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Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2‐week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues. [ABSTRACT FROM AUTHOR]

This article describes a novel three-dimensional classification for external cervical resorption (ECR). The European Society of Endodontology and American Association of Endodontists & American Academy of Oral & Maxillofacial Radiology position statements advise that Cone beam computed tomography should be considered for the assessment and/or management of root resorption if it appears to be clinically amenable to treatment following clinical and conventional radiographic examination. The new classification takes into account the ECR lesion height (1: at CEJ level or coronal to the bone crest (supracrestal), 2: extends into the coronal third of the root and apical to the bone crest (subcrestal), 3: extends into the mid-third of the root, 4: extends into the apical third of the root), circumferential spread (A: ≤90° B: ≤180° C: ≤270° D: >270°) and proximity to the root canal (d: lesion confined to dentine, p: probable pulpal involvement), thus classifying ECR in three dimensions. At present, there is no classification to accurately describe ECR. This novel and clinically relevant three-dimensional classification should allow effective and accurate communication of ECR lesions between colleagues. It will also allow the effect of the nature of ECR on the outcome of treatment to be assessed objectively. [ABSTRACT FROM AUTHOR]

The article provides information on aspects related to role of gender in determining outcome of community acquired Staphylococcus aureus bacteraemia. Topics discussed include outcomes of infectious diseases, associated risks to mortality, behavioural and socio economic differences, and analysis population based medical registers.

Abstract: A novel, straightforward and high yielding synthesis of enantiomerically pure 2,6-disubstituted morpholines has been developed through the regioselective cyclization of diols. Cyclization precursors have been obtained by the ring opening of commercially available chiral epoxides under solid–liquid phase transfer catalysis conditions (SL-PTC). [Copyright &y& Elsevier]

Foschi F, Cavrini F, Montebugnoli L, Stashenko P, Sambri V, Prati C. Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients. Oral Microbiol Immunol 2005: 20: 289–295.© Blackwell Munksgaard, 2005. The presence of selected bacteria ( Enterococcus faecalis, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, Treponema denticola) in infected root canals was studied using polymerase chain reaction (PCR) assays, and the association of bacteria with clinical signs of endodontic disease was assessed. The null hypothesis, that no difference could be observed between clinical signs of apical periodontitis and a specific bacterial strain, was tested. Microbial samples were obtained from 62 teeth in 54 patients with endodontic disease. For each tooth, clinical data including patient symptoms were collected. Teeth were categorized by diagnosis as having acute apical periodontitis (AAP, teeth with clinical symptoms but no periapical radiolucency, n = 22), chronic apical periodontitis (CAP, teeth with radiolucency but no clinical symptoms, n = 15) or exacerbated apical periodontitis (EAP, teeth with symptoms and radiolucency, n = 25). Seventy-one percent of cases were primary endodontic infections, and 29% were recurrent (‘secondary’) endodontic infections (failing cases). PCR assays were used to detect the presence of the selected bacteria. T. denticola and E. faecalis were each detected in 15 of 62 samples (24%), P. gingivalis in 8 samples (13%), P. intermedia in 5 samples (8%), and T. forsythensis in 4 samples (7%). T. denticola was detected in 56% of teeth with EAP. E. faecalis was found in 60% of teeth with CAP and in 72% of teeth with secondary infection. Statistical analysis demonstrated an association of CAP and secondary endodontic infection with the presence of E. faecalis. ( P < 0.01). EAP was associated with the presence of T. denticola ( P < 0.01). T. denticola was associated with symptomatic endodontic disease in the presence of apical bone resorption. E. faecalis was associated with treatment failures. We suggest that these species may play critical roles in endodontic pathology. [ABSTRACT FROM AUTHOR]

