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The article aims to draw attention to the book Quale Europa cristiana? La continuità di una presenza (Which Christian Europe? The Continuity of a Presence) by Franco Buzzi, a Milanese theologian and renowned scholar of the Lutheran Reformation. It particularly focuses on Buzzi’s intention to explore the relationship between Western Europe and Christianity, not only regarding the developments stemming from the birth and spread of Luther’s Reformation but also concerning the critique of Luther’s thought and reformist work, which continues to characterise certain strands of Catholic historiography and theology. At the core of this critique lies a twofold conviction: that Luther is the instigator of the division of Christianity and Europe, and that he is the primary cause of the decline of European Christendom. The article explains why Buzzi considers these convictions to be entirely unfounded and unjust. Moreover, it demonstrates that his interpretative stance offers important insights, enabling further progress in exploring the theme of ‘Europe and Christianity’ and examining the interconnection between the unity of Europe and the unity of Christianity.

Czech translation of O. J. Herstein’s Justifying Subversion: Why Nussbaum Got (the Better Interpretation of) Butler Wrong.

Introduction and aim: The presented case study documents the course of diagnosis and treatment of plasma cell neoplasia of the lower jaw in a 79-years-old female patient. The aim is to highlight the possibility of plasmacytoma manifestation in the differential diagnosis of jawbone lesions and to emphasize the importance of interdisciplinary cooperation, in this case between the dentoalveolar/maxillofacial surgeon and the haematooncologist.Case description: The patient was first examined at our facility in November 2023 upon the request of a general dental practitioner due to recurrent difficulties following extraction of the right permanent lower second molar (tooth #47), which had been performed two months earlier. In 2021, the patient underwent surgery for ovarian carcinoma and had no history of diabetes, bleeding disorders, shortness of breath, or other illnesses. She was not using any medications affecting bone metabolism. Based on the clinical findings, duration of symptoms, OPG image showing noticeable poorly defined radiolucency of the mandibular body in the area of missing teeth, and laboratory tests, a working diagnosis of osteomyelitis of the mandibular body on the right side was established. Empirical treatment with oral broad-spectrum antibiotics of the penicillin class was initiated promptly and resulted in clinical improvement. Cone-beam computed tomography (CBCT) performed two days after the initial examination revealed osteolytic indistinctly demarcated changes causing lingual wall resorption of the mandibular body reaching to the lower edge of the mandible in the region of the molars on the lower right side. This radiological finding raised suspicion of malignant neoplasm of the lower jaw. Subsequent CT scan with contrast confirmed soft tissue infiltration and the osteolytic nature of the lesion described above. Based on these findings, a diagnostic biopsy of the pathological tissue was indicated and performed, revealing plasma cell neoplasia. In the differential diagnosis, it was necessary to distinguish whether it was a solitary bone plasmacytoma with extraosseous propagation or multiple myeloma infiltration. The patient was referred for haematological examination to a specialized clinic where a definitive diagnosis of multiple myeloma was established. There the patient was treated with a triple combination of bortezomide, lenalidomide, and dexamethasone. The first cycle of this treatment resulted in complete regression of the intraoral lesion and healing of the extraction socket at the site of tooth #47.Conclusion: This case study highlights the rare but possible occurrence of oral plasmacytomas and emphasizes the importance of interdisciplinary collaboration.

Introduction: Peri-implantitis is a serious disease affecting the tissues around the dental implant (DI). Non-surgical therapy (NCHT) plays an important role in the management of this disease. One method for NCHT is the treatment with an air abrasive device (MAP). The aim of this prospective, randomized controlled clinical trial was to compare the efficacy of MAP in NCHT of peri-implantitis in combination with or without systemic antibiotic (ATB) therapy. Methods: The population included 33 patients (15 men and 18 women) with a mean age of 55.4 years at the time of first treatment and a total of 88 dental implants (DI) with diagnosed peri-implantitis. Patients were examined and the clinical parameters of probing depth (PD), bleeding on probing (BOP) and suppuration on probing (SOP) were recorded. The patients were then randomly divided into two groups. The first, the test group, initiated the treatment session using the systemic ATB and then continued to use ATB for 7 days after the therapy. The second, control group, underwent the same therapy, without adjunctive ATB treatment. The therapy itself was performed with Airflow plus powder with erythritol crystals applied using a MAP Perioflow® with a Perioflow nozzle (EMS; Nyon, Switzerland). Patients were subsequently called for a follow-up examination 1, 3, 6, 12, and 24 months after the treatment. Results: As part of the control examinations, there was a significant reduction of the PD parameter in both the test and control groups compared to the baseline. The test group had significantly greater differences in PD sum values after 6 months (p = 0.003) and 12 months (p < 0.0001) than in patients without ATB therapy. Conclusion: A reduction in the values of clinical parameters (BOP, SOP, PD) is possible with the use of MAP and erythritol powder, regardless of the systemic administration of ATB. However, the systemic use of ATB as supportive therapy in NCHT of peri-implantitis significantly reduces both PD and BOP compared to the group of patients without systemic ATB.

Introduction, aim: Maintaining homeostasis of the oral cavity is associated not only with the immune response and soft tissue metabolism but also the action of commensal and pathogenic bacteria. In the development of dental remedies against pathogenic forms, new/alternative antibiotic agents are being sought. One of the currently studied groups of these substances are the phytocannabinoids, in particular cannabidiol (CBD). The aim of the presented study was to evaluate the antimicrobial effects of four non- psychotropic phytocannabinoids on selected oral bacteria.Methods: The antimicrobial effects (MIC - minimal inhibition concentrations) of phytocannabinoids were determined in vitro using a standard microdilution technique. The effect of CBD, cannabigerol (CBG), cannabichromene (CBC), cannabinol (CBN) and selected phytocannabinoid extracts composed of 50% CBD or CBG was evaluated on Streptococcus mutans CCM 7409 and Porphyromonas gingivalis CCM 3985. The effect of CBD was further tested on Lactobacillus acidophilus CCM 4833, Lactobacillus casei CCM 1825, Aggregatibacter actinomycetemcomitans CCM 4688, and Eikenella corrodens CCM 5985. Chlorhexidine digluconate (CHX) was used as an active comparator.Results: The MIC values of CBD in P. gingivalis were similar to those for CHX (1-2 μg/ml). In case of S. mutans, the lowest MIC was found for CBG (8 μg/ml). For L. casei and L. acidophilus, MIC for CBD was close to MIC for CHX. Specifically for L. casei, CBD was as effective as CHX (MIC 2-4 μg/ml). In L. acidophilus, MICs were determined for CBD (4-8 μg/ml) and for CHX (2-4 μg/ml). For other microbes, the efficacy of CBD was lower than that for CHX. A. actinomycetemcomitans growth was significantly more inhibited by CHX (MIC = 4 μg/ml) than by CBD (MIC > 128 μg/ml). Similar effects were observed for E. corrodens with the following antimicrobial activity for CBD (MIC 16-32 μg/ml) and CHX (MIC 2-4 μg/ml). The tested complex mixtures showed no superior antimicrobial effects than individual phytocannabinoids.Conclusion: The results show that non-psychotropic phytocannabinoids (predominantly CBD) inhibit some oral bacteria. At the same time, they are able to inhibit the growth of periodontopathogens such as P. gingivalis, and in case of CBD also E. corrodens, which suggests the possibility of further research and application in dentistry.

