The Effects of Calcium Silicate- and Calcium Hydroxide-based Root Canal Sealers on Postoperative Pain: A Randomized Clinical Trial.

INTRODUCTION: This study aimed to compare the postoperative pain level changes resulting from using calcium silicate- (EndoSeal MTA) and calcium hydroxide-based (Sealapex) root canal sealers in mandibular first and second molar teeth with symptomatic apical periodontitis. METHODS: A total of 60 patients with symptomatic apical periodontitis in their lower molar teeth were randomly allocated into 2 groups according to sealer type (n = 30). Demographic data, including gender, age, and smoking habit, and preoperative pain measures were recorded. Root canal treatments were performed in a single visit. Postoperative pain measurements and analgesic intake were measured at 6, 12, 24, and 48 hours and after 3, 5, and 7 days using the visual analog scale. The data were statistically analyzed using a chi-squared test (to compare gender, age, smoking habit, analgesic intake, and sealer extrusion), the Mann-Whitney U test (to compare pain levels), Friedman tests (for the evaluations of the reduction in pain levels over time), and Spearman's correlation test (to analyze the relationships of age, gender, smoking habit factors with postoperative pain) (P = .05). RESULTS: The statistical analysis showed no significant differences between the groups in postoperative pain and analgesic intake at any of the time intervals evaluated (P > .05). CONCLUSIONS: Patients treated with calcium silicate- and calcium hydroxide-based root canal sealers experienced similar postoperative pain and no statistically significant differences were observed in analgesic intake.

Effects of negative pressure wound therapy on an axial congested rabbit skin flap model without any bare surface.

One of the most important problems encountered in reconstructive surgery is partial or total flap loss, and venous congestion is the most common reason. It should be solved as early as possible. The purpose of this study is to investigate the effects of Negative pressure wound therapy (NPWT) on an ideal congested rabbit skin flap model without any open wound. The current study included 28 female, adult, New Zealand albino rabbits. Animals were divided into four groups according to the duration of NPWT to be applied. An axial pattern ideal congested skin flap was designed on the posterior surface of the ear. After surgical intervention on the right ears, we applied NPWT treatment for 2, 4, 6 and 8 days. The left ears were followed without any treatment. Samples were taken for edema, congestion and neo-angiogenesis examination. There was no significant difference between the NPWT applied group and control group in the 2nd, 4th, 6th, and 8th days for edema and neo-angiogenesis and no differences in the 2nd, 6th, and 8th days for congestion. NPWT group had a higher flap survival rate than the control group but without a significant difference. This study used an ideal congested rabbit skin flap model imitating venous congestion. Our findings illustrate that NPWT treatment does not have a significant effect on the congested skin flap model we utilized where a closed system was created maintaining a skin barrier without a bare surface of the flap. Level of Evidence: Level I, experimental study.

Risk Assessment of Surgical Interventions Performed on Non-Infected Patients During COVID-19 Pandemic.

Background A number and a variety of surgical interventions were highly affected by the novel coronavirus disease (COVID-19) outbreak. Most of the elective operations were discontinued with the fear of exacerbating the disease in patients and spreading it among healthcare professionals. Objective The objective of this study was to report postoperative rates of COVID-19 in patients who underwent emergency and urgent surgery during the pandemic and to determine a safe algorithm in order to propose an ideal approach for surgeries. Patients and methods A total of 162 patients being operated upon emergency or urgent causes between March 11 and May 31 2020 were included in the study. Safety measures advised by the World Health Organization were applied. The patients' operative data and postoperative COVID-19 status were recorded and statistically evaluated. Results Surgical interventions were required for skin cancer, upper extremity trauma, soft tissue infections, maxillofacial trauma, lower extremity trauma and other causes. Local anesthesia was used for 127 patients (78.4%). General anesthesia was used for 28 patients (17,3%). Two of 162 patients contracted COVID-19 postoperatively on days 15 and 21, respectively. No statistical significance was found between surgery and anesthesia types regarding COVID-19 risk. Conclusion It appears that emergency and urgent surgeries can be performed safely. However, this relies upon adequate safety measures being taken with regards to screening for COVID-19 antigen positivity in patients preoperatively. Further evidence is required to determine the safety of elective surgeries.