Foschi F, Nucci C, Montebugnoli L, Marchionni S, Breschi L, Malagnino VA, Prati C.SEM evaluation of canal wall dentine following use of Mtwoand ProTaper NiTi rotary instruments.International Endodontic Journal,37, 832–839, 2004.To compare using scanning electron microscopy (SEM) root canal walls following instrumentationin vitrowith two different rotary NiTi instruments. The hypothesis was that no difference should be observable between the experimental groups in terms of debris on canal walls and surface morphology.Twenty-four single-rooted human teeth were selected. Two types of NiTi instruments were used, Mtwo(Sweden&Martina, Padova, Italy) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland). Irrigation for both groups was performed after each instrument change with 5% NaOCl, 3% H2O2 and 17% EDTA solutions. Three different areas (coronal, middle and apical thirds) of the root canal were evaluated using SEM. The canal wall of each sample was assessed and compared using a predefined scale of four parameters, namely, smear layer, pulpal debris, inorganic dentine debris, surface profile. Data were analysed statistically using the Kruskal–Wallis test (anova).A statistically significant difference (P <0.01) was found between the apical third and the middle and coronal thirds for both groups. No difference was observable between instrumentation groups. In the apical third canal walls were often contaminated by inorganic debris and by smear layer. In the apical third, the surface profile was affected by uninstrumented regions, comprising dentine depressions and grooves in which predentine was still visible.Both instruments produced a clean and debris-free dentine surfaces in the coronal and middle thirds, but were unable to produce a dentine surfaces free from smear layer and debris in the apical third. The presence of deep grooves and depression on dentine walls in the apical third may well explain the presence of less-instrumented areas. [ABSTRACT FROM AUTHOR]

Highlights two cases of myocardial infarction (MI) that followed a Mueller degree 4 reactions to Hymenoptera sting and the recommendation for allergen-specific systemic immunotherapy. Skin prick tests and specific IgE evaluation after MI; Characteristics of anaphylactic reactions.

Aim To assess in an ex vivo model the accuracy of detection of simulated periapical lesions using two cone-beam computed tomography (CBCT) dose modes and periapical radiography. Methodology Small and large artificial periapical lesions were created with burs at the base of the socket of eleven mandibular molars, in seven human dry mandibles. Digital periapical radiographs, 360° and 180° rotations CBCT scans with standard dose and dose reduction (DR) modes were obtained before and after periapical lesions were prepared. Six blinded examiners scored the presence/absence of lesions. Inter- and intra-examiner reliability were determined. Sensitivity, specificity, positive predictive values and negative predictive values and receiver operating characteristic (ROC) area under the curve (overall accuracy) were determined for each modality. Results The mean sensitivity and specificity of both CBCT rotations with dose reduction mode were higher compared to that of standard dose CBCT scans. The ROC Az mean values for periapical radiographs, 360° scan with standard dose and dose reduction and 180° scans with standard dose and dose reduction were 0.62, 0.94, 0.95, 0.95 and 0.97, respectively. No significant difference in the diagnostic accuracy of CBCT scans taken with standard and dose reduction modes, whilst their accuracy was significantly higher than periapical radiographs. Conclusions Using dose reduction with 360° and 180° CBCT scans demonstrated good diagnostic accuracy in the detection of simulated periapical lesions whilst reducing the radiation dose by 54% and 51%, respectively, compared to conventional settings. Clinical evaluation is now needed to determine whether this is applicable to patients. [ABSTRACT FROM AUTHOR]

Aim Part 2 of this prospective clinical study aimed to compare the 1-year outcome of root canal retreatments, when individual roots and teeth were assessed by periapical radiographs and cone beam computed tomography (CBCT). Methodology Subjects participating in this study had been referred for management of an endodontic problem associated with one or more root filled teeth. Root canal retreatment was performed by Specialists or postgraduate students under the direct supervision of Specialist endodontic staff. A total of 98 teeth (84 patients) were reassessed clinically and radiographically 1 year after completion of root canal retreatment. The postoperative periapical radiographs and CBCT scans were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The increase or decrease in size of existing periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two calibrated examiners. They also determined an appropriate management plan for each case based on the radiographical findings. Comparison of the outcome diagnosis of individual roots and teeth and case management, when assessed by periapical radiographs and CBCT scans, was performed using chi-squared and McNemar's tests. Results An overall favourable result of 93% success for teeth (96% roots) was recorded when the assessment was undertaken by periapicals compared with 77% success for teeth (87% roots) when assessed by CBCT. A significant difference in outcome diagnosis of single paired roots ( P < 0.0001) and teeth ( P = 0.0001) was observed when comparing periapicals to CBCT for the cohort of teeth as a whole. When comparing the future management plan on the basis of radiographic information alone, there was a significant difference between periapicals and CBCT-based management ( P = 0.01). Conclusion Diagnosis using CBCT revealed a significantly lower number of favourable outcomes than periapicals in root canal retreatment. This significantly affected the future management of cases attending for a review. [ABSTRACT FROM AUTHOR]