Introduction: The aim of this article is to present and summarize the non-surgical treatment options in management of peri-implant diseases and compare the effectiveness of the treatment with/without adjunctive use of antibiotics. Methods: A search was conducted in the PubMed- MEDLINE, Scopus, Embase, and Google Scholar databases, and available repositories, followed by a hand search. The relevant clinical studies, reviews, and consensuses about the non-surgical peri-implant therapy published between 1990-2022 in English language were included. Conclusion: Based on the available information, it can be said that there is a great diversity in the treatment of dental implants affected by peri-implantitis. Studies testing different therapeutic protocols are rare and highly heterogeneous. Stabilization of peri-implant disease after the treatment without systemic or local antibiotics is possible, but the reduction of probing depth around the dental implant using only the non-surgical therapy is still insufficient. Non-surgical treatment is therefore successful particularly in solving the peri-implant mucositis and also as a conditioning before surgical therapy.

Introduction and aim: The aim of article is to present the new classification of diseases of peri-implant tissues and also summarize the available evidence about their etiology and prevention.Materials and methods: A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google Scholar databases and available repositories, followed by hand search. The relevant clinical studies, reviews and consensuses about peri-implant tissues and their health and diseases which were published between 1990-2021 in English language were included.Conclusion: In the case of knowing the risk factors in developing of disease of peri-implant tissues it is more then appropriate to select eligible patient. The patients with active marginal periodontitis must not be treatetd with dental implants before its stabilization. In the event thatfurther risk factors such as diabetes mellitus or smoking are present we should consider another prosthodontic alternatives. Consecutive follow-up of patient should be initiated immediately after dental implant placement and should be repeated regularly.

Introduction and aim: Midazolam is a short-acting, effective sedative with a rapid onset and minimal side effects, belonging to the benzodiazepine group. The work deals with the use of the midazolam in the dental treatment of children, the history of which dates back to the 1990s. The reason for its popularity in treating children is mainly its sedative and amnestic effects which help both children to cope with the treatment and doctors to cope with the emotional burden, that treating children undoubtedly is. Furthermore, it has a short half-life time and the oral route of administration is preferred by children. The authors describe the physical properties, mechanism of action, pharmacokinetics and the most common side and adverse effects of midazolam. The authors perceive the inconsistency of the professional public in the view, procedure, dosage, and the extent of treatment in sedation while aware of the application of midazolam in children. The aim of the work is to revise the current indications and contraindications for the treatment of paediatric patients in conscious sedation with midazolam, with the help of the available literature, withregard to the age of the child, the extent and nature of the performed procedure. Also, to discuss the methods of administration and safe course of midazolam in outpatient practice.Methods: The literature search and survey was focused on the keywords "midazolam", "dental treatment", "children", and "conscious sedation". The PubMed database was used to find it. Furthermore, we drew information from the specialized books dealing with the given topic. The available literature was subsequently critically evaluated for the needs of this review. Conclusion: Treatment of children is often complicated by the fear of dental treatment. The appropriate method of midazolam administration in the suitable background offers a safe, fast, affordable, and effective treatment option of conscious sedation with minimum side effects. When properly indicated, it can be of a great help in gaining the children´s cooperation.

Significant malrotation of the femur after osteosynthesis is a serious complication of treatment and has a number of con- sequences for the patients and causes deterioration of their quality of life. Therefore, it is necessary to be familiar with intra-operative techniques to control the correct rotation, mostly clinical and radiological, which give us the possibility to minimize rotational errors. In the postoperative period, with even a slight suspicion of malrotation, it is necessary to proceed to its exact verification and, in indicated cases, to perform necessary correction. We recommend one of the CT techniques as a very reliable method, however in younger patients we prefer to use MRI. Early diagnosis of the rotational error and especially its size is essential from the point of view of potential reconstructive surgery, which is then chosen also with regard to the location of the original lesion. [ABSTRACT FROM AUTHOR]

Introduction, aim: This work describes the attitudes of Czech Dental Chamber members to anti-epidemic measures during the COVID-19 pandemic. Responses are further classified according to the respondents' COVID-19 status.Method: The data were obtained via an online questionnaire survey from June 23 to September 4, 2021.Results: A total of 2716 members of the Czech Dental Chamber participated in this survey, representing 24.3% of all chamber members. Almost 90% of the respondents considered the official recommendation against the transmission of SARS-CoV-2 infection issued by the Czech Dental Chamber to be adequate, approximately 6% insufficient, and 4% too strict. The prevalence of COVID-19 in the group considering the recommendation too strict was statistically significantly higher compared to the group considering the recommendation to be adequate(p = 0.0345, odds ratio (OR) 1.592). The respondents who performed COVID-19 testing in their practices showed a statistically significantly higher percentage of detected COVID-19 infections (p < 0.0001, OR 1.883). Almost three-quarters of respondents want to maintain strict anti-epidemic measures even after the pandemic; this commitment is statistically significantly higher for the respondents who did not have COVID-19 (p = 0.0041, OR 1.511). COVID-19 infection did not affect the willingness to be vaccinated against influenza. In contrast, the respondents with a positive attitude towards vaccination against COVID-19 showed a statistically significantly higher willingness to get vaccinated against the flu (p < 0.0001, OR 10.36).Conslusion: The prevalence of COVID-19 was statistically significantly higher among dentists who preferred less stringent measures against infection transmission. Respondents who performed COVID-19 testing in their practices showed a statistically higher percentage of detected COVID-19 infections. Almost three quarters of respondents intended to adhere to strict measures against the infection transmission even after the end of the pandemic. The will to be vaccinated against COVID-19 was significantly higher than against the flu. Respondents with a positive approach to vaccination against COVID-19 were significantly more willing to be vaccinated against influenza.

