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Background: This study was designed to evaluate the safety and efficacy of a novel, self-cross-linked hyaluronic acid (HA) hydrogel compared with carboxymethylcellulose (CMC) viscous foam in promoting healing when applied after ethmoidectomy. A prospective, randomized, controlled, blinded clinical trial was performed. The study was performed by four surgeons operating in two community hospitals., Methods: Thirty patients with bilateral chronic rhinosinusitis underwent bilateral total ethmoidectomy. Intraoperatively, each patient received 5 mL of HA hydrogel in one ethmoid cavity and 5 mL of CMC contralaterally. The material applied within each ethmoid cavity was randomly assigned before surgery. An independent surgeon, blinded to the material used to treat each ethmoid cavity, evaluated postoperative endoscopic video at 1 and 2 weeks for edema, crusting, and mucopurulence and at 6 and 12 weeks for remucosalization and scarring/synechiae. Twenty-item Sino-Nasal Outcome Test SNOT-20 data were collected at each visit. A small sample underwent endoscopic mucosal biopsy., Results: Twenty-nine of 30 patients completed the protocol. The difference in edema, crusting, and mucopurulence at 1 and 2 weeks was not statistically significant; however, at 6 and 12 weeks, the HA hydrogel showed statistically significant reduction in both overall endoscopic grade (p < 0.05), as well as synechiae formation (p < 0.05), with a trend toward superiority in remucosalization (p = 0.08). Histological analysis of six subjects at 12 weeks showed a nonsignificant trend toward a greater amount of regenerated cilia present with the HA hydrogel (p = 0.23). SNOT-20 scores declined 78.8% from preoperative scores., Conclusion: Self-cross-linked HA hydrogel provides superior wound healing to CMC after ethmoidectomy.

Background: The outcomes of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) can be compromised by postoperative inflammation, recurrent polyposis, middle turbinate lateralization, and synechiae, often requiring subsequent interventions. A bioabsorbable steroid-eluting sinus implant placed in the operating room following ESS has been proven safe and effective in 2 randomized controlled trials and a subsequent meta-analysis, for its ability to preserve sinus patency, and reduce medical and surgical interventions. This trial sought to evaluate the safety, feasibility, and outcomes of implants placed in the office after achieving hemostasis., Methods: Twenty patients with CRS underwent ESS including bilateral ethmoidectomy. A steroid-eluting bioabsorbable implant was deployed into each ethmoid cavity in the office within 7 days after ESS. Endoscopic appearance of the ethmoid cavities was evaluated at 1 week, 2 weeks, and 4 weeks postoperatively by the operating surgeon and an independent blinded evaluator. Procedural tolerance was assessed at week 2 using a patient preference questionnaire. The 20-item Sino-Nasal Outcome Test (SNOT-20) questionnaire was completed at baseline, week 2, and week 4., Results: In-office placement of steroid-eluting bioabsorbable implants was well tolerated, with 90% of patients very satisfied with the overall experience, and 80% very satisfied with the recovery process. At 1 month, there were no significant adhesions or frank polyposis, and middle turbinate lateralization was only 5%. Compared to baseline, ethmoid sinus inflammation was significantly reduced (p = 0.03), and the mean SNOT-20 score was significantly improved (p < 0.001)., Conclusion: In-office placement of steroid-eluting bioabsorbable implants after achieving hemostasis was well tolerated and might improve local drug diffusion and surgical outcomes., (© 2014 ARS-AAOA, LLC.)

Adhesion of porcelain to dentin may be important in those cases with little remaining enamel. The purpose of this study was to determine the bond strength of porcelain to dentin using a dentin adhesive (All-Bond) and compare it to the enamel bond strength. Sixty human molar teeth had either a dentin or enamel bonding site prepared by flat grinding to a 600 grit. The teeth were divided into three groups of 20 each. Sixty porcelain cylinders were prepared, hydrofluoric acid etched on one end and silane treated. Twenty of the cylinders were bonded to enamel, 20 bonded to dentin with a dentin adhesive to be tested at 48 hours, and 20 bonded to dentin with a dentin adhesive to be tested after 24 hours of thermocycling (800 cycles at 6 degrees C to 60 degrees C). The specimens were tested in an Instron at a crosshead speed of 0.5 mm/minute. The following bond strengths were found: enamel (19.0 +/- 2.9 MPa), dentin at 48 hours (14.4 +/- 5.4 MPa), and dentin after thermocycling (10.1 +/- 3.8 MPa). When this data was subjected to statistical analysis (ANOVA), there was a significant difference between the groups. A Scheffe's test found that the dentin-porcelain bond at 48 hours was stronger than the thermocycled group, and that the enamel bond was significantly stronger than the two dentin bonds.

A 4-META-containing adhesive was evaluated for its ability to bond a composite resin and two types of amalgam to dentin. One group of composite resin was tested after 24 hours and another group after 24 hours of thermocycling. Shear bond strengths were: composite resin at 24 hours = 22.38 MPa; thermocycled composite resin = 20.86 MPa; spherical alloy = 3.38 MPa; admixed alloy = 3.84 MPa. Microleakage was evaluated after the 4-META adhesive was applied to cavity preparations and compared to that of a group treated with a cavity varnish. There was statistically significantly less microleakage in the 4-META group at both the occlusal and gingival margins.

A recently introduced porcelain repair system utilizing 4-META (Etch-Free Primer with C & B-Metabond) was evaluated for bond strength to porcelain. This system purportedly eliminates hydrofluoric acid-etching and silane pretreatment. Forty porcelain specimens were prepared and treated with the 4-META repair system. A resin cylinder was bonded to the treated porcelain surface. Twenty of the specimens were tested after 24 hours while the other 20 were tested after thermocycling (800 cycles at 6 degrees C to 60 degrees C). The mean bond strengths were: 24 hours 17.4 MPa (+/- 4.8), thermocycled 19.1 MPa (+/- 7). Cohesive failure of the porcelain occurred in all of the specimens, both the 24 hour and the thermocycled. These bond strengths compare favorably with or exceed those of other porcelain repair systems tested in other studies.