Prevalencija bakterija Enterococcus faecalis i Porphyromonas gingivalis u inficiranim kanalima korena zuba i njihova osetljivost na endodontsko lečenje - molekularna studija

Introduction Because apical periodontitis is recognizably an infectious disease, elimination or reduction of intracanal bacteria is of utmost importance for optimum treatment outcome. Objective The prevalence of Enterococcus faecalis and Porphyromonas gingivalis in infected root canals was studied Also, the effect of endodontic therapy by using intracanal medicaments, calcium hydroxide paste (CH) or gutta-percha points containing calcium hydroxide (CH-GP) or chlorhexidine (CHX-GP) on these microorganisms was assessed by polymerase chain reaction (PCR) assay. Methods Fifty-one patients with chronic apical periodontitis were randomly allocated in one of the following groups according to the intracanal medicament used: CH, CH-GP and CHX-GP group. Bacterial samples were taken upon access (S1), after chemomechanical instrumentation (S2) and after 15-day medication (S3). PCR assay was used to detect the presence of selected bacteria. Results E. faecalis was detected in 49% (25/51) and P. gingivalis in 17.6% (9/51) of the samples. Samples which showed no bacterial presence at S1 were excluded from further analysis. Overall analysis of all 29 samples revealed significant differences between S1 and S2 (p lt 0.001), S2 and S3 (p lt 0.05), and S1 and S3 (p lt 0.001). When distinction was made between the intracanal medications, there was a significant difference in the number of PCR positive samples between S1 and S2, S1 and S3, but not between S2 and S3 samples. Conclusion E. faecalis is more prevalent than P. gingivalis in primary endodontic infection. Intracanal medication in conduction with instrumentation and irrigation efficiently eliminates E. faecalis and P. gingivalis from infected root canals.Uvod Budući da je apeksni parodontitis oboljenje koje nastaje usled postojanja infekcije, za postizanje optimalnog ishoda lečenja najznačajnije je uklanjanje bakterija iz kanala korena zuba ili barem smanjenje njihovog broja. Cilj rada Cilj ovog rada je bio da se ispita prevalencija bakterija Enterococcus faecalis i Porphyromonas gingivalis u inficiranim kanalima korena zuba i ustanovi efekat endodontskog lečenja primenom intrakanalnih medikamenata - kalcijum-hidroksidne suspenzije (CH), gutaperka-poena na bazi kalcijum-hidroksida (CH-GP) ili gutaperka-poena na bazi hlorheksidina (CHX-GP) - na ove mikroorganizme metodom lančane reakcije polimerizacije (PCR). Metode rada Istraživanjem je obuhvaćena 51 osoba koja je imala zub s hroničnim apeksnim parodontitisom. Ispitanici su metodom slučajnog uzorka svrstani u tri grupe u zavisnosti od vrste primenjenog intrakanalnog medikamenta (CH, CH-GP i CHX-GP). Bakterijski uzorci iz kanala korena sakupljani su pri inicijalnom ulasku u kanal korena (S1), posle hemomehaničke obrade (S2) i posle petnaestodnevnog lečenja (S3). PCR analiza je korišćena za određivanje prisustva ispitivanih bakterija. Rezultati E. faecalis je izolovan iz 25 (49%) uzoraka, a P. gingivalis iz devet (17,6%). Uzorci u kojima nisu nađene bakterije u S1 fazi isključeni su iz dalje analize. Analiza svih 29 uzoraka je ukazala na statistički značajnu razliku između S1 i S2 uzoraka (p lt 0,001), S2 i S3 (p lt 0,05) i S1 i S3 (p lt 0,001). Kada se uzme u obzir vrsta intrakanalnog medikamenta, statistički značajna razlika u broju PCR-pozitivnih uzoraka zabeležena je između S1 i S2, S1 i S3, ali ne i između S2 i S3. Zaključak U primarnoj endodontskoj infekciji E. faecalis se češće javlja od P. gingivalis. Intrakanalna medikacija zajedno s instrumentacijom i irigacijom efikasno uklanja E. faecalis i P. gingivalis iz inficiranih kanala korena

Mogućnosti rekonstrukcije endodontski lečenih zuba s velikim oštećenjima krunice - dva prikaza iz prakse

