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Introduction/Objective. of this study is to use scanning electron microscopy (SEM) analysis to examine surfaces of new and same sets of Ni-Ti instruments after canal preparations, to check their suspectability to corrosion. Methods. In this study, we used five different endodontic Ni-Ti instruments: K3, Mtwo, ProTaper Universal, HyFlex and BioRaCe. Instruments were analyzed before and after preparation of canals of different curvature, using SEM (150–2000 ×). Results. Corrosion of the working part was observed in 5.5% of new Ni-Ti instruments of the K3 system (apical and middle segment), in 5.5% of Mtwo instruments (apical third), and in 11.1% of ProTaper Universal systems (apical and middle third). Corrosion was not observed on the new instruments of the HyFlex and BioRaCe kits. After instrumentation, disinfection, and sterilization, corrosion was observed in all sets of K3 and ProTaper Universal systems and in all HyFlex instruments of the first group. Corrosion was observed in the HyFlex system in the second group in 16.7% of instruments (apical and middle third) and in the third 83.3% in the apical and 66.7% in the middle segment. In the Mtwo set, corrosion was observed in 16.7% of instruments in the first (apical and middle third), in the second group in 33.3% of instruments in the apical part and 50% in the middle third, while in the third group, corrosion was observed in 16.7% of instruments in the middle third of instruments. Conclusion. Rotary Ni-Ti instruments K3 and ProTaper Universal are susceptible to corrosion in a very high percentage. Ni-Ti systems with post-heat treatment of the working part (HyFlex) are somewhat more resistant to corrosion, while in Ni-Ti systems with electropolished surface (BioRaCe), corrosion is not observed.

Introduction/Objective. Calcium hydroxide (CH) is the medicament of choice in endodontic treatment of internal root resorptions. The aim of the study was to compare the effectiveness of three different techniques for CH removal from simulated internal root resorptions. Methods. Twenty-nine extracted single-root teeth were prepared using NiTi rotary files of BioRaCe system (40/.04) following irrigation. A round diamond drill was used in the making of a symmetrical standardized internal resorptions 6 mm from the apex. Three techniques for CH removal from internal resorptions were tested: modified conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), XP-endo Finisher (XP). Resorptive cavities and apical thirds were observed under a stereomicroscope (×45) and scored (from 1 to 5), while representative samples were analysed by a scanning electron microscope. Obtained results were statistically processed by Kruskal–Wallis and Mann–Whitney U-test (p < 0.05). Results. The most efficient system was PUI, with 66.7% of samples rated 1 and 33.3% rated 2. The next one was XP, and the least efficient was CSI, with 33.3% of samples rated 1 (resorptive defect without medicament). There was a statistically significant difference between the PUI and CSI systems (p < 0.05), while there was no difference between the PUI and XP systems. Conclusion. No system completely removed the CH from the simulated internal root resorption cavities. PUI was the most effective system for removing CH. The combination of techniques provides better performance in removing CH paste residues from the canal walls

More certain therapeutic and significantly facilitated solution of everyday endodontic problems are provided by the introduction of NiTi rotary files in endodontic practice and their proper application. However, their widespread use has caused more and more frequent fractures and has become a significant frustrating factor that diminishes their numerous benefits. Torsional stress and cyclic fatigue are the main reasons for the occurrence of a fracture, and the frequency of NiTi file fractures is exactly proportional to the degree of bending of the canal, knowledge of the features of the file, ie. the skill and expertise of the therapist. The most dominant factor for the occurrence of fractures is the dentist who, in addition to manual dexterity, must have a good knowledge of the anatomy of various canal systems and file design in order to make the best choice for each individual case. Properly formed access cavity and knowledge of the working part of NiTi files enable maximum realization of endodontic skills, increased efficiency of intervention and reduced possibility of error during canal instrumentation. The special treatment of NiTi alloy and new solutions related to the design of the working part have significantly increased file flexibility and resistance to cyclic fatigue. Specific design (reduced number of threads, change of conicity, interruption of blade continuity), reduced engagement of file, ie. change of dynamics of movement in the canal (full rotation, reciprocal, eccentric, transaxial), as well as reduced number of processing files, have also significantly influenced the reduction of fracture risks. The aim of this paper was to analyze the most common reasons for the fracture of NiTi files and emphasize measures and factors that can increase their safe use and reduce complications during canal instrumentation.

Introduction The aim of this study was to analyze working surfaces of new hand endodontic instruments and to check possible existence of dirt or defects on working surface that resulted from manufacturing process using SEM. Material and methods Three sets of new hand instruments: K-File (KF), (18 instruments) (Dentsply Maillefer, Switzerland) and Hedstorm Files (HF), (18 instruments) (SybronEndo Co, USA) were used. Instruments were analyzed by SEM method at 170× magnification while semi-quantitative EDS analysis was used to determine chemical composition of dirt particles. Fisher test (p < 0.05) was applied in statistical analysis. Results Results showed that none of the instruments was defect-free. The most common defects were metal strips and fretting noticed at the surface of all tested instruments. Debris was present on all KF (100% in apical and middle third) and HF (56% in apical and 56% in middle third) instruments. Pitting was noticed in KF (33% in apical and 39% in middle third) and HF (11% in apical and 6% in middle third) instruments. Corrosion of working surface, metal flash and disruption of cutting edge were marked only in KF group. Conclusion Manufacturing defects were noticed in all instruments and the most common type of irregularity were metal strips and fretting.

