Long-term outcome in patients with juvenile dermatomyositis: A case series.

BACKGROUND: Follow-up of juvenile dermatomyositis (JDM) patients has demonstrated the impact of the disease on several organs in the long term. OBJECTIVE: As there is little information on the long-term outcome of JDM, we aimed to assess long-term outcomes in a series of JDM patients. METHODS: After selection of JDM patients, a consultation with a dermatologist and a rheumatologist was held for each patient. Cutaneous, muscle, and disease damage was assessed using different validated scores including the abbreviated Cutaneous Assessment Tool (aCAT), 8-muscle Manual Muscle Testing (MMT8), Childhood Myositis Assessment Scale (CMAS), Myositis Damage Index (MDI), Childhood Health Assessment Questionnaire (CHAQ), and Health Assessment Questionnaire (HAQ). Long-term disease outcomes were recorded including growth and pubertal development, educational and vocational achievement, and development of comorbidities. RESULTS: Seven patients were included in the study. After a mean follow-up of 14.9±8.8 years, the mean aCAT score was 0.57±1.4 and only one patient had a positive aCAT activity score. The mean aCAT damage score was 1.4±1.3 and five (71%) patients had a score of ≥1. Five (71.4%) patients had normal muscle strength with an MMT8 score of >72, and none had severe muscle weakness (MMT8 ≤32, and CMAS<35). The mean total extent of damage according to the MDI was ≥1 in five (71%) patients and mainly involved the skin. Two (29%) patients had mild disability according to the CHAQ/HAQ disability index. In terms of quality of life, no patient had a score of<40 (1 SD below the mean for healthy controls). CONCLUSIONS: Based on validated cutaneous and musculoskeletal scores, our study demonstrated the good functional outcomes of JDM at long-term follow-up.

Root canal treatment of compromised teeth as alternative treatment for patients receiving bisphosphonates: 60-month results of a prospective clinical study.

AIM: This 60-month prospective study aimed to evaluate tooth survival and healing rates after root canal treatment in patients taking bisphosphonates (BPs). Secondary outcomes were complications and clinical variables observed during and after treatment. METHODS: Root canal treatment was performed using manual K-file canal instrumentation and a carrier-based filling technique with an epoxy resin-based sealer. Teeth without adequate root/crown integrity were restored by trained operators at the tissue level (TL group) to prevent occlusal/mechanical stress and to enable periapical lesion healing without the risk of root fracture. Other teeth were restored with normal occlusal contacts (OC group). Healthy patients who had undergone one or more root canal treatments of the same type constituted the control group. The relationships of the following variables to survival and health status were examined (chi-squared test and multivariate analysis, P = 0.05): age, gender, smoking habit, tooth location, treatment type, BPs treatment, BPs exposure, initial periapical index (PAI) and occlusal restoration. Survival curves were constructed using Kaplan-Meier analysis, with extraction serving as the end-point. RESULTS: In total, 65 patients with 109 root canal-treated teeth who were taking BPs were included. At 60 months, data from 57 patients (52F, 5M; median age 65.7 ± 8.6 years) who had undergone 96 root canal treatments were analysed (drop-out rate = 16.9%). The survival rate was 85%, and the success rate was 76%. The control group consisted of 46 patients (21F, 25M; median age 60.3 ± 7.2 years) who had undergone 102 root canal treatments. The survival rate was 88%, with 12 teeth lost during follow-up. The success rate was 73%. In the BP group, 55 teeth were restored normally (OC group) and 41 teeth were restored at the tissue level (TL group). No difference in the success or survival rate was observed between the BP and control groups (P > 0.05). Univariate Kaplan-Meier analysis revealed that only tooth type significantly affected survival status in the BP group. The analysis revealed the clinical relevance of smoking, tooth location and initial PAI on patients' health status (P < 0.05). CONCLUSION: Root canal treatments and post-endodontic restoration with tissue-level filling procedures represent a safe approach for severely damaged teeth in patients receiving BPs having comparable results to root filled teeth restored with occlusal contacts and to the control group.

Local ice cryotherapy decreases synovial interleukin 6, interleukin 1ß, vascular endothelial growth factor, prostaglandin-E2, and nuclear factor kappa B p65 in human knee arthritis: a controlled study.

