Effects of continuous chelation on the instrumentation of curved canals with a martensitic NiTi file system: an ex vivo micro-CT evaluation

This study aimed to evaluate the influence of continuous chelation on apical transportation and centrality in shaped curved canals prepared with a martensitic file system and evaluated by micro-CT. Twenty-four lower molar canals with a curvature of 25º-40º were scanned pre-operatively with micro-CT and divided into 2 groups according to two different irrigation regimens (n = 12). Group 1 was irrigated with NaOCl, group 2 with Dual Rinse. All canals were prepared with VDW.ROTATE system. The samples were scanned post-operatively and evaluated at 1, 3 and 5 mm from the apex to determine apical transportation and canal centrality using VG Studio software. Statistical analysis was performed with SPSS software using the non-parametric Mann-Whitney test. No statistically significant differences were found between the two groups for both apical transportation and canal centrality at any of the levels studied (p < 05). The use of continuous chelation during the instrumentation of the canals with martensitic alloy files does not produce greater transportation and does not generate changes in centralization compared to NaOCl-only irrigation. Combined chelation and disinfection while shaping with martensitic NiTi can simplify the irrigation regimen without inducing iatrogenic aberrations.

External cervical resorption: part 2 - management

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

Rapid Bacterial Detection during Endodontic Treatment

Bacteria present in the root canal (RC) space following an RC treatment (RCT) can lead to persistent infections, resulting in treatment failure and the need for reintervention or extraction. Currently, there are no standardized methods in use to clinically detect bacterial presence within RC spaces. The use of paper point sampling and fluorescence staining was shown to be a rapid method, able to detect residual bacteria following treatment. The study demonstrated that Calcein acetoxymethyl (AM) proved to be a suitable dye for detecting vital bacteria within mature endodontic biofilms, with an improved sensitivity over colony-forming unit counting in a stressed biofilm model. Furthermore, in a clinical trial with primary RCTs, 53 infected teeth were sampled in vivo, and increased detection of vital cells was found when compared with colony-forming unit counting, highlighting the sensitivity of the technique in detecting low cell numbers. By combining fluorescent staining and microspectroscopy with software-based spectral analysis, successful detection of vital cells from RCs was possible after 5 min of Calcein AM incubation. Application of this technology during RCT has the potential to reduce persistent infections through vital cell detection and additional treatment. Furthermore, this technique could be applied to antimicrobial research and disinfection control in clinical settings ( ClinicalTrials.gov NCT03055975).

The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography - part 2: a 1-year post-treatment follow-up

AIM

Part 2 of this clinical study aims to compare the radiographic change in periapical status of individual roots determined using digital periapical radiographs versus cone beam computed tomography (CBCT) 1year after primary root canal treatment and to determine the radiological outcome of treatment for each tooth.

METHODOLOGY

Periapical radiographs and CBCT scans of 123 teeth in 99 patients assessed 1year after completion of primary root canal treatment by a single operator were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The presence or absence as well as the increase or decrease in size of existing periapical radiolucency was assessed by a consensus panel consisting of two calibrated examiners. The panel viewed the images under standardized conditions. Paired comparison of the outcome diagnosis of individual roots and teeth was performed using generalized McNemar's or Stuart-Maxwell test of symmetry analysis.

RESULTS

The 'healed' rate (absence of periapical radiolucency) for all roots combined was 92.7% using periapical radiographs and 73.9% for CBCT (P<0.001). This rate increased to 97.2% and 89.4%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included (P<0.001). A statistically significant difference in outcome diagnosis of single roots was observed between DPA and CBCT in single-rooted teeth and the buccal or mesio-buccal roots of multi-rooted teeth (P<0.05). Analysis by tooth revealed that the 'healed' rate (absence of periapical radiolucency) was 87% using periapical radiographs and 62.5% using CBCT (P<0.001). This increased to 95.1% and 84.7%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included (P<0.002). Outcome diagnosis of teeth showed a statistically significant difference between systems (P<0.001). Reconstructed CBCT images revealed more failures (17.6%) in teeth with no pre-operative periapical radiolucencies compared with periapical radiographs (1.3%) (P=0.031). In teeth with existing pre-operative periapical radiolucencies, reconstructed CBCT images also showed more failures (13.9%) compared with periapical radiographs (10.4%).

CONCLUSION

Diagnosis using CBCT revealed a lower healed and healing rate for primary root canal treatment than periapical radiographs, particularly in roots of molars. There was a 14 times increase in failure rate when teeth with no pre-operative periapical radiolucencies were assessed with CBCT compared with periapical radiographs at 1year.

