Evaluación de la filtración apical al utilizar dos selladores biocerámicos / Evaluation of apical leakage when using two bioceramic sealers

Objetivo: Evaluar con técnica de diafanización el gra-do de filtración apical al utilizar dos selladores bio-cerámicos y la técnica de cono único con taper ex vivo. Materiales y métodos: Se utilizaron 60 premola-res inferiores humanos uniradiculares extraídos. La instrumentación se realizó con lima Primary 25/.07 (WaveOne Gold, Dentsply Maillefer), según protocolo del fabricante. Se irrigó con NaOCl 2,5% y EDTAC 17%. Para la obturación, la muestra se dividió aleatoria-mente en 4 grupos (n=15). Grupo 1: Cono único y Bio C Sealer. Grupo 2: Cono único y MTA Fillapex. Grupo control negativo: no se obturó. Grupo control positi-vo: Cono único y AH Plus. En todas las muestras se aplicaron dos capas de esmalte para uñas en toda la superficie dentaria con excepción del tercio apical y del grupo control positivo, que se esmaltó en su tota-lidad. Medio de filtración: tinta china negra por difu-sión pasiva. Se diafanizó con técnica de Robertson. Se usó programa AutoCad 2022, para medir filtración en milímetros lineales. Los datos se analizaron me-diante prueba de Kruskal-Wallis seguida por compa-raciones post hoc empleando el método de Conover (p<0,05, significativo). Resultados: La filtración con Bio C Sealer, MTA Fillapex, control negativo y control positivo tuvo una media (mínimo-máximo) de 0 (0-2), 1 (0-3), 6 (2-12) y 0 (0-0); sin diferencias significativas entre Bio C Sealer y MTA Fillapex (p>0,05), ni entre Bio C Sealer y control positivo (p>0,05); pero con di-ferencias significativas entre MTA Fillapex y control positivo (p<0,05), y entre control negativo y cual-quiera de los otros tres grupos (p<0,05). Conclusión: La obturación con Bio C Sealer lograría un nivel de sellado similar al que se obtiene con el control po-sitivo; mientras que la obturación con MTA Fillapex produciría un sellado ligeramente menos efectivo que el control positivo. Sin embargo, la filtración no variaría sustancialmente entre obturaciones con Bio C Sealer y MTA Fillapex (AU)

Objective: To evaluate the degree of apical filtration with diaphanization technique, using two bioceramic sealers and single cone technique with taper, ex vivo. Materials and methods: 60 extracted single-root human mandibular premolars were used. The instrumentation was carried out with primary file 25/.07 (WaveOne Gold, Dentsply Maillefer), according to the manufacturer's protocol. Irrigation was done with 2.5% NaOCl and 17% EDTAC. For obturation, the sample was randomly divided in 4 groups (n=15). Group 1: Single cone and Bio C Sealer. Group 2: Single cone and MTA Fillapex. Negative control group: it was not obturated. Positive control group: Single cone and AH Plus. In all samples, two layers of nail polish were applied to the entire tooth surface with exception of apical third and the positive control group, which was completely glazed. Filtration medium: black Chinese ink by passive diffusion. It was diaphanized with Robertson technique. AutoCad 2022 program was used to measure filtration in linear millimeters. Data were analyzed using Kruskal-Wallis test, followed by post hoc comparisons using Conover method (p < 0.05, significant). Results: Filtration with Bio C Sealer, MTA Fillapex, negative control and positive control had a mean (minimum-maximum) of 0 (0-2), 1 (0-3), 6 (2-12) and 0 (0-0); no significant differences between Bio C Sealer and MTA Fillapex (p > 0.05), nor between Bio C Sealer and positive control (p > 0.05); but with significant differences between MTA Fillapex and positive control (p < 0.05), and between negative control and any of the other three groups (p < 0.05). Conclusion: Obturation with Bio C Sealer would achieve a level of sealing similar to obtained with the positive control; while obturation with MTA Fillapex would produce a slightly less effective seal than the positive control. However, filtration would not vary substantially between fillings with Bio C Sealer and MTA Fillapex (AU)

Avances en endodoncia regenerativa: reporte de caso con uso de la membrana amniótica humana / Advances in regenerative endodontics: report of a case using a human amniotic membrane

Los procedimientos endodónticos regenerativos (REPs) representan una evolución significativa en el campo de la endodoncia, buscando no sólo tratar la infección o lesión presente en el diente, sino tam-bién promover la regeneración de los tejidos denta-rios afectados. El presente caso clínico muestra un incisivo lateral superior izquierdo con apexogénesis incompleta y diagnóstico de absceso alveolar crónico reagudizado en una paciente de 22 años, en el que se aplicó un procedimiento de endodoncia regenerativa (REPs). La estrategia terapéutica elegida se basó en los principios de ingeniería tisular, incorporando la novedosa aplicación de la membrana amniótica hu-mana liofilizada esterilizada como andamio bioactivo intraconducto. Las evaluaciones clínicas, radiográ-ficas y tomográficas a corto, mediano y largo plazo revelaron el éxito de la terapia. La resolución exitosa mostró en los controles a la pieza dentaria asintomá-tica, con una notable remisión de la patología apical, aumento de la longitud radicular y disminución del calibre apical. Se ha podido destacar la eficacia de los REPs, con una exitosa aplicabilidad de la membra-na amniótica como andamio innovador (AU)

