Analysis of the centre of pressure in bipedal stance among individuals with and without intellectual disabilities, individuals with Down syndrome and dancers with Down syndrome.

BACKGROUND: Individuals with intellectual disabilities (IDs) often present deficiencies in motor, balance and postural control. On the other hand, the practice of physical activity and dance usually reduces these deficiencies. Therefore, in this study, we aimed to compare the control of the centre of pressure (COP) in people with Down syndrome (DS) or other causes of ID in relation to people without disabilities and to observe the influence of vision and the practice of dance. METHODS: This cross-sectional study analyses the COP in a static standing position with open and closed eyes in four study groups. A total of 273 people were recruited (80 adults without ID, 46 adults with DS, 120 adults with other causes of ID and 27 dancers with DS). RESULTS: A greater area of oscillation and path of the COP was observed in the participants with ID compared with the participants without ID, especially in the sway area of the COP. The oscillation speed of the COP was also higher. When analysing the displacement of the COP, anteroposterior and mediolateral components, there were also differences, except when comparing the group of dancers with DS with respect to the group without ID. The visual condition only influenced the group of participants without disabilities. CONCLUSIONS: The results of our study show that there is a less efficient static postural control in people with ID, as greater displacements were observed in the COP of the participants with ID. The differences in some specific variables that analyse the displacement of the COP were smaller when comparing the group of dancers with DS and the individuals without ID.

European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by.

This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT) in Endodontics. This paper is an update of the ESE CBCT position statement which was published in 2014 (European Society of Endodontology 2014, https://doi.org/10.1111/iej.12267). Recent review articles provide more detailed background information and the basis for this position statement. It is intended that this position statement will be updated at least every 4-5 years to keep abreast of relevant research. The aim of this paper is to provide clinicians with evidence-based guidance on the application of CBCT in Endodontics. Since 2014, there has been an increase in the number of clinical studies confirming the positive impact of CBCT on treatment planning, decision-making when reviewing cases and reduced practitioner stress levels.

Cone beam computed tomography in Endodontics - a review of the literature.

The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.

Postoperative pain after removal of gutta-percha from root canals in endodontic retreatment using rotary or reciprocating instruments: a prospective clinical study.

OBJECTIVES: The aim of this clinical study was to evaluate and compare the incidence and intensity of postoperative pain following removal of gutta-percha from root canals using rotary and reciprocating instruments. MATERIALS AND METHODS: One hundred and sixty patients scheduled for a non-surgical endodontic retreatment were included for evaluation. Preoperative pain was recorded with using a questionnaire with a 10-cm visual analogical scale (VAS). Endodontic filling material was removed with Reciproc (VDW, Munich, Germany) or ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. Patients then recorded their postoperative pain in a VAS pain scale at 4, 8, 16, 24, 48, and 72 h post-treatment. Results were analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-square tests. Multivariate logistic and a multiple regression analysis were used to detect the effect of confounding factors. RESULTS: Results showed a direct relation between the intensity of pre-operative pain and that of postoperative pain (P < .05). No significant differences were observed between the two groups regarding postoperative pain (P > .05) as a qualitative variable. As numerical values, statistically significant differences were found regarding sex and the system used (P < .05). CONCLUSIONS: The method for pain evaluation was determinant in postoperative pain findings. Endodontic retreatment preparation with Reciproc results in lower values of postoperative pain compared with ProFile. Women are more susceptible to postoperative pain than are men. CLINICAL RELEVANCE: One of the most significant contributions of this research is the importance given to the method used for pain evaluation. The present study analyzed postoperative pain resulting from the use of reciprocating or continuous rotary instruments during removal of gutta-percha in retreatment procedures.

Comparative accuracy of the Clearing Technique, CBCT and Micro-CT methods in studying the mesial root canal configuration of mandibular first molars.

AIMS: To compare the accuracy of the clearing technique and cone beam computed tomography (CBCT) in the assessment of root canal configurations using micro-computed tomography (micro-CT) imaging system as the reference standard. METHODOLOGY: Thirty-two mesial roots of mandibular first molars, selected on the basis of micro-CT scans (voxel size: 19.6 µm) and presenting several canal configurations, were evaluated using 2 CBCT scanners (voxels sizes: 120 µm and 150 µm) followed by the clearing technique. Two examiners analysed the data from each method and classified the anatomical configuration of the mesial canal according to Vertucci's system. Data were compared using Fisher's exact and chi-square tests. Reliability for each assessment was verified by the kappa test, and significance level was set at 5%. RESULTS: Kappa value indicated a high level of agreement between the examiners. Detection of type I configurations was significantly lower in cleared teeth (P < 0.05), whilst type II root canals were detected in all specimens by both tests (P > 0.05). In mesial roots with variable anatomical configurations, CBCT and the clearing method were significantly less accurate than the reference standard (P < 0.05). CONCLUSION: Within the tooth population studied, accuracy of identifying mesial root canal configuration was influenced greatly by the evaluation method and the type of anatomy. Detection of type I configurations in cleared teeth was significantly lower, whilst type II configurations were detected in all specimens by both methods. In mesial roots with variable anatomical configurations, neither CBCT nor clearing methods were accurate for detecting the actual root canal anatomy.

