Influence of various application systems on the amount of extruded irrigant in simulated immature teeth with regard to gravity: An ex-vivo study.

Background: Gravity impact has been mainly evaluated in mature teeth related to debris extrusion, even though it may affect the amount of apically extruded irrigant. In the literature the influence of gravity on the amount of apically extruded irrigant in immature teeth has been studied by a 45o inclined plate to mimic the position of the maxillary teeth and 90o for the mandibular teeth. However, patients are positioned horizontally in the dental chair while treatment. There is no study in the literature testing the horizontal position to mimic the clinical settings realistically. Aim: The aim of this study was to evaluate the influence of various irrigation systems on the amount of extruded irrigant in simulated immature maxillary and mandibular teeth irrigated in vertical and horizontal positions. Materials and Methods: Twenty-five maxillary central incisors with an apical opening of 1.3 mm in diameter were included. Irrigation procedures were performed with EndoVac, closed-ended, and open-ended needles using a VATEA peristaltic pump. The amount of apically extruded irrigant was determined using a microbalance. Statistical analysis was performed using the Kruskal-Wallis test. Results: The EndoVac system caused almost no irrigant extrusion in all tested positions (P > 0.05); however, closed-ended and open-ended needles extruded more irrigant in a mandibular vertical position compared to maxillary vertical (P < 0.05) and maxillary horizontal positions (P < 0.05). Open-ended needles extruded the highest amount of irrigant. Conclusions: The EndoVac macrocannula is a more reliable and safer irrigation system as it prevents irrigant extrusion independent of the position of the tooth.

Changes in the prognostic values of modern cardiovascular biomarkers in relation to duration of diabetes mellitus.

BACKGROUND: Based on the complex pathophysiology of type 2 diabetes and atherosclerosis we hypothesized a dynamic change in prognostic value of cardiovascular biomarkers over time. METHODS: In this prospective study 746 patients with type 2 diabetes mellitus, being followed up for 60 months were analysed. The primary endpoint was defined as unplanned hospitalization for cardiovascular disease or death. Beside others, especially the prognostic performance of the biomarkers of interest (GDF-15, NT-proBNP, hs-TnT) was evaluated in relation to quartiles of diabetes duration. RESULTS: In patients having a diabetes duration below 7 years lnGDF-15 (HR 2.84; p < 0.01) and lnhs-TnT (HR 2.96; p < 0.01) were significant predictors of the primary endpoint. LnAge (HR 40.01; p < 0.01) and lnNT-proBNP (HR 1.56; p = 0.03) were significant predictors in patients with a diabetes duration between 7 and 12 years. In the third quartile (diabetes duration 12-22 years) lnurinary albumin to creatinine ratio (HR 1.25; p = 0.005) and lnNT-proBNP (HR 2.13, p < 0.001) predicted the endpoint. In patients with a diabetes duration above 22 years, lnAge (HR 75.35; p = 0.001) and lnNT-proBNP (HR 2.0; p < 0.01) were the only significant predictors of the endpoint. CONCLUSION: Prognostic power of cardiovascular biomarkers changes dynamically in relation to duration of type 2 diabetes mellitus. In patients with shorter duration of the disease markers of subclinical cardiovascular dysfunction and inflammation perform better than markers of systemic advanced organ dysfunction and cardiovascular disease.

In vitro evaluation of root canal wall cleanliness in primary molars after preparation with Self-Adjusting-File (SAF) or Mtwo NiTi-instruments and final irrigation.

AIM: In vitro evaluation of cleanliness of root canal walls of primary molars after preparation with the Self-Adjusting-File and Mtwo-instruments and final irrigation with citric acid and sodium hypochlorite. MATERIALS AND METHODS: s Study Design: In 23 matched pairs, teeth were prepared either with SAF or with Mtwo NiTi-instruments, and final irrigation was performed with 2 mL citric acid and 4 mL NaOCl. Roots were split longitudinally, SEM-images were taken, and smear layer was evaluated by two blinded observers using a four-grade score. Statistical evaluation was performed with Mann-Whitney-U-Test and Wilcoxon Signed Rank Test (P<0.05). RESULTS: No significant difference between SAF and Mtwo (P=0.9454) was observed. Overall removal of the smear layer was significantly better in the coronal part of the root canal than in the apical one (P=0.0004393). Mtwo showed no significant difference in cleanliness when comparing the coronal and apical part of the root canal (P=0.1089), whereas SAF cleaned the coronal part of the root canal significantly better than the apical part (P=0.00108). CONCLUSION: None of the two instruments was superior concerning cleanliness in root canals of primary molars. Both show good cleaning ability when using an irrigation protocol with citric acid and sodium hypochlorite.

