Irrigation protocols effects on radicular dentin: Cleaning, disinfection and remaining ultrastructure / Efecto del protocolo de irrigación en la dentina radicular: limpieza, desinfección y ultraestructura remanente

A successful endodontic treatment requires a combination of satisfactory mechanical instrumentation, adequate irrigation protocols, and three-dimensional obturation of the canal system. Irrigation is considered the most critical procedure to ensure cleaning and disinfection. To date, a large variety of irrigants has been proposed. However, sodium hypochlorite (NaOCl) remains the gold standard. In order to achieve complete cleaning and disinfection, final irrigation with EDTA and ultrasonic devices has been used as an ideal protocol. Most endodontic research focuses on the cleaning and antibacterial properties of the irrigant solutions. Recent evidence demonstrated that the irrigation protocols cause erosion, affecting the radicular dentin ultrastructure. This article aims to describe the clinical features of the present knowledge concerning the effect of irrigation protocols on radicular dentin.

Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.

Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions: A Preclinical Assessment of Safety and Durability.

BACKGROUND: A novel ablation and mapping system can toggle between delivering biphasic pulsed field (PF) and radiofrequency energy from a 9-mm lattice-tip catheter. We assessed the preclinical feasibility and safety of (1) focal PF-based thoracic vein isolation and linear ablation, (2) combined PF and radiofrequency focal ablation, and (3) PF delivered directly atop the esophagus. METHODS: Two cohorts of 6 swine were treated with pulsed fields at low dose (PFLD) and high dose (PFHD) and followed for 4 and 2 weeks, respectively, to isolate 25 thoracic veins and create 5 right atrial (PFLD), 6 mitral (PFHD), and 6 roof lines (radiofrequency+PFHD). Baseline and follow-up voltage mapping, venous potentials, ostial diameters, and phrenic nerve viability were assessed. PFHD and radiofrequency lesions were delivered in 4 and 1 swine from the inferior vena cava onto a forcefully deviated esophagus. All tissues were submitted for histopathology. RESULTS: Hundred percent of thoracic veins (25 of 25) were successfully isolated with 12.4±3.6 applications/vein with mean PF times of <90 seconds/vein. Durable isolation improved from 61.5% PFLD to 100% with PFHD (P=0.04), and all linear lesions were successfully completed without incurring venous stenoses or phrenic injury. PFHD sections had higher transmurality rates than PFLD (98.3% versus 88.1%; P=0.03) despite greater mean thickness (2.5 versus 1.3 mm; P<0.001). PF lesions demonstrated homogenous fibrosis without epicardial fat, nerve, or vessel involvement. In comparison, radiofrequency+PFHD sections revealed similar transmurality but expectedly more necrosis, inflammation, and epicardial fat, nerve, and vessel involvement. Significant ablation-related esophageal necrosis, inflammation, and fibrosis were seen in all radiofrequency sections, as compared with no PF sections. CONCLUSIONS: The lattice-tip catheter can deliver focal PF to durably isolate veins and create linear lesions with excellent transmurality and without complications. The PF lesions did not damage the phrenic nerve, vessels, and the esophagus.

Lattice-Tip Focal Ablation Catheter That Toggles Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation: A First-in-Human Trial.