Effects of Insulin, Metoprolol and Deferoxamine on Fat Graft Survival.

BACKGROUND: The main problem faced with fat grafting is unpredictable resorption rates. Many substances have been reported to increase the survival of fat grafts. The aim of this study was to compare the effects of insulin, metoprolol and deferoxamine on fat graft survival. METHODS: Inguinal fat pads of male Sprague-Dawley rats were harvested and split into four parts as grafts. The grafts were placed in subcutaneous pockets in four quadrants on the back area of the rats. The insulin and metoprolol group fat grafts were incubated in regular insulin and metoprolol solutions, until they were placed. Deferoxamine and control group fat grafts were placed without incubation. After surgery, the control group fat grafts were injected with 10 doses of NaCl solution once every 3 days, and the deferoxamine group fat grafts were injected with 10 doses of deferoxamine solution once every 3 days. After a graft maturation period of 3 months, the grafts were harvested for weight measurements and histological and immunohistochemical evaluation. RESULTS: According to the rate of perilipin staining, the metoprolol group had 30% more mature viable adipocytes than the control and insulin group fat grafts (p < 0.05 and p < 0.01, respectively). CD31 activation rates were significantly higher in the deferoxamine and insulin group than in the metoprolol group (p < 0.05). CD34 staining rates did not differ between any groups (p > 0.05). CONCLUSIONS: In this experimental study, we have shown that there was no significantly increased fat graft survival rate seen in any drug treatment group. Low survival rates of stem cells demonstrated that the adipogenesis period ended at 3 months. Treatment of fat grafts with the selective ß1-blocker metoprolol resulted in good quality better graft take with more viable mature adipocytes. However, better viability of adipocytes did not result in increased weight of the fat graft. Studies aiming to compare the effects on fat graft survival of beta-blockers with long or short durations of action, different potencies and different receptor selectivity may be designed in the future. In addition, further studies may be performed, in which immunohistochemical markers used to assess inflammation and fibrosis are added to the study after the completion of the fat graft maturation period at the end of the first year to test the permanence of the results. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors - www.springer.com/00266 .

Comparison of subacute and delayed free flap reconstruction in the treatment of open lower extremity fractures.

BACKGROUND: Although early free flap coverage for lower extremity traumatic defects has been recommended by several authors, it is often not practical due to associated patient injuries or logistics. The aim of this study was to evaluate the impact of subacute and delayed surgical timing on flap success. METHODS: A retrospective analysis of adult patients who underwent a microsurgical free flap operation between 2007 and 2012 following lower extremity trauma was performed. The patients were divided into 2 groups according to the time period between the injury and the free flap operation: a subacute group (flap performed 10 to 29 days after injury) and a delayed repair group (>30 days after injury). The details of patient demographics, the mechanism of injury, timing from operation to discharge, minor and major complications, and flap failure rates were evaluated and compared. RESULTS: The study included 35 patients who underwent 37 free flap operations. A total of 20 patients were operated on 10 to 29 days after the injury (subacute repair group), and 15 patients were operated on more than 30 days after the injury (32-92 days) (delayed repair group). No significant correlation was found between the timing of the reconstruction, flap failure, and complication rates. CONCLUSION: Both subacute and delayed reconstruction for lower extremity traumatic defects can be performed with favorable results with appropriate wound preparation and precise preoperative planning.

The effect of photobiomodulation on total amount of substance P in gingival crevicular fluid: placebo-controlled randomized clinical trial.

