Medical Spanish Graphic Activity: A MeGA Deliberate Practice Approach to Reducing Jargon Use With Spanish-Speaking Acute Care Patients.

Introduction: Medical Spanish courses in US medical schools aim to teach patient-centered communication, yet many existing resources focus on technical vocabulary and may inadvertently increase jargon use with patients. Graphic medicine presents an opportunity for interactive learning that centers the patient experience, yet it has never been explored in medical Spanish education. Methods: We developed a Medical Spanish Graphic Activity (MeGA) for medical student deliberate practice of patient-centered verbal communication focused on three aspects: diagnosis, treatment, and follow-up care. Each 30-minute activity included a comics handout depicting a patient with a common problem. Students used voice-to-text technology to record their explanations in response to prompts. Transcripts were analyzed for jargon use, including total jargon, unexplained jargon, and problem words (non-Spanish words plus unexplained jargon), utilizing a previously published, reliable protocol for Spanish medical jargon classification. Participants voluntarily provided postactivity feedback. Results: Twenty-nine fourth-year students with intermediate or greater Spanish skills participated in a series of 10 MeGA activities between January and April 2022. Unexplained jargon use and problem words progressively decreased for all transcripts (diagnosis, treatment, and follow-up; all ps < .001). Total jargon use also decreased, but this was not significant in follow-up transcripts (p = .38). All students agreed that MeGA helped them enhance communication skills applicable to patient care and self-identify strengths and limitations. Discussion: MeGA is realistic to implement, engages students' active participation in the speaking domain, and reduces unexplained jargon use. Future studies should explore the broader application of this model and engage patient perspectives.

Spanish medical jargon: A new metric for improving patient-centered communication with Spanish-speaking patients.

OBJECTIVE: Reducing medical jargon improves patient-centered communication, which is a core objective of medical Spanish courses. We aimed to develop a reliable methodology for identifying and classifying Spanish medical jargon. METHODS: Fourth-year medical students in a medical Spanish course recorded themselves explaining diagnosis, treatment, and follow-up care during ten clinical scenarios. We developed a stepwise process for identifying and classifying Spanish medical jargon in the recording transcripts. Two reviewers scored jargon, unexplained jargon, and non-Spanish (neologisms/English) word counts. We evaluated jargon metric correlations with other course performance data. RESULTS: We identified 439 Spanish jargon words and 134 non-Spanish words across 480 transcripts. Mean Spanish jargon per minute was 6.57, and 30% was classified as unexplained. Overall inter-rater reliability was excellent (interclass correlation=0.88). Students with post-course Spanish proficiency of "very good" or higher had less unexplained jargon in follow-up care transcripts (P < 0.05); other course outcomes did not correlate with jargon findings. CONCLUSION: A Spanish medical jargon metric can be reliably used to evaluate student communication skills in a medical Spanish course. Next steps include engaging patient perspectives and exploring strategies to automate jargon analysis. PRACTICE IMPLICATIONS: Spanish medical jargon adds a previously unexplored dimension to the assessment of Spanish-language patient-centered communication.

The supplementary use of XP-endo Finisher R after Reciproc enhances the removal of a bioceramic sealer in oval root canals.

This study compared the performance of Reciproc and Reciproc Blue endodontic files in retreatment time and re-establishment of apical patency, plus removal of a bioceramic sealer from the canal surface with the supplementary use of the XP-endo Finisher R. Following preparation, slightly curved oval root canals in mandibular incisors were filled using a corresponding gutta-percha point and a bioceramic sealer. Apical patency achievement was assessed and the time required to reach the original working length was recorded. The samples were split longitudinally and were photographed to assess the material remaining on the canal walls. No significant differences were observed regarding patency achievement or retreatment times when comparing Reciproc and Reciproc Blue. Significant less material remained on the canal walls when Reciproc was followed by XP-endo compared with Reciproc alone, and when the data for Reciproc and Reciproc Blue were pooled.

Page phenomenon in a transplanted kidney: is it salvageable?