BACKGROUND: The tissue selectivity of pulsed field ablation (PFA) provides safety advantages over radiofrequency ablation in treating atrial fibrillation. One-shot PFA catheters have been shown capable of performing pulmonary vein isolation, but not flexible lesion sets such as linear lesions. A novel lattice-tip ablation catheter with a compressible 9-mm nitinol tip is able to deliver either focal radiofrequency ablation or PFA lesions, each in 2 to 5 s. METHODS: In a 3-center, single-arm, first-in-human trial, the 7.5F lattice catheter was used with a custom mapping system to treat paroxysmal or persistent atrial fibrillation. Toggling between energy sources, point-by-point pulmonary vein encirclement was performed using biphasic PFA posteriorly and either temperature-controlled irrigated radiofrequency ablation or PFA anteriorly (RF/PF or PF/PF, respectively). Linear lesions were created using either PFA or radiofrequency ablation. RESULTS: The 76-patient cohort included 55 paroxysmal and 21 persistent atrial fibrillation patients undergoing either RF/PF (40 patients) or PF/PF (36 patients) ablation. The pulmonary vein isolation therapy duration time (transpiring from first to last lesion) was 22.6±8.3 min/patient, with a mean of 50.1 RF/PF lesions/patient. Linear lesions included 14 mitral (4 RF/2 RF+PF/8 PF), 34 left atrium roof (12 RF/22 PF), and 44 cavotricuspid isthmus (36 RF/8 PF) lines, with therapy duration times of 5.1±3.5, 1.8±2.3, and 2.4±2.1 min/patient, respectively. All lesion sets were acutely successful, using 4.7±3.5 minutes of fluoroscopy. There were no device-related complications, including no strokes. Postprocedure esophagogastroduodenoscopy revealed minor mucosal thermal injury in 2 of 36 RF/PF and 0 of 24 PF/PF patients. Postprocedure brain magnetic resonance imaging revealed diffusion-weighted imaging+/fluid-attenuated inversion recovery- and diffusion-weighted imaging+/fluid-attenuated inversion recovery+ asymptomatic lesions in 5 and 3 of 51 patients, respectively. CONCLUSIONS: A novel lattice-tip catheter could safely and rapidly ablate atrial fibrillation using either a combined RF/PF approach (capitalizing on the safety of PFA and the years of experience with radiofrequency energy) or an entirely PF approach. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT04141007 and NCT04194307.

Selective debridement of burn wounds using hydrosurgery system.

In recent years, hydrosurgery is a technology that has been applied more and more in debridement procedures. However, the selectivity of hydrosurgery to cutaneous necrotic tissues has not been proved. This study was designed to investigate the possible tissue selectivity of hydrosurgery in the debridement in burn wounds. Deep partial-thickness burns were produced on the back of porcine, and 48 hours later, both burn wounds and normal skin were debrided using the hydrosurgery system. Then tissue samples were taken, and histological staining was performed and observed under microscope. Burn wound resection rates and the normal skin damaged rates were measured. Our result indicated that the burn wounds were significantly more sensitive than the normal skin when the water pressure produced by the hydrosurgery system was set between 3000 and 5000 psi (pounds per square inch), that is, the necrotic tissue portions were debrided more easily than the normal skin tissue. Based on these data, we suggest that 3000 to 5000 psi of water pressure in the hydrosurgery system has a skin tissue selectivity in burn wounds.

Larger and deeper ventricular lesions using a novel expandable spherical monopolar irrigated radiofrequency ablation catheter.

BACKGROUND: Radiofrequency (RF) ablation is an established treatment for ventricular tachycardia (VT). However, the inability of current RF catheters to address deep or large substrate may explain most of the clinical failures. OBJECTIVES: The aim of this study is to assess the efficacy and safety of ablation in the left ventricle (LV) in sheep using a novel 8-Fr deflectable ablation catheter (Sphere-9; Affera, Inc) with a 9-mm expandable spherical monopolar irrigated RF tip vs a standard RF irrigated catheter (Biosense Webster, Diamond Bar, CA). The impact on tissue was assessed on local bipolar electrograms (from nine uniformly distributed mini surface electrodes and an internal central reference electrode), as well as on direct lesion measurement post mortem. METHODS AND RESULTS: Eleven sheep underwent LV endocardial ablation in healthy tissue using the Sphere-9 catheter (n = 6), or a conventional irrigated RF catheter (n = 5). Twenty lesions were created with the Sphere-9 (current limit: 2.7 A; temp. limit: 60°C; irrigation: 30 mL/min; and duration: 60-120 seconds). Local bipolar electrograms at the surface of the catheter disappeared during RF delivery in 17 of 20 (85%) lesions. The mean lesion volume was 1707 ± 771 mm 3 (length: 15.8 ± 3.3 mm; width: 11.6 ± 4.2 mm; and depth: 10.3 ± 2.9 mm). Twenty-five lesions were created with a standard RF irrigated catheter (power control 35 W; irrigation: 30 mL/min; duration: 60 seconds; volume 537 ± 398 mm 3 ; length: 8.2 ± 2.3 mm; width: 5.2 ± 1.8 mm; and depth: 5.5 ± 2.4 mm). The novel spherical RF catheter created significantly larger lesions ( P < .001 for measurements in all dimensions). There were no steam pops with the novel ablation catheter vs one with the conventional catheter. CONCLUSIONS: This novel spherical monopolar irrigated RF catheter creates lesions that are twice as large and deep as a standard irrigated RF catheter.