To investigate the effect of photobiomodulation (PBM) and placebo on total amount of substance P in gingival crevicular fluid (GCF) pre- and postoperatively. Twenty-six patients having tooth with symptomatic apical periodontitis were enrolled in this study. GCF was collected preoperatively. The patients were assigned into two groups (n = 13), as follows: placebo and PBM. Sampling was repeated 7 days after root canal treatment. Two independent samples T test was used for analyzing of the differences between preoperative and postoperative substance P levels in GCF (p = .05). The Pearson correlation analysis was used for determination of correlation among substance P levels and other variables. For placebo group, there is no significant difference between preoperative and postoperative total amounts of substance P level (p = 0.553). For PBM group, postoperative total amount of substance P level was significantly higher than those of preoperative level (p = 0.005). Within the limitation of the present study, PBM has immunomodulation effect linked to the modulation of the total amount of substance P in the gingival crevicular fluid. Thai Clinical Trials Registry: TCTR20161228002.

Effect of Low-level Laser Therapy on Postoperative Pain in Molars with Symptomatic Apical Periodontitis: A Randomized Placebo-controlled Clinical Trial.

INTRODUCTION: In this clinical trial, we evaluated the effect of low-level laser therapy (LLLT) on postoperative pain in mandibular molar teeth with symptomatic apical periodontitis. METHODS: Forty-two patients were included in the study according to the inclusion and exclusion criteria. Root canal treatment was conducted using reciprocating instruments. The patients were randomly distributed into 3 groups using a Web program as follows: control (no laser was applied), placebo (mock laser therapy), and LLLT. Postoperative pain levels on the 1st, 3rd, 5th, 7th, and 30th day and postoperative percussion pain levels on the visual analog scale were recorded. The chi-square, 1-way analysis of variance, and least significant difference post hoc tests were performed to analyze the data (P = .05). RESULTS: LLLT resulted in lower pain levels than those noted in the control and placebo groups on days 1 and 3 (P < .05). There were no significant differences among the placebo, LLLT, and control groups in terms of postoperative percussion pain levels (P < .05). CONCLUSIONS: LLLT can be beneficial in reducing postoperative pain in endodontics.

Effect of intracanal diode laser application and low-level laser therapy on CGRP change

Abstract: The aim of this study was to investigate the effect of a placebo, intracanal diode laser application, and low-level laser therapy (LLLT) on the change of the total amount of calcitonin gene-related peptide (CGRP) in the gingival crevicular fluid (GCF) (split-mouth study design). GCF sampling was performed on a contralateral tooth and experimental tooth (root canal-treated tooth) of thirty-nine patients. The patients were divided into three groups (n = 13), as follows: placebo (mock laser application), intracanal laser application, and LLLT. GCF sampling was repeated at the same sites (experimental and control teeth) one week after root canal treatment. The data were analyzed using the Pearson's correlation analysis and the independent-samples t-tests (p=0.05). In the placebo group, the total CGRP level changes in the GCF before and after treatment was significantly higher for experimental teeth than for control teeth (p<0.05). However, there was no significant difference between experimental and control teeth in the intracanal laser application and LLLT groups (p > 0.05). Intracanal laser application and low-level laser therapy have immunomodulation effects linked to the modulation of the total amount of CGRP in the GCF.

Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled, Triple-blind, Randomized Clinical Trial.

INTRODUCTION: Low-level laser therapy (LLLT) is a practical, nonpharmacologic technique for reducing pain. This study evaluated the effect of LLLT on postoperative pain after root canal retreatment (RCR). METHODS: This study enrolled patients (N = 36) who required root canal retreatment (RCR) on mandibular molar teeth, presented with periapical lesions with periapical index scores of 2 or 3, and had a pain visual analog scale (VAS) <50 and a percussion pain VAS <50. The participants were divided into 2 groups: (1) patients scheduled for RCR followed by LLLT (n = 18) and (2) patients scheduled for RCR followed by a mock LLLT (placebo) (n = 18). Postoperative pain was assessed using the VAS. Data were collected and statistically analyzed with the chi-square test, the independent sample t test, and the Mann-Whitney U test (P = .05). RESULTS: On the first 4 days, postoperative pain significantly reduced in the LLLT group compared with the placebo group (P < .05). However, no statistically significant differences in postoperative pain were found between the 2 groups after 5 and 7 days (P > .05). The number of patients who needed analgesics was lower in the LLLT group than in the placebo group (P < .05). No patient reported pain during LLLT application. CONCLUSIONS: LLLT may reduce postoperative pain after RCR of mandibular molars.

