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1.
Int Endod J ; 53(7): 1007-1016, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32220071

RESUMEN

AIM: To evaluate a modular 3D print training dental model with embedded human teeth and electronic working length determination for undergraduate endodontic education. METHODOLOGY: Cone-beam volume tomography data of a human skull were transferred into stereolithographic (STL) data, and a customizable modular 3D print model with individually removable sextants and teeth was generated for the use in commercially available phantom heads. Each of sixty-eight students performed a complete root canal treatment on an extracted human tooth. Working lengths were determined with electronic apex locators (EAL) and verified radiographically. Subsequently, an evaluation was carried out with regard to the difficulty of the working steps access cavity preparation, working length determination, root canal preparation/irrigation and canal filling, and these steps were compared to commonly used benchtop models. Additionally, the agreement of electronic and radiographic working length determination was assessed and analysed statistically with the chi-square test. RESULTS: A total of 68 teeth (20 incisors, 26 premolars and 22 molars) with 127 root canals were treated. In total, 87% of the students considered the modular 3D print model considerably more demanding than the conventional benchtop model. Overall, 96% felt better prepared for the clinical situation, 92% felt markedly reduced stress levels during endodontic practice in the subsequent clinical courses, and 93% of the students suggested the model should be used in future preclinical endodontic training. The preradiographic use of EAL resulted in 85% of the cases having radiographically acceptable working length determination within 0-2 mm from the radiographic apex. Readings more than 2 mm from the apex or beyond were significantly more common in molars than in premolars and incisors (P < 0.05). CONCLUSIONS: The vast majority of students rated the modular 3D print training model positively despite it being more demanding. They also recommended its use in preclinical teaching and training. The model allowed a more realistic simulation of the clinical situation with a simultaneous use of EALs and led to reduced stress levels in endodontic treatment in the subsequent clinical courses.


Asunto(s)
Cavidad Pulpar , Preparación del Conducto Radicular , Humanos , Diente Molar , Odontometría , Tratamiento del Conducto Radicular , Ápice del Diente
2.
Int Endod J ; 53(5): 690-697, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31955439

RESUMEN

AIM: To gain information in a laboratory setting about the effect of thermal treatment of epoxy resin-based and zinc oxide-eugenol-based sealers. METHODOLOGY: AH Plus and Pulp Canal Sealer (PCS) were exposed to thermal treatment at 37, 47, 57, 67, 77, 87 and 97 °C for 30 s. According to clinically relevant considerations, intracanal sealer temperature is likely not to exceed 60 °C during warm vertical root canal filling. Heat application is recommended for less than 30 s during continuous wave technique, but might exceed this threshold in complex cases. Furthermore, heat treatment at 97 °C was performed for 60 and 180 s to simulate inappropriate implementation of warm vertical filling techniques. Specimens were heated inside 2-mL plastic tubes in a thermo-controlled water bath until the temperatures were reached and kept at this temperature for the determined period of time. Afterwards, specimens were cooled to body temperature and physical properties (setting time, flow, film thickness according to ISO 6876) were assessed. Chemical properties (Fourier transformed infrared spectroscopy) were assessed after complete setting of the specimens in an incubator at 37 °C and 100% humidity. Statistical analysis of physical properties was performed using Kruskal-Wallis test (P = 0.05). RESULTS: The setting time of AH Plus and PCS decreased when temperature and duration of heat application increased. Whilst the setting time of AH Plus decreased from 622 min at 20 °C (for 30 s) to 381 min at 97 °C (for 180 s; P < 0.05), heat treatment of PCS at 97 °C for 180 s led to an immediate setting of the material. From 20 °C (for 30 s) to 97 °C (for 30 s), the setting time of PCS decreased from 80.1 to 41.0 h (P < 0.05). Film thickness and flow were not relevantly influenced by thermal treatment except for PCS at 97 °C for 180 s. FT-IR spectroscopy did not reveal any chemical changes of either sealer after thermal treatment. CONCLUSIONS: Thermal treatment simulating clinically relevant temperature levels and heating times did not lead to any substantial physical or chemical changes at all temperature levels when heating did not exceed 60 s. AH Plus and Pulp Canal Sealer can be considered suitable for warm root filling techniques.