BACKGROUND: The aim of this study was to assess the anti-inflammatory effects of local cryotherapy in human non-septic knee arthritis. METHODS: In the phase I of the study, patients were randomized to receive either ice (30 min; N = 16) or cold CO2 (2 min; N = 16) applied twice during 1 day at an 8-h interval on the arthritic knee. In phase II, 16 other ice-treated arthritic knees according to the same protocol were compared to the contralateral non-treated arthritic knees (N = 16). The synovial fluid was analyzed just before the first cold application, then 24 h later. IL-6, IL-1ß, TNF-α, IL-17A, VEGF, NF-kB-p65 protein, and PG-E2 levels were measured in the synovial fluid and compared before/after the two cold applications. RESULTS: Forty-seven patients were included (17 gouts, 11 calcium pyrophosphate deposition diseases, 13 rheumatoid arthritides, 6 spondyloarthritides). Local ice cryotherapy significantly reduced the IL-6, IL-1ß, VEGF, NF-kB-p65, and PG-E2 synovial levels, especially in the microcrystal-induced arthritis subgroup, while only phosphorylated NF-kB-p65 significantly decreased in rheumatoid arthritis and spondyloarthritis patients. Cold CO2 only reduced the synovial VEGF levels. In the phase II of the study, the synovial PG-E2 was significantly reduced in ice-treated knees, while it significantly increased in the corresponding contralateral non-treated arthritic knees, with a significant inter-class effect size (mean difference - 1329 [- 2232; - 426] pg/mL; N = 12). CONCLUSIONS: These results suggest that local ice cryotherapy reduces IL-6, IL-1ß, and VEGF synovial protein levels, mainly in microcrystal-induced arthritis, and potentially through NF-kB and PG-E2-dependent mechanisms. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03850392-registered February 20, 2019-retrospectively registered.

A 20-year historical prospective cohort study of root canal treatments. A Multilevel analysis.

AIM: To evaluate the number of healthy and functional root filled teeth of patients included in a recall programme for at least 20 years. METHODOLOGY: Teeth were root filled by a single specialist following manual canal instrumentation, lateral/vertical compaction of gutta-percha and restored with glass-ionomer cements and bonding system/composite resin. In a large percentage of teeth, a metal-ceramic crown was placed during follow-up. Patients included in the recall programme (n = 130) were blindly assessed both clinically and radiographically (every 2 years) to evaluate clinical symptoms and periapical status (PAI). The following variables were analysed: age, tooth location, tooth type, initial diagnosis, PAI, root filling length and coronal restoration type. Chi-square test and multilevel analysis were performed to detect variables associated with treatment functionality and disease/lesions (P < 0.05). A cumulative teeth survival curve was constructed by means of Kaplan-Meier using extractions as the end-point. RESULTS: At the 20-year recall, 72 patients (31 M, 41 F; mean age 57.7 ± 8.29 years; 196 teeth) completed the follow-up. Thirty-six patients were excluded for medical complications or died before the end of the study. Drop-outs consisted of 22 patients (17%) who did not complete the follow-up. Single metal-ceramic crowns were positioned after 4-6 months in 40% of teeth. Composite restorations were replaced with single metal-ceramic crowns during the follow-up in 53% of teeth after 8-19 years. Of 196 teeth, 155 were classified as Survived (79%), 128 of which (65%) were Healthy (PAI ≤ 2). Thirty-nine teeth (20%) were extracted for nonendodontic reasons. Twenty-nine teeth (15%) were classified as: re-exacerbation (11 teeth; 5.6%) or persistent asymptomatic lesions (18 teeth; 9%). Only two re-exacerbated teeth were extracted. Multilevel analysis confirmed the clinical relevance of tooth type (P = 0.001) on Survived and healthy teeth (P = 0.007). Tooth location (P = 0.0045) and initial diagnosis (P = 0.019) significantly affected only Healthy teeth. CONCLUSIONS: Root filled teeth were more frequently extracted for non-endodontic reasons rather than for endodontic disease. The majority of teeth with adequate root fillings, adequate restorations and included in a recall programme remained functional and healthy for more than 20 years.

Survival and periapical health after root canal treatment with carrier-based root fillings: five-year retrospective assessment.

