Importance of radiological examination in the evaluation of canal fillings performed with bioceramic sealers.

Bioceramic-based fillers have been evaluated in several in vitro studies but in vivo studies are still limited. The present study examined 36 postoperative radiographic analyses that were divided into four groups, of which three used bioceramic-based fillers, namely Total Fill, BioRoot RCS and Biodentine, while the fourth group was used as control and implemented the resin-based AH Plus Jet sealer. The present results did not indicate significant differences in radiopacity between sealers at a certain level of obturation. Biodentine-based fillers have a radiodensity close to that of dentin, which makes it difficult for the physician to radiologically assess the correctness of the canal filling.

Approach of Acromegaly during Pregnancy.

Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism­mostly affecting the pituitary axis in hypopituitarism (10−80%), and negative effects of glucose profile (GP) anomalies (10−70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5−15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English­published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers­13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7−50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception­continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother's disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT + ve and PT − ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.

Approach of Heterogeneous Spectrum Involving 3beta-Hydroxysteroid Dehydrogenase 2 Deficiency.

We aim to review data on 3beta-hydroxysteroid dehydrogenase type II (3ßHSD2) deficiency. We identified 30 studies within the last decade on PubMed: 1 longitudinal study (N = 14), 2 cross-sectional studies, 1 retrospective study (N = 16), and 26 case reports (total: 98 individuals). Regarding geographic area: Algeria (N = 14), Turkey (N = 31), China (2 case reports), Morocco (2 sisters), Anatolia (6 cases), and Italy (N = 1). Patients' age varied from first days of life to puberty; the oldest was of 34 y. Majority forms displayed were salt-wasting (SW); some associated disorders of sexual development (DSD) were attendant also-mostly 46,XY males and mild virilisation in some 46,XX females. SW pushed forward an early diagnosis due to severity of SW crisis. The clinical spectrum goes to: premature puberty (80%); 9 with testicular adrenal rest tumours (TARTs); one female with ovarian adrenal rest tumours (OARTs), and some cases with adrenal hyperplasia; cardio-metabolic complications, including iatrogenic Cushing' syndrome. More incidental (unusual) associations include: 1 subject with Barter syndrome, 1 Addison's disease, 2 subjects of Klinefelter syndrome (47,XXY/46,XX, respective 47,XXY). Neonatal screening for 21OHD was the scenario of detection in some cases; 17OHP might be elevated due to peripheral production (pitfall for misdiagnosis of 21OHD). An ACTH stimulation test was used in 2 studies. Liquid chromatography tandem-mass spectrometry unequivocally sustains the diagnostic by expressing high baseline 17OH-pregnenolone to cortisol ratio as well as 11-oxyandrogen levels. HSD3B2 gene sequencing was provided in 26 articles; around 20 mutations were described as "novel pathogenic mutation" (frameshift, missense or nonsense); many subjects had a consanguineous background. The current COVID-19 pandemic showed that CAH-associated chronic adrenal insufficiency is at higher risk. Non-adherence to hormonal replacement contributed to TARTs growth, thus making them surgery candidates. To our knowledge, this is the largest study on published cases strictly concerning 3ßHSD2 deficiency according to our methodology. Adequate case management underlines the recent shift from evidence-based medicine to individualized (patient-oriented) medicine, this approach being particularly applicable in this exceptional and challenging disorder.

Post Placement and Restoration of Endodontically Treated Canines: A Finite Element Analysis Study.

The purpose of this study was to show the improved outcomes of restoring endodontically treated teeth with fiberglass posts compared to restorations using metal posts. In our study, we used the Finite Element Method (FEM), which is based on the principle that a physical model that supports a given load distributes the stress throughout its volume. We sought to assess what stress results in a tooth when it is restored using a fiberglass post compared to restoration using a metal post. The finite element analysis showed that a system consisting of a tooth with a fiberglass post is more stable in terms of the maximum stress than a system consisting of a tooth with a metal post. The maximum displacements and deformations were obtained in the case of a canine restored with a fiberglass post, which showed that this system had a high elasticity, therefore, higher strength than a canine restored with a metal post, which had high rigidity.