The prognosis of endodontically treated teeth depends not only on the success of the endodontic treatment, but also on the type of reconstruction. The use of fiber-reinforced resin (FRR) posts to restore endodontically treated teeth has gained popularity due to its mechanical and esthetic characteristics as well as properties of modern adhesive systems. The aim of this article was to show a clinical technique to reconstruct endodontically treated teeth with great loss of tooth structure using direct fiber-reinforced post systems and direct composite restorations. The first case was a patient with the fractured right second lower premolar. The tooth was endodontically treated and reconstructed thereafter. After the preparation of the root canal and cementation of a FRR post, particular attention was paid to the incremental and curing techniques adopted to reconstruct coronal part of the tooth. The second case was a patient with the fractured first right lower incisor. This tooth was treated in the same way. Direct composite reconstruction of endodontically treated teeth is an alternative to the prosthodontic therapy and can postpone prosthodontic therapy for a long time.Prognoza endodontski lečenog zuba ne zavisi samo od uspešno izvedene endodontske terapije, već i od pravilne restauracije zuba i njegovog vraćanja u funkciju. Kompozitni kočići ojačani vlaknima poslednjih godina dobijaju na popularnosti u rekonstrukciji endodontski lečenih zuba zahvaljujući svojim estetskim i biomehaničkim osobinama, te mogućnosti ostvarivanja adhezivne veze za zub. Cilj ovog rada je da na primerima iz prakse ukaže na mogućnost konzervativne terapije endodontski lečenih zuba s velikim oštećenjima krunice primenom kompozitnih kanalnih kočića. Kod jedne pacijentkinje s frakturom donjeg desnog drugog premolara obavljeno je najpre endodontsko lečenje, a potom je urađena konzervativna restauracija. Posle preparacije prostora za kanalni kočić i njegovog cementiranja, krunični deo zuba je restauriran direktnim kompozitnim ispunom slojevitom tehnikom. Na isti način je lečen i donji desni centralni sekutić druge pacijentkinje. Restauracija devitalizovanih zuba s opsežnim lezijama konzervativnim lečenjem je dobra alternativa protetičkoj restauraciji, koja protetički tretman može odložiti za duži vremenski period

Klinička ispitivanja restauracija cervikalnih nekarijesnih lezija

The therapy of non-caries cervical lesions is an important problem in restorative dentistry, for the ambiguous aetiology, clinical diagnoses and for the selection of restorative procedure. Aim: The aim of this work was to clinically check the efficiency of non-caries cervical lesions restoration depending on materials used for restorative fillings. Materials and methods: Clinical researches covered 62 teeth of different morphology group at the patients of both gender and of different age. The restoration of gingival lesions, with no previous preparation, was done with composite adhesive system SINGLE BOND/Valux Plus (3M) (30 teeth) and with campomer DYRACT AO (Dentsplay) (32 teeth). The fillings were estimated on the checkups which took place on 3,6 and12 months applying modified criteria according to Ridge and Cvar. Results: The acquired results showed that after 3 to 6 months there were no changes at none of examined parameters and all the fillings got maximal mark A. 12 months latter, in the two cases with composite filling, the marginal adaptation got the mark B (607%). The marginal adaptation at two teeth restored with compomers got the mark B (6.3%) Postoperative sensitiveness phenomenon, marginal discoloration and secondary caries weren’t registered in none of the cases after the observation period of 12 months. Conclusion: For the restoration of non-caries cervical lesions, composite materials with suitable adhesive system and the new generation of compomers could be used.Terapija nekarijesnih cervikalnih lezija je značajan problem u restaurativnoj stomatologiji, zbog nejasne etiologije, kliničke dijagnoze ali i izbora restaurativne procedure. Cilj: Cilj ovog rada je bio da se klinički proveri efikasnost restauracija nekarijesnih cervikalnih lezija zuba u zavisnosti od korišćenih materijala za restaurativne ispune. Materijal i metod: Klinička ispitivanja su obuhvatila 62 zuba različitih morfoloških grupa kod pacijenata oba pola i različite starosti. Restauracija gingivalnih lezija, bez prethodne preparacije, urađena je kompozitnim adhezivnim sistemom SINGLE BOND/Valux Plus (3M) (30 zuba) i kompomerom DYRACT AP (Dentsplay) (32 zuba). Ispuni su procenjivani na kontrolnim pregledima posle 3, 6 i 12 meseci primenom modifikovanih kriterijuma po Ridge-u i Cvar-u. Rezultati: Dobijeni rezultati su pokazali da posle 3 i 6 meseci nije bilo promena na ispunima ni kod jednog ispitivanog parametra i svi ispuni su ocenjeni maksimalnom ocenom A. Posle 12 meseci, u dva slučaja ispunjenih kompozitima, ivična adaptacija je ocenjena ocenom B (6,7%). Ivična adaptacija je i u dva zuba restaurisanih kompomerima ocenjena ocenom B (6,3%). Pojava postoperativne osetljivosti, ivične diskoloracije i sekundarnog karijesa nije registovana ni u jednom slučaju posle observacionog perioda od 12 meseci. Zaključak: Za restauraciju nekarijesnih cervikalnih lezija mogu se koristiti kompozitni materijali sa odgovarajućim adhezivnim sistemima i novije generacije kompomera

