The effectiveness of ethylenediaminetetraacetic, etidronic, and peracetic acids activated with ultrasonics or diode laser on calcium hydroxide removal from root canal walls.

BACKGROUND: To assess the efficiency of ethylenediaminetetraacetic acid (EDTA), etidronic (HEBP), and peracetic (PAA) acids agitated with ultrasonic energy or diode laser on removing calcium hydroxide (CH) dressings from root canal walls. MATERIAL AND METHODS: Single root canals of eighty extracted human teeth were chemomechanically instrumented and filled with CH. Sixty teeth were divided into six experimental groups (n = 10) according to the applied irrigation regimens for the removal of CH: Group 1: 5.25% NaOCl-17% EDTA, Passive ultrasonic irrigation (PUI); Group 2: 5.25% NaOCl + 9% HEBP, PUI; Group 3: 5.25% NaOCl-2% PAA, PUI; Group 4: 5.25% NaOCl-17% EDTA, Diode laser-activated irrigation (LAI); Group 5: 5.25% NaOCl + 9% HEBP, LAI; Group 6: 5.25% NaOCl-2% PAA, LAI. The other 20 teeth were served as negative (n = 10) and positive controls (n = 10). The residuary amount of CH was scored in coronal, middle, and apical thirds of the root canals by using scanning electron microscope. The data were statistically analyzed using Kruskal-Wallis H with Bonferroni adjusted Mann-Whitney U test with a significance level of 0.05. RESULTS: Etidronic acid activated with ultrasonics or diode laser removed the highest amount of CH from the middle third of root canals, compared to the other irrigation regimens (P < 0.001). Although the residual CH scores of PAA-PUI, PAA-LAI, and EDTA-PUI, EDTA-LAI groups were not statistically different from each other (P > 0.05), lower amount of CH was observed in the PAA-PUI and PAA-LAI groups. CONCLUSIONS: Use of etidronic acid activated with ultrasonics or diode laser can be an appropriate irrigation regimen for CH removal from root canal system.

Indirect inguinal hernia repair conducted with single conventional port intracorporeal conventional equipment-endoscopic surgery.

PURPOSE: Laparoscopic or laparoscopy-assisted inguinal hernia repair (IHR) can be performed using one port plus two stab wounds. We herein present our experience with laparoscopic IHR conducted using a single conventional port and a single working instrument. METHODS: The records patients who underwent single conventional port intracorporeal IHR during November 2013-December 2018 were evaluated. The main outcome measurements were patient's demographic characteristics, hernia side, presence of incarceration, operative time, and complications. RESULTS: A total of 132 inguinal hernias (52 right, 40 left, and 20 bilateral) were repaired in 112 patients (76 boys, 36 girls). The mean ages of the patients were 69.8 ± 53.4 months (3 months to 17 years). In six patients, contralateral processus vaginalis was found to be patent during operation. Incarcerated inguinal hernia was present in two patients. Mean operative time was 17.9 ± 3.8 min (9-30 min) in unilateral hernias and 28.9 ± 6.5 min (24-45 min) in bilateral hernias. No intraoperative and postoperative complications were encountered. The mean hospital stay of the patients was 8.8 ± 5.0 h (4-36 h). Postoperative follow-up was 16.5 ± 5.1 months (6-24 months). No recurrent inguinal hernias were detected during follow-up. CONCLUSION: Single conventional port intracorporeal IHR obviates additional stab wounds. Additionally, present technique eliminates the risk of skin puckering, subcutaneous granuloma, infection, nerve, and muscle damage development induced by the subcutaneously placed knot in laparoscopy-assisted IHR. Single conventional port intracorporeal IHR in children is a feasible and safe operative technique with low complication rates.

Nanohardness reduction and root dentine erosion after final irrigation with ethylenediaminetetraacetic, etidronic and peracetic acids.

