Endodontic variables in patients with SARS-CoV-2 infection (COVID-19) in relation to the severity of the disease.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. It has been hypothesized oral health may be related to the severity and complications of COVID-19. The aim of this study was to analyze the prevalence of apical periodontitis and the frequency of root canal treatment in a sample of patients with SARS-CoV-2 infection (COVID-19), correlating them with the severity of the disease. MATERIAL AND METHODS: This retrospective study was conducted following the Strengthening Reporting Observational Studies in Epidemiology (STROBE) guidelines. The study examined 280 patients with positive real time PCR COVID-19 test whose treatment was performed in our hospital. Fifty-two patients aged 52.3 ± 17.3 years, including 30 males and 22 females, who had an orthopantomography in their clinical record, performed in the last 2 years, were included. Patients with SARS-CoV-2 infection were grouped as mild or moderate (MM) and severe or critical (SC) illness groups, according to the NIH COVID-19 Treatment Guidelines (Wu & McGoogan 2020). Radiographic records were analyzed and apical periodontitis (AP) was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, χ2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: The number of carious teeth was significantly higher in the SC group (3.4 ± 4.1), which showed more than twice as many teeth with carious lesions than the MM group (1.4 ± 1.8) (p = 0.02). Multivariate regression analysis showed association between the number of carious teeth and the severity of SARS-CoV-2 disease (OR = 1.5; 95% CI = 1.1-2.1; p = 0.017). Endodontic status (OR = 7.12; 95% CI = 1.2-40.9; p = 0.027) also correlated with the disease severity. CONCLUSIONS: The results suggest that the oral health status of COVID-19 patients correlated with the severity of the SARS-CoV-2 virus infection. Significant association has been found between the severity of COVID-19 disease and the presence of a greater number of teeth with caries lesions, as well as with endodontic status.

[Muscular control of scapholunate instability. An experimental study]. / Control muscular de la inestabilidad escafolunar. Estudio experimental.

PURPOSE: As long as the neuromuscular stabilizers are intact, a lesion of the scapholunate ligament may or may not progress to a carpal instability. The mechanisms by which the muscles compensate this defect are not very well known. We designed an experimental study with the aim of clarifying these mechanisms. MATERIAL AND METHOD: Using 10 fresh wrists, with no pre-existing lesions, we studied the movements of the scaphoid, triquetrum and capitate produced by the isometrical loading of the muscles which move the wrist, each of them isolated or combined, before and after cutting off the scapholunate ligaments. To do this, we placed sensors in each of these bones and used the Fastrack system to record these movements. RESULTS: The simultaneous loading of the muscles of the wrist produce rotational movements in flexion and supination of the proximal carpal row. After cutting off the scapholunate ligaments, the scaphoid rotates in pronation and flexion, while the triquetrum rotates in pronation and extension. In this situation of a scapholunate lesion, the muscles that worsen the carpal dexasation are the extensor carpi ulnaris and flexor carpi ulnaris. On the other hand, the isolated loading of the radial muscles reduce the scapholunate diastasis, thus improving the carpal alignment. CONCLUSION: In dynamic scapholunate instabilities, isometric contraction of the ulnar carpal muscles must be avoided, as it promotes the scapholunate diastasis. The rest of the muscles have the opposite effect, stabilizing the carpus when primary stabilizers have failed.

[Carpal dynamic stability mechanisms. Experimental study]. / Mecanismos de estabilización dinámica del carpo. Estudio experimental.

OBJECTIVE: To evaluate, experimentally in cadavers, the effect of the motor muscles in the wrist in the kinetic behaviour of the carpal, under axial load, and the wrist in a neutral position. MATERIAL AND METHOD: The changes in the spatial orientation of the carpal bones were recorded with a movement trajectory gauge that functions with electromagnetic fields. A total of 30 fresh cadaver wrists were used, in which the principal motor tendons were isolated and subjected to loads proportional to the area of the physiological section of each muscle. The experiment was performed under isometric load conditions of all the tendons, and separately from each tendon. RESULTS: The simultaneous load of all the tendons studied caused a three-dimensional change of the carpal bones. The flexor carpi radialis led to supination of the scaphoids and pronation of the pyramidal. Conversely, the isolated load of the flexor carpi ulnaris, abductor pollicis longus and the extensor carpi radialis longus, caused a supination movement of the 2 carpal rows. Only the extensor carpi ulnaris led to a marked pronation of the carpal. COMMENTS AND CONCLUSIONS: The forearm muscles, as well as the movements of the wrist, cause pronation/supination/supination, flexion/extension and radial/cubital inclination movements. It is proposed that the most important movements in the dynamic stabilisation of the carpal are the intercarpal pronation and supination movements provoked by these muscles. Depending on the carpal injury mechanism or instability, the stimulating of one muscle group or the other may be beneficial.

Role of the extensor carpi ulnaris and its sheath on dynamic carpal stability.

Ten cadaveric forearms were tested using a wrist testing apparatus specifically designed to investigate the mechanisms of muscle stabilization of the wrist. The specimens were set in a jig allowing the distal row to migrate proximally and rotate around the axis of pronosupination. The extensor carpi ulnaris (ECU) was loaded with specific weights. Reactive rotations of the scaphoid, triquetrum, and capitate were measured by an electromagnetic motion tracking device. Loading the ECU caused pronation of both proximal and distal rows. After sectioning its sheath, the overall direction of the movement remained unchanged, but there was a 40% and 50% decrease of the pronation power over the distal and proximal carpal row, respectively. In addition to stabilizing the distal radiolunar joint, the ECU is an important structure that contributes to the dynamic stability of the wrist. Furthermore, its sheath plays a crucial role in maintaining the effect of the ECU muscle on the carpus.

Effects of forearm muscles on carpal stability.

Thirty cadaveric forearms were tested using a wrist testing apparatus specifically designed to investigate the mechanisms of muscle stabilization of the wrist. The specimens were set in a jig allowing the distal row to migrate proximally and to rotate around the pronosupination forearm axis. Five wrist motor tendons (FCR, FCU, ECU, ECRL and APL) were loaded with specific weights. Reactive rotations of the scaphoid, triquetrum and capitate were measured by an electromagnetic motion tracking device. When all five tendons were loaded simultaneously, the capitate supinated and the proximal row predominantly supinated and flexed. By contrast, when the ECU was loaded in isolation, it caused pronation to both proximal and distal rows. The FCR exhibited a mixed effect pronating the capitate and triquetrum, whilst supinating the scaphoid. Based on this, a hypothesis is proposed linking wrist stability to the balance of wrist pronators (ECU and FCR) and supinators (FCU, ECRL and APL).