Physical activity and biochemical markers of bone turnover in elderly patients

To assess the role of physical therapy in improving the remodelling processes of bone turnover, biochemical markers of bone formation and resorption (osteocalcin, parathormone, bone-specific alcaline phosphatase, somatotropic hormone, C-terminal propeptide type I procollagen, somatomedin, insulin-like growth factor bound protein, C-terminal telopeptide type I collagen) have been investigated in elderly patients before and after a cycle of physical therapy. Patients of both sexes, immobilized on hospital admission day because of fractures or neurologic diseases, underwent physiotherapy for one month. Following physical treatment we found significant increases of osteocalcin, bone-specific alcaline phosphatase and somatomedin in the female group, while no significant difference was detected in males. Our data support that the mechanical stimulus significantly improves the recovery of osteoblastic activity in women, while in men the increases in bone remodelling markers are not significant. Differences in life-style between male and female patients are proposed as determinants in the bone remodelling response to physical therapy.

Treponema denticola in disseminating endodontic infections

Treponema denticola is a consensus periodontal pathogen that has recently been associated with endodontic pathology. In this study, the effect of mono-infection of the dental pulp with T. denticola and with polymicrobial "red-complex" organisms (RC) (Porphyromonas gingivalis, Tannerella forsythia, and T. denticola) in inducing disseminating infections in wild-type (WT) and severe-combined-immunodeficiency (SCID) mice was analyzed. After 21 days, a high incidence (5/10) of orofacial abscesses was observed in SCID mice mono-infected with T. denticola, whereas abscesses were rare in SCID mice infected with the red-complex organisms or in wild-type mice. Splenomegaly was present in all groups, but only mono-infected SCID mice had weight loss. T. denticola DNA was detected in the spleen, heart, and brain of mono-infected SCID mice and in the spleen from mono-infected wild-type mice, which also had more periapical bone resorption. The results indicate that T. denticola has high pathogenicity, including dissemination to distant organs, further substantiating its potential importance in oral and linked systemic conditions.

Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients

BACKGROUND/AIMS

The presence of selected bacteria (Enterococcus faecalis, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, Treponema denticola) in infected root canals was studied using polymerase chain reaction (PCR) assays, and the association of bacteria with clinical signs of endodontic disease was assessed. The null hypothesis, that no difference could be observed between clinical signs of apical periodontitis and a specific bacterial strain, was tested.

METHODS

Microbial samples were obtained from 62 teeth in 54 patients with endodontic disease. For each tooth, clinical data including patient symptoms were collected. Teeth were categorized by diagnosis as having acute apical periodontitis (AAP, teeth with clinical symptoms but no periapical radiolucency, n=22), chronic apical periodontitis (CAP, teeth with radiolucency but no clinical symptoms, n=15) or exacerbated apical periodontitis (EAP, teeth with symptoms and radiolucency, n=25). Seventy-one percent of cases were primary endodontic infections, and 29% were recurrent ('secondary') endodontic infections (failing cases). PCR assays were used to detect the presence of the selected bacteria.

RESULTS

T. denticola and E. faecalis were each detected in 15 of 62 samples (24%), P. gingivalis in 8 samples (13%), P. intermedia in 5 samples (8%), and T. forsythensis in 4 samples (7%). T. denticola was detected in 56% of teeth with EAP. E. faecalis was found in 60% of teeth with CAP and in 72% of teeth with secondary infection. Statistical analysis demonstrated an association of CAP and secondary endodontic infection with the presence of E. faecalis. (P<0.01). EAP was associated with the presence of T. denticola (P<0.01).

CONCLUSION

T. denticola was associated with symptomatic endodontic disease in the presence of apical bone resorption. E. faecalis was associated with treatment failures. We suggest that these species may play critical roles in endodontic pathology.

SEM evaluation of canal wall dentine following use of Mtwo and ProTaper NiTi rotary instruments

AIM

To compare using scanning electron microscopy (SEM) root canal walls following instrumentation in vitro with two different rotary NiTi instruments. The hypothesis was that no difference should be observable between the experimental groups in terms of debris on canal walls and surface morphology.

METHODOLOGY

Twenty-four single-rooted human teeth were selected. Two types of NiTi instruments were used, Mtwo (Sweden & Martina, Padova, Italy) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland). Irrigation for both groups was performed after each instrument change with 5% NaOCl, 3% H2O2 and 17% EDTA solutions. Three different areas (coronal, middle and apical thirds) of the root canal were evaluated using SEM. The canal wall of each sample was assessed and compared using a predefined scale of four parameters, namely, smear layer, pulpal debris, inorganic dentine debris, surface profile. Data were analysed statistically using the Kruskal-Wallis test (anova).