Regenerative endodontic procedures (REPs) represent a significant evolution in the field of endodontics, aiming not only to address the infection or injury within the tooth, but also to promote the regeneration of the affected dental tissues. In this clinical case, an upper left lateral incisor with incomplete apexogenesis and diagnosis of acute exacerbation of a chronic periapical lesion in a 22-year-old patient is presented. A regenerative endodontic procedure (REPs) was applied. The chosen therapeutic strategy was based on tissue engineering principles, incorporating the innovative use of sterilized lyophilized human amniotic membrane as an intraconduct bioactive scaffold. Clinical, radiographic, and tomographic assessments at short, medium, and long-term follow-up revealed the success of the therapy. Successful resolution demonstrated an asymptomatic tooth in the follow-up, with a notable resolution of apical pathology, increased root length, and decreased apical caliber. The effectiveness of REPs has been highlighted, demonstrating the successful applicability of amniotic membrane as an innovative scaffold (AU)

Evaluation of the treatment effect on sinus elevation and implant restoration in cases with odontogenic maxillary sinusitis after tooth extraction / 口腔疾病防治

Objective@#To investigate the clinical effects of sinus elevation surgery and implant restorationdue to insufficient bone massafter tooth extraction in patients with odontogenic maxillary sinusitis (OMS) and to provide a reference for use in clinical practice.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-five teeth were extracted from patients with OMS in the maxillary posterior area (the study group). Sinus elevation and implantation were performed due to insufficient bone height in the implant area 6-8 months after tooth extraction in the study group. Forty-eight teeth were extracted from patients without "OMS" in the maxillary posterior area (the control group), and sinus elevation and implantation were performed due to insufficient bone height in the implant area 6-8 months after tooth extraction inthe control group. In the study group, 13 cases of discontinuous maxillary sinus floor bone and residual alveolar bone height of the maxillary sinus floor less than 4 mm were addressed with lateral wall sinus elevation, and the other 32 cases were addressed with crest-approach sinus elevation. In the control group, 8 cases of residual alveolar bone height less than 4 mm in the maxillary sinus floor were addressed with lateral wall sinus,and the other 40 cases were addressed with crest approach sinus elevation. Restorations were placed 6 to 8 months after surgery. The patients were followed up 21 days, 3 months, and 8 months after implantation and every 6 months after the placement of the restorations. The sinus bone gain (SBG), apical bone height (ABL) and marginal bone loss (MBL) were statistically analyzed 24 months after the restoration.@*Results@#The average preoperative mucosal thickness in the 45 patients in the study group was (1.556 ± 0.693) mm, which was significantly larger than that in the control group (1.229 ± 0.425) mm (P<0.001). There were no perforations in either group. Twenty-four months after restoration, there was no significant difference in the SBG, ABH or MBL between the two groups (P>0.05).@*Conclusion@#After the extraction of teeth from patients with OMS, the inflammation of the maxillary sinus decreased, and the bone height and density in the edentulous area were restored to a certain degree. The effects of sinus floor lifting surgery and implant restoration do not differ between patients with and without OMS.

Role of apical sodium-dependent bile acid transporter in hepatobiliary diseases / 临床肝胆病杂志

Apical sodium-dependent bile acid transporter （ASBT） is a key transporter responsible for intestinal reabsorption of bile acid and plays an important role in maintaining bile acid and cholesterol homeostasis， and its expression is regulated by various factors including transcription factors， nuclear receptors， and intestinal microflora. The abnormal expression and function of ASBT can lead to disorders in the metabolism of bile acid and cholesterol， causing a variety of hepatobiliary diseases. At present， ASBT has attracted wide attention as a therapeutic target. This article elaborates on the biological characteristics and expression regulation mechanism of ASBT and reviews the role of ASBT in hepatobiliary diseases， in order to provide a new direction for the treatment of related diseases.

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases / 口腔疾病防治

@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

Influence of sealer type on treatment outcome of teeth with apical periodontitis: a systematic review

Abstract The purpose of this article was to Evaluate the influence of sealer on the outcome of non-surgical endodontic treatment or retreatment of permanent teeth with apical periodontitis (PROSPERO registration: CRD42020205951). Methodology: A systematic review of original clinical studies was carried out following PRISMA guidelines to answer whether the type of sealer used in endodontic treatment or retreatment influences the repair of apical periodontitis determined by clinical and radiographic parameters. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library database, until May 2023. Gray literature and a hand search of reference lists were also performed. The risk of bias was assessed using Cochrane RoB2 for randomized trials and the Newcastle-Ottawa Scale (NOS) for prospective and retrospective cohort and case-control studies. Results: Among 1046 studies, a total of 819 were selected by title and abstract, resulting in 23 for full-text review. In total, 11 studies met the inclusion criteria (1467 patients/teeth with apical periodontitis). The quality assessment using RoB2 included five randomized control trials, of which four had medium risk and one had a low risk of bias. According to the NOS scale, five studies were classified as low risk and one study was considered as medium risk of bias. The sealer type and obturation techniques varied, and the mean follow-up time was 3.7 years. Most studies used two-dimensional radiographic criteria to assess the treatment outcome sealers and not cements. Eight studies did not find significant differences when comparing cements. The healing rates ranged from 56.7% to 90%. Conclusions: The results of this review support that the current endodontic sealers do not seem to influence the treatment outcome of permanent teeth with apical periodontitis. Although the studies had medium and low risk of bias, the results should be interpreted with caution. More randomized studies of long-term outcomes comparing filling materials are needed to strengthen this claim and allow for a meta-analysis.