Cone beam computed tomography in Endodontics - a review.

Cone beam computed tomography (CBCT) produces undistorted three-dimensional information of the maxillofacial skeleton, including the teeth and their surrounding tissues with a lower effective radiation dose than computed tomography. The aim of this paper is to: (i) review the current literature on the applications and limitations of CBCT; (ii) make recommendations for the use of CBCT in Endodontics; (iii) highlight areas of further research of CBCT in Endodontics.

An evaluation of the periapical status of teeth with necrotic pulps using periapical radiography and cone-beam computed tomography.

AIM: To evaluate the presence or absence of periapical (PA) radiolucencies on individual roots of teeth with necrotic pulps, as assessed with digital PA radiographs and cone-beam computed tomography (CBCT). METHODOLOGY: Digital PA radiographs and CBCT scans were taken from 161 endodontically untreated teeth (from 155 patients) diagnosed with non-vital pulps (pulp necrosis with normal PA tissue, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess and chronic apical abscess). Images were assessed by two calibrated endodontists to analyse the radiographic PA status of the teeth. A consensus was reached in the event of any disagreement. The data were analysed using a McNemar's test, and significance was set at P ≤ 0.05. RESULTS: Three hundred and forty paired images of roots were assessed with both digital PA radiographs and CBCT images. Fifteen additional roots were identified with CBCT. PA radiolucencies were present in 132 (38.8%) roots when assessed with PA radiographs, and in 196 (57.6%) roots when assessed with CBCT. This difference was statistically significant (P < 0.05). In teeth diagnosed with pulp necrosis, symptomatic apical periodontitis or acute apical abscess, CBCT images revealed a statistically larger number of PA radiolucencies than did PA radiographs (P < 0.05). No statistical differences were observed between PA radiographs and CBCT in teeth classified with asymptomatic apical periodontitis (P = 0.31) or chronic apical abscess (P = 1). CONCLUSIONS: Unlike PA radiographs, CBCT revealed a higher prevalence of PA radiolucencies when endodontically untreated teeth with non-vital pulps were examined.

European Society of Endodontology position statement: the use of CBCT in endodontics.

This Position Statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the use of Cone Beam Computed Tomography (CBCT). The statement is based on the current scientific evidence, and provides the clinician with evidence-based criteria on when to use CBCT in Endodontics. Given the dynamic and changing nature of research, development of new devices and clinical practice relating to CBCT, this Position Statement will be updated within 3 years, or before that time should new evidence become available.

Mandibular first molars with disto-lingual roots: review and clinical management.

The purpose of this review was (i) to conduct a literature review on the prevalence and morphologic classification of mandibular first molars with disto-lingual (DL) roots, and (ii) to discuss the clinical approach to diagnosis and root canal treatment of these teeth. A search was carried out on electronic (MEDLINE, PubMed and Cochrane) and hand databases, which covered all publications from 1970 to December 2011. Two reviewers independently assessed the studies and recorded type of study, origin and sample sizes, number of teeth with three roots and type of root canal configuration. Forty-five studies were identified with a total of 19,056 mandibular first molar teeth. The frequency of DL roots was 14.4% and was associated with certain ethnic populations. The most common canal configuration of mesial and distal roots was Vertucci types IV and I, respectively. No significant differences were observed in the prevalence of DL roots according to gender. Variable results related to side were observed as well as a trend in bilateral occurrence. The root length of the DL roots was in general shorter than that of the disto-buccal roots (DB). Most DL roots had a greater angle of curvature and a smaller radius of curvature in a bucco-lingual orientation. The best methods to identify DL roots are a 25° mesial parallax periapical radiograph or cone-beam computed tomography (CBCT). A trapezoidal shape access cavity is desirable to locate the orifice of the DL canal. Clinicians should be aware of the variable furcation levels during coronal pre-flaring or post-space preparation to avoid furcal/strip perforations and a weakening of DL roots.

Managing severe curvature of radix entomolaris: three-dimensional analysis with cone beam computed tomography.