Stern S, Patel S, Foschi F, Sherriff M, Mannocci F. Changes in centring and shaping ability using three nickel-titanium instrumentation techniques analysed by micro-computed tomography (μCT). International Endodontic Journal, 45, 514-523, 2012. Abstract Aim To compare the centring ability and the shaping ability of ProTaper (PT) files used in reciprocating motion and PT and Twisted Files (TF) used in continuous rotary motion, and to compare the volume changes obtained with the different instrumentation techniques using micro-computed tomography. Methodology Sixty mesial canals of thirty mandibular molars were randomly assigned to three instrumentation techniques: group 1, canals prepared with the PT series (up to F2) ( n = 20); group 2, canals prepared with the F2 PT in reciprocating motion ( n = 20); group 3 canals prepared with the TF series (size 25) ( n = 20). Teeth were scanned pre- and post-operatively using micro-computed tomography to measure volume and shaping changes, and the obtained results were statistically analysed using parametric tests. Results The increase in canal volume obtained with the three instrumentation techniques was not significantly different. Canals were transported mostly towards the mesial aspect in the apical- and mid-third of the roots, and towards the furcal aspect coronally. No difference in the transportation and centring ratio was found between the techniques. There was no significant difference between the times of instrumentation (TF: 62.5 ± 5.4 s; PT: 60.6 ± 3.9 s; and F2 PT file in reciprocating motion: 51.0 ± 3.3 s). Conclusions ProTaper files used in reciprocating motion and PT and TF used in continuous rotary motion were capable of producing centred preparations with no substantial procedural errors. [ABSTRACT FROM AUTHOR]

Lennon S, Patel S, Foschi F, Wilson R, Davies J, Mannocci F. Diagnostic accuracy of limited-volume cone-beam computed tomography in the detection of periapical bone loss: 360° scans versus 180° scans. International Endodontic Journal, 44, 1118-1127, 2011. Abstract Aim To investigate the effect of reducing limited-volume cone-beam computed tomographs arc of rotation from 360° to 180° on the ability to diagnose small, artificially created apical lesions. Methodology Small, artificial apical bone lesions were prepared with a bur in the apical region of the distal root of ten mandibular first molars, in human dry mandibles. The jaws were scanned in a fixed position with limited-volume CBCT making a 360° and 180° arc of rotation, before and after each periapical lesion had been created. A 4 × 4 cm field of view was used at 90 kV, with a current of 4 mA. Ten examiners blinded to the scan parameters and controls scored the presence/absence of bone lesions. Intra-examiner reliability was determined after 2 weeks, reviewing half the data set. Statistical analyses with paired t-tests determined the diagnostic accuracy of the two modalities (360° vs. 180°) in terms of sensitivity, specificity, receiver operating characteristic area under the curve, positive predictive values and negative predictive values. Results The mean values for sensitivity of the 360° and 180° scans were 0.91 and 0.89, respectively; their mean specificities were 0.73. No significant differences were reflected in the statistical analyses. Conclusions Both 360° and 180° cone-beam computed tomography scans yielded similar accuracy in the detection of artificial bone lesions. The use of 180° scans might be advisable to reduce the radiation dose to the patient in line with the ICRP guidance to use as low a dosage as reasonably achievable. [ABSTRACT FROM AUTHOR]

