Time Frame Analysis of Potassium Nitrate and Hydrogen Peroxide Diffusion into the Pulp Chamber

OBJECTIVES

The primary objective of this study was to evaluate the effect of an innovative double-layer, single-application desensitizing/whitening technique of potassium nitrate (PN) and hydrogen peroxide (HP) diffusion at different time points.

METHODS AND MATERIALS

Specimens were prepared from extracted caries-free human molars (n=90). Teeth were randomly assigned into four groups: Group A (HP CTRL) treated with 25% HP for 45 minutes, group B (PN CTRL) received a single-layer treatment of 5% PN for 45 minutes, group C received the double-layer treatment of 5% PN and 25% HP for 45 minutes, and group D received a 3% PN incorporated in a 40% HP gel for 45 minutes. PN and HP concentrations were measured at 5, 15, 30, and 45 minutes using standard chemical kits. Group comparisons were made using a repeated measures analysis of variance (ANOVA) test. Pairwise tests for differences in diffusion were done, using the Tukey adjustment of p values for multiple comparisons. A significance level of 5% was used.

RESULTS

Group A showed no significant difference in HP diffusion rates between the 5- and 15- minute, 15- and 30-minute, or 30- and 45-minute time points; group D showed a similar trend; however, group C differed significantly at the 5-and 15-minute time points (p=0.0004), at the 15-and 30-minute time points (p=0.0026), and the 30- and 45-minute time points (p=0.0014). For PN diffusion, groups B and C had significantly different levels at the 15-, 30-, and 45-minute time points (p=0.0005, p=0.0002, and p<0.0001, respectively); and at the 15-, 30-, and 45-minute time points, groups D and C had significantly different PN diffusion (p=0.0327, p=0.0004, and p< 0.0001, respectively). Group C had significantly different PN diffusion at the 5- and 15-minute time points (p=0.0004), the 15- and 30-minute time points (p=0.0026), and at the 30- and 45-minute time points (p=0.0014).

CONCLUSION

The double-layer technique showed superior diffusion of PN into the pulp chamber and did not affect the diffusion of HP when compared to other techniques. The double-layer technique may be suggested as an alternative tooth-whitening treatment to minimize tooth sensitivity.

Efficacy of Direct Restorative Materials in Proximal Box Elevation on the Margin Quality and Fracture Resistance of Molars Restored With CAD/CAM Onlays

PURPOSE

The purpose of this study was to investigate the effect of four direct restorative materials that can be used in the proximal box elevation (PBE) technique.

METHODS AND MATERIALS

Seventy-five molar teeth were randomly assigned to one of five groups (n=15): type II glass ionomer (GI), type II resin-modified glass ionomer (RMGI), resin-based composite (RBC), bulk-fill (BF) resin-based composite, and a control with no box elevation procedure. Specimens were prepared for a standard mesio-occlusal-distal, computer-aided design/computer-aided manufactured (CAD-CAM) resin, nanoceramic onlay with mesial cervical margins located 1 mm above the cementoenamel junction (CEJ) and distal cervical margins located 2 mm below the CEJ. PBE was used to elevate the distal margins to 1 mm above the CEJ in all groups except the control group. For the control group the onlay margin was placed directly on the prepared distal tooth structure without PBE. A Lava Ultimate CAD/CAM resin, nanoceramic onlay restorative was manufactured and bonded on all specimens with RelyX Ultimate adhesive resin cement. The quality of the tooth-PBE material and PBE material-onlay interface was evaluated with scanning electron microscopy using epoxy resin replicas before and after cyclic loading (100,000 cycles, 1.2 Hz at 65N and 37°C). In addition to margin quality, the fracture resistance of each group was measured using a universal testing machine. Fracture pattern was recorded by visual examination. The Levene test for homogeneity and the Welch analysis of variance were completed for fracture resistance and margin quality. A χ² test was completed for break mode.

RESULTS

For dentin margins, a statistically significant difference was detected between the RMGI and control groups at baseline (p=0.0442). All other groups-GI, RBC, and BF-showed no difference from the control at baseline (p>0.05). No statistical significance was observed among groups for post-cyclic fatigue (p=0.8735). For onlay margins, no statistical significance was observed among groups for pre-cyclic fatigue, post-cyclic fatigue, or change (p=0.9713, p=0.528, p=0.4385, respectively). No significant difference was observed for the fracture resistance among groups or for the type of break by material used (p=0.1593, p=0.77, respectively).

CONCLUSION

Within the parameters of this study, after mechanical fatigue, the materials used for PBE: RMGI, RBC, and BF, did not influence results in terms of margin quality and fracture resistance. Therefore, collective findings suggest that these materials might be suitable for PBE procedures. Nevertheless, clinical caution is recommended with any PBE procedure and further testing of GI materials is needed.

Relationship between number of proximal contacts and survival of root canal treated teeth

AIM

The present study tested the hypothesis that having two proximal contacts (PCs) at access is associated with improved survival of root canal treated (RCT) teeth, controlling for important presenting conditions, endodontic variables and restorative factors.

METHODOLOGY

A treatment database at the University of Iowa College of Dentistry was used to identify permanent teeth undergoing obturation between 1 July 1985 and 31 December 1987. The list was restricted to teeth of patients with at least one dental visit in each two-year interval from 1985 to 1996, and a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 221 teeth satisfying study inclusion criteria. Multivariate Cox models were developed, with standard errors adjusted to account for clustering of teeth within patients.

RESULTS

The final Cox model showed that teeth with < or =1 PC at access were lost at a rate three times that of teeth with 2 PCs (hazard ratio = 3.1; 95% confidence interval = 1.9-5.1), controlling for tooth type, presence of radiographic caries at access, and presence of a crown before or after obturation.

CONCLUSIONS

Because RCT teeth with two PCs at access experienced substantially better survival than teeth with fewer than two PCs, the influence of PCs on prognosis should be recognized during treatment planning. Future research should employ prospective study designs, capture additional variables, and provide data to support endodontic treatment decisions.

Acute toxicity during external-beam radiotherapy for localized prostate cancer: comparison of different techniques

PURPOSE

The chronic and acute toxicities associated with conventional radiotherapy of localized prostate cancer are well documented. However, the degree and incidence of toxicities with conformal techniques are not known. Studying side effects associated with modern radiotherapeutic techniques is more important now since there has been a general trend to use computerized tomography-based techniques in recent years; beam's eye view-based conformal techniques are also becoming more commonplace. It is possible that the local disease control can be improved with the delivery of higher doses than currently used. Conformation of the treatment volume to the target volume may facilitate such dose-escalation. However, prior to such dose-escalation, it is important to know the toxicities associated with such techniques with conventional doses.

METHODS AND MATERIALS

We have compared week-by-week acute toxicities associated with conventional (Group A, 16 patients), computerized tomography-based, manual (Group B, 57 patients) and beam's eye view-based (Group C, 43 patients) techniques during 7 weeks of radiotherapy. Group B and C patients were treated contemporaneously (1988-1990).

RESULTS

Acute side effects gradually increased from week 1 through weeks 4-5 and generally declined or plateaued after that. The incidence of acute toxicities was significantly less with the beam's eye view/based technique than with the other two methods. For instance, the percentages of Grade 2 acute genitourinary toxicities for Groups A, B, and C were as follows: Week 1-0, 0, 0; Week 2-6, 0, 0; Week 3-6, 9, 2; Week 4-12, 14, 9; Week 5-35, 14, 9; Week 6-31, 16, 7; Week 7-33, 8, 8, respectively. The p values associated with differences in acute genitourinary toxicities for Weeks 1-7 using chi-square test were 0.072, 0.627, 0.389, 0.538, 0.123, 0.06, and 0.012; the p values for acute gastrointestinal toxicities were 0.512, 0.09, 0.031, 0.031, 0.003, < 0.0001, and 0.004, respectively. Pairwise comparison (Wilcoxon rank-sum test) showed statistically significant lower acute toxicity in Group C than Group B (e.g., p values, Weeks 1-7 for gastrointestinal toxicity: 0.633, 0.056, 0.010, 0.014, < 0.0001, < 0.0001, and < 0.0001, respectively) in the latter part of the treatment course. No correlation was found between the extent of toxicity and the patient age or the overall treatment time. Also, no correlation was found between the degree of toxicity and the radiation dose and fraction size, within the narrow ranges used (65-70 Gy and 180-200 cGy, respectively). A trend suggesting increased severity of toxicity with increase in the volume of treatment was seen.

CONCLUSION

The findings in this retrospective study need to be confirmed by other prospective studies.