RESULTS

A statistically significant difference (P < 0.01) was found between the apical third and the middle and coronal thirds for both groups. No difference was observable between instrumentation groups. In the apical third canal walls were often contaminated by inorganic debris and by smear layer. In the apical third, the surface profile was affected by uninstrumented regions, comprising dentine depressions and grooves in which predentine was still visible.

CONCLUSION

Both instruments produced a clean and debris-free dentine surfaces in the coronal and middle thirds, but were unable to produce a dentine surfaces free from smear layer and debris in the apical third. The presence of deep grooves and depression on dentine walls in the apical third may well explain the presence of less-instrumented areas.

[Celiac disease and spontaneous abortion]

BACKGROUND

Over the last ten years it has become clear that the clinical expression of celiac disease is more heterogeneous than was thought in the past. Although celiac disease is a relatively frequent disease (1/170-200), it is only diagnosed in a small percentage of adult cases compared to the real situation because it is manifested with few symptoms or in an atypical form, or occasionally is completely silent. Gynecological problems have been reported in women with celiac disease, in particular delayed menarche, early menopause, sterility, recurrent abortion and fetal intrauterine growth retardation. The main aim of this study was to investigate the association between celiac disease and abortion, and in particular to evaluate whether patients suffering from recurrent spontaneous abortion might present an atypical or subclinical form of the disease.

METHODS

During the period 1997-1998 a series of laboratory tests were carried out at the Department of Obstetrics and Gynecology and at the Institute of Medicine B of Verona University, in a sample of 184 women (149 from the Obstetrics Clinic and 35 from Internal Medicine B ). These tests included circulating anti-gliadin (AGA) and anti-endomysium (EMA) antibodies and total serum immunoglobulins. In positive cases, further diagnostic tests were performed using small bowel biopsy specimens.

RESULTS

In our selected sample of cases, 5 women (2.7%) were positive for immunological screening against IgA-EMA and for bowel biopsy (confirmed diagnosis of celiac disease). Four of these women (2.1%) formed part of a group of patients with a positive history of spontaneous abortion and one (0.5%) was from the control group.

CONCLUSIONS

An analysis of the cases that emerged from this study and those reported in the literature shows that tests to identify the celiac disease should be extended to the population with a risk of developing this disease. These subjects should include those with a family history or clinical symptoms, in particular women with a history of multiple abortions. In these cases, there are grounds for suspecting an atypical form of celiac disease.

[Assisted labor among non European community pregnant women at the Gynecology and Obstetrics Clinic of the Verona University]

BACKGROUND

The aim of this paper is to evaluate the role and the prevalence of the non-European Community pregnant women in our Institute during the period 1992-1998. The peculiarity of the female immigration in the world and particularly in Italy is stressed from the point of view of the different cultural, ethnic and religious problems of these women.

METHODS

During the observed period 8972 women delivered; 434 of them came from non-European Community countries and their individual (age, country) and obstetric (parity, physiological or pathological evaluation of pregnancy, mode of delivery) data were observed. On the basis of the different countries of provenance these women have been subdivided into five groups (East Europe, North Africa and Middle East, Central Africa, Far East and Latin America).

RESULTS

The percentages of preterm births (24.2% vs 23.1%), of < or = 1500 g newborns (6.9% vs 5.3%) and of caesarean sections (34.3% vs 27.7%) are higher in the non-European Community women that delivered in our Institute. In 222 (51.1%) cases the women delivered without induction of labour; while in 14.5% of cases it was induced. The length of labour and the genital conditions (episiotomy, tearing) were considered in all ethnic groups of women.

CONCLUSIONS

On the basis of the literature and of the analysis of our data, some suggestions about the management of labour and delivery of non-European Community women in Italy are proposed. In particular, the problems of linguistic communication and of the hospital staff preparation in the assistance to labour and delivery are stressed.

[An unusual case of regular menstrual cycles and endocrine pattern typical for the reproductive age in a patient of advanced age]

The Authors report the persistence of regular menses in a very old woman. Although in the absence of a pulsatile gonadotropin pattern the patient showed estradiol levels typical of the reproductive age.

Sonography of unilateral megalencephaly in the fetus and newborn infant

A 27-year-old primigravida women was referred for ultrasound studies at 32 weeks' gestation because of the suspicion of fetal ventriculomegaly. Sonographic examination of the fetal brain found a marked shift of the midline, with enlarged left hemisphere and ipsilateral occipital horn, and abnormal convolutions. A 3500 gm male infant was delivered by cesarean section at 39 weeks' gestation because of worsening macrocrania after which the diagnosis of unilateral megalencephaly was confirmed by computed tomography.