Intracellular free calcium concentration, phosphoinositide turnover, and inositol phosphate production were analyzed in peripheral blood lymphocytes from seven well-nourished alcoholic patients without severe acute or chronic liver disease, before and after stimulation with anti-CD3 antibody. Seven comparable nondrinkers were studied as controls. A lower increase in intracellular free calcium concentration was detected in alcoholics, after anti-CD3 stimulation of lymphocytes, than in control subjects. Lymphocyte activation generated inositol phosphates in both controls and alcoholics, but inositol phosphate production was significantly lower in alcoholics. The agreement between these findings indicates that the reduction in inositol phosphates is one of the most important events in the early phases of lymphocyte activation in alcoholics. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To provide an estimate of the proportion of successful outcomes of primary and secondary root canal treatments (retreatments) determined by periapical radiographs and cone beam computed tomography (CBCT), a pooled analysis of the data collected from three previous prospective clinical outcome studies was undertaken. Methodology: The analysis pooled the 1‐year results for 354 teeth, including 123 primary treatments and 231 retreatments. All root canals were instrumented with ProTaper Universal and filled using a warm vertical condensation technique. Comparisons of favourable results between root canal treatments and retreatments and between different tooth types were made using chi‐square/Fisher's exact test. Results: The overall percentage of favourable results was 91% using periapical radiographs and 80% for CBCT (P < 0.001). With CBCT, the percentage of favourable results for primary treatments (84.7%) was not significantly different (P = 0.316) from that of retreatments (77.9%). When assessed by tooth group, the overall percentage of favourable results with CBCT was 75.5%, 90.6% and 91.1% for molar, premolar and anterior teeth, respectively. When CBCT is used to assess the outcome, the proportion of favourable outcomes in molars was significantly lower than that of premolars and anterior teeth (P < 0.05). Teeth with root fillings terminating more than 2 mm short of the radiographic apex had less favourable outcomes (73%) compared to long (83%) and adequate root filling length (84%). Conclusions: The proportions of favourable outcomes of primary root canal treatments and retreatments assessed with CBCT were lower when compared to periapical radiographs, and also lower than those historically reported by periapical radiograph‐based outcome studies. Considering the very high favourable outcome of anterior teeth and premolars compared to molar teeth, future studies assessing the effect of new materials and techniques on the outcome of root canal treatments should be based on preoperative and postoperative CBCT images, and focus on molar teeth. [ABSTRACT FROM AUTHOR]

The article describes the case of a woman aged 83 diagnosed with primary cutaneous diffuse large B cell lymphoma-leg type (PCDLBCL-LT). It outlines the symptoms of the patient and the findings of her physical and laboratory examination. It relates the outcome of the immunochemotherapy administered to the patient and the results of lenalidomide therapy after her lymphoma progressed at both legs.

Long-term functional outcomes of sofosbuvir-based antiviral treatment were evaluated in a cohort study involving 16 Italian centres within the international compassionate use programme for post-transplant hepatitis C virus ( HCV) recurrence. Seventy-three patients with cirrhosis (n=52) or fibrosing cholestatic hepatitis ( FCH, n=21) received 24-week sofosbuvir with ribavirin±pegylated interferon or interferon-free sofosbuvir-based regimen with daclatasvir/simeprevir+ribavirin. The patients were observed for a median time of 103 (82-112) weeks. Twelve of 73 (16.4%) died (10 non- FCH, 2 FCH) and two underwent re- LT. Sustained virological response was achieved in 46 of 66 (69.7%): 31 of 47 (66%) non- FCH and 15 of 19 (79%) FCH patients. All relapsers were successfully retreated. Comparing the data of baseline with last follow-up, MELD and Child-Turcotte-Pugh scores improved both in non- FCH (15.3±6.5 vs 10.5±3.8, P<.0001 and 8.4±2.1 vs 5.7±1.3, P<.0001, respectively) and FCH (17.3±5.9 vs 10.1±2.8, P=.001 and 8.2±1.6 vs 5.5±1, P=.001, respectively). Short-treatment mortality was higher in patients with baseline MELD≥25 than in those with MELD<25 (42.9% vs 4.8%, P=.011). Long-term mortality was 53.3% among patients with baseline MELD≥20 and 7.5% among those with MELD<20 ( P<.0001). Among deceased patients 75% were Child-Turcotte-Pugh class C at baseline, while among survivors 83.9% were class A or B ( P<.0001). Direct acting antivirals-based treatments for severe post-transplant hepatitis C recurrence, comprising fibrosing cholestatic hepatitis, significantly improve liver function, even without viral clearance and permit an excellent long-term survival. The setting of severe HCV recurrence may require the identification of 'too-sick-to-treat patients' to avoid futile treatments. [ABSTRACT FROM AUTHOR]

