The Outcome of GaAlAs Diode Laser (980 Nm) Pulpotomy in Patients with Symptomatic Irreversible Pulpitis Assessed Using CBCT - Randomised Controlled Trial with an 18-Month Follow-up.

OBJECTIVE: To evaluate the effect of diode laser (GaAlAs-980 nm) for full coronal pulpotomy (FCP) compared to conventional crown pulpotomy (CCP) in mature teeth with symptomatic irreversible pulpitis (SIP) and assess dentine bridge formation after FCP using CBCT. METHODS: A total of 86 patients (43 per group) with SIP in permanent mandibular molars were included. Access opening and FCP were done, after which haemostasis was achieved with 2.5% NaOCl in the CCP group and a diode laser (GaAlAs-980 nm) in the laser crown pulpotomy group (LCP). Biodentine (Septodont, Saint-Maur-des-Fossés, France) was placed, and the cavity was sealed. Clinical and radiographic follow-ups were done at 6, 12, and 18 months, with additional CBCT evaluation at 18 months. Statistical analysis was performed using the Mann-Whitney U test, and survival rates were assessed using Kaplan-Meier analysis. The Cox proportional model was used to determine the effect of possible covariates on pulpotomy outcomes. P<0.05 was considered to be statistically significant. RESULTS: The overall success rate for CCP and LCP at 18 months was 88.4% and 93% respectively. At the end of 18 months, 8 cases (5 in CCP, 3 in LCP) failed. The postoperative pain score at 48 hours was significantly higher for CCP (mean +- standard deviation: 1.7+-1.4; p<0.001). CBCT analysis at 18 months revealed thicker dentine bridge formation for LCP (Median & IQR: 0.89, 1.06) compared to CCP (p=0.0479). The Kaplan-Meier curve showed a more rapid decline in the survival rate of CCP (0.89) compared to that of LCP (0.93). Postoperative pain at 48 hours, PAI scores at 6, 12, 18 months, and age were found to affect the hazard ratio based on the Cox regression model. CONCLUSION: Within the limitations of this trial, there was no significant difference in the outcome between diode laser and conventional pulpotomy. However, LCP resulted in lesser postoperative pain at 48 hours and thicker dentine bridge formation at 18 months, with a longer estimated survival rate. (EEJ-2023-01-011).

Phosphoric acid treatment enhances adaptation of glass-ionomer cement to bioceramic sealer-conditioned dentin.

Background: This study evaluated the interface between fresh eugenol/bioceramic sealer-conditioned coronal dentin and high-viscous glass-ionomer cement (HVGIC), treated with various dentin conditioners (saline, 10% polyacrylic acid, and 37% phosphoric acid). Materials and Methods: Standard endodontic access preparation and instrumentation were done in 21 freshly extracted mandibular molar teeth in this in vitro study. Teeth were divided into two interventional groups (n = 9/group), based on the type of sealer (zinc oxide eugenol [ZOE]/bioceramic [BioRoot RCS] sealer) used for obturation. Samples were further subdivided based on the type of dentin-conditioning procedures performed (saline/10% polyacrylic acid/37% phosphoric acid). Post dentin conditioning, the access cavity was sealed with HVGIC. Later, material-dentin interfacial analysis and elemental analysis were done using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy. Results: The interfacial SEM images of HVGIC layered over B-RCS/ZOE sealer-conditioned dentin, treated with saline, showed predominantly adhesive debonding failures, whereas cohesive debonding was observed with polyacrylic and phosphoric acid. In the elemental analysis, the intensity of zirconium (depicting the residue of B-RCS)/zinc (depicting ZOE sealer) was very high on the dentin side treated with saline, in comparison to the dentin treated with polyacrylic and phosphoric acid. Furthermore, the intensity of elements from HVGIC was low on the dentin side of the groups with saline, whereas these elements showed maximum penetration into the dentin when treated with phosphoric acid. Conclusion: Conditioning of the endodontic access cavity using 37% phosphoric acid immediately postobturation resulted in higher penetration of HVGIC into the dentin, in comparison to the other dentin conditioners.

Tooth substance loss after incisal endodontic access and novel single-tooth template-guided endodontic access in three-dimensional printed resin incisors with simulated pulp canal calcification: A comparative in vitro study.

