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The effect of dentin on the pulp tissue dissolution capacity of sodium hypochlorite and calcium hydroxide prostate cancer outlook buy discount fincar 5 mg on line. Tissue dissolution ability of sodium hypochlorite activated by photon-initiated photoacoustic streaming technique. Questions 1 What was the major disadvantage of lasers in the initial studies in root canal cleaning A Thermal damage B Apical extrusion C Patient compliance D Operator fatigue 2 the major shift in the use of lasers in endodontics has been from attempting to shape the root canal to cleansing the root canal. A True B False 3 All of the following are disadvantages of a smear layer left on root canal walls except A It interferes with sealing ability of obturation material B It acts as a substrate for unremoved bacteria. What level of energy is more conducive to pulp survival and successful healing after pulpotomy A the apical third of each canal B At full working length for complete disinfection C At 1 to 2 mm into the orifice of each canal D In the pulp chamber E At the occlusal surface of the accessed tooth 10 What do the studies demonstrate so far in terms of apical extrusion with different irrigation technique E No significant difference exists among the irrigation techniques for apical extrusion. The dental pulp is small in scale but has a highly complex structure that exerts multiple functions such as tooth development, mineralized tissue formation, nutrition supply to the surrounding mineralized tissues, immune response, and neurogenic/immunogenic inflammation as well as sensory function [1]. Research that endeavors to understand the underlying mechanisms of dental pulp regeneration is still in its early stage, but the laboratory and preclinical findings have been translated into successful clinical applications. In this chapter, the development and limitations of clinical dental pulp regeneration therapy, and cell-based and cell-free therapy for dental pulp regeneration, are reviewed and discussed. However, the ingrowth of fibrous connective tissue was not observed in most of the necrotic cases, although it was identified in the majority of vital cases [3]. To enhance root canal disinfection for pulp regeneration in immature nonvital teeth, Rule and Winter [4] introduced polyantibiotics consisting of neomycin sulfate, polymyxin B sulfate, bacitracin, and nystatin and absorbable iodoform into the root canals. They found continued root development and apical barrier formation in their nonvital cases. Clinical dental pulp regeneration How did early research efforts evolve into a current treatment modality The early efforts to regenerate dental pulp in patients did not provide reliable clinical outcomes.
They are normal inhabitants of the skin and are usually nonpathogenic (Roth and James 1988) but can be frequent contaminants of blood and body fluid cultures prostate cancer and sex order fincar 5 mg free shipping. The human cutaneous propionibacteria include Propionibacterium acnes and Propionibacterium propionicum (also called Propionibacterium propionicus, and formerly Arachnia propionica). These species can be opportunistic pathogens, causing diverse infections that include acnes vulgaris (Vowels et al. The species produce proinflammatory enzymes (lipases, neuraminidases, phosphatases, and proteases) with the capacity to contribute to direct damage to the host (Perry and Lambert 2006). Many Actinomyces species are commensals in the oral cavity but can become opportunistic pathogens in humans and other mammals (Yeung 1999; Mardis and Many 2001). Higher cell-surface 168 Endodontic Microbiology (a) (b) (c) (d) (e) (f) (g) (h) (i) Virulence of Endodontic Bacterial Pathogens 169 P. The species has been cultured from deep layers of infected root canal dentin (Ando and Hoshino 1990) and has the ability to penetrate into dentinal tubules (Siqueira et al. In teeth with apical periodontitis undergoing root canal treatment, the most frequent Propriobacterium spp. For example, the production of a bacteriocin by a producer strain that has an inhibitory activity against other strains may provide the producer with a selective advantage (Riley and Wertz 2002), thereby modulating the infectious process. In contrast, virulence might be enhanced by synergistic interactions among species. Using confocal microscopy, coaggregation interactions were observed in association with Prevotella, Streptococcus, and Fusobacterium species isolated from acute endodontic infections (Khemaleelakul et al. Interactions among genetically distinct bacteria are involved in the establishment and maintenance of biofilms (Kolenbrander et al. Specific interactions between streptococci and other bacteria may facilitate their invasion into dentin. Significant associations were reported to occur between specific combinations of species and clinical symptoms: swelling and the combination of P. In root canals of teeth with apical periodontitis receiving treatment there may be an association between Lactobacillus spp. Endodontic infections are typically polymicrobial biofilm communities (Siqueira and R^ cas 2009). The circle indicates a likely communication between the center of the lesion and the sinus tract. Bacterial filaments are arranged in dense aggregates at the periphery, surrounded by layers of an amorphous material. The main advantage of this approach over genomic techniques is that by directly characterizing the virulence-associated proteins present in endodontic infections, a more global insight into the physiology and pathogenicity of the infected root canal microbial community can be obtained.