Introduction, aim: Extraesophageal reflux (EER) is the backflow of gastric fluids (most often acidic) above the level of the upper esophageal sphincter (it differs from gastroesophageal reflux). The symptoms of extraesophageal reflux are non-specific, of varying intensity and depend on the location of the pathological action of the refluxate. In the case of the effect of refluxate on the hard dental tissue, EER can contribute to the formation of dental erosions. In addition to refluxate, other factors such as the composition of saliva and the microbiome of the oral cavity are discussed. In recent years, there has been a significant shift in the understanding of extraesophageal reflux, especially the pathogenesis, and the resulting implications for diagnosis and treatment. The aim of the article is to inform about EER and give an overview of the current possibilities of diagnosis and its treatment, as well as to summarize the results of recent meta-analyses regarding the role of EER in the development of dental diseases.Methods: The basis for the presented article was professional publications obtained in the PubMed, Cochrane Library and Scopus databases from 2002 to 2022. Publications were searched using a combination of keywords in English and Czech languages: extraesophageal reflux, gastroesophageal reflux, dental erosion. A total of 21 studies discussing the association between reflux and dental erosions were analyzed through review, clinical prospective and retrospective studies and meta analyses. The included studies were conducted in the adult population and information on gastroesophageal reflux in relation to the occurrence of dental erosions was used only if it was diagnosed by multichannel intraluminal pH impedance monitoring. The first part of the article presents a current view of the pathophysiology, diagnosis and treatment of EER. The second part summarizes knowledge about dental erosions. In the third part, studies dealing with the effect of EER on dental erosion are presented.Results: The obtained information indicates a higher prevalence of dental erosions in patients with EER compared to the healthy population. The reason is that acids of both exogenous and endogenous origins play an important role in dissolving enamel minerals, which ultimately leads to tooth erosion. Based on the analyzed studies, the relationship between reflux and the development of dental erosions cannot currently be considered causal, mainly due to the low quality of the studies. The authors recommend that further studies investigating the relationship between EER and dental damage should be conducted.Conclusions: Based on the findings, it can be assumed that extraesophageal reflux is involved in the development of dental diseases. A possible link is also supported by the fact that the prevalence of dental erosions in population with reflux or the prevalence of reflux in the population with dental erosions is much higher compared to the healthy population. In the future, however, further studies are needed to investigate the causality of extraesophageal reflux in the occurrence of dental erosions.

Introduction and aim: Dental implant treatment in the posterior maxilla is often complicated by the poor healing of the alveolar process and by the pneumatization of the maxillary sinus. The authors are explaining the Cologne Classification of the Alveolar Ridge Defects (CCARD) with special emphasis on the maxillary sinus area and listing the main fators influencing process of selection of dental implant treatment. The aim of this article is to demonstrate, using case reports, four types of treatment. Results and conclusions: There are four types of treatment implant surgeon must choose from while considering treatment in posterior maxilla. Current literature does not give a guidance as to which treatment method to use. Transalveolar sinus lift has a good clinical outcome regardless of presence or absence of grafting material. Short implants with a long clinical crown are good alternative to treatment at times where Schneiderian membrane manipulation is not advised.

Introduction and aim: In recent decades, the whole field of medicine has been undergoing a digital revolution. This phenomenon is making its way into dental fields as well, including orthodontics, and gradually more and more workflow procedures are being digitalized. The digital models of dental arches can be obtained with the help of an intraoral scanner, and afterwards, using a 3D printer, they can be transformed into physical models. In the field of orthodontics, dental models are needed as study models for diagnostic analysis and determining the therapeutical plan. Dental models at the end of orthodontic therapy are very important as working models for the production of retention devices. The thermoplastic retention plates are very frequently given to patients as retention apparatus and are very popular among them. They are being manufactured at high temperatures in a vacuum machine in a process also known as vacuuming. Conventionally this manufacturing tends to be performed on classic gypsum models. With the growing popularity of digital dental models and their subsequent 3D printing, it is important to know whether dental models made in this way are also suitable for the production of thermoplastic retention plates. Currently, the most widely used method for 3D printing is called Fused Deposition Modeling, using molten plastics as a material for the printing.The aim of this research was to evaluate 3 thermoplastic materials - ABS, ASA, and Z-Ultrat and to measure their dimensional stability while being exposed to the conditions of vacuuming during the production of the thermoplastic plates. It was important to determine whichof them would retain its dimensional stability under given conditions in the best way.Methods: To obtain the necessary data, we first made intraoral scans of the upper dental arch of two patients using an iTero intraoral scanner. With the use of Zortrax M200 3D printer, these scans were then used to produce physical 3D models. The following parameters were setfor the 3D printing: layer thickness - 0.09 mm, density of the infill - 70%, and orientation of the model in the Z axis - 45°. The physical 3D models were then digitized again with GOM ATOS TripleScan extraoral 3D scanner, placed in a vacuum machine, and then scanned again. GOM Inspectsoftware was used to evaluate the dimensional accuracy of manufactured parts. The maximum clinically acceptable deviation between the first 3D scan and the scan of the physical model after vacuuming was determined by the authors to be +/- 0.50 mm.Results: Dental models from all 3 examined thermoplastic materials have shown a statistically significant change in their dimensions. However, the magnitude of these deviations is acceptable for clinical practice. All models printed from ABS and Z-Ultrat met the maximum clinically permissible deviation of +/- 0.50 mm.Conclusions: Certified material Z-Ultrat, having a chemical composition of PC-ABS, showed the best dimensional stability. Based on the obtained data, it can be concluded that the models of dental arches printed by the FDM method can be used in practice as working models for the production of thermoplastic retention plates.