A male in his late 70s with a history of an uncomplicated kidney transplantation 20 years prior was brought to the Emergency Department after experiencing blunt abdominal trauma following a motor vehicle collision. Imaging revealed a large perinephric haematoma, a retroperitoneal haematoma and multiple fractures. He was admitted to the intensive care unit where a renal haematoma was found to be expanding with ultrasonography (US) and developed renal dysfunction including anuria and hyperkalemia. His creatinine rose to twice his baseline and Doppler US showed elevated resistive indices, confirming extrinsic compression and causing a Page phenomenon. An open surgical exploration through the upper aspect of his Gibson incisional scar was performed followed by evacuation of the haematoma. An intraoperative US was done demonstrating good flow in the renal vessels. His postoperative course was uncomplicated and was discharged home with renal function back to baseline. On follow-up, he continued to have a good renal function.

Regenerative Endodontic Procedure in an Immature Permanent Incisor with Internal Root Resorption: a Case Report.

This report describes a regenerative endodontic procedure of an immature permanent incisor with internal root resorption (IRR) and 4-years follow-up. A healthy 8-year-old man was referred for treatment of tooth #9 after a traumatic intrusion. The periapical radiograph showed an IRR and an open apex with periradicular lesion. A diagnosis of pulp necrosis and chronic apical abscess was achieved. In the first appointment, under local anesthesia and rubber dam isolation, an access cavity was designed and the root canal was chemically cleaned under irrigation with 10 mL 1.5% sodium hypochlorite (NaOCl). The root canal was then dried and calcium hydroxide paste was placed. During the second appointment, the root canal was irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 5 minutes and dried. The blood clot was established in a time of 3 minutes after the bleeding from the periapical tissue was trigged. White mineral trioxide aggregate (MTA) was placed up to the amelocemental junction and the final restoration of the access cavity was carried out. During periodic clinical and radiographic follow-up, the patient remained symptom free, the periapical region was completely healed, inhibition of the root resorption process achieved, and formation of the new periodontal ligament as well as tooth widening development observed, meeting functional expectations after 48 months. The regenerative endodontic procedures are an available option to treat IRR in severely immature teeth. The available literature on the regenerative endodontic procedures applied to IRR treatment is limited, and more research is needed in this field.

Effectiveness of XP-Endo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using two Different Chelating Agents.

STATEMENT OF THE PROBLEM: The smear layer may harbor microorganisms and necrotic pulp tissue, jeopardizing irrigant penetration. Recently, Dual Rinse®, a weak chelating agent, has been introduced to the market. However, its chelating capacity in the final irrigation protocol with different activation systems has not yet been deeply analyzed. PURPOSE: The aim of this ex vivo study was to evaluate the effectiveness of passive ultrasonic irrigation (PUI) and XP-endo Finisher (XP) on smear layer removal in combination with two chelating agents, ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP). MATERIALS AND METHOD: This in vitro, experimental study evaluated fifty-two single-rooted human teeth were standardized to 16 mm in length. Root canal instrumentation was performed by the ProTaper Gold system up to the F4 file. The apical end of the samples was sealed with wax to simulate a closed system. Teeth from group 1 (n=24) were irrigated with 3% sodium hypochlorite (NaOCl) and 17% EDTA, while teeth from group 2 (n=24) were irrigated with 3% NaOCl mixed 9% HEDP. Both groups were divided into two subgroups (n=12) depending on the activation system used: XP (group XP-EDTA and XP-HEDP) or PUI (group PUI-EDTA and PUI-HEDP). The specimens were evaluated by scanning electron microscopy at 3, 5 and 8mm from the apex. Statistical analysis was performed using ANOVA and Bonferroni tests considering p> 0.05 as significant. RESULTS: PUI-EDTA was the most effective at removing the smear layer, with a statistically significant difference from XP-EDTA (p< 0.042) and group XP-HEDP (p< 0.003). There were no statistically significant differences among the other groups. CONCLUSION: Under the conditions of this ex vivo study, no activation system was able to completely remove the smear layer from the root canal walls. However, the combination of NaOCl with ultrasonically activated EDTA obtained better results than the other treatments.

