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1.
Gen Dent ; 70(1): 22-25, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34978985

RESUMO

The aim of this study was to compare the effectiveness of a reciprocating file (Reciproc) and a rotary retreatment file (Mtwo retreatment [Mtwo-R]) for the removal of filling material during root canal retreatment. A total of 30 mandibular molars with a mesial root curvature between 20° and 40° were selected and prepared using a Reciproc R25 file. The canals were filled using the lateral condensation technique and a root canal sealer. The specimens were randomly allocated into 2 groups according to the retreatment technique used (n = 15): a Reciproc R25 file or Mtwo-R 15/.05 and 25/.05 files. After retreatment, the specimens were longitudinally sectioned and photographed with an operating microscope under ×10 magnification. The percentage of total remaining filling material and the percentages in the cervical, middle, and apical thirds of the specimens were calculated. The Student t test was used for statistical comparisons of the 2 groups, and the analysis of variance followed by Tukey test was used to verify differences among the root thirds within each group. No statistically significant difference between the 2 groups was detected in the percentage of total remaining filling material (P = 0.87) or the percentage in any of the thirds of the root canals (P > 0.05) after reinstrumentation. In both groups, there was a significantly greater amount of remaining material in the apical third (P < 0.05). The results suggested that there is no difference between the 2 systems in their effectiveness at removing filling material.


Assuntos
Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular , Cavidade Pulpar , Desenho de Equipamento , Guta-Percha , Humanos , Retratamento , Preparo de Canal Radicular
2.
Int J Comput Dent ; 24(4): 419-427, 2021 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-34931777

RESUMO

The treatment of teeth with severely calcified canals is a difficult procedure for clinicians. Procedural accidents such as drill path deviation or perforation of the root canal often occur. 3D-printed directional guides made using CBCT and CAD/CAM can help the clinician to accurately drill in the original root canal direction. Furthermore, chairside operating times and excessive loss of tooth structure are reduced, and the risk of perforation is avoided. The present case report describes two cases of calcified root canals with path deviations that were retreated utilizing a guided endodontic technique.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Cavidade Pulpar , Humanos , Impressão Tridimensional , Retratamento , Tratamento do Canal Radicular
3.
Braz. j. oral sci ; 20: e210432, jan.-dez. 2021. ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1254269

RESUMO

Aim: The aim of this study was to evaluate, by micro-computed tomography (micro-CT) analysis, the remaining filling material during endodontic retreatment performed with Protaper retreatment without solvent. Methods: Forty mandibular molars were divided into two groups (n = 20) according to the sealer used in the obturation: the bioceramic TotalFill BC (TF) or the resin-based AH Plus (AHP). The specimens were scanned before instrumentation, after obturation and after filling removal. Only the mesial roots were analysed. The filling volumes and the remaining filling material were calculated in the entire root canal and in the cervical, middle and apical thirds. Results: The volume of obturation and the volume of remaining filling material in the entire root canal and in the cervical, middle and apical thirds of the canal between the groups were not statistically different (independent t-test, p > 0.05). In the AHP group, there was a higher percentage of remaining filling material in the middle third than in the cervical third (p < 0.05). Conclusion: The filling material could not be entirely removed from any specimen


Assuntos
Materiais Restauradores do Canal Radicular , Retratamento , Microtomografia por Raio-X , Dente Molar
4.
Braz Oral Res ; 35: e117, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34816905

RESUMO

This study evaluated by the efficacy of rotary and reciprocating systems to remove filling material by micro-CT. Sixty human canines were instrumented up to F3 by ProTaper Universal system and filled with AH Plus/ gutta-percha. Specimens were submitted to 1,200 thermal cycles, scanned by microCT SkyScan 1176 and randomly distributed in groups according to the filling material removal protocol (n = 10): ProTaper Universal, ProTaper Universal/xylol, ProTaper Next, ProTaper Next/xylol, Reciproc and Reciproc/xylol. After filling removal, specimens were analyzed by microCT to separately verify the presence of gutta-percha and sealer remnants. The data (mm3) were analyzed by two way ANOVA and Tukey´s test (5%). For the remaining gutta-percha, the use of xylol provided the highest values for Reciproc (7.60 ± 0.73), which was statistically different from the other groups (p < 0.05) that presented lower values and were statistically similar to each other (p > 0.05). For the remaining sealer, xylol provided the highest values (21.25 ± 6.94) different (p < 0.05) from the use of instruments alone (11.47 ± 9.45). ProTaper Next presented the lowest values (8.16 ± 1.37) for the remaining sealer, different (p < 0.05) from that of Reciproc (24.67 ± 6.32). The qualitative analysis revealed that all groups presented some remaining root filling material, with the highest volumes presented by Reciproc and Reciproc/xylol. In conclusion the rotary systems provided greater removal of filling material regardless of the use of xylol. The use of xylol negatively interfered with the action of the reciprocating system in the removal of the gutta-percha and sealer.


