Imaging Update of Congenital Hearing Loss: A Recent Insight Imaging Including 3D MRI Cisternography Prior to Cochlear Implant.

SNHL in children is an important issue. Cochlear implant is a highly technological device that is surgically inserted in the cochlea to solve this issue. To evaluate types of anomalies of the inner ear in children with sensorineural hearing loss in a tertiary care hospital and confirm that the routine MRI, MR cisternography and HRCT provides the surgeon with the imaging finding and criteria of patients candidates for CI. Patients and method: 600 patients with SNHL underwent HRCT and MRI. CT examinations were normal in 457 patients (76.2%) and 143 patients (23.8%) with inner ear anomalies. MRI examinations were normal in 440 patients (73.3%) and had inner ear anomalies in 160 patients (26.7%). 3D bFFE and 3D DRIVE was summarized. The 3D bFFE sequence was statistically significantly better than the 3D DRIVE for the demonstration of the cochlear vestibule. Superior, inferior vestibular nerves and facial nerves while 3D DRIVE is superior to 3D bFFE in the visualization of the semicircular canals. HRCT and MRI provide accurate anatomical delineation of complex inner ear structures and 3D improves pre-implant evaluation.

Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation.

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

The Effect of Final Irrigation Agitation Techniques on Postoperative Pain after Single Visit Root Canal Treatment of Symptomatic Irreversible Pulpitis: A Randomised Clinical Trial.

OBJECTIVE: To evaluate the degree of postoperative pain and rate of analgesic intake in patients with symptomatic irreversible pulpitis in mandibular first molar teeth at 6 h, 12 h, 24 h, 48 h, and 72 h after using different irrigation activation techniques in single-visit endodontic treatment. METHODS: A total of 78 patients with symptomatic irreversible pulpitis with no signs of periapical pathology were randomly divided into 3 groups according to the final irrigation activation technique; Group XP-endo Finisher, Group Ultra X ultrasonic device, and Group side-vented needle. The teeth underwent standardised single-visit root canal treatment procedures using 2.5% sodium hypochlorite for irrigation. Each patient was given a chart to record postoperative pain at 6, 12, 24, 48 and 72 hours intervals. Ibuprofen, 400 mg tablets, was prescribed to be taken when the pain was unbearable. The incidence and number of analgesic tablets taken were recorded. Data were analysed using a Kruskal-Wallis test followed by a pairwise Mann-Whitney U test with Bonferroni correction for intergroup comparisons and Freidman's test followed by Dunn's post hoc test for intragroup comparisons. RESULTS: No statistically significant difference was found between all groups regarding the incidence and intensity of pain at different time intervals (p>0.05). There was no significant difference in analgesic intake between different groups, with most cases in all groups not taking analgesics (p>0.05). CONCLUSION: Adding XP-endo Finisher or passive ultrasonic irrigation to the final irrigation protocol in singlevisit endodontic treatment had no significant effect on postoperative pain or analgesic intake. (EEJ-2021-11-185).

Histopathological and immunohistochemical profiles of pulp tissues in immature dogs' teeth to two recently introduced pulpotomy materials.

OBJECTIVE: The pulpal response to Hoffmann's Pulpine mineral (PMIN) and Pulpine NE (PNE) was compared to mineral trioxide aggregate (MTA) when used as pulpotomy materials in immature permanent teeth in dogs. MATERIALS AND METHODS: Immature premolars were randomly divided according to the observation period into three equal groups (n = 24) (10 days, 30 days, and 90 days) then furtherly subdivided into 3 subgroups according to the material used. Histopathological analysis regarding inflammatory cell infiltration and dentin bridge (DB) formation was done. Immunohistochemical analysis was performed using osteopontin marker. RESULTS: The results showed that after 90 days, both MTA and PMIN subgroups had 100% complete thick DB without inflammation in 87.5% of the samples, while the PNE subgroup failed to form DB in 37.5% of the samples and 50% of samples showed thin initial DB with heavy inflammation in 62.5% of the samples. There was no significant difference between MTA and PMIN, while there was a statistically significant difference between PNE and the two other subgroups in DB formation and inflammatory cell infiltration (P > 0.05). After 90 days, MTA showed the highest mean value of osteopontin positive fraction area followed by PMIN without statistically significant differences, while the least value was recorded in PNE subgroup with statistically significant difference with the remaining subgroups (P < 0.05). CONCLUSION: PMIN is a promising alternative to MTA when used for pulpotomy. CLINICAL RELEVANCE: Vital pulp therapy in immature teeth can be done using PMIN as an alternative to MTA.