The New Anatomical Classification System for Orbital Exenteration Defect.

BACKGROUND: The unique anatomy of the orbita and the different behavior of each malignant tumor cause us to perform the various types of orbital exenteration that yields to varying defect each of which has own specific demands in terms of the reconstruction. Current classification of orbital exenteration defects seems not to be adequate to provide detailed description. This study reviews 50 exenteration defects to offer a more effective anatomical classification system. METHODS: Over a 15 years period, 50 orbital exenteration defects in 47 patients were reconstructed. Defects were categorized according to the resected orbital wall, dura, and ethmoid resection. If the maxillectomy was performed, A or B was added to define the type of maxillectomy as partial (intact palate) or total maxillectomy, respectively. According to these criteria, 4 types of defect patterns were determined including Type 0 (n = 5) with intact orbital wall, Type I (n = 9) with sino-orbital fistula, Type II (n = 4) with crania-orbital fistula with intact dura, Type III (n = 6) with crania-orbital fistula associated with dura defect, and Type IV (n = 8) with cranio-nasal-orbital fistula. There were 12 partial (A) and 6 total maxillectomy (B) defects along with the orbital exenteration. RESULTS: There was no major complication except one. The minor wound-healing problems occurred in 7 patients. Nine patients (19%) used prosthesis. Twenty-two (46.8%) patients chose a patch to cover the area. The remaining 16 patients were not able to use any type of prosthesis because of the reconstruction methods. CONCLUSION: The authors believe that the authors' anatomical classification system provides more precise description of the defect which eventually enhances the success rate of both reconstruction and resection.

Prelaminated extended temporoparietal fascia flap without tissue expansion for hemifacial reconstruction.

BACKGROUND: Disfigurement of the face caused by postburn scars, resected congenital nevi and vascular malformations has both functional and psychological consequences. Ideal reconstruction of the facial components requires producing not only function but also the better appearance of the face. The skin of the neck, supraclavicular or cervicothoracic regions are the most commonly used and the most likely source of skin for facial reconstruction in those techniques which prefabrications with tissue expansion are used. This retrospective cohort study describes the two staged prelaminated temporoparietal fascia flap which eliminates the usage of tissue expansion by using skin graft harvested from the neck and occipital region and the application of this flap for the lower three-fourths of the face. METHOD: 5 patients received prelaminated temporoparietal fascia flap without tissue expansion for facial resurfacing. The mean age at surgery was 39, 2 years (range, 17-60 years). The average follow up was 21.6 months (range, 10-48 months). RESULT: The size of the raised prelaminated temporoparietal fascia flaps ranged from 9 × 8 cm to 14 × 10 cm. All flaps survived after second stage. Varied degrees of venous congestion were observed after flap insets in all cases but none required any further treatment for the congestion. The entire lesion could not be resected due to the large size of the lesion in all patients. CONCLUSION: Two stage prelaminated temporoparietal fascia flap with skin graft is an effective technique for the reconstruction of partial facial defects in selected patients. It is simple, quick, safe and reliable, and requires no expansion of skin or no microsurgery.

Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: a confocal microscopic study.