AIM: To evaluate the nanohardness reduction and erosion in root canal dentine after application of 17% ethylenediaminetetraacetic acid (EDTA), 9% etidronic acid (HEBP) and 2% peracetic acid (PAA) either alone or combined with sodium hypochlorite (NaOCl). METHODOLOGY: One hundred and sixty single-rooted teeth were decoronated and their root canals were chemomechanically prepared. For the nanohardness evaluation, 80 roots with instrumented canals were split longitudinally into two halves. Dentine blocks with a length of 7 mm were obtained from the middle third of one half of each tooth and were embedded in epoxy resin blocks exposing the root canal walls. Initial nanohardness values of root canal dentine were measured for each specimen using a nanoindenter with a Berkovich tip. The specimens were divided into seven experimental (n = 10) and one control (n = 10) group according to the final irrigation regimens: Group 1: 2.5% NaOCl, Group 2: 17% EDTA, Group 3: 2.5% NaOCl-17% EDTA, Group 4: 2% PAA, Group 5: 2.5% NaOCl-2% PAA, Group 6: 9% HEBP, Group 7: 2.5% NaOCl + 9% HEBP and Group 8: Distilled water (control). The measurement of the nanohardness values was repeated for each specimen after being exposed to the irrigants. The nanaohardness reduction of each sample was calculated and recorded. The other 80 instrumented root canals were used for scanning electron microscope (SEM) evaluation. First, they were irrigated with the same protocols stated above and longitudinally split into two halves. One half of each root canal was viewed using SEM for the amount of erosion. The erosion scores were recorded. Data were analysed statistically using Kruskal-Wallis and Bonferroni-adjusted Mann-Whitney U-tests with a significance level of 0.05. RESULTS: Use of etidronic acid and NaOCl + HEBP reduced the nanohardness values significantly more than the other experimental solutions (P < 0.05). There was no significant difference between the values for the nanohardness reduction in the samples irrigated with a single chelator and chelator combined with NaOCl (P > 0.05). Peritubular and intertubular erosion were observed in the samples irrigated with HEBP and NaOCl + HEBP. CONCLUSION: Final irrigation of root canals using etidronic acid alone or combined with NaOCl was associated with structural alterations in root canal dentine of extracted teeth.

The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects.

AIM: To evaluate the effectiveness of NaOCl, NaOCl-EDTA and NaOCl + HEBP activated by ultrasonics and XP-endo Finisher on organic tissue removal from simulated internal root resorption cavities. METHODOLOGY: The root canals of 144 single-rooted teeth were instrumented. The teeth were split longitudinally, and semicircular cavities were prepared in the canal walls on each half of the roots. Samples obtained from ground bovine muscle tissue were weighed and adapted into the semicircular cavities. The root fragments were reassembled and cemented to create a circular simulated resorption cavity within the canal. Teeth were divided into twelve groups (n = 12) according to the irrigation protocols: group 1: NaOCl, no activation; group 2: NaOCl, passive ultrasonic irrigation (PUI); group 3: NaOCl, XP-endo Finisher; group 4: NaOCl-EDTA, no activation; group 5: NaOCl-EDTA, PUI; group 6: NaOCl-EDTA, XP-endo Finisher; group 7: NaOCl + HEBP, no activation; group 8: NaOCl + HEBP, PUI; group 9: NaOCl + HEBP, XP-endo Finisher; group 10: distilled water, no activation; group 11: distilled water, PUI; and group 12: distilled water, XP-endo Finisher. The teeth were disassembled, and the tissue remaining inside the resorption cavities were weighed. The data were analysed statistically using two-way anova and Fisher's LSD tests with a significance level of 0.05. RESULTS: The use of XP-endo Finisher with the experimental solutions resulted in the greatest tissue weight loss compared to the other activation protocols (P < 0.001). There was no significant difference between NaOCl and NaOCl + HEBP in terms of tissue removal. CONCLUSION: The use of a NaOCl + HEBP mixture activated with XP-endo Finisher was an effective irrigation regimen for removing simulated organic tissues from artificial internal root resorption cavities in the straight root canals of single-rooted teeth.

Dislodgement resistance of calcium silicate-based materials from root canals with varying thickness of dentine.

AIM: To evaluate the dislodgement resistance of DiaRoot BioAggregate and Biodentine from canals in roots with varying amounts of remaining dentine thickness. METHODOLOGY: A total of 90 maxillary incisor teeth with similar dimensions were used. The teeth were extracted for periodontal reasons from adult subjects aged between 52 and 61 years. They were decoronated at the cemento-enamel junction. Simulated internal cavities with a depth of 3 mm were performed by widening the canals on the coronal thirds of the roots, leaving varying amounts of remaining dentine thickness. The canals were enlarged progressively using round diamond burs until the desired dentine wall thickness was obtained. The samples were divided into three main groups (n = 30 each) according to the dentine thickness as follows: group 1: dentine thickness of 0.75 mm, group 2: dentine thickness of 1.50 mm and group 3: dentine thickness of 2.25 mm. Then, these main groups were further divided into two subgroups (n = 15 each) according to the filling material (DiaRoot BioAggregate or Biodentine). Horizontal root slices of 1 mm were obtained from each specimen. Vertical loading was applied to the filling materials at a cross-head speed of 1 mm min-1 using a universal testing machine. The force that led to dislodgement of the filling was recorded in Newtons. The resistance to dislodgement was calculated in megapascals (MPa) by dividing the load in Newtons by the area of the bonded interface. The data were statistically analysed with two-way anova with Tukey's honestly significant difference (HSD) test. RESULTS: Biodentine had significantly higher resistance to dislodgement than DiaRoot BioAggregate (P < 0.001). The specimens with thinner remaining dentine had lower dislodgement resistance compared to those with dentine thicknesses of 1.50 and 2.25 mm (P < 0.001). The lowest mean value for dislodgement resistance was obtained from the DiaRoot BioAggregate group with 0.75 mm dentine thickness (2.72 ± 0.90 MPa). CONCLUSION: The dislodgement resistance of Biodentine and DiaRoot BioAggregate from root dentine was influenced by remaining dentine thickness, which determines dentinal tubular density.

