In vitro study on cyclic fatigue resistance of three types of nickel titanium files in preparation for bending root canals / 口腔疾病防治

Objective@#The purpose of this study was to investigate the differences in the anti cyclic fatigue performance of Woride KS (WKS), Proteper Gold (PTG), and Hyflex CM (HCM) nickel titanium instruments with different tip diameters in curved root canal models, and to provide reference for the targeted selection of suitable nickel titanium instruments in clinical preparation of curved root canals.

Anatomía de la cámara pulpar y sistema de conductos radiculares: Estrategias pedagógicas unarevisión de literatura / Anatomy of the pulp chamber and the root canal system: Pedagogical strategiesAliterature review

Antecedentes: El conocimiento anatómico de la cámara pulpar y del sistema de conductos radiculareses fundamental para el correcto diagnóstico y planificación del tratamiento en endodoncia. Las herramientas pedagógicasdirigidasa los estudiantes de odontologíacomo apoyo en los procesos formativosde la asignatura de endodoncia favorecen la apropiación del conocimiento e identificación de las variantes morfológicas del sistema de conductos radiculares, que permiten al estudiantela integración del conocimiento. Objetivo:Identificar mediante una revisión de la literatura las estrategias pedagógicas que se utilizan para la enseñanza de morfología del sistema de conductos radiculares en endodoncia. Materiales y métodos: Se realizó una búsqueda bibliográfica de estudios originales en las bases de datos Medline (Pubmed), SciELO, Lilacs, Medline (Ovid), Web of science, Scopus, Embase, Google académico, eligiendo estudios publicadosa partir del año 2010 al 2022, para la selección de los artículos definitivos se seleccionaron estudios concernientes a procesos pedagógicos en endodoncia, excluyendo así otros tipos de enfoques en el área de odontología. Resultados: Se identificaron un total de 63 referencias, los cuales fueron analizados y seleccionados16, siendo excluidos 47 por no cumplir los criterios de inclusión. Conclusión: El uso de herramientas pedagógicas virtuales, didácticas y tecnológicas propician un efecto positivo en el estudiante de pregrado de odontología durante el aprendizaje de anatomía de sistemas de conductos radiculares que aumentan la confianza y seguridad al momento de realizar un tratamiento endodóntico en pacientes

Background: Anatomical knowledge of the pulp chamber and the root canal system is essential for correct diagnosis and treatment planning in endodontics. The pedagogical tools aimed at dental students as support in the training processes of the endodontics subject favor the appropriation of knowledge and identification of the morphological variants of the root canal system, which allow the student the integration of knowledge. Objective: To identify, through a review of the literature, the pedagogical strategies used to teach morphology of the root canal system in endodontics. Materials and methods: A bibliographic search of original studies was carried out in the Medline (Pubmed), SciELO, Lilacs, Medline (Ovid), Web of Science, Scopus, Embase, and Google academic databases, choosing studies published from 2010 to 2022. , for the selection of the definitive articles, studies concerning pedagogical processes in endodontics were selected, thus excluding other types of approaches in the area of dentistry. Results: A total of 63 references were identified, 16 of which were analyzed and selected, 47 being excluded for not meeting the inclusion criteria. Conclusion: The use of virtual, didactic and technological pedagogical tools favor a positive effect on the dentistry undergraduate student while learning the anatomy of root canal systems that increase confidence and security when performing endodontic treatment in patients.

Cone beam computed tomography study on the root and root canal morphology of mandibular first permanent molars in a Tibetan population / 口腔疾病防治

Objective @#To investigate and analyze the root and root canal morphology of mandibular first molars (MFMs) in the Tibetan population using cone-beam computed tomography (CBCT) and to provide references for clinical root canal treatment in the Tibetan population. @*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. CBCT imaging data of 300 mandibular first molars from 300 Tibetan patients were included. Patient age, the number of roots in mandibular first molars were recorded. The morphology and incidence of mesial root and mesial root canals and the morphology and incidence of distal root and distal root canals were statistically analyzed by Vertucci classification. @*Results @#There were 198 double-root teeth and 102 three-root teeth in the 300 mandibular first permanent molars. Among the three-rooted molars, 1 case had mesiolingual roots, and the rest had distolingual roots. The incidence rate of the distolingual root was 33.7%(101/300). The most common root canal configuration was Vertucci Ⅳ 65.7% (197/300), followed by Vertucci Ⅱ 20.3% (61/300) in the mesial roots. The overall incidence of middle mesial canals (MMCs) was 6% (18/300), with the highest incidence of MMCs in the 20-40 year-old group at 9% (9/100). The distal roots canals of single-distal-rooted mandibular first molars were mainly Vertucci Ⅰ 66.8% (133/199), followed by Vertucci Ⅱ 14.6% (29/199) and Vertucci Ⅳ 11.6% (23/199). For the mandibular first permanent molars with two distal roots, 96% (97/101) of the distal buccal roots and 100% (101/101) of the distal lingual roots were Vertucci Ⅰ root canals. @*Conclusion@# The root and root canal morphology of mandibular first permanent molars in a Tibetan population is complex and variable. Approximately one-third of patients have distolingual roots, and clinicians should carefully explore the root canals under the guidance of CBCT.

Análise comparativa das características composicionais, técnicas e comerciais dos cimentos endodônticos obturadores à base de silicato de cálcio / Comparative analysis of compositional, technical and commercial characteristics of calcium silicate-based endodontic root canal sealers

Introdução: os cimentos endodônticos obturadores à base de silicato de cálcio têm sido amplamente utilizados na endodontia, principalmente em razão de suas reconhecidas propriedades bioativas. Como consequência, uma quantidade expressiva de marcas comerciais foi lançada no mercado, dificultando a compreensão do profissional, principalmente no que diz respeito às diferentes composições químicas, apresentações, formas de uso e custo-benefício. Objetivos: o Objetivo deste trabalho foi analisar as diferenças composicionais, técnicas (indicações e apresentação comercial) e comerciais (custo e disponibilidade de venda) dos cimentos endodônticos obturadores à base de silicato de cálcio, disponíveis para uso e comercialização no Brasil. Metodologia: foi realizada uma busca sistemática no site da Anvisa, sendo identificados sete cimentos endodônticos obturadores biocerâmicos para uso no Brasil. As bulas dos produtos foram analisadas para verificação de composição, apresentação e indicação de uso. Sites especializados foram consultados para verificação de preço dos produtos. Resultados: observou-se que a composição química varia bastante, a depender do fabricante, sendo os silicatos tricálcico e dicálcico os componentes mais frequentes. A maioria dos cimentos é apresentada comercialmente pronta para uso, e possui óxido de zircônio como agente radiopacificador. A venda através de sites especializados ainda é restrita a alguns produtos, e o custo varia de acordo com a quantidade de material por embalagem. Conclusão: este trabalho apresentou as características composicionais, técnicas e comerciais de sete cimentos endodônticos obturadores à base de silicato de cálcio registrados na ANVISA e autorizados para uso no Brasil.