Syndromes
It has been well demonstrated that any interruption in chest compressions - even a brief pause for ventilation - decreases coronary perfusion pressure and forward blood flow androgen hormone chemotherapy discount fincar 5 mg mastercard, which are vital to the heart and brain. The combination of uninterrupted compressions and a minimal "preshock pause" may improve defibrillation success and neurological outcomes. The necessary distraction can dilute the focus on quality, minimally interrupted compressions and - at worst - can put patients at risk. A number of studies have questioned the use of advanced airways in cardiac arrest patients during the prehospital phase of care, a strategy that has been linked to poor outcomes. Modern external defibrillators are available in a variety of designs with proprietary waveforms (eg, biphasic truncated exponential, pulsed biphasic, rectilinear biphasic, damped sinusoid monophasic, and monophasic truncated exponential) specific to the manufacturer. The suggested energy for biphasic defibrillation depends on the manufacturer, varying between 150 and 360 joules. Logistically, this period often includes a rhythm assessment, charging the defibrillator, delivering the defibrillation, and waiting for instructions to resume chest compressions. Care providers should communicate with each other to ensure that the device is charging while a compression cycle is finishing. The provider on the monitor should quickly verify that the rhythm is shockable and press "shock. The primary activities during the postshock pause are rhythm and pulse checks after defibrillation. Hands-on defibrillation - essentially continuing compressions while a shock is administered - is an alternative technique for eliminating the peri-shock pause altogether. A compelling study of patients undergoing elective cardioversion with a biphasic defibrillator demonstrated that rescuers, protected only by standard polyethylene gloves, could be in contact with the chest without exposure to dangerous levels of current. The technique first was described in the electrophysiology lab as a strategy for terminating persistent atrial fibrillation. Be careful and creative in choosing logistic maneuvers so as to minimize hands-off time. However, inadvertent intracranial insertion of a nasopharyngeal airway has been reported in patients with basal skull fractures. Advanced Airways Prehospital advanced airway management is a controversial topic beyond the scope of this chapter. There is no clear evidence of its benefit, and the incidence of adverse events during intubation attempts becomes unacceptably high when prehospital personnel do not receive active, ongoing skill training. Evidence is mixed regarding the optimal timing of advanced airway management during cardiac arrest resuscitation; however, earlier airway management (<5 minutes) has been associated with an improved rate of 24-hour survival. The worst neurological outcomes were found in those who were ventilated with a supraglottic device.
Transmission of herpesvirus 7 through multigenerational families in the same household prostate cancer holistic treatment generic 5 mg fincar. Relationship between prostaglandin E2 concentrations in periapical exudates from root canals and clinical findings of periapical periodontitis. Polymorph nuclear cells are no sites of persistence of human cytomegalovirus in healthy individuals. Activation of interleukin 1 gene transcription by human cytomegalovirus: molecular mechanisms and relevance to periodontitis. Relationship between human cytomegalovirus transcription and symptomatic apical periodontitis in Iran. Primary natural killer/T-cells lymphomas of the oral cavity a aggressive neoplasms. Inside the cell wall, cell membrane, nucleus, a large vacuole, and membrane-bound organelles (mitochondria, endoplasmic reticulum) comprise other parts of a yeast cell. The septa have holes through which cytoplasm and organelles can move from segment to segment. In certain conditions, yeast cells can grow true hyphae or pseudohyphae (see section 9. Taxonomy of Candida is as follows: kingdom, Fungi; phylum, Ascomycota; subphylum, Ascomycotina; class, Ascomycetes; order, Saccharomycetales; family, Saccharomycetaceae; genus, Candida (Waltimo et al. Among more than 300 cultivated microbial species or types in the oral cavity, there are many Candida Endodontic Microbiology, Second Edition. These benign, commensal, or opportunistic species have important roles in the development of oral as well as dental diseases. Candida albicans is the most pathogenic type among the seven species most commonly found in the oral cavity (C. The prevalence of the yeasts tends to be lower in healthy individuals than in hospital patients of any kind.