In Vitro Effect of Er:YAG Laser on Different Single and Mixed Microorganisms Being Associated with Endodontic Infections.

Objective: The purpose of this in vitro study was to evaluate the antimicrobial effect of activated irrigation with different modes of erbium-doped yttrium aluminum garnet (Er:YAG) laser application on microorganisms related to secondary endodontic infection. Background: Er:YAG laser has been recommended as an adjuvant tool for root canal disinfection during endodontic treatment. Materials and methods: Laser-activated irrigation (LAI) with 300 or 600 µm tips were tested with or without intermittent irrigation with 0.9% sodium chloride (NaCl) solution against different microorganisms (five single strains and dual species (Streptococcus gordonii combined with Actinomyces oris or Fusobacterium nucleatum) in root canals after 3 days of incubation. In a 21-day infection model, LAI was used together with intermittent rinsing with sodium hypochlorite (NaOCl) against the dual-species mixtures; here the incidence of microbial regrowth after up to 7 days was monitored. Results: In the 3-day root infection model, LAI protocols did not show any significant reduction of the microbial load when compared with manual irrigation with saline solution. In the 21-day infection, S. gordonii combined with A. oris were not detectable anymore after applying the LAI protocol with a 600 µm tip (30 mJ/10 pps) up to 7 days after treatment. Conclusions: Application of LAI with a 600 µm tip by using an Er:YAG laser might be advantageous in treatment of endodontic infections.

Cisternal lavage via third ventriculostomy through the fenestrated lamina terminalis after aneurysm clipping: Technical note.

Delayed cerebral infarction (DCI) contributes to the burden of morbidity and mortality acquired by patients with aneurysmal subarachnoid hemorrhage (SAH). Cisternal lavage may prevent DCI. Delivery of lavage therapy to the basal cisterns, however, is challenging. Here, we report a novel method for the delivery of cisternal lavage using a cisterno-ventricular catheter (CVC) inserted via the fenestrated lamina terminalis during aneurysm clipping. In two high-risk aSAH patients a CVC was inserted into the third ventricle through the fenestrated lamina terminalis during aneurysm clipping. Post-operatively, continuous cisternal lavage using Urokinase or Nimodipine was applied using an external ventricular drain (EVD) as inflow tract and the CVC as outflow tract. Neurological outcome at 6 months was assessed by modified Rankin scale. Catheter placement into the third ventricle through the fenestrated lamina terminalis was performed without complications. Application of a free-running electrolyte solution containing Urokinase or Nimodipine via the EVD and drainage via the CVC was feasible. Cisternal Nimodipine application normalized sonographic vasospasm in both cases. DCI did not occur. CVC placement for ventriculo-cisternal lavage may represent a useful method for DCI prevention. It can be considered in aSAH patients at risk for DCI if the chiasmatic region is accessed during aneurysm clipping.

Long-term results using a transanal irrigation system (Peristeen®) for treatment of stool incontinence in children with myelomeningocele.

INTRODUCTION: Faecal incontinence due to constipation associated with myelomeningocele (MMC) is a frustrating problem. It could have a bad impact on patients and their families' quality of life. Conservative measures could be a starting point. In case of failure, Malone antegrade continence enema (MACE) is commonly considered. However, it is associated with higher complications. Peristeen transanal irrigation (TAI) depends on the injection of water into the colon through a rectal catheter with an inflatable balloon to promote a controlled evacuation of large quantities of faecal contents. Transanal irrigation could be an alternative in these patients to avoid surgery. OBJECTIVE: The objective of this study was to evaluate the long-term effectiveness and satisfaction of TAI management (Peristeen®, Coloplast, Denmark) in children with MMC who failed to respond to conservative measures for stool incontinence. STUDY DESIGN: All patients with MMC who did not respond to conservative measures for stool incontinence and were using TAI with the last follow-up 6 months before the end date were included. Data were collected retrospectively from January 2008 till January 2016. The data collected included the age of starting Peristeen, duration of using the Peristeen, acceptance and compliance of the patient's family with the TAI. Success was defined as stool continence. RESULTS: A total of 109 patients (55 males and 54 females) diagnosed as having MMC were started on TAI Peristeen. With a mean follow-up of 48 months (24-108), 101 patients (90.4%) achieved complete stool continence and 8 patients were considered failures. DISCUSSION: The study results are comparable with those of previously reported publications. The main limitation of Peristeen TAI is that it cannot be performed by the patient himself/herself. This may present a problem with later independence. CONCLUSION: Transanal irrigation with Peristeen® system is a safe and good alternative option for stool incontinence when other conservative measures fail.

Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update.

Saline nasal irrigations (SNIs) are often recommended as an additional non-pharmacological treatment for adults with chronic rhinosinusitis (CRS), for which it could even be considered a first-line treatment. However, there is a wide range of different SNI protocols. The aim of this article is to review the published literature regarding all of the potential therapeutic effects of SNIs in adult CRS patients who had not undergone sinus surgery and clarify the role of the various saline nasal solutions and protocols (particularly the volume, frequency and duration of treatment), and describe the nasal devices used. A search was made of the PubMed, Google Scholar and Ovid databases using the key words 'saline nasal irrigation' and 'chronic rhinosinusitis', or medical subject headings. The search identified 11 studies involving 663 patients. There was no consensus about but substantial agreement concerning the frequency and duration of treatment, the type of device, and the amount of solution to be used when managing CRS. A hypertonic solution with the addition of the natural minerals and oligo-elements found in seawater and some thermal waters may be associated with greater clinical benefit in terms of endoscopic scores and mucociliary clearance than isotonic solutions. Further studies are required to compare the different forms of SNI and define SNI protocols and nasal devices, while considering patient compliance.

The efficacy of supplementary sonic irrigation using the EndoActivator® system determined by removal of a collagen film from an ex vivo model.

AIM: To evaluate the efficacy of sonic irrigation (EndoActivator® ) using various polymer tips and power settings in a stained collagen ex vivo model. METHODOLOGY: The root canals of fifty human, straight single-rooted extracted teeth were prepared to size 40, .08 taper. The roots were split longitudinally; stained collagen applied to the canal surfaces, photographed and re-assembled. The canals were subjected to syringe without supplementary (group 1, n = 10) or with supplementary sonic (groups 2-5, n = 10) irrigation. EndoActivator® tip sizes (size 15, .02 taper for groups 2 and 3; size 35, .04 taper for groups 4 and 5) and power settings (low for groups 2 and 4; high for groups 3 and 5) were tested. After irrigation, the canals were re-photographed and the area of residual stained collagen was quantified using the UTHSCA Image Tool program (Version 3.0). The data were analysed using Wilcoxon signed rank test and general linear mixed models. RESULTS: Supplementary sonic irrigation using EndoActivator® resulted in significantly (P < 0.0001) less residual collagen compared with syringe irrigation only. Agitation of irrigant using the large EndoActivator® tip with high power resulted in significantly less (22.4% - 29.5%) residual collagen compared to other combinations (large tip/low power P = 0.001; small tip/low power P = 0.01; small tip/high power P = 0.04). There was no significant difference amongst the latter three groups (P > 0.5). CONCLUSIONS: Supplementary sonic irrigation using the EndoActivator® system was significantly more effective in removing stained collagen from the canal surface than syringe irrigation alone. EndoActivator® used with large tip (size 35, .04 taper) and high power setting in size 40, .08 taper canals was more effective than other combinations.

A novel automatic regulatory device for continuous bladder irrigation based on wireless sensor in patients after transurethral resection of the prostate: A prospective investigation.

BACKGROUND: Benign prostatic hyperplasia is a common progressive disease in aging men, which leads to a significant impact on daily lives of patients. Continuous bladder irrigation (CBI) is a supplementary option for preventing the adverse events following transurethral resection of the prostate (TURP). Regulation of the flow rate based on the color of drainage bag is significant to prevent the clot formation and retention, which is controlled manually at present. To achieve a better control of flow rate and reduce inappropriate flow rate-related adverse effects, we designed an automatic flow rate controller for CBI applied with wireless sensor and evaluated its clinical efficacy. METHODS: The therapeutic efficacy was evaluated in patients receiving the novel automatic bladder irrigation post-TURP in the experimental group compared with controls receiving traditional bladder irrigation in the control group. RESULTS: A total of 146 patients were randomly divided into 2 groups-the experimental group (n = 76) and the control group (n = 70). The mean irrigation volume of the experimental group (24.2 ±â€Š3.8 L) was significantly lower than that of the controls (54.6 ±â€Š5.4 L) (P < 0.05). Patients treated with automatic irrigation device had significantly decreased incidence of clot retention (8/76) and cystospasm (12/76) compared to controls (21/70; 39/70, P < 0.05). There was no significant difference between the 2 groups with regard to irrigation time (28.6 ±â€Š2.7 vs 29.5 ±â€Š3.4 hours, P = 0.077). CONCLUSION: The study suggests that the automatic regulating device applied with wireless sensor for CBI is safe and effective for patients after TURP. However, studies with a large population of patients and a long-term follow-up should be conducted to validate our findings.

