Maxillary first molar usually exhibits a radicular anatomy of three roots and three or four canals. However, different anatomic variations like extra number of roots and canals are possible. For a successful treatment...Maxillary first molar usually exhibits a radicular anatomy of three roots and three or four canals. However, different anatomic variations like extra number of roots and canals are possible. For a successful treatment, clinicians must have well equipment and a thorough knowledge of the external and internal anatomy of teeth and its variation. Using of CBCT may help to locate extra canals by giving a chance to clinicians to see the root canal anatomy in 3-D view. The aim of this study was to present a case report about a diagnosis and treatment in maxillary first molar with three roots and five canals. It is concluded that the diagnosing and the treatment of unusual cases are key factors for successful endodontic treatment of these teeth.展开更多
BACKGROUND TypeⅢb dens invaginatus(DI)with a lateral canal located at the mid-third of the root is rarely reported.Here,we report a rare case of typeⅢb DI in the left upper anterior tooth with a lateral canal that l...BACKGROUND TypeⅢb dens invaginatus(DI)with a lateral canal located at the mid-third of the root is rarely reported.Here,we report a rare case of typeⅢb DI in the left upper anterior tooth with a lateral canal that led to persistent periodontitis.CASE SUMMARY A 15-year-old female patient presented with a chief complaint of pain associated with recurrent labial swelling in the area of the left anterior tooth.A diagnosis of typeⅢb DI and chronic periodontitis was made.Intentional replantation was performed after conventional endodontic treatment failed.After 6 mo,the patient was asymptomatic,but a sinus tract was observed.Cone-beam computed tomography images showed bone loss in the mesial of the mid-root.Based on methylene blue staining and microscopy images,the lateral foramen located at the middle third of the root was surgically treated.After 3 years of follow-up,the clinical findings and radiographic assessment presented a favorable prognosis of bone healing without root absorption or ankylosis.CONCLUSION TypeⅢb DI with a lateral canal can be successfully treated by root canal treatment,intentional replantation,and surgical therapy.展开更多
Objective: To explore the clinical efficacy of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy and the effect on the serum inflammatory ...Objective: To explore the clinical efficacy of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy and the effect on the serum inflammatory cytokines. Methods: A total of 156 patients with gingival pain and swelling after root canal therapy due to dental pulp necrosis were included in the study and randomized into the control group (n=78) and teh treatment group (n=78). The patients in the control group were given metronidazole tablets. On the above basis, the patients in the treatment group were given local injection of neurogrowth factors. 10-day treatment was regarded as one course, and the patients were continuously treated for 2 courses. The improvement of clinical symptoms before and after treatment in the two groups was evaluated. Gingival sulcus index and serum inflammatory cytokines before and after treatment in the two groups were detected and compared. Results: When compared with before treatment, the periodontal soft tissue swelling, tooth mobility, and periapical pain scores after treatment in the two groups were significantly reduced, and those in the treatment group were significantly lower than those in the control group. When compared with before treatment, the gingival sulcus bleeding index 1 and 2 courses after treatment in the two groups was significantly reduced, and that 2 courses after treatment was significantly lower than that after 1 course treatment. The gingival sulcus bleeding index 1 and 2 courses after treatment in the treatment group was significantly lower than that in the control group. When compared with before treatment, the serum IL-8 and IL-6 levels after treatment in the two groups, and TNF-α level after treatment in the treatment group were significantly reduced, and the above indicators in the treatment group were significantly lower than those in the control group. Conclusions: The neurogrowth factors in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy can effectively improve the clinical symptoms, and inhibit the inflammatory reaction, with a significant efficacy.展开更多
BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with o...BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.展开更多
BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars loca...BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars located at the end of the dental arch.However,advancements in digital dental diagnosis and treatment techniques can solve these problems.Here,we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel“inlay-guided endodontics”technique based on improved computer-generated programs.CASE SUMMARY A 63-year-old man complained of a defect in the maxillary left second molar.The tooth,diagnosed with post-treatment endodontic disease,was initially treated by conventional methods,which were ineffective.Our“inlay-guided endodontics”technique was subsequently adopted,with the establishment of a precise integrated three-dimensional(3D)plate model of cone-beam computed tomography data and a digital impression of the dentition.An optimal root canal approach was generated for the“virtual file”in the 3D model.The plate data were imported into a 3D printer and printed.With the help of the guide plate,the file was accurately placed into the cervical third of the distal root canal.The root canal and prosthodontic treatments successfully proceeded subsequently.CONCLUSION Our newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.展开更多
