Management of Air Emphysema with Cyanosis Following Dental Treatment - A Case Report with Scientific Reasoning

Air emphysema as a consequence of dental procedures is a rare but dangerous state if not diagnosed and treated timely. It can occur incidentally or iatrogenically in many dental procedures such as restorations, endodontic and periodontal treatments, surgical and non-surgical tooth extraction, and use of air or water sprays and syringes.1-6 Subcutaneous emphysema of dental origin most commonly occurs after surgical extraction of an impacted mandibular third molar.7 Several studies have reported that the use of high speed hand-piece during surgical extraction led to escape of air into the subcutaneous tissues. 7-10 Wilson (1983) reported subcutaneous emphysema in the eyelids after extraction of the maxillary molar teeth due to vigorous irrigation combined with air and water spray for 10 seconds.6 Subcutaneous emphysema in the cheek after extraction of the maxillary third molar without using high speed hand-piece is not a common phenomenon. In the present case, we demonstrate air emphysema in the cheek associated with hematoma after extraction of the impacted right maxillary 3rd molar. Since it was a soft tissue impaction, no hand-piece was used during the tooth removal. The purpose of this case report is to create awareness among the dental surgeons about the simple extraction procedures that may lead to air emphysema associated with hematoma.

O que é preciso saber sobre microabrasão

Objective: Having in mind the growing value that is given to esthetic procedures it has been carried out a literature review about the main polemics that goes around Enamel Microabrasion technique. Action mechanism: the microabrasion compound modifies light refraction and reflection indexes producing an optical effect which allows the camouflage of the subsurface stains. Indications: the technique is indicated to remove any stain, since it is restrict to the most superficial layer of enamel. Advantages: immediate and permanent results with minimum loss of dental structure. Technique: with all care steps taken, a mixture of hydrochloric acid or phosphoric acid and pumice is applied to dental surface for 12 to 16 times, during 10 seconds each application. The application can be done manually or with the help of a low rotation hand-piece. Conclusions: the enamel microabrasion is an effective, safe and conservative technique if compared with other alternatives available. However, some authors affirm that it must be very carefully used because of enamel loss and risks of lesion by the acid.

Improving Consistency of Photobiomodulation Therapy: A Novel Flat-Top Beam Hand-Piece versus Standard Gaussian Probes on Mitochondrial Activity

The tremendous therapeutic potential of photobiomodulation therapy in different branches of medicine has been described in the literature. One of the molecular mechanisms for this treatment implicates the mitochondrial enzyme, cytochrome C oxidase. However, the efficacy and consistency of clinical outcomes with photobiomodulation treatments has been fiercely debated. This work was motivated by this need to improve photobiomodulation devices and delivery approaches. We designed a novel hand-piece with a flat-top beam profile of irradiation. We compared the beam profile versus a standard hand-piece and a fibre probe. We utilized isolated mitochondria and performed treatments at various spots within the beam, namely, the centre, left and right edge. We examined mitochondrial activity by assessing ATP synthesis with the luciferin/luciferase chemiluminescent method as a primary endpoint, while mitochondrial damage was assessed as the secondary endpoint. We observed a uniform distribution of the power density with the flat-top prototype compared to a wide Gaussian beam profile with the standard fibre and standard hand-piece. We noted increased production of ATP in the centre of all three beams with respect to the non-treated controls (p < 0.05). Both the fibre and standard hand-piece demonstrated less increase in ATP synthesis at the edges than the centre (p < 0.05). In contrast, ATP synthesis was increased homogenously in the flat-top handpiece, both in the centre and the edges of the beam. Fibre, standard hand-piece and the flat-top hand-piece prototype have discrete beam distribution characteristics. This significantly affected the mitochondrial activity with respect to their position within the treated areas. Flat-top hand-piece enhances the uniformity of photobiomodulation treatments and can improve the rigour and reproducibility of PBM clinical outcomes.

A custom virtual reality training solution for ophthalmologic surgical clinical trials

We present a summary of the development and clinical use of two custom designed high-fidelity virtual-reality simulator training platforms. This simulator development program began in 2016 to support the phase III clinical trial Archway (ClinicalTrials.gov identifier, NCT03677934) intended to evaluate the Port Delivery System (PDS) developed by Genentech Inc. and has also been used to support additional clinical trials. The two simulators address two specific ophthalmic surgical procedures required for the successful use of PDS and provide state-of-the-art physical simulation models and graphics. The simulators incorporate customized active haptic feedback input devices that approximate different hand pieces including a custom hand piece specifically designed for PDS implantation. We further describe the specific challenges of the procedure and the development of corresponding training strategies realized within the simulation platform.