Asunto(s)
Materiales de Obturación del Conducto Radicular , Óxido de Zinc , Resinas Epoxi , Eugenol , Calor , Ensayo de Materiales , Silicatos , Espectroscopía Infrarroja por Transformada de Fourier , Cemento de Óxido de Zinc-Eugenol
3.
Int Endod J ; 52(10): 1427-1445, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31267579

RESUMEN

The endodontic literature contains a plethora of studies on static and dynamic cyclic fatigue resistance tests performed on a large array of rotary or reciprocating nickel-titanium endodontic instruments. It was the aim of this review to summarize the currently available evidence to point out the different outcomes from static versus dynamic tests and to assess whether cyclic fatigue tests provide useful data and information for clinical practice. An electronic literature research in the database PubMed was performed using appropriate search terms, and the titles and abstract were screened for relevance. Language was restricted to English. The review reveals marked differences between the results obtained in static and dynamic tests, and also, the results for the same instruments assessed either under static or dynamic experimental conditions are widely inconsistent. Between the lowest and the highest value for one and the same pathfinding instrument was a factor of about 123 when cyclic fatigue was assessed either under static or dynamic experimental conditions. Moreover, standard deviations of up to 30% have been reported. Environmental temperature has a 500% impact on the lifetime of instruments. In conclusion, fatigue resistance tests conducted under room temperature should be regarded as having little meaning and the scientific and clinical benefits of fatigue resistance tests are very limited. These data should be provided by the manufacturer of the instruments.


Asunto(s)
Aleaciones Dentales , Preparación del Conducto Radicular , Diseño de Equipo , Falla de Equipo , Ensayo de Materiales , Estrés Mecánico , Titanio
4.
Int Endod J ; 52(1): 94-104, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29969837

RESUMEN

AIM: To assess the real-time dynamic torque values and axial forces during preparation of straight root canals using three different endodontic motors and hand preparation. METHODOLOGY: Sixty maxillary incisors were divided into four homogeneous groups (n = 15). After glide path establishment (size 20) the root canals were prepared to an apical size 40 using the rotary NiTi system F6 SkyTaper. Motors (DentaPort ZX OTR, EndoPilot and VDW.silver) were set to 'auto-torque-reverse' mode and DentaPort ZX was set to its specific OTR mode (optimum torque reverse). One group served as a control using manual balanced-force canal preparation with K-Flexofiles. Teeth were embedded in resin and fixed in a multi-component sensor measuring axial and torsional load during active instrumentation with 50 Hz. Preparation time was also recorded. Data were statistically analysed using the Kruskal-Wallis test. RESULTS: The maximum axial forces (peak) and both peaks of dynamic clockwise and counter-clockwise torque did not differ significantly when using the three different motors despite different gear ratios and pre-settings. Only the VDW.silver motor exceeded the torque values during the use of 30 instruments (3.3%). The Morita OTR motor exceeded the maximum intrinsic torque set at 1.0 Ncm in approximately 53% of cases. The larger tapered F6 SkyTaper instruments (size 20, .06 taper and size 30, .06 taper) created significantly higher torque values (P < 0.0001). Manual instrumentation created significantly lower torque levels and higher axial values compared to rotary instrumentation (P < 0.0001) and was significantly more time consuming (P < 0.0001). CONCLUSIONS: Manual preparation was associated with significantly lower torque peaks compared to rotary instrumentation. The three motors remained well within the safety torque values of the instruments.


Asunto(s)
Instrumentos Dentales , Equipos y Suministros Eléctricos , Preparación del Conducto Radicular/instrumentación , Estrés Mecánico , Torque , Aleaciones Dentales/química , Análisis del Estrés Dental , Diseño de Equipo , Humanos , Incisivo/anatomía & histología , Níquel/química , Rotación , Titanio/química
5.
Int Endod J ; 51(10): 1088-1103, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29574784

RESUMEN

In the past 10 years, several proprietary processing procedures for nickel titanium (NiTi) alloy were developed to improve the mechanical properties of NiTi endodontic instruments. Beside specific thermal and mechanical treatments, manufacturers introduced several machining procedures (e.g. twisting, electrical discharge machining), as well as techniques for final surface finishing. NiTi alloys used for endodontic instruments can be subdivided into instruments that mainly contain the austenite phase (austenitic: conventional NiTi, M-Wire, R-Phase) and those mainly containing the martensite phase (martensitic: CM Wire, Gold and Blue heat-treated NiTi). Thermomechanically treated NiTi alloys have been reported to be more flexible with improved cyclic fatigue resistance and greater angle of deflection at failure when compared to conventional NiTi. These enhanced properties may be attributed to a modified phase composition containing varying amounts of R-phase and martensite. Endodontic instruments made of austenitic alloys possess superelastic properties because of stress-induced martensite transformation and consequently tend to spring-back to their original form after deformation. In contrast, the martensitic instruments can easily be deformed due to the reorientation of the martensite variants and show a shape memory effect when heated. The use of martensitic alloy results in more flexible instruments, with an increased cyclic fatigue resistance compared with austenitic alloy.