BACKGROUND The incidence rate of severely curved root canals in mandibular molars is low,and the root canal treatment of mandibular molars with this aberrant canal anatomy may be technically challenging.CASE SUMMARY A...BACKGROUND The incidence rate of severely curved root canals in mandibular molars is low,and the root canal treatment of mandibular molars with this aberrant canal anatomy may be technically challenging.CASE SUMMARY A 26-year-old Chinese female patient presented with intermittent and occlusal pain in the left mandibular second molar.The patient had undergone filling restoration for caries before endodontic consultation.With the aid of cone beam computed tomography(CBCT),a large periapical radiolucency was observed,and curved root canals in a mandibular second molar were confirmed,depicting a severe and curved distolingual root.Nonsurgical treatments,including novel individualized preparation skills and techniques and the use of bioceramic materials as an apical barrier,were performed,and complete healing of the periapical lesion and a satisfactory effect were achieved.CONCLUSION A case of severely curved root canals in a mandibular second molar was successfully treated and are reported herein.The complex anatomy of the tooth and the postoperative effect were also evaluated via the three-dimensional reconstruction of CBCT images,which accurately identified the aberrant canal morphology.New devices and biomaterial applications combined with novel synthesis techniques can increase the success rate of intractable endodontic treatment.展开更多
BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiqu...BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.展开更多
BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need...BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need for a multidisciplinary diagnostic and treatment approach.AIM To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal the-rapy in the treatment of severe odontogenic maxillary sinusitis caused by peria-pical periodontitis.METHODS The clinical data,diagnosis,and treatment of 200 patients with severe odonto-genic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively.Among them,63 patients were treated with simple root canal therapy as the control group,and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group.The therapeutic effect,Lund-Kennedy endoscopic score,paranasal sinus Lund-Mackay score,complication rate,recurrence rate,and patient satisfaction were compared between the two groups.RESULTS First,we compared the effective rates:23 cases were cured,22 were improved,and 8 were ineffective in the control group,yielding a total effective rate of 84.90%.Meanwhile,97 cases were cured,34 improved,and 6 were ineffective in the observation group,resulting in a total effective rate of 95.62%.The observation group had a higher total effective rate compared with the control group(P<0.05).Second,we compared the Lund–Kennedy endoscopic score.Before treatment,no significant difference(P>0.05)was observed in this score between the two groups.After treatment,the Lund–Kennedy endoscopic score decreased in both groups.The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group(P<0.05).Third,we compared the Lund–Mackay score of paranasal sinuses.Before treatment,there was no significant difference in this score between the two groups(P>0.05).After treatment,the Lund–Mackay scores of paranasal sinuses decreased in both groups.The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group(P<0.05).Fourth,we compared the incidence and recurrence rate of complications.Three months after treatment,no significant difference was found in the incidence and recurrence rate of complications between the observation group(6.56%)and the control group(9.52%)(P>0.05).However,6 mo after treatment,the incidence and recurrence rate of complications in the observation group(2.91%)was significantly higher compared to that of the control group(12.69%)(P<0.05).Fifth,we compared patient satisfaction.Six months after treatment,the patient satisfaction of the observation group(93.43%)was significantly better than that of the control group(84.12%)(P<0.05).CONCLUSION Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis,and it can reduce the injury of maxillary sinus mucosa and bone,and significantly reduce the incidence of complications and recurrence rate.Meanwhile,it has high patient satisfaction and remarkable therapeutic effect,which is suggested to be popularized and applied in clinic.展开更多
Sixteen fresh extracted human teeth paired according to their anatomic locations,were divided into two groups at random.The root canais of the teeth in Group 1 were preparedwith an ultrasonic unit and those of Group 2...Sixteen fresh extracted human teeth paired according to their anatomic locations,were divided into two groups at random.The root canais of the teeth in Group 1 were preparedwith an ultrasonic unit and those of Group 2 with hand instruments.Then,the specimens wereobserved under a scanning electron microscope and their pnotographs were taken.Blindevaluation of cleanness was performed for each canal.Statistical dnalysis of the data indicatesthat the canal walls were cleaner in Group 1 than in Group 2 and that the ultrasonic preparationtook less time.展开更多