What are the implications of melatonin in the peritoneal fluid?

The Authors evidence the presence of melatonin (MT) in the peritoneal fluid (PF). They researched possible correlations between MT and other protein and steroid hormones in the PF and in the plasma. The only significant correlation found was a "negative" one between plasma MT and plasma E2. The Authors exclude an ovarian source for peritoneal fluid MT. They believe that MT may have a role in menstrual cycle regulation, directly modulating ovarian steroid production. To determine if MT has indeed such a role, they feel it important to study the possible presence of ovarian MT receptors.

Vasopressin, prolactin and growth hormone in Alzheimer's disease: their evaluation after metoclopramide stimulation

Recent studies have shown that there is a relationship between an alteration of central neurotransmitters and the modification of some biohumoral parameters in Alzheimer's Disease (AD). In this study the authors evaluated, after metoclopramide (MTC) stimulation, the concentration curve of vasopressin (AVP), prolactin (PRL) and growth hormone (HGH) in the plasma of 34 subjects (20 males and 14 females, mean age 70.5+/-6.9 years; 17 were AD patients, the others constituted the control group). MTC increased AVP serum concentration in healthy (P <0.001), but not in AD patients. This result seemed to be due to the lack of 'procholinergic' action of the drug in the AD patients probably due to an alteration in their cholinergic pathways. The PRL response to MTC was reduced only in the AD female group (P <0.005), suggesting an alteration in dopaminergic control. Lastly, the HGH response in AD did not differ in the two groups, neither in basal conditions, nor after MTC stimulation. The absence of HGH response both in AD and in healthy subjects, demonstrated the ineffectiveness of MTC stimulation. We can conclude that AVP and PRL responses to MTC stimulation efficiently separated the two groups (AD and controls); the former test showing a higher discriminant power than the latter.

Evaluation of plasmatic ANP levels in subjects affected by essential arterial hypertension and in a group of patients undergoing dialysis

In the first part of this study we selected 24 hypertensive subjects (11 males, 13 females, mean age 55.4 +/- 10.2 years) affected by essential arterial hypertension (EAH). Eleven people (5 males, 6 females, mean age 21.6 +/- 9.5 years) had one or two hypertensive parents. Seventeen subjects (8 males, 9 females, mean age 56.4 +/- 5.9 years) were the control group. Plasmatic ANP was measured using the RIA method, after extracting the peptide on Sep-Pak C18 cartridges. The results show the following ANP values: healthy control subjects 27.6 +/- 8.6 pg/ml; offspring of essentially hypertensive subjects 25.6 +/- 7.7 pg/ml; essentially hypertensive subjects 45.5 +/- 24.9* pg/ml* (P less than 0.005). In the second part of our study, we evaluated the plasma levels of this hormone in a group of subjects undergoing dialysis. The group consisted of 21 subjects (12 males, 9 females, mean age 63.1 +/- 10.5 years), 11 of whom were affected by EAH. ANP evaluation was done during the dialysis after a "long" dialytic interval of three days. Both groups showed a noticeable increase in ANP levels, even if the hypertensive group had overall higher values (254.5 +/- 134.9 pg/ml, vs. 188.7 +/- 113.7 pg/ml). All subjects, after dialysis, had ANP values significantly lower than the initial ones.

Significance of free testosterone assay in comparison with traditional R.I.A. androgens in diagnosis of androgens excess

In 35 women, 16-32 years old (average age 24) affected by hirsutism associated to menstrual disorders as oligomenorrhea or secondary amenorrhea, the real utility of testosterone's free fraction assay (FT) in comparison with conventional hormonal assays has been valued. The free testosterone (FT) resulted the most frequently elevated hormone (69%). The analysis of the different groups shows a good sensitivity and specificity of FT assay in some conditions as PCOD, but it is not so sensitive and specific in other conditions as secondary amenorrhea. We conclude that FT assay is particularly useful for the hyperandrogenism study, especially in the PCOD; for its high diagnostic sensitivity it would be assayed in all the women with hirsutism, but it isn't sufficient for the screening of the different hyperandrogenic states.

Pineal gland hypothalamus-pituitary-adrenal axis relationships

The authors refer the results of their study in 15 healthy women in whom 24-hours serum melatonin (MT) and cortisol (F) were assayed by RIA method. Both hormones showed a clear circadian rhythm: Melatonin reached the highest values between 24.00 and 04.00 while cortisol were at the lowest values. The relationships between Corticotropin Releasing Factor (CRF) and pineal function are analysed. A strict correlation between the hypothalamus-pituitary-adrenal axis and melatonin is suggested.