Asunto(s)
Aleaciones Dentales , Endodoncia/instrumentación , Níquel , Titanio , Ensayo de Materiales , Fenómenos Mecánicos , Resistencia a la Tracción
6.
Int Endod J ; 50(10): 983-990, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27809348

RESUMEN

AIM: To compare apical transportation and canal straightening when using three continuous tapered rotary NiTi systems [F6 SkyTaper (Komet/Brasseler, Lemgo, Germany), Mtwo (VDW, Munich, Germany) and OneShape (Micro Méga, Besançon, France)] in severely curved root canals. METHODOLOGY: A total of 60 root canals in extracted human teeth with angles of curvatures ranging between 25° and 35° and radii ranging between 4 and 9 mm were divided into three groups (n = 20). Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature (P = 1.0 and P = 0.994, respectively). All canals were prepared to an apical size 30 according to the manufacturer's instructions. Pre- and post-instrumentation radiographs were superimposed and apical transportation and canal straightening were analysed using a computer imaging program. Preparation time and instrument failure were also recorded. Data were analysed statistically using anova and Student-Newman-Keuls test. RESULTS: During preparation, no file fractured. All instruments maintained the original canal curvature well with no significant differences between the instruments (P = 0.542). Concerning apical transportation, no significant differences were obtained (P = 0.414). Regarding preparation time, no significant differences were obtained between F6 SkyTaper and OneShape (P > 0.05), but both were significantly faster than Mtwo (P < 0.05). CONCLUSION: Under the conditions of this study, all instruments respected the original canal curvature well and apical transportation was negligible. Instruments were safe to use. Preparation with F6 SkyTaper and OneShape was faster than with Mtwo.


Asunto(s)
Cavidad Pulpar/anomalías , Tratamiento del Conducto Radicular/métodos , Cavidad Pulpar/diagnóstico por imagen , Endodoncia/instrumentación , Humanos , Preparación del Conducto Radicular/instrumentación , Preparación del Conducto Radicular/métodos , Tratamiento del Conducto Radicular/instrumentación
7.
Int Endod J ; 49(11): 1057-1064, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26426069

RESUMEN

AIM: To investigate the incidence of dentinal defects after preparation of severely curved root canals using the Reciproc single-file system with and without prior creation of a glide path. METHODOLOGY: Mesial roots from extracted mandibular first molars were collected and scanned with CBCT to assess the morphology of the root canal systems. Three groups of 20 anatomically comparable specimens were generated. The control group was left unprepared, whilst the experimental groups were prepared with Reciproc R25 with and without a glide path (groups RG and R, respectively). Roots were then sectioned perpendicular to the long axis at 2, 4, 6, 8 and 10 mm from the apex, and coloured photographs of the sections at 40× were obtained. Two blinded examiners registered the presence of dentinal defects twice at 2-week interval. Data were statistically analysed using the Fisher exact and Cochran's Q tests. RESULTS: No defects were observed in the control group. The overall incidence of dentinal defects was 26% in group R and 24% in group RG, with no significant differences between them (P > 0.05). Dentinal defects occurred significantly more often in the middle and coronal thirds compared to the apical third of the canals (P < 0.05). CONCLUSIONS: Prior preparation of a glide path had no impact on the incidence of dentinal defects when using Reciproc files.


Asunto(s)
Instrumentos Dentales , Dentina/lesiones , Preparación del Conducto Radicular/efectos adversos , Preparación del Conducto Radicular/instrumentación , Raíz del Diente/anatomía & histología , Diseño de Equipo , Humanos , Mandíbula , Persona de Mediana Edad , Diente Molar/anatomía & histología , Níquel , Preparación del Conducto Radicular/métodos , Titanio
8.
Int Endod J ; 48(8): 774-81, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25156248

RESUMEN

AIM: To compare the shaping ability of four different nickel-titanium rotary instruments during the preparation of curved root canals in extracted teeth. METHODOLOGY: A total of 80 root canals with curvatures ranging between 25° and 39° were divided into four groups of 20 canals. Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature. Canals were prepared to a final apical size of 40 using Mtwo, ProTaper Universal, ProTaper NEXT and BT-RaCe. Using pre- and post-instrumentation radiographs, straightening of the canal curvatures and canal transportation were determined with a computer image analysis programme. Preparation time and instrument failures were also recorded. The data were analysed statistically using anova and Student-Newman-Keuls test. RESULTS: The use of BT-RaCe files resulted in significantly more straightening during instrumentation compared to Mtwo (P < 0.05), whilst the differences between all other instruments were not significant (P > 0.05). No significant differences were obtained between all four instruments regarding canal transportation (P = 0.429). Instrumentation with ProTaper NEXT files was significantly faster than with all other instruments (P < 0.05). During the preparation of the curved canals, one BT2 instrument fractured, whilst no fracture occurred when using the other instruments (P > 0.05). CONCLUSIONS: Within the parameters of this study, all instruments maintained root canal curvature well and were safe. However, care should be taken when using the BT2 instrument due to its unique cylindrical design.