Resumo O objetivo deste artigo foi avaliar a influência do cimento no resultado do tratamento ou retratamento endodôntico não cirúrgico de dentes permanentes com periodontite apical (registro PROSPERO: CRD42020205951). Metodologia: Uma revisão sistemática de estudos clínicos originais foi realizada seguindo as diretrizes PRISMA para responder se o tipo de cimento usado no tratamento ou retratamento endodôntico influencia a reparação da periodontite apical determinada por parâmetros clínicos e radiográficos. Pesquisas eletrônicas foram realizadas no PubMed, Embase, Web of Science, Scopus e no banco de dados Cochrane Library, até maio de 2023. A literatura cinza e uma pesquisa manual das listas de referências também foram realizadas. O risco de viés foi avaliado usando Cochrane RoB2 para os estudos randomizados e Newcastle-Ottawa Scale (NOS) para coorte prospectiva e retrospectiva e estudos de caso-controle. Resultados: Entre 1.046 estudos, um total de 819 foram selecionados por título e resumo, resultando em 23 para revisão de texto completo. No total, 11 estudos preencheram os critérios de inclusão (1.467 pacientes/dentes com periodontite apical). A avaliação de qualidade usando RoB2 incluiu cinco estudos randomizados de controle, dos quais quatro tinham risco médio e um tinha baixo risco de viés. De acordo com a escala NOS, cinco estudos foram classificados com baixo risco e um estudo foi considerado com médio risco de viés. O tipo de cimento e as técnicas de obturação variaram, e o tempo médio de acompanhamento foi de 3,7 anos. A maioria dos estudos utilizou critérios radiográficos bidimensionais para avaliar o resultado do tratamento. Oito estudos não encontraram diferenças significativas ao comparar os cimentos. As taxas de reparação variaram de 56,7% a 90%. Conclusões: Os resultados desta revisão suportam que os cimentos endodônticos atuais não parecem influenciar o resultado do tratamento de dentes permanentes com periodontite apical. Embora os estudos tiveram médio e baixo risco de viés, os resultados devem ser interpretados com cautela. Mais estudos randomizados de resultados de longo prazo comparando materiais de obturação são necessários para fortalecer essa afirmação e permitir uma meta-análise.

Analysis of antimicrobial efficacy of sodium hypochlorite and ozonated water against biofilm in oval canals

Abstract This in vitro study compared the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl) and 8 µg/mL ozonated water agitated by passive ultrasonic irrigation (PUI) or PUI combined with EndoActivator (EA) against mature multispecies biofilm. One hundred and five oval-shaped mandibular premolars were instrumented, sterilized, and inoculated with Enterococcus faecalis, Candida albicans, and Staphylococcus aureus, divided into: control group - saline; O3 group - ozonated water; O3 PUI group - ozonated water with PUI agitation; O3 PUI+EA group - ozonated water with PUI+EA agitation; NaOCl group - NaOCl; NaOCl PUI group - NaOCl with PUI agitation; and NaOCl PUI+EA group - NaOCl with PUI+EA agitation. Microbiological samples were collected before (S1) and after (S2) the disinfection procedures and the data were statistically analyzed using the Kruskal-Wallis test. In the culture method, there was significant disinfection in the O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). The combination of NaOCl with PUI+EA reduced microbial counts to zero (p˂0.05). In the qPCR method, there was a significant reduction in the total count of viable microorganisms in the O3 PUI, O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). It can be concluded that 2.5% NaOCl with and without agitation, as well as 8 µg/mL ozonated water with its action enhanced by the agitation techniques, were effective in root canal disinfection, and their antimicrobial efficacy is related to the microorganisms present in the biofilm.

Resumo Este estudo in vitro comparou a desinfecção do hipoclorito de sódio 2,5% (NaOCl) e da água ozonizada 8 µg/mL agitados pela irrigação ultrassônica passiva (PUI) e por associação da PUI com EndoActivator (EA) na redução de biofilme misto maduro. Cento e cinco pré-molares inferiores ovalados foram instrumentados, esterilizados e inoculados com Enterococcus faecalis, Candida albicans e Staphylococcus aureus, divididos em: Grupo controle: soro; Grupo O3: água ozonizada; Grupo O3 PUI: água ozonizada agitada por PUI; Grupo O3 PUI + EA: água ozonizada agitada por PUI e EA: Grupo NaOCl: hipoclorito de sódio; Grupo NaOCl PUI: hipoclorito de sódio agitado por PUI; Grupo NaOCl PUI + EA: hipoclorito de sódio agitado por PUI e EA. Amostras microbiológicas foram coletadas antes (S1) e após (S2) os procedimentos de desinfecção e os dados foram analisados estatisticamente pelo teste de Kruskal-Wallis. No método de cultura, houve desinfecção significativa nos grupos O3 PUI + EA, NaOCl, NaOCl PUI e NaOCl PUI + EA (p˂0.05), sendo que no grupo NaOCl PUI + EA não houve crescimento de microrganismo (p˂0.05). No método de qPCR, nas contagens dos microrganismos antes e após os protocolos de desinfecção, houve redução microbiana nos grupos O3 PUI, O3 PUI + EA, NaOCl, NaOCl PUI, NaOCl PUI + EA (p˂0.05). Concluiu-se que o NaOCl 2,5% com e sem agitação foi eficiente, assim como a água ozonizada 8 µg/mL potencializada pelos métodos de agitação na desinfecção e que a mesma está relacionada com os microrganismos presentes no biofilme.

Subcostal right ventricular free wall strain in patients with pulmonary hypertension / Strain subcostal de la pared libre del ventriculo derecho en pacientes con hipertensión pulmonar

Abstract Right ventricular longitudinal strain (RVLS) is frequently used as a measure of right ventricular systolic function. Abnormal RV strain is associated with poor prognosis in patients with pulmonary hyper tension (PH); however, the measure is not always easy to obtain in patients with poor apical acoustic windows. Objective: This study aims to analyze the RVLS and determine if there is a difference when measured from the apical and subcostal views. Methods: In this cross-sectional study, we analyzed 22 adult outpatients (≥ 18 years old), 81% female, mean age 49.9 ± 17.3 years, with a diagnosis of PH using right heart catheterization, followed from January 2016 to January 2020. Results: RVLS measured in the RV free wall from the apical views was -15% (-19% to -10%) and subcostal views -14.5% (-18% to -11%) were highly correlated (Person's r = 0.969, p < 0.0001). Segment by segment analysis did not show significant differences either: basal four-chamber vs. sub costal view was -16.5% (-21% to -11%) vs. -15.5% (-20% to -11%), p = 0.99, mid four-chamber view vs. subcotal view was -16.5% (-21% to -12%) vs. -16.5% (-20% to -11%), p = 0.87, apical four-chamber view vs. subcostal view was -12% (-18% to -8%) vs. -13.5% (-19% to -10%), p = 0.93. Conclusion: Subcostal RVLS free wall is a feasible and accurate alternative to conventional RVLS free wall from the apical view in patients with pulmonary hypertension and could be useful in patients with poor acoustic apical four-chamber windows.

