Research Outputs (Oral Health Sciences)
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Item Ferric sulphate and formocresol pulpotomies in baboon primary molars: histological responses(2002) Cleaton-Jones, P.; Duggal, M.; Parak, R.; Et alAim: To compare pulpal reactions to ferric sulphate and formocresol pulpotomies in primary molar teeth with inflamed pulps. Study design: An experimental study in 15 juvenile baboons (Papio ursinus). Materials and methods: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 57 primary molars; after 14 days a pulpotomy was performed on the same primary molars with the two pulp medicaments randomly allocated; the pulp was covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. Results: Reaction frequencies in the ferric sulphate-treated and formocresol-treated teeth were: recognisable pulp 52% and 50%, dentine bridges 16% and 12%, internal root resorption 12% and 4%, external resorption 28% and 31%, bacteria 12% and 23%, peri-apical abscesses 32% and 38%. Statistics: Fisher’s exact probability test showed no statistically significant differences between reaction frequencies in the two treatment groups. Conclusion: A pulpotomy in a primary tooth may be clinically successful in the presence of adverse histological reactions.Item Airway status in civilian maxillofacial gunshot injuries in Johannesburg, South Africa(2002) Tsakiris, P.; Cleaton-Jones, P. E.; Lownie, M. A.BACKGROUND: Airway management of the maxillofacial gunshot injury constitutes a critical decision and an area that requires review in the context of civilian injuries. Most of our knowledge is extrapolated from military experience, which constitutes a different trauma patient group. This paper reports a retrospective survey of airway status in relation to maxillofacial gunshot injuries. The objective is to correlate clinical findings with treatment decisions. METHODS: A survey was done of 11,622 archived maxillofacial surgery records (1987-1992) in the three academic hospitals in Johannesburg. RESULTS: There were 211 maxillofacial gunshot injuries, for which 92 patient records had sufficient detail for inclusion in the analysis. The typical patient was a black male aged 20-29 years, shot with a low-velocity bullet of 0.38 calibre, admitted to hospital the day of the injury, operated on within 4 days, and discharged 4 days later. The airway was threatened in 20/92 cases at admission; 12/20 cases were treated with oro-or nasotracheal intubation, and 9/12 later had elective tracheostomies; 8/20 needed immediate surgical airways, 5 tracheostomies and 3 cricothyroldotomies (all later converted to tracheostomies). Three of thirty-seven patients with normal airways on admission later required emergency tracheostomy. CONCLUSIONS: An abnormal airway was significantly more likely after a high-velocity injury, and when the tongue, floor of mouth, midline or bilateral facial skeletal bones were involved.Item How well do fourth year Wits Dental Students place resin composite restorations?(2003) Lightfoot, J.; Clarke, F. M.; Grossman, E. S.OBJECTIVES:To evaluate, by means of a scanning electron microscope (SEM) the quality of resin composite restorations, placed as a first attempt by fourth-year dental students. METHODS: Ten Class IV direct composite restorations, placed in plaster-mounted extracted incisor teeth as part of pre-clinical course requirements, were selected. Specimens were evaluated and graded on a two-point scale by a staff member according to departmental clinical evaluation criteria. Five restored teeth were prepared for surface evaluation of marginal integrity, surface roughness and contour using SEM. The remaining specimens were embedded in resin and ground down transversely, parallel to the incisal edge until a dentine core was apparent. The ground surfaces were polished, prepared for SEM and assessed for etched layer, placement of bonding agent, composite adaptation and overall consistency. RESULTS: Clinical assessment and SEM surface evaluation correlated favourably for all criteria, except contour, indicating that students were reasonably competent in finishing techniques. Ground samples revealed acceptable etched enamel layers and marginal adaptation. Bonding agent thickness varied between 0 and 200 microns casting doubt on procedural accuracy. Porosities and voids were apparent within the resin composite. Internal features were the main reason for unsatisfactory grades. CONCLUSIONS: Students placed restoration satisfactorily. They would benefit if able to examine sectioned restorations to understand critical placement techniques which would contribute to resin composite restoration success. A research component can be introduced into the dental undergraduate curriculum by way of similar projects linked to didactic course-work.Item Clinical, histological and microbiological study of hand-excavated carious dentine in extracted permanent teeth(2003) Bönecker, M.; Grossman, E.; Cleaton-Jones, P. E.; et alChanges in cultivable flora in dentine samples collected before and after hand excavation were examined in association with clinical status of the cavity surface, light microscopy and scanning electron microscopy (SEM). Thirty-five extracted permanent molar teeth with an occlusal caries lesion were