Introduction and aim: The aim is to summarize the current literature regarding possible dental and skeletal changes after rapid maxillary expansion (RME). RME is one type of treatment for transverse maxillary anomalies. It is an effective orthodontic treatment procedure in mixed and permanent dentition. It is indicated in patients with transverse dental arch dysplasia. The treated patients are diagnosed with crossbite in the lateral dentition. The goal of treatment is maxillary expansion, which is possible in younger patients due to immature sutures in the maxillary region, especially the palatal suture. The maxillary expansion is mediated by a special orthodontic appliance that is activated periodically. During this treatment, the surrounding structures are also affected and it is therefore advisable to know the limits of the treatment and its effect on the entire perimaxillary complex. In terms of skeletal changes, we focus on transverse, anterior, posterior and vertical changes, palatal suture, nasal cavity, sutures and synchondrosis as well as orbital structures. As an example of dental changes, we consider the change in the position of the molars and the possibility of root and alveolar bone resorption. An example of a commonly used orthodontic appliance for RME is the hyrax. This palatal expander is anchored to the lateral teeth and activated as needed under individually determined conditions. In addition to clinical examination, changes during RME can be monitored by two- dimensional imaging methods such as skull posteroanterior view and teleradiography, and with the development of imaging methods, by three-dimensional X-ray imaging such as cone beam computed tomography (CBCT). Material and methods: The literature search and review focused on rapid maxillary expansion and the changes that accompany it. PubMed, Web of Science, Cochrane, and Scopus databases were used to find literature. The size of the patient cohort, length and method of follow-up, inclusion of a control group, and long-term stability were important for subsequent article selection. Conclusion: RME is a proven orthodontic method to widen the palatal suture in younger individuals. RME treatment affects not only the palatal suture but also the adjacent maxillary structures. In practice, we find the dental changes mainly include a change in the intermolar distance, buccal inclination of the teeth, possible resorption of the tooth root or resorption of the vestibular alveolar bone. Significant skeletal changes are in the nasal cavity, where air passage may be positively affected with a reduction in airway resistance. Other skeletal effects include, for example, changes in the perimaxillary sutures and synchondroses or orbital structures.

Introduction and aim: The fracture of Ni-Ti instruments is a complication that most dentists will sooner or later encounter in the dental office. There are mainly two basic mechanisms behind it and these are exceeding the cyclic fatigue limit, exceeding the torsional fatigue limit and their mutual combination. The purpose of this article is to describe the fracture mechanism of a nickel-titanium endodontic instrument based on cyclic fatigue, the influencing factors and related issues of laboratory testing. Methods: Literature searches were performed using PubMed (MEDLINE), ScienceDirect and the Wiley Online Library database. Keywords related to the topic were used to search the literature. Then suitable sources were selected. Instrument fracture mechanism: A cyclic fatigue fracture consists of three basic phases. Initiation, which is the period of time when morphological changes occur, especially on the surface and subsurface of the instrument, until the formation of the primary crack. After that the crack gradually grows with the formation of characteristic striations. As soon as the fracture toughness limit is exceeded, it is time for final failure and separation of part of the instrument. Factors affecting fracture: One of the most significant effects on fracture formation has the quality of the alloy. Today, rotary endodontic instruments can be divided according to their structure into the instruments with a predominance of martensite or austenite. From the point of view of cyclic fatigue, martensitic instruments are significantly more durable than austenitic. From a physical point of view, surface roughness has a direct effect on fracture formation as surface irregularities serve as predisposing points for stress concentration. The shape of the instrument also has an important effect, as the smaller diameter of the instrument and its core has a positive effect on the resistance to cyclic fatigue. As the cross-section area of the instrument increases, the tensile strain on its surface increases, thus, a faster failure occurs. The ambient temperature significantly affects the properties of the instruments. Higher temperature reduces resistance to cyclic fatigue. It should be kept in mind that the instrument may behave diametrically differently at room temperature compared to the root canal temperature. We must also not forget the parameters of the root canal, which fundamentally affect the failure of the instrument. The type of instrument movement kinematics in the root canal is also very important. From this point of view, we can clearly say that the rotational mode reduces the instruments's resistence to cyclic fatigue compared to reciprocal ones. An ideal irrigant has not yet been identified for cyclic fatigue testing. Conclusion: The topic of failure of endodontic instruments based on cyclic fatigue is very extensive. Its development and understanding can help the production of more durable instruments and thus minimize the presence of this complication in a general dental office.

Introduction, aim: Periodontitis, which is one of the most common diseases in the adult population, is almost as common cause of tooth loss in people over the age of 35 as it is due to tooth decay. The aim of this study was to evaluate the utility of new-generation sequencing methods as a tool for complex characterization of subgingival bacterial biofilm in patients with advanced periodontitis and for monitoring the dynamics of changes in the composition of subgingival bacterial biofilm during therapy. We assume that next-generation sequencing methods will provide a new quality of monitoring the course of treatment and offer periodontologists a tool for objective evaluation of the effectiveness of the chosen therapeutic procedure and choice of further treatment. Methods: The study included 43 patients with a diagnosis of advanced periodontitis. Patients were divided into two subgroups and treated with one of two standard approved methods - deep scaling and root planing only (subgroup A - 20 patients) and deep scaling and root planing supplemented with antibiotic therapy (subgroup B - 23 patients) - and their periodontal status was assessed by periodontal indices BOP (bleeding on probing), CAL (clinical attachment loss) a PPD (periodontal pocket depth) before treatment and two weeks, three months and 18 months after therapy. A set of four samples was taken from each deepest periodontal pocket at equal time intervals to determine the microbiome composition. Results: During treatment, there was a significant decrease in the periodontal indices PPD, BOP and CAL in both subgroups of patients. There was also a significant decrease in the periodontal risk index R/G during treatment. In addition, the subgroup of patients treated with deep scaling and root planing with antibiotics (subgroup B) had a significantly higher decrease in R/G index 14 days after treatment compared to subgroup A treated with deep scaling and root planing alone. Three months and 18 months after treatment, the periodontal risk index R/G values were similar in both subgroups of patients. Conclusion: Taxonomic characterization of the microbiome expressed in the form of R/G index allows to monitor dynamic changes during treatment, in contrast to mere monitoring of clinical parameters shows clear differences between groups with and without antibiotics at 14 days after deep scaling and root planing therapy. However, given the clinical parameters of the two groups, which do not differ significantly after three or 18 months, it is appropriate to carefully consider whether antibiotic support for deep scaling and root planing is beneficial, as there is a significant risk of developing and spreading resistance. The use of antibiotics in periodontology should be based on detailed clinical, microbiological and general medical examination.