Assuntos
Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular , Cavidade Pulpar/diagnóstico por imagem , Guta-Percha , Humanos , Retratamento , Preparo de Canal Radicular , Solventes , Microtomografia por Raio-X
5.
JAMA ; 326(17): 1713-1724, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34726708

RESUMO

Importance: The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear. Objective: To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days. Design, Setting, and Participants: Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019. Interventions: Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401). Main Outcomes and Measures: The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates. Results: Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI -∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI -∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, -∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, -∞ to 7.4%]; P value for interaction = .73). Conclusions and Relevance: Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings. Trial Registration: ISRCTN Identifier: ISRCTN76888927.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Administração Oral , Pré-Escolar , Esquema de Medicação , Duração da Terapia , Feminino , Humanos , Lactente , Masculino , Alta do Paciente , Retratamento/estatística & dados numéricos , Índice de Gravidade de Doença
6.
Anticancer Res ; 41(10): 5007-5014, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593449

RESUMO

BACKGROUND/AIM: In our previous study, first-line eribulin (ERI) showed 25 weeks of progression-free survival (PFS). This study investigated the efficacy and safety of ERI re-administration in metastatic breast cancer (MBC) patients. PATIENTS AND METHODS: HER2-negative MBC patients who had never received chemotherapy for MBC received first-line ERI for 18 weeks if they did not have disease progression, and then one cycle of S-1 before ERI re-administration. RESULTS: Twelve patients received ERI re-administration. The PFS of re-administered ERI was 13 weeks. Total duration of ERI use was 30 weeks. The incidence and severity of adverse events were consistent with previous reports. CONCLUSION: In the first-line setting, the total PFS of eribulin was extended by S-1 administration before disease progression, compared with that of our previous report.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Receptor ErbB-2/metabolismo , Adulto , Idoso , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Furanos/administração & dosagem , Humanos , Cetonas/administração & dosagem , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Prognóstico , Retratamento , Taxa de Sobrevida
7.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(1): 39-44, 2021 Jan 09.
Artigo em Chinês | MEDLINE | ID: mdl-34645233

RESUMO

Dental caries is a common chronic oral disease of tooth with multiple factor involvement. It has the characteristics of high incidence, low rate of treatment and high rate of retreatment. How to further improve the standardized treatment and management of dental caries has become a clinical problem. Hence, clinical difficulty assessment system of caries prevention and management is established on the base of caries diagnosis and classification. This system mainly includes caries risk assessment and caries treatment evaluation and can provide effective basis for caries management. This review article discusses caries diagnosis and classification, caries risk assessment and caries treatment difficulty assessment, which are the most important parts of caries management in the whole life cycle.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Humanos , Incidência , Retratamento , Medição de Risco
8.
J Appl Oral Sci ; 29: e20201079, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495106

RESUMO

OBJECTIVE: To examine the factors affecting the transitions through treatment interventions after failure of non-surgical root canal treatment (NS-RCT). METHODOLOGY: Insurance enrollment and claim information for enrollees of Delta Dental of Wisconsin (DDWI), USA were analyzed for 438,487 initial NS-RCT procedures to determine the effect of initial provider type and other covariates on additional treatments (no additional treatment, nonsurgical retreatment, surgical retreatment and extraction). A multi-state model was created using the "mstate" R package. Transitions between the four states identified by Code on Dental Procedures and Nomenclature were analyzed. Cox proportional Hazards regression stratified by transition type was used to estimate the effect of provider type on the risk of each transition, adjusting for covariates. RESULTS: The overall survival rates for all teeth that were treated by NS-RCT was 82.8% [95% CI 82.57%, 83.11%] at 10 years. Approximately, 7% of cases changed from the first state of initial NS-RCT during the 13-year study period with ultimately 0.9%, 0.4% and 5% of cases receiving non-surgical retreatment, surgical retreatment or extraction, respectively. Teeth are more likely to be retreated non-surgically than surgically, and to be extracted than retreated. In general, the probability of a tooth having non-surgical retreatment was higher if the initial provider was not an endodontist (Hazard Ratio (HR)=3.2). Molars were more likely to be non-surgically retreated (HR=2.0) or extracted (HR=2.8) when compared to anterior teeth. The probability of non-surgical retreatment (HR=0.93) or extraction (HR=0.50) was lower when a crown was placed within 90 days after NS-RCT. CONCLUSION: Most teeth remained in the same state after treatment with no additional treatment transitions. When a transition occurred, it was more likely to be an extraction. Type of provider, age, location of the tooth, gender, and time to placement of final restoration significantly influence treatment transitions.