Effect of several thermoplastic canal filling techniques on surface temperature rise on roots with simulated internal resorption cavities: an infrared thermographic analysis.

AIM: To evaluate the surface temperature rise using an infrared thermal imaging camera on roots with and without simulated internal resorption cavities, during canal filling with injectable (Obtura II), carrier-based (Soft-Core) gutta-percha and continuous wave of condensation (System B) techniques. METHODOLOGY: Root canals of 60 mandibular premolar teeth were instrumented to an apical size of 40. Circular artificial internal resorption cavities with a diameter of 2.40 mm were prepared on the root canal walls of 30 teeth. All teeth were divided into six groups of 10 specimen and root filled as follows: group 1 (teeth with internal resorption): thermoplasticized injectable gutta-percha (Obtura II), group 2 (teeth without internal resorption): thermoplasticized injectable gutta-percha (Obtura II), group 3 (teeth with internal resorption): carrier-based gutta-percha (Soft-Core), group 4 (teeth without internal resorption): carrier-based gutta-percha (Soft-Core), group 5 (teeth with internal resorption): continuous wave of condensation (System B) and group 6 (teeth without internal resorption): continuous wave of condensation (System B). The surface temperature changes during filling of canals were measured with an infrared thermal imaging camera. The thermograms were recorded at 2-s intervals over a period of 40 s to determine the maximum temperature rise at the apical, middle and cervical thirds of the root surface. The data were statistically analysed with one-way anova and Tukey HSD post hoc or Kruskal-Wallis and Bonferroni-adjusted Mann-Whitney U-tests if appropriate. RESULTS: The temperature rise on the surface of roots with artificial resorptive defects was significantly higher compared with the ones without defects in the Obtura II and System B groups (P < 0.001). The System B group with internal resorption was associated with the maximum temperature rise in the apical (4.3 ± 2.1) and middle (19.5 ± 8.9) thirds amongst the groups (P < 0.001). CONCLUSION: Use of System B and Obtura II for filling canals with internal resorptive cavities resulted in surface temperature rise over the critical threshold. However, Soft-Core root filling did not increase the temperature over 10 °C.

Efficacy of single buccal infiltrations for maxillary first molars in patients with irreversible pulpitis: a randomized controlled clinical trial.

AIM: To evaluate the efficacy of a single buccal infitration using 4% articaine hydrochloride (HCl) with 1 : 100,000 epinephrine or 4% articaine HCl with 1 : 100 000 epinephrine bitartrate for obtaining adequate pulpal anaesthesia in the palatal roots of maxillary first molars associated with irreversible pulpitis. METHODOLOGY: In this single-blind randomized clinical trial, fifty subjects were randomly allocated to receive maxillary buccal injections of 1.5 mL 4% articaine with 1 : 100,000 epinephrine (n = 25) or 1.5 mL 4% articaine with 1 : 100,000 epinephrine bitartrate (n = 25). Visual analogue scale (VAS) scores and pulse rate measurements were recorded during access cavity preparation and initial file placement into the mesiobuccal, distobuccal and palatal canals. Data were analysed using Duncan and t-tests. RESULTS: There was no significant difference between the two anaesthetic solutions regarding the VAS scores and pulse rate measurements during endodontic procedures. The mean VAS ratings of the 50 patients during file placement into the palatal canals were significantly higher compared with the other three root canal procedures (P < 0.0001). The heart rates during negotiation of palatal canals were significantly higher than when negotiating the mesiobuccal and distobuccal canals (P < 0.0001). CONCLUSION: Single buccal infiltration did not achieve adequate pulpal anaesthesia in the palatal root canal of the maxillary first molars associated with irreversible pulpitis.

Effect of exercise intensity on cerebrospinal fluid interleukin-6 concentration during recovery from exhaustive exercise in rats.