The availability of direct-acting antiviral agents ( DAA) regimens has expanded the pool of patients eligible for treatment. However, data on the virologic response and tolerability of DAAs in elderly patients are lacking. We evaluated the efficacy and safety of DAAs in patients with advanced fibrosis/cirrhosis in real-life practice with the focus on those aged ≥65 years. Between January and December 2015, all consecutive patients with HCV-related advanced fibrosis/cirrhosis treated with DAA at eleven tertiary referral centres in Emilia Romagna (Italy) were enrolled. Regimen choice was based on viral genotype and stage of disease, according to guidelines. The primary end point was sustained virologic response 12 weeks after the end of treatment ( SVR12). Overall, 282 of 556 (50.7%) patients evaluated were elderly, most of them with cirrhosis. Antiviral therapy was stopped prematurely in four (1.4%) patients. Two patients, both with cirrhosis, died during treatment due to worsening of liver/renal function. SVR12 was achieved by 94.7% and was comparable to that obtained in patients aged <65 ( P=.074). Similar data were also reported in subgroup of patients aged ≥75 years. All patients with advanced fibrosis achieved virologic response. SVR12 was 80.8% in Child-Pugh-Turcotte ( CTP)-B cirrhosis and 95.4% in CTP-A ( P=.013). According to genotype, the SVR12 was achieved in 172 of 181 (95%) with genotype 1b cirrhosis and in 44 of 48 (91.7%) with genotype 2 cirrhosis. In conclusions, in a real-world setting, DAAs are safe and effective in elderly patients with HCV-related advanced fibrosis/cirrhosis, but SVR12 is lower with worsening CTP class. [ABSTRACT FROM AUTHOR]

The article offers information on the unusual reaction to hymenoptera sting. The case of a 12-year-old girl who suffered from Schönlein-Henoch syndrome after a bee sting is discussed. It is noted that after three days, arthralgias was present on both ankles and knees. Schönlein-Henoch purpura is a form of vasculitis to hypersensitivity characterized by inflammation of the small vessels.

Background Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. Aim To assess how many years of life are lost after HCC diagnosis. Methods Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. Results Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour ≥2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. Conclusions Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) and alcohol abuse are the main risk factors for hepatocellular carcinoma (HCC) in Western countries. Aim To investigate the role of alcoholic aetiology on clinical presentation, treatment and outcome of HCC as well as on each Barcelona Clinic Liver Cancer (BCLC) stage, as compared to HCV-related HCCs. Methods A total of 1642 HCV and 573 alcoholic patients from the Italian Liver Cancer (ITA.LI.CA) database, diagnosed with HCC between January 2000 and December 2012 were compared for age, gender, type of diagnosis, tumour burden, portal vein thrombosis (PVT), oesophageal varices, liver function tests, alphafetoprotein, BCLC, treatment and survival. Aetiology was tested as predictor of survival in multivariate Cox regression models and according to HCC stages. Results Cirrhosis was present in 96% of cases in both groups. Alcoholic patients were younger, more likely male, with HCC diagnosed outside surveillance, in intermediate/ terminal BCLC stage and had worse liver function. After adjustment for the lead-time, median (95% CI) overall survival (OS) was 27.4 months (21.5-33.2) in alcoholic and 33.6 months (30.7-36.5) in HCV patients (P = 0.021). The prognostic role of aetiology disappeared when survival was assessed in each BCLC stage and in the Cox regression multivariate models. Conclusions Alcoholic aetiology affects survival of HCC patients through its negative effects on secondary prevention and cancer presentation but not through a greater cancer aggressiveness or worse treatment result. In fact, survival adjusted for confounding factors was similar in alcoholic and HCV patients. [ABSTRACT FROM AUTHOR]

