Transient bacteremia after removal of a bonded maxillary expansion appliance

Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis-Part 2

This article explores the various challenges systemic conditions can pose before and during orthodontic treatment. Cardiovascular conditions like infective endocarditis require antibiotic prophylaxis before certain orthodontic procedures are started. Patients with bleeding disorders require special considerations in regards to viral infection risk and maintenance of excellent atraumatic oral hygiene. Orthodontists play an important role in early identification of signs and symptoms of eating disorders and should deal with these patients sensitively. Congenital disorders, craniofacial anomalies, and nutritional deficiencies require special considerations and should be addressed appropriately before orthodontic treatment is started.

Transient bacteremia following the removal of four different types of rapid palatal expanders

PURPOSE

General health related recommendations for prophylactic measures in connection with orthodontic treatments are limited due to the lack of evidence-based data. This study aimed to investigate the development of transient bacteremia following the removal of four types of rapid palatal expanders (RPE).

METHODS

Seventy-five individuals aged 10-18 years undergoing rapid palatal expansion with four types of RPE were categorized according to the type of RPE used in their treatment: banded tooth-borne (group A (1), n = 17), banded tooth- and tissue-borne (group A (2), n = 17), bonded tooth-borne (group B (1), n = 18), and bonded tooth- and tissue-borne (group B (2), n = 23). Gingival inflammation was assessed using the gingival index one day before RPE removal. Furthermore, samples of blood (5 ml each) were collected before and 3 min after RPE removal. The groups were statistically evaluated for comparability with respect to sex, age, or wear time of the RPE and to the gingival index. In addition, the prevalence of bacteremia in the different groups was evaluated and statistically compared.

RESULTS

No significant difference was found among the groups (p > 0.05) for sex, age, and RPE wear time. Mean gingival index was higher in group B (2) than in group A (1) (p < 0.05). The prevalence of bacteremia did not differ significantly between groups. Streptococcus species were identified in all bacteremia cases. The bacteremia prevalence of the groups was as follows: group A (1), 11.8%; group A (2), 23.5%; group B (1), 16.7%; and group B (2), 30.4%.

CONCLUSION

This investigation demonstrated that removal of a RPE could cause bacteremia, but the RPE design did not affect the prevalence of bacteremia. The results of this study support the necessity of prophylaxis measures before RPE removal in indicated patients.

Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study

OBJECTIVE

This study aimed to evaluate the volume, amount, and localization of root resorption in the maxillary first premolars using micro-computed tomography (micro-CT) after expansion with four different rapid maxillary expansion (RME) appliances.

METHODS

In total, 20 patients who required RME and extraction of the maxillary first premolars were recruited for this study. The patients were divided into four groups according to the appliance used: miniimplant- supported hybrid RME appliance, hyrax RME appliance, acrylic-bonded RME appliance, and full-coverage RME appliance. The same activation protocol (one activation daily) was implemented in all groups. For each group, the left and right maxillary first premolars were scanned using micro-CT, and each root were divided into six regions. Resorption craters in the six regions were analyzed using special CTAn software for direct volumetric measurements. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test with Bonferroni adjustment.

RESULTS

The hybrid expansion appliance resulted in the lowest volume of root resorption and the smallest number of craters (p < 0.001). In terms of overall root resorption, no significant difference was found among the other groups (p > 0.05). Resorption was greater on the buccal surface than on the lingual surface in all groups except the hybrid appliance group (p < 0.05).

CONCLUSIONS

The findings of this study suggest that all expansion appliances cause root resorption, with resorption craters generally concentrated on the buccal surface. However, the mini-implant-supported hybrid RME appliance causes lesser root resorption than do other conventional appliances.

Juvenile/Adolescent Idiopatic Scoliosis and Rapid Palatal Expansion. A Pilot Study

The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2–0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE; Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle (p ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle (p = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.

Diagnosis and management of sternoclavicular joint infections: a literature review

The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.

[Oral diseases structure in patients with diffuse liver lesions before and after transplantation]

Purpose of the study was to identify dental risk factors for complications at the stage of rehabilitation adaptation in patients with diffuse liver lesions. The study included 52 patients with diffuse liver lesions aged 25-55 years, who were divided between two groups of 26 persons with different dental status, depending on the main disease stage of treatment.

RESEARCH METHODS

Clinical, x-ray, morphological, analytical, statistical.