AIM: This retrospective study explored survival and periapical healing outcomes in teeth root filled with Thermafil obturators. METHODOLOGY: Root canals of 213 teeth (94 subjects, mean age 48 ± 13 years), instrumented with a step-down technique, irrigated with 5% NaOCl and 10% EDTA and filled with Thermafil and AH Plus sealer, were involved in a recall programme. Teeth were retrospectively re-examined after 5 ± 1 years in a controlled environment. Clinical and radiographic data that were collected included the following: preoperative Periapical Index (PAI) score and signs/symptoms, treatment type, root filling length and presence/absence of voids, restoration type, follow-up PAI score and signs/symptoms. Teeth were considered 'healthy' (PAI ≤ 2, no signs/symptoms) or 'diseased' (PAI ≥ 3, signs/symptoms present, retreated, extracted for endodontic reasons). Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed at level of patient and tooth (α = 5%). RESULTS: Of 213 teeth treated, 187 (88%) survived and 26 were extracted, six (3%) for persistent endodontic infection (considered 'diseased'), and 20 (9%) for root fracture, periodontal disease or coronal fracture (excluded from analysis). Whilst survival was significantly associated with tooth type (P = 0.015), type of treatment (P = 0.012) and pulpal/periapical diagnosis (P = 0.035), none of these variables were substantiated as survival predictors by the multilevel analysis. A total of 164 of 193 teeth (85%) were assessed as 'healthy', with significantly higher (chi-square; P < 0.04) 'healthy' rates for teeth with PAI score ≤2 and root fillings of adequate length. Multilevel analysis identified PAI score ≤2 (P = 0.002) as the only predictor of periapical health. CONCLUSIONS: In this 5 ± 1 year retrospective assessment, survival and healing rates after root canal treatment with Thermafil root fillings were comparable to those previously reported for conventional root filling techniques.

Properties of BioRoot RCS, a tricalcium silicate endodontic sealer modified with povidone and polycarboxylate.

AIM: To evaluate the chemical and physical properties of a tricalcium silicate root canal sealer containing povidone and polycarboxylate (BioRoot RCS), a calcium silicate MTA-based sealer containing a salicylate resin (MTA Fillapex), a traditional eugenol-containing sealer (Pulp Canal Sealer) and an epoxy resin-based root canal sealer (AH Plus). METHODOLOGY: Calcium release, pH, setting time, water sorption, volume of open pores, volume of impervious portion, apparent porosity and weight loss were measured. The ability to nucleate calcium phosphates (CaP) after ageing 28 days in a simulated body fluid was evaluated using ESEM-EDX and micro-Raman spectroscopy. Data were statistically analysed (P = 0.05) using one-way anova (setting time, radiopacity, solubility, water sorption, porosity) or two-way anova (ion release tests). RESULTS: BioRoot RCS had a final setting time of 300 min and adequate radiopacity (5.2 mm Al). It demonstrated the highest (P < 0.05) and more prolonged ability to release calcium ions (721 ppm at 3 h) and to increase the pH (11-12) (P < 0.05); B-type carbonated apatite deposits were found on aged BioRoot RCS (biointeractivity-related CaP-forming ability). A final setting time of 270 min and good calcium release (17.4 ppm at 3 h) were measured for MTA Fillapex; apatite deposits were present on aged samples. No calcium release and no alkalizing activity were measured for Pulp Canal Sealer and AH Plus; no CaP nucleation was detected on aged Pulp Canal Sealer, and some apatite deposits were found on aged AH Plus (chemi/physisorption-related CaP-deposition). Higher and significantly different (P < 0.05) porosity, water sorption and solubility were measured for the two calcium silicate sealers, especially for BioRoot RCS. CONCLUSIONS: BioRoot RCS had bioactivity with calcium release, strong alkalizing activity and apatite-forming ability, and adequate radiopacity.

Exploring patient safety culture in preventive medicine settings: an experience from Northern Italy.