Introduction: calcium silicate-based endodontic sealers have been widely used in endodontics, mainly because of their recognized bioactive properties. As a result, a significant number of commercial brands were launched on the market, making it difficult for professionals their comprehension, especially with regard to different chemical compositions, presentations, forms of use and cost-effectiveness. Objective: the Objective of this work was to analyze the compositional, technical (indications and commercial presentation) and commercial (cost and availability) differences of calcium silicate-based endodontic sealers, available for use and commercialization in Brazil. Methodology: a systematic search was carried out on the Anvisa website, and seven bioceramic endodontic sealers for use in Brazil were identified. Product leaflets were analyzed to verify composition, presentation and indication of use. Specialized websites were consulted to verify the price of the products. Results: it was observed that the chemical composition varies a lot, depending on the manufacturer, with tricalcium and dicalcium silicates being the most frequent components. Most sealers are commercially available ready-to-use, and have zirconium oxide as a radiopacifying agent. The sale through specialized websites is still restricted to some products, and the cost varies according to the amount of material per package. Conclusion: this work presented the compositional, technical and commercial characteristics of seven calcium silicate-based endodontic sealers registered at ANVISA and authorized for use in Brazil.

Assessment of root canal anatomy of maxillary and mandibular canine teeth: a cone-beam computed tomography study / Evaluación de la anatomía del canal radicular de caninos maxilares y mandibulares: un estudio de tomografía computarizada de haz cónico

Abstract To investigate the root canal anatomy of permanent maxillary and mandibular canines in a Turkish subpopulation using cone beam computed tomography (CBCT). Retrospective CBCT data of 300 patients admitted to our clinic between 2016 and 2018 were screened and evaluated. A total of 235 patients, 100 males and 135 females, aged 14-76 years (mean age 37.27±13.40) were included in this study. A total of 191 (44,8%) maxillary canine teeth and 235 (55,2%) mandibular canine teeth were examined. The number of roots and root canal morphology according to Vertucci's classification, the presence of accessory canals, and the position of the apical foramen of the root were analyzed. The effect of gender and age on the incidence of root canal morphology was also investigated. The majority of the teeth had a Type I canal configuration in both maxillary canines (100%) and mandibular canines (92,8%). In the mandibular canines the other canal patterns found were Type III (6,8%), and Type II (0,4%). Apical foramen was centrally positioned in the majority of the teeth, 70,2% and 66,8% in maxillary and mandibular canines, respectively. The occurrence of two roots in mandibular canines was 3,8% and the root canal separation was found 53,8% and 46,2% in the middle and cervical third of the root, respectively. No significant statistical difference was observed effect of gender and age on the incidence of the root canal morphology and the position of the apical foramen. Due to the diverse morphology and the potential presence of a second canal for canine teeth among the Turkish subpopulation, dentists should perform endodontic treatments with greater care. CBCT is an accurate tool for the morphological assessment of the root canals.

Resumen Investigar la anatomía del conducto radicular de los caninos maxilares y mandibulares permanentes en una subpoblación turca utilizando la tomografía computarizada de haz cónico (CBCT). Se examinaron y evaluaron los datos CBCT retrospectivos de 300 pacientes ingresados en nuestra clínica entre 2016 y 2018. Un total de 235 pacientes, 100 hombres y 135 mujeres, de entre 14 y 76 años (edad media de 37,27±13,40) fueron incluidos en este estudio. Se examinaron un total de 191 (44,8%) dientes caninos maxilares y 235 (55,2%) dientes caninos mandibulares. Se analizó el número de raíces y la morfología del conducto radicular según la clasificación de Vertucci, la presencia de conductos accesorios y la posición del foramen apical de la raíz. También se investigó el efecto del sexo y la edad en la incidencia de la morfología del conducto radicular. La mayoría de los dientes tenían una configuración de conductos de tipo I tanto en los caninos maxilares (100%) como en los caninos mandibulares (92,8%). En los caninos mandibulares los otros patrones de conductos encontrados fueron el Tipo III (6,8%) y el Tipo II (0,4%). El foramen apical estaba situado en posición central en la mayoría de los dientes, 70,2% y 66,8% en los caninos maxilares y mandibulares, respectivamente. La ocurrencia de dos raíces en los caninos mandibulares es del 3,8% y la separación del conducto radicular se encontró en el tercio medio y cervical de la raíz en el 53,8% y el 46,2%, respectivamente. No se observó ninguna diferencia estadística significativa en el efecto del sexo y la edad sobre la incidencia de la morfología del conducto radicular y la posición del foramen apical. Debido a la diversa morfología y a la posible presencia de un segundo conducto en los dientes caninos entre la subpoblación turca, los odontólogos deberían realizar los tratamientos endodónticos con mayor cuidado. La CBCT es una herramienta precisa para la evaluación morfológica de los conductos radiculares.

Bioactivity and biocompatibility of bioceramic sealers in endodontics: an integrative review

Introduction: Bioceramic sealers have been gaining prominence in endodontics, meaning a great advance for endodontic therapy, mainly due to their biocompatibility and bioactivity. Objectives: research and discuss the literature about the bioactivity and biocompatibility of bioceramic sealants. Materials and methods: An integrative review was performed. The systematic plan consisted of four steps. In the first stage, a bibliographic survey was carried out in the Capes Periódicos Portal database. The search criteria were articles published between 2017 and 2022, found in the "advanced search" mode, using cross-references with the following keywords: bioceramics sealers AND endodontology AND root canals AND endodontic sealer AND bioactivity AND biocompatibility. Only documents found and published in full were evaluated. In the second stage, the titles and abstracts of the articles were read. In the third stage, a selection was made of those containing 3 to 5 keywords and a wording equal to or close to the proposed keywords. The fourth step consisted of reading the texts in full, followed by checking for duplicity and building a table with the collected information. Results: In view of the research carried out, 23 articles were obtained in the first stage. After reading the titles and abstracts, 21 articles were obtained. After selecting those containing 3 to 5 keywords, 10 articles met the criteria. One article was deleted due to duplicates. 9 articles met the exclusion and inclusion criteria and were selected to be part of the integrative review. Discussion: The selected studies in this literature review showed that bioceramic endodontic sealants perform well in endodontic therapy. Conclusion: To advance in its clinical application, more in vivo and in vitro studies with precise methods are needed to obtain more reliable data about its properties.