Aim To investigate the dynamics of a disinfection regimen using 1% trypsin and 1% proteinase K in combination with 2% chlorhexidine (with or without ultrasonics) using a nutrient-stressed endodontic multispecies model biofilm. Methodology Nutrient-stressed biofilms ( Propionibacterium acnes, Staphylococcus epidermidis, Actinomyces radicidentis, Streptococcus mitis and Enterococcus faecalis OMGS 3202) were grown in prepared root canals of single-rooted teeth. The treatment groups included 1% trypsin and 2% chlorhexidine ( CHX), 1% proteinase K and 2% CHX (with and without ultrasonics). 2% CHX was the positive control and untreated group, and sterile saline (with and without ultrasonics) was the negative control. The biofilms were investigated using confocal laser scanning microscopy ( CLSM) with live/dead staining and quantitative microbial culture. Results The trypsin and CHX group with ultrasonics was significantly more effective in reducing viable counts and the substratum coverage than those of all other groups ( P < 0.05). The viable counts of the proteinase K and CHX group used with (4.26 ± 0.58 log10 cfu mL−1) or without ultrasonics (5.05 ± 1.36 log10 cfu mL−1) were significantly reduced ( P < 0.05) as compared with the untreated control (7.67 ± 0.84 log10 cfu mL−1) and saline groups used with (6.57 ± 0.73 log10 cfu mL−1) and without ultrasonics (6.74 ± 0.10 log10 cfu mL−1). The CHX group was less effective in biofilm disruption compared to when used in combination with trypsin and proteinase K. Conclusion The trypsin and CHX group with ultrasonics was significantly more effective at reducing bacterial viable counts and disrupting biofilm. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the bonding performance of model resin-based adhesives doped with bioactive glass or calcium-silicate modified dicalcium-phosphatedihydrate microfillers to root canal wet-dentine with water or ethanol. The experimental resin was prepared by using urethane-dimethacrylate (UDMA), triethylene-glycol-dimethacrylate (TEGDMA) and hydroxyethyl-methacrylate (HEMA). This resin blend was mixed with 50 wt% ethanol to create the experimental primers. Bioactive glass 45S5 (BAG) or calcium-silicate modified dicalcium-phosphate dihydrate (DCPD) microfillers were mixed at 40 wt% to the blend. The bonding performance to root canal was assessed by push-out bond strength, SEM analysis of fractures, and interfacial confocal microscopy after filling the canals with the core composite Bis-Core (Bisco). Three-way ANOVA (bonding technique, adhesive resin and dentine area) and Student-Newman-Keuls post-hoc were used to statistically compare the results (α=5%). Filler-free adhesive applied on water-wet dentine showed lower bond strength than the same resin applied on ethanol-wet dentine (p<0.05). Only the former group showed predominantly adhesive fractures whereas all other treatments led mostly to mixed failures. The presence of both fillers did not influence the push-out bond strength using ethanol-wet approach (p>0.05) but did improve using the water-wet strategy. BAG and DCPD also promoted mineral deposition and tubular occlusion in the well-hybridised fractured root surfaces especially using the ethanol-wet technique. The confocal interfacial analysis showed impaired resin infiltration only using the filler-free resin on water-wet dentine. As a conclusion, bioactive glass and DCPD micro-fillers as well as the ethanol-wet bonding were able to improve the adhesion of etch-and-rinse adhesives to radicular dentine. [ABSTRACT FROM AUTHOR]

Aim To establish a nutrient-stressed multispecies model biofilm and investigate the dynamics of biofilm killing and disruption by 1% trypsin and 1% proteinase K with or without ultrasonic activation. Methodology Nutrient-stressed biofilms ( Propionibacterium acnes, Staphylococcus epidermidis, Actinomyces radicidentis, Streptococcus mitis and Enterococcus faecalis OMGS 3202) were grown on hydroxyapatite discs and in prepared root canals of single-rooted teeth in modified fluid universal medium. The treatment groups included trypsin, proteinase K, 0.2% chlorhexidine gluconate and 1% sodium hypochlorite (Na OCl) (with and without ultrasonics). Na OCl and chlorhexidine were the positive controls and untreated group, and sterile saline was the negative control. The biofilms were investigated using confocal laser scanning microscopy ( CLSM) with live/dead staining and quantitative microbial culture. Results Nutrient stress in the multispecies biofilm was apparent as the medium pH became alkaline, glucose was absent, and serum proteins were degraded in the supernatant. The CLSM showed the percentage reduction in viable bacteria at the biofilm surface level due to nutrient starvation. On the disc model, trypsin and proteinase K were effective in killing bacteria; their aerobic viable counts were significantly lower ( P < 0.01) than the negative control and chlorhexidine. NaOCl was the most effective agent ( P < 0.001). In the tooth model, when compared to saline, trypsin with ultrasonics caused significant killing both aerobically and anaerobically ( P < 0.05). Chlorhexidine (1.46 ± 0.42), trypsin (3.56 ± 1.18) and proteinase K (4.2 ± 1.01) with ultrasonics were significantly effective ( P < 0.05) in reducing the substratum coverage as compared to saline with ultrasonics (12% ± 4.9). Conclusion Trypsin with ultrasonic activation has a biofilm killing and disrupting potential. [ABSTRACT FROM AUTHOR]