INTRODUCTION: Patient safety and quality in healthcare are inseparable. Examining patient safety culture in staff members contributes to further develop quality in healthcare. In Italy there has been some experience in assessing patient safety culture in staff working in hospital. In this pilot study we explored patient safety culture in public health staff working in Italian Local Health Authorities. METHODS: We carried out a descriptive cross sectional study in four Italian territorial Prevention facilities in Northern Italy. We administrated an adapted Italian version of the US Hospital Survey of Patient Safety Culture to all the staff within these facilities. The survey consisted of 10 dimensions based on 33 items, according to the results of a previous psychometric validation. RESULTS: Seventy per cent of the staff responded to the survey (N = 479). Overall, six out of the 10 dimensions exhibited composite scores of positive response frequency for patient safety culture below 50%. While "communication openness" (65%) was the most developed factor, "teamwork across Units" (37%) was the least developed. The work areas with the highest composite scores were Management and the Public Health Laboratory, while in terms of professional categories, Physicians had the highest scores. Patient safety culture in the staff participating in this study was lower than in hospital staff. DISCUSSION: Our descriptive cross sectional study is the first to be carried out in Preventive medicine settings in Italy. It has clearly indicated the need of improvement. Consequently, several interventions with this aim have been implemented.

Properties of NeoMTA Plus and MTA Plus cements for endodontics.

AIM: To test a novel calcium silicate cement mixed with a water-based gel (NeoMTA Plus) with regard to chemical-physical properties and apatite-forming ability. METHODOLOGY: NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA; lot. 2014090301) and a commercial MTA-based material with similar properties (MTA Plus, Prevest Denpro Limited, Jammu, India; lot. 41001) were tested for ion-releasing ability, initial and final setting times, radiopacity, open and impervious porosity and apparent porosity, water sorption, weight loss, solubility, ability to nucleate calcium phosphates (CaP) after immersion in HBSS (Hank's Balanced Salt Solution) by ESEM-EDX and micro-Raman spectroscopy. The results were analysed statistically with the anova test (P  <  0.05). RESULTS: NeoMTA Plus had a prolonged setting time (315 min) and a satisfactory radiopacity (3.76 mm Al). Calcium and hydroxyl ion release was significantly greater and more prolonged in comparison with MTA Plus (P < 0.05). Both NeoMTA Plus and MTA Plus had high values of open porosity and solubility. ESEM-EDX and micro-Raman confirmed the ability to nucleate calcium phosphates on their surface after immersion in HBSS. CONCLUSION: NeoMTA Plus is a new calcium silicate-based cement for root filling with an adequate radiopacity and prolonged setting time. The ion release and CaP-forming ability could increase stability of the root filling and promote endodontic and periodontal tissue regeneration, enhancing the bioactivity and biocompatibility of the material.

Glucocorticoids improve endothelial function in rheumatoid arthritis: a study in rats with adjuvant-induced arthritis.

To determine the effect of glucocorticoids (GCs) on endothelial dysfunction (ED) and on traditional cardiovascular (CV) risk factors in the adjuvant-induced arthritis (AIA) rat model. At the first signs of AIA, a high dose (HD) [10 mg/kg/day, intraperitoneally (i.p.), GC-HD] or low dose (LD) (1 mg/kg/day, i.p., GC-LD) of prednisolone was administered for 3 weeks. Endothelial function was studied in aortic rings relaxed with acetylcholine (Ach) with or without inhibitors of nitric oxide synthase (NOS), cyclooxygenase 2 (COX-2), arginase, endothelium derived hyperpolarizing factor (EDHF) and superoxide anions ( O2-°) production. Aortic expression of endothelial NOS (eNOS), Ser1177-phospho-eNOS, COX-2, arginase-2, p22phox and p47phox was evaluated by Western blotting analysis. Arthritis scores, blood pressure, heart rate and blood levels of cytokines, triglycerides, cholesterol and glucose were measured. GC-HD but not GC-LD reduced arthritis score significantly and improved Ach-induced relaxation (P < 0·05). The positive effect of GC-HD resulted from increased NOS activity and EDHF production and decreased COX-2/arginase activities and O2-° production. These functional effects relied upon increased phospho-eNOS expression and decreased COX-2, arginase-2 and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase expression. Despite the lack of effect of GC-LD on ED, it increased NOS and EDHF and down-regulated O2-° pathways but did not change arginase and COX-2 pathways. GC-HD increased triglycerides levels and blood pressure significantly (P < 0·05). Both doses of GCs decreased to the same extent as plasma interleukin (IL)-1ß and tumour necrosis factor (TNF)-α levels (P < 0·05). Our data demonstrated that subchronic treatment with prednisolone improved endothelial function in AIA via pleiotropic effects on endothelial pathways. These effects occurred independently of the deleterious cardiometabolic effects and the impact of prednisolone on systemic inflammation.