The Effect of Trypsin-Chymotrypsin on Postoperative Pain after Single Visit Endodontic Treatment: A Randomized Controlled Trial.

INTRODUCTION: The efficacy of trypsin-chymotrypsin in postoperative pain management following single-visit root canal treatment of teeth with symptomatic irreversible pulpitis was evaluated. Additionally, synergistic effects with nonsteroidal anti-inflammatory drugs and reported side effects were also investigated. METHODS: This prospective, parallel, triple-blinded phase IV randomized controlled trial included 60 patients with mandibular first molars exhibiting symptomatic irreversible pulpitis. The patients were randomly allocated using computer software to one of four treatment groups (n = 15 each), and either ibuprofen (600 mg), ambezim-G (trypsin 5mg-chymotrypsin 5 mg), a combination of both, or a placebo drug were administered postoperatively. The participants scored pain intensity at different time-intervals using a numerical scale, and passive surveillance of harm was used to detect clinical safety. Age was compared between groups using a one-way analysis of variance test. Pain scores were analyzed using the Kruskal-Wallis and Friedman's tests and, if significant, Dunn's test was used for pairwise comparisons. The chi-square test was used to compare qualitative data, and the significance level was set at P value ≤ .05. RESULTS: All interventions were found to be effective in reducing postoperative pain, and no statistically significant differences were observed between the ibuprofen, trypsin-chymotrypsin, and combination groups. However, all 3 groups differed significantly from the placebo group. The safety profile of the interventions did not differ significantly. CONCLUSIONS: Trypsin-chymotrypsin exhibits comparable efficacy to nonsteroidal anti-inflammatory drugs. No synergistic effects occur when the 2 are used in combination. This is the first randomized controlled trial to assess the effects of proteolytic enzymes on postendodontic pain. TRIAL REGISTRATION: clinicaltrials.gov, Identifier: NCT05479747.

Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation

Abstract Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation.

Purpose: To compare cartilage tympanoplasty (CT) combined with eustachian tube balloon dilatation (ETBD) and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media (AdOM) in terms of graft healing, audiological outcomes, and impact on life style, using Chronic Otitis Media Outcome Test 15 (COMOT-15). Methods: 50 patients with AdOM were randomly classified into 2 groups: 25 patients for cartilage tympanoplasty only (CT group) and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation (CT + ETBD group). Clinical outcomes in both groups were compared at 3 and 6 months of follow up. Results: There was no significant difference in graft healing between the two groups. Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up (P < 0.05). Hearing improvement was achieved, as the mean preoperative ABG was 26.5 ± 5.4 and 27.1 ± 4.6 dB, and the mean postoperative ABG at 6 months was 19.4 ± 4.4 and 14.6 ± 3.9 dB in the CT and the CT + ETBD groups, respectively. The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up (P < 0.05) in favour of the CT + ETBD group. Conclusion: ETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.

The effect of changing apical foramen diameter on regenerative potential of mature teeth with necrotic pulp and apical periodontitis.

OBJECTIVE: The aim of the present study was to evaluate the regenerative potential of permanent necrotic mature teeth with different apical foramen diameters in comparison to conventional endodontic treatment. METHODS: Pulp necrosis and periapical pathosis were induced in premolars (144 roots) in six mongrel dogs. The infected teeth were divided into six groups; conventional root canal treatment (RCT) group prepared up to apical preparation sizes #F3 ProTaper file, regenerative endodontic therapy (RET) groups; groups RET-F3, RET-F4, and RET-F5 where regenerative endodontic procedures were applied after apical preparation up to sizes #F3, F4, and F5 ProTaper file, respectively, control groups; and positive (P) and negative (N) groups included infected and healthy teeth respectively. Each group (12 teeth with 24 roots each) was further subdivided into two subgroups (6 teeth with 12 roots each) according to the evaluation periods 1 and 3 months; each group was equally randomized in the upper and lower jaws during each evaluation period. RESULTS: The inflammatory cell counts for the RCT group were statistically significantly higher than that of all RET groups at the first period and only significantly higher than RET-F5 at the second period. The enlargement of the apical foramen to #F5 showed no statistically significant difference with #F4 regarding the inflammatory cell count, tissue in-growth inside the root canal, and percentage of bone resorption. The tissue formed after RET was not true pulp tissue and is considered tissue repair with connective tissue, dilated blood vessels, and cementum-like structures.  CONCLUSION: Increasing the apical size diameter was associated with less inflammatory cell count, less percentage of bone resorption, more tissue ingrowth, and more percentage of new hard tissue formation inside root canal. The minimum apical diameter that should be enlarged for RET is 0.4 mm. CLINICAL RELEVANCE: RET could be used as an alternative procedure to RCT for the treatment of mature teeth with necrotic pulp and apical periodontitis.