Introduction and aim: Zirconia is currently the most commonly used representative of polycrystalline dental ceramics. It is highly valued for its mechanical properties: hardness, strength and toughness. On the contrary, its aesthetics is percieved as a disadvantage. Its insufficient transparency makes it impossible to mimic the optical properties of enamel, and therefore its indication in monolithic form is often limited to distal sections only. This article discusses the properties of zirconia ceramics and its evolution. Particular emphasis is placed on the chemical-physical nature of the phenomena involved in determining the properties of dental zirconia. Conclusion: The economic potential of zirconia ceramics is proving to be a strong stimulant of its development. The aesthetic disadvantages of the material were the biggest limiting factor for its wider use. The simplest and earliest solution to this problem was the veneering of zirconia using high glass content ceramics. This combination of materials, however, was found to have relatively frequent complications associated with chipping of the surface layers of the veneer. The use of zirconia ceramics in monolithic form proved to be the most advantageous from a mechanical point of view. Therefore, the development of zirconia ceramics in the last ten years has gone in the direction of increasing the transparency of the zirconia ceramic itself. The result of these efforts has been the latest generation of zirconia ceramics, which have significantly improved aesthetics and can be used even in relatively aesthetically exposed areas. These new materials retain only a fraction of the mechanical durability of their predecessors, and therefore their indications are limited to three-unit bridges. However, they still significantly expand the portfolio of applications for monolithic zirconia ceramics and are becoming a suitable alternative to older materials used for crown and bridge fabrication.

Introduction: Odontogenic keratocystics are benign intraosseous lesions. They are characterised by an local aggresive behaviour. Expansion is in anterior-posterior direction. This lesions were hidden for a long time. Orthopantomogram is gold standard examination, so nowadays diagnostics is not so difficult. But still there is relatively high recurrence rate and the choice of operation method is not definite. In this retrospective study is presented treatment modalities and succes rate.Methods: In this retrospective study 62 patients are presented. This lesions were treated from 2000 to 2019 on Department of Oral and Maxillofacial Surgery in Faculty Hospital Olomouc. In this period 77 new and recurrence lesions of OKC were reported. This lesions were treated in local and general anaesthesia. OKC lesions are divided in several modalities: unilocular and multilocular and syndromic cysts. In this study, eight patients were treated with Gorlin-Goltz´s syndrome. Mutation of gen PTCH has been confirmed.Result: Altogether 98 operations were carried out during nine years. Together 62 patients were treated. In local anaesthesia were treated 16 cases, in general anaesthesia 82 cases. The number of male and female was approximately same. Majority of cystic lesions (57 cases = 74%) occured in lower jaw. Localization in lower jaw was majority in angle and branch of mandible. (52 cases = 68%). More frequency on the right. five cysts (6%) were occured in frontal part of lower jaw. In maxilla, there were 20 cases (26%) of odontogenic keratocysts. Most number of OKC were diagnosed in second and sixth aged decade. Solitary OKC occured in 50 patients; eight patients with multiple OKC were genetic treated with confirmed Gorlin-Goltz syndrome. In one patient, seven years after first operation of OKC was malignancy on odontogenic carcinoma, 22 patients (35.5%) were reoperated for after surgery relaps. In relation between localization, postoperated relaps, authors compare succes of various operating methods (marsupialization, enucleation, enucleation with Carnoy´s solution, enucleation with augmentative methods, resection with and without free flap). Conclusion: The choice of the treatment has always been difficult. And correct treatment modality is not complete. Patients should know various operation modalities, risk of reccurence and recommendation for long term dispenzarization.

Introduction, aim: Exosomes generated by the endosomal pathway are released by the exocytosis into the extracellular space, including saliva. They contain nucleic acids, proteins and lipids that are transported to different parts of the body. They participate in intercellular communication, whether they support or disrupt various physiological processes. The aim of this work was to verify the efficiency of the ultracentrifugation method of isolation of exosomes from saliva, to exctract and identify proteins contained therein, with an emphasis on exosomal proteins related to diseases of the oral cavity or systemic diseases with manifestations in the oral cavity. Methods: Exosomes were isolated from full unstimulated human saliva by repeated centrifugation steps with washing in phosphate buffer followed by methanol/chloroform protein precipitation. Proteins were identified by a bottom-up approach using mass spectrometry with pre-separation by liquid chromatography. Results: The identified proteins were classified according to protein classes, molecular functions and biological processes. The most identified proteins were of the protein classes: cytoskeletal proteins, defense/immune proteins and structural proteins and proteins responsible for catalytic activity and structural molecular activity. Conclusions: Proteins have been classified into groups based on their molecular function and biological processes in which they participate in the human body. Some proteins/family of proteins have been identified that may be of interest in investigating the etiology of some oral diseases e.g. annexin A1, zymogen granular protein 16 homologue B, mucin-5B, Ig lambda-3 chain C region, Ig kappa chain C region, Ig alpha-2 chain C region and Ig alpha-1 chain C region.

This year marks the 20th anniversary of the launch of the chronic thromboembolic pulmonary hypertension (CTEPH) surgical treatment programme, which involves three departments of the Cardiac Centre of the General University Hospital in Prague. Diagnosis and decision-making on the type of treatment, including indication for surgical treatment, is carried out at the Centre. Other non-surgical treatments and long-term dispensary care are also available to patients. Over 500 patients with CTEPH have been operated on during the program's lifetime. Our Centre also concentrates on patients with other types of severe pulmonary hypertension who are indicated for various challenging surgical procedures, as they can be offered comprehensive perioperative care by experienced anaesthetists and intensivists. Anaesthesia and intensive postoperative care of patients indicated for pulmonary endarterectomy has certain specifics, which are based on the fact that patients undergoing this operation have right-sided heart failure with chronic low cardiac output, are significantly symptomatic, and have minimal circulatory and ventilatory reserves. In addition, they are at risk of developing several serious complications during the surgery and in the early postoperative period, which increase morbidity and mortality. This review work is based on twenty years of experience at our center, many of which have been materialized in independent original studies published in peer-reviewed journals. In addition to their practice, the authors draw on the experience of other European and international centers, many of which they have established useful collaborations with. The anaesthetic and intensive care procedures used have undergone many changes over the past twenty years and have been re-evaluated based on recommendations and experience, always to improve outcomes and reduce the rate of perioperative complications. [ABSTRACT FROM AUTHOR]