Assuntos
Cavidade Pulpar , Dente não Vital , Humanos , Retratamento , Estudos Retrospectivos , Tratamento do Canal Radicular , Resultado do Tratamento
9.
Ann Palliat Med ; 10(9): 10083-10090, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34551569

RESUMO

With the growing use of immune checkpoint inhibitors (ICIs), recurrent immune-related adverse events (irAEs) have become more common after recovery from initial immune toxicity. Here we report one case of anti-PD-1-related pneumonitis in a patient with advanced thymoma, who experienced two episodes of pneumonitis during 10 months of treatment with a PD-1 inhibitor. By reviewing recent advances in ICI-related adverse events, we summarize the clinical characteristics of recurrent immune-related pneumonitis, illustrate potential predictive biomarkers for irAEs, and evaluate the value of resuming anti-PD-1 treatment in this patient. To date, evidence regarding retreatment following improvement from an irAE is scarce, and further clinical trials are needed to address this scenario.


Assuntos
Pneumonia , Timoma , Neoplasias do Timo , Humanos , Inibidores de Checkpoint Imunológico , Pneumonia/induzido quimicamente , Pneumonia/tratamento farmacológico , Retratamento , Timoma/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico
10.
J Endod ; 47(12): 1865-1874, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34562500

RESUMO

INTRODUCTION: Bibliographic analysis using quantitative measurements such as citation number and citation density is a common method used to evaluate the impact of previously published studies on current research. Several bibliographic endodontic studies ranking publications based on their number of citations have been published. However, to date, a focus on the most cited articles related to the outcome of endodontic treatment is lacking. The purpose of this study was to identify the most cited publications and their citation density as related to the outcome of nonsurgical root canal treatment (NSRCT), nonsurgical root canal retreatment (NSRCR), and root canal surgery (RCS). METHODS: A search of all citations regarding the outcome of NSRCT, NSRCR, and RCS was performed using the Web of Science platform. The search included key words covering all relevant categories. Only publications in the English language published between May 1960 and July 2021 were included. The publications were divided into the following groups: NSRCT, NSRCR, and RCS. Each group was further subdivided into experimentation studies and review studies. The publications were analyzed and sorted in descending order according to the number of citations that each publication has received. Only publications with 100 citations or more were included. Citation density was also assessed. RESULTS: The total number of NSRCT citations found was 257; 221 (86%) were experimentation studies, and 36 (14%) were review studies. Of the 221 NSRCT experimentation studies, 41 (18.55%) had 100 citations or more. Of the 36 NSRCT review studies, 9 (25%) had 100 citations or more. The total number of NSRCR citations found was 61; 51 (83.6%) were experimentation studies, and 10 (16.4%) were review studies. Of the 51 NSRCR experimentation studies, 5 (9.8%) had 100 citations or more. Of the 10 NSRCR review studies, 2 (20%) had 100 citations or more. The total number of RCS citations found was 119; 90 (75.6%) were experimentation studies, and 29 (24.4%) were review studies. Of the 90 RCS experimentation studies, 11 (12.2%) had 100 citations or more. Of the 29 RCS review studies, 2 (6.9%) had 100 citations or more. In total, 70 publications on the outcome of endodontic treatment had 100 or more citations. Fifty publications (71.4%) pertained to the NSRCT groups, 7 publications (10%) to the NSRCR groups, and 13 publications (18.6%) to the RCS groups. CONCLUSIONS: Bibliographic analysis is a beneficial aid for assessing the impact of publications studying the outcome of endodontic treatment on the field of endodontics.