Application of a new System for Classifying Root and Canal Anatomy in Clinical Practice - Explanation and Elaboration.

Adequate understanding and accurate characterization of normal and unusual root and canal morphology are essential requirements for successful root canal treatment. A new coding system for classifying root and canal morphology, accessory canals and anomalies has been introduced. In addition to technological advances related to experimental studies involving micro-computed tomography, the continuing clinical advances in magnification, illumination, imaging and intra-operative root canal treatment procedures have allowed clinicians to identify an increasingly wide range of anatomical variations in roots and canals in an attempt to achieve more predictable clinical outcomes. This review aims to provide a step-by-step explanation for the clinical application of the new coding system in dental practice, and to describe the anatomical variations in roots and canals for teeth scheduled for root canal treatment.

Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. Is it justified? A retrospective Comparative cohort study.

BACKGROUND: Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of an undersized prosthetic valve especially with Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. OBJECTIVE: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement. METHODS: The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between Jan. 2016 and Sept. 2020. Only (50) patients had ARE with DVR.  ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick¢s or Manouguian procedures. The estimated postoperative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least postoperative follow-up period was 6 months. RESULTS: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.5 ±0.20 m2, aortic annulus diameter was 20±1.4 mm, aortic orifice area was 0.80±0.50 cm2, and aortic peak gradient (PG) 80±40 mm Hg. During follow-up period, there was a mild to moderate paravalvular leak (1%) with, (1%) heart block, and residual PG on prosthetic aortic valve; that was all in DVR alone. CONCLUSION: Enlargement of aortic root by Nick¢s or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

Lufenuron induces reproductive toxicity and genotoxic effects in pregnant albino rats and their fetuses.

Insecticides and other agrochemicals have become indispensable components of the agricultural system to ensure a notable increase in crop yield and food production. As a natural consequence, chemical residues result in significantly increased contamination of both terrestrial and aquatic ecosystems. The present study evaluated the teratogenic, genotoxic, and oxidative stress effects of residual-level lufenuron exposure on pregnant rats during the organogenesis gestational period of both mother and fetus. The tested dams were divided into three groups; control (untreated), low-dose group (orally administered with 0.4 mg/kg lufenuron) and high-dose group (orally administered with 0.8 mg/kg lufenuron). The dams of the two treatment groups showed teratogenic abnormalities represented by the asymmetrical distribution of fetuses in both uterine horns, accompanied by observed resorption sites and intensive bleeding in the uterine horns, whereas their fetuses suffered from growth retardation, morphologic malformations, and skeletal deformations. Histologic examination of the liver and kidney tissues obtained from mothers and fetuses after lufenuron exposure revealed multiple histopathologic changes. DNA fragmentation and cell cycle perturbation were also detected in the liver cells of lufenuron-treated pregnant dams and their fetuses through comet assay and flow cytometry, respectively. Moreover, lufenuron-induced oxidative stress in the liver of mothers and fetuses was confirmed by the increased malondialdehyde levels and decreased levels of enzymatic antioxidants (glutathione peroxidase and superoxide dismutase). Taken together, it can be concluded that lufenuron has a great potential in exerting teratogenic, genotoxic, and oxidative stresses on pregnant rats and their fetuses upon chronic exposure to residual levels during the organogenesis gestational period. The obtained results in the present study imply that women and their fetuses may have the same risk.

Histopathological evaluation of different regenerative protocols using Chitosan-based formulations for management of immature non-vital teeth with apical periodontitis: In vivo study.