Resumen El strain longitudinal del ventrículo derecho (SLVD) permite medir la función sistólica del ventrículo derecho (VD). La disminución del strain (deformación) del VD se asocia con mal pronóstico en pacientes con hipertensión pulmonar (HP), pero no siempre es fácil de obtener en pacientes con mala ventana acústica apical. Objetivo: Este estudio tiene como objetivo analizar el SLVD y determinar si las vistas apical y subcostal son comparables. Métodos: En este estudio transversal, se incluyeron 22 pacientes adultos ambulatorios (≥18 años), 81% mujeres, edad promedio 49.9 ± 17.3 años, con diagnóstico de HP mediante cateterismo cardíaco derecho, seguidos desde enero de 2016 hasta enero de 2020. Se midió la deformación de la pared libre del ventrículo derecho desde las vistas de cuatro cámaras apical y cuatro cámaras subcostal. Resultados: El SLVD medido en la pared libre del VD desde la vista apical fue -15% (-19% a -10%) vs. -14.5% (-18% a -11%) cuando se midió desde la vista subcostal (p = 0,99). El análisis segmento por s egmento tampoco mostró diferencias significativas: el segmento basal apical vs. subcostal fue -16.5% (-21% a -11%) vs. -15.5% (-20% a -11%), p = 0.99, el segmento medio apical vs. la vista subcotal fue -16.5% (-21% a -12%) vs. a -16.5% (-20% a -11%), p = 0.87, el segmento apical vs. la vista subcostal fue -12% (-18% a -8%) frente a -13.5% (-19% a -10%), p = 0.93. Conclusión: En pacientes con HP, el SLVD obtenido en la pared libre subcostal es una alternativa útil en los casos con ventana acústica apical subóptima.

Asociación entre calidad del tratamiento endodóntico y periodontitis apical, evaluada mediante Tomografía Computarizada de Haz Cónico en una población colombiana / Association between endodontic treatment quality and apical periodontitis assessed through cone beam computarized tomography in a colombian population / Associação entre qualidade do tratamento endodôntico e periodontite apical, avaliada por tomografia computadorizada de feixe cônico em uma população colombiana

Introducción: La prevalencia de periodontitis apical en dientes con tratamiento endodóntico oscila entre el 35 y el 60%, se ha encontrado una fuerte asociación con respecto al grado de inflamación sistémica generada por la periodontitis apical, como por ejemplo altos niveles de citoquinas proinflamatorias, proteína C reactiva e interleuquina 6; estudios refieren que un tratamiento endodóntico adecuado puede reducir los niveles de proteína C reactiva en individuos sanos y con periodontitis apical. Objetivo: Evaluar la frecuencia de periodontitis apical en una población adulta colombiana seleccionada y su correlación con la calidad del tratamiento endodóntico. Materiales y métodos: Estudio observacional analítico de corte transversal, se determinó la frecuencia de periodontitis apical en 318 CBCT (Tomografía Computarizada de Haz Cónico), de pacientes de una subpoblación de Bucaramanga y Medellín y evaluó la asociación de la calidad del tratamiento endodóntico con el estado periapical. Resultados: Sólo el 37,66% de los dientes evaluados fueron considerados sanos; el 44,81% se clasificaron como tratamiento endodóntico adecuado. La calidad del tratamiento endodóntico influyó significativamente en la condición del periodonto apical. Conclusiones: Los tratamientos evaluados presentaron alta frecuencia de periodontitis apical, la cual se asoció en buena parte a la alta frecuencia de tratamientos endodónticos inadecuados.

Introduction: The prevalence of apical periodontitis in teeth with endodontic treatment ranges between 35% and 60%, and a strong association has been found with respect to high levels of systemic inflammation markers (pro-inflammatory cytokines, protein C-reactive and interleukin 6) caused by apical periodontitis. Studies have shown that an adequate endodontic treatment can reduce C-reactive protein levels in healthy individuals and those with apical periodontitis. Objective: To evaluate the frequency of apical periodontitis in a selected Colombian adult population and its correlation with the quality of endodontic treatment. Materials and methods: Observational, analytical, cross-sectional study. The frequency of apical periodontitis was determined in 318 CBCTs of patients from Bucaramanga and Medellin, and the association between quality of endodontic treatment and periapical status was analyzed. Results: Only 37.66% of the observed teeth were considered healthy, whereas 44.81% were classified as teeth with appropriate endodontic treatment. Quality of endodontic treatment significantly affected the condition of the apical periodontium. Conclusions: The analyzed treatments had a high apical periodontitis frequency, which was associated with a high frequency of inadequate endodontic treatments.