Background and Purpose: Despite the strong body of evidence for vestibular rehabilitation, research is lacking for effective clinical management of patients with superior semicircular canal dehiscence (SSCD) and endol...Background and Purpose: Despite the strong body of evidence for vestibular rehabilitation, research is lacking for effective clinical management of patients with superior semicircular canal dehiscence (SSCD) and endolymphatic hydrops (EH). The purpose of this case report is to describe the effects of physical therapy in the treatment of a patient diagnosed with bilateral SSCD. Case Description: The patient was a 56-year-old woman with a long-standing otologic history involving bilateral SSCD and EH. The patient’s body structure and function impairments include constant headaches, dizziness with head rotation and eye movements, sensitivity to sounds and lights, and instability during gait. Her activity limitations include lower extremity dressing, driving, and playing her flute. Her participation restrictions include taking part in social gatherings, going to church, driving longer than 30 minutes, playing with her dogs, and teaching flute lessons. Interventions: Specific interventions included vestibular habituation and adaptation exercises, balance and gait training, and patient education. Physical therapy services were provided for approximately 11 weeks with a frequency of two times per week. Outcomes: After eleven weeks of physical therapy, the patient made improvements on the Lower Extremity Functional Scale (43/80 to 52/80), the Dynamic Gait Index (19/24 to 24/24), the Dizziness Handicap Inventory (86/100 to 68/100), and the Sharpened Romberg (2 seconds to >30 seconds). The patient improved in all her activity limitations and participation restrictions. She was able to play her flute for 20-minute intervals, play with her dogs, partake in social gatherings, and drive for 5 hours without symptoms. The patient had plans to pursue surgical intervention within the next year. Discussion: For a patient with a complex otologic history and a current diagnosis of bilateral SSCD, vestibular rehabilitation was an effective management option. The information from this case can be used to guide the effective treatment of similar patients diagnosed with vestibular dysfunction.展开更多
Purpose: The aim of this systematic review was to answer the question “Which treatment protocol, am- ong classical methods and/or various laser applica- tions is the most effective in root canal disinfection, in vitr...Purpose: The aim of this systematic review was to answer the question “Which treatment protocol, am- ong classical methods and/or various laser applica- tions is the most effective in root canal disinfection, in vitro”. Materials and Methods: A MEDLINE, a Co- chrane and an Embase search (three specified search- es) were conducted to identify randomized controlled trials (RCT) until June 2010, conducted on human teeth and published in English, German or French language, examining the root canal disinfection after the use of lasers with or without mechanical instru-mentation. Additionally, hand search was conducted and contact with authors, when needed. Results: The MEDLINE, the Cochrane and the EMBASE search identified 240, 28, and 35 published articles, respec-tively. Ten articles from the MEDLINE and 5 articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and va-lidity assessment criteria. In E. faecalis elimination, instrumentation of the root canal and diode laser/665 nanometer/1 Watt (diode laser/665 nm/1 W) irradia-tion with the combined effect of Methylene Blue (MB) as photosensitizing agent (logCFU/ml = 1636) seemed to be the best method. In P. aeruginosa and in A.naeslundii elimination, instrumentation of the root canal followed by irrigation with 5, 25% NaOCl (log-CFU/ml = 0) seemed to be the best method. In gen-eral, instrumentation of the root canal followed by irrigation with 5, 25% NaOCl (logCFU/ml = 0) and instrumentation of the root canal and Er: YAG laser/ 2940 nm/0.8 W irradiation (logCFU/ml = 1924) seemed to be the best (polymicrobial studies). Conclusions: There are treatment protocols with the assistance or not of laser irradiation that can eliminate E. faecalis, E. coli and S. aureus inside the root canal. However, there is a serious number of S. anginosus, F. nuclea-tum, A. naeslundii and P. aeruginosa that remain in-side the root canal even after laser irradiation. New research is needed in order to set a treatment proto-col effective in the root canal disinfection from all bac-teria that are related to endodontic origin pathology.展开更多
AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospi...AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively.Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments.RESULTS:Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation.Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5-245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5-27) months. Six patients had a long-term survival.CONCLUSION:Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N2-3 tumors.展开更多
AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.METHODS: Literature was researched in CNKI and CBMDisc, Pu...AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.METHODS: Literature was researched in CNKI and CBMDisc, Pub Med, CALIS, Proquest, Web of Scienceand 11 kinds of Chinese or English dentistry journals. Retrieval time on Internet was in all years and hand retrieval time was from January 2013 to October 2013. The literatures were selected through reading abstracts and full texts by two reviewers independently and Revman 5 software was used to analysize the literature. RESULTS: Six articles met the inclusion criteria. According to Meta-analysis of tooth root bending properties, total standardized mean difference(SMD) was 0.63(95%CI:-0.24-1.50, P > 0.05). That indicated there was no statistically significant between the two groups. Subgroup analysis was carried out. SMD were 2.22(95%CI: 0.23-4.20, P < 0.05) and-0.61(95%CI:-1.05--0.17, P < 0.05) when the premolar teeth with a single canal or the mesiobuccal roots of molars were used as the materials for tests to compare the effects of different root canal preparation methods on root fracture resistance. That only indicated that there were statistically significant in two subgroups.CONCLUSION: In vitro experiments, the effects on the fracture resistance of root had no statistical difference with Ni-Ti rotary instruments and stainless steel hand instruments in root canal preparation.展开更多
In this paper, we explore the diagnosis and treatment of hemangiopedcytoma （HPC）. A rare case of HPC in the vertebral canal of thoracic segments is reported, and the clinical features as well as treatment approaches...In this paper, we explore the diagnosis and treatment of hemangiopedcytoma （HPC）. A rare case of HPC in the vertebral canal of thoracic segments is reported, and the clinical features as well as treatment approaches of similar cases in the literature are discussed. In the present case, we operatively resected the tumor and performed postoperative radiation therapy, with good treatment results.展开更多
文摘Maxillary first molar usually exhibits a radicular anatomy of three roots and three or four canals. However, different anatomic variations like extra number of roots and canals are possible. For a successful treatment, clinicians must have well equipment and a thorough knowledge of the external and internal anatomy of teeth and its variation. Using of CBCT may help to locate extra canals by giving a chance to clinicians to see the root canal anatomy in 3-D view. The aim of this study was to present a case report about a diagnosis and treatment in maxillary first molar with three roots and five canals. It is concluded that the diagnosing and the treatment of unusual cases are key factors for successful endodontic treatment of these teeth.
基金Supported by Health and Medical Research Fund of the Food and Health Bureau,Hong Kong,China,No.06171376Natural Science Foundation of Anhui Province,China,No.2008085MH255Scientific Research Funding of Anhui Medical University,China,No.2020xkj148。
文摘BACKGROUND TypeⅢb dens invaginatus(DI)with a lateral canal located at the mid-third of the root is rarely reported.Here,we report a rare case of typeⅢb DI in the left upper anterior tooth with a lateral canal that led to persistent periodontitis.CASE SUMMARY A 15-year-old female patient presented with a chief complaint of pain associated with recurrent labial swelling in the area of the left anterior tooth.A diagnosis of typeⅢb DI and chronic periodontitis was made.Intentional replantation was performed after conventional endodontic treatment failed.After 6 mo,the patient was asymptomatic,but a sinus tract was observed.Cone-beam computed tomography images showed bone loss in the mesial of the mid-root.Based on methylene blue staining and microscopy images,the lateral foramen located at the middle third of the root was surgically treated.After 3 years of follow-up,the clinical findings and radiographic assessment presented a favorable prognosis of bone healing without root absorption or ankylosis.CONCLUSION TypeⅢb DI with a lateral canal can be successfully treated by root canal treatment,intentional replantation,and surgical therapy.
文摘Objective: To explore the clinical efficacy of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy and the effect on the serum inflammatory cytokines. Methods: A total of 156 patients with gingival pain and swelling after root canal therapy due to dental pulp necrosis were included in the study and randomized into the control group (n=78) and teh treatment group (n=78). The patients in the control group were given metronidazole tablets. On the above basis, the patients in the treatment group were given local injection of neurogrowth factors. 10-day treatment was regarded as one course, and the patients were continuously treated for 2 courses. The improvement of clinical symptoms before and after treatment in the two groups was evaluated. Gingival sulcus index and serum inflammatory cytokines before and after treatment in the two groups were detected and compared. Results: When compared with before treatment, the periodontal soft tissue swelling, tooth mobility, and periapical pain scores after treatment in the two groups were significantly reduced, and those in the treatment group were significantly lower than those in the control group. When compared with before treatment, the gingival sulcus bleeding index 1 and 2 courses after treatment in the two groups was significantly reduced, and that 2 courses after treatment was significantly lower than that after 1 course treatment. The gingival sulcus bleeding index 1 and 2 courses after treatment in the treatment group was significantly lower than that in the control group. When compared with before treatment, the serum IL-8 and IL-6 levels after treatment in the two groups, and TNF-α level after treatment in the treatment group were significantly reduced, and the above indicators in the treatment group were significantly lower than those in the control group. Conclusions: The neurogrowth factors in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy can effectively improve the clinical symptoms, and inhibit the inflammatory reaction, with a significant efficacy.