Evaluation of the vestibulo-ocular reflex in patients with chronic otitis media / Avaliação do reflexo vestíbulo-ocular em pacientes com otite média crônica

Abstract Introduction In recent years, scientific evidence has shown that chronic otitis media may cause balance and vestibular dysfunction. Objective To compare the results of the video head impulse test (gain and symmetry of the vestibulo-ocular reflex and presence of covert and overt saccades) in patients with chronic otitis media and controls. Methods Cross-sectional study of patients with chronic otitis media (study group), aged between 18 and 60 years. The patients in the study group were further divided according to the chronic otitis media type as (1) non-suppurative, (2) suppurative, and (3) cholesteatomatous. For the comparative analysis, we selected volunteers with no history of ear and vestibular diseases (control group), who met the same inclusion and exclusion criteria as the study group. Patients in both groups underwent a video head impulse test. Results The study group consisted of 96 volunteers, and the control group of 61 individuals. The prevalence of vestibular symptoms was 66% in the study group and 3.2% in the control group (p< 0.001). The results show a higher prevalence of changes in the vestibulo-ocular reflex gain (22.9%) and corrective saccades (12.6%) in the chronic otitis media group compared to the control group (p< 0.001). Despite the higher prevalence of changes in gain, the average vestibulo-ocular reflex gains in the chronic otitis media groups were within the pre-defined values ​​of normality; however, the mean vestibulo-ocular reflex gain in the anterior semicircular canal was statistically worse in the cholesteatomatous chronic otitis media group compared to controls (p< 0.001). Regarding the corrective saccades, the prevalence of saccades was statistically higher in the suppurative and cholesteatomatous chronic otitis media subgroups compared to the non-suppurative and control groups (p= 0.004). Conclusion The present study demonstrated that chronic otitis media is associated with a higher prevalence of vestibular symptoms and also a higher prevalence of changes in gain and corrective saccades when compared to controls.

Resumo Introdução Nos últimos anos, evidências científicas demonstraram que a otite média crônica se associa a alterações de equilíbrio e disfunção vestibular. Objetivo Comparar os resultados do teste do impulso cefálico por vídeo (ganho e simetria do reflexo vestíbulo-ocular e presença de sacadas cobertas e descobertas) em pacientes com otite média crônica e controles. Método Estudo transversal que envolveu pacientes com otite média crônica (grupo de estudo), entre 18 a 60 anos. Os pacientes no grupo estudo ainda foram divididos de acordo com o tipo de otite média crônica em (1) não supurativa, (2) supurativa e (3) colesteatomatosa. Para análise comparativa, selecionamos voluntários sem história de doenças otológicas e vestibulares (grupo controle), que obedeceram aos mesmos critérios de inclusão e exclusão do grupo de estudo. Os pacientes de ambos grupos foram submetidos ao teste de impulso cefálico por vídeo. Resultados O grupo estudo foi composto por 96 voluntários e o grupo controle por 61 indivíduos. A prevalência de sintomas vestibulares foi de 66% no grupo de estudo e 3,2% no grupo controle (p < 0,001). Os resultados mostram maior prevalência de alterações do ganho do reflexo vestíbulo-ocular (22,9%) e de sacadas corretivas (12,6%) no grupo otite média crônica em comparação ao grupo controle (p < 0,001). Apesar da maior prevalência de alterações de ganho, a média dos ganhos do reflexo vestíbulo-ocular dos grupos de otite média crônica estava dentro dos valores pré-definidos de normalidade; porém, a média do ganho do reflexo vestíbulo-ocular no canal semicircular anterior foi estatisticamente pior no grupo otite média crônica colesteatomatosa em comparação aos controles (p< 0,001). Em relação às sacadas corretivas, a prevalência de sacadas foi estatisticamente maior nos subgrupos otite média crônica supurativa e colesteatomatosa em comparação aos grupos não supurativa e controle (p = 0,004). Conclusão A otite média crônica se associa à maior prevalência de sintomas vestibulares e também maior prevalência de alterações no ganho e de sacadas corretivas em comparação a controles.

Prevalence and C-shaped root canal configuration in lower molars in the metropolitan region, Chile / Prevalencia y configuración de conductos en C en molares inferiores de la región metropolitana, Chile

Objetive: The aim of this study was to determine the prevalence, demographics, and root configuration of C-shaped canals of mandibular molars by means of cone beam computed tomography in the population of the Metropolitan Region, Chile. Material and Methods: 912 molars (456 first and 456 second molars) resulting from the analysis of 228 mandibular CT scans were evaluated. The root configuration was established by means of a panoramic reconstruction and axial tomographic sections, classifying the presence and type of canals through the analysis of five sections or cuts along the root. Data were statistically analyzed using a 5% confidence interval. Results: Of the 912 molars analyzed, 70 were classified as C-shaped canals (7.68%), corresponding to 58.33% of those molars that presented fused roots. 95.7% of this root canal configuration was observed in lower second molars, occurring more frequently in females (n=45, 64.29%). 45.65% of the cases that presented C-shaped canals were bilateral and the most frequent configuration was C3 (n=401, 66.63%) according to the Melton classification.Conclusion: The C-shaped canals of the mandibular molars in the studied population were observed mainly in second molars, showing a clear prevalence among females and a high percentage of bilaterality. The presence of fused roots significantly increases the possibility of finding this type of root configuration.

Objetivo: El objetivo del presente estudio fue determinar, por medio de tomografía computarizada de haz cónico, la prevalencia, demografía y configuración radicular de los conductos en forma de C de molares inferiores en la población de la Región Metropolitana, Chile. Material y Métodos: 912 molares (456 primeros y 456 segundos molares) resultantes del análisis de 228 tomografías mandibulares fueron evaluados. Mediante una reconstrucción panorámica y cortes tomográficos axiales se estableció la configuración radicular, clasificando la presencia y tipo de conducto por medio del análisis de 5 cortes a lo largo de la raíz. Los datos fueron analizados estadísticamente con un intervalo de confianza del 5%. Resultados: De los 912 molares analizados, 70 fueron clasificados como conductos en forma de C (7.68%), correspondiendo al 58.33% de aquellos molares que presentaron raíces fusionadas. El 95.7% de esta configuración de conductos fue observada en segundos molares inferiores, presentándose con mayor frecuencia en mujeres (n=45, 64.29%). El 45.65% de los casos que presentaron conductos en C se manifestaron bilateralmente y la configuración más frecuente observada fue la C3 (n=401, 66.63%) según la clasificación de Melton. Conclusión: Los conductos en forma de C de los molares mandibulares en la población estudiada fueron observados principalmente en segundos molares, marcando una clara predilección por el sexo femenino y un alto porcentaje de bilateralidad. La presencia de raíces fusionadas aumenta significativamente la posibilidad de encontrar este tipo de configuración radicular.

Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo / Características clínicas de pacientes com vertigem posicional paroxística benigna multicanal

Abstract Introduction Multi-canal benign paroxysmal positional vertigo is considered to be a rare and controversial type in the new diagnostic guidelines of Bárány because the nystagmus is more complicated or atypical, which is worthy of further study. Objective Based on the diagnostic criteria for multi-canal benign paroxysmal positional vertigo proposed by International Bárány Society, the study aimed to investigate the clinical characteristics, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo. Methods A total of 41 patients with multi-canal benign paroxysmal positional vertigo were included and diagnosed by Roll, Dix-Hallpike and straight head hanging tests. Manual reduction was performed according to the involvement of semicircular canals. Results Among the 41 cases, 19 (46.3%) patients showed vertical up-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with posterior-horizontal canal. 11 (26.8%) patients showed vertical up-beating nystagmus with torsional component on one side and vertical down-beating nystagmus with or without torsional component on the other side during Dix-Hallpike test or straight head hanging test and were diagnosed with posterior-anterior canal benign paroxysmal positional vertigo 9 (26.8%) patients showed vertical down-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with anterior-horizontal canal 2 (4.9%) patients showed vertical geotropic torsional up-beating nystagmus on both sides and were diagnosed with bilateral posterior canal benign paroxysmal positional vertigo. High correlation between the sides with reduced vestibular function or hearing loss and the side affected by Multi-canal benign paroxysmal positional vertigo was revealed (contingency coefficient = 0.602, p = 0.010). During one-week follow up, nystagmus/vertigo has been significantly alleviated or disappeared in 87.8% (36/41) patients. Conclusion Posterior-horizontal canal benign paroxysmal positional vertigo was the most common type. Multi-canal benign paroxysmal positional vertigo involving anterior canal was also not uncommon. Caloric tests and pure tone audiometry may help in the determination of the affected side. Manual reduction was effective in most of Multi-canal benign paroxysmal positional vertigo patients.

Resumo Introdução A vertigem posicional paroxística benigna multicanal é considerada um tipo raro e controverso nas novas diretrizes de diagnóstico da Bárány Society, porque o nistagmo é mais complicado ou atípico, o que é digno de mais estudos. Objetivo Com base nos critérios diagnósticos para a vertigem posicional paroxística benigna multicanal proposta pela International Bárány Society, o estudo teve como objetivo investigar as características clínicas, o diagnóstico e o tratamento da vertigem posicional paroxística benigna multicanal. Método Foram incluídos 41 pacientes com vertigem posicional paroxística benigna multicanal e diagnosticados pelo teste de Dix-Hallpike, roll test ou e teste straight head hanging A redução manual foi feita de acordo com o envolvimento dos canais semicirculares. Resultados Entre os 41 casos, 19 (46,3%) pacientes apresentaram nistagmo de batimento ascendente vertical com ou sem componente de torção e nistagmo horizontal apogeotrópico e geotrópico e foram diagnosticados com vertigem posicional paroxística benigna de canal horizontal-posterior. Onze (26,8%) pacientes apresentaram nistagmo vertical de batimento ascendente com componente de torção de um lado e nistagmo vertical de batimento descendente com ou sem componente de torção do outro lado durante o teste de Dix-Hallpike ou teste straight head hanging e foram diagnosticados com vertigem posicional paroxística benigna do canal posterior-anterior. Nove (26,8%) pacientes apresentaram nistagmo vertical com batimento descendente com ou sem componente de torção e nistagmo horizontal apogeotrópico e geotrópico e foram diagnosticados com vertigem posicional paroxística benigna de canal anterior-horizontal. Dois (4,9%) pacientes apresentaram nistagmo de torção geotrópico vertical de batimento ascendente em ambos os lados e foram diagnosticados com vertigem posicional paroxística benigna de canal posterior bilateral. Foi revelada alta correlação entre os lados com função vestibular reduzida ou perda auditiva e o lado afetado pela vertigem posicional paroxística benigna multicanal (coeficiente de contingência = 0,602, p = 0,010). Durante o seguimento de uma semana, o nistagmo/vertigem foi significativamente aliviado ou desapareceu em 87,8% (36/41) dos pacientes. Conclusões A vertigem posicional paroxística benigna de canal horizontal e posterior foi o tipo mais comum. A vertigem posicional paroxística benigna multicanal que envolveu canal anterior também não foi incomum. Testes calóricos e audiometria tonal pura podem ajudar na determinação do lado afetado. A redução manual foi eficaz na maioria dos pacientes com vertigem posicional paroxística benigna multicanal.

Guided endodontic access of severe calcified tooth without incisal edge ­ case report / Acesso endodôntico guiado de dente calcificado severamente sem borda incisal ­ relato de caso

Pulp tissue may suffer calcification because of trauma, operative procedures or carious lesions. This paper aimed to report and discuss the guided endodontic access as an alternative treatment. A 52 years old female patient had severe root canal calcification of tooth #11 associated with a radiolucent periapical lesion. Firstly, the crown and metal post and core were removed. A digital impression and cone-beam computed tomography "CBCT" scans were performed and imported to implant planning software (SimPlant Version 11; Materialise Dental, Leuven, Belgium).The guided endodontic access template was designed to allow the drill to reach a distance of 2 mm short of the apical foramen, once printed, it was tested in the mouth to evaluate its insertion and stability in the dental arch. The calcified root canal was penetrated using the access drill rotating by a low-speed hand-piece (10,000 rpm) under saline solution irrigation through advancing movements. Then, the apical foramen was negotiated with C-Pilot files #10 and #15. The working length was measured using the iPex-II apex locator. The instrumentation was carried out with Reciproc R50 and 2.5% sodium hypochlorite. One week later, a full-ceramic crown preparation was performed, and polyvinyl siloxane impression was carried out. A total of three follow-up sessions were performed after one week, one and twelve months. Bone neoformation was observed in the site of the periapical lesion and the patient had no signs or symptoms of any discomfort. Therefore, guided endodontics is indicated for severe calcified root canals.(AU)