CFD analysis on the effect of combining positive and negative pressure during the irrigation of artificial isthmuses.

Fluid dynamics generated by irrigation needles have not been deeply analyzed in root canal irregularities such as apical ramifications or isthmus where the cleaning capacity of irrigants might be compromised and hence the treatment outcome. The goal of this study was to compare the key irrigation parameters (flow pattern, irrigant velocity, apical pressure, and shear stress) between two irrigation needles and the additional effect of aspiration cannulas through computational fluid dynamics. A 3D-model consisting of two canals linked by an isthmus was modeled. The abovementioned needles irrigated the primary canal, whereas an aspiration cannula was located inside the secondary canal. Both the geometry definition and spatial discretization were carried out with ANSYS 16.2, through which six different simulations were performed: lateral exit (LE) needle, frontal exit (FE) needle, LE and cannula in crown (LEC), FE and cannula in crown (FEC), LE and cannula in middle third (LEM), FE and cannula in middle third (FEM). FE and FEM showed that the irrigation flow only passes through the isthmus in the most apical section (maximum irrigant velocity / shear stress = 8.44 m/s / 1628.44 Pa and 8.63 m/s / 1185.69 Pa, respectively). However, the remaining simulations showed the irrigation flow passing through the isthmus twice, through the most apical section first and through the upper part of the isthmus later (maximum irrigant velocity / shear stress = 8.48 m/s / 1298.24 Pa (LE), 8.61 m/s / 1261.36 Pa (LEM), 8.61 m/s / 1355.24 Pa (LEC), 8.59 m/s / 1256.87 Pa (FEC)). Furthermore, the highest velocity values were detected when aspiration cannulas were added.

Regeneración pulpar: una segunda oportunidad al diente inmaduro. A propósito de un caso / Regenerative endodontics: at second chance to immature apex. A case report

Desde la introducción del término revascularización en 1971, muchos han sido los protocolos descritos para el tratamiento de un diente inmaduro con necrosis pulpar y periodontitis apical. La complejidad que supone la realización de técnicas de apicoformación en dientes con raíces cortas, paredes frágiles, ápices no formados y divergentes, permiten que el tratamiento de endodoncia regenerativa esté indicado. El caso que presentamos a continuación se trata de un paciente de corta edad que acude a la consulta por presentar dolor en el cuarto cuadrante. Tras la anamnesis y pruebas complementarias, llegamos al diagnóstico de necrosis pulpar con periodontitis apical sintomática del diente 44. En la radiografía podemos apreciar la presencia de una raíz corta, con paredes frágiles y ápice no formado. Tras hablar con los padres del paciente decidimos optar por el tratamiento de endodoncia regenerativa. Discutiremos a lo largo del caso la técnica empleada durante la realización de este caso clínico, centrándonos en la desinfección del interior del sistema de conductos, y la posterior creación de una matriz de andamiaje necesaria para poder colocar nuestro material biocerámico. En el apartado de discusión acercaremos al clínico las distintas opciones presentes en la literatura para afrontar la desinfección, medicación intraconducto y material de sellado, pilares fundamentales para el éxito del tratamiento de endodoncia regenerativa. En el seguimiento del caso, el paciente se presenta totalmente asintomático, con un desarrollo radicular completo y una formación de las paredes que devuelven la integridad al diente inmaduro

Since the introduction of the term revascularization in 1971, there have been many specific protocols for the treatment of an immature tooth with pulp necrosis and apical periodontitis. The complexity of performing apexification techniques on teeth with short roots, fragile walls, and non-formed and divergent apices, allows regenerative endodontic treatment to be indicated. The case presented below is about a young patient who comes to the office for presenting pain in the fourth quadrant. After the anamnesis and complementary tests, we arrived at the diagnosis of pulp necrosis with symptomatic apical periodontitis of tooth 44. On radiography, we can detect the presence of a short root, with fragile walls and an unformed apex. After talking with the patient's parents, we decided to opt for regenerative endodontic treatment. We will discuss throughout the case the technique used during the realization of this clinical case, focusing on the disinfection of the interior of the duct system, and the subsequent creation of a scaffolding matrix necessary to be able to place our bioceramic material. In the discussion section we will approach the clinician the different options present in the literature to deal with disinfection, intra-conduction medication and sealing material, fundamental pillars for the success of regenerative endodontic treatment. In the follow-up of the case, the patient appears totally asymptomatic, with a complete root development and a formation of the walls that restore integrity to the immature tooth

The effect of a preparation containing glycocholic acid and/or agitation on the tissue dissolution ability of sodium hypochlorite.