Assuntos
Endodontia , Retratamento , Tratamento do Canal Radicular
11.
Dental Press J Orthod ; 26(4): e2119247, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524377

RESUMO

INTRODUCTION: Class III malocclusions are some of the most difficult occlusal anomalies to be treated. Some patients with this condition may require orthognathic surgery, while others may be treated with dental camouflage. Proper patient assessment and selection remains critical in order to achieve favorable results. OBJECTIVES: This report outlines the case of an 18-year-old male who sought retreatment for a severe skeletal Class III dentofacial deformity after undergoing orthodontic camouflage treatment involving mandibular arch extractions. A treatment plan comprising dental decompensation and orthognathic surgery was implemented in order to achieve optimal facial and occlusal results. RESULTS: After 28 months of treatment, skeletal and dental correction was achieved and facial features were significantly improved. The orthognathic surgery required a 20-mm sagittal maxillomandibular skeletal correction, combined with a 4-mm correction of the midlines and a 2-mm impaction of the maxilla. CONCLUSION: Dental compensation may be a risky treatment alternative for severe dentoskeletal discrepancies. In these patients, orthodontics combined with orthognathic surgery is the recommended treatment option.


Assuntos
Má Oclusão Classe III de Angle , Procedimentos Cirúrgicos Ortognáticos , Adolescente , Cefalometria , Humanos , Masculino , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/cirurgia , Maxila , Retratamento
12.
Oncology ; 99(10): 665-672, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34515197

RESUMO

BACKGROUND: Due to few efficacious options in later lines of therapy in metastatic colorectal cancer (mCRC), there has been considerable interest in the possibility of retreatment with previously administered agents. This study investigated the efficacy and safety of irinotecan retreatment (IRI2) in patients with refractory mCRC. METHODS: We performed a retrospective analysis of patients with mCRC who were retreated with irinotecan-based regimens. The retreatment regimens with anti-epidermal growth factor receptor therapies were excluded. RESULTS: A total of 64 patients were included. Patients had a median age of 56 years and were offered mainly in the setting of third- or fourth-line therapy with IRI2. The disease control rate was 78.2% including an objective response of 23.5%. Median progression-free survival and overall survival were 5.5 and 19.3 months, respectively. The most frequent grade 3 or higher toxicities were nausea/vomiting (27.9%) and neutropenia (25%). CONCLUSION: IRI2 might be a reasonable option for heavily pretreated patients with mCRC who achieved disease control with prior irinotecan therapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/patologia , Humanos , Irinotecano/administração & dosagem , Irinotecano/efeitos adversos , Pessoa de Meia-Idade , Metástase Neoplásica , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
13.
Int Endod J ; 54(12): 2173-2183, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34516682

RESUMO

AIM: To evaluate the impact of various predictors on the outcome of root canal retreatment in symptomatic mandibular first molars with periapical lesions after a minimum of 2 years. METHODOLOGY: One hundred and twenty previously root canal treated symptomatic mandibular first molars with periapical lesions which were diagnosed as symptomatic apical periodontitis or acute apical abscess with localized intraoral swelling were included. Root canal retreatment was performed by an experienced endodontist using a standardized treatment protocol. The teeth were followed up clinically and radiographically and the radiographic outcome was assessed using a modified periapical index scale (PAI). The cumulative success proportion and the influence of predictors on the outcome of the root canal retreatment were analysed using Kaplan-Meier analyses and log-rank tests, and the hazard ratios for the predictors were also investigated using Univariate Cox Proportional Hazard regression analysis at a significance level of 5%. RESULTS: Of the 120 teeth, 103 teeth were re-examined with an 85% recall rate. The cumulative success rate was 88% in which 64% were healed and 24% were healing, and failure rate was recorded as 12%. None of the preoperative predictors, including age, gender, soft tissue tenderness, intraoral swelling, size of the lesion, PAI score, apical level and density of root canal filling before root canal retreatment, nor intraoperative predictors, such as active exudate drainage, density of root canal filling after root canal retreatment and restoration type had an influence on the outcome of root canal retreatment (p > .05). The only factor that significantly reduced the success rate of root canal retreatment was the apical level of the root canal filling; when it was more than 2 mm short of the radiographic apex in teeth where apical patency was not established, the success was significantly lower (p = .023). CONCLUSIONS: Root canal retreatment in symptomatic mandibular first molars with periapical lesions resulted in a success rate of 88%. None of the predictors had a significant influence on the outcome, except for the apical level of the root canal filling after root canal retreatment with short root fillings being associated with significantly more post-treatment endodontic disease.