In the setting of traumatic cardiac arrest androgen hormone production discount fincar 5 mg buy, the clinician should focus on prompt airway management, empiric chest tube placement, hemorrhage control, the transfusion of blood products, and consideration of resuscitative thoracotomy. Poisoned Patients Since resuscitation of the critically ill patient often is undertaken without the benefit of a complete medical history, consideration of underlying causes is of prime importance. Certain toxidromes are associated with myocardial depression, lethal arrhythmias, and high fatality rates. In children, cardiac arrest typically results from hypoxic insult (as opposed to lethal arrhythmia), so special attention to airway management is of extreme importance when managing these vulnerable patients. In general, pediatric resuscitation emphasizes airway management and the correction of underlying pathology. Lengthy attempts to establish intravenous access are discouraged in favor of quicker modalities such as intraosseous needle insertion. Some tertiary care centers report favorable results with extra corporeal membrane oxygenation in victims of refractory arrest. Pediatric supplies must be readily accessible and familiar to all clinicians charged with leading resuscitation. Weight-based drug regimens and color-coded kits containing appropriately sized equipment can minimize stress during an arrest scenario. There is a clear stepwise relationship between outcomes and quartiles of the intervals. This approach requires invasive hemodynamic monitoring and will be best tested in patients who experience an inhospital cardiac arrest. Targeting these endpoints might reduce vasopressor use, thereby increasing cerebral perfusion pressure and brain tissue oxygenation. Achieving return of spontaneous circulation is one component of an effective cardiac arrest strategy. Comprehensive resuscitation care requires the engagement of both emergency health care practitioners and the lay public. In select patients, mechanical chest compression devices provide a bridge to invasive therapies. Increasing lengths of the peri-shock pause are negatively associated with the survival rate. Cricoid pressure impairs laryngoscopy and the placement of advanced airways; it should not be performed routinely. Evidence for advanced airway management in the setting of out-of-hospital cardiac arrest is lacking.
In cases of fluidrefractory prostate cancer proton therapy buy fincar 5 mg on-line, catecholamine-resistant shock, consider adrenal insufficiency and administer stress-dose hydrocortisone (2 mg/kg, maximum 100 mg). In cases of sepsis, promptly administer broad-spectrum antibiotics after appropriate cultures have been obtained. Additionally, rapid fluid resuscitation can prevent shock from progressing to cardiorespiratory failure. Pediatric intravenous placement can be difficult in the hands of an inexperienced clinician, and further complicated by the stress of a code situation. When responding to a crashing or coding child, do not waste time attempting to place a central line; if peripheral intravenous access cannot be secured rapidly (ie, after three attempts), move immediately to intraosseous placement. Intraosseous lines are a rapid, safe, effective option for resuscitation in all age groups (from premature infants to adults). Complications are similar to those associated with traditional intraosseous needles, including needle displacement, fracture, infection, and compartment syndrome. Nevertheless, the ease and rapidity of placement, as well as the effectiveness of drug delivery, make it an ideal technique for pediatric resuscitation. If attempts at intravenous and intraosseous line placement fail, some medications may be given via the endotracheal route. Although optimal endotracheal doses are unknown, most experts recommend double or 850 triple the typical intravenous dose for lidocaine, atropine, and naloxone, and 10 times the typical dose for epinephrine (0. In both cases, immediately give several assisted bag ventilations to help distribute the drug deep into the bronchial tree. Overall, the endotracheal route is discouraged because of erratic and inconsistent drug absorption and potential toxicity. Postresuscitation Care When reperfusion is achieved, the immediate postresuscitation phase is critical. During this period, patients are at high risk for brain injury, seizures, ventricular arrhythmias, and extension of reperfusion injuries; interventions should focus on minimizing reperfusion injury and supporting cellular recovery. During the immediate postcardiac arrest period, it is important to avoid hyperthermia and hypoxia and maintain normotension, normoglycemia, and normocarbia. Fever, which is common after pediatric cardiac arrest, is associated with a decreased rate of survival and unfavorable neurological outcomes. Use a length-based resuscitation tape (eg, Broselow tape) to determine equipment sizes and drug doses. Physiological differences between children and adults that complicate airway management include increased oxygen consumption and metabolic rate and decreased pulmonary reserve. When managing a difficult airway, do not continue to do the same thing and expect a different result. The universal compression-to-ventilation ratio is 30:2 for a lone rescuer and 15:2 for two rescuers. Once an advanced airway is in place, deliver simultaneous ventilations and compressions with a ventilation rate of 8 to 10 breaths/min.