This study assessed the porcine palatal mucosa dissolution, from artificial grooves, by a final rinse of sodium hypochlorite (NaOCl) solely or mixed with Keratobacter ((KB); or agitation) passive ultrasonic irrigation (PUI) or sonic activation (SA). Soft-tissue samples (n = 123) were weighed and placed inside root canal grooves in central maxillary incisors. The specimens were randomly divided into six test groups (n = 20): NaOCl 3% with or without KB and the irrigation dynamics: positive pressure (PP), SA or PUI. An EDTA intermediate rinse was included. Soft-tissue weights were measured subsequently. The NaOCl + KB_PUI group showed the highest mean weight reduction, whilst the NaOCl_PP group recorded the lowest. NaOCl + KB subgroups were associated with hastened reduction compared with NaOCl subgroups. NaOCl_PP presented with significantly lower weight reduction when compared with the remaining experimental groups. The addition of KB to NaOCl or its agitation enhances tissue dissolution ex vivo. The agitation of KB-containing mixtures offers no further benefits.

Etidronic acid and ethylenediaminetetraacetic acid associated with sodium hypochlorite have limited effect on the compressive fracture resistance of roots ex vivo.

AIMS: To assess the effect of etidronic acid (EA) mixed with sodium hypochlorite (NaOCl) and two ethylenediaminetetraacetic acid-containing preparations (EDTA and SmearClear) alternated with NaOCl, as a final rinse, on root fracture resistance to a compressive force. MATERIALS AND METHODS: Seventy-two premolar roots were randomly allocated to the following groups according to the irrigant solutions. For the EA group, 9% EA + 2.5% NaOCl were used throughout the assays (n = 21). The remaining groups received 2.5% NaOCl during and immediately after chemo-mechanical instrumentation. Intermediately, the roots received 17% EDTA (n = 19), or SmearClear (n = 16), or no irrigation (control) (n = 16) plus a final rinse with 2.5% NaOCl. The specimens were subjected to a vertical compressive force loaded at a crosshead speed of 0.02 mm/s parallel to the long axis of the root until fracture occurred. The results were compared statistically using the one-way analysis of variance for intergroup comparisons. RESULTS: The negative control presented with the highest values, whereas the SmearClear presented with the lowest values, though no significant differences were found when comparing the different groups (P = 0.82). CONCLUSIONS: The use of EA + NaOCl or two EDTA formulations in association with NaOCl does not affect the fracture resistance of previously chemo-mechanically prepared roots.

Comparison of the Volume of Root Canal Irrigant Collected by 2 Negative Pressure Needles at Different Flow Rates of Delivery.

INTRODUCTION: A greater irrigant volume improves the effectiveness of root canal irrigation. The purpose of this study was to compare 2 negative pressure systems regarding the volume of irrigant collected from the apical area in moderately curved canals at 3 different flow rates of delivery in vitro. METHODS: The mesiobuccal canals of 30 molars with a curvature between 20° and 40° were prepared to size #40.04 taper. A closed system was created. The canals were irrigated at 3, 6, and 12 mL/min for 30 seconds using EndoVac (SybronEndo, Orange, CA) and the INP needle (Mixnus Fine Engineering Co Ltd, Nagano, Japan) (both independent variables). A recovery trap was used to collect the irrigant aspirated by the negative pressure needles. Irrigant volume (dependent variable) was measured in milliliters. Data were analyzed using mixed analysis of variance. RESULTS: There was a statistically significant interaction between the negative pressure system and the irrigant volume collected (P < .0005). The mean irrigant volume collected by the different negative pressure systems was greater for INP at 3 (P < .001), 6 (P < .001), and 12 mL/min (P < .001) flow rate. Both negative pressure needles showed statistically significant differences (P < .001) between mean irrigant volume collected at different flow rates. CONCLUSIONS: A greater volume was collected by increasing the flow rate of irrigant delivery for both EndoVac and INP. The INP needle could collect a greater volume of irrigant from the apical third compared with EndoVac at all 3 different flow rates.