Asunto(s)
Preparación del Conducto Radicular/instrumentación , Aleaciones Dentales , Instrumentos Dentales , Diseño de Equipo , Falla de Equipo , Humanos , Técnicas In Vitro , Níquel , Rotación , Titanio , Torque
9.
Int Endod J ; 48(1): 109-14, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24673737

RESUMEN

AIM: To compare the shaping ability of WaveOne, Reciproc and OneShape single-file systems in severely curved root canals in extracted human molar teeth. METHODOLOGY: Sixty mandibular molars with mesio-buccal canals with curvatures ranging between 25° and 35° and radii of curvature ranging between 4 and 9 mm were divided into three groups of 20 teeth each: group W (WaveOne), group R (Reciproc) and group O (OneShape). Using standardized pre- and post-instrumentation radiographs, straightening of canal curvatures was determined using the NIH Image J software. A double-digital standardized radiographic technique was used to determine apical transportation at 0.5 mm from the working length (1.5 mm coronal to the major foramen). Preparation time and instrument failures were also recorded. Data were analysed using one-way analysis of variance (anova) and post-hoc Tukey-test. RESULTS: During root canal preparation, no instruments fractured but all OneShape instruments were deformed after preparation of four canals. The use of OneShape resulted in significantly greater canal straightening and apical transportation than WaveOne and Reciproc (P < 0.05), with no significant differences between WaveOne and Reciproc (P > 0.05). Instrumentation with OneShape was significantly faster than with WaveOne and Reciproc (P < 0.05), whilst Reciproc was significantly faster than WaveOne (P < 0.05). CONCLUSIONS: All instruments were safe to use. Reciproc and WaveOne instruments respected the original canal curvature better than OneShape files. The use of OneShape instruments required less time to prepare the curved canals compared with Reciproc and WaveOne.


Asunto(s)
Cavidad Pulpar/anatomía & histología , Preparación del Conducto Radicular/instrumentación , Cavidad Pulpar/diagnóstico por imagen , Diseño de Equipo , Humanos , Técnicas In Vitro , Ensayo de Materiales , Diente Molar , Radiografía Dental Digital
10.
Int Endod J ; 48(2): 131-6, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24697590

RESUMEN

AIM: To compare the shaping ability of ProTaper Next, iRaCe and Hyflex CM rotary NiTi files during the preparation of severely curved root canals in extracted human molar teeth. METHODOLOGY: Sixty mandibular molars with mesio-buccal canals having angles of curvature ranging from 25° to 35° were divided according to the instrument used into three groups of 20 teeth each: group PTN (ProTaper Next), group IR (iRaCe) and group HF (Hyflex CM). Using standardized pre- and post-instrumentation radiographs, straightening of canal curvature was determined using image analysis software. A double-digital standardized radiographic technique was used to determine apical transportation 0.5 mm from the working length (1.5-mm coronal of the major foramen). Preparation time and instrument failures were also recorded. Data were analysed using one-way analysis of variance (anova) and post hoc Tukey's test, and significance was set at P < 0.05. RESULTS: During root canal preparation, no instruments fractured. The use of PTN resulted in significantly greater canal straightening than IR and HF (P < 0.05), with no significant differences between IR and HF (P > 0.05). There were no significant differences between the three groups with respect to apical transportation (P > 0.05). IR and HF were significantly faster than PTN (P < 0.05), with no significant differences between IR and HF (P > 0.05). CONCLUSIONS: Under the conditions of this study, PTN, IR and HF respected original canal curvature well and were safe to use.


Asunto(s)
Instrumentos Dentales , Diente Molar , Preparación del Conducto Radicular/instrumentación , Diseño de Equipo , Falla de Equipo , Humanos , Técnicas In Vitro , Níquel , Factores de Tiempo , Titanio
11.
Int Endod J ; 47(5): 405-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-23889673

RESUMEN

AIM: To assess in a laboratory setting the amount of apically extruded debris associated with different single-file nickel-titanium instrumentation systems compared to one multiple-file rotary system. METHODOLOGY: Eighty human mandibular central incisors were randomly assigned to four groups (n = 20 teeth per group). The root canals were instrumented according to the manufacturers' instructions using the reciprocating single-file system Reciproc, the single-file rotary systems F360 and OneShape and the multiple-file rotary Mtwo instruments. The apically extruded debris was collected and dried in pre-weighed glass vials. The amount of debris was assessed with a micro balance and statistically analysed using anova and post hoc Student-Newman-Keuls test. The time required to prepare the canals with the different instruments was also recorded. RESULTS: Reciproc produced significantly more debris compared to all other systems (P < 0.05). No significant difference was noted between the two single-file rotary systems and the multiple-file rotary system (P > 0.05). Instrumentation with the three single-file systems was significantly faster than with Mtwo (P < 0.05). CONCLUSIONS: Under the condition of this study, all systems caused apical debris extrusion. Rotary instrumentation was associated with less debris extrusion compared to reciprocal instrumentation.