Introdução: A prevalência de periodontite apical em dentes com tratamento endodôntico varia entre 35 e 60 %, uma forte associação foi encontrada com relação ao grau de inflamação sistêmica gerada pela periodontite apical, como altos níveis de citocinas pró-inflamatórias, proteína C reativa e interleucina 6; estudos relatam que o tratamento endodôntico adequado pode reduzir os níveis de proteína C-reativa em indivíduos saudáveis ​​e naqueles com periodontite apical. Objetivo: Avaliar a frequência da periodontite apical em uma população adulta colombiana selecionada e sua correlação com a qualidade do tratamento endodôntico. Materiais e métodos: Estudo transversal analítico observacional; a frequência de periodontite apical foi determinada em 318 CBCT de pacientes de uma subpopulação de Bucaramanga e Medellín, foi avaliada a associação da qualidade do tratamento endodôntico com o estado periapical. Resultados: Apenas 37,66% dos dentes avaliados foram considerados saudáveis, 44,81% dos dentes foram classificados como tratamento endodôntico adequado. A qualidade do tratamento endodôntico influenciou significativamente a condição do periodonto apical. Conclusões: Os tratamentos avaliados apresentaram alta frequência de periodontite apical, que foi amplamente associada à alta frequência de tratamentos endodônticos inadequados.

Comparison of Fracture Resistance of Simulated Immature Teeth Using Four Different Commercially Available Apexification Materials ? An invitro Study

Introduction: The aim of this study was to compare the fracture resistance of simulated immature teeth using four different apical plug materials, i.e. Pro? Root MTA, Neo? MTA Plus, Biodentine, and Bioactive Glass. Materials and Methods: 80 extracted human maxillary anterior teeth were divided into 4 groups for this study. They were prepared using Peeso reamers to simulate immature teeth and to mimic Cvek’s stage 3 of root development. A 5 mm apical barrier was placed using different materials. The remaining canal was obturated using gutta?percha and AH plus sealer. The final samples were stored at 37°C and 100% humidity for 4 weeks. Fracture resistance of the teeth was measured in Newtons using a universal testing machine. The comparison of fracture resistance between the four groups was done using Kruskal Walis ANOVA followed by post hoc Mann Whitney U test for pairwise comparison. Results: Biodentine group showed the highest fracture resistance as compared to the other three groups and the difference was highly significant (P < 0.001). Conclusions: Biodentine can be advocated over MTA as an effective material for the management of teeth with wide open apex. Bioactive glass also has shown promising results in increasing the fracture resistance of simulated immature teeth.

Strain echocardiography in predicting LV dysfunction in RV apical pacing

Right ventricular (RV) pacing is associated with a reduction in left ventricular (LV) systolic function, thought to be mediated by pacing-induced ventricular dyssynchrony. The prevalence of heart failure after RV pacing is reported to range from 31±3%. We studied 60 subjects with high-grade atrioventricular block and Complete Heart Block (CHB) scheduled to undergo right ventricular apical pacing. 2D echocardiography was done at baseline, 1 month and 12 months. Pacing-induced cardiomyopathy was defined as a reduction in LVEF to <45%. Strain was evaluated off-line from digitally stored images using all advanced software package (cardiac wall motion quantification (CMQ); Toshiba Medical Systems). Longitudinal strain for individual myocardial segments was measured from the apical four-chamber, two-chamber and long axis views (16 segment AHA/ASE model). None had LV dysfunction at baseline based on 2D and strain echo imaging. Subsequently 18 patients were detected to develop low GLS score (less than -14.5) at 1 month. On subsequent follow up at 1 year, all 18 patients developed LV dysfunction on 2D Echocardiography. Thus Strain imaging with GLS score helped in early detection of LV dysfunction in RV apical pacing subjects. Pacing-induced cardiomyopathy had significant association with high grade AV block with pacemaker dependency. It had no significant associations with other comorbidities like diabetes, hypertension, ischemic heart disease or with the type of medication intake. However there was a statistically significant association with heart failure

Tomographic, microbiological and histological characterization of secondary apical periodontitis: case series

Abstract This case series included a tomographic, microbiological, and histopathological description of 15 secondary apical periodontitis (SAP) lesions obtained by apical microsurgery performed in 10 patients to better understand the etiology and pathogenesis of SAP. Preoperative tomographic analyses were performed through Cone beam computerized tomography - Periapical index (CBCT-PAI), and apical microsurgeries were then carried out. The removed apices were used for microbial culturing and for molecular identification using PCR for the detection of 5 strict anaerobic bacteria (P. gingivalis, P. intermedia, P. nigrescens, T. forsythia, and T.denticola) and 3 viruses Herpes simplex viruses (HSV), Cytomegalovirus (CMG) and Epstein-Barr Virus (EBV) by nested PCR. The removed apical lesions were histologically described. Univariate statistical analyses were performed by using STATA MP/16 (StataCorp LLC, College Station, TX, United States). CBCT-PAI analyses revealed PAI 4 and PAI 5 score lesions that involved cortical plate destruction. Eight SAPs were positive by culture, while nine SAP lesions were positive by PCR. Fusobacterium species were the most frequently cultured organisms in 7 SAP lesions, followed by D. pneumosintes in 3. In contrast, by single PCR, T. forsythia and P. nigrescens were detected in 5 lesions, T. denticola in 4 lesions, and P. gingivalis in 2 lesions. Twelve periapical lesions were granulomas, and the remaining three SAP lesions were radicular cysts. In conclusion, this case series study revealed that secondary apical lesions presented tomographic involvement of PAI 3 to 5, and that most SAP lesions were apical granulomas containing anaerobic and facultative microorganisms.