Sodium Hypochlorite and a Preparation Containing Glycocholic Acid and Surfactants Have a Synergistic Action on Organic Tissue Dissolution In Vitro.

INTRODUCTION: The aim of this study was to evaluate porcine palatal mucosa dissolution by sodium hypochlorite (NaOCl) with or without an auxiliary dissolving agent containing glycocholic acid and a mixture of surfactants (Keratobacter [KB]; Saint Joseph DID, Valencia, Spain). METHODS: One hundred forty samples were obtained from porcine palatal mucosa and weighed using a high-precision balance. The samples were randomly divided into 4 experimental groups (n = 35) based on the test solution used: distilled water (the negative control), CanalPro NaOCl 6% (Coltene Whaledent, Altstätten, Switzerland), KB, and a 9:1 vol/vol mixture of NaOCl with KB (NaOCl + KB). After 5, 10, 15, and 20 minutes of immersion in the solutions at 27°C ± 1°C, the samples were weighted by a blinded assessor. The intergroup weight at the different time points was statistically analyzed using the analysis of variance test with the Bonferroni posttest. RESULTS: All test groups presented with tissue dissolution although complete dissolution did not occur in any sample. The largest percent in weight reduction occurred between time points (t) = 0 minutes and t = 5 minutes for the NaOCl + KB group (22.5%) followed by KB (18.5%) for the same time period. NaOCl presented with similar tissue dissolution activity during the different time points, ranging from 7.8% (t = 10 minutes-t = 15 minutes) to 6.8% (t = 15 minutes-t = 20 minutes). Significant weight differences were found among the different experimental groups after 5, 10, and 15 minutes of incubation, with the only exception being KB versus NaOCl + KB. No significant differences were found when comparing the test groups at t = 20 minutes. CONCLUSIONS: The addition of KB to NaOCl increased porcine palatal mucosa dissolution in vitro.

Effect of Passive Ultrasonic Activation on Organic Tissue Dissolution from Simulated Grooves in Root Canals Using Sodium Hypochlorite with or without Surfactants and EDTA.

INTRODUCTION: The aim of this study was to evaluate the porcine palatal mucosa dissolution from artificial grooves using a final rinse with sodium hypochlorite (NaOCl) with or without a surfactant or ultrasonic activation (PUI). METHODS: The root canals of 130 human maxillary central incisors were chemomechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in 1 of the root halves. One hundred thirty porcine palatal mucosa samples were collected, adapted in order to fit into the grooves, and weighed. The reassembled specimens were randomly divided in 3 experimental groups (n = 40) based on their irrigation protocol (ie, positive pressure [PP] and PUI during 15 [PUI-15] or 30 seconds [PUI-30]) and divided in subgroups according to the NaOCl preparation used: Vista 6% plain (Vista Dental Products, Racine, WI) or Chlor-XTRA (Vista Dental Products) (containing surfactant). An EDTA intermediate rinse was included. Palatal mucosa weights were measured after the assays. The intergroup weight changes were statistically analyzed. RESULTS: Complete dissolution did not occur in any sample. Chlor-XTRA subgroups were associated with increased weight reduction compared with Vista 6% plain subgroups; however, the differences were significant (P < .05) only for PP and PUI-15. PUI-30 increased weight reduction compared with PP for both hypochlorites and PUI-15 using Vista 6% plain (P < .05). PUI-30 with Vista 6% plain performed significantly better than PP with Chlor-XTRA (P < .05). CONCLUSIONS: The addition of a surfactant to NaOCl and/or PUI activation increased palatal mucosa dissolution within artificial grooves in the root canal of incisor teeth. PUI agitation was often able to compensate for the absence of surfactants.