Vibration Exposure and Transmissibility on Dentist’s Anatomy: A Study of Micro Motors and Air-Turbines

The use of dental hand pieces endanger dentists to vibration exposure as they are subjected to very high amplitude and vibration frequency. This paper has envisaged a comparative analysis of vibration amplitudes and transmissibility during idling and drilling with micro motor (MM) and air-turbine (AT) hand pieces. The study aims to identify the mean difference in vibration amplitudes during idling, explore different grasp forces while drilling with irrigant injection by the dentist, and various vibration transmission of these hand pieces. The study utilized 22 separate frequency resonances on two new and eight used MMs and two new and eight used ATs of different brands by observing the investigator at 16 different dentist clinics. The study adopted a descriptive research design with non–probability sampling techniques for selecting dentists and hand pieces. Statistical methods like Levene Test of Homogeneity, Welch ANOVA, independent t-test, and Games–Howell test were utilized with SPSS version 22 and MS-Excel. The results reveal that vibration amplitudes and vibration transmissibility when measured at position 2 are higher than in another position 1. Vibrations during idling for used MMs are more than AT hand pieces, and the used MM (MUD) and used AT (AUA) hand pieces differ due to their obsolescence and over-usage. Vibration amplitudes increase every time with the tightening of grasping of the hand piece. Vibration amplitudes for each grasping style of MM hand piece differ from all other grasping styles of AT hand pieces. Routine exposure to consistent vibrations has ill physical, mental, and psychological effects on dentists. The used hand pieces more hazardous as compared to newer ones. The study suggests that these hand pieces must be replaced periodically, sufficient to break between two operations, especially after every hand piece usage. Hence, the present research work can be further extended by creating some control groups among dentists and then studying the vibration amplitude exposure of various dental hand pieces and subsequent transmissibility to their body parts.

Dental mitigation strategies to reduce aerosolization of SARS-CoV-2

Limiting infection transmission is central to the safety of all in dentistry, particularly during the current SARS-CoV-2 pandemic. Aerosol-generating procedures (AGPs) are crucial to the practise of dentistry; it is imperative to understand the inherent risks of viral dispersion associated with AGPs and the efficacy of available mitigation strategies. In a dental surgery setting, crown preparation and root canal access procedures were performed with an air turbine or electric speed-controlled hand-piece, with mitigation via rubber dam or high-volume aspiration and a no mitigation control. A phantom head was used with a 1.5 mL flow of artificial saliva infected with Φ6 bacteriophage (a surrogate virus for SARS-CoV-2) at ~108 plaque forming units mL-1, reflecting the upper limits of reported salivary SARS-CoV-2 levels. Bioaerosol dispersal was measured using agar settle plates lawned with the bacteriophage's host, Pseudomonas syringae. Viral air concentrations were assessed using MicroBio MB2 air sampling, and particle quantities using Kanomax 3889 GEOα particle counters. Compared to an air turbine, the electric hand-piece reduced settled bioaerosols by 99.72%, 100.00% and 100.00% for no mitigation, aspiration and rubber dam, respectively. Bacteriophage concentrations in the air were reduced by 99.98%, 100.00% and 100.00%, with the same mitigation strategies. Use of the electric hand-piece with high-volume aspiration, resulted in no detectable bacteriophage, both on settle plates and in air samples taken 6-10-minutes post-procedure. To our knowledge, this study is the first to report the aerosolization of active virus as a marker for risk determination in the dental setting. Whilst this model represents a worst-case scenario for possible SARS-CoV-2 dispersal, these data showed that the use of electric hand-pieces can vastly reduce the risk of viral aerosolization, and therefore remove the need for clinic fallow time. Furthermore, our findings indicate that the use of particle analysis alone cannot provide sufficient insight to understand bioaerosol infection risk.

Endoscopic retrieval of an accidentally ingested bur during a dental procedure: a case report

Background Accidental ingestion of a dental bur during the dental procedure is a rare, but a potentially serious complication. Early recognition and foreign body retrieval is essential to prevent adverse patient outcomes. Case presentation A 76-year old male patient, presented to the department with a chief complaint of sensitivity in his upper right back tooth due to attrition. After assessing the pulp status, root canal therapy was planned for the tooth. During the procedure, it was noticed that the dental bur slipped out of the hand piece and the patient had accidentally ingested it. The patient was conscious and had no trouble while breathing at the time of ingestion of the bur although he had mild cough which lasted for a short duration. The dental procedure was aborted immediately and the patient was taken to the hospital for emergency care. The presence and location of the dental bur was confirmed using chest and abdominal x-rays and it was subsequently retrieved by esophagogastroduodenoscopy (EGD) procedure under general anaesthesia on the same day as a part of the emergency procedure. The analysis of this case reaffirms the importance of the use of physical barriers such as rubber dams and gauze screens as precautionary measures to prevent such incidents from occurring. Conclusion Ingestion of instruments are uncertain and hazardous complications to encounter during a dental procedure. The need for physical barrier like rubber dam is mandatory for all dental procedures. However, the dentist should be well trained to handle such medical emergencies and reassure the patient by taking them into confidence. Each incident encountered should be thoroughly documented to supply adequate guidance for treatment aspects. This would fulfil the professional responsibilities of the dentist/ clinician and may help avoid possible legal and ethical issues. This case report emphasizes on the need for the usage of physical barriers during dental procedures in order to avoid medical emergencies.