Modeling and Simulating an Orthodontic System Using Virtual Methods.

Cone beam computed tomography (CBCT) is a modern imaging technique that uses X-rays to investigate the structures of the dento-maxillary apparatus and obtain detailed images of those structures. The aim of this study was to determine a functional mathematical model able to evaluate the elastic force intensity on each bracket and tube type element and the ways in which those components act on the orthodontic system being used. To analyze a real orthodontic system, we studied the case of a 13-year-old female patient. To transfer geometric information from tomographic images, we used the InVesalius software. This software can generate three-dimensional reconstructions based on sequences and files in the DICOM format and was purchased from CBCT equipment. We analyzed and processed the geometries of the converted tissues in InVesalius using the Geomagic software. After using the Geomagic software, we exported the resulting model to the SolidWorks software used in computer-aided design. In this software, the model is transformed into a virtual solid. After making the geometric model, we analyzed the model using the Ansys Workbench software, which incorporates finite element analysis techniques. Following the simulations, we obtained result maps, which showed the complete mechanical behavior of the analyzed structures.

Diabetes mellitus: Plasticizers and nanomaterials acting as endocrine-disrupting chemicals (Review).

Various plasticizers and nanomaterials have been linked to endocrine disruptors or endocrine-disrupting chemicals (EDCs) which represent a large, heterogeneous, yet incompletely understood group of structures acting on normal and pathological body pathways such as hormonal production, secretion, transport and receptor binding. By contrast, various applications of nanoparticles are currently under investigation since the delivery of useful drugs, particularly insulin in diabetes mellitus, is essential in case of insulin deficiency. The aim of the present review was to introduce and examine different plasticizers and nanomaterials with potential applications for diabetic patients (such as selenium or gold-based nanoparticles that help the oral delivery of insulin) or plasticizers/nanomaterials acting similarly to EDCs in relation to the human and animal body, particularly glucose metabolism impairment such as diabetes mellitus (DM). Bisphenol A is a chemical used worldwide; however, the effect of exposure varies with regard to the source, environment, time of exposure and the age of the organism. Daily exposure is mostly related to food and drinks stored in polycarbonate plastics. However, exposure may also be through the skin or through the maternal placenta or breast milk which are risk factors for the fetus and for the newborn. It exerts an estrogen-like profile, but it also induces insulin resistance by impairing peripheral insulin receptors or it decreases insulin secretion by acting at the level of insulin-secreting pancreatic ß-cells. Phthalates, compounds of flexible plastics, act as EDCs via their human metabolites such as diethyl phthalate and derivative monoethyl phthalate. Their role in inducing gestational DM and weight gain/obesity during pregnancy has been showcased. The vast field of plasticizers and nanomolecules acting as endocrine disruptors is widely linked to clinical aspects of DM, a serious condition with a major population impact. The importance of understanding and using these agents and applications is reflected in saving numerous human lives.

Use of optical coherence tomography in orthodontics.

Optical coherence tomography (OCT) is a modern imaging method with applicability in orthodontics. In recent years, there has been an increasing trend in the use of ceramic brackets. The aim of the present study was to investigate the effects of bonding metallic and ceramic brackets on tooth enamel, using optical coherence tomography. For this purpose, 20 permanent teeth we bonded and were subsequently debonded using a side cutter or anterior bracket removal pliers. Using the OCT technique, the enamel, the amount of adhesive remaining and the bracket fragments remaining on the tooth surface were analyzed following the debonding procedure. It was demonstrated that enamel cracks were present only in the samples bonded with ceramic brackets. At the same time, it was noted that the type of pliers did not affect the incidence and extent of damage to the enamel. The type of debonding technique (using the side cutter or the anterior removal pliers) used did not markedly affect the amount of adhesive remaining on the teeth. Thus, as demonstrated herein, by analyzing the enamel structure through the use of OCT, the quality of the processes and the materials used for manufacturing brackets can be increased.