Asunto(s)
Instrumentos Dentales , Preparación del Conducto Radicular , Humanos , Técnicas In Vitro , Incisivo
12.
Int Endod J ; 47(5): 470-6, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-23998461

RESUMEN

AIM: To compare the shaping ability of three different nickel-titanium rotary instruments during the preparation of curved root canals in extracted teeth. METHODOLOGY: A total of 60 root canals with curvatures ranging between 25° and 35° were divided into three groups of 20 canals. Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature. Canals were prepared to a final apical size of 35 using Mtwo, Hyflex CM, and Revo-S. Using pre- and post-instrumentation radiographs, straightening of the canal curvatures was determined with a computer image analysis program. Preparation time, changes of working length and instrument failures were also recorded. These data were analysed statistically using anova and Student-Newman-Keuls test. RESULTS: During preparation, no file fractured. Mtwo and Hyflex CM maintained the original canal curvature significantly better than Revo-S (P < 0.05). Instrumentation with Mtwo and Hyflex CM was significantly faster than with Revo-S and resulted in less loss of working length (P < 0.05), whilst no significant differences were obtained between Mtwo and Hyflex CM (P > 0.05). CONCLUSIONS: Under the conditions of this study, Mtwo and Hyflex CM respected the original canal curvature well and were safe to use. The use of Revo-S instruments required more time to prepare the curved canals and resulted in more pronounced canal straightening compared with Mtwo and Hyflex CM.


Asunto(s)
Instrumentos Dentales , Cavidad Pulpar/anatomía & histología , Níquel , Preparación del Conducto Radicular , Titanio , Humanos , Técnicas In Vitro
13.
BMJ Mil Health ; 2024 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-39004444

RESUMEN

INTRODUCTION: The present study determined the (1) day-to-day reliability of basal heart rate (HR) and HR variability (HRV) measured by the Equivital eq02+ LifeMonitor and (2) agreement of ultra short-term HRV compared with short-term HRV. METHODS: Twenty-three active-duty US Army Soldiers (5 females, 18 males) completed two experimental visits separated by >48 hours with restrictions consistent with basal monitoring (eg, exercise, dietary), with measurements after supine rest at minutes 20-21 (ultra short-term) and minutes 20-25 (short-term). HRV was assessed as the SD of R-R intervals (SDNN) and the square root of the mean squared differences between consecutive R-R intervals (RMSSD). RESULTS: The day-to-day reliability (intraclass correlation coefficient (ICC)) using linear-mixed model approach was good for HR (0.849, 95% CI: 0.689 to 0.933) and RMSSD (ICC: 0.823, 95% CI: 0.623 to 0.920). SDNN had moderate day-to-day reliability with greater variation (ICC: 0.689, 95% CI: 0.428 to 0.858). The reliability of RMSSD was slightly improved when considering the effect of respiration (ICC: 0.821, 95% CI: 0.672 to 0.944). There was no bias for HR measured for 1 min versus 5 min (p=0.511). For 1 min measurements versus 5 min, there was a very modest mean bias of -4 ms for SDNN and -1 ms for RMSSD (p≤0.023). CONCLUSION: When preceded by a 20 min stabilisation period using restrictions consistent with basal monitoring and measuring respiration, military personnel can rely on the eq02+ for basal HR and RMSSD monitoring but should be more cautious using SDNN. These data also support using ultra short-term measurements when following these procedures.

14.
Int Endod J ; 46(6): 590-7, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23240965

RESUMEN

AIM: To compare the shaping ability of three different single-file systems with Mtwo rotary instruments during the preparation of curved root canals in extracted teeth. METHODOLOGY: A total of 80 root canals with curvatures ranging between 25° and 35° were divided into four groups of 20 canals. Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature. Canals were prepared to the following apical sizes: Mtwo: size 30 using the single-length technique; Reciproc, F360, and OneShape: size 25. Using pre- and post-instrumentation radiographs, straightening of the canal curvatures was determined with a computer image analysis programme. Preparation time, changes in working length, and instrument failures were also recorded. These data were analysed statistically using anova and Student-Newman-Keuls test. RESULTS: During preparation, no file fractured. All instruments maintained the original canal curvature well with no significant differences between the instrument systems (P = 0.792). Instrumentation with Reciproc and OneShape was significantly faster than with F360 and Mtwo (P < 0.05), while F360 was significantly faster than Mtwo (P < 0.05). No significant differences were obtained regarding changes in working length during instrumentation with the different instruments (P = 0.784). CONCLUSIONS: Under the conditions of this study, all instruments respected the original canal curvature well and were safe to use. The use of Reciproc and OneShape instruments required less time to prepare the curved canals compared with Mtwo and F360.


