Endless loop tachycardia among patients with devices having advanced preventive algorithms: A case series and brief review.

BACKGROUND: Endless loop tachycardia (ELT) is the commonest pacemaker mediated tachycardia (PMT) encountered among patients with cardiac implantable electronic devices (CIEDs). Despite being enabled with various preventive algorithms, we encountered several cases having recurrent, long, and symptomatic ELT. MATERIALS AND METHODS: We retrospectively analyzed consecutive device checkups at device clinic at a single center of eastern India between January 2019 to March 2023. RESULTS: There were 20 cases of confirmed and sustained ELT among 4520 device checks. Although mostly benign, in two cases ELT led to clinical worsening in patients having left ventricular (LV) systolic dysfunction. Even with good ventricular function, ELT resulted in improper atrioventricular (AV) synchrony leading to disabling symptom in one case. The differentiation of ELT from sinus tachycardia and atrial tachycardia (AT) was not always easy. Magnet application is certainly useful to differentiate. The situations that provoked ELT in this study were-long AV delays, VIP (ventricular intrinsic preferences)/MVP (managed ventricular pacing), atrial non-capture, atrial under/over sensing, premature ventricular contractions (PVCs)/couplets, premature atrial contractions (PAC) and slower ventriculo-atrial (VA) conduction. Rate responsive shortening of post-ventricular atrial refractory period (PVARP) also promoted its occurrence and hindered troubleshooting. When ELT occurred despite post-PVC extension of PVARP, lowering the atrial sensitivity, switching to bipolar sensing and manual setting of longer PVARP after measuring VA conduction time were useful. "Rate responsive PVARP" had to be turned off in a few cases to prevent ELT. On the contrary, an over aggressive prolongation of PVARP led to repetitive non-reentrant ventriculo-atrial synchrony (RNRVAS) in two cases. Checking VA conduction during implantation and noninvasive program stimulation (NIPS) during follow up were useful to check the tendency for ELT. CONCLUSION: Clinically significant ELT is rare but not uncommon among devices having in-built preventive algorithms. Manual adjustments are often useful to troubleshoot the same.

A Comparative Evaluation of the Shear Bond Strength of Three Different Hybrid Tooth-Colored Restorative Materials to Dentin: An In-Vitro Study.

INTRODUCTION: Silver amalgam, glass ionomer, resin-modified glass ionomer, compomers, light polymerized hybrid composite resin, and hybrid glass ionomer are among the most frequent restorative materials used as cavity-based or post-endodontics. Thus, to meet the needs of both patients and dentists, Cention N reimagines the traditional filling by integrating bulk placement, ion release, and durability into a dual-curing, aesthetically pleasing solution. Hoewver, we do not have enough information from studies comparing this hybrid restorative material's shear bond strengths to dentin to draw any firm conclusions. Cention N, zirconomer, and Vitremer are three hybrid tooth-colored restorative materials that were evaluated for their shear bond strength to dentin. This research aimed to compare and evaluate these materials. METHODOLOGY: The purpose of this research was to use a universal Instron machine to measure the shear bond stress of three distinct hybrid tooth-colored restorative materials in relation to dentin. The research samples consisted of 45 extracted lower first premolars from humans. The teeth were then assigned into three groups of 15 samples each according to different color acrylic resin blocks, namely, group A (pink acrylic blocks), which had Cention in cement; group B (white acrylic blocks), which has zirconomer cement; and group C (violet acrylic blocks), which had Vitremer cement. RESULTS:  There was no statistically significant difference between the three groups and the normal distribution, as shown by the negligible values in the tests involving the three groups. Put simply, each of the three categories exhibits data that follows a normal distribution. This allows for further data analysis to be conducted using the parametric test of significance. CONCLUSION: The shear bond strength of hybrid glass ionomer restorative materials has to be further investigated in both laboratory and living organism settings.

Minimal Invasive Endodontics: A Comprehensive Narrative Review.

It is the aim of any surgical procedure to restore the tooth to its normal form and function, as well as to restore the tooth's appearance when it is appropriate to do so. One of the primary purposes of endodontic therapy is to clear out the root canal system of germs, pulpal remains, and other foreign matter. A tooth's biomechanical properties have to be compromised in order to achieve this goal; hence the tooth has a poor prognosis for restorative success. The remaining dental structure and restorations have a significant impact on the long-term viability of an endodontically treated tooth. Minimally invasive endodontics (MIE) is an endodontic technique that aims to maintain as much of the healthy coronal, cervical, and radicular tooth structure as possible. Access opening, root canal cleaning and shaping, and surgical endodontics are all possible applications for MIE in endodontic treatment. The objective of new-age endodontics is minimum intervention, and this review article examines a variety of methods that may be combined at each level of endodontics to reach this goal. A favorable outcome with minimally invasive treatment may be achieved while preserving the tooth's natural structure with careful case selection.

Assessment of Efficiency of Diode Laser in Root Canal Disinfection: An Original Research.