RESULTS

It has been reliably established that low level of oral hygiene, high intensity and prevalence of caries and its complications (foci of odontogenic infection), inflammatory periodontal diseases joined with severe teeth hyperesthesia, dominate in patients before liver transplantation, which confirms low level of sanitation on stages of preparation for surgical treatment. Chronic odontogenic infection in periodontal tissues with phenomena of epithelial cells dystrophy, candidiasis of the oral mucosa, foci of odontogenic infection, low level of oral hygine, tendency to precancerous diseases development are the risk factors for complications arise on the stage of rehabilitation adaptation in patients with diffuse liver lesions.

CONCLUSION

The revealed relationship between diffuse liver lesions and dental status of patients, at the stages of preparation and after liver transplantation indicates, that a low level of oral cavity sanitation, the presence of odontogenic infection and periodontal disease worsen the course of the main disease, increase the risk of transplant rejection and require the creation of a dental rehabilitation system for this category of patients.

A complicated cockroach-ectomy

The exact incidence of foreign body aspiration among adults is unknown, and its clinical presentation is vastly divergent. We report the previously undescribed occurrence of cockroach aspiration in an adult, presenting with a “crawling sensation” in his chest. Flexible endobronchial examination revealed a foreign body impacted in the lingula, resembling the Australian cockroach Periplaneta australasiae. Partial extraction via biopsy forceps was performed and complicated by acute hypoxia on disimpaction, requiring a brief period of bag/mask ventilation. Following the offset of procedural sedation, the remaining foreign body was manually expectorated. A total of 24 h post‐procedure, the patient was febrile with positive blood cultures (Micrococcus luteus). We highlight the importance of definitive airway support during endobronchial interventions and raise the question regarding the significance of transient bacteraemia following bronchoscopic manipulation.

Investigation of bacteremia after debonding procedures

OBJECTIVE

The purpose of this study is to investigate the effect of debonding procedures after completion of orthodontic treatments on bacteremia.

MATERIALS AND METHODS

Twenty-eight patients who were treated with fixed orthodontic treatment at the Faculty of Dentistry's Department of Orthodontics at Gaziantep University and who had an indication of debonding were selected for this study, and blood samples were taken from these patients at different times and examined for bacteremia. Blood culture samples were taken from the antecubital veins of the patients prior to debonding (T₀), immediately after removing the bracket (T₁), and immediately after cleaning the composite residues and plaque deposits on the enamel surface (T₂). The blood samples were then inoculated in blood culture bottles and investigated for bacterial growth.

RESULTS

The results showed that there was no bacterial growth in the blood samples taken at T₀ and T₁, whereas 10 of the blood culture samples taken at T₂ showed bacterial growth including the following bacteria; Streptococcus viridans, Streptococcus mitis, Streptococcus parasanguinis, Streptococcus salivarius, Streptococcus oralis, Staphylococcus aureus, Actinomyces oris, Actinomyces naeslundii and Klebsiella pneumoniae.

CONCLUSION

It was concluded that patients in the risk group could develop bacteremia during debonding procedures. The presence of these bacteria in sterile blood suggested the possibility of bacterial endocarditis.

Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature

Patient: Male, 62

Final Diagnosis: Sternoclavicular osteomyelitis

Symptoms: —

Medication: —

Clinical Procedure: Debridement

Specialty: Infectious Diseases

An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients

Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.

Bacteremia after piezocision

INTRODUCTION

The aim of this study was to investigate the presence of transient bacteremia after a piezocision procedure.

METHODS

The sample consisted of 30 subjects (24 women, 6 men; mean age, 19.6 ± 0.7 years; range, 18.1-22.4 years) with the American Society of Anesthesiologists' physical status I. All patients had Class I skeletal and dental relationships and had fixed orthodontic treatment with the Damon system. The piezocision surgery was performed 1 week after the placement of the orthodontic appliances in all patients. Two 20-mL venous blood samples were collected before and 30 to 60 seconds after the first microincision using an aseptic technique. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were assessed in the BACTEC blood culture analyzer (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md). The results were analyzed statistically using the McNemar test, with P <0.05 indicating statistical significance.

RESULTS

No significant difference between the preoperative and postoperative samples was determined with respect to transient bacteremia (P = 0.250). No bacteremia was detected in the pretreatment samples, although Gemella sanguinis, Streptococcus pluranimalium, and Streptococcus mitis/oralis were detected in 3 postoperative blood samples.