Evaluation of Apically Extruded Debris using Two Niti Systems Associated with Two Irrigation Techniques in Primary Teeth.

PURPOSE: The aim of this study was to compare the effects of 2 NiTi file systems [Twisted File Adaptive (TFA) and Reciproc (RP)] and 2 irrigation techniques [Conventional needle irrigation (CNI) and Laser activated irrigation (LAI)] on the amount of apically extruded debris in primary maxillary molars. STUDY DESIGN: Sixty extracted primary maxillary molars were randomly divided into 4 groups. The mesio-buccal roots of teeth in 4 groups were instrumented using TFA with LAI, RP with LAI, TFA with CNI and RP with CNI respectively. Debris extruded during instrumentation was collected into Eppendorf tubes and amounts were determined. The data were analyzed using two-way ANOVA test at 0.05 level of significance. RESULTS: The results indicated all instrumentation and irrigation systems caused a measurable apical extrusion of debris. However, no statistically significant difference in debris extrusion was observed between irrigation techniques or instrumentation systems (P > 0.05). The total amount of debris extruded apically by LAI was greater than that by CNI. CONCLUSIONS: All instrumentation and irrigation techniques caused debris extrusion. However, the optimal laser activation time and power settings should be investigated to ensure minimal extrusion of debris and irrigant due to cavitation and pressure during LAI in root canal treatment.

Evaluation of Root Canal Dentin Erosion after Different Irrigation Methods Using Energy-dispersive X-ray Spectroscopy.

INTRODUCTION: The purpose of this study was to examine the level of erosion in root dentin caused by different irrigation methods and protocols. METHODS: Thirty-five extracted upper molar teeth were instrumented and divided into 7 groups to undergo treatment by different methods: negative control, GentleWave System (Sonendo Inc, Laguna Hills, CA), and syringe needle irrigation following different protocols. The teeth were instrumented to size #25/.08 or #30/.09 for needle irrigation groups and to ProTaper size S1 for the GentleWave group under 5% sodium hypochlorite (NaOCl). The needle irrigation groups were subjected to final rinses of 2 minutes of 3% NaOCl + 2 minutes of 8% EDTA (3% N2 + 8% E2), 2 minutes of 3% NaOCl + 2 minutes of 8% EDTA + 1 minute of 3% NaOCl (3% N2 + 8% E2 + 3% N1), 2 minutes of 5% NaOCl + 2 minutes of 17% EDTA (5% N2 + 17% E2), 2 minutes of 5% NaOCl + 2 minutes of 17% EDTA + 1 minute of 5% NaOCl (5% N2 + 17% E2 + 5% N1), and 5 minutes of 5% NaOCl + 5 minutes of 17% EDTA + 5 minutes of 5% NaOCl (5% N5 + 17% E5 + 5% N5), respectively. The root canal surface was observed by scanning electron microscopy, and the dentin composition was analyzed by continuous line scanning for 300 µm into dentin using energy-dispersive X-ray spectroscopy. RESULTS: A slight but statistically significant decrease of calcium and an increase of carbon was measured in the 5% N2 + 17% E2 group in comparison with the control; no significant difference was found among GentleWave, 3% N2 + 8% E2, and 5% N2 + 17% E2 (P > .05). A final 1-minute rinse with 3% or 5% NaOCl reduced calcium and phosphorus to a significantly lower level than in groups without a 1-minute final rinse (P < .05). Final irrigation with 5% NaOCl for 5 minutes removed almost all calcium and phosphorus. Scanning electron microscopy showed canal wall erosion when an additional final irrigation with NaOCl was done. CONCLUSIONS: NaOCl followed by final EDTA irrigation performed either by syringe needle or the GentleWave System caused minimal dentin erosion. Erosion was measured as increased loss of calcium and phosphorus in samples in which additional final irrigation was performed using NaOCl after EDTA.