Osteoinductive potential and bone-bonding ability of ProRoot MTA, MTA Plus and Biodentine in rabbit intramedullary model: Microchemical characterization and histological analysis.

OBJECTIVE: To study the in vivo osteoinductive potential, bone-bonding ability (bioactivity) and bone biomineralization of current hydraulic calcium silicate cements used as graft materials and placed in contact with medullary bone. METHODS: ProRoot MTA, MTA Plus and Biodentine were used to fill surgical bone defects (2-mm diameter through the entire cortical thickness to reach the medullary bone) in the tibia of mature male rabbits. Tibiae were retrieved after 30days and submitted to histological analysis and microchemical characterization using Optical Microscopy (OM) and Environmental Scanning Electron Microscopy with Energy Dispersive X-ray analysis (ESEM-EDX). Bone neoformation and histomorphometric evaluations, degree of mineralization (by Ca/P, Ca/N and P/N ratios) and the diffusion of material elements were studied. RESULTS: Bone neoformation was observed in response to all materials. No sign of necrosis were found on the walls of the pre-existing cortical bone. No osteoclasts and no formation of fibrous tissue were evident. Sign of angiogenesis were present. EDX (element content, line profile and element mapping) showed the increase in Ca and P and decrease in C, S and N from the mature bone towards the mineralizing interface. Ca/P, Ca/N and P/N ratios showed differences in the degree of mineralization/maturation stage of bone. MTA Plus and ProRoot MTA exhibited close contact with the pre-existing bone and good bone-bonding with neoformed bone juxtaposed on the medullary side of the materials without interposed connective tissue or resorption lacunae or gaps. The materials showed a dense appearance with 100% of residual materials and no colonization by fluids and cells. No migration of Bi or Al material elements to the newly formed bone was found. Biodentine showed newly formed trabecular bone with marrow spaces and sparse traces of residual material (≈9%). SIGNIFICANCE: The in vivo osteoinductive properties with dynamic biomineralization processes around these calcium silicate materials extruded in medullary bone in appropriate animal model have been demonstrated by ESEM-EDX in association with OM. Good biocompatibility was evident as only slight inflammatory infiltrate and no sign of necrosis at the interface with the pre-existing bone were found. MTA Plus and ProRoot MTA exhibited bioactive potential as they can bond to bone directly without interposed connective tissue. Biodentine was replaced by newly formed bone. CLINICAL SIGNIFICANCE: The results of the study demonstrate the capacity of calcium silicate cements to allow osteoid matrix deposition by activated osteoblasts and favour its biomineralization, and to achieve a direct bond between the (bioactive) materials surface and the mineralized bone matrix.

Structural analysis of HyFlex EDM instruments.

AIM: To compare the phase transformation behaviour, the microstructure, the nano-hardness and the surface chemistry of electro-discharge machined HyFlex EDM instruments with conventionally manufactured HyFlex CM. METHODOLOGY: New and laboratory used HyFlex EDM were examined by X-ray diffraction (XRD) and differential scanning calorimetry (DSC). Nano-hardness and modulus of elasticity were also investigated using a maximum load of 20 mN with a minimum of 40 significant indentations for each sample. Raman spectroscopy and field emission-scanning electron microscope (FE-SEM) were used to assess the surface chemistry of HyFlex EDM. HyFlex CM were subjected to the same investigations and used as a comparison. Nano-indentation data were statistically analysed using the Student's t-test. RESULTS: XRD analysis on HyFlex EDM revealed the presence of martensite and rhombohedral R-phase, while a mixture of martensite and austenite structure was identified in HyFlex CM. DSC analysis also disclosed higher austenite finish (Af) temperatures for electro-discharge machining (EDM) instruments. Significant differences in nano-hardness and modulus of elasticity were found between EDM and CM files (P < 0.05). FE-SEM and EDS analyses confirmed that both new EDM and CM files were covered by an oxide layer. Micro-Raman spectroscopy assessed the presence of rutile-TiO2 . CONCLUSIONS: HyFlex EDM revealed peculiar structural properties, such as increased phase transformation temperatures and hardness. Present results corroborated previous findings and shed light on the enhanced mechanical behaviour of these instruments.