Differences in disinfection protocols for root canal treatments between general dentists and endodontists: A Web-based survey.

BACKGROUND: The purpose of this study was to determine whether differences exist in disinfection protocols between endodontists and general dentists. METHODS: The authors sent an invitation to participate in a Web-based survey to 950 dentists affiliated with the Spanish Board of Dentistry. Participants responded to 9 questions about irrigation protocols and other factors related to disinfection during root canal therapy. RESULTS: A total of 238 (25.05%) study participants successfully completed and returned the surveys. Among these participants, 50% were general dentists and 50% were endodontists. The authors found no statistically significant differences in respondents' first choice of an irrigant solution (that is, sodium hypochlorite), but they noted statistically significant differences in the protocols used by general dentists and by endodontists in relation to the concentration of sodium hypochlorite (P = .0003), the use and type of irrigant used to remove the smear layer (P = 5.39 × 10(-10)), the use of adjuncts to irrigation (P = 5.98 × 10(-8)), the enlargement of the apical preparation when shaping a necrotic tooth (P = .001), and the maintenance of apical patency throughout the debridement and shaping procedure (P = .04). CONCLUSIONS: General dentists and endodontists embrace different disinfection protocols. The results of the survey demonstrated that endodontists keep up to date with protocols published in the literature, whereas general dentists use protocols learned during their dental training. Both groups of clinicians should be aware of the importance of disinfection techniques and their relationship to treatment outcomes. PRACTICAL IMPLICATIONS: Controlling microorganisms during a root canal treatment, especially in cases with necrotic pulp, is essential to improve treatment outcomes. Clinicians should update their protocols and also consider referring patients to a specialist when their protocols are based on traditional techniques, especially in those cases with necrotic pulp.

Root Canal Penetration of a Sodium Hypochlorite Mixture Using Sonic or Ultrasonic Activation

The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.

O objetivo deste estudo in vivo foi determinar, para os sistemas "abertos" e "fechados", se o design tem influência na penetração, em milímetros, do hipoclorito de sódio misturado com um meio radiopaco quando empregado na ativação com pressão positiva (PP) e ativação sônica (SI) ou ultrassônica passiva (PUI). Sessenta dentes unirradiculares foram divididos em dois grupos: sistema aberto e sistema fechado (n=30). Os canais radiculares foram trabalhados até um comprimento de trabalho de 17 mm. Os grupos foram subdivididos em três subgrupos (n=10) de acordo com a solução irrigadora e a ativação: PP, e ativação SI ou PUI. Usando radiografias, a distância de penetração foi medida e avaliado o vapor contido. Para o grupo fechado, as distâncias médias de penetração foram PP 15,715 (±0,898) mm, SI 16,299 (±0,738) mm e PUI 16,813 (±0,465) mm e houve vapor contido em 53,3% das amostras. No grupo aberto, houve penetração de 17 mm em 97.6% das amostras, sem contenção de vapor. A penetração do irrigante e avaliação da distribuição usando sistemas aberto e fechado produziram resultados significativamente diferentes. Para os sistemas fechados, PUI é mais eficaz para levar o irrigante até preencher o comprimento de trabalho, seguido por SI.

Root canal penetration of a sodium hypochlorite mixture using sonic or ultrasonic activation.

The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.

Instrumentación tridimensional de sistemas de conductos mediante el sistema self adjusting file (SAF). A propósito de un caso / Tridimensional instrumentation of root canal systems through self adjusting file (SAF). A case report