文摘BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.
基金the Youth Development Project of Army Military Medical University,No.2018XQN014the Clinical Innovation Project of Army Military Medical University,No.2019XLC2014the Science and Technology Foundation of Chongqing,China,No.cstc2014jcyjA10092.
文摘BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars located at the end of the dental arch.However,advancements in digital dental diagnosis and treatment techniques can solve these problems.Here,we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel“inlay-guided endodontics”technique based on improved computer-generated programs.CASE SUMMARY A 63-year-old man complained of a defect in the maxillary left second molar.The tooth,diagnosed with post-treatment endodontic disease,was initially treated by conventional methods,which were ineffective.Our“inlay-guided endodontics”technique was subsequently adopted,with the establishment of a precise integrated three-dimensional(3D)plate model of cone-beam computed tomography data and a digital impression of the dentition.An optimal root canal approach was generated for the“virtual file”in the 3D model.The plate data were imported into a 3D printer and printed.With the help of the guide plate,the file was accurately placed into the cervical third of the distal root canal.The root canal and prosthodontic treatments successfully proceeded subsequently.CONCLUSION Our newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.
基金Supported by Natural Science Foundation of Hunan Province,No.S2021JJQNJJ1682Changsha Municipal Natural Science Foundation,No.kq 2014215.
文摘BACKGROUND The incidence rate of severely curved root canals in mandibular molars is low,and the root canal treatment of mandibular molars with this aberrant canal anatomy may be technically challenging.CASE SUMMARY A 26-year-old Chinese female patient presented with intermittent and occlusal pain in the left mandibular second molar.The patient had undergone filling restoration for caries before endodontic consultation.With the aid of cone beam computed tomography(CBCT),a large periapical radiolucency was observed,and curved root canals in a mandibular second molar were confirmed,depicting a severe and curved distolingual root.Nonsurgical treatments,including novel individualized preparation skills and techniques and the use of bioceramic materials as an apical barrier,were performed,and complete healing of the periapical lesion and a satisfactory effect were achieved.CONCLUSION A case of severely curved root canals in a mandibular second molar was successfully treated and are reported herein.The complex anatomy of the tooth and the postoperative effect were also evaluated via the three-dimensional reconstruction of CBCT images,which accurately identified the aberrant canal morphology.New devices and biomaterial applications combined with novel synthesis techniques can increase the success rate of intractable endodontic treatment.
文摘BACKGROUND Following the successful Perioperative Surgical Home(PSH)practice for total knee arthroplasty(TKA)at our institution,the need for continuous improvement was realized,including the deimplementation of antiquated PSH elements and introduction of new practices.AIM To investigate the transition from femoral nerve blocks(FNB)to adductor canal nerve blocks(ACB)during TKA.METHODS Our 13-month study from June 2016 to 2017 was divided into four periods:a three-month baseline(103 patients),a one-month pilot(47 patients),a three-month implementation and hardwiring period(100 patients),and a six-month evaluation period(185 patients).In total,435 subjects were reviewed.Data within 30 postoperative days were extracted from electronic medical records,such as physical therapy results and administration of oral morphine equivalents(OME).RESULTS Our institution reduced FNB application(64% to 3%)and increased ACB utilization(36% to 97%)at 10 mo.Patients in the ACB group were found to have increased ambulation on the day of surgery(4.1 vs 2.0 m)and lower incidence of falls(0 vs 1%)and buckling(5% vs 27%)compared with FNB patients(P<0.05).While ACB patients(13.9)reported lower OME than FNB patients(15.9),the difference(P=0.087)did not fall below our designated statistical threshold of P value<0.05.CONCLUSION By demonstrating closure of the“knowledge to action gap”within 6 mo,our institution’s findings demonstrate evidence in the value of implementation science.Physician education,technical support,and performance monitoring were deemed key facilitators of our program’s success.Expanded patient populations and additional orthopedic procedures are recommended for future study.