The purpose of this study was to investigate the possible role of moderate and strenuous swimming training on plasma and cerebrospinal fluid (CSF) IL-6 (interleukin-6) levels during recovery from exhaustive exercise in rats. Wistar rats were divided into three groups: sedentary control (C), moderately trained (MT) and strenuously trained (ST). MT rats underwent swimming exercise for one hour/day and 5 days/week for 8 weeks. Animals in the ST group began swimming with 1 h/day and swimming duration was progressively increased by 30 min/wk, reaching 2.5 h/day by week 4 and stayed constant for an additional 4 weeks. After all animals underwent an acute exhaustive swimming exercise, animals were divided into 3 groups, and decapitated immediately, 24 and 48 hours after exhaustion to obtain tissue samples. Muscle citrate synthase activity, plasma and CSF IL-6 levels were determined. The citrate synthase activity was found to be higher in MT and ST groups compared to the C group. Although plasma IL-6 levels were found unaltered among all groups, the CSF IL-6 concentration was found to be increased 24 hours after exhaustive exercise of the ST group. We conclude that exercise training intensity is an important factor determining cerebrospinal IL-6 concentration after exhaustive exercise.

Fracture resistance of thin-walled roots restored with different post systems.

AIM: To compare the fracture resistance of thin-walled roots after restoration with different types of post systems. METHODOLOGY: One hundred and sixty-five decoronated maxillary central incisors were root filled and randomly assigned to three groups with respect to the remaining dentine thickness of root (1.0 mm, 1.5 mm, 2.0 mm). Each group was randomly divided into five equal subgroups. The subgroups were restored with one of the following post systems: polyethylene woven fibre (R), composite resin cured by light-transmitting post + glass fibre post (L), electrical glass fibre post (E), composite corono-radicular restoration (C) and cast metal post (M). Standard cores were constructed using composite resin in the first four groups. The samples were subjected to a gradually increasing force (1 mm min(-1)). The force required to fracture was recorded. The data was analysed with anova and Tukey test (P = 0.05). RESULTS: The cast metal post group had the highest fracture strength (P < 0.001). There was no significant difference in fracture resistance between the other four groups. Fracture resistance was affected largely by the remaining dentine thickness in fibre post groups; however, the difference was not significant. On the contrary in the cast metal post group load failure was inversely influenced by axio-proximal dimension of dentine walls. CONCLUSION: The cast post group had a higher fracture strength than resin groups. The force required to fracture the roots was similar for all fibre post systems and for all dentine thicknesses.

Value of perineural edema/inflammation detected by fat saturation sequences in lumbar magnetic resonance imaging of patients with unilateral sciatica.

BACKGROUND: Routine lumbar spine magnetic resonance imaging (MRI) may not show any evidence of the cause of sciatica in some cases. The relationship between nerve root compression detected on lumbar MRI and sciatica is also sometimes uncertain. PURPOSE: To ascertain whether axial (and, when necessary, sagittal and coronal) short-tau inversion recovery or fat-saturated T2-weighted MRI findings can be used to study the level of sciatica in patients with a non-yielding routine MRI examination. MATERIAL AND METHODS: A total of 215 patients with unilateral sciatica underwent MRI. All patients were asked to complete pain drawing forms describing their pain dermatomal distributions. Perineural edema/inflammation corresponding to the pain location indicated by the pain drawings was sought on short-tau inversion recovery or fat-saturated T2-weighted images. RESULTS: Routine MRI findings revealed that 110 of the 215 patients had nerve root compromise related to the patients' symptoms. Routine MRI could not ascertain the cause of these symptoms in the remaining 105 patients. In 31 (29.5%) of these 105 patients, short-tau inversion recovery or fat-saturated T2-weighted magnetic resonance images revealed perineural edema/inflammation surrounding the nerve roots related to the pain locations indicated in the pain drawings. CONCLUSION: Axial (and, when required, sagittal and coronal) short-tau inversion recovery or fat-saturated T2-weighted magnetic resonance images may be helpful for revealing additional findings in cases of unexplained sciatica in standard magnetic resonance imaging. However, the value of this imaging may be not great enough to justify routine use of these additional sequences to study the level of sciatica.

Monostotic fibrous dysplasia of the clivus: MRI and CT findings.

Fibrous dysplasia is a developmental disorder caused by abnormal proliferation and maturation of fibroblasts resulting in replacement of mature bone by structurally weak, immature woven bone. Clival involvement in monostotic fibrous dysplasia is extremely unusual, and has rarely been reported previously. We report a case of monostotic fibrous dysplasia of the clivus with special emphasis on the imaging findings and differential diagnosis.