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The 1-year observation in many studies reporting on the outcome of apical microsurgery (Table 15 man health wire discount fincar 5 mg on line. As result of such longterm regression, the healed rates in given populations declined from 84% to 76% at 5 years (von Arx et al. By relying primarily on short-term studies, the recent systematic reviews (Tsesis et al. The majority of studies on the prognosis of apical microsurgery appear to classify outcomes based on wellestablished criteria (Rud et al. According to the classic criteria, both "complete" and "incomplete" healing represent a favorable outcome or success, while "uncertain" and "unsatisfactory" healing represent unfavorable outcome or failure. Instead, it has been erroneously assigned to teeth showing reduced radiolucency (Gagliani et al. In specific studies, outcomes can be properly interpreted when both complete and incomplete healing categories are specified (Chong et al. The prognosis has been further inflated by a specific research 364 Endodontic Microbiology group, frequently reporting on the prognosis of apical microsurgery, who include teeth with "uncertain healing" in the favorable outcome or success tally (Taschieri et al. In several studies frequently cited for the prognosis of apical microsurgery, the entire cohort (Zuolo et al. In those teeth, apical periodontitis may have been sustained by bacteria colonizing apical root canal ramifications or extraradicular infection (see section 15. Accordingly, the outcome of apical surgery is better when it is preceded by orthograde retreatment (Taschieri et al. Thus, studies that include many teeth with treatment history of previous orthograde retreatment, but that do not characterize their cohorts in this regard, may overestimate the prognosis of apical surgery. Similarly to the studies on nonsurgical treatment, some differences in case selection and composition of study materials exist among the three selected current studies on apical surgery (Barone et al. To address this risk of regression, it is advisable to re-examine teeth 3 years or longer after apical microsurgery. One study consistent with the current best evidence reported better prognosis in teeth where the measured distance between the interproximal bone level and the cementoenamel junction was 3 mm (78% healed) compared to >3 mm (53% healed) (von Arx et al. This finding supported earlier observations in a rather large number of nonselected studies (Rud et al. Taken together, both higher and lower level evidence suggests that the prognosis may be compromised by considerable attachment loss of the treated tooth. Studies based on an in vivo model developed to simulate clinical conditions (Friedman et al. The reported outcomes may have varied somewhat because of differences in proportions of previously retreated teeth and in treatment procedures.
These goals are not contradictory and a thorough debridement and enlargement of the root canal lumen highly favors the chance to eliminate bacteria from the root canal prostate 41 purchase 5 mg fincar with mastercard. The use of irrigation and interappointment dressing is to further make it possible to kill, reduce, or eliminate bacteria from the root canal. There is an ongoing debate as to whether this is necessary or possible, and if this should or could be performed in one visit or if two steps or multiappointments and repeatable treatments are necessary, or at least gives a higher success rate (Molander et al. Is it restricted to future exacerbations and new acute infections, remaining symptoms, persistent lesions observed radiographically, and/or those lesions above a certain size Second, the root canal should be mechanically debrided and enlarged in a way that it can be adequately obturated with a permanent root filling. There are several reasons why it is difficult in practice to eliminate microorganisms from the root canal. Some even believe that it is impossible or doubt its importance because bacteria may be entombed and die in the filled root canal. Even if it is difficult to eliminate bacteria, this argument cannot be accepted as a reason for not trying hard enough, for doing a number of shortcuts, or even for neglecting the importance of the antimicrobial efforts. First, the importance of careful antiseptic measures in all treatment steps cannot be overestimated. It seems obvious that a rubber dam should isolate the tooth and a careful disinfection of the operative field is a must (as discussed previously) to avoid reinfection. Bacteria may penetrate, especially in long-standing infections, into the dentine tubules which makes it difficult to reach them by mechanical or chemical procedures. It is even more difficult in the teeth of older people with much hard tissue formation (calcification and secondary dentine) on the root canal walls. In the apical region, this hard tissue may give rise to a very complicated apex delta that will not be possible to reach mechanically. Bacteria could also penetrate through the apex and be present externally on the tooth, in particular after an acute infection when abscess has occurred. Bacteria may thus be present on the periapical root surface which may be difficult to reach by intracanal treatment procedures. Third, mechanically unreachable bacteria remain in niches of the root canal system forming biofilms (Nair et al. Notably, the increase of resistance against all types of antimicrobial agents should be considered.