excavated with hand instruments according to the atraumatic restorative treatment (ART) approach. Excavation pressure, dentine colour and consistency were recorded at the dentine-enamel junction (DEJ) prior to carious dentine removal and at the cavity floor after the final excavation; a microbiological sample of dentine was taken at both stages. Twelve restored teeth; six with positive and six with negative bacterial growth on the second sample, were selected for light microscopy and SEM. The hand-excavation removed tooth structure was soft, irreversibly damaged, dark and highly infected. Hand excavation reached dentine of increased hardness with a more normal colour to provide a sound structural base for restoration. Light and SEM examination of the cavity floor showed infected dentinal tubules in all 12 teeth examined. Linear logistic analysis showed a statistical association between light-yellow dentine on the cavity floor and an absence of bacterial growth (P = 0.006). This short-term in vitro study showed that caries-producing bacteria remained in dentine close to the cavity floor in 26/35 teeth despite clinical observations that indicated a suitably prepared cavity floor.Item Long in the tooth(2002) Volchansky, A.Item To splint or not to splint, that is the question(2001) Volchansky, A.; Gavron, G.Item Monitoring of research - is it practical or only a dream?(2002) Cleaton-Jones, P.Item Comparative cost of ART and conventional treatment within a dental school clinic(2002) Mickenautsch, S.; Munshi, I.; Grossman, E. S.BACKGROUND: The changing oral health needs in South Africa require that both the teaching and clinical techniques of atraumatic restorative treatment (ART) form a part of the restorative undergraduate curriculum. OBJECTIVE: This study was undertaken to establish and compare the estimated costing of an amalgam, composite resin and ART restoration within the Board of Health Funders (BHF) recommended scale of benefits at the School of Oral Health Sciences Oral and Dental Hospital, University of the Witwatersrand (SOHS). METHODS: Fixed and variable costs were calculated by pricing items and equipment used in each procedure. The output values were established according to the recommended scale of benefits (BHF, 1999). This enabled the calculation of contribution margins and net income for each of the three restorations. RESULTS: The annual capital cost for the ART approach is approximately 50% of the other two options (e.g. per multiple surface restoration ART = R1.58; amalgam and composite resin restorative procedures: R3.12 and R3.10 respectively), despite the fact that ART restorations are rendered in a modern dental setting. CONCLUSIONS: Our study shows that implementation of the ART approach within the clinic setting of the SOHS can be accomplished without additional cost. Furthermore ART can be performed as an economically viable alternative to conventional treatment procedures within the clinic setting. The study represents a first step towards determining the cost efficiency of implementing ART as a pragmatic and cost-effective restorative option within the SOHS, University of the Witwatersrand.Item How does zinc oxide-eugenol compare to ferric sulphate as a pulpotomy material?(2001) Chien, MM; Setzer, S.; Cleaton-Jones, P.This study compared the clinical and radiographic responses after 3 months to a sterile compression technique with zinc oxide-eugenol or 15.5% ferric sulphate in 145 pulpotomised primary teeth in 30 children. In both groups of teeth the success rate was 100%. These short-term results suggest that either technique may be used.Item Surface roughness of aesthetic restorative materials: an in vitro comparison(2001) Rosen, M.; Grossman, E. S.; Cleaton-Jones, P. E.The purpose of this study was to compare the surface roughness of three types of aesthetic restorative material. Six standard samples of two brands of each type of material were prepared namely: hybrid composites (Prodigy, Z100), compomers (Compoglass F, Hytac Aplitip) and glass ionomer cements (Photac-Fil, Vitremer) in a perspex mould (N = 36). Upper and lower surfaces were covered with Mylar strips which, in turn, were covered with glass slides and compressed to express excess material. After light curing, specimens were stored in distilled water for 14 days. Thereafter, one side of each specimen was polished sequentially with medium, fine and super fine Soflex discs (treatment). Untreated surfaces served as controls. All surfaces were examined with Talysurf and the surface roughness (Ra) of each specimen was recorded. Three measurements were made of each specimen. A 4-way ANOVA and Tukey's Studentised range test were used to analyse the data. Statistically significant effects were found for both type of material (P = 0.0001) and for treatment process (P = 0.0065). Among unpolished specimens: Compoglass F is significantly rougher than Vitremer, Z100, Prodigy and Hytac Aplitip, and compomers are significantly rougher than hybrids. Among polished specimens: Photac-Fil is significantly rougher than Z100 but does not differ from Compoglass F, Vitremer, Prodigy and Hytac Aplitip, and glass ionomers are also significantly rougher than hybrids. The smoothest surface is obtained when curing materials against a Mylar strip.