AIM: To present a case of a mandibular first molar with an additional distolingual root [radix entomolaris (RE)] and to discuss the use of cone beam computed tomography (CBCT) for its identification and management during root canal treatment. SUMMARY: A 52-year-old Caucasian woman was referred for root canal treatment of the right mandibular first molar (tooth 46). After clinical and radiographic examination, a symptomatic irreversible pulpitis was diagnosed. Three periapical radiographs with different horizontal angulations revealed the presence of an additional distolingual root. This extra root, termed RE, has an incidence of <5% in the Caucasian population. A CBCT examination was also taken, which revealed a severe root canal curvature, especially in the middle third, of this supernumerary root. CBCT provided more accurate information in terms of RE inclination and root canal curvature before commencing root canal treatment. The conventional access opening was modified into a more trapezoidal cavity, and five root canals were found. All canals were instrumented with new nickel-titanium (NiTi) files to reduce the risk of fractured instruments. After preparation, the root canals were filled using thermoplastified techniques. The 1-year follow-up periapical radiographs and CBCT images revealed a continuous periodontal space with no signs of apical periodontitis. KEY LEARNING POINTS: • Cone beam computed tomography imaging is useful in identifying the root canal system and the surrounding structures. • An accurate detection of supernumerary roots, such as RE, can avoid complications during and after root canal treatment. • The analysis of root canal curvature is important because instrument fracture has been linked to angle and radius of curvature. • The use of new instruments can reduce the incidence of instrument fracture.

Electromyographic study of the arms in competitive karting senior category drivers / Estudio electromiográfico de los brazos en pilotos senior de karting de competición

The main goal of this cross-sectional study was to assess the muscular activity of the upper limbs in competitive kart drivers while driving in a closed karting circuit, using surface electromyography (EMGS). The most significant muscles of the upper limbs while driving were evaluated in thirteen drivers. Linear mixed models adjusted to a gamma distribution were used to evaluate differences in muscle activity based on the arm, number of laps, track characteristics, and kart type (with/without gears). Significant differences were found between muscle activity according to the type of kart (p <0.0001). Although changes were observed in the mean EMGS values, there were no significant differences between the laps of the circuit or the dominant arm. However, the results showed that there was a significant interaction between the type of kart and the dominant arm (p = 0.021). Muscle activity increased more significantly in the curves traced towards the dominant arms of the drivers (AU)

El objetivo del estudio transversal fue analizar la actividad muscular de las extremidades superiores en pilotos senior de karting de competición, mediante electromiografía de superficie (EMGS). Se evaluaron los músculos más significativos de las extremidades superiores durante la conducción en trece conductores. Se utilizaron modelos lineales mixtos ajustados a una distribución gamma para evaluar diferencias de actividad muscular en base al brazo, número de vueltas, características del trazado, y tipo de kart (con/sin marchas). Se encontraron diferencias significativas entre la actividad muscular según el tipo de kart (p<0,0001). Aunque se observaron cambios en los valores medios de EMGS, no hubo diferencias significativas entre las vueltas del circuito o el brazo dominante. Sin embargo, los resultados mostraron que hubo una interacción significativa entre el tipo de kart y el brazo dominante (p=0,021). La actividad muscular aumentó de manera más significativa en las curvas trazadas hacia el brazo dominante de los conductores (AU)

Estudio comparativo de las huellas plantares en jóvenes con síndrome de Down / Comparative study of plantar footprints in youth with Down syndrome

Introducción. Los trastornos musculoesqueléticos a nivel del pie son frecuentes en las personas con síndrome de Down (SD). Por ello el diagnóstico precoz mediante examen podológico de las huellas plantares puede ayudar a prevenir las manifestaciones ortopédicas. El objetivo es analizar, medir y clasificar la huella plantar mediante los índices podológicos (gold standard) en jóvenes con SD. Método. Estudio transversal comparativo; se analizaron 86 huellas plantares correspondientes a 2 grupos: 21 sujetos sin SD, 11 hombres de 20,45 (2,16) años y 10 mujeres de 20 (1,70) años; y 22 sujetos con SD, 11 hombres de 23,82 (3,12) años y 11 mujeres de 24,82 (6,81) años. Se registraron las huellas plantares en bipedestación estática mediante la utilización de un podoscopio óptico y una cámara digital. Los índices analizados son Hernández-Corvo, Chippaux-Smirak, Stahelli y ángulo de Clarke. Se compararon los resultados de ambas muestras y se analizó la concordancia entre los tipos de pies, derecho e izquierdo, mediante la prueba de Chi-cuadrado. Resultados. Los sujetos con SD se clasifican con pie plano y pronador en un 38,6% según el índice de Hernández-Corvo; Chippaux-Smirak 50%; Stahelli 70,4%; y ángulo de Clarke 59,1%. Los sujetos control presentan pies cavos en un 57,1% según el índice de Hernández-Corvo; Chippaux-Smirak 59,5%; Stahelli 81%; y como pie normal según el ángulo de Clarke en un 57,1%. Hay diferencia significativa (p < 0,01) en los índices Chippaux-Smirak, Stahelli y el ángulo de Clarke. La concordancia entre pie derecho e izquierdo no fue significativa. Conclusión. Los jóvenes con SD presentan más porcentaje de pie plano pronador y menos cavos que el grupo control (AU)