文摘BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need for a multidisciplinary diagnostic and treatment approach.AIM To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal the-rapy in the treatment of severe odontogenic maxillary sinusitis caused by peria-pical periodontitis.METHODS The clinical data,diagnosis,and treatment of 200 patients with severe odonto-genic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively.Among them,63 patients were treated with simple root canal therapy as the control group,and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group.The therapeutic effect,Lund-Kennedy endoscopic score,paranasal sinus Lund-Mackay score,complication rate,recurrence rate,and patient satisfaction were compared between the two groups.RESULTS First,we compared the effective rates:23 cases were cured,22 were improved,and 8 were ineffective in the control group,yielding a total effective rate of 84.90%.Meanwhile,97 cases were cured,34 improved,and 6 were ineffective in the observation group,resulting in a total effective rate of 95.62%.The observation group had a higher total effective rate compared with the control group(P<0.05).Second,we compared the Lund–Kennedy endoscopic score.Before treatment,no significant difference(P>0.05)was observed in this score between the two groups.After treatment,the Lund–Kennedy endoscopic score decreased in both groups.The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group(P<0.05).Third,we compared the Lund–Mackay score of paranasal sinuses.Before treatment,there was no significant difference in this score between the two groups(P>0.05).After treatment,the Lund–Mackay scores of paranasal sinuses decreased in both groups.The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group(P<0.05).Fourth,we compared the incidence and recurrence rate of complications.Three months after treatment,no significant difference was found in the incidence and recurrence rate of complications between the observation group(6.56%)and the control group(9.52%)(P>0.05).However,6 mo after treatment,the incidence and recurrence rate of complications in the observation group(2.91%)was significantly higher compared to that of the control group(12.69%)(P<0.05).Fifth,we compared patient satisfaction.Six months after treatment,the patient satisfaction of the observation group(93.43%)was significantly better than that of the control group(84.12%)(P<0.05).CONCLUSION Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis,and it can reduce the injury of maxillary sinus mucosa and bone,and significantly reduce the incidence of complications and recurrence rate.Meanwhile,it has high patient satisfaction and remarkable therapeutic effect,which is suggested to be popularized and applied in clinic.
文摘Sixteen fresh extracted human teeth paired according to their anatomic locations,were divided into two groups at random.The root canais of the teeth in Group 1 were preparedwith an ultrasonic unit and those of Group 2 with hand instruments.Then,the specimens wereobserved under a scanning electron microscope and their pnotographs were taken.Blindevaluation of cleanness was performed for each canal.Statistical dnalysis of the data indicatesthat the canal walls were cleaner in Group 1 than in Group 2 and that the ultrasonic preparationtook less time.
文摘Background and Purpose: Despite the strong body of evidence for vestibular rehabilitation, research is lacking for effective clinical management of patients with superior semicircular canal dehiscence (SSCD) and endolymphatic hydrops (EH). The purpose of this case report is to describe the effects of physical therapy in the treatment of a patient diagnosed with bilateral SSCD. Case Description: The patient was a 56-year-old woman with a long-standing otologic history involving bilateral SSCD and EH. The patient’s body structure and function impairments include constant headaches, dizziness with head rotation and eye movements, sensitivity to sounds and lights, and instability during gait. Her activity limitations include lower extremity dressing, driving, and playing her flute. Her participation restrictions include taking part in social gatherings, going to church, driving longer than 30 minutes, playing with her dogs, and teaching flute lessons. Interventions: Specific interventions included vestibular habituation and adaptation exercises, balance and gait training, and patient education. Physical therapy services were provided for approximately 11 weeks with a frequency of two times per week. Outcomes: After eleven weeks of physical therapy, the patient made improvements on the Lower Extremity Functional Scale (43/80 to 52/80), the Dynamic Gait Index (19/24 to 24/24), the Dizziness Handicap Inventory (86/100 to 68/100), and the Sharpened Romberg (2 seconds to >30 seconds). The patient improved in all her activity limitations and participation restrictions. She was able to play her flute for 20-minute intervals, play with her dogs, partake in social gatherings, and drive for 5 hours without symptoms. The patient had plans to pursue surgical intervention within the next year. Discussion: For a patient with a complex otologic history and a current diagnosis of bilateral SSCD, vestibular rehabilitation was an effective management option. The information from this case can be used to guide the effective treatment of similar patients diagnosed with vestibular dysfunction.