Asunto(s)
Cavidad Pulpar/anatomía & histología , Preparación del Conducto Radicular/instrumentación , Aleaciones Dentales/química , Cavidad Pulpar/diagnóstico por imagen , Diseño de Equipo , Falla de Equipo , Seguridad de Equipos , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Ensayo de Materiales , Níquel/química , Radiografía de Mordida Lateral/métodos , Preparación del Conducto Radicular/métodos , Rotación , Propiedades de Superficie , Factores de Tiempo , Titanio/química , Torque
15.
J Eur Acad Dermatol Venereol ; 26(4): 495-502, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21569115

RESUMEN

BACKGROUND: Diagnosis and therapy of chronic wounds constitute an interdisciplinary challenge and should be oriented on the guideline standards. Although no data on the quality-of-care are available for Germany, it can be concluded from qualitative estimates and expert reports that the majority of patients are not receiving adequate treatment. OBJECTIVES: Evaluation of the quality-of-care for leg ulcers in the metropolitan area of Hamburg by means of newly developed guideline-based indicators. METHODS: Leg ulcer patients of any aetiology were consecutively included. The spectrum of 220 health-care providers ranged from wound clinics, office-based practices, nursing homes to home-care services and doss houses. The survey included a clinical examination and the completion of questionnaires covering quality of life, experiences with treatment and quality of health care. RESULTS: A total of 520 patients with leg ulcers were included. Among these patients, 63% were of venous, 23% of mixed, 2% of vasculitic and 12% of other origin; 78.6% of the patients were treated with moist wound dressings. Pain therapy was performed in 54.1%, compression therapy in 53.5%. Shortcomings were noted in the diagnostic work-up and in concomitant wound care such as physiotherapy. Around 70% displayed marked to profound impairment in quality of life. The quality-of-care index showed that 64% of the indicators were met by the actual care; 61.8% of the patients exhibiting a sufficient quality-of-care, regardless of age, social status, place of abode or insurance status. CONCLUSIONS: Although the majority of patients received adequate therapy, many patients are not being treated properly in accordance with the guidelines.


Asunto(s)
Úlcera de la Pierna/terapia , Calidad de Vida , Femenino , Alemania , Humanos , Masculino
16.
Int Endod J ; 45(5): 449-61, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22188401

RESUMEN

AIM: To compare shaping ability and cleaning effectiveness of two reciprocating single-file systems with Mtwo and ProTaper rotary instruments during the preparation of curved root canals in extracted teeth. METHODOLOGY: A total of 80 root canals with curvatures ranging between 25° and 39° were divided into four groups of 20 canals. Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature. Canals were prepared to the following apical sizes: Mtwo: size 35 using the single-length technique; ProTaper: F3, instruments were used in a modified crown-down manner; Reciproc and WaveOne: size 25. Using pre- and post-instrumentation radiographs, straightening of the canal curvatures was determined with a computer image analysis program. Preparation time and instrument failures were also recorded. These data were analysed statistically using anova and Student-Newman-Keuls test. The amounts of debris and smear layer were quantified on the basis of a numerical evaluation scale and were analysed statistically using the Kruskal-Wallis test. RESULTS: During preparation no file fractured. All instruments maintained the original canal curvature well with no significant differences between the different files (P = 0.382). Instrumentation with Reciproc was significantly faster than with all other instruments (P < 0.05), while WaveOne was significantly faster than Mtwo and ProTaper (P < 0.05). For debris removal, Mtwo and Reciproc instruments achieved significantly better results (P < 0.05) than the other instruments in the apical third of the canals. In the middle and coronal parts, no significant differences were obtained between Mtwo, Reciproc and WaveOne (P > 0.05), while ProTaper showed significantly more residual debris (P < 0.05). The results for remaining smear layer were similar and not significantly different for the different parts of the canals (P > 0.05). CONCLUSIONS: Under the conditions of this study, all instruments maintained the original canal curvature well and were safe to use. The use of Mtwo and Reciproc instruments resulted in better canal cleanliness in the apical part compared with ProTaper and WaveOne.