This study aimed to assess regenerative treatment protocols for maturogenesis of immature teeth with apical periodontitis in dogs. Apical periodontitis was induced in immature premolars of 8 mongrel dogs teeth that were divided into 5 groups; regeneration via blood clotting (REG group); chitosan loaded with demineralised bone matrix (REG-CD group); chitosan loaded with dexamethazone corticosteroid (REG-CC group); and positive and negative control groups. All groups showed comparable apical hard tissue formation and significantly different from the control group. Results also showed decrease in inflammatory tissue reaction, bone resorption and periodontal ligament thickness. Tissue reaction and inflammatory infiltrates were significantly less in REG-CC group compared to others. Other parameters showed no significant difference. In conclusion, regenerative endodontic techniques using chitosan-based formulations have the potential to be used as an alternative for root maturation in teeth with apical periodontitis.

The Study of SALL4 Gene and BMI-1 Gene Expression in Acute Myeloid Leukemia Patients.

BACKGROUND: In acute myeloid leukemia (AML), many genes have been studied as prognostic markers. SALL4 is expressed constitutively in human leukemia cell lines and primary AML cells. BMI-1 is expressed highly in purified hematopoietic stem cells (HSCs), and its expression declines with differentiation. OBJECTIVE: To study the expression levels of SALL4 and BMI-1 and their clinical significance in patients with AML. METHODS: The study was performed with 60 patients newly diagnosed with AML and 50 control individuals. SALL4 and BMI-1 expression detection were performed using real-time polymerase chain reaction (PCR). RESULTS: The expression of SALL4 and BMI-1 was significantly higher in cases of AML and showed a strong association with failure to achieve complete remission (CR) or with relapse (P = .02, P = .03, respectively). In multivariate analysis, these genes were the most powerful independent predictors of poor prognosis (P = .01 for SALL4, P = .02 for BMI-1). CONCLUSION: SALL4 and BMI-1 are significant prognostic factors in AML and could be strong targets for novel types of therapy.

Are Patients with Vitiligo More Prone to Myocardial Infarction?: A Case-control Study.

Background: Vitiligo is a multifactorial polygenic disorder commonly associated with other autoimmune diseases. The reported link between vitiligo and abnormalities of serum interleukin (IL)-17, zinc, calcium, and vitamin D is not fully understood. Objectives: We sought to assess the serum levels of vitamin D, calcium, zinc, and IL-17 in patients with vitiligo and to answer the question of whether patients with vitiligo are more prone to experience myocardial infarction. Design: This was a case-control study and we did not exclude any eligible participants with other systemic autoimmune diseases. Serum vitamin D, calcium, zinc, and IL-17 levels were measured and correlated with disease severity. Setting: The study was conducted at Benha University Hospital in Egypt. Participants: Thirty patients with vitiligo and 30 age- and sex-matched healthy volunteers were included. Measurements: Disease severity was measured using the Vitiligo Extent Tensity Index (VETI) score. Results: Patients with vitiligo showed significantly lower levels of vitamin D (p<0.001), calcium (p<0.001), and zinc (p<0.001), and an insignificantly higher level of IL-17 compared to the control group (p=0.102). Patients with other autoimmune diseases showed significantly lower vitamin D (p=0.0001) and calcium (p<0.0001) levels and higher IL-17 (p=0.0431) and zinc (p=0.0274) compared to controls. Conclusion: The levels of measured markers might make patients with vitiligo, especially those with autoimmune diseases, prone to myocardial infarction; the investigation of myocardial infarction, especially when a patient shows low vitamin D, calcium, and zinc or high IL-17 are recommended.

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study.