O tecido pulpar pode sofrer calcificação por trauma, procedimentos cirúrgicos ou como resposta a lesões cariosas. Este trabalho teve como objetivo relatar e discutir o acesso endodôntico guiado como opção de tratamento. Paciente do sexo feminino, 52 anos, com calcificação severa do canal radicular do dente 11 associada a lesão periapical radiolucida. Na primeira intervenção clínica, a coroa e o pino de metal foram removidos. Uma impressão digital e imagens de CBCT foram realizadas e importadas para o software de planejamento de implante (SimPlant Versão 11; Materialize Dental, Leuven, Bélgica) tentando projetar um modelo de acesso endodôntico guiado para permitir que a broca alcance uma distância de 2 mm antes do forame apical, uma vez impresso, foi testado na boca para avaliar sua inserção e estabilidade na arcada dentária. O canal radicular calcificado foi penetrado com broca de acesso girando por peça de mão de baixa velocidade (10.000 rpm) sob irrigação com solução salina por meio de movimentos de avanço. Em seguida, o forame apical foi negociado com as limas C-Pilot nº 10 e nº 15. O comprimento de trabalho foi determinado usando o localizador de ápice iPex-II. A instrumentação foi realizada com Reciproc R50 e hipoclorito de sódio 2,5%. Uma semana depois, foi realizado o preparo da coroa total em cerâmica e a moldagem com polivinilsiloxano. Um total de três sessões de acompanhamento foram realizadas após uma semana, um e doze meses. A neoformação óssea foi observada no local da lesão periapical e a paciente não apresentava sinais ou sintomas de qualquer desconforto. Portanto, o acesso endodôntico guiado é indicado para canais radiculares calcificados severamente.(AU)

Factores asociados a falla terapéutica con maniobras de reposición canalicular en pacientes con diagnóstico de vértigo posicional paroxístico benigno en la Clínica de Otorrinolaringología de Antioquia, Medellín, Colombia / Factors associated with therapeutic failure with canalicular repositioning maneuvers in patients diagnosed with benign paroxysmal positional vertigo at Antioquia Otorhinolaryngology Clinic, Medellin, Colombia"

Introducción: múltiples factores se han relacionado con el desarrollo de la recurrencia del vértigo posicional paroxístico benigno (VPPB). Objetivo: determinar la asociación entre la falla terapéutica de las maniobras de reposición canalicular (MRC) y las variables sociodemográficas y clínicas en los pacientes con diagnóstico de VPPB. Diseño: estudio observacional de cohorte retrospectiva. Materiales y métodos: revisión de historias clínicas de la consulta de vértigo de la Clínica Orlant, Medellín, Colombia. Resultados: se incluyeron 41 pacientes con diagnóstico de VPPB a quienes se les realizó MRC y seguimiento clínico entre 1 y 8 semanas. El 90,2 % eran de sexo femenino, con una mediana de edad de 58 (±183) años; se encontró uso de vestibulosupresores en un 68,3 %, y es la betahistina el más consumido (43,9 %). El 51,2 % de pacientes presentaron falla terapéutica y se identificó una asociación con el número total de MRC realizadas y el uso de vibrador mastoideo (p < 0,001), teniendo en cuenta que los pacientes mejoraron clínicamente al final del seguimiento con una media de 77 % (p < 0,001). No se encontraron asociaciones estadísticamente significativas con el resto de variables. Conclusión: no hubo asociación entre la falla terapéutica y las variables estudiadas, excepto número de MRC, el uso del vibrador mastoideo y la mejoría clínica final, posiblemente porque el vibrador mastoideo se aplica a los pacientes en quienes hay persistencia de síntomas y signos con las maniobras desencadenantes, y por factores fisiopatológicos no esclarecidos; con esto finalmente se logra una mejoría clínica con más de dos MRC

Introduction: Multiple factors have been related to the development of recurrence of benign paroxysmal positional vertigo (BPPV). Objective: To determine the association between therapeutic failure of canalicular repositioning maneuvers (CRM) with sociodemographic and clinical variables in patients with a diagnosis of BPPV. Design: Observational retrospective cohort study. Materials and methods: Review of medical records of the vertigo clinic of the Orlant Clinic, Medellín - Colombia. Results: 41 patients with a diagnosis of BPPV who underwent CRM and clinical follow-up between 1 and 8 weeks were included. 90.2% were female, with a median age of 58 (± 18.3) years, use of vestibulosuppressants was found in 68.3%, betahistine being the most consumed (43.9%). 51.2% of patients presented therapeutic failure, identifying an association with the total number of CRMs performed and the use of a mastoid vibrator with (p < 0.001), taking into account that the patients improved clinically at the end of follow-up with a mean of 77% (p < 0.001). No statistically significant associations were found with the rest of the variables. Conclusion: There was no association between therapeutic failure and the variables studied except number of CRM, use of the mastoid vibrator and final clinical improvement, possibly because the mastoid vibrator is applied to patients in whom there are persistence of symptoms and signs with the triggering maneuvers for unclear pathophysiological factors, finally achieving clinical improvement with more than two CRMs.

Mandibular pre-molars endodontic anatomy and role in sex dimorphism for Western Asia population using CBCT 3d imaging technique / Anatomía endodóntica de premolares mandibulares y papel en el dimorfismo sexual para la población de Asia Occidental utilizando la técnica de imagen 3d CBCT

SUMMARY: Cone Beam Computerized Tomography (CBCT) imaging technique can be used for identifying the root canal anatomy and its use in determining sexual dimorphism. The aim of current study was to identify the commonly found root canal morphology and gender dimorphism for mandibular pre-molars in Western Asia population according to Vertucci's classification using CBCT 3D imaging technique. On ethical approval 470 patients from Western Asia population with intact healthy mandibular first and second pre-molars were included in the study. The selected patients were sent to radiology department of Riyadh Elm University, Saudi Arabia for CBCT images. The observations recorded included: i) number of roots; and ii) type of root canal morphology based on Vertucci's classification. All the mandibular first and second pre-molars had single root both in males and females. The type of Vertucci's classification commonly observed was Type I both in males (88.94 %) and females (100 %) in mandibular first pre-molars. Similarly Type I was identified as a common root canal configuration in mandibular second pre-molars for males (82.77 %) and females (100 %). The two canal configurations Type IV and V were only observed in the males. It can be concluded from the results mandibular first and second pre-molars in the Western Asia population are single rooted with common Vertucci's Type I canal configuration in the females with rare evidence of two canals in males. Additionally CBCT is an effective technique and should be used for detection of root canals in the mandibular pre-molars which can aid dentists in providing a successful endodontic therapy.