文摘Purpose: The aim of this systematic review was to answer the question “Which treatment protocol, am- ong classical methods and/or various laser applica- tions is the most effective in root canal disinfection, in vitro”. Materials and Methods: A MEDLINE, a Co- chrane and an Embase search (three specified search- es) were conducted to identify randomized controlled trials (RCT) until June 2010, conducted on human teeth and published in English, German or French language, examining the root canal disinfection after the use of lasers with or without mechanical instru-mentation. Additionally, hand search was conducted and contact with authors, when needed. Results: The MEDLINE, the Cochrane and the EMBASE search identified 240, 28, and 35 published articles, respec-tively. Ten articles from the MEDLINE and 5 articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and va-lidity assessment criteria. In E. faecalis elimination, instrumentation of the root canal and diode laser/665 nanometer/1 Watt (diode laser/665 nm/1 W) irradia-tion with the combined effect of Methylene Blue (MB) as photosensitizing agent (logCFU/ml = 1636) seemed to be the best method. In P. aeruginosa and in A.naeslundii elimination, instrumentation of the root canal followed by irrigation with 5, 25% NaOCl (log-CFU/ml = 0) seemed to be the best method. In gen-eral, instrumentation of the root canal followed by irrigation with 5, 25% NaOCl (logCFU/ml = 0) and instrumentation of the root canal and Er: YAG laser/ 2940 nm/0.8 W irradiation (logCFU/ml = 1924) seemed to be the best (polymicrobial studies). Conclusions: There are treatment protocols with the assistance or not of laser irradiation that can eliminate E. faecalis, E. coli and S. aureus inside the root canal. However, there is a serious number of S. anginosus, F. nuclea-tum, A. naeslundii and P. aeruginosa that remain in-side the root canal even after laser irradiation. New research is needed in order to set a treatment proto-col effective in the root canal disinfection from all bac-teria that are related to endodontic origin pathology.
文摘AIM:To evaluate the results of salvage resection in the management of persistent or locally recurrent anal canal cancer.METHODS: Details of all patients with anal canal cancer treated from 1978 to 1994 at Cancer Hospital of Chinese Academy of Medical Sciences (CAMS) were reviewed retrospectively.Sixteen patients who presented with persistent or locally recurrent anal canal cancer received salvage surgery. Before surgery all of the patients had received radiotherapy alone as their primary treatments.RESULTS:Of the 16 patients, 14 received salvage abdominoperineal resection (APR) and two had transanal local excision. There were no deaths attributable to operation.Delayed healing of the perineal wound occurred in eight patients. Complications unrelated to the perineal wound were found in five patients. The median follow-up time was 120 (range 5-245) months after salvage surgery. Nine patients died of disease progression, with a median survival time of 16 (range 5-27) months. Six patients had a long-term survival.CONCLUSION:Salvage resection after radiotherapy can yield a long-time survival in selected patients with anal canal cancer. However it offers little hope to patients with T4 and/or N2-3 tumors.
文摘AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.METHODS: Literature was researched in CNKI and CBMDisc, Pub Med, CALIS, Proquest, Web of Scienceand 11 kinds of Chinese or English dentistry journals. Retrieval time on Internet was in all years and hand retrieval time was from January 2013 to October 2013. The literatures were selected through reading abstracts and full texts by two reviewers independently and Revman 5 software was used to analysize the literature. RESULTS: Six articles met the inclusion criteria. According to Meta-analysis of tooth root bending properties, total standardized mean difference(SMD) was 0.63(95%CI:-0.24-1.50, P > 0.05). That indicated there was no statistically significant between the two groups. Subgroup analysis was carried out. SMD were 2.22(95%CI: 0.23-4.20, P < 0.05) and-0.61(95%CI:-1.05--0.17, P < 0.05) when the premolar teeth with a single canal or the mesiobuccal roots of molars were used as the materials for tests to compare the effects of different root canal preparation methods on root fracture resistance. That only indicated that there were statistically significant in two subgroups.CONCLUSION: In vitro experiments, the effects on the fracture resistance of root had no statistical difference with Ni-Ti rotary instruments and stainless steel hand instruments in root canal preparation.
文摘In this paper, we explore the diagnosis and treatment of hemangiopedcytoma （HPC）. A rare case of HPC in the vertebral canal of thoracic segments is reported, and the clinical features as well as treatment approaches of similar cases in the literature are discussed. In the present case, we operatively resected the tumor and performed postoperative radiation therapy, with good treatment results.