Effects of Levosimendan on cardiac function, size and strain in heart failure patients.

Levosimendan improves cardiac function in heart failure populations; however, its exact mechanism is not well defined. We analysed the short-term impact of levosimendan in heart failure patients with ischemic and non-ischemic cardiomyopathy (CMP) using multiparametric cardiac magnetic resonance (CMR). We identified 33 patients with ischemic or non-ischemic CMP who received two consecutive CMR scans prior to and within one week after levosimendan administration. Changes in LV ejection fraction (LVEF) and LV volumes, as well as changes in strain rates, were measured prior to and within one week after levosimendan infusion. LV scarring, based on late gadolinium enhancement (LGE), was correlated to changes in LV size and strain rates. Both LV endiastolic (EDV) and endsystolic volumes (ESV) significantly decreased (EDV: p=0,001; ESV: p=0,002) after levosimendan administration, with no significant impact on LVEF (p=0.41), cardiac output (p=0.61), and strain rates. Subgroup analyses of ischemic or non-ischemic CMP showed no significant differences between the groups in terms of short-term LV reverse remodeling. The presence and extent of scarring in LGE did not correlate with changes in LV size and strain rates. CMR is able to monitor cardiac effects of levosimendan infusion. Short-term follow-up of a single levosimendan infusion using CMR shows a significant decrease in LV size, but no impact on LVEF or strain measurements. There was no difference between patients with ischemic or non-ischemic CMP. Quantification of LV scarring in CMR is not able to predict changes in LV size and strain rates in response to levosimendan.

Accessing distributions of exchange and dipolar couplings in stiff molecular rulers with Cu(II) centres.

Determining distributed exchange couplings is important for understanding the properties of synthetic magnetic molecules. Such distributions can be determined from pulsed dipolar spectroscopy (PDS) data, but this is challenging due to the similar influence of both exchange and dipolar couplings on such data. In this work we introduce two models that aim to identify these two contributions to the spin-spin couplings from frequency-domain PDS data of shape-persistent molecules having either two Cu(ii) ions, or a Cu(ii) ion and a nitroxide radical as the paramagnetic moieties. The first model assumes correlated Lorentzian or Gaussian exchange and dipole-dipole coupling distributions whose parameters are the model's unknowns. The second model relies on prior knowledge of the distance distribution and by performing Tikhonov regularization along the exchange coupling dimension yields the latter distribution model-free. Both models were able to differentiate between the absence and the presence of exchange interaction, to determine the coupling regime (ferro- or antiferromagnetic) and to estimate the distribution shape. In contrast, calculations within the exchange resilient model of the neural network analysis implemented in DeerAnalysis2018 were not able for our data to identify exchange couplings and return correct distance distributions. However, the generic model was able to identify and separate the strongly curved intermolecular background in the relaxation-induced dipolar modulation enhancement (RIDME) experiments. Our analysis revealed that in such systems exchange coupling may be present up to at least 3.3 nm in π-conjugated systems involving Cu(ii)-PyMTA, while it is negligible for distances r ≥ 4.5 nm between Cu(ii) ions and r ≥ 3.8 nm between a Cu(ii) ion and an unpaired electron of a nitroxide radical. Disruption of the π-conjugation between the ligand of the Cu(ii) complex and the nitroxide leads to negligible exchange coupling at distances r ≥ 2.6 nm in the corresponding [Cu(ii)-TAHA]-nitroxide ruler. Overall, for cases with known distance distributions, the presented analysis techniques allow to determine distributions of exchange couplings from PDS data.

A critical appraisal of studies on cyclic fatigue resistance of engine-driven endodontic instruments.

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.

Consistency of electronic measurements of endodontic working length when using multiple devices from the same manufacturer-an in vitro study.