Double dye technique and fluid filtration test to evaluate early sealing ability of an endodontic sealer.

OBJECTIVES: The aim of the present study is to evaluate the possible correlation between sealer penetration into dentinal tubules and sealing ability both in presence and absence of smear layer. MATERIALS AND METHODS: Fourteen maxillary central incisors were treated with 5.25 % NaOCl +10 % EDTA to remove the smear layer (SL-free group) or 5.25 % NaOCl without EDTA (SL group). Root canals were filled using #25 Thermafil Obturators with Topseal sealer labelled with 0.1 wt% rhodamine B. Sealing ability was measured as fluid filtration rate with a fluid-flow meter using water supplemented with 0.3 % calcein fluorescent dye. Specimens were sectioned, observed under confocal microscope to co-localize the presence of sealer (rhodamine B labelling) into dentinal tubules and gaps (calcein labelling) into the root canal. The depth of sealer penetration into dentinal tubules and the percentage of sealer penetration around the root canal were measured at 3, 5 and 8 mm from the apex. RESULTS: No significant differences between groups were observed in fluid filtration rate nor in depth of calcein penetration. Sealer penetration depth and percentage into dentinal tubules were not significantly different between groups, except at 8-mm level in absence of smear layer. CONCLUSION: Sealer penetration at 3- and 5-mm levels was not influenced by smear layer while it was significantly reduced at 8-mm level. Fluid filtration rate was not correlated either with depth of calcein penetration nor with sealer penetration into dentinal tubules. CLINICAL RELEVANCE: The sealing ability of Topseal sealer is not affected by presence or absence of smear layer.

Properties of a novel polysiloxane-guttapercha calcium silicate-bioglass-containing root canal sealer.

OBJECTIVE: Root canal filling sealers based on polymethyl hydrogensiloxane or polymethyl hydrogensiloxane-guttapercha--introduced to improve the quality of conventional guttapercha-based and resin-based systems--showed advantages in handiness and clinical application. The aim of the study was to evaluate the chemical-physical properties of a novel polysiloxane-guttapercha calcium silicate-containing root canal sealer (GuttaFlow bioseal). METHODS: GuttaFlow bioseal was examined and compared with GuttaFlow2, RoekoSeal and MTA Fillapex sealers. Setting times, open and impervious porosity and apparent porosity, water sorption, weight loss, calcium release, and alkalinizing activity were evaluated. ESEM-EDX-Raman analyses of fresh materials and after soaking in simulated body fluid were also performed. RESULTS: Marked differences were obtained among the materials. GuttaFlow bioseal showed low solubility and porosity, high water sorption, moderate calcium release and good alkalinizing activity. MTA Fillapex showed the highest calcium release, alkalinizing activity and solubility, RoekoSeal the lowest calcium release, no alkalinizing activity, very low solubility and water sorption. Only GuttaFlow bioseal showed apatite forming ability. SIGNIFICANCE: GuttaFlow bioseal showed alkalinizing activity together with negligible solubility and slight calcium release. Therefore, the notable nucleation of apatite and apatite precursors can be related to the co-operation of CaSi particles (SiOH groups) with polysiloxane (SiOSi groups). The incorporation of a calcium silicate component into polydimethyl polymethylhydrogensiloxane guttapercha sealers may represent an attractive strategy to obtain a bioactive biointeractive flowable guttapercha sealer for moist/bleeding apices with bone defects in endodontic therapy.

HyFlex EDM: superficial features, metallurgical analysis and fatigue resistance of innovative electro discharge machined NiTi rotary instruments.