Introduction: For the complete removal of the intracanal debris and the infectious agents, the intracanal irrigation plays a significant role. Hence, in our study, we assessed the efficiency of diode laser in root canal disinfection. Materials and Methods: We conducted an in vitro study on 45 extracted single noncarious teeth. We equally divided the teeth into controls, Endovac, and diode laser. Later the mean colony-forming units (MCFU) of the Enterococcus faecalis were calculated and compared statistically. Results: We observed that the MCFU in the controls, Endovac, and diode laser was 108/ml, 104/ml, and 0, respectively, after the incubation. Conclusion: We can conclude that diode laser can be successful in irrigation of the root canals.

Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Triple Antibiotic Paste, and 2% Chlorhexidine Combined with 0.5% Cetrimide against Enterococcus faecalis Biofilm-Infected Dentin Model: An In vitro Study.

BACKGROUND: Enterococcus faecalis is the most common and important microorganism found in infected root canals associated with persistent periapical periodontitis and failing endodontically treated tooth. Intracanal medicaments used after chemomechanical preparation of an infected root canal play a vital in eradication of this microorganism and pave the way for long-term success of endodontic therapy. Hence, the present in vitro study was conducted to assess the antimicrobial efficacy of calcium hydroxide (Ca(OH)2), triple antibiotic paste (metronidazole 400 mg + minocycline 100 mg + ciprofloxacin 500 mg), and 2% chlorhexidine (CHX) combined with 0.5% cetrimide on eradication of E. faecalis biofilm. MATERIALS AND METHODS: Eighty dentin specimens were taken and infected extraorally with E. faecalis to induce microbial colonization. The specimens were then divided into four groups of twenty each based on medicaments used and further subdivided into two subgroups based on assessment of live cells done either immediately after the elimination of the medicament or after 24-h incubation in brain-heart infusion (BHI) medium: Group I specimens were treated with Ca(OH)2, Group II with triple antibiotic paste, Group III with 2% CHX combined with 0.5% cetrimide, and Group IV with saline (control) for 7 days at 37°C. Assessment of live cells was done using confocal microscope. RESULTS: 2% CHX combined with 0.5% cetrimide (Group III) and triple antibiotic paste (Group II) showed a statistically significant result with high antimicrobial efficacy and lower percentage of live cells as compared to Ca(OH)2 (Group I). The mean percentage of live cells in Group I immediately after elimination of medicaments was 64.7%, in Group II was 1.52%, in Group III was 1.49%, and in Group IV was 83.4%. After 24 h of incubation in BHI medium, 2% CHX combined with 0.5% cetrimide (Group III) showed a statistically significant (p < 0.05) result of 1.27% mean live cells as compared to 84.2% in Ca(OH)2 (Group I), 1.82% in triple antibiotic paste (Group II), and 94.2% in saline (Group IV control). CONCLUSION: 2% CHX combined with 0.5% cetrimide exhibited maximum antimicrobial efficacy with least number of mean live cells followed by triple antibiotic paste as compared to Ca(OH)2. Based on these findings, 2% CHX combined with 0.5% cetrimide was most effective in eradicating E. faecalis from the extraorally infected dentine biofilm.

Preparedness of dental under-graduate students towards practicing endodontics in rural and remote areas of India.

BACKGROUND: Undergraduate students can provide valuable opinions and suggestions for modifying the educational program for the enhancement of learning. Therefore, the aim of this study was to explore the preparedness of undergraduate dental students with regard to practice endodontics in the rural and remote areas of India. MATERIALS AND METHODS: The present cross-sectional questionnaire-based study was conducted among dental undergraduates (interns). The survey was conducted among the students of 3 private dental colleges. For the data collection, a close-ended questionnaire was designed to test the knowledge for performing endodontic therapy, root canal therapy (RCT), attitude, and behavior of performing these procedures in the rural set-ups. Unpaired t test and one way analysis of variance (ANOVA) was used to compare the significant difference based on demographics and Pearson's correlation was applied to find the associations among knowledge, attitude, and behavior of study participants. The level of significance was set at below 0.05. RESULTS: A total of 79 students participated, out of which 22 respondents were males (27.8%), and 57 were females (72.15%). Overall mean knowledge scores for endodontics was 9.72 ± 2.19, and the scores of female students were slightly higher than males, whereas the attitude and behavior were better in males but there was no statistical significant difference between both the genders (P > 0.05). A statistically significant positive correlation was observed between attitude and behavior on practicing endodontics in rural settings among study subjects (P < 0.05). CONCLUSION: These findings highlights the necessity for taking initiatives to enhance the community-based dental education programs by various dental colleges for improving oral health care access for rural and isolated populations.

Methotrexate toxicity presenting as ulceration of psoriatic plaques: a report of two cases.

We describe two cases of methotrexate toxicity occurring due to inappropriate self-medication with the drug. The first patient was a 57-year-old man with plaque-type psoriasis on intermittent methotrexate therapy. He discontinued his medications for 2 months and had exacerbation of psoriasis for which he self-medicated with methotrexate following which he developed ulceration of the psoriatic plaques accompanied by bone marrow suppression. The second patient was a 68-year-old man with chronic plaque-type psoriasis for 20 years and was being treated with intermittent methotrexate for 15 years. He also self medicated with oral methotrexate 15 mg daily for 7 days for exacerbation of psoriasis and developed ulceration of the psoriatic plaques with bone marrow suppression and evidence of gastrointestinal erosions.