OBJECTIVES: To assess the consistency of electronic determination of endodontic working length obtained from four identical electronic root canal length measurement devices (ERCLMD) from five different types of ERCLMD each under various in vitro conditions. MATERIALS AND METHODS: Eight extracted teeth, seven single-rooted teeth, and one molar were accessed. Root length was measured and instruments were inserted and fixed with the tip placed beyond and short of the apical constriction, in roots with an artificial perforation or an open apex. Devices tested were Root ZX (Morita, Kyoto, Japan), Dentaport ZX (Morita), Apex ID (SybronEndo, Glendora, USA), ProPex II (Dentsply Maillefer, Victoria, Australia), and Raypex 6 (VDW-Antaeos, Munich, Germany). Teeth were irrigated with different solutions (NaOCl, EDTA, CHX). ERCLMDs were connected and measurements were recorded. Consistency was classified by the scores 0-4. Comparisons were carried out using the Kruskal-Wallis test (α = 0.05). For multiple testing, the level of significance was adjusted and analysis was performed using the Mann-Whitney U test. RESULTS: Among the five types of ERCLMD, Apex ID and Raypex 6 showed the highest consistency. There was no statistically significant difference between the settings and conditions. Raypex 6 showed the highest consistency for measurements in case of a perforation. CONCLUSION: Different devices from one type of ERCLMD show a high consistency. Nevertheless, general statements on the accuracy of one type of ERCLMD taken from studies investigating only one device per type should be drawn with caution. CLINICAL RELEVANCE: The study refers to the reliability and repeatability of determination of endodontic working length by using ERCLMDs.

Effect of final irrigation procedures on fracture resistance of root filled teeth: an ex vivo study.

AIM: To evaluate the effect of chlorhexidine (CHX) on fracture resistance of roots treated with different concentrations of ethylenediaminetetraacetic acid (EDTA). METHODOLOGY: One hundred and twenty intact single-rooted premolar teeth were sectioned below the cementum-enamel junction to standardize the length of the teeth to 12 mm. The canals of one hundred specimens were instrumented with ProTaper Universal rotary instruments up to size F4 and were randomly divided into five groups (n = 20) according to the final irrigating solutions: Group 1: distilled water (DW); Group 2: 5% EDTA and 2.5% NaOCl; Group 3: 17% EDTA and 2.5% NaOCl; Group 4: 5% EDTA, 2.5% NaOCl, DW and 2% CHX; Group 5: 17% EDTA and 2.5% NaOCl, DW and 2% CHX. Root canals were filled with gutta-percha and epoxy resin-based root canal sealer using a single-cone technique. Twenty teeth served as negative controls and were not instrumented nor root filled (Group 6). All specimens were embedded in self-curing acrylic resin and loaded vertically at 0.5 mm min-1 until fracture occurred. The data were evaluated statistically using one-way anova test followed by Holm-Sidak's multiple comparison test (P < 0.05). RESULTS: Group 1 (only DW) had the lowest vertical fracture strength, followed by Group 3 (17% EDTA and 2.5% NaOCl; P < 0.05). Group 6 (negative control group) had the highest fracture resistance. Final irrigation with CHX following irrigation with 17% EDTA or 5% EDTA and 2.5% NaOCl (groups 4 and 5) significantly increased the fracture resistance of roots (P < 0.05). However, the difference between Group 4 and Group 5 was not significant (P > 0.05). CONCLUSIONS: Intracanal CHX rinse of EDTA/NaOCl-treated root dentine enhanced the fracture resistance of roots filled with AH Plus.

Efficiency and apical extrusion of debris: a comparative ex vivo study of four retreatment techniques in severely curved root canals.

AIM: To compare the amount of apically extruded debris and of remaining filling material during the removal of root canal filling material using three rotary NiTi retreatment instruments or Hedström files. METHODOLOGY: Ninety-six severely curved human molars of both jaws were selected. The root canals were prepared to size X2 (tip size 25, .06 taper) using the ProTaper Next system (Dentsply Sirona, Ballaigues, Switzerland), filled with gutta-percha and AH Plus sealer (Dentsply De Trey, Konstanz, Germany) and then randomly divided into four experimental groups (n = 24 each) with two subgroups of maxillary and mandibular teeth each. An experimental model was used as a phantom head to simulate the upper and lower jaws. The root filling materials were removed with one of the following files using a crown-down preparation technique: I. Hedström files (H-files) (VDW, Munich, Germany), II. R-Endo (Micro-Mega, Besançon, France), III. Reciproc (VDW) and IV. ProTaper Universal Retreatment system (PTU-R) (Dentsply Maillefer). Apically extruded material was collected in vials, which were weighed with a microbalance (10-5  g) before and after the retreatment. The area of residual filling material in the coronal, middle and apical root level was assessed using digital analysis. These data were analysed statistically using ANOVA and the Kruskal-Wallis test. RESULTS: Reciproc was associated with significantly less extruded debris than the H-files (P = 0.009). No significant differences were detected amongst the four retreatment techniques concerning residual filling material (P = 0.082). The amount of extruded debris and areas of remaining filling material were not correlated (P = 0.901). Location of teeth in the maxilla or mandible had no impact on the amount of extruded debris within each instrument group (P = 0.609). However, when teeth were evaluated in general irrespective of the instruments, significantly more debris was extruded in the mandibular location (P < 0.001). CONCLUSIONS: All retreatment systems were associated with apical extrusion of debris, but H-files extruded significantly more material than Reciproc. Remnants of filling material were observed in all samples with no significant differences between the four techniques.

Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes.

OBJECTIVE: We hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus. METHODS: This is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase. RESULTS: The primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p<0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p<0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p<0.01, CI 1.26 to 1.66). The number of elevated markers showed a strong complementarity to predict future long-term risk. Adding hs-TnT and GDF-15 to a zero model already including NT-proBNP led to a net reclassification improvement (NRI) of 33.6% (CI 16.0% to 50.8%, NRI for patients with event: 11.1% CI -4.7% to 26.6%, for patients without event: 22.5% CI 13.6% to 30.5%). CONCLUSIONS: GDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes.

Beneficial effects of levosimendan on survival in patients undergoing extracorporeal membrane oxygenation after cardiovascular surgery.

BACKGROUND: The impact of levosimendan treatment on clinical outcome in patients undergoing extracorporeal membrane oxygenation (ECMO) support after cardiovascular surgery is unknown. We hypothesized that the beneficial effects of levosimendan might improve survival when adequate end-organ perfusion is ensured by concomitant ECMO therapy. We therefore studied the impact of levosimendan treatment on survival and failure of ECMO weaning in patients after cardiovascular surgery. METHODS: We enrolled a total of 240 patients undergoing veno-arterial ECMO therapy after cardiovascular surgery at a university-affiliated tertiary care centre into our observational single-centre registry. RESULTS: During a median follow-up period of 37 months (interquartile range 19-67 months), 65% of patients died. Seventy-five per cent of patients received levosimendan treatment within the first 24 h after initiation of ECMO therapy. Cox regression analysis showed an association between levosimendan treatment and successful ECMO weaning [adjusted hazard ratio (HR) 0.41; 95% confience interval (CI) 0.22-0.80; P=0.008], 30 day mortality (adjusted HR 0.52; 95% CI 0.30-0.89; P=0.016), and long-term mortality (adjusted HR 0.64; 95% CI 0.42-0.98; P=0.04). CONCLUSIONS: These data suggest an association between levosimendan treatment and improved short- and long-term survival in patients undergoing ECMO support after cardiovascular surgery.

Association of nutritional risk index with metabolic biomarkers, appetite-regulatory hormones and inflammatory biomarkers and outcome in patients with chronic heart failure.

AIMS: We aimed to evaluate the association of the nutritional status by using the nutritional risk index (NRI) with metabolic and inflammatory biomarkers, and appetite-regulatory hormones in a cohort of stable patients with heart failure (HF), and to analyse its prognostic value. METHODS AND RESULTS: In this prospective observational cohort study, we included 137 stable chronic HF patients (median age, 60 years; median body mass index, 27 kg/m(2) ) with optimised medical treatment. Baseline NRI of < 113 (n = 45) was associated with a significant increase in the levels of ghrelin (p < 0.001), peptide YY (p = 0.007), pentraxin-3 (p = 0.001), tumour necrosis factor-alpha (p = 0.018), adiponectin (p < 0.0001) and the N-terminal prohormone of brain natriuretic peptide (NT-proBNP; p < 0.0001) compared with those in patients with NRI of ≥ 113. The NRI was found to be correlated with the homoeostasis model assessment of insulin resistance index (r = 0.444; p < 0.0001) and inversely correlated with the NT-proBNP level (r = -0.410; p < 0.0001). The overall mortality rate was 20%. A baseline NRI of < 113 was associated with a higher risk of all-cause mortality (log rank = 0.031). CONCLUSION: We propose that the NRI is a useful and easily applicable tool for the early identification of nutritional depletion in patients with chronic HF as it discriminates metabolic changes prior to the clinical manifestation of body wasting. Furthermore, poor nutritional status, represented as a low NRI, is associated with an increased incidence of death in such cases.

Causes and management of post-treatment apical periodontitis.