Introduction/Objective. The objective of this study is to use scanning electron microscopy (SEM) to analyze working surfaces of new manual and rotary endodontic instruments and to check possible existence of manufacture dirt particles or defects on the working surface. Methods. In this study, we used three sets of new manual instruments: K-File, KF (Dentsply Maillefer, Switzerland) and Hedstorm Files, HF (SybronEndo Co, USA) and three sets of mechanical Ni-Ti instruments – type K3 (SybronEndo Co, USA) and BioRaCe (FKG DENTAIRE Swiss Dental Products, Switzerland). The instruments were analyzed using SEM method at 170 × magnification while semi-quantitative energy dispersive x-ray analysis was used to determine chemical composition of dirt particles. Fisher test (p < 0.05) was applied in statistical analysis. Results. Results showed that none of the instruments were defect-free. The most common defect type was the presence of metal strips, which were noticed at the surface of all tested instruments. Debris was present on all manual and only one type of mechanical instruments, K3 (39% in the apical and 33% in the middle third). Fretting was noticed in all manual KF and all mechanical instruments of the K3 group. Pitting was common in all manual instruments, KF (33% in the apical and 39% in the middle third) and HF (11% in the apical and 6% in the middle third). Corrosion of the working surface, metal flash, and disruption of the cutting edge were marked only in the KF group. Conclusion. Manufacture defects were noticed in all instruments and the most common type of irregularity were metal strips. Electropolished surface of BioRaCe instruments showed no debris of organic origin.

Introduction/Objective. The application of nickel–titanium (NiTi) instruments in cleaning and shaping of the root canal system is a standard and a precondition for the success of endodontic treatment. The objective of this study was to use scanning electron microscopy (SEM) analysis in order to examine the efficiency of cleaning the apical third of the root canal system using two different NiTi systems with reciprocating movements. Methods. The study included 20 single-rooted teeth (premolars) divided into two groups. In group 1, the canal preparation was realized with a single file UNICONE with reciprocating movements (MEDIN, Inc., Nove Město na Moravě, Czech Republic), and in group 2, with а RECIPROC BLUE instrument with reciprocating movements (VDW GmbH, Munich, Germany). The same quantities of 2% NaOCl solution and 17% EDTA solution were used as irrigation solutions. The samples prepared for SEM analysis of the smear layer in the apical third were evaluated on a scale of 1–5 and at a magnification of 1,000×. Results. SEM analysis pointed to mostly clean canal walls in the apical segment in both tested groups. Slightly cleaner walls were observed after the application of the UNICONE file (78%) compared to the samples of the second group, where the instrumentation was realized by the RECIPROC BLUE file (76%), but without statistically significant differences. Conclusion. Single-file reciprocating systems do not remove the smear layer completely, but provide efficient cleaning of the apical region of the canal.

Introduction/Objective. Irrigation has an important role in root canal cleaning and its efficiency depends on the type of irrigants, the amount, the technique and the irrigation protocol. The aim of this work was to estimate the efficiency of cleaning of the canal walls by using scanning electron microscope analysis after the instrumentation by rotary NiTi instruments with the use of three different irrigation solutions and two final irrigation protocols. Methods. Sixty extracted human incisors were divided into two groups after the rotary instrumentation with the iRace instruments. In both groups, the same amount (1.5 ml) of three solutions (2% sodium hypochlorite solution, 2% chlorhexidine solution, and 10% citric acid solution) and total final irrigation time (90 seconds) was the same. The final irrigation in the first group was accomplished using the technique of continuous irrigation and in the second group it was done using the intermittent protocol. The roots were cut longitudinally and analyzed by thirds (coronal, middle, and apical) on a scanning electron microscope (JSM 6460LV, JEOL Ltd., Tokyo, Japan) with 1,000× magnification. Results. The most efficient cleaning of the root canal walls in both groups was seen after the use of citric acid with the intermittent protocol of the final irrigation (90.7% clean walls), while the least efficient was the final irrigation by chlorhexidine with continuous irrigation (80.3%). The most efficient cleaning of the canal walls in both groups was observed in the coronal third and the largest amount of the smear layer in the apical third. Conclusion. The most efficient cleaning of the canal was achieved by the use of citric acid and the intermittent protocol of the final irrigation. In all tested solutions, the intermittent protocol of irrigation was more efficient than continuous irrigation.