CONCLUSIONS

The piezocision procedure might be related to transitory bacteremia. Hence, orthodontists should consider the possibility of bacterial endocarditis in at-risk patients when piezocision is part of the treatment plan.

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures

The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.

Interceptive therapy for maxillary constriction: a cast-metal-type splint expander

A new cast-metal-type splint expander was used to treat severe maxillary constriction. This new appliance has the same advantages of a rapid expander on acrylic splints, compared to a Haas or to a banded expander. Furthermore, it is characterized by greater respect for the gingival tissue, both during the therapy and immediately after the removal of the expander. It is also more comfortable for the patient, so that it is possible to maintain the expander in the mouth for several months without gingival suffering. This appliance is very versatile and well indicated for permanent, mixed and deciduous dentitions.

Molecular detection of in-vivo microbial contamination of metallic orthodontic brackets by checkerboard DNA-DNA hybridization

INTRODUCTION

Knowing the microbiota that colonizes orthodontic appliances is important for planning strategies and implementing specific preventive measures during treatment. The purpose of this clinical trial was to evaluate in vivo the contamination of metallic orthodontic brackets with 40 DNA probes for different bacterial species by using the checkerboard DNA-DNA hybridization (CDDH) technique.

METHODS

Eighteen patients, 11 to 29 years of age having fixed orthodontic treatment, were enrolled in the study. Each subject had 2 new metallic brackets bonded to different premolars in a randomized manner. After 30 days, the brackets were removed and processed for analysis by CDDH. Data on bacterial contamination were analyzed descriptively and with the Kruskal-Wallis and Dunn post tests (α = 0.05). Forty microbial species (cariogenic microorganisms, bacteria of the purple, yellow, green, orange complexes, "red complex +Treponema socranskii," and the cluster of Actinomyces) were assessed.

RESULTS

Most bacterial species were present in all subjects, except for Streptococcus constellatus, Campylobacter rectus, Tannerella forsythia, T socranskii, and Lactobacillus acidophillus (94.4%), Propionibacterium acnes I and Eubacterium nodatum (88.9%), and Treponema denticola (77.8%). Among the cariogenic microorganisms, Streptococcus mutans and Streptococcus sobrinus were found in larger numbers than L acidophillus and Lactobacillus casei (P <0.001). The periodontal pathogens of the orange complex were detected in larger numbers than those of the "red complex +T socranskii" (P <0.0001). Among the bacteria not associated with specific pathologies, Veillonella parvula (purple complex) was the most frequently detected strain (P <0.0001). The numbers of yellow and green complex bacteria and the cluster of Actinomyces were similar (P >0.05).

CONCLUSIONS

Metallic brackets in use for 1 month were multi-colonized by several bacterial species, including cariogenic microorganisms and periodontal pathogens, reinforcing the need for meticulous oral hygiene and additional preventive measures to maintain oral health in orthodontic patients.

Bacteremia following dental implant surgery: preliminary results

OBJECTIVES

The aims of this study were to investigate the incidence of bacteremia, bacteriology and antibiotic susceptibility against to causative bacteria associated with dental implant installation.

STUDY DESIGN

30 generally healthy patients were enrolled in this study. Blood samples were collected at baseline and at 30 minutes after dental implant installation and 24 hours after dental implant surgery. Blood samples were cultured in a BACTEC system. The isolated bacteria were identified using conventional methods. Antimicrobial sensitivity tests were performed by disc diffusion.

RESULTS

No bacteria were isolated at the baseline and 24 hours after surgery, whereas the prevalence of bacteremia at 30 minutes after dental implant installation was 23%. The isolated bacteria species were Staphylococcus epidermidis, Eubacterium spp., Corynebacterium spp. and Streptococcus viridans. The Staphylococcus epidermidis, which was isolated in three patients, was found to be resistant to penicillin which is first choice of many clinicians.

CONCLUSION

Our findings suggest that installation of dental implants can produce bacteremia. Within the limitations of this study, it can be speculated that the resistance of antibiotics may compromise the routine prophylaxis against infective endocarditis. Therefore use of blood cultures and antibiograms may be suggested in risky patients. The outcome of the present study should be verified using a larger patient group with varying conditions.