OBJECTIVES: The aim of this in vitro study was to evaluate the efficacy of different irrigation techniques including laser-activated irrigation using an erbium:yttrium-aluminum-garnet (Er:YAG) laser with a novel tip design (photon-induced photoacoustic streaming (PIPS)), Er:YAG laser with Preciso tip, sonic activation, and passive ultrasonic activation on the final irrigation solution penetration into dentinal tubules by using a laser scanning confocal microscope. MATERIAL AND METHODS: In this study, 65 extracted single-rooted human mandibular premolars were instrumented up to size 40 and randomly divided into 5 groups (n = 13) based on the activation technique of the final irrigation solution as follows: conventional irrigation (control group), sonic activation, passive ultrasonic activation, Er:YAG-PIPS tip activation, and Er:YAG-Preciso tip activation. In each group, 5 mL of 5% NaOCl labeled with fluorescent dye was used during the activation as the final irrigation solution. Specimens were sectioned at 2.5 and 8 mm from the apex and then examined under a confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc tests (P = 0.05). RESULTS: Both Er:YAG laser (Preciso/PIPS) activations exhibited a significantly higher penetration area than the other groups (P < 0.05). Additionally, passive ultrasonic activation had significantly higher penetration than the sonic activation group and the control group. Statistically significant differences were also found between each root canal third (coronal > middle > apical) (P < 0.001). CONCLUSIONS: The results from the present study support the use of Er:YAG laser activation (Preciso/PIPS) to improve the effectiveness of the final irrigation procedure by increasing the irrigant penetration area into the dentinal tubules. CLINICAL RELEVANCE: The activation of the irrigant and the creation of the streaming with the Er:YAG laser have a positive effect on the irrigant penetration.

The effect of various kinematics on postoperative pain after instrumentation: a prospective, randomized clinical study

ABSTRACT Objective: To evaluate various kinematic movements on postoperative pain using a Reciproc system. Material and Methods: Fifty-six molar teeth were divided into four groups according to kinematics as follows: continuous rotation, 360° CCW – 30° CW, 270° CCW – 30° CW, and 150° CCW – 30° CW. Preoperative and postoperative pain levels using visual analogue scale (VAS), percussion pain, and analgesic intake were recorded for each subject. Postoperative pain levels at 1, 3, 5, and 7 d were evaluated. Data were analyzed statistically using the Kruskal-Walis, Mann-Whitney-U, one-way analysis of variance, and chi-square tests (p=0.05). Results: Continuous rotation resulted in more pain at Day 1 when compared with the reciprocating groups (360° CCW – 30° CW and 270° CCW – 30° C) (p<0.05). Conclusions: Continuous rotation resulted in more postoperative pain at Day 1 than in reciprocating groups, and thereafter no significant pain was found among the groups.

Fracture Resistance of Endodontically Retreated Roots After Retreatment Using Self-Adjusting File, Passive Ultrasonic Irrigation, Photon-Induced Photoacoustic Streaming, or Laser.

OBJECTIVE: Additional cleaning techniques and devices are required to remove maximum amount of residual filling material, which might limit disinfection of root canal system during retreatment. This study aimed to compare fracture resistance of roots when self-adjusting file (SAF), photon-induced photoacoustic streaming (PIPS), passive ultrasonic irrigation (PUI), erbium-doped yttrium aluminum garnet (Er:YAG), or neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are applied following the use of retreatment files in endodontics. MATERIALS AND METHODS: A total of 117 human mandibular canine teeth of similar dimensions were selected and divided into nine groups (n = 13). Aside from control, instrumented, and only-prepared groups, 91 teeth were remaining, of which 13 were assigned to the only-filling group and final 78 to retreatment, thus R-Endo file, R-Endo+SAF, R-Endo+PUI, R-Endo+Er:YAG laser, R-Endo+Nd:YAG laser, and R-Endo+PIPS. RESULTS: The fracture strengths of the retreatment groups were lower than control, instrumented, and only-filling groups (p < 0.05). There was no difference between the R-Endo group and additional retreatment procedure groups (p > 0.05). CONCLUSIONS: Further cleaning methods using SAF, PIPS, Er:YAG laser, Nd:YAG laser, or PUI did not decrease the fracture resistance when compared with the R-Endo group.

Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and guttaflow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study.

BACKGROUND AND OBJECTIVE: Varied physical and chemical characteristic of root canal sealers and different irrigant agitation systems can influence the depth of penetration. The aim of this in vitro study was to use a laser scanning confocal microscope in order to assess the dentinal tubules penetration of various sealers after the application of different final irrigation techniques. STUDY DESIGN/MATERIALS AND METHODS: A total of 156 single-rooted extracted mandibular premolars were prepared up to size 40 and randomly distributed into four groups according to the sealer type (n = 39): AH Plus, iRoot SP, MTA Fillapex, and GF Bioseal. Each group was randomly subdivided into three groups according to the final irrigation protocol (n = 13): conventional needle irrigation (CI), photon-induced-photoacoustic streaming activation (PIPS), and passive ultrasonic irrigation (PUI). After the final irrigation procedures, the root canals were obturated with single gutta-percha and labeled sealer mixed with 0.1% fluorescent rhodamine B isothiocyanate. Specimens were sectioned at 2, 5, and 8 mm from the apex, and all the sections were examined under confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using three-way analysis of variance and Tukey's post hoc tests (P = 0.05). RESULTS: iRoot SP exhibited a significantly higher penetration area than the other groups (P < 0.001), although there were no statistically significant differences between AH Plus, MTA Fillapex, and GF Bioseal (P > 0.05). Er:YAG laser activation with PIPS and PUI had significantly higher penetration than CI (P < 0.001). Statistically significant differences were also determined at each root canal third (coronal > middle > apical; P < 0.001). CONCLUSIONS: The dentinal tubule penetration area was significantly affected by the selection of root canal sealer, final irrigation procedure, and root canal third. Use of iRoot with PIPS tip or PUI seems advantageous in dentinal tubule penetration.

The effect of chloroform, orange oil and eucalyptol on root canal transportation in endodontic retreatment.

The purpose of the present study was to assess the effect of solvents on root canal transportation in endodontic retreatment. Sixty extracted human permanent mandibular first molars with curved root canals were selected. All of the root canals were prepared using Twisted File Adaptive instruments (SybronEndo, Orange, CA, USA) and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the cold lateral compaction technique. The teeth were assigned to four retreatment groups as follows (n = 15): eucalyptol, chloroform, orange oil and control. The canals were scanned using cone-beam computed tomography scanning before and after instrumentation. The chloroform group showed a significantly higher mean transportation value than the orange oil and control groups at the 3 and 5 mm levels (P = 0.011 and P = 0.003, respectively). There was no significant difference among the orange oil, eucalyptol and control groups in terms of canal transportation (P > 0.61). The chloroform led to more canal transportation than the eucalyptol and orange oil during endodontic retreatment.

A Novel and Alternative Treatment Method for Diabetic Heel Ulceration Exposing the Calcaneus Which Is Not Suitable for Flap Surgery: Vacuum Assisted Sandwich Dermal Matrix.

BACKGROUND: Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers. METHODS: We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method. RESULTS: None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability. CONCLUSION: VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients.

Origin, Reality, and Clinical Importance of the Arcade of Struthers: An Anatomic Study.

The literature contains confusing and opposing views about the naming, prevalence, anatomic structure, and clinical significance of the arcade of Struthers. The conflicting rates of arcade (between 0% and 100%) prevalence found in the literature may be due to the varying definition of the arcade among the authors, as well as the dissection method. The present study aims to examine the structure to determine whether or not the arcade of Struthers exists through an anatomic dissection study of a fresh human cadaver and seeks to compare its findings with those in the literature. Twenty arms from fresh frozen cadavers were dissected. An arcade of Struthers was not found in any specimen. Study concluded that its existence is unproven, and the arcade of Struthers does not exist.