Aim To describe a technique for the placement of apical Mineral trioxide aggregate ( MTA) plugs in canals with wide apices. Summary A novel technique to fill root canals with an apical diameter larger than 0.4 mm is presented. The technique includes three main stages; three Thermafil carriers of increasing size, previously de-sheathed by removing the Gutta-percha coating, are selected to engage 1, 2 and 3 mm short of the apex. Their use allows the negotiation of acute curvatures and ledged canals. Subsequently, an MTA plug matching the apical gauge is pre-formed with a pellet block, placed and condensed using the modified carriers in sequence. The presented protocol for the management of teeth with apices of a diameter greater than 0.4 mm allows a favourable apical control of the MTA. Clinical cases completed using this methodology are presented. Key learning points MTA placement in teeth with wide apices was facilitated by using de-sheathed Thermafil carriers, to create an appropriate seal and stable platform for Gutta-percha backfilling or subsequent fibre post placement., The use of de-sheathed Thermafil carriers of different sizes allows predictable placement of pre-formed MTA plugs., Gauging of Thermafil carriers enhances control of the condensation phase to limit the extrusion of MTA. [ABSTRACT FROM AUTHOR]

Patel S, Wilson R, Dawood A, Foschi F, Mannocci F. The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography - Part 2: a 1-year post-treatment follow-up. International Endodontic Journal, 45, 711-723, 2012. Abstract Aim Part 2 of this clinical study aims to compare the radiographic change in periapical status of individual roots determined using digital periapical radiographs versus cone beam computed tomography (CBCT) 1 year after primary root canal treatment and to determine the radiological outcome of treatment for each tooth. Methodology Periapical radiographs and CBCT scans of 123 teeth in 99 patients assessed 1 year after completion of primary root canal treatment by a single operator were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The presence or absence as well as the increase or decrease in size of existing periapical radiolucency was assessed by a consensus panel consisting of two calibrated examiners. The panel viewed the images under standardized conditions. Paired comparison of the outcome diagnosis of individual roots and teeth was performed using generalized McNemar's or Stuart-Maxwell test of symmetry analysis. Results The 'healed' rate (absence of periapical radiolucency) for all roots combined was 92.7% using periapical radiographs and 73.9% for CBCT ( P < 0.001). This rate increased to 97.2% and 89.4%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included ( P < 0.001). A statistically significant difference in outcome diagnosis of single roots was observed between DPA and CBCT in single-rooted teeth and the buccal or mesio-buccal roots of multi-rooted teeth ( P < 0.05). Analysis by tooth revealed that the 'healed' rate (absence of periapical radiolucency) was 87% using periapical radiographs and 62.5% using CBCT ( P < 0.001). This increased to 95.1% and 84.7%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included ( P < 0.002). Outcome diagnosis of teeth showed a statistically significant difference between systems ( P < 0.001). Reconstructed CBCT images revealed more failures (17.6%) in teeth with no pre-operative periapical radiolucencies compared with periapical radiographs (1.3%) ( P = 0.031). In teeth with existing pre-operative periapical radiolucencies, reconstructed CBCT images also showed more failures (13.9%) compared with periapical radiographs (10.4%). Conclusion Diagnosis using CBCT revealed a lower healed and healing rate for primary root canal treatment than periapical radiographs, particularly in roots of molars. There was a 14 times increase in failure rate when teeth with no pre-operative periapical radiolucencies were assessed with CBCT compared with periapical radiographs at 1 year. [ABSTRACT FROM AUTHOR]