RESUMEN: La imagen de la tomografía computarizada de haz cónico (CBCT) se puede utilizar para identificar la anatomía del conducto radicular y para determinar el dimorfismo sexual. El objetivo del estudio fue identificar la morfología del conducto radicular y el dimorfismo de sexo, comúnmente encontrados en los premolares mandibulares en la población de Asia occidental, de acuerdo con la clasificación de Vertucci, utilizando la técnica de imágenes CBCT 3D. Tras la aprobación ética, se incluyeron en el estudio 470 pacientes de la población de Asia occidental con primeros y segundos premolares mandibulares sanos intactos. Los pacientes seleccionados fueron enviados al departamento de radiología de la Universidad de Riyadh Elm, Arabia Saudita, para las imágenes CBCT. Las observaciones incluyeron: i) número de raíces; y ii) tipo de morfología del conducto radicular según la clasificación de Vertucci. Se observó solamente una raíz en los primeros y segundos premolares mandibulares tanto en hombres como en mujeres. El tipo de clasificación de Vertucci comúnmente observado fue Tipo I tanto en hombres (88,94 %) como en mujeres (100 %) en los primeros premolares mandibulares. El Tipo I se identificó como una configuración común del conducto radicular en los segundos premolares mandibulares para hombres (82,77 %) y mujeres (100 %). Ambas configuraciones de canal Tipo IV y V solo se observaron en los varones. Se puede concluir a partir de los resultados de los primeros y segundos premolares mandibulares en la población de Asia occidental, que éstos tienen una sola raíz con una configuración de canal de Vertucci Tipo I común en mujeres con una evidencia de dos canales infrecuente en los hombres. La CBCT es una técnica eficaz y debe usarse para la detección de conduc- tos radiculares en los premolares mandibulares, lo que puede ayu- dar a los dentistas a proporcionar una terapia endodóntica exitosa.

Capacidad de sellado de los conductos laterales con distintas técnicas de obturación del conducto radicular / Sealing capacity of lateral canals with different root canal obturation techniques

Objetivo: Estimar y comparar la eficacia de diferentes técnicas de obturación para impedir el flujo de colorante a través de los conductos laterales. Materiales y métodos: Se emplearon 50 premolares inferiores extraídos y conservados en formol neutro al 5% hasta el momento de su uso, a los cuales se les realizaron conductos laterales artificiales. Una vez instrumentados los conductos principales, los dientes fueron divididos al azar en 5 grupos (n=10) para ser obturados con cuatro técnicas distintas: A) System B + inyección de gutapercha termoplástica del sistema Elements, Extruder; B) obturadores de Thermafil, ProTaper Universal; C) técnica híbrida y D) obturación con inyección de gutapercha termoplástica del sistema Elements, Extruder. Inmersos en tinta china y diafanizadas las raíces, se evaluó la longitud de penetración de la tinta en los conductos laterales. Se empleó el análisis de la varianza para detectar diferencias significativas (P<0,05) entre los niveles medios de penetración del colorante según las técnicas de obturación y las zonas del diente, y se efectuaron pruebas de rango múltiple (HSD de Tukey) para realizar comparaciones dos a dos, manteniendo fija la tasa de error por familia. Resultados: A la técnica B le correspondió el valor medio más bajo (30,63%) de penetración de tinta china. Los valores medios más elevados (54,52% y 51,74%) correspondieron a las técnicas A y C, respectivamente. Conclusión: Ninguna de las técnicas de obturación del conducto radicular empleadas ha sido capaz de impedir la filtración del colorante en los conductos laterales (AU)

Aim: To estimate and compare the different obturation techniques to avoid the flow of colorant through lateral canals. Materials and methods: 50 extracted lower premolars preserved in 5% neutral formol until the moment of use, had artificial lateral canals made. Once canals were instrumented, the teeth were randomly divided into 5 groups (n=10) to be filled with four different techniques: A) System B + injection of thermoplastic gutta-percha, Elements system, Extruder; B) Thermafil, ProTaper Universal obturators; C) hybrid technique, and D) injection of thermoplastic gutta-percha, Elements system, Extruder. Having immersed the premolars in India ink and diaphanized the roots, the penetration length of the India ink inside the canals was assessed. Analysis of variance was used to detect significant differences (P<0.05) between the mean levels of dye penetration according to the filling techniques and tooth areas, and multiple range tests (Tukey's HSD) were performed for two-to-two comparisons, keeping the error rate per family fixed. Results: Technique B had the lowest mean value (30.63%) of penetration. The highest mean values (54.52% and 51.74%) corresponded to techniques A and C, respectively. Conclusion: No obturation technique of the root canal used was able to avoid filtration of colourant in the lateral canals (AU)

Expecting The Unexpected

Report of unusual presentation of two root canals in all the mandibular anterior teeth in a single patient.Incidence of two canals in individual mandibular anterior teeth ranges from 5-37% but all six anterior teeth showing two canals is a rare finding and is seen in less then 5% of the population. We report Endodontic management of such case. Conclusion:Successful endodontic therapy of a tooth demands that a dentist should have a thorough knowledge of the root canal morphology, making it mandatory towards proper radiographic evaluation and diagnosis of the status of the pulp canals as well as periapical areas. Improper diagnostic protocol may lead to failure of Endodontic treatment. The case presented here shows successful root canal treatment of all the mandibular anterior teeth with two root canals each. The frequency of mandibular anterior teeth havingtwo root canals varies from 5% to 37 % in different populations.Pulp space anatomy of mandibular anterior teeth shows high incidence of complexity which includes variation in canal configurations, number of canals and presence of isthmus. Thorough knowledge of root canal anatomy and morphology, additional radiographs taken at different angles and correct interpretation of radiographs is mandatory

Cortical bone modifications after radiotherapy: cortex porosity and osteonal changes evaluated over time

Abstract Aiming to evaluate cortical bone microarchitecture and osteonal morphology after irradiation, twelve male New Zealand rabbits were used. The animals were divided: control group (no radiation-NIr); and 3 irradiated groups, sacrificed after: 7 (Ir7d); 14 (Ir14d) and 21 (Ir21d) days. A single radiation dose of 30 Gy was used. Computed microtomography analyzed the cortical microarchitecture: cortical thickness (CtTh), bone volume (BV), total porosity (Ct.Po), intracortical porosity (CtPo-cl), channel/pore number (Po.N), fractal dimension (FD) and degree of anisotropy (Ct.DA). After scan, osteonal morphology was histologically assessed by means: area and perimeter of the osteons (O.Ar; O.p) and of the Haversian canals (C.Ar; C.p). Microtomographic analysis were performed by ANOVA, followed by Tukey and Dunnet tests. Osteon morphology analyses were performed by Kruskal-Wallis, and test Dunn's. Cortical thickness was significant difference (p<0.010) between the NIr and irradiated groups, with thicker cortex at Ir7d (1.15±0.09). The intracortical porosity revealed significant difference (p<0.001) between irradiated groups and NIr, with lower value for Ir7d (0.29±0.09). Bone volume was lower in Ir14d compared to control. Area and perimeter of the osteons were statistically different (p<0.0001) between NIr and Ir7d. Haversian canals also revealed lower values (p<0.0001) in Ir7d (80.57±9.3; 31.63±6.5) compared to NIr and irradiated groups. Cortical microarchitecture was affected by radiation, and the effects appear to be time-dependent, mostly regarding the osteons morphology at the initial days. Cortex structure in Ir21d revealed similarities to control suggesting that microarchitecture resembles normal condition after a period.