Asunto(s)
Cavidad Pulpar/anatomía & histología , Preparación del Conducto Radicular/instrumentación , Cavidad Pulpar/diagnóstico por imagen , Dentina/anatomía & histología , Diseño de Equipo , Falla de Equipo , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Ensayo de Materiales , Radiografía , Preparación del Conducto Radicular/métodos , Preparación del Conducto Radicular/normas , Rotación , Capa de Barro Dentinario , Propiedades de Superficie , Factores de Tiempo , Ápice del Diente/anatomía & histología , Cuello del Diente/anatomía & histología , Torque
17.
AJNR Am J Neuroradiol ; 43(12): 1802-1809, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36328408

RESUMEN

Nelarabine is a nucleoside analog critical for the treatment of patients with T-cell acute lymphoblastic leukemia/lymphoma. However, clinical peripheral and central neurologic adverse events associated with nelarabine administration have been reported. Neuroimaging of brain neurotoxicity has only been described in very few reports in pediatric patients so far. Six children with diagnosed T-cell acute lymphoblastic leukemia who clinically experienced possible, probable, or definite nelarabine-induced toxicity and underwent spine and/or brain MR imaging were reviewed. Neuroimaging findings showed a mixture of patterns including features of acute toxic leukoencephalopathy (seen in 6 cases), posterior reversible encephalopathy syndrome (2 cases), involvement of deep gray structures (1 case) and brainstem (2 cases), cranial and spinal neuropathy (2 cases each), and myelopathy (2 cases). Even though neuroimaging findings are nonspecific, the goal of this article was to alert the pediatric neuroradiologists, radiologists, and clinicians about the possibility of nelarabine-induced neurotoxicity and its broad neuroimaging spectrum.


Asunto(s)
Síndrome de Leucoencefalopatía Posterior , Leucemia-Linfoma Linfoblástico de Células Precursoras , Enfermedades de la Médula Espinal , Humanos , Niño , Arabinonucleósidos/efectos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico
18.
Eur J Vasc Endovasc Surg ; 41(4): 540-7, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21239190

RESUMEN

OBJECTIVES: The aim of this study was to investigate the effect of a red-vine-leaf extract (AS195, Antistax(®), Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany) on the volume of the leg and clinical symptoms in patients with chronic venous insufficiency (CVI). DESIGN, MATERIALS AND METHODS: A multicentre, randomised, double-blind and placebo-controlled study was carried out with 720 mg AS195 per day over 12 weeks in CVI patients (CEAP Grades 3-4a) and moderate-to-severe clinical symptoms. Efficacy endpoints were changes in limb volume determined by water displacement volumetry, clinical CVI symptoms assessed on a 10-cm visual analogue scale and global efficacy evaluations. RESULTS: The full-analysis set included 248 patients (placebo: n = 122; AS195: n = 126). After 12 weeks, AS195 significantly reduced lower limb volume by a mean of 19.9 standard error (SE) 8.9 ml over placebo (95% confidence interval (CI): -37.5, -2.3; p = 0.0268; analysis of covariance, ANCOVA). The standardised effect size of 0.28 for volume reduction indicates a clinically relevant effect. On Day 84, the symptom of 'pain in the legs' assessed by visual analogue scale decreased in the AS195 group compared with the placebo group: mean difference -6.6 SD 3.3 mm (95% CI: -13.1,-0.1; p = 0.047). Other symptoms showed no significant change. The tolerability of AS195 was similar to that of placebo. CONCLUSIONS: AS195 treatment for 84 days resulted in an approximately 20 ml reduction of limb volume in the active treatment group compared with the placebo group. Patients reported subjective improvement following treatment with AS195 compared with placebo. However, patients' overall rating of efficacy did not correlate well with measured reductions in limb volume. TRIAL REGISTRATION: ClinicalTrials.gov NCT00855179.


Asunto(s)
Fármacos Cardiovasculares/uso terapéutico , Extractos Vegetales/uso terapéutico , Quercetina/análogos & derivados , Insuficiencia Venosa/tratamiento farmacológico , Vitis , Adulto , Anciano , Anciano de 80 o más Años , Fármacos Cardiovasculares/efectos adversos , Enfermedad Crónica , Método Doble Ciego , Edema/tratamiento farmacológico , Edema/etiología , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Dolor/etiología , Dimensión del Dolor , Efecto Placebo , Extractos Vegetales/efectos adversos , Hojas de la Planta , Quercetina/efectos adversos , Quercetina/uso terapéutico , Comprimidos , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia Venosa/complicaciones , Adulto Joven
19.
Int Endod J ; 44(5): 447-57, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21276014