The relationship between the balance of helper T-cell type 1 (Th1) or type 2 (Th2) cytokines and the clinical course of hepatitis C virus (HCV) infection is unclear. We evaluated Th1 [interleukin (IL)-2, interferon-gamma (IFN- γ)] and Th2 cytokine (IL-4, IL-10) and 2,5-oligoadenylate synthetase (OAS, an IFN-induced antiviral protein) production by peripheral blood mononuclear cells from 10 healthy anti-HCV-positive individuals (group A), 10 HCV-RNA-positive with persistently normal alanine aminotransferase (ALT) levels (group B), 10 HCV-RNA-positive with abnormal ALT (group C) and 10 uninfected healthy controls. IL-2 production was significantly increased in group B when compared with all the other groups. No difference was found for IFN- γ. IL-4 was significantly higher in group C than in both group B ( P = 0.0006) and controls ( P = 0.004). Compared with controls, IL-10 was significantly decreased in group A ( P = 0.013) and B ( P = 0.004). The production of 2,5-OAS was significantly higher in group B than in A ( P = 0.04) and in C ( P = 0.004). Finally, in all HCV-RNA-positive patients, a significant correlation was found between ALT and both IL-2 ( r = −0.78; P = 0.0008) and IL-4 ( r = 0.75; P = 0.0008). In conclusion: (i) subjects who cleared HCV showed a cytokine profile similar to controls; (ii) a preferential shift towards a Th1 profile seems associated with a more favourable clinical outcome in chronic hepatitis C; and (iii) a prevalent Th2 profile seems implicated in HCV pathogenesis and severity of liver disease. [ABSTRACT FROM AUTHOR]

Fatty acid composition of phosphatidylinositols was analyzed in peripheral blood lymphocytes from nine alcoholic patients who were well nourished and without severe acute and chronic liver disease, before and after stimulation with anti-CDs antibody. Six comparable nondrinkers were studied as controls. A reduction in unsaturated fatty acid (mainly arachidonic) and an increase in palmitic and stearic acid molar content were observed in phosphatidylinositol (PI), phos-phatidylinositol-4-phosphate (PIP), and phosphatidylinositol-4,5-bis-phosphate (PIP2) in unstimulated samples from alcoholic patients in comparison with normal subjects, leading to a significant decrease in the saturated/unsaturated ratio. In controls, anti-CD3 stimulation caused a marked decrease in arachidonic acid relative molar content counterbalanced by an increase in other polyunsaturated fatty acid relative molar content in PI, PIP, and PIP2 fractions. Interestingly, after anti-CD3 stimulation, alcoholic patients show the same trend of modification in the fatty acid composition resulting in a sharp reduction of arachidonic acid relative molar content. These results support the hypothesis of an alteration in nutrients being responsible for immune derangement in alcoholics. [ABSTRACT FROM AUTHOR]

Background: Age is considered one of the important contraindications to surgery for hepatocellular carcinoma (HCC) in cirrhosis patients. We therefore evaluated the safety and prevalence of side effects in endoarterial therapy (EAT) in subjects aged over 65 years compared with younger treated patients.Methods: Thirty-eight patients with HCC aged 65 years and over underwent transcatheter arterial chemoembolization (TACE) (n = 28) or intraarterial chemotherapy (IAC) (n = 10). The survival rate was calculated using Kaplan-Meier's method with respect to a control group consisting of younger treated subjects (44 TACE; 21 IAC) comparable for stage of HCC and severity of the underlying cirrhosis.Results: The comparison between the two groups regarding side effects, procedure-related death, and survival did not show any difference considering the whole EAT procedure. TACE in elderly subjects reached a statistically lower outcome with respect to younger patients (p < .025) but remained statistically superior in survival versus both older and younger patients treated with IAC (p < .05, respectively). Stratifying the patients following the degree of Lipiodol uptake of tumor mass in the three groups (Group I, > 75%; Group II, 50-75%; Group III, < 50%), in the young subjects a higher probability of survival was strictly correlated to a degree of uptake over 75%, while in the elderly patients an impregnation over 50% was sufficient to obtain a satisfactory survival curve.Conclusions: EAT is a reliable and safe therapeutic option for the geriatric patient with HCC, with TACE showing a better efficacy than IAC, requiring a lesser degree of Lipiodol uptake to achieve an improvement of outcome. [ABSTRACT FROM AUTHOR]