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Copyright of Anaesthesiology & Intensive Medicine / Anesteziologie a Intenzivní Medicína is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Dental pulp stem cells (DPSCs) express naturally high positivity for surface receptor glycoprotein CD 44 which is involved in the induction of odontoblast mineralization with hyaluronic acid (HA) being its major ligand. The aim of this experiment was to assess the effect of HA in low (LMW-HA), medium (MMW-HA) and high (HMW-HA) molecular weights on the phenotypic profile, proliferation activity and differentiation potential of human DPSCs. Methods: The experiment was conducted in vitro on two lines of human DPSCs from different donors (third molar - male, 25 years and first premolar - male, 9 years). These lines were cultured in standard medium and from the second passage also in three experimental culture media containing 0.1% HA in three molecular weights: LMW-HA (116 kDa), MMW-HA (540 kDa) and HMW-HA (1500 kDa). The phenotypic analysis was performed in the seventh passage using a Vi-Cell XR flow cytometer, viability was evaluated by the Vi-Cell Analyzer in the seventh passage and proliferation activity measured by the Z2 Counter Analyzer in every passage. Osteo- and chondro- differentiation were inducted by commercially supplied cultivation media and demonstrated by histological staining with alcian blue and alizarin red. Results: DPSCs used in our experiment expressed phenotype typical for human DPSCs (high positivity for CD 13, CD 29, CD 44, CD 90 and OCT 3/4), they were able to exceed Hayflick limit and differentiate in the osteogenic as well as the chondrogenic extracellular matrix. During the experiment, DPSCs line 1 cultivated in control medium / medium 1 (116 kDa HA) / medium 2 (540 kDa HA) / medium 3 (1500 kDa HA) achieved in this order in total 14.1/15.3/15.4/14.8 population doublings. The median of doubling time with the minimal and maximal values in the same order was 31.6 (29.2; 36.8) / 29.6 (28.5; 30.6) / 30.3 (26.7; 31.3) / 30.5 (29.7; 33.8) hours. The viability of the DPSCs obtained from the seventh passage was in the same order 92.3/93.1/91.8/92.6%. DPSC line 2 cultivated in control medium / medium 1 (116 kDa HA) / medium 2 (540 kDa HA) / medium 3 (1500 kDa HA) achieved in this order in total 16.7/17.2/16.7/16.8 population doublings. The median of doubling time with the minimal and maximal values in the same order was 28.9 (24.5; 35.2) / 27.4 (24.5; 32.6) / 28.3 (24.0; 38.4) / 27.1 (25.3; 33.9) hours. The viability of the DPSCs obtained from the seventh passage was in the same order 80.1/82.5/81.8/80.9%. Conclusion: We verified that DPSCs in the presence of hyaluronic acid at a concentration of 0.1% and molecular weights of 116, 540 and 1500 kDa survive, proliferate and maintain the ability to differentiate in mature cellular elements. We also verified the original assumption that the low molecular weight form of hyaluronic acid has a different impact on the DPSCs' phenotype than the high molecular weight form of hyaluronic acid.

Introduction, aim: Composite materials used in dentistry are increasingly used for several reasons - aesthetics, hypersensitivity of some individuals to amalgam and concerns about the possible release of amalgam metals, and at the same time limiting its use due to the negative impact on the environment both during production and disposal. Composite materials consist of monomers, filler, polymerization initiation system and other substances that improve the properties of the filler. After application to the cavity, the filler material solidifies by a polymerization process which is initiated chemically, by light or dual. The conversion of monomers used in dentistry will never reach 100%, which is one of the weaknesses of these materials. Upon contact of the composite materials with water, alcohol as well as an acidic environment, it has been found that some components, such as non-polymerized monomers, can be gradually released from the composite. In the oral cavity, composite fillings are exposed to the constant action of saliva as well as food and beverages, which affect the release of composite components. They can cause local allergic reactions, but they can also affect the whole human body by swallowing saliva-containing monomers. Methods: In this work, the amount of unpolymerized monomers released from selected composite materials, prepared in the shape of a cylinder with a height of approx. 2 mm and diameter of 3 mm, weighing approximately 0.05 g and cured - polymerised according to the procedure specified by the manufacturer, was determined. Subsequently, the composites were immersed in unstimulated saliva at 37 °C and the amount of monomers released was determined at several time intervals. A high performance liquid chromatography with a UV detector was used for saliva analysis. The amount of monomers released into saliva over time from the curing of the composite was monitored. Results: During the elution of monomers from composite fillers into saliva, their amount gradually increases, different monomers leach out at different concentration levels. The largest amount of released monomers was measured from composite materials containing triethylene glycol dimethacrylate, while bisphenol A-glycidyl methacrylate was eluted in the smallest quantity. Conclusion: Due to the relatively high levels of released monomers, it is important in the development of composite materials to monitor their levels in saliva in the first hours after application as well as in the long term in order to produce a more biologically compatible composite.

Introduction, aim: The rise of research papers and investments made into 3D printing are the proof of the increased interest about this manufacturing method. The American Charles W. Hull is considered to be the inventor with the first patent in the field. The principle of 3D printing is printing the desired item in layers according to its template, most often present in .stl format. There are seven main technological processes of 3D printing, five of them are used in dentistry. Text deals with the three methods that are used the most: Vat Polymerisation, Material Extrusion and Powder Bed Fusion. In dentistry, additive manufacturing already has an important role for a longer period of time especially in implantology for the printing of surgical guides and in orthodontics for printing of study models and so-called invisible aligners. Additive manufacturing also allows to print retention appliances, and it facilitates the autotransplantation of teeth, while its importance is slowly rising in other sectors of dentistry such as in conservative dentistry in Class IV reconstruction or in guided endodontics and in prosthetic dentistry for printing of metal substructures and other components either in fixed or removable prosthetics in dental laboratory. Printing of accessories such as protective masks and face-shields or printing of 3D models of the real teeth and demonstration models in order to improve undergraduate, postgraduate and continuous education are among current applications. In medicine the printing is used for example for the production of biomaterials. The range of applications is therefore vast and the impact of 3D printing on dentistry is unquestionable. Shortcomings of printing are undergoing constant research and therefore it is just a matter of time until 3D printing will replace the conventional methods. The objective of this review paper was to sort the basic information about 3D printing with regards to its history, principle and types of printing but more importantly to summarise its use in dentistry.