Algunas de las dificultades que nos encontramos en los retratamientos son la eliminación del material de obturación intraconducto y la presencia de dentina muy contaminada por microorganismos resistentes, en muchas ocasiones asociados en biofilms. En el caso que presentamos nos ayudamos en la última fase del retratamiento de un nuevo sistema que combina instrumentación e irrigación simultáneamente, cuya principal característica es la de adaptarse a la sección transversal de los conductos y de este modo permitir alcanzar áreas en las que la instrumentación rotatoria presenta grandes limitaciones. Facilitándonos, de este modo, la eliminación de cemento y gutapercha remanentes así como dentina contaminada, respetando la anatomía original. El caso ejemplifica esta técnica clínica sobre la que hemos realizado una discusión a partir de la literatura revisada. El diente tratado, un segundo molar inferior, presenta una periodontitis apical aguda producida por una subextensión del material obturador y una deficiente condensación del mismo. Su anatomía inusual formada por un único y amplio conducto es desobturada y desinfectada para proceder a su obturación termoplástica. La evolución del caso a los 6 meses indica una mejora de la sintomatología sin signos radiográficos que indiquen patología periapical (AU)

Some of the difficulties we can find in a retreatment are the removal of the filling material and the presence of intracanal dentin heavily contaminated with resistant organisms, often associated in biofilms. In this case report we help in the last phase of treatment that combines a new simultaneously instrumentation and irrigation system whose main characteristic is to adapt to the cross section of the canals and thus allow to reach areas in which the rotary instrumentation has great limitations. In retreatments, this system provide us thereby removing residual cement and gutta percha and most infected entin, respecting the original anatomy. The present case illustrates the clinical technique on which we have made a discussion from the literature reviewed. The treated tooth presents a acute apical periodontitis with a subextensión of the root canal treatment and a poor condensation. Its unusual anatomy consists of a single large canal which is desobturated and disinfected to proceed with thermoplastic seal. The evolution of the case at 6 months indicates an improvement of symptoms without radiographic signs of apical periodontitis (AU)

Resultados de la aplicación de la terapia neural en la lumbalgia inespecífica / Results of the application of neural therapy in unspecific low backache

El dolor lumbar es un problema a nivel mundial, y sus consecuencias han alcanzado proporciones relevantes. En EEUU es la primera causa de discapacidad física y de consulta médica. Objetivos: determinar la eficacia de la terapia neural en el tratamiento de la neuralgia inespecífica. Métodos: se realizó un ensayo clínico abierto, multicéntrico y prospectivo en 34 pacientes, diagnosticados con lumbalgia inespecífica, en el periodo comprendido desde Abril 2007 hasta Diciembre 2007. Los instrumentos evaluativos utilizados fueron: escala analógica visual para Lumbalgia y Ciatalgia, Cuestionarios de calidad de vida específicos: Oswestry y Roland-Morris para dolor y discapacidad por lumbalgia respectivamente. Para el procesamiento de la información se utilizó el paquete estadístico SPSS para Windows y como técnicas estadísticas, la media aritmética, la desviación típica, dócima Kolmogorov - Smirnov y la dócima t-students. Resultados: se estudiaron 34 enfermos. Se obtuvo una reducción de la escala analógica visual para lumbalgia de 5,23 puntos y para ciatalgia de 3,88 puntos, el Oswestry arrojó una reducción del 36,1 por ciento en dolor y el Roland-Morris 11 puntos menos en discapacidad por lumbalgia que al inicio del tratamiento. Conclusiones: se demostró la eficacia de la terapia neural en la lumbalgia inespecífica por lo que se propone como método neurorreflejoterápico (AU)

Lumbar pain is a worldwide problem, and their consequences have reached outstanding proportions. In USA it is the first cause of physical disability and of medical consultation. Objectives: to determine the effectiveness of neural therapy in the treatment of unspecific neuralgia. Methods: an open, multicentric and prospective clinical trial was carried out in 34 patients, diagnosed with unspecific low backache, from April 2007 to December 2007. Evaluative instruments used were: analogical visual scale (AVS) for low backache and ciatalgia, specific questionnaires of quality of life: Oswestry and Roland-Morris for pain and disability for low backache respectively. For the information processing the SPSS statistical package was used for Windows and as statistical techniques, the arithmetic mean, the typical deviation, Kolmogorov-Smirnov test and the Students t- test. Results: thirty-four sick persons were studied. A reduction of the analogical visual Sscale was obtained for low backache of 5,23 points and for ciatalgia of 3,88 points, the Oswestry showed a reduction of 36,1 percent in pain and the Roland-Morris 11 points in disability for low backache less than at the beginning of the treatment. Conclusions: the efficacy of the neural therapy was demonstrated in unspecific low backache what we propose as neuroreflextherapeutic method (AU)