Endodontic treatment failure is usually characterised by the presence of post-treatment apical periodontitis, which may be persistent, emergent or recurrent. The major aetiology of post-treatment disease is persistent intraradicular infection, but in some cases a secondary intraradicular infection due to coronal leakage or an extraradicular infection may be the cause of failure. Understanding the causes of endodontic treatment failure is of paramount importance for the proper management of this condition. Teeth with post-treatment apical periodontitis can be managed by either nonsurgical endodontic retreatment or periradicular surgery, both of which have very high chances of restoring the health of the periradicular tissues and maintaining the tooth function in the oral cavity. This review article focuses on the aetiological factors of post-treatment apical periodontitis and discusses the indications and basics of the procedures for optimal clinical management of this condition.

Efficacy of reciprocating and rotary NiTi instruments for retreatment of curved root canals assessed by micro-CT.

AIM: To compare the efficacy of reciprocating and rotary NiTi-instruments in removing filling material from curved root canals using micro-computed tomography. METHODOLOGY: Sixty curved root canals were prepared and filled with gutta-percha and sealer. After determination of root canal curvatures and radii in two directions as well as volumes of filling material, the teeth were assigned to three comparable groups (n = 20). Retreatment was performed using Reciproc, ProTaper Universal Retreatment or Hedström files. Percentages of residual filling material and dentine removal were assessed using micro-CT imaging. Working time and procedural errors were recorded. Statistical analysis was performed by variance procedures. RESULTS: No significant differences amongst the three retreatment techniques concerning residual filling material were detected (P > 0.05). Hedström files removed significantly more dentine than ProTaper Universal Retreatment (P < 0.05), but the difference concerning dentine removal between both NiTi systems was not significant (P > 0.05). Reciproc and ProTaper Universal Retreatment were significantly faster than Hedström files (P = 0.0001). No procedural errors such as instrument fracture, blockage, ledging or perforation were detected for Hedström files. Three perforations were recorded for ProTaper Universal Retreatment, and in both NiTi groups, one instrument fracture occured. CONCLUSIONS: Remnants of filling material were observed in all samples with no significant differences between the three techniques. Hedström files removed significantly more dentine than ProTaper Universal Retreatment, but no significant differences between both NiTi systems were detected. Procedural errors were observed with ProTaper Universal Retreatment and Reciproc.

Comparison of hand and rotary instrumentation for removing gutta-percha from previously treated curved root canals: a microcomputed tomography study.

AIM: To compare the efficacy of hand and rotary nickel-titanium (NiTi) instruments in removing filling material from curved root canals of root filled teeth with unknown preparation parameters. METHODOLOGY: Ninety mandibular molars with root fillings in curved root canals and homogenous root canal filling extending to 0-2 mm short of the radiographic apex were selected. Root canal curvatures and radii were measured in two directions and microcomputed tomography (micro-CT) scans were used to determine preoperative volumes of the filling material. Subsequently, the teeth were assigned to two identical groups (n = 14). The root fillings were removed with Hedström files or FlexMaster NiTi rotary instruments. Postoperative micro-CT imaging was used to assess the percentage of residual filling material as well as the amount of dentine removal. Working time and procedural errors were recorded. Data were compared using analysis of covariance and analysis of variance procedures. RESULTS: Root canals retreated with Hedström files were associated with less remaining filling material compared with FlexMaster instruments (P < 0.05). Both retreatment techniques removed similar amounts of dentine with no significant differences (P > 0.05). FlexMaster instruments were significantly faster than Hedström files (P < 0.05). No procedural errors were detected in the Hedström group, whilst three instruments fractured in the FlexMaster group. CONCLUSIONS: Hand instrumentation resulted in significantly less residual filling material than retreatment with rotary NiTi instruments. Dentine removal was not significantly different for both techniques. FlexMaster NiTi rotary files were significantly faster than Hedström files, but were associated with a higher risk of instrument fracture.

The effect of four different irrigation systems in the removal of a root canal sealer.