Introduction and aim: Retrospective study focused on clinically and biopsy-proven cases of proliferative verrucous leukoplakia (PVL). The aim of the work is to point out the necessity of correlation of oral manifestations of PVL with clinical and radiological examination of the periodontium. Methods: The study evaluated the process of PVL disease in 53 patients followed between 1994 and 2024 at the Oral Medicine Department, Dentistry Clinic, University hospital in Pilsen. Apart from anamnestic-pathological correlations, also the aspects of coincidence with other lesions of the oral mucosa, the formation of dysplasia during this aggressive disease and the frequency of malignant transformation were assessed. The mucosal manifestation of the disease was regularly compared to the clinical and radiological state of the periodontium. Results: During dispensary, recurrence occurred in 56% of cases (n = 30/53) and transformation into oral squamous cell carcinoma (OSCC) in 38% of patients (n = 20/53). Oncological recurrence was in five cases (9%). The majority of patients with malignant transformation were women with 70% (n = 14/20). Conclusion: In contrary to other diseases of the oral mucosa, taking OPG or CBCT images is diagnostically more beneficial within the PVL dispensary. In several patients with lesions in the area of the alveolar mucosa and gingiva, there is significant resorption of the alveolar bone in the corresponding locations in the case of an ongoing malignant transformation. Malignant transformation of PVL is indeed high, up to 38% in our group. Due to the risk of diagnostic confusion of oral lichen planus and chronic hyperplastic candidiasis with incipient PVL, it is necessary to tighten the dispensary rules for these cases as well. [ABSTRACT FROM AUTHOR]

Introduction: The oral cavity is a complex system in which mutual chemical communication occurs between tissues, microbiota, and components of saliva and food. This paper focuses on hormetic effects and electrophilic compounds, which can play a role in defense mechanisms against oxidative stress and inflammatory processes. Hormetic effects, induced by sublethal or subtoxic stressors, can activate repair mechanisms and enhance tissue resistance to damage. Methods: The analysis was conducted through searches in three electronic databases: Web of Science, PubMed, and Scopus. Our research focused on studies published between 2000 and 2023 that dealt with redox processes, inflammatory conditions, and activation of the Nrf2 pathway in the oral cavity. Studies focused on cancerous diseases were excluded. Conclusion: Electrophilic compounds act as one of the agents that interfere with the homeostasis of the oral cavity, and can thus find therapeutic potential in dentistry, specifically in periodontology. However, findings based on in vitro and preclinical studies require further verification under clinical conditions, and also considering interactions with oral microbiota. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study aimed to evaluate the results of closed reduction and epiphyseodesis of unstable slips of the proximal femoral epiphysis. The hypothesis was that the clinical and radiological results of this method and incidence of avascular necrosis are comparable to the results of closed reduction and open reduction using surgical hip dislocation reported by literature. MATERIAL AND METHODS In the period 2013–2023, 20 patients were treated for unstable slips in one institution. Whereas the boys were older (mean age of 13.4 years) than girls (mean age of 11.6 years), the gender distribution was equal. Acute on chronic slips prevailed over the acute slips (ratio 3:1). The slips were treated using the closed reduction, transphyseal fixation and capsular decompression at 6 to 240 hours after slip (81 hours on average). All patients were treated concurrently on the contralateral side as the prevention of the slip or to treat the grade I slips (two patients). The follow-up ranged from 7 months to 7 years. Clinical results were evaluated according to two scores: 1) own score (Bulovka University Hopspital score) based on the reduction of ROM, shortening of extremity and limitations of activities; 2) D’Aubigne-Postel score. In the radiological evaluation, correction of slip angle, alpha-angle, avascular necrosis (AVN) and the prominence of the anterior margin of the femoral neck on axial radiographs were evaluated. RESULTS According to the Bulovka University Hospital score, there were 10 excellent results (50%) with no limitation of activity, including sport, in tree cases the results were very good (15%) and in five cases good (25%), respectively, with some limitation of activity, and two results were unsatisfactory (10%) with severe limitation of activity due to the AVN. According to the D’Aubigne-Postel score, there were 14 excellent results (70%), four good results (20%), and two unsatisfactory results (10%). The slip reduction was as follows: under 20 deg. in five patients; under 30 deg. in 10 patients, and over 30 deg. in five patients, respectively. Alfa-angle was greater than 63 degrees (range 45-88 deg.) on average. Prominence of the off-set epiphysis-femoral neck and femoroacetabular impingement (FAI) were observed in six patients. Remodelling of this prominence was seen in one patient four years after surgery. Shortening of the femoral neck over 1 cm was reported in two patients. Complete AVN with severe deformity of the hip was noted in two patients. DISCUSSION Our hypothesis was confirmed because the results of treatment of the unstable slips by closed reduction are comparable with the published results of the same method and with surgical hip dislocation. The results correspond with those of large published cohorts of patients concerning the correction as well as rate of complications. CONCLUSIONS According to our results, urgent gentle closed reduction, transphyseal fixation and capsular decompression represent efficient and relatively safe methods of treatment of unstable slips with low incidence of complication. Residual deformity of the off-set epiphysis-femoral neck and FAI represent limitations of this method. [ABSTRACT FROM AUTHOR]

Introduction and goal: Tooth replacement with dental implants is an invasive method, demanding in time and money. For these reasons, it is important to understand the technical complications that occurs in five years in about 12% of crowns on dental implants. Loosening of the screw in the abutment can have serious consequences for the patient, from the destruction of the crown when trying to find the fixation screw, associated with bacterial colonization leading to perimplantitis or its accentuation, to the fracture of the screw or fixture. The aim of the presented communication is to present current knowledge about the causes of screw loosening in the abutment, their prevention and a suitable method of treatment. Conclusion: Loosening the screw in the abutment is a common occurrence with adverse consequences that may jeopardize functionality, aesthetics and treatment success. This is not a devastating complication, but recurrence is not desirable. A loose screw can be an early warning of inadequate replacement biomechanics, or implant overload. Accurate diagnosis is also necessary so that an implant with loss of osseointegration is not considered a loose crown on the implant and vice versa.