Resumo Esta série de casos incluiu uma descrição tomográfica, microbiológica e histopatológica de 15 lesões de periodontite apical secundária (SAP) obtidas por microcirurgia apical realizada em 10 pacientes para melhor compreender a etiologia e patogénese do SAP. As análises tomográficas pré-operatórias foram realizadas através de tomografia computadorizada de feixe cônico - índice Periapical (CBCT-PAI), e as microcirurgias apicais foram então realizadas. Os ápices removidos foram utilizados para a cultura microbiana e também para a identificação molecular por PCR para a detecção de 5 bactérias anaeróbias rigorosas (P. gingivalis, P. intermedia, P. nigrescens, T. forsythia, e T.denticola) e 3 vírus Herpes simplex (HSV), Cytomegalovirus (CMG) e Epstein-Barr Virus (EBV) por PCR aninhada. As lesões apicais removidas foram descritas histologicamente. Foram realizadas análises estatísticas univariadas utilizando STATA MP/16 (StataCorp LLC, College Station, TX, Estados Unidos da América). As análises CBCT-PAI revelaram lesões PAI 4 e PAI 5 que envolveram a destruição da placa cortical. Oito SAPs foram positivos por cultura, enquanto nove lesões de SAP foram positivas por PCR. As espécies de Fusobacterium foram os organismos mais frequentemente cultivados em 7 lesões SAP, seguidas por D. pneumosintes em 3. Em contraste, por PCR simples, T. forsythia e P. nigrescens foram detectados em 5 lesões, T. denticola em 4 lesões, e P. gingivalis em 2 lesões. Doze lesões periapicais foram granulomas, e as restantes três lesões SAP foram cistos. Em conclusão, este estudo de série de casos revelou que as lesões apicais secundárias apresentavam envolvimento tomográfico de PAI 3 a 5, e que a maioria das lesões de SAP eram granulomas apicais contendo microrganismos anaeróbios e facultativos.

Evaluación de la capacidad de centrado y transporte apical de los sistemas Reciproc Blue y XP-endo Shaper / Evaluation of the centering and apical transport capacity of Reciproc Blue and XP-endo Shaper systems

Resumen Objetivo: Comparar la capacidad de centrado y el transporte apical de los sistemas Reciproc Blue y XP-endo Shaper en bloques de resina con fotografías pre y posoperatorias yuxtapuestas, mediante un programa de análisis de imágenes. Materiales y Métodos: Se dividieron al azar 20 tacos de resina en dos grupos (n=10) preparados con XP-endo Sha- per y Reciproc Blue respectivamente. Se tomaron fotografías digitales de los tacos, antes y después de la preparación con cada sistema en una misma posición. Luego las fotografías obtenidas fueron yuxtapuestas mediante el software Photo shop. Se midieron las desviaciones del centro del conducto con respecto a la pared interna y externa del mismo en diversos puntos de referencia preestablecidos. Estos datos fueron analizados estadísticamente con el test de ANOVA. Resultados: Ambos sistemas produjeron transporte y desviación respecto a la trayectoria original del conducto radicular, pero el análisis estadístico (ANOVA Factorial 2x8) no cuantificó diferencias significativas entre ambos sistemas (p=0,4044) Conclusiones: Bajo las condiciones de este trabajo, ambos sistemas producen transporte y desviación respecto a la trayectoria original del conducto radicular.

Abstract Aim: To compare the centering capacity and apical transport of the Reciproc Blue and X-Pendo Shaper system in resin blocks with juxtaposed pre and postoperative photographs, using the Photoshop software. Materials and methods: 20 resin plugs were randomly divided into two groups (n=10) that were prepared with XP-endo Shaper and Reciproc Blue respectively. Digital photographs of the blocks were taken, before and after preparation, with each system in the same position. Then the obtained photographs were juxtaposed using Photoshop software. The deviations of the center of the canal, with respect to its inter nal and external wall, were measured at various pre-established reference points. These data were statistically analysed with the ANOVA test. Results: Both systems produced transport and deviation from the original trajectory of the root canal, but the statistical analysis (2x8 Factorial ANOVA) did not quantify significant differences between both systems (p=0.4044) Conclusions: Under the conditions of this work, both systems produce transport and deviation with respect to the original trajectory of the root canal.

Different concentrations of fetal bovine serum affect cytokine modulation in Lipopolysaccharide-activated apical papilla cells in vitro

Abstract Fetal bovine serum (FBS) is the most used supplement in culture media; however, it may interfere with in vitro assays via effects on cell proliferation and cytokine production. The ideal FBS concentration for assays using apical papilla cells (APCs) remains unknown. Therefore, this study aimed to evaluate the effects of FBS on APC activation, cell viability/proliferation, and cytokine production. Methodology Human APCs were cultured, plated, and maintained in media containing increasing concentrations of FBS for 24 h, 48 h, 72 h, 7 days, and 14 days in the presence of Lipopolysaccharide (LPS - 1 µg/mL). At each time point, the cells were subjected to the MTT assay. The cytokines transforming growth factor (TGF)-β1, osteoprotegerin (OPG), and interleukin (IL)-6, along with the chemokine CCL2, were quantified using the enzyme-linked immunosorbent assay at the 24-h time-point. Statistical analysis was performed using two-way analysis of variance (ANOVA) followed by Tukey's post-hoc test (p<0.05). Results In general, APCs exhibited increasing metabolic activity in an FBS concentration-dependent fashion, regardless of the presence of LPS. In contrast, FBS interfered with the production of all the cytokines evaluated in this study, affecting the response induced by the presence of LPS. Conclusion FBS increased APC metabolism in a concentration-dependent manner and differentially affected the production of TGF-β1, OPG, IL-6, and CCL2 by APCs in vitro.