Context Background: Guided endodontics has various applications, one of which is for calcified canal negotiation. Recently, a new single-tooth template has been fabricated to overcome the drawbacks of bulky guides, which are difficult to use with rubber dam isolation. Aim: This study aimed to assess the efficacy of the novel single-tooth template for negotiation of pulp canal calcification (PCC) in three-dimensional (3D)-printed resin incisors by comparing substance loss and time taken between incisal endodontic access (IEA) and single-tooth template-guided endodontic access (SGEA). Methods: Forty-two resin incisor teeth having patent canal in the apical third were used (N = 21/group). They were subcategorized based on operator's experience into senior endodontist (SE), postgraduate (PG), and undergraduate (UG) (n = 7/operator). Canals were negotiated conventionally for IEA and using the single-tooth template for SGEA. Substance loss was calculated from the volume difference between pre- and postoperative cone-beam computed tomography scans. The time taken was also recorded. Statistical Analysis Used: Statistical analysis was performed using unpaired t-test and one-way analysis of variance test. Results: Canals were successfully negotiated in 100% and 95% of teeth in the SGEA and IEA groups, respectively. Overall substance loss and time taken were significantly lesser for SGEA for all operators (P < 0.001). In the IEA group, post hoc test showed statistical significance between SE and UG for substance loss (P < 0.05) and SE-UG and PG-UG for time taken (P < 0.05). No significant difference among operators was noted for both parameters in SGEA. Conclusions: SGEA resulted in significantly lesser substance loss and time taken for canal negotiation in 3D-printed resin incisors with simulated PCC. This was independent of the experience levels of the operator.

Dynamic Navigation in Guided Endodontics - A Systematic Review.

OBJECTIVE: The objective of this systematic review was to comprehensively assess the literature regarding the applications, accuracy, advantages and limitations of dynamic navigation in endodontics. METHODS: Case reports and laboratory studies in the English language, which used the Dynamic Navigation System (DNS) for endodontic application and assessed the accuracy of treatment, the time required for treatment and iatrogenic errors were included. PubMed, Scopus, Embase and Web of Science were searched for eligible articles (up to July 2021). Additional hand searching of four peer-reviewed endodontic journals and a grey literature search were also carried out. A risk of bias assessment was done using the Joanna Briggs Institute (JBI) critical appraisal checklists. Data were extracted based on endodontic application of DNS, tooth type, DNS brand, accuracy, iatrogenic errors, and time taken, followed by qualitative analysis. RESULTS: Fourteen articles (three case reports and eleven in-vitro studies) met the eligibility criteria and were included. The quality assessment revealed a low risk of bias, with mean scores of 83.34% for case reports and 84.09% for in-vitro studies. DNS was used for various clinical applications such as access cavity preparation, pulp canal obliteration, endodontic retreatment and microsurgery. The DNS brands used were Navident, X-guide, ImplaNav, and DENACAM. Due to the nature of the component studies, meta-analysis was not possible. CONCLUSION: Challenging clinical situations like pulp canal obliteration, conservative access preparation, endodontic retreatment and microsurgery can be managed efficiently with fewer iatrogenic errors in a shorter time using DNS. However, this systematic review's evidence is low since the included articles are either case reports or in-vitro studies. Clinical studies are needed to test DNS efficacy among operators, including those who are less proficient and compare the accuracy of currently available systems.

Motivational Factors and Barriers Towards Initiating and Maintaining Strength Training in Women: a Systematic Review and Meta-synthesis.

Strength training (ST) or resistance training is important in the development and maintenance of musculoskeletal and cardiovascular health in women of all ages; however, uptake of ST amongst women is low. To improve female musculoskeletal health, it is vital that more women are encouraged to participate in ST to maintain musculoskeletal integrity. This systematic review aimed to identify motivators and barriers to women initiating and maintaining ST. Following protocol registration and systematic search, studies were included if they were primary qualitative or mixed-method studies reporting participant verbatim quotes, included adult women, and focused on motivators and barriers for ST. Searches generated 2534 articles from 3 databases, with 20 studies (N = 402 participants) meeting eligibility criteria. Participant quotes and authors' interpretations were analysed using thematic synthesis. The most frequently observed barriers were gender-based stigmas, discouragement, and negative comments, particularly in women currently engaging in ST. Other factors associated with poor adherence included boredom, poor knowledge of ST, poor gym accessibility, lack of supervision or routine, and difficulty in balancing work and family life. Social support from friends and family, words of affirmation, and accompaniment facilitated ST, particularly in older women. Women who saw expected results such as weight loss were motivated to continue ST. Interventions aimed at increasing participation in ST amongst women should focus on the specific benefits valued by women and the dissemination of accurate information to counter misconceptions and increase knowledge. The adaptation of gym environments to make them more welcoming to women, and reduce gender-focused criticism, is especially important.

Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis.

Aim The aim of this systematic review and network meta-analysis was to identify the best irrigant activation technique (IAT) for the removal of accumulated hard tissue debris (AHTD) from the mesial root of mandibular molars evaluated using micro-CT studies.Methods The research question was based on the PICO format. Four electronic databases - PubMed, Scopus, Embase and Web of Science - were searched for articles up to June 2020. Selected articles were assessed for bias using the Joanna Briggs Institute Critical appraisal tool. The network meta-analysis using a fixed-effects model and SUCRA ranking were performed. The quality of the evidence was assessed using the CINeMA framework.Results Eleven studies were included for qualitative synthesis while seven were included for quantitative synthesis. The risk of bias of all included articles was low. The results based on SUCRA values revealed the IAT shock wave-enhanced emission photoacoustic streaming (100%) resulted in the greatest reduction of the volume of AHTD from mesial roots of mandibular molars. Ranking of the other IATs was as follows: photon-induced photoacoustic streaming (87%), laser-activated irrigation (79.3%), XP EndoFinisher (71.2%), ultrasonically activated irrigation (59.6%), apical negative pressure (42.3%), EasyClean (37.4%), EDDY (26.2%), EndoActivator (24.2%), self-adjusting file (11.6%) and needle irrigation (11.3%).Conclusion None of the IATs rendered the root canals completely free of AHTD. The laser-activated irrigation groups fared better than all other interventions in reducing AHTD from the mesial roots of mandibular molars. The confidence rating ranged from low to high for indirect evidence and moderate to high for mixed evidence. Results must be interpreted with caution due to the laboratory nature of the included studies.

Development and economic trends in anticancer drugs licensed in the UK from 2015 to 2019.

Analysis of new anticancer drugs licensed in the UK found that 44 new therapies were approved from 2015 to 2019. No other 5-year period has produced as many new therapies. Most new drugs are kinase inhibitors (KIs, N=18) and monoclonal antibodies (mAbs, N=16) with only one classical cytotoxic chemotherapy (CC) licensed. The average median treatment duration has risen by 55 days to 318 days (263 days in 2010-2014). Drug costs have escalated; an average treatment course now costs £62 343, compared to £35 383 in 2010-2014. New drugs are delivering significant clinical benefits with longer treatment durations. However, the financial burden is greater, heralding economic challenges for healthcare providers.

Portable microfluidic chip for detection of Escherichia coli in produce and blood.

Pathogenic agents can lead to severe clinical outcomes such as food poisoning, infection of open wounds, particularly in burn injuries and sepsis. Rapid detection of these pathogens can monitor these infections in a timely manner improving clinical outcomes. Conventional bacterial detection methods, such as agar plate culture or polymerase chain reaction, are time-consuming and dependent on complex and expensive instruments, which are not suitable for point-of-care (POC) settings. Therefore, there is an unmet need to develop a simple, rapid method for detection of pathogens such as Escherichia coli. Here, we present an immunobased microchip technology that can rapidly detect and quantify bacterial presence in various sources including physiologically relevant buffer solution (phosphate buffered saline [PBS]), blood, milk, and spinach. The microchip showed reliable capture of E. coli in PBS with an efficiency of 71.8% ± 5% at concentrations ranging from 50 to 4,000 CFUs/mL via lipopolysaccharide binding protein. The limits of detection of the microchip for PBS, blood, milk, and spinach samples were 50, 50, 50, and 500 CFUs/mL, respectively. The presented technology can be broadly applied to other pathogens at the POC, enabling various applications including surveillance of food supply and monitoring of bacteriology in patients with burn wounds.