RESUMEN

AIM: To compare the cleaning effectiveness and shaping ability of Mtwo, PVD-coated and uncoated EasyShape nickel-titanium rotary instruments during the preparation of curved root canals in extracted human teeth. METHODOLOGY: A total of 60 root canals of mandibular and maxillary molars with curvatures ranging between 25° and 35° were divided into three groups of 20 canals. Based on radiographs taken prior to instrumentation with the initial instrument inserted into the canal, the groups were balanced with respect to the angle and the radius of canal curvature. Canals were prepared using a low-torque control motor according the single-length technique. Using pre- and post-instrumentation radiographs, straightening of the canal curvatures was determined with a computer image analysis program. Preparation time, changes of working length and instrument failures were also recorded. These data were analysed statistically using ANOVA and Student-Newman-Keuls test. The amounts of debris and smear layer were quantified on the basis of a numerical evaluation scale. The data established for scoring the debris and the smear layer were recorded separately and analysed statistically using the Kruskal-Wallis test. RESULTS: During preparation, one coated and two uncoated EasyShape files fractured. Completely clean root canals were never observed. All instruments maintained the original canal curvature well with no significant differences between the different instruments (P > 0.05). Instrumentation with Mtwo files was significantly faster than with the two other instruments (P < 0.05). For debris removal Mtwo instruments achieved significantly better results (P < 0.001) than the two EasyShape instruments. The use of coated EasyShape files resulted in significantly less debris compared to instrumentation with uncoated EasyShape instruments (P < 0.05). The results for remaining smear layer were similar and not significantly different for the coronal, middle and apical third of the canals (P > 0.05) but in summary significantly less smear layer was observed following instrumentation with Mtwo (P < 0.01). CONCLUSIONS: Under the conditions of this study, all instruments maintained the original canal curvature well. The use of Mtwo instruments resulted in good canal cleanliness. PVD-coating of EasyShape instruments had no impact on their shaping ability but improved their cleaning effectiveness.


Asunto(s)
Instrumentos Dentales , Cavidad Pulpar/anatomía & histología , Preparación del Conducto Radicular/instrumentación , Capa de Barro Dentinario , Análisis de Varianza , Aleaciones Dentales , Equipo Dental de Alta Velocidad , Cavidad Pulpar/cirugía , Cavidad Pulpar/ultraestructura , Diseño de Equipo , Humanos , Mandíbula , Maxilar , Diente Molar , Níquel , Preparación del Conducto Radicular/métodos , Estadísticas no Paramétricas , Titanio
20.
J Wound Care ; 20(7): 319-20, 322-5, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21841720

RESUMEN

OBJECTIVE: To examine if wound aetiology has an effect on the pain-relieving properties of an ibuprofen-releasing foam dressing, which was previously shown to reduce pain in wounds of various aetiologies, compared with local best practice (LBP). METHOD: This was a secondary analysis of data from a multicentre, randomised, parallel group trial of patients with painful exuding wounds of various aetiologies. Wound aetiology was determined at enrolment. Of 853 patients enrolled into the trial, 688 belonged to a wound aetiology subgroup that included >25 patients and were included in the analysis reported here. Patients were randomised to a dressing containing 112.5mg of ibuprofen (ibuprofen foam) or to LBP for 5 days. Patients recorded pain relief and pain intensity daily. The main endpoint was the proportion of patients who, from day 1 to day 5, reported a summed pain relief score >50% of the total maximum pain relief score (TOTPARD5>50%) and the corresponding number needed to treat (NNT) for each wound aetiology subgroup. Further analyses included the proportion of patients who, on a daily basis, reported pain relief >50% of the maximum daily pain relief, the proportion of patients who, on day 5, experienced a reduction in pain intensity of >50% of the maximum score (PIDD5>50%), and if PIDD5>50% was related to baseline pain intensity. RESULTS: Patients were categorised by the following five wound types: arterial, venous, and mixed arterial-venous leg ulcers, vasculitis and traumatic ulcers. The ibuprofen foam dressing was associated with significantly greater pain relief than LBP in all different wound aetiology subgroups, whether chronic or traumatic (acute). Overall, TOTPARD5>50% was 55% in the ibuprofen foam group and 24% in the LBP group (p<0.0001; NNT, 3.2). The pain intensity evaluations revealed similar results in favour of ibuprofen foam compared with LBP. No correlation was observed between PIDD5>50 and initial pain intensity. CONCLUSION: In this study, the ibuprofen foam dressing was shown to consistently relieve wound pain in exuding wounds of various aetiologies, irrespective of basal pain intensity. The data suggest that local pain relief by an ibuprofen foam dressing is possible in the most common, painful, exuding, chronic and acute/traumatic wounds and so is a safer alternative to systemic pain treatment.


Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Ibuprofeno/administración & dosificación , Apósitos Oclusivos , Dolor/prevención & control , Úlcera Cutánea/terapia , Heridas y Lesiones/terapia , Administración Tópica , Anciano , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Regresión
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