Morphological alterations of the apical foramen after foraminal enlargement: a systematic review of ex vivo studies / Alterações morfológicas do forame apical após ampliação foraminal: uma revisão sistemática de estudos ex vivo

Foraminal enlargement has been recommended to optimize the disinfection of infected root canals, although some authors still claim that the foramen should be kept in its original shape and position. This study aimed to evaluate morphological alterations of apical foramen after foraminal enlargement through a systematic review. An electronic search was conducted until April 2022. Ex vivo studies evaluating influence of foraminal enlargement in the morphologic changes of apical foramen were included. Studies without a control group or available full text were excluded. Foraminal deformation and area increase were considered as primary outcomes. Risk-of-bias assessment was performed according to a modified Joanna Briggs Institute's Checklist. From 702 studies retrieved, five were eligible. Most studies used single-rooted teeth, and rotary systems for instrumentation ranging from ­ 2 mm to + 1 mm to the apex. All studies found increased major foramen deformation after foraminal enlargement. Among four studies that evaluated foraminal area, all found increased area after foraminal enlargement. Insufficient data for touched/untouched walls by instruments and dentinal microcrack formation was observed. A low risk of bias was found. Foraminal enlargement during root canal preparation seems to increase deformation and major apical foramen area. Future investigations with standardized methodologies are encouraged (AU)

A ampliação foraminal tem sido recomendada para otimizar a desinfecção de canais radiculares infectados, embora alguns autores ainda afirmem que o forame deve ser mantido em sua forma e posição originais. Este estudo teve como objetivo avaliar alterações morfológicas do forame apical após ampliação foraminal por meio de uma revisão sistemática. Uma busca eletrônica foi realizada até abril de 2022. Foram incluídos estudos ex vivo que avaliaram a influência da ampliação foraminal nas alterações morfológicas do forame apical. Foram excluídos estudos sem grupo controle ou com texto completo indisponível. A deformação foraminal e o aumento da área foram considerados desfechos primários. A avaliação do risco de viés foi realizada de acordo com uma lista de verificação modificada do Instituto Joanna Briggs. Dos 702 registros recuperados, cinco foram elegíveis. A maioria dos estudos utilizou dentes unirradiculares e sistemas rotatórios para instrumentação, com comprimento de trabalho variando de ­ 2 mm a + 1 mm até o ápice. Todos os estudos encontraram aumento da deformação do forame maior após ampliação foraminal. Dos quatro estudos que avaliaram a área foraminal, todos encontraram aumento de área após alargamento foraminal. Foram observados dados insuficientes para paredes tocadas/intocadas pelos instrumentos e formação de microfissuras dentinárias. Um baixo risco de viés foi encontrado. A ampliação foraminal durante o preparo do canal radicular parece aumentar a deformação e a área do forame apical. Futuras investigações com metodologias padronizadas são incentivadas (AU)

Tomografía computarizada en la identificación de la sinusitis odontogénica de origen endodóntico: reporte de un caso / Computerized tomography in the identification of odontogenic sinusitis of endodontic origin: report of a case

Objetivo: se presenta el caso clínico de sinusitis de origen endodóntico, conocida como síndrome en-doantral, haciendo énfasis en la dificultad de diag-nóstico con radiografía periapical y la importancia de la tomografía computarizada. Caso clínico: una mujer de 32 años, con antecedentes de apretamiento dental nocturno y sinusitis recurrente, fue remitida para evaluación endodóntica. El examen clínico reve-ló sensibilidad a la percusión y palpación en la unidad dental. La radiografía periapical no indicó lesión en el diente 16 y la prueba de sensibilidad pulpar fue ne-gativa, además, la tomografía computarizada reveló una extensa lesión periapical y comunicación entre la raíz del diente 16 y el seno maxilar, confirmada por la pérdida de la continuidad de la imagen hiperdensa en el suelo del seno, lo que llevó al tratamiento endo-dóntico. El control de la infección dental resolvió la sinusitis, resaltando la importancia del diagnóstico preciso y el tratamiento en casos de sinusitis odon-togénica. Conclusión: este caso destaca el valor de la tomografía computarizada como herramienta diag-nóstica crucial en contextos clínicos complejos (AU)

Objective: the clinical case of sinusitis of endodontic origin, known as endoantral syndrome, is presented, emphasizing the difficulty of diagnosis with periapical radiography and the importance of computed tomography. Clinical case: a 32-year-old woman, with a history of tooth clenching and recurrent sinusitis, was referred for endodontic evaluation. The clinical examination revealed sensitivity to percussion and palpation in the dental unit. The periapical radiograph did not indicate a lesion in tooth 16 and the pulp sensitivity test was negative, in addition, the computed tomography revealed an extensive periapical lesion and communication between the root of tooth 16 and the maxillary sinus, confirmed by the loss of continuity of the hyperdense image in the sine floor, which led to endodontic treatment. Dental infection control resolved sinusitis, highlighting the importance of accurate diagnosis and treatment in cases of odontogenic sinusitis. Conclusion: this case highlights the value of computerized tomography as a crucial diagnostic tool in complex clinical contexts (AU)

Asociación entre lesiones periapicales y diabetes mellitus

Las lesiones periapicales son procesos inflamatorios que generan la reabsorción de los tejidos mineralizados. En pacientes diabéticos este proceso puede verse afectado. Este trabajo tiene como objetivo identificar la asociación entre la diabetes mellitus y las lesiones periapicales y conocer si los pacientes diabéticos presentan mayor prevalencia y severidad. Se realizó una revisión amplia de la literatura disponible, de tipo narrativa. Se consultaron las bases de datos PubMed (Medline) y SciELO y los recursos Timbó y Google Scholar. Los criterios de exclusión fueron: trabajos anteriores al año 2010 y reportes de caso Se incluyeron artículos anteriores a la fecha de exclusión por considerarse relevantes para el trabajo. A pesar que la evidencia científica continúa siendo insuficiente y el diseño de los estudios debe mejorarse, se demuestra asociación entre lesiones periapicales y diabetes mellitus. Esto implica que los pacientes diabéticos podrían presentar mayor prevalencia y severidad de lesiones.