Resultados de la aplicación de la terapia neural en la lumbalgia inespecífica / Results of the application of neural therapy in unspecific low backache

El dolor lumbar es un problema a nivel mundial, y sus consecuencias han alcanzado proporciones relevantes. En EEUU es la primera causa de discapacidad física y de consulta médica. Objetivos: determinar la eficacia de la terapia neural en el tratamiento de la neuralgia inespecífica. Métodos: se realizó un ensayo clínico abierto, multicéntrico y prospectivo en 34 pacientes, diagnosticados con lumbalgia inespecífica, en el periodo comprendido desde Abril 2007 hasta Diciembre 2007. Los instrumentos evaluativos utilizados fueron: escala analógica visual para Lumbalgia y Ciatalgia, Cuestionarios de calidad de vida específicos: Oswestry y Roland-Morris para dolor y discapacidad por lumbalgia respectivamente. Para el procesamiento de la información se utilizó el paquete estadístico SPSS para Windows y como técnicas estadísticas, la media aritmética, la desviación típica, dócima Kolmogorov - Smirnov y la dócima t-students. Resultados: se estudiaron 34 enfermos. Se obtuvo una reducción de la escala analógica visual para lumbalgia de 5,23 puntos y para ciatalgia de 3,88 puntos, el Oswestry arrojó una reducción del 36,1 por ciento en dolor y el Roland-Morris 11 puntos menos en discapacidad por lumbalgia que al inicio del tratamiento. Conclusiones: se demostró la eficacia de la terapia neural en la lumbalgia inespecífica por lo que se propone como método neurorreflejoterápico.

Lumbar pain is a worldwide problem, and their consequences have reached outstanding proportions. In USA it is the first cause of physical disability and of medical consultation. Objectives: to determine the effectiveness of neural therapy in the treatment of unspecific neuralgia. Methods: an open, multicentric and prospective clinical trial was carried out in 34 patients, diagnosed with unspecific low backache, from April 2007 to December 2007. Evaluative instruments used were: analogical visual scale (AVS) for low backache and ciatalgia, specific questionnaires of quality of life: Oswestry and Roland-Morris for pain and disability for low backache respectively. For the information processing the SPSS statistical package was used for Windows and as statistical techniques, the arithmetic mean, the typical deviation, Kolmogorov-Smirnov test and the Student’s t- test. Results: thirty-four sick persons were studied. A reduction of the analogical visual Sscale was obtained for low backache of 5,23 points and for ciatalgia of 3,88 points, the Oswestry showed a reduction of 36,1 percent in pain and the Roland-Morris 11 points in disability for low backache less than at the beginning of the treatment. Conclusions: the efficacy of the neural therapy was demonstrated in unspecific low backache what we propose as neuroreflextherapeutic method.

Invasive cervical resorption Class III in a maxillary central incisor: diagnosis and follow-up by means of cone-beam computed tomography.

INTRODUCTION: Invasive cervical resorption (ICR) is a type of external resorption that begins below the epithelial attachment. The etiology of ICR is mainly caused by trauma or orthodontic treatment. In many cases, cone-beam computed tomography (CBCT) is a very useful tool to achieve proper diagnosis. METHODS: This case presented with invasive cervical resorption class III (Heithersay) caused by trauma on tooth #9. CBCT was performed allowing observation of the extent of the lesion in the three spatial planes. RESULTS: Treatment was combined: surgical treatment to expose the resorptive defect and nonsurgical root canal therapy to remove the necrotic pulp and disinfect the root canal system; finally, the resorptive defect was filled up with resin ionomer (Geristore; Den-Mat Corporation, Santa Maria, CA). CONCLUSIONS: Follow up x-ray films showed healing of the periradicular tissues, and then a control CBCT was performed to assess the reliability of the conventional x-ray film; a small periapical lesion was observed in two of the CBCT sections.