BACKGROUND: Hypercoagulability can lead to serious thromboembolic events. The aim of this study was to assess the perioperative coagulation status in liver transplant recipients with a tendency to hypercoagulability. METHODS: In a prospective observational study (South African Cochrane Registry 201405000814129), 151 potential liver transplant recipients were screened for thrombophilic factors from October 2014 to June 2017, and 57 potential recipients fulfilled the inclusion criterion of presenting two or more of the following thrombophilic factors: low protein C, low protein S, low anti-thrombin, increased homocystein, increased antiphospholipid IgG/IgM antibodies, increased lupus anticoagulant, and positive Factor V Leiden mutation. Seven patients were excluded from the study because they fulfilled the exclusion criteria of cancelling the liver transplantation, oral anticoagulation, or intraoperative treatment with rFVIIa. Accordingly, 50 patients were included in the final analysis. Thromboelastometry (ROTEM) (EXTEM, INTEM and FIBTEM) and conventional coagulation tests (CCT) were performed preoperatively, during the anhepatic phase, post reperfusion, and on postoperative days (POD) 1, 3 and 7. ROTEM was used to guide blood product transfusion. Heparin was infused (60-180 U/kg/day) postoperatively for 3 days and then was replaced by low-molecular-weight heparin (20 mg/12 h). RESULTS: FIBTEM MCF significantly increased postoperatively above reference range on POD 7 despite normal fibrinogen plasma concentrations (p < 0.05). Both EXTEM and INTEM demonstrated significant changes with the phases of transplantation (p < 0.05), but with no intra- or postoperative hypercoagulability observed. INTEM CT (reference range, 100-240 s) normalized on POD 3 and 7 (196.1 ± 69.0 and 182.7 ± 63.8 s, respectively), despite prolonged aPTT (59.7 ± 18.7 and 46.4 ± 15.7 s, respectively; reference range, 20-40 s). Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) were reported in 12.0% and 2.0%, respectively, mainly after critical care discharge and with high FIBTEM MCF values in 57% on POD 3 and 86% on POD 7. Receiver operating characteristics curve analyses of FIBTEM MCF were significant predictors for thromboembolic events with optimum cut-off, area under the curve and standard error on POD 3 (>23 mm, 0.779 and 0.097; p = 0.004) and POD 7 (>28 mm, 0.706 and 0.089; p = 0.020). Red blood cells (mean ± SD, 8.68 ± 5.81 units) were transfused in 76%, fresh frozen plasma (8.26 ± 4.14 units) in 62%, and cryoprecipitate (12.0 ± 3.68 units) in 28% of recipients. None of the recipients received intraoperative platelet transfusion or any postoperative transfusion. Main transplant indication was hepatitis C infection in 82%. 76% of recipients included in this highly selected patient population showed increased lupus anticoagulant, 2% increased antiphospholipid IgG/IgM antibodies, 20% increased homocysteine, 74% decreased anti-thrombin, 78% decreased protein C, 34% decreased protein S, and 24% a positive Factor V Leiden mutation. Overall 1-year survival was 62%. CONCLUSION: A significant postoperative step-wise increase in FIBTEM MCF beyond the reference range was observed despite normal fibrinogen plasma concentrations, and FIBTEM MCF was a predictor for thromboembolic events in this study population, particularly after POD 3 and 7 on surgical wards when CCTs failed to detect this condition. However, the predictive value of FIBTEM MCF for postoperative HAT and PVT needs to be confirmed in a larger patient population. A ROTEM-guided anticoagulation regime needs to be developed and investigated in future studies.

Improved dentin disinfection by combining different-geometry rotary nickel-titanium files in preparing root canals.

OBJECTIVES: This study was to evaluate the antibacterial effect of different instrumentation and irrigation techniques using confocal laser scanning microscopy (CLSM) after root canal inoculation with Enterococcus faecalis (E. faecalis). MATERIALS AND METHODS: Mesiobuccal and mesiolingual canals of extracted mandibular molars were apically enlarged up to a size 25 hand K-file, then autoclaved and inoculated with E. faecalis. The samples were randomly divided into 4 main groups according to the system of instrumentation and irrigation: an XP-endo Shaper (XPS) combined with conventional irrigation (XPS/C) or an XP-endo Finisher (XPF) (XPS/XPF), and iRaCe combined with conventional irrigation (iRaCe/C) or combined with an XPF (iRaCe/XPF). A middle-third sample was taken from each group, and then the bacterial reduction was evaluated using CLSM at a depth of 50 µm inside the dentinal tubules. The ratio of red fluorescence (dead cells) to green-and-red fluorescence (live and dead cells) represented the percentage of bacterial reduction. The data were then statistically analyzed using the Kruskal-Wallis test for comparisons across the groups and the Dunn test was used for pairwise comparisons. RESULTS: The instrumentation and irrigation techniques had a significant effect on bacterial reduction (p < 0.05). The iRaCe/XPF group showed the strongest effect, followed by the XPS/XPF and XPS/C group, while the iRaCe/C group had the weakest effect. CONCLUSIONS: Combining iRaCe with XPF improved its bacterial reduction effect, while combining XPS with XPF did not yield a significant improvement in its ability to reduce bacteria at a depth of 50 µm in the dentinal tubules.