AIM: To evaluate the surface and microstructural alterations of new and used HyFlex EDM prototypes and to test their fatigue resistance. METHODOLOGY: Fifteen HyFlex EDM prototypes were used for in vitro instrumentation of severely curved root canals. Surface and microstructural characteristics of new and used files were compared by ESEM analysis equipped with energy dispersive X-ray spectrophotometry (EDS) and optical metallographic imaging. Usage-induced degradation was assessed. Thirty additional HyFlex EDM prototypes and 20 standard manufactured HyFlex CM files were subjected to cyclic fatigue tests. Time to fracture was recorded, and results were validated using the Kruskal-Wallis test (α-level 0.05). Fatigued files were analysed by ESEM for fractographic evaluation. RESULTS: Surface and microstructural characterization of EDM prototypes revealed the typical spark-machined surface of a NiTi EDM alloy. No fractures were registered during root canal instrumentation. No evident surface alterations and minor degradation were observed between new and used instruments. The metallographic analysis of new and used files disclosed a homogeneous structure, mostly composed of lenticular martensite grains, and some residual austenite. The cyclic fatigue test showed an increase of fatigue resistance up to 700% on the EDM compared to CM files. CONCLUSIONS: Spark-machined peculiar surface is the main feature of HyFlex EDM. Low degradation was observed after multiple canal instrumentations. Prototypes exhibited surprising high values of cyclic fatigue resistance and a safe in vitro use in severely curved canals.

Calcium silicate/calcium phosphate biphasic cements for vital pulp therapy: chemical-physical properties and human pulp cells response.

OBJECTIVES: The aim was to test the properties of experimental calcium silicate/calcium phosphate biphasic cements with hydraulic properties designed for vital pulp therapy as direct pulp cap and pulpotomy. METHODS: CaSi-αTCP and CaSi-DCDP were tested for ion-releasing ability, solubility, water sorption, porosity, ability to nucleate calcium phosphates, and odontoblastic differentiation­alkaline phosphatase (ALP) and osteocalcin (OCN) upregulation­of primary human dental pulp cells (HDPCs). RESULTS: The materials showed high Ca and OH release, high open pore volume and apparent porosity, and a pronounced ability to nucleate calcium phosphates on their surface. HDPCs treated with CaSi-αTCP showed a strong upregulation of ALP and OCN genes, namely a tenfold increase for OCN and a threefold increase for ALP compared to the control cells. Conversely, CaSi-DCDP induced a pronounced OCN gene upregulation but had no effect on ALP gene regulation. CONCLUSIONS: Both cements showed high biointeractivity (release of Ca and OH ions) correlated with their marked ability to nucleate calcium phosphates. CaSi-αTCP cement proved to be a potent inducer of ALP and OCN genes as characteristic markers of mineralization processes normally poorly expressed by HDPCs. CLINICAL RELEVANCE: Calcium silicate/calcium phosphate cements appear to be attractive new materials for vital pulp therapy as they may provide odontogenic/dentinogenic chemical signals for pulp regeneration and healing, and dentin formation in regenerative endodontics.

Micro-topography and reactivity of implant surfaces: an in vitro study in simulated body fluid (SBF).

The creation of micro-textured dental implant surfaces possessing a stimulating activity represents a challenge in implant dentistry; particularly, the formation of a thin, biologically active, calcium-phosphate layer on their surface could help to strengthen the bond to the surrounding bone. The aim of the present study was to characterize in terms of macrostructure, micro-topography and reactivity in simulated body fluid (SBF), the surface of titanium (Ti) implants blasted with TiO2 particles, acid etched with hydrofluoric acid, and activated with Ca and Mg-containing nanoparticles. Sandblasted and acid-etched implants were analyzed by ESEM-EDX (environmental scanning electron microscope with energy dispersive X-ray system) to study the micromorphology of the surface and to perform elemental X-ray microanalysis (microchemical analyses) and element mapping. ESEM-EDX analyses were performed at time 0 and after a 28-day soaking period in SBF Hank's balanced salt solution (HBSS) following ISO 23317 (implants for surgery­in vitro evaluation for apatite-forming ability of implant materials). Microchemical analyses (weight % and atomic %) and element mapping were carried out to evaluate the relative element content, element distribution, and calcium/phosphorus (Ca/P) atomic ratio. Raman spectroscopy was used to assess the possible presence of impurities due to manufacturing and to investigate the phases formed upon HBSS soaking. Micro-morphological analyses showed a micro-textured, highly rough surface with microgrooves. Microchemical analyses showed compositional differences among the apical, middle, and distal thirds. The micro-Raman analyses of the as-received implant showed the presence of amorphous Ti oxide and traces of anatase, calcite, and a carbonaceous material derived from the decomposition of an organic component of lipidic nature (presumably used as lubricant). A uniform layer of Ca-poor calcium phosphates (CaPs) (Ca/P ratio <1.47) was observed after soaking in HBSS; the detection of the 961 cm⁻¹ Raman band confirms this finding. These implants showed a micro-textured surface supporting the formation of CaPs when immersed in SBF. These properties may likely favor bone anchorage and healing by stimulation of mineralizing cells.