Assuntos
Cavidade Pulpar , Periodontite Periapical , Humanos , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Estudos Prospectivos , Retratamento , Tratamento do Canal Radicular , Resultado do Tratamento
14.
J Clin Neurosci ; 92: 147-152, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509242

RESUMO

OBJECTIVE: Carotid blister aneurysms remain a formidable surgical challenge with varied surgical options. There have been significant advancements in the endovascular management of these aneurysms with the introduction of flow diverters. The comparative risk profiles for different endovascular options compared to surgical management of these lesions is not completely understood. METHODS: The study is a comprehensive systematic review and meta-analysis on the treatment of carotid blood blister aneurysms. Pubmed searches were used to identify relevant articles and patient level data was extracted. Two and three group analyses were conducted comparing surgical and endovascular strategies and surgical, stent coil and flow diversion techniques respectively. Patient outcomes were graded on the modified Rankin Scale with a score of 2 or less defined as favorable. RESULTS: In total, 83 studies (41 and 42 studies on surgical and endovascular interventions, respectively) with 1119 patients met our inclusion criteria. A statistically significant difference (at the 5% level of significance) in the effect among three different interventions was not found (Q = 3.41, p = 0.1815) under the random-effect model. Our results did show summary proportions of favorable outcomes were higher in the stent coil (0.87, 95% CI: 0.79 - 0.94) and flow diversion (0.87, 95% CI: 0.75 - 0.96) than that of surgery (0.76, 95% CI: 0.71 - 0.83). CONCLUSIONS: Our results suggest a trend towards improved patient outcomes with endovascular techniques compared to surgical strategies but statistical significance was not achieved. We also found that endovascular techniques compare favorably. Increasing retreatments were found to negatively affect patient outcomes.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Artéria Carótida Interna , Humanos , Aneurisma Intracraniano/cirurgia , Retratamento , Estudos Retrospectivos , Stents , Resultado do Tratamento
15.
J Endod ; 47(12): 1942-1946, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34481831

RESUMO

Endodontic procedures can result in various complications. Separation of the endodontic instrument is a common complication of incorrect use or overuse of the instrument. However, a separated endodontic instrument may hinder cleaning and shaping during endodontic treatment procedures, which can potentially impact prognosis. Therefore, it is necessary to manage this complication by removal of the separated instruments from inside the root canal. Although several devices are used, nonsurgical removal for retreatment remains difficult. We report the case of a failed attempt to manage a separated endodontic instrument nonsurgically by a private dentist, which resulted in extrusion of the instrument beyond the root apex and its migration into the mandible. We describe a novel surgical approach involving intentional tooth replantation combined with alveolar osteotomy. There have been few reports on the management of separated endodontic instruments that were pushed out beyond the root apex. Our novel surgical approach suggests a technique for the potential removal of a separated endodontic instrument extruded beyond the root apex.


Assuntos
Tratamento do Canal Radicular , Reimplante Dentário , Humanos , Mandíbula , Osteotomia , Retratamento , Tratamento do Canal Radicular/efeitos adversos
18.
Blood Adv ; 5(15): 3016-3020, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34351389

RESUMO

The recent emergence of anti-B-cell maturation antigen (BCMA) therapies holds great promise in multiple myeloma (MM). These include chimeric antigen receptor (CAR) T cells, bispecific antibodies, and antibody-drug conjugates. Their development in clinical trials and further approval are changing the strategy for treating MM. Considering that a cure has not been reached, a central question in the coming years will be the possibility of using these therapies sequentially. Here, we report 2 cases of the serial use of anti-BCMA therapies with parallel monitoring of BCMA expression and anti-CAR antibodies. We further discuss recent data from clinical studies that have informed us about the different mechanisms of resistance to anti-BCMA therapies, including antigen escape, BCMA shedding, anti-drug antibodies, T-cell exhaustion, and the emergence of an immunosuppressive microenvironment. This knowledge will be essential to help guide the strategy of serial treatments with anti-BCMA therapies.