Various methods and systems have been developed to provide effective delivery (Box 3 prostate cancer gleason score 9 5 mg fincar purchase fast delivery. They might also be indirectly involved with the transfer of irrigants within the canal spaces. Research has shown that gently moving a well-fitting gutta-percha master cone up and down in short 2- to 3-mm strokes within an instrumented canal can produce an effective hydrodynamic effect and significantly improve the displacement and exchange of any given reagent. The system has three different sizes of polymer tips that are easily attached (snap on) to a portable handpiece that creates the sonic vibrations. EndoActivator does not deliver new irrigant to the canal, but it facilitates the penetration and renewal of the irrigant in the canal [144]. Studies have indicated that the use of EndoActivator facilitates irrigant penetration and mechanical cleansing compared with needle irrigation, with no increase in the risk of irrigant extrusion through the apex [145, 146]. Ultrasonics Ultrasonic irrigation can be used as an intermittent irrigation or a continuous ultrasonic irrigation. In intermittent flushed ultrasonic irrigation, the irrigant is delivered to the root canal by a syringe needle. The irrigant is then activated with the use of an ultrasonically oscillating instrument. Ultrasonic handpieces pass sound waves to an endodontic file and cause it to vibrate at about 25,000 vibrations per second. Active ultrasonic irrigation is the simultaneous combination of ultrasonic irrigation and instrumentation. The literature indicates that it is more advantageous to apply ultrasonics after completion of canal preparation rather than as an alternative to conventional instrumentation [147,148]. Cavitation and acoustic streaming of the irrigant contribute to the biological and chemical activity for maximum effectiveness. Ultrasonic files must have free movement in the canal without making contact with the canal wall to work effectively [148]. Acoustic streaming significantly produces cleaner canals when activated with ultrasonic energy in a passive manner. The F File is a single-use plastic rotary file with a unique file design with a diamond abrasive embedded into a 80 Current therapy in endodontics nontoxic polymer. Pressure-alteration devices Positive pressure versus apical negative pressure There are two dilemmas associated with conventional syringe-needle delivery of irrigants. It is difficult for the irrigants to reach the apical portions of the canals because of air entrapment, when the needle tips are placed too far away from the apical end of the canals.
Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review androgen insensitivity syndrome hormone therapy discount fincar 5 mg mastercard. Combined apexification and orthodontic intrusion of a traumatically extruded immature permanent incisor. The radiographic outcomes of direct pulp-capping 334 Endodontic Microbiology procedures performed by dental students: a retrospective study. Enhanced removal of Enterococcus faecalis biofilms in the root canal using sodium hypochlorite plus photon-induced photoacoustic streaming: an in vitro study. Root resorption associated with orthodontic force in inbred mice: genetic contributions. Identification of hard tissue after experimental pulp capping using dentin sialoprotein (dsp) as a marker. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Adult mesenchymal stem cells: characterization, differentiation, and application in cell and gene therapy. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol Pulp capping of carious exposures: treatment outcome after 5 and 10 years-a retrospective study. Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/ revitalization. A histological study of the periapical tissues of incompletely formed pulpless teeth filled with calcium hydroxide. The in vivo evaluation of hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars. A scanning electron microscopic evaluation of human dentinal tubules according to age and location. Apexification of immature teeth with calcium hydroxide or mineral trioxide aggregate: systematic review and meta-analysis. Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift. Capping of the dental pulp mechanically exposed to the oral microflora: a 5 week observation of wound healing in the monkey. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha: a retrospective clinical study. Pulp reactions to exposure after experimental crown fractures or grinding in adult monkeys.