As lesões periapicais são processos inflamatórios que geram a reabsorção de tecidos mineralizados. Em pacientes diabéticos este processo pode ser afetado. Este trabalho tem como objetivo identificar a associação entre diabetes mellitus e lesões periapicais e saber se os pacientes diabéticos apresentam maior prevalência e gravidade. Foi realizada uma revisão abrangente da literatura disponível, do tipo narrativa. Foram consultadas as bases de dados PubMed (Medline) e SciELO e os recursos Timbó e Google Acadêmico. Os critérios de exclusão foram: trabalhos anteriores ao ano de 2010 e relatos de casos.Os artigos anteriores à data de exclusão foram incluídos por serem considerados pertinentes ao trabalho. Apesar de as evidências científicas ainda serem insuficientes e o delineamento dos estudos precisar ser aprimorado, foi demonstrada uma associação entre lesões periapicais e diabetes mellitus. Isso implica que os pacientes diabéticos podem ter maior prevalência e gravidade das lesões.

Summary Periapical lesions are inflammatory processes that generate the resorption of mineralized tissues. In diabetic patients this process may be affected. This work aims to identify the association between diabetes mellitus and periapical lesions and to know if diabetic patients have a higher prevalence and severity. A comprehensive review of the available literature, of a narrative type, was carried out. The PubMed (Medline) and SciELO databases and the Timbó and Google Scholar resources were consulted. The exclusion criteria were: works prior to the year 2010 and case reports. Articles prior to the exclusion date were included, as they were considered relevant to the work. Despite the fact that the scientific evidence is still insufficient and the design of the studies should be improved, an association between periapical lesions and diabetes mellitus has been demonstrated. This implies that diabetic patients could have a higher prevalence and severity of lesions.

Giant fibroma of left ventricular apex with T wave inversion: 2 cases report and literature review / 中国综合临床

Objective:To investigate the clinical features, diagnostic methods and treatments of left ventricular apical fibroma.Methods:The clinical manifestations, ECG, imaging features and treatment plans of 2 patients with giant fibroma of left ventricular apex diagnosed in September 2020 and May 2022 were analyzed retrospectively, and the related literature was reviewed.Results:Both patients had slight chest distress and discomfort after activities. The ECG showed T-wave inversion of different degrees, which were misdiagnosed as “myocarditis” and “coronary heart disease” respectively. The cardiac magnetic resonance imaging and echocardiography showed left ventricular apical mass. Coronary artery stenosis was not found in coronary angiography. One patient required conservative treatment, and there was no significant change in clinical symptoms and tumor size in the follow-up for half a year; Another patient underwent cardiac mass removal, and the pathological examination after operation confirmed that it was cardiac fibroma, and there was no recurrence in the follow-up 2 years.Conclusion:Fibroma of left ventricular apex is a rare cardiac tumor, which is easy to be missed and misdiagnosed, and is one of the rare causes of T-wave inversion. Cardiac magnetic resonance imaging, CT and echocardiography are commonly used imaging methods to diagnose cardiac fibroma, and surgical resection is an effective treatment.

Research advances on pelvic floor deformation characteristics and biomechanical axial in apical suspension / 现代泌尿外科杂志

Female pelvic organ prolapse (POP) is caused by damage or loss of pelvic floor support, resulting in displacement of the pelvic organs, which leads to abnormalities in the position and function of the organs, mainly due to damage to the pelvic floor mechanical support structures caused by transvaginal birth, loss of elasticity of the pelvic floor mechanical support structures in old women, and loss of the ability to maintain the pelvic floor. The key to POP surgery is the repair of the apical vagina, but treatment based on this theory has failed to achieve satisfactory clinical outcomes. This article will analyze the common procedures of apical suspension in the treatment of mid-pelvic prolapse from the perspective of pelvic floor morphological features and pelvic floor biomechanics axially.

The Performance of Graduation from Traditional Growing Rods with Apical Control Technique in Patients with Congenital Early-Onset Scoliosis / 罕见病研究

  Objective  Different from other etiologies of early-onset scoliosis (EOS), congenital early-onset scoliosis (CEOS) is mainly linked to vertebral anomalies, such as formation failures and segmentation failures at the apex segments. So far, there is little research on CEOS patients who have completed traditional growing rods (TGR) treatment, and the initial outcomes of TGR with or without apical control technique (ACT) are different. Therefore, we compared the "final" results of CEOS patients who completed TGR treatment with or without ACT.  Methods  We conducted a retrospective study of CEOS patients who completed TGR treatment from 2007—2020. They either had final fusion or were followed up after reaching skeletal maturity. We split the patients into two groups based on whether they had ACT with TGR or not. The ACT-TGR group had apical vertebrectomy/hemivertebrectomy with short fusion and TGR. The TGR-only group had only TGR. We looked at their demographic features, radiographic measurements, and complications.  Results  This study enrolled 46 CEOS patients, of which 13 patients were in the ACT-TGR group and 33 patients in the TGR group. The ACT-TGR group had a longer distraction interval (1.17 years vs. 0.75 years). The ACT-TGR group had a larger preoperative main curve [87.00(63.50, 98.00)], but the residual curve degrees were comparable between the two groups at the last follow-up (P=0.354). At the last follow-up, the T1-12 and T1-S1 heights were similar between the two groups. The ACT-TGR group had a lower number of implant-related complications per patient (0.77 vs. 1.48). Three patients in the ACT-TGR group underwent final fusion, while 17 patients in the TGR group underwent final fusion (P=0.060).  Conclusions  Both ACT-TGR and traditional TGR coud effectively correct deformity and preserve spinal growth in CEOS patients. ACT-TGR had a better corrective effect on patients with severe deformity and did not have a significant impact on spinal height. For patients with acceptable correction, spontaneous fusion and without implant failure, retaining the implant and continuing observation could be a strategy for graduating from growing rod treatment.