"Cardio-Neuromodulation" With a Multielectrode Irrigated Catheter: A Potential New Approach for Patients With Cardio-Inhibitory Syncope.

Syncope is frequently neurally mediated and can seriously affect quality of life. Different ablation strategies have been successfully performed. These approaches have not gained wide acceptance and are quite extensive and complex, exposing patients to significant risks. This article reports the case of a 16-year-old girl who was severely affected by frequent and prolonged episodes of syncope and was treated by tailored ablation of the anterior right ganglionated plexus with a multielectrode irrigated catheter. She had fainted >30 times in the 5 years preceding treatment, experiencing approximately 10 severe episodes of syncope in the previous 12 months. After 3 minutes of ablation, the P-P interval was reduced by >400 milliseconds. Syncope disappeared and the patient has remained completely asymptomatic over a follow-up of 22 months. The "reset" basal P-P interval has remained unchanged (follow-up electrocardiogram at 16 months). At 6 months, there was no residual heart rate activity <50 bpm. On 24-hour rhythm registration, P-P intervals ≥1,000 milliseconds (corresponding to a heart rate of ≤60 bpm) were reduced by >16,000 beats. We believe that this case report is original for several reasons: the unusual clinical presentation; the unique structure targeted; the very limited ablation, implying much lower risks for the patient; the anatomical approach; and the different endpoint. This new "cardio-neuromodulation" approach could be useful for the treatment of patients with neurally mediated syncope.

Efficacy of Laser-Activated Irrigants in Calcium Hydroxide Removal from the Artificial Grooves in Root Canals: An Ex Vivo Study.

OBJECTIVE: The aim of this study was to investigate the efficacy of an erbium chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser with different irrigation solutions [sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), QMix 2in1, and peracetic acid] in removing calcium hydroxide (CH) from artificial grooves created in root canals. BACKGROUND DATA: CH has to be removed totally before the root canal filling. Any CH residue on the dentin walls may affect the dentinal bond strength and the penetration of sealers into the dentin tubules, and may increase apical leakage. In addition, such a remnant could react chemically with sealers and, possibly, influence physical properties. Therefore, complete removal of CH placed inside the root canals is recommended, using various products and techniques. METHODS: The root canals of 160 extracted single-rooted mandibular premolars were prepared with ProTaper Universal rotary instruments up to size F4. The roots were split longitudinally along the length of the instrumented canals, and a standardized groove was prepared in the apical part of one segment. CH powder mixed with distilled water was placed into the grooves, and the root halves were then reassembled. The roots were randomly divided into two main groups according to the selected irrigation techniques (needle and laser activation) and then each main group was divided into four subgroups according to the final irrigation (NaOCl, EDTA, QMix 2in1, and peracetic acid) protocols used. After irrigation, the roots were disassembled and digital images were taken using a stereomicroscope. Measurements of residual CH were performed as percentages of the overall groove surface area with image analysis software. The data obtained were analyzed using one way analysis of variance and Tukey's honest significant difference tests. Statistical significance was set at p < 0.05. RESULTS: Significantly less residual CH was obtained in the laser-activated groups than in the needle-irrigated groups (p < 0.05). According to both main groups' data, NaOCl left significantly more CH than the other groups (p < 0.05). However, there was no significant difference among the EDTA, QMix 2in1, and peracetic acid groups. CONCLUSIONS: None of the techniques removed the CH dressing completely. Laser-activated irrigation was significantly more effective than needle irrigation.

Evaluation of bacterial transmission to the paranasal sinuses through sinus irrigation.