Resumo Com o objetivo de avaliar a microarquitetura óssea cortical e a morfologia dos osteons após irradiação, foram utilizados doze coelhos machos da Nova Zelândia. Os animais foram divididos: grupo controle (sem radiação-NIr); e 3 grupos irradiados, sacrificados após: 7 (Ir7d); 14 (Ir14d) e 21 (Ir21d) dias. Foi utilizada uma dose única de radiação de 30 Gy. A microtomografia computadorizada analisou a microarquitetura cortical: espessura cortical (CtTh), volume ósseo (BV), porosidade total (Ct.Po), porosidade intracortical (CtPo-cl), número de canal/ poro (Po.N), dimensão fractal (DF) e grau de anisotropia (Ct.DA). Após a varredura, a morfologia dos osteosn foi avaliada histologicamente por meio de: Área e perímetro do osteon (O.Ar; O.p) e dos canais de Havers (C.Ar; C.p). A análise microtomográfica foi realizada por ANOVA, seguida pelos testes de Tukey e Dunnet. As análises morfológicas do osteon foram realizadas por Kruskal-Wallis e testadas por Dunn. A espessura cortical foi diferente (p<0,010) entre os grupos controle e irradiados, com córtex mais espesso no Ir7d (1,15±0,09). A porosidade intracortical revelou diferenças significativas (p<0,001) entre os grupos irradiados e o controle, com menor valor para Ir7d (0,29±0,09). O volume ósseo foi menor no Ir14d em relação ao controle. Área e perímetro do osteon foi diferente (p<0,0001) entre o controle e Ir7d. Os canais haversianos também revelaram valores mais baixos (p<0,0001) em Ir7d (80.57±9.3; 31.63±6.5) em relação ao controle e demais grupos irradiados. A microarquitetura cortical é afetada pela radiação e os efeitos parecem ser dependentes do tempo, principalmente em relação à morfologia dos osteons nos dias iniciais. A estrutura cortical em Ir21d revelou semelhanças com o controle, sugerindo que a microarquitetura se assemelha à condição normal após um período.

Micro-push-out bond strength of mineral­based root canal sealer in canals with different tapers / Fuerza de unión por micro-expulsión del sellador de conductos radiculares a base de minerales en conductos con diferentes ahusamientos

Objective: The aim of this study was to assess the micro-push-out bond strength of a mineral-based root canal sealer, BioRoot RCS in canals prepared by K3XF rotary systems of two different tapers. Material and Methods: Eighty caries free maxillary central incisors were used in this study. The samples were allocated into 4 groups (n=20) according to the root canal sealer and taper of the rotary instruments. The samples were obturated using single cone obturation technique. From each root 1mm thick slices at coronal, middle and apical thirds were collected using hard tissue microtome under continuous water coolant. Push-out tests were done for these sections using a Universal testing machine (INSTRON 8801) at a crosshead speed of 1mm/min. One-way analysis of variance (ANOVA) was used to compare the bond strengths within groups and Tukey's multiple post hoc analysis was used for pair-wise comparison of bond strengths. Results: AH Plus exhibited higher micro-push-out bond strength than BioRootRCS though they did not differ significantly (p>0.05). Preparation of root canals with 6% taper rotary instruments showed higher bond strength than 4% though they did not differ significantly (p>0.05). Conclusion: There was no significant difference between micro-push-out bond strength values of BioRoot RCS and AH Plus. The bond strength values were high in 6% taper canals than 4% canals though the difference was not significant statistically.

Objetivo: El objetivo de este estudio fue evaluar la fuerza de unión por micro-expulsión de un sellador de conductos radiculares de base mineral, BioRoot RCS, en conductos preparados por sistemas rotativos K3XF con dos conos diferentes. Material y Métodos: En este estudio se utilizaron 80 incisivos centrales superiores libres de caries. Las muestras se distribuyeron en cuatro grupos (n = 20) de acuerdo al sellador del conducto radicular y al cono de los instrumentos rotativos. Las muestras se obturaron mediante la técnica de obturación de un solo cono. De cada raíz se recogieron rodajas de 1 mm de grosor en los tercios coronal, medio y apical utilizando un micrótomo de tejido duro con refrigeración continua por agua. Posteriormente, se realizó una prueba de expulsión para estas secciones utilizando una máquina de prueba universal (INSTRON 8801) a una velocidad del cabezal transversal de 1mm/min. Se utilizó el análisis de varianza unidireccional (ANOVA) para comparar las resistencias de la unión dentro de los grupos y el análisis post hoc multiple de Tukey se utilizó para la comparación por pares de las resistencias de la unión. Resultados: AH Plus exhibió una fuerza de unión de micro-expulsión más alta que BioRootRCS, aunque no difirieron significativamente (p>0,05). La preparación de los conductos radiculares con instrumentos rotativos ahusados al 6% mostró una fuerza de unión superior al 4%, aunque no difirieron significativamente (p>0,05). Conclusión: No hubo diferencias significativas entre los valores de fuerza de unión de micro-expulsión de BioRoot RCS y AH Plus. Los valores de la fuerza de unión fueron más altos en canales cónicos al 6% que en canales al 4%, aunque la diferencia no fue significativa estadísticamente.