Assuntos
Anticorpos Biespecíficos , Mieloma Múltiplo , Anticorpos Biespecíficos/uso terapêutico , Antígeno de Maturação de Linfócitos B , Humanos , Mieloma Múltiplo/tratamento farmacológico , Retratamento , Linfócitos T , Microambiente Tumoral
19.
Int Endod J ; 54(11): 2016-2024, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34383324

RESUMO

AIM: This randomized clinical trial aimed to assess the effect of two rotary (ProTaper Retreatment + ProTaper Gold and Hyflex EDM) and two reciprocating (Reciproc Blue and WaveOne Gold) NiTi systems on postoperative pain after root canal retreatment on single-rooted incisor teeth. METHODOLOGY: One hundred and eighty patients scheduled for root canal retreatment were randomly assigned to one of the four groups according to the NiTi system (ProTaper Retreatment + ProTaper Gold, Hyflex EDM, Reciproc Blue or WaveOne Gold) used for the removal of root canal fillings and further canal preparation. The working length was determined to be 1 mm shorter than the '0.0' mark of the apex locator. Root canals were filled with gutta-percha and an epoxy resin-based root canal sealer using a lateral compaction technique. The teeth were restored using a resin composite material. A single operator performed the retreatments in a single visit. The incidence and intensity of postoperative pain were rated on a numeric rating scale by patients 24, 48 and 72 h after retreatment. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analysed using the Mann-Whitney U, Wilcoxon and chi-square tests. RESULTS: For the intensity of postoperative pain, the difference between the four groups was not significantly different (p > .05). No significant difference was found between the groups in terms of analgesic medication intake (p > .05). CONCLUSIONS: The rotary and reciprocating NiTi systems tested in this study were associated with similar intensity of postoperative pain and intake of analgesics following root canal retreatment on single-rooted incisor teeth completed in one visit.


Assuntos
Cavidade Pulpar , Materiais Restauradores do Canal Radicular , Guta-Percha/uso terapêutico , Humanos , Incisivo , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Retratamento , Materiais Restauradores do Canal Radicular/uso terapêutico , Obturação do Canal Radicular , Preparo de Canal Radicular
20.
Int Endod J ; 54(11): 2006-2015, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34383325

RESUMO

AIM: To compare the effect of low-level laser therapy (LLLT) on postoperative pain after single-visit root canal retreatment on mandibular molars. METHODOLOGY: This randomized controlled clinical trial included 36 patients referred to the Department of Endodontics, Islamic Azad University, Tehran, Iran. Healthy patients who required root canal retreatment on symptomatic first or second mandibular molars, with a PAI index score of 2 or 3, preoperative tooth and percussion pain of <56 mm on a 170-mm visual analogue scale (VAS) were included. After local anaesthesia using inferior alveolar nerve block followed by rubber dam isolation and access cavity preparation, the D RaCe retreatment system was used to remove the existing root filling material, and after canal negotiation and gaining patency, working length was determined with an apex locator. Further canal enlargement was carried out with size 35, 0.04 taper, and size 40, 0.04 taper RaCe rotary instruments and then canals were filled using laterally compacted gutta-percha points and AH Plus sealer. The patients were randomly assigned to treatment groups: In the LLLT group, a 980-nm diode laser set at 6.89 W/cm2 energy density, 0.5 W power, and a tip diameter of 10 mm were activated from the buccal side on the mesial and distal root apices for 15 s. In the sham group, the laser handpiece was placed inside the patient's mouth at the same location, but the laser was not activated. Then patients were instructed to record their postoperative pain levels at 4, 8, 12 and 24 h and 2, 3 and 7 days after treatment on separate VAS scales. For data analysis, the independent sample t and the Mann-Whitney U tests were used. Nominal variables were analysed by using the chi-square test. RESULTS: In the LLLT group, the most intense pain was reported 24 and 48 h post-treatment [mean (SD) = 0.22 (0.54) for both], whereas in the sham group, the most intense pain level was observed 4 h post-treatment [mean (SD) = 0.78 (0.80)]. At the 4-h interval, pain intensity was significantly lower in the LLLT group (p = .016). CONCLUSIONS: Low-level laser therapy reduced postoperative pain after single-visit root canal retreatment of mandibular molars only four hours following the procedure.


Assuntos
Terapia com Luz de Baixa Intensidade , Cavidade Pulpar , Humanos , Irã (Geográfico) , Dente Molar/cirurgia , Dor Pós-Operatória , Retratamento , Preparo de Canal Radicular
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