Eighteen cases of crowned dens syndrome: Presentation and diagnosis.

BACKGROUND AND PURPOSE: Crowned dens syndrome is an ill-known etiology of acute neck pain. METHODS: We carried out a retrospective study of 18 cases of patients with crowned dens syndrome, assessing clinical and radiological features. RESULTS: The results of our study are comparable to data from the literature. The clinical presentation of acute febrile neck pain, occipital headache and multidirectional stiff neck especially affects women aged over 60. No predisposing factor was recognized. However, a history of peripheral joint chondrocalcinosis may reinforce the diagnosis. In more than 50% of cases, laboratory tests showed a marked inflammatory syndrome. The diagnosis was obtained with cervical CT-scan focusing on the C1/C2 joint. This gold standard test was able to show a calcification of the cruciform ligament in connection with deposits of calcium pyrophosphate crystals in almost 80% of cases. Other imaging tests provided little information, including standard radiographs of the cervical spine. MRI can eliminate some differential diagnoses such as infections or neurological emergencies. Complications are infrequent. The standard treatment is based on anti-inflammatory drugs (NSAID, colchicine) or corticosteroids. These treatments are highly effective: a drammatic full recovery of cervical mobility may be observed within 48 hours. In over half of cases, a different diagnosis was initially made, responsible of unnecessary additional tests and treatment. CONCLUSION: A comprehensive consultation, a complete clinical examination and a precise analysis of the imaging will avoid certain investigations and rule out differential diagnoses.

The response of cementoblasts to calcium phosphate resin-based and calcium silicate-based commercial sealers.

AIM: To investigate cell viability and gene expression of cementoblasts (OCCM.30) exposed to extractable components released by resin-based sealers with different chemical composition Hybrid Root Seal (HRS), SimpliSeal (SS), Real Seal (RS) and AH Plus (AH) and by a MTA-based sealers Tech Biosealer Endo (TBE). METHODOLOGY: Discs of all materials were prepared and allowed to set in humid conditions at 37° for 48 h. The discs were then incubated for 72 h at 37 °C to obtain material extracts (1/1) in DMEM. The extracts containing the components released by the sealers were filtered and other dilutions (1/2, 1/4) were prepared from the original solution (1/1). Original and diluted solutions were tested on the cementoblasts. Impedance-based real-time cell analysis (RTCA) was used to evaluate cell viability, quantitative real-time polymerase chain reaction (QRT-PCR) was used to examine the expression of mineralization-related genes (osteocalcin; OCN, Runt-related transcription factor-2; Runx2, collagen type 1; COL I, alkaline phosphatase; ALP). For statistical analysis, one-way analysis of variance (anova) and Tukey's honestly significant difference (HSD) tests were used. RESULTS: TBE (1/2), RS (1/2, 1/4), and HRS (1/2, 1/4) significantly decreased cell viability (P < 0.001). AH (1/2, 1/4) and SS (1/2, 1/4) had similar cell viability to the control at 30 h. All tested materials significantly decreased cell viability when compared to the control group except AH (1/2, 1/4) and SS (1/4) at 90 h. All of the tested sealers reduced COL I mRNA expressions when compared to the control. SS was associated with significant increases in OCN and Runx2 mRNA expressions when compared to the control (P < 0.001). Whereas all of the dilutions of TBE, RS and HRS significantly decreased BSP mRNA expressions (P < 0,001), 1/2 and 1/4 dilutions of SS increased BSP mRNA expression (P < 0,001). Except the 1/4 dilutions of AH and SS, all the sealer dilutions significantly reduced ALP mRNA expression in cementoblasts (P < 0,001). CONCLUSIONS: SimpliSeal and AH Plus resulted in more favourable response to cementoblasts because of their regulation potential on the mineralized tissue-associated protein's mRNA expressions.