Clinical and radiographic examination compared to microscopic examination in the detection of anatomical features of mesiobuccal canals in maxillary first molars: a diagnostic study / Comparación entre examen radiológico y clínico con examen microscópico en la detección de características anatómicas de los canales mesiobucales en los primeros molares maxilares: un estudio diagnóstico

SUMMARY: The aim of the present study was to determine the accuracy, sensitivity, and specificity of the clinical and radiographic examination (CRE) method compared to the examination with the dental operating microscope (DOM) on the detection of anatomical features of mesiobuccal canals in maxillary first molars. One hundred maxillary first molars were selected to assess the number of canals orifice entrances, accessibility, and ending of their mesiobuccal canals using the CRE method and the examination with the DOM. The diagnostic tests of the CRE exhibited, in general, high levels of accuracy, sensitivity, and specificity. However, low levels of these outcomes occurred, mainly, on the detection of the number of canals entrance orifices of the mesiobuccal root. The statistically significant differences (p<0.05) occurred for accessibility and ending of canals in 61 of the 62 cases (out of 100) when two of them were present: 2 accessible root canals (48 cases; 77.42 %), and 1 accessible and 1 inaccessible canals (13 cases; 20.97 %); 1 foramen after fusion (18 cases; 29.03 %), 2 foramens (30 cases; 48.39 %), and 1 foramen and 1 blind foramen (13 cases; 20.97 %). This study proves that the clinical and radiographic method (still the most commonly used worldwide) can't be trusted absolutely in situations of complex internal anatomy regarding the mesiobuccal root canals of maxillary first molars.

RESUMEN: El objetivo del presente estudio fue determinar la precisión, sensibilidad y especificidad del método de examen clínico y radiográfico (ECR) en comparación al examen con el microscopio quirúrgico dental (MQD) en la detección de características anatómicas de los canales mesiovestibulares en primeros molares maxilares.Se seleccionaron 100 primeros molares maxilares para evaluar el número de entradas de los canales, la accesibilidad y la terminación de sus canales mesiovestibulares utilizando el método ECR y el examen con el MQD.Las pruebas de diagnóstico del ECR exhibieron, en general, altos niveles de precisión, sensibilidad y especificidad. Sin embargo, también hubo niveles bajos de estos resultados, principalmente, en la detección del número de orificios de entrada a los canales de las raíces mesiovestibulares. Hubo diferencias estadísticamente significativas (p<0,05) para la accesibilidad y terminación de los canales en 61 de los 62 casos (del total de 100), cuando dos de ellos estaban presentes: 2 canales radiculares accesibles (48 casos, 77,42 %), y 1 accesible y 1 inaccesible (13 casos, 20,97 %). Después de la fusión, un orificio (18 casos, 29,03 %), 2 orificios (30 casos, 48,39 %) y 1 orificio más otro, ciego (13 casos, 20,97 %). Este estudio demuestra que no se puede confiar plenamente en el método clínico y radiográfico (todavía el más utilizado en todo el mundo), cuando existe una anatomía interna compleja de los canales de la raíz mesiovestibular de los primeros molares superiores.

Impacto de la hipertensión arterial sobre la microcirculación pulpar / Impact of arterial hypertension on pulp microcirculation

Resumen Introducción: La hipertensión arterial, es una enfermedad crónica, la cual es considerada un problema de salud pública en todo el mundo. Se conoce que es causada por distintos mecanismos fisiopatológicos. De la misma forma las alteraciones pulpares son muy comunes, siendo un grupo de cuadros clínicos de origen infeccioso e inflamatorio. Objetivo: El propósito de este artículo es dar a conocer si existe algún impacto de la hipertensión arterial sobre la microcirculación pulpar. Métodos: Revisión de literatura Conclusiones: La pulpa dental no es propensa a alteraciones importantes ante fenómenos antihipertensivos.

Abstract Introduction: Hypertension, is a chronic disease, which is considered a public health problem throughout the world. It is known that it is caused by different physiopathological mechanisms. In the same way, the alterations are very common, as a group of clinical characteristics of infectious and inflammatory origin. Objective: The purpose of this article is to show if there is any impact of high blood pressure on the pulpal microcirculation. Methods: Literature Review Conclusions: The dental pulp does not develop considerable alterations when subjected to antihypertensive phenomena.

A CBCT based digital analysis of shaping ability of Max Wire® alloy file in the treatment of large and curved root canals

Aim: To evaluate the limits of the shaping ability of MaxWire® alloy file in the treatment of pre-created large and curved root canals with different apical sizes by using cone-beam computed tomography (CBCT). Materials and methods: Forty-five permanent maxillary first molars with moderately curved palatal roots (20°-30°) were divided into three groups, and large root canals were created with apical diameter #35 (Group 1), #40 (Group 2) or #50 (Group 3) by using BioRace NiTi System. Then, they were reshaped with the MaxWire alloy file, XP-endo Shaper®. Canals were scanned before and after instrumentation by using the CBCT scanner. Canal transportation (CT), centering ratio (CR), % increased prepared area (PA), and % increased prepared outline (PO) at 2, 3, and 4 mm from the apex were calculated. Data were statistically analyzed at P < 0.05. Results: There was a significant difference in the mean increase in PO in all apical sizes and all three levels. At both 3 mm and 4 mm levels the maximum PA and PO were achieved in apical size 35, while at 2 mm level the maximum values were obtained in apical size 40. There was no statistically significant difference in CT and CR within groups at 2 mm distance from the apex. Conclusion: Max Wire alloy technology of this novel instrument makes it possible to clean and touch the dentin walls of large and curved root canals. Small FOV and small voxel size of CBCT could also be used in shaping ability studies in endodontics.

Importance of Vestibulo-ocular Reflex Gain and Refixation Saccade Analysis in Individuals with Auditory Neuropathy Spectrum Disorder

Abstract Introduction Auditory neuropathy spectrum disorder (ANSD) features the presence of otoacoustic emissions, poor speech identification score and absent auditory brainstem response. Objective The present study was designed to evaluate the functioning of all six semicircular canals in individuals with ANSD and to compare it with those of normalhearing individuals. Methods A total of 50 individuals participated in the present study, in which Group I comprised25normal-hearingindividuals, and GroupII comprised25individualswithANSD. All of the participants underwent case history, pure tone audiometry, immittance, otoacoustic emissions, auditory evoked response and video head impulse test (vHIT). Results The independent sample t-test revealed significantly lower vestibulo-ocular reflex gain values in individuals with ANSD. A presence of 100% corrective refixation saccades was observed in the same group. The Pearson correlation test revealed no significant correlation between vestibulo-ocular reflex (VOR) gain with duration of hearing loss and pure tone thresholds for any of the three orthogonal planes. The chisquared test revealed no association between the VOR gain values and the presence or absence of saccades in any of the semicircular canals (p>0.05). Conclusion Huge percentages of individuals with ANSD have been found to have associated vestibular dysfunction as well. Therefore, the vHIT can be used as one of the important tests of the vestibular test battery to evaluate all six semicircular canals in individuals with ANSD.