OBJECTIVES: The aim of this study was to compare the efficiency of sonic, ultrasonic, and hydrodynamic devices in the removal of a root canal sealer from the surface and from simulated irregularities of root canals. MATERIALS AND METHODS: Fifty-three root canals with two standardized grooves in the apical and coronal parts of longitudinally split roots were covered with AH Plus root canal sealer. Compared were the effects of (control) syringe irrigation, (1) CanalBrush, (2) passive ultrasonic irrigation, (3) EndoActivator, and (4) RinsEndo on the removal of the sealer. The specimens were divided into four groups (N = 12) and one control group (N = 5) via randomization. The amount of remaining sealer in the root canal irregularities was evaluated under a microscope using a 4-grade scoring system, whereas the remaining sealer on the root canal surface was evaluated with a 7-grade scoring system. RESULTS: Passive ultrasonic irrigation is more effective than the other tested irrigation systems or syringe irrigation in removing sealer from root canal walls (p < 0.01). None of the techniques had a significant effect on cleaning the lateral grooves. CONCLUSIONS: Within the limitations of this study protocol ultrasonic irrigation shows a superior effect on sealer removal from the root canal surface during endodontic retreatment. Cleaning of lateral grooves seems not to be possible with one of the techniques investigated. CLINICAL RELEVANCE: Incomplete removal of root canal sealer during re-treatment may cause treatment failure. Passive Ultrasonic irrigation seems to be the most effective system to remove sealer from a root canal.

Efficacy of D-RaCe and ProTaper Universal Retreatment NiTi instruments and hand files in removing gutta-percha from curved root canals - a micro-computed tomography study.

AIM: To compare the efficacy of two rotary NiTi retreatment systems and Hedström files in removing filling material from curved root canals. METHODOLOGY: Curved root canals of 57 extracted teeth were prepared using FlexMaster instruments and filled with gutta-percha and AH Plus. After determination of root canal curvatures and radii in two directions, the teeth were assigned to three identical groups (n = 19). The root fillings were removed with D-RaCe instruments, ProTaper Universal Retreatment instruments or Hedström files. Pre- and postoperative micro-CT imaging was used to assess the percentage of residual filling material as well as the amount of dentine removal. Working time and procedural errors were recorded. Data were analysed using analysis of covariance and analysis of variance procedures. RESULTS: D-RaCe instruments were significantly more effective than ProTaper Universal Retreatment instruments and Hedström files (P < 0.05). Hedström files removed significantly less dentine than the rotary NiTi systems (P < 0.0001). D-RaCe instruments were significantly faster compared to both other groups (P < 0.05). No procedural errors such as instrument fracture, blockage, ledging or perforation were detected in the Hedström group. In the ProTaper group, four instrument fractures and one lateral perforation were observed. Five instrument fractures were recorded for D-RaCe. CONCLUSIONS: D-RaCe instruments were associated with significantly less residual filling material than ProTaper Universal Retreatment instruments and hand files. Hedström files removed significantly less dentine than both rotary NiTi systems. Retreatment with rotary NiTi systems resulted in a high incidence of procedural errors.

Serum uric acid is related to cardiovascular events and correlates with N-terminal pro-B-type natriuretic peptide and albuminuria in patients with diabetes mellitus.

BACKGROUND: Hyperuricemia is a risk factor for cardiovascular events and renal insufficiency. It correlates to intima-media thickness and microalbuminuria. In this study we evaluated uric acid as an independent marker for cardiac events in patients with diabetes. METHODS: In a prospective observational study we recruited 494 patients with diabetes. Patients were then followed for 12.8 months (mean follow-up) and hospitalizations as a result of cardiac events (ischaemic heart disease, arrhythmias, heart failure) were recorded. RESULTS: The median duration of diabetes was 11 ± 10.35 years. Patients were in the mean 60 ± 13 years old and mean HbA(1c) was 62 ± 13 mmol/mol (7.8 ± 3.3%). At baseline, mean uric acid was 321.2 ± 101.1 µmol/l (range 101.1-743.5 µmol/l), median N-terminal pro-B-type natriuretic peptide was 92 ± 412 pg/ml and median urinary albumin to creatinine ratio was 8 ± 361 mg/g; Uric acid significantly correlated to N-terminal pro-B-type natriuretic peptide (r = 0.237, P < 0.001) and urinary albumin:creatinine ratio (r = 0.198, P < 0.001). In a Cox regression model, including age, estimated glomerular filtration rate, gender, systolic blood pressure, smoking and alcohol consumption, uric acid was the best predictor of cardiac events (hazard ratio 1.331, confidence interval 1.095-1.616, P = 0.04). However, uric acid lost its prognostic value when the natural logarithm of N-terminal pro-B-type natriuretic peptide was added to the model. CONCLUSION: Serum uric acid is a predictor of cardiac events and correlates to N-terminal pro-B-type natriuretic peptide and albuminuria, underscoring the importance of uric acid as a cardiovascular risk marker in patients with diabetes.