Introduction and aim: The aim of this article is to introduce the method of skeletally anchored inter-jaw elastic forces in patients with skeletal class III malocclusion to the dental specialists. Skeletal class III malocclusion is an anomaly that affects 4-14% of the population in the context of anthropological specifics of different ethnic groups, with 0.48-4.0% in the Caucasian European and North American populations.This diagnosis in children often opens many therapeutic embarrassments not only in dentist, but also in orthodontist office. If the skeletal class III malocclusion develops dynamically and, moreover, with the emphasis on the unfavorable type of growth, during the adolescence it may result in the indication of demanding jaw correction operation. This is always accompanied with a complex orthodontic preparation, necessary postoperative orthodontic treatment and a long-term retention phase. In some types of skeletal class III malocclusions, it is possible to successfully intervene during growth. Early differential diagnosis by an orthodontist or maxillofacial surgeon is essential, followed by the determination of the most effective procedure for comprehensive treatment. Except for the described method, skeletal class III malocclusions are treated using removable and fixed appliances or extraoral elastic forces at the time of growth. A goal of this early age treatment is to create and maintain an overbite of the upper frontal teeth, to expand the upper dental arch, and to control the growth tendencies of the lower jaw at the time of dental replacement. Methods: The authors describe a surgical and orthodontic protocol for the use of skeletally anchored Bollard modified miniplates, which offers a therapeutic alternative to challenging orthognathic surgery. With a proper indication, the skeletal class III malocclusion manifestation can be significantly reduced and orthodontically compensated entirely or only partially to reduce the invasivity and extent of the necessary final orthognathic surgical intervention. The presented method offers a possibility of a growth modification of the upper jaw or of the entire stomatognathic system together with occlusion and dental arches relationship. An orthodontic part of the treatment involves adjusting the size and shape of dental arches, especially the transversal dimension of the upper dental arch. Furthermore, by applying elastic forces, the orthodontist regulates the growth of the jaws and adjusts, respectively changes their relationship. A surgical part consists of insertion of the skeletally anchored miniplates for application intermaxillary elastic forces. Results and conclusion: The authors present the therapeutic procedure which, despite its simplicity, remains on a margin of professional interest and out of the spectrum of commonly indicated methods of choice. The therapeutic appliances, considered diagnostic criteria and orthodontic as well as surgical treatment protocol are discussed, including possible complications.

Introduction, aim: The oxide layers on surface of titanium alloy are influencing corrosion resistance and biocompatibility. The compatibility between the bony tissue and titanium alloy is prevalently dependent on properties of a stable titanium dioxide layer. These layers can be prepared by various methods. The oxidation process (and its conditions) is resulting in different types of oxide layer: difference in chemical composition, mechanical properties, inner structure etc. The deviation inside of the layers structure may influence the stability of the layer, its adhesion or biocompatibility.The anodic oxidation of titanium alloys in appropriate electrolyte (under certain conditions) can lead not only to creation of the oxide layer, but to creation of an oxide layer with structured surface. This kind of structure is usually characterized by pores in nanometer scale. The structured surface radically changes the interaction between the titanium alloys surface and cells; and thus influencing its behavior inside a body. The cell interaction with the structured surfaces is not properly described yet. This work aims for better understanding of such structured layers. Methods: The anodic oxidation was carried out on Ti6Al4V ELI polished samples. The oxidation process was realized in 1M H2SO4 electrolyte with the voltage 100 V and current density 50 mA/cm2. The thickness and surface morphology of the resulting oxide layer were evaluated and documented using a scanning electron microscope (SEM). The changes of color and roughness of the surface after the oxidation were observed as well.The cytocompatibility of the materials surface is expressed by a surface area colonized by cells after the three days of cultivation. This method is standardly used and accredited by ČIA. The MG63 cells were used for the experiment and the percentage of colonized surface area was evaluated. The evaluation was done on polished and oxidized Ti6Al4V ELI samples and the results were compared. Result: The structure of samples prepared using the anodic oxidation consisted of pores with size ranging from tens to hundreds of nanometers.The cytocompatibility testings showed that the cells colonized larger area on the oxidized samples. The cells covered 56.9% of the surface area of the polished samples, while 63.5% of the surface area of the anodized samples. Results of all samples exhibited Gaussian distribution. Conclusion: The anodic oxidation lead to a creation of nanostructured oxide layer on Ti6Al4V ELI samples. The cytocompatibility of this layer was compared to polished samples. It was shown that cells are colonizing the larger surface area on the oxidized samples.

Introduction, aim: The issue of fracture of endodontic nickel-titanium instruments is quite extensive. It is an alloy that has the ability to change its internal structure. A great deal of effort is devoted to the development of an alloy with ideal properties. Instruments fracture occurs for two basic reasons. The first one is exceeding the limit of resistence of the instrument to cyclic fatigue and the other one is exceeding the limit of torsional load of the instrument. Most authors agree, that the main factor influencing instruments fracture is exceeding the limit of cyclic fatigue. The aim of this study was to evaluate the resistence to cyclic fatigue of the Unicone Plus in comparison with its predecessor, Unicone, under different enviromental conditions. Methods: A total of forty (20 + 20) Unicone 6/025 and Unicone Plus 6/025 instruments (Medin, Czech republic) with identical tip diameter of 0.25 mm and constant taper of 0.06 were subjected to cyclic fatigue test at temperatures 20 °C ± 1 °C and 35 °C ± 1 °C. Special device was constructed for testing. This device uses the principle of using an artificial root canal made of stainless steel with a radius of the curvature of 5 mm, an angle of curvature of 60°. A thermostatic bath was added to the set-up. The liquid of the desired temperature was added to the container and maintained at that temperature throughout the test under the control of an infrared thermometer. Due to the fact that tested instruments are used in reciprocal movement, they were tested in Reciproc ALL mode. To evaluate cyclic fatigue of the instruments, the time was measured from the start of rotation of the instrument, until the fracture occured with an accuracy of whole seconds. The non-parametric Kruskal-Wallis test was used for statistical evaluation, followed by Mann-Whitney U-tests of multiple comparison and Bonferroni correction at the significance level of 5%. Results: The obtained results from four groups were compared. Unicone instruments were statistically significantly less durable than Unicone Plus at both temperatures tested (p < 0.05). Higher enviromental temperature had statistically significant effect on lowering of cyclic fatigue resistence (p < 0.05). Conclusion: Unicone Plus instruments are more resistant to cyclic loading than Unicone. In this case, greater durability is most likely associated with innovative manufacturing processes. Furthermore, the resistence of instruments to cyclic fatigue dereases with increasing ambient temperature.