Introduction: Musculoskeletal disorders of the locomotive apparatus are common in young people with Down syndrome (DS), especially in the feet. Early diagnosis by examination of podiatric footprints can help prevent orthopaedic symptoms. Our objective was to analyze, measure and classify footprints on the basis of podiatric indices (gold standard) in young people with DS. Method: Cross-sectional study; 86 footprints were analyzed from 2 groups; there were 21 healthy subjects, 11 men 20.45 (2.16) years and 10 females 20.00 (1.70) years; and 22 subjects with DS, 11 men 23.82 (3.12) years and 11 females 24.82 (6.81) years. Footprints were recorded in standing position using an optical pedoscope and a digital camera system. We calculated the Hernández-Corvo index, Chippaux-Smirak index, Clarke’s angle and Stahelli index. We then compared the results of both samples and analyzed the concordance between types of feet and right and left feet by Chi-square test. Results: Footprints in individuals with DS showed flatfoot and/or pronated foot of 38.6% according to Hernández-Corvo index; 50%, to Chippaux-Smirak; 70.4%, to Stahelli; and 59.1%, to Clarke’s angle. In healthy subjects the rates of cavus foot were 57.1%, according to Hernández- Corvo index; 59.5%, to Chippaux-Smirak index; and 81%, to Stahelli index; while 57.1% showed a normal foot based on Clarke’s angle. Differences between the 2 groups were statistically significant (P < .01) in Chippaux-Smirak index, Stahelli index and Clarke’s angle. The correlation between the right and left foot was not significant. Conclusions: Young people with DS had a higher percentage of pronation and a lower percentage of cavus foot than the control group (AU)

Evaluación del estado periapical de dientes tratados endodónticamente mediante radiografías periapicales digitales y tomografía computarizada de haz cónico / Evaluating the periapical status of endodontically treated teeth using digital periapical radiography and cone-beam computed tomography

Objetivos: La radiolucidez apical, signo común de la periodontitis apical, se puede detectar mediante radiografías periapicales (RP) o cortes obtenidos a partir de la tomografía computarizada de haz cónico (TCHC). El objetivo de este estudio clínico fue comparar la prevalencia de lesiones periapicales en raíces individuales de dientes tratados endodónticamente evaluados mediante RP digitales y TCHC. Material y métodos: Se evaluaron un total de 135 dientes (131 pacientes) mediante RP digitales y TCHC. Los dientes fueron clasificados según su diagnóstico en: tejidos apicales normales, periodontitis apical sintomática, periodontitis apical asintomática, absceso apical agudo y absceso apical crónico. Dos examinadores calibrados determinaron la presencia o ausencia de lesión periapical. En caso de desacuerdo, la lectura se discutía hasta alcanzar un consenso. Resultados: Se analizaron 290 raíces emparejadas con RP digitales y TCHC, y se detectaron 159 (54,8%) lesiones periapicales mediante RP digitales. En cambio, se detectaron 204 (70,3%) lesiones periapicales cuando estas mismas 290 raíces fueron observadas mediante TCHC. Además, se observaron 4 raíces accesorias solo identificadas mediante TCHC. Conclusiones: El análisis de las imágenes obtenidas mediante TCHC revelaron un 15,5% más de lesiones periapicales que las obtenidas mediante RP digitales en dientes endodonciados habiendo diferencias estadísticamente significativas (P < .05) en los dientes clasificados como tejidos apicales normales, periodontitis apical sintomática y absceso apical agudo

Objective: Periapical radiolucency, detected on a periapical (PA) radiograph or by reconstructed scans obtained using cone beam computed tomography (CBCT), is a common sign of apical periodontitis. The aim of this study was to compare the prevalence of PA lesions on individual roots viewed with digital PA radiographs and CBCT of endodontically treated teeth. Material and methods: One hundred and thirty-five paired roots (in 131 patients) were evaluated with both radiological systems, digital PA radiographs and CBCT. The teeth were classified according to their diagnosis in cases of normal apical tissues, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess and chronic apical abscess. Two calibrated examiners determined the presence of absence of periapical lesion. A consensus agreement was reached if there was any disagreement. Results: Two hundred and ninety paired roots were assessed with PA radiographs and CBCT; periapical lesions were present in 159 (54.8%) roots assessed with digital PA radiographs. When the same 290 sets of roots were assessed with CBCT, lesions were present in 204 (70.3%). Four additional roots were detected with CBCT. Conclusions: The analysis of the images obtained by CBCT revealed 15.5% more PA lesions than those obtained by digital PA radiographs. Statistically significant difference (P <.05) was observed between digital PA radiographs and CBCT for teeth classified as having normal apical tissues, symptomatic apical periodontitis and acute apical abscess