Tissue Dissolution by Sodium Hypochlorite: Effect of Concentration, Temperature, Agitation, and Surfactant

Aim: Sodium hypochlorite is the most commonly used endodontic irrigant because of its antimicrobial and tissue-dissolving activity. The aim of this study was to evaluate and compare the effects of concentration, temperature, and agitation on the tissue-dissolving ability of sodium hypochlorite. In addition, a hypochlorite product with added surface active agent was compared with conventional hypochlorite solutions. Methods: Three sodium hypochlorite solutions from two different manufacturers in concentrations of 1%, 2%, 4%, and 5.8% were tested at room temperature, 37 degrees C, and 45 degrees C with and without agitation by ultrasonic and sonic energy and pipetting. Distilled and sterilized tap water was used as controls. Pieces of bovine muscle tissue (68 +/- 3 mg) were placed in 10 mL of each solution for five minutes. In selected samples, agitation was performed for one, two, or four 15-second periods per each minute. The tissue specimens were weighed before and after treatment, and the percentage of weight loss was calculated. The contact angle on dentin of the three solutions at concentrations of 1% and 5.8% was measured. Results: Weight loss (dissolution) of the tissue increased almost linearly with the concentration of sodium hypochlorite. Higher temperatures and agitation considerably enhanced the efficacy of sodium hypochlorite. The effect of agitation on tissue dissolution was greater than that of temperature; continuous agitation resulted in the fastest tissue dissolution. Hypochlorite with added surface active agent had the lowest contact angle on dentin and was most effective in tissue dissolution in all experimental situations. Conclusions: Optimizing the concentration, temperature, flow, and surface tension can improve the tissue-dissolving effectiveness of hypochlorite even 50-fold. (J Endod 2010;36:1558-1562

Temporal analysis of the spontaneous baroreceptor reflex during mild emotional stress in the rat

The effect of emotional stress on the spontaneous baroreceptor reflex (sBRR) in freely moving rats was investigated. Six male Wistar rats equipped with an intra-arterial polyethylene catheter were exposed to a 2-min air-jet stress. For time course analysis of the sBRR response to stress, the records of systolic blood pressure (SBP) and pulse interval (PI) were divided into five regions: baseline (BASELINE), acute exposure to air-jet stress (STRESS), immediate recovery (IMMED. RECOVERY), remaining recovery (RECOVERY), and delayed response (DELAYED RESPONSE). In addition to sBRR sensitivity and effectiveness, we introduce the sequence coverage area and its median for evaluation of the sBRR operating range and set point. During exposure to STRESS and IMMED. RECOVERY, sBRR sensitivity was preserved, its effectiveness was decreased, its operating range was enlarged, and the set point was shifted towards higher SBP and lower PI values. According to the joint symbolic dynamics analysis, the SBP and PI relationship became less predictable hence more prone to respond to stress. In RECOVERY the parameters regained baseline values and DELAYED RESPONSE occurred during which re-setting of sBRR was noted. It follows that emotional stress modulates sBRR differentially during the time course of stress and recovery, affecting both linearity and unpredictability of the BP and PI relationship. © 2010 Informa Healthcare USA, Inc