative endodontics. Despite many case reports, and a few case series that have been reported, the procedure is still shrouded in uncertainty as differing interventions have been used, though broadly based on similar principles. In the Department of Paediatric Dentistry at the Leeds Dental Institute we have used a particular regenerative endodontic technique (RET), using a mixture of two antibiotics (Amoxicillin and Metronidazole). In this paper, we aim to present the rationale for this technique and present two cases successfully treated and followed for up to two years

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Regenerative endodontischeTechnik unter Verwendung einer Kombination aus Amoxicillin und Metronidazol = Regenerative endodontic technique using a combination of amoxicillin and metronidazole

Die Behandlung von devitalen bleibenden Frontzähnen bei Kindern ist eine klinische Herausforderung. Sobald der Zahn devital wird, setzt die weitere Entwicklung der Wurzeln aus. Dies schwächt den Zahn, so dass er den physiologischen Kräften beim Kauvorgang nicht mehr standhalten kann. Aufgrund der resultierenden hohen Frakturhäufigkeit ergibt sich eine mittel- bis langfristig ungünstige Prognose. Seit einiger Zeit gibt es jedoch einen Paradigmenwechsel beim Herangehen an dieses klinische Problem, und zwar durch den Einsatz der regenerativen Endodontie. Trotz vieler Fallberichte und einiger veröffentlichter Fallserien ist dieses Verfahren noch recht undefiniert, da es unterschiedliche - wenn auch im Großen und Ganzen auf ähnlichen Prinzipien beruhende - Vorgehensweisen gibt. Die Abteilung für Kinderzahnheilkunde am Leeds Dental Institute verwendet eine besondere regenerative endodontische Technik, bei der eine Mischung von zwei Antibiotika (Amoxicillin und Metronidazol) eingesetzt wird. In dem Beitrag soll diese Technik erläutert und anhand von zwei erfolgreich behandelten sowie 2 Jahre lang nachverfolgten Patientenfällen vorgestellt werden. Treatment of permanent permanent anterior teeth in children is a clinical challenge. As soon as the tooth becomes devitalized, the further development of the roots ceases. This weakens the tooth so that it can no longer withstand the physiological forces during the chewing process. Due to the resulting high fracture frequency, the prognosis is unfavorable in the medium to long term. For some time now, however, there has been a paradigm shift in addressing this clinical problem through the use of regenerative endodontics. Despite many case reports and some published case series, this procedure is still rather undefined because there are different approaches, albeit largely based on similar principles. The Pediatric Dentistry Department at Leeds Dental Institute uses a special regenerative endodontic technique that uses a mixture of two antibiotics (amoxicillin and metronidazole). This article is intended to explain this technique and present it on the basis of two successfully treated patient cases and two patient cases followed up for two years