Introduction Efficient cleaning and canal design present a basic precondition for successful endodontic treatment. The aim of this study was to evaluate, using SEM analysis, the efficacy of cleaning the apical third of the canal with one instrument in both reciprocating motion and full rotation systems. Materials and methods Thirty (30) single-rooted teeth (upper incisors), extracted due to periodontal problems, were used and selected in 2 groups. In the group 1, instrumentation was done with a single instrument UNICONE with reciprocal movements (MEDIN, Czech Republic), while in the group 2, a single instrument XPS endo SHAPER (XPS) (FKG, Dentaire, Swiss) with full rotation was used. 2% solution of NaOCl and 17% EDTA solution were used as irrigation agents in both groups. SEM analysis of the smear layer in the apical third was done at standard magnification of 1000x and presented on a scale of 1-5. Results showed mostly clean canal walls and no smear layer in the apical region in both tested groups. Canal walls were somewhat cleaner after using UNICONE with reciprocal movements (80%) compared to the canals instrumented with XPS ENDO SHAPER (76%), but this difference was not statistically significant. Conclusion Single-file NiTi systems did not remove smear layer completely, but provided efficient cleaning in the api-cal part of the canal. UNICONE file with reciprocal movements was somewhat more efficient in removing the smear layer compared to the full rotation XPS ENDO SHAPER file.

Introduction the main objective of endodontic treatment is to eliminate infection from root canal and prevent re-infection by three-dimensional hermetic obturation of the canal system. Endodontic failure can occur due to inability of complete control and elimination of infection from the root canal. The aim of this study is to investigate, by PCR technique, microbiological status of previously endodontically unsuccessfully treated teeth immediately after the removal of obturation material. Material and Methods the analysis included 30 teeth indicated for endodontic retreatment. After removing previous root canal filling material, the bacteriological sample was taken by sterile instrument (# 15) and paper points. Standard PCR technique was used to analyze the incidence of E.faecalis, P.micros, P.intermedia, P. endodontalis and a.actinomycetemcomitans. Results Positive bacteriological findings were registered in 80% of cases, while bacteria were not identified in 20% of all samples (all taken from the root canals without significant changes in periapical tissue). From 24 canals with identified bacteria, 17 had affected apical periodontium. The most dominant microbe in root canals with positive bacteriological finding was E.faecalis (83.3% of the canals) and P.intermedia (75%). In case of teeth with chronic periapical changes, the most common was E. faecalis (94%) and P.intermedia (82.3%). Conclusion the presence of periapical lesions significantly affects microbiological status of endodontically treated teeth. The presence of bacteria was confirmed in most teeth with periapical lesions, while the most frequently identified bacteria were E. faecalis, P.intermedia and P.micros.

Introduction Development of inflammatory lesions or their persistence after primary treatment is considered endodontic failure. The reason for failure can be complex anatomy of the canal system and numerous iatrogenic factors. The objective of this study was to analyze, clinically and radiographically, the causes of primary endodontic treatment failure and assess possibilities for retreatment of teeth with failed endodontic treatment. Method The study included 79 teeth (36 multirooted and 43 singlerooted tooth) indicated for repeated endodontic treatment. Based on the radiographic assessment of the status of periapical structures, teeth were divided into two groups. The first group included teeth without periapical lesions, i.e. the healthy periodontal tissues (PAI score of 1 and 2) in which retreatment was required for prosthodontic reason due to the poor quality of obturation (28 teeth), and the second group included teeth with visible signs of periapical tissue damage (PAI scores 3, 4 and 5) (51 teeth). In both groups, quality of obturation, coronal sealing and the presence or absence of clinical symptoms was analyzed. Results The most common radiographic finding of definitive obturation was short filling (65.8% of cases); “forgotten” canals (25.3%); non-homogeneous obturation with correct length (5.1%) and fractured instrument (3.8%). There was significant difference between healthy periodontal ligament and adequate restoration (P < 0.001). In 95% of patients with symptoms, changes in the periapical tissue were observed. Also, there was significant difference in the presence of symptoms after primary treatments, between the teeth with healthy apical periodontal tissue and teeth with periapical lesions (P = 0.019). Conclusion The outcome of the root canal treatment is significantly affected by the quality (density) of obturation and the presence and quality of coronal restoration. In patients with symptoms there were changes in the periapical tissue.

Introduction The aim of this study was to evaluate the efficacy of new rotary NiTi instrument XP endo SHAPER (XPS) used with conventional irrigation protocol on the root canal cleaning in the apical area. Material and methods The research was conducted in vitro on 40 extracted single-rooted teeth divided into the four groups. Instrumentation in the first group was performed using iRa Ce NiTi rotary instruments, in the second group the same instruments were used plus XP endo FINISHER (XPF) for smear layer removal. In the third group, canal instrumentation was done using new instrument XPS, and in the fourth XPS instruments plus XPF was used. During the instrumentation 2% NaOCl solution was used for rinsing canals. The SEM analysis of the cleaning quality in the apical third of the canal was performed on longitudinal root cross-sections and standardized microphotography with a 2000x magnification. Results The thickest smear layer in the apical third was recorded in the first group (iRa Ce) NiTi instruments (2.12), and somewhat less in the group with the new XPS instrument (1.95). An identical and somewhat smaller amount of smear layer was registered in the second and fourth groups where XPF was used with the final irrigant (1.64) (p

Root canal (endodontic) treatment is demanding and complex procedure. A variety of difficulties can occur in different phases of endodontic procedure. Complex anatomorphological tooth structure, curved canals, close proximity of