Sinikar, 40 years: However, in the nonimmunized control monkeys this capsule was not formed, the inflammatory cells were spread deeper in the tissues including the bone (osteitis), and the radiographic lesions were more diffuse and sometimes not detectable. Although triple antibiotic paste has been shown to be effective in controlling bacterial infection in vitro (Hoshino et al. Children: 70 mg/kg (maximum 5 g) In isoniazid overdose, pyridoxine can be given in an amount equal to the dose of isoniazid ingested. As a consequence of these factors, phenotype-based identification does not always allow an unequivocal identification.
Dan, 33 years: In these scenarios, time is of the essence - immediate intervention is required if any signs of life are present. The second incision is depicted in the middle image, and it extends from the base of the first incision to the crest of alveolar bone, creating a split-thickness flap in this area. There is an ongoing discussion as to if and when these lesions should be retreated. Thus any errors during diagnosis (false diagnosis) can result in accidental removal of the dental pulp.
Domenik, 61 years: Radial land (number and type of working surfaces) Another critical design feature in rotary instruments is the concept of radial land. Streptococci and lactobacilli have been generally regarded as important microorganisms of dental plaque (Loesche 1986), while Candida is believed to be present temporarily as harmless saprophytic microorganisms. This facilitates looking directly down on the tooth at a right angle to the long axis of the tooth. Consequently, the endodontic microbiota has been refined and redefined by molecular methods.
Umbrak, 24 years: One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. This organism was not found in any of the nondiseased aorta specimens that were used as controls (Okuda et al. The apical fragment usually remains in its original position while the coronal fragment is displaced. The topical antimicrobial used on root dentin can interact with the organic and 290 Endodontic Microbiology inorganic constituents of the dentin matrix, resulting in a buffering effect.
Rathgar, 37 years: Among the various techniques for removal, ultrasound used in association with the surgical microscope has a high profile. However, the importance of the lamina dura in defining an endodontic lesion has been questioned (Ricucci et al. The new generation of balanced solutions (eg, Normosol and Plasma-Lyte) deploys alternative metabolizable anions such as lactate, acetate, and gluconate to 163 maintain electroneutrality. Diagnosis, Epidemiology, and Global Impact of Endodontic Infections 13 Sensitivity testing by temperature or electrical pulses can give reasonably accurate assessment of nerve tissue activity in the pulp, but relating such recordings to the degree of pulpal inflammation is difficult considering the large variation in such measurements and their dependence on other clinical parameters associated with the tooth (Fischer et al.
Tom, 25 years: Moreover, in the clinical situation, tissue fluids and exudate can seep into the canal and comprise the main sustainable source of nutrients to intraradicular bacteria. This vital sign is best measured by auscultation or by palpating the umbilicus or the brachial artery. The demineralizing agent in the irrigant solution is expected to contribute towards debris and smear layer removal, while the broad-spectrum antibiotic provides the antimicrobial properties for the solution. History and Physical Examination In many cases, the most valuable information comes from those who observed an allergic event from its onset.
Gunnar, 59 years: Normotension should not be interpreted as a reliable indicator of normal perfusion. An in vitro study has shown that heating of sodium hypochlorite (20 C to 45 C) produced a 100-fold increase in bacterial killing (Sirtes et al. The use of vasoactive agents via peripheral intravenous access during transport of critically ill 858 infants and children. Infections associated with ventricular assist devices: epidemiology and effect on prognosis after transplantation.
Bram, 56 years: Thus, the instrument can be removed, minimizing damage to the surrounding dentin [28, 29] and also preventing root perforations, steps, zips, and even root fractures. In order for this to happen in uninjured tissue, the temperature gradient needs to diffuse from the mineralized tissues and reach C-fibers at a noxious levels sufficient for activating these high threshold fibers. Whole body imaging in blunt multisystem trauma patients without signs of injury: results of a prospective study. Binding of streptococci of the mutans group to type 1 collagen associated with apatitic surfaces.
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