Effectiveness of guided endodontics in locating calcified root canals: a systematic review.

OBJECTIVES: The aim of this study is to answer the question: "Is guided endodontics an effective technique for locating calcified canals?". METHODS: A systematic search was carried out by two independent authors in PubMed, Web of Science, Scopus, and Scielo databases. According to the PIOS criteria, observational studies, ex vivo studies, clinical case reports, and case series were included. The quality of evidence of observational studies, case reports, and case series were assessed using the respective Joanna Briggs Institute critical appraisal tool, and a previous personalized tool was used to assess the quality of the ex vivo studies. RESULTS: Forty-five studies were included. Of them, 21 were clinical case reports, 11 case series, 12 ex vivo studies, and 1 cohort study. Of the 45 studies analyzed, 43 reported that guided endodontics is an effective and precise technique to access the permeable portion of calcified canals. Only 2 studies report accidents or failures related to the use of endodontic guides. CONCLUSIONS: Guided endodontics allows conservative access, minimizes accidents, and is effective in locating calcified canals; however, it is a technique that still presents limitations. CLINICAL RELEVANCE: Guided endodontics has been proposed as a simple and effective technique for the treatment of calcified canals. The expansion of this technique requires knowing its benefits and limitations to ensure success and avoid accidents.

Efficacy of MR angiography in the detection and characterization of occlusive disease in the vertebrobasilar system.

PURPOSE: The purpose of this work was to determine the efficacy of MR angiography (MRA) in the detection and characterization of occlusive disease in the vertebrobasilar system. METHOD: We retrospectively reviewed the posterior circulation registry of our institution to select 42 consecutive patients with posterior circulation ischemic symptoms who underwent both MRA and angiography. The extracranial vertebral arteries (ECVAs) were examined by two-dimensional time-of-flight MRA above the C6 level, and the intracranial vertebral arteries (ICVAs) and basilar arteries (BAs) were examined by three-dimensional time-of-flight MRA. Sixty-two ECVAs, 63 ICVAs, and 39 BAs were examined by the readers. RESULTS: Occlusive disease was seen on angiography in 22 of the 42 patients. The sensitivity and specificity values for detection of lesions in 12 ECVA, 19 ICVA, and 12 BA abnormalities were as follows: ECVA, 92 and 96% for Reader A and 100 and 90% for Reader B; ICVA, 84 and 93% for Reader A and 74 and 82% for Reader B; and BA, 100 and 88% for Reader A and 100 and 78% for Reader B. For ICVA, the sensitivity of MRA was less than that of angiography because of lesions missed by the readers at the junctional area of the extra-and intracranial MRA. MRA accurately characterized 9 of the 12 (75%) ECVA, 10 of the 19 (43%) ICVA, and 11 of the 12 (92%) BA lesions. CONCLUSION: MRA is an effective method for detection of occlusive lesions in the ECVAs and BAs. Clinically important lesions can be missed by MRA in the ICVA. MRA is more accurate in characterization of occlusive lesions in BAs than in ECVAs or ICVAs.

Two groups of TH-like immunoreactive neurons in the frog (Rana pipiens) retina.

The morphology and distribution of TH-like immunoreactive (TH-IR) cells in the retina of Rana pipiens were studied in retinal whole mounts and in radial and horizontal sections. A large majority (96%) of the immunoreactive cells were found in the inner nuclear layer while a few cells were found in the ganglion cell layer. All TH-IR cells had round to oval somata with average diameter of 10 microm. The 2-4 primary processes of these cells distributed extensively to sublamina 1 of the inner plexiform layer (IPL) and sparsely to sublamina 5. Two groups of TH-IR cells were distinguished: one, designated thin cells, had only thin (<2 microm diameter) primary processes; the second, designated thick cells, had one or more primary processes with diameter(s) exceeding 2 microm for a distance of 5 microm or more from the soma. The thin cells did not significantly differ from the thick cells in soma diameter, number of primary processes, horizontal spread of processes or vertical lamination of processes. Nearest neighbor analyses of the two types revealed that the population of TH-IR cells (thick and thin together) have an orderly distribution while the thick cells alone are more randomly distributed, indicating that the thick cells do not comprise a functional population. The total number of TH-IR cells varied between retinas; the variability was due principally to variation of thin cell density. It is hypothesized that the thick cells are a subpopulation of the TH-IR cells which are in a particular physiological state at the time of fixation.