BACKGROUND: Saline nasal irrigation is effective in the treatment of sinonasal disorders, including chronic rhinosinusitis (CRS). Despite bacterial contamination in rinse bottles and reports of infections from contaminated irrigation water, tap water is still used by ∼50% of irrigation users, raising a potential public health concern. This study aimed to determine whether bacteria from the water supply used in sinus irrigations colonizes the paranasal sinuses. METHODS: Samples were taken from the: (1) water used for irrigation, (2) faucet or container the water originated from, (3) rinse bottle, and (4) postoperative ethmoid cavity from 13 subjects with CRS. Microbiota were characterized using quantitative polymerase chain reaction (qPCR) and 16S ribosomal RNA (rRNA) gene sequencing. The Morisita-Horn beta-diversity index (M-H) was used to assess similarity in microbiota between samples, and genomic analysis was performed to assess clonality of cultured bacteria. RESULTS: Of 13 subjects, 6 used distilled water, 6 used tap water, and 1 used well water in this institutional review board (IRB)-approved observational study. Well-water had markedly more bacteria than tap or distilled water. There was a trend toward tap having more bacteria than distilled water. The sinus samples were notably dissimilar to the bottle, faucet, and irrigant (M-H 0.15, 0.09, and 0.18, respectively). There was no difference in postoperative microbiotas between distilled and tap water users. CONCLUSION: The current study suggests that irrigation plays little role in establishing the sinus microbiome. Although rinsing with tap water may never be formally recommended, these data are useful to counsel patients who prefer to do so in non-endemic areas if the municipal water supply is appropriately treated.

Efficacy of ultrasonic activation of NaOCl and orange oil in removing filling material from mesial canals of mandibular molars with and without isthmus

Objectives The aim of this study was to evaluate the volume of remaining filling material after passive ultrasonic irrigation (PUI) of sodium hypochlorite (NaOCl) and orange oil in mesial canals of mandibular molars, with and without isthmus. Material and Methods Thirty mesial roots of mandibular molars were divided according to the presence or absence of isthmus. Canals were prepared and filled (Micro-CT #1). Filling was removed using rotary instruments, and specimens were sub-divided into three groups according to the irrigation procedures: Conventional – conventional irrigation with NaOCl, PUI/NaOCl – PUI of NaOCl (three activations, 20 seconds each), and PUI/orange oil – PUI of orange oil (Micro-CT#2). Specimens were enlarged using the X2 and X3 ProTaper Next instruments and submitted to the same irrigation protocols (Micro-CT #3). Results No differences were found between the experimental groups in each stage of assessment (P>0.05). The volume of residual filling material was similar to that in Micro-CT #2 and Micro-CT #3, but lower than that observed in Micro-CT #1 (P<0.05). When groups were pooled according to the presence or absence of an isthmus, volume of residual filling material was higher in specimens presenting isthmus (P<0.05). Conclusions PUI of NaOCl or orange oil did not improve filling removal. Isthmus consists in an anatomical obstacle that impairs the removal of filling material.

Peristeen(®) transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study.

AIM: In paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colon has gained popularity due to the introduction of a specifically designed device. The aim of this pilot study was to present the results of TAI using the Peristeen(®) TAI system in a group of paediatric patients with anorectal malformation (ARM) and congenital or acquired spinal cord lesions (SCLs). METHOD: Eight Italian paediatric surgery and spina bifida centres participated in the study. The inclusion criteria were age between 6 and 17 years, weight above 20 kg and unsatisfactory bowel management. Patients with chronic inflammatory bowel disease, mental disability and surgery within the previous 3 months were excluded. At the beginning of treatment (T0) and after 3 months (T1) the Bristol scale, a questionnaire assessing bowel function, and two questionnaires on quality of life (QoL) for patients aged 6-11 years (CHQ-pf50) and 12-17 years (SF36) were administered. RESULTS: Eighty-three patients were enrolled, and seventy-eight completed the study (41 ARMs, 37 SCLs). At T1, constipation was reduced in ARMs from 69% to 25.6% and in SCLs from 92.7% to 41.5%, faecal incontinence in ARMs from 50% to 18.6% and in SCLs from 39% to 9.8% and flatus incontinence in ARMs from 20.9% to 9.8% and in SCLs from 31.7% to 10%. At T0, the Bristol Stool Scale types were 1-2 in 45% of ARMs and 77.5% of SCL patients, whereas at T1 types 1-2 were recorded in only 2.5% of SCL patients. QoL improved in both groups. In the younger group, a significant improvement in QoL was recorded in ARM patients for eight of nine variables and in SCL patients for seven of nine variables. CONCLUSION: This study showed that Peristeen TAI resulted in a significant time reduction in colonic cleansing, increased independence from the carer and improved QoL in paediatric patients with ARMs and SCLs.