Improved dentin disinfection by combining different-geometry rotary nickel-titanium files in preparing root canals

OBJECTIVES: This study was to evaluate the antibacterial effect of different instrumentation and irrigation techniques using confocal laser scanning microscopy (CLSM) after root canal inoculation with Enterococcus faecalis (E. faecalis). MATERIALS AND METHODS: Mesiobuccal and mesiolingual canals of extracted mandibular molars were apically enlarged up to a size 25 hand K-file, then autoclaved and inoculated with E. faecalis. The samples were randomly divided into 4 main groups according to the system of instrumentation and irrigation: an XP-endo Shaper (XPS) combined with conventional irrigation (XPS/C) or an XP-endo Finisher (XPF) (XPS/XPF), and iRaCe combined with conventional irrigation (iRaCe/C) or combined with an XPF (iRaCe/XPF). A middle-third sample was taken from each group, and then the bacterial reduction was evaluated using CLSM at a depth of 50 µm inside the dentinal tubules. The ratio of red fluorescence (dead cells) to green-and-red fluorescence (live and dead cells) represented the percentage of bacterial reduction. The data were then statistically analyzed using the Kruskal-Wallis test for comparisons across the groups and the Dunn test was used for pairwise comparisons. RESULTS: The instrumentation and irrigation techniques had a significant effect on bacterial reduction (p < 0.05). The iRaCe/XPF group showed the strongest effect, followed by the XPS/XPF and XPS/C group, while the iRaCe/C group had the weakest effect. CONCLUSIONS: Combining iRaCe with XPF improved its bacterial reduction effect, while combining XPS with XPF did not yield a significant improvement in its ability to reduce bacteria at a depth of 50 µm in the dentinal tubules.

Endodontic Management of a Mandibular First Molar with Unusual Canal Morphology.

A comprehensive knowledge and understanding of root canal anatomical variations are essential for successful root canal treatment. Mandibular molar teeth show considerable variations in their external and internal radicular morphology that require special attention from dental practitioners to provide the best clinical outcomes to the patients. This report aims to present root canal treatment of a mandibular first molar that has six separate root canals (three root canals in the mesial roots and three in the distal roots [236 M3 D3]). This report points out the importance of proper exploration for identifying additional canals in mandibular molars.

Mass size distributions of elemental aerosols in industrial area.

Outdoor aerosol particles were characterized in industrial area of Samalut city (El-minia/Egypt) using low pressure Berner cascade impactor as an aerosol sampler. The impactor operates at 1.7 m(3)/h flow rate. Seven elements were investigated including Ca, Ba, Fe, K, Cu, Mn and Pb using atomic absorption technique. The mean mass concentrations of the elements ranged from 0.42 ng/m(3) (for Ba) to 89.62 ng/m(3) (for Fe). The mass size distributions of the investigated elements were bi-modal log normal distribution corresponding to the accumulation and coarse modes. The enrichment factors of elements indicate that Ca, Ba, Fe, K, Cu and Mn are mainly emitted into the atmosphere from soil sources while Pb is mostly due to anthropogenic sources.

Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols.

INTRODUCTION: Regenerative endodontics is a promising alternative treatment for immature teeth with necrotic pulps. The present study was performed to assess the regenerative potential of young permanent immature teeth with necrotic pulp after the following treatment protocols: (1) a mineral trioxide aggregate (MTA) apical plug, (2) the regenerative endodontic protocol (blood clot scaffold), and (3) the regenerative endodontic protocol with a blood clot and an injectable scaffold impregnated with basic fibroblast growth factor. METHODS: Immature necrotic permanent maxillary central incisors (n = 36) of patients 9-13 years old were divided into 3 groups according to the treatment protocol: the MTA group (MTA apical plug), the REG group (regenerative endodontic protocol [blood clot]), and the FGF group (regenerative endodontic protocol [blood clot + injectable scaffold]). Follow-up was done up to 18 months. Standardized radiographs were digitally evaluated for an increase in root length and thickness, a decrease in the apical diameter, and a change in periapical bone density. RESULTS: After a follow-up period of 18 months, most of the cases showed radiographic evidence of periapical healing. Groups 2 and 3 showed a progressive increase in root length and width and a decrease in apical diameter. CONCLUSIONS: The regenerative endodontic procedure allowed the continued development of roots in teeth with necrotic pulps. The use of artificial hydrogel scaffold and basic fibroblast growth factor was not essential for repair.