Biomedical subjects
Publications and source records attributed to R A Reinhardt.
Restorative treatments for canines were discussed to correct three clinical abnormalities: (1) fully erupted permanent canine in the lateral incisor position, (2) missing permanent canines, and (3) partially exposed canines in normal arch position. The primary concerns are the development of esthetics, anterior guidance, and adequate support for fixed restorations.
The complete removal of accretions during closed scaling and root planing in moderate-deep pockets is difficult, presumably due to inadequate mechanical and visual access. The purpose of this study was to evaluate the effect of minimal papilla reflection and illumination with a prototype fiber optic unit on root planing efficiency. Nonmolar teeth with moderate-deep interproximal pockets (greater than 3 mm) in four patients scheduled to receive immediate complete dentures were randomly divided into groups for treatment: Group I--interproximal root planing augmented by papilla reflection and fiber optic illumination (n = 26 surfaces); Group II--interproximal root planing with papilla reflection only (n = 24); Group III--untreated controls (n = 23). Immediately after treatment, the experimental teeth were extracted, stained with toluidine blue and interproximal areas were evaluated for remaining accretions with a microscope-digitizing pad-computer system. Significantly less (P less than 0.01) root surface was covered by deposits in Group I than Group II (0.57 +/- 0.29% vs. 2.42 +/- 0.63%), and both treatment groups had fewer (P less than 0.0005) accretions than untreated controls (57.72 +/- 3.40%). These results suggest that root planing with papilla reflection produces an interproximal surface with few remaining deposits, and fiber optic illumination and transillumination further enhance this effect.
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Long acting local anesthetics have been used successfully during third molar extractions and endodontic procedures. They were shown to provide longer duration of anesthesia and contribute to less postoperative pain. This study evaluated the effectiveness of one long acting local anesthetic agent (etidocaine) for periodontal flap procedures. A double-blind, split mouth design treated 17 matched contralateral pairs of posterior sextants. One region was treated following administration of 1.5% etidocaine HCl with 1:200,000 epinephrine. The matched control region was treated following administration of 2% lidocaine with 1:100,000 epinephrine. The results indicate that, while etidocaine provided a longer duration of anesthesia (P less than 0.005), no difference was noted in the number of pain pills patients took or the period of time over which they took them. Inadequate hemostasis was a recurrent problem with etidocaine anesthesia. The use of 1.5% etidocaine HCl with 1:200,000, epinephrine offers no significant advantages over traditional anesthetic solutions.
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Adverse healing responses, including necrosis of soft tissue and sequestration of alveolar bone, have been reported following the use of electrosurgery for intraoral incisions. These responses are usually attributed to excessive heat accumulation during the surgical procedure. The purpose of this investigation was to measure temperature changes in subadjacent connective tissue during intraoral electrosurgical incisions in palatal mucosa of miniature swine. Results indicate that single electrosurgical incisions should be accomplished at a speed of approximately 7 mm. per second and that successive incisions should be separated by a cooling interval of 8 to 10 seconds to avoid generation of heat sufficient to initiate an adverse healing response.
A study was designed to document heat production subjacent to tissue excision by electrosurgery. In Phase I of the study, 20 electrosurgery excisions were made with a loop electrode in the palatal mucosa of miniature swine. Subjacent heat production was measured with implantation thermistors. Temperature measurements adjacent to 20 single incisions made with a needle electrode were used for comparison. Energy used and duration of active electrode contact with the tissue were recorded for each procedure with an electronic measuring device. In Phase II, 20 sets of excisions consisting of three successive excisions were performed. The following intraexcisional cooling periods were used for four sets each: 1 second, 5 seconds, 8 seconds, 10 seconds, and 15 seconds. Results indicate that single electrosurgery excisions with a loop electrode generate more energy than incisions made with a needle electrode. Subjacent heat production, however, is not significantly different. Cooling intervals of at least 15 seconds between successive electrosurgery excisions made with a loop electrode are necessary to prevent heat build-up of a magnitude capable of initiating destructive alveolar changes.
The periosteal and endosteal interproximal bone remodeling activity following clinically simulated blade and electrosurgical mucoperiosteal incisions was investigated by histologic and morphometric analyses. Undecalcified histologic sections were prepared and evaluated using standard bone morphometric techniques. Periosteal and endosteal bone surfaces subjacent to incisions were examined and the percentages of forming, resorbing, and quiescent surfaces, and the number of osteoclasts per millimeter of bone surface, were calculated. Based on indices of bone remodeling activity, the potentials for activation of interproximal bone remodeling by clinically appropriate blade and electrosurgery incisions in dogs appear to be similar.
Dentin stresses from simulated functional loads to post-reinforced tooth models with four levels of periodontal support were calculated using finite element analysis. As bone levels diminished, stresses were found to increase dramatically and to concentrate in the small amount of dentin remaining near the post apex.
An exopolysaccharide (EP), purified from spent culture fluid previously inoculated with Capnocytophaga ochracea strain 25, suppressed in vitro human peripheral blood lymphocyte responses to the mitogen concanavalin A. EP was suppressive when added to cultures before the mitogen, but enhanced responses when added 24 or 48 hr after the mitogen.
Since periodontal disease provides a portal of entry for oral microorganisms during such common events as toothbrushing and mastication, treatment must resolve the inflammatory response if the teeth are to be maintained safely in patients at risk of infectious endocarditis. Prophylactic antibiotics should be administered during periodontal treatment such as debridement of the periodontal pocket and surgical repair of anatomic defects, as well as during oral hygiene training. If optimal periodontal health is achieved and maintained, the risk of systemic bacteremia is minimal.
Fifty-four Class V amalgam restorations were placed in nine beagle dogs to determine whether electrosurgical effects on pulp tissue could be altered by the presence of metallic restorations. An electrosurgical technique was performed, simulating clinical procedures for tissue removal while traversing the restorations. Time and power-use measurements were recorded for each operation. All operations that were performed within a time range imitating clinical procedures failed to produce changes in pulpal histology. When electrosurgical exposures were extended beyond 0.4 second contact with restorations, pulpal alterations occurred in the majority of specimens.
A patient with Stage I systemic sarcoid (affecting the mediastinum and cervical lymph nodes) is presented. This patient had ptosis of the eyelid and miosis (Horner's syndrome) due to involvement of the cervical-thoracic sympathetic nerves by the granulomatous process. Bony destruction simulating periodontal disease occurred in the molar-premolar region and caused pain and paresthesia. Systemic sarcoid may occur more commonly in the jaws than reported cases would indicate. Sarcoidosis should be considered in the differential diagnosis when periodontal disease appears refractory to local therapy.
The contribution of nonsterile water irrigation during ultrasonic scaling to postoperative blood stream contamination was evaluated. Thirty human volunteers were subjected to a random split-mouth technique comparing sterile and municipal tap water irrigation with ultrasonic root preparation on contralateral mandibular quadrants. Scaling was performed by a single operator using a premeasured quantity of irrigant. Postoperative blood samples were obtained immediately and cultured aerobically and anaerobically in tryptic soy broth and on BHI agar plates for enumeration of colony forming units. Positive blood cultures were inoculated onto selective media for presumptive identification. The difference in the bacteremia incidence after scaling with sterile water (50%) versus scaling with tap water (53.3%) was not significant. The degree of the bacteremias (less than 1 colony forming unit/ml) was similar between groups. Therefore tap water irrigation used in ultrasonic scaling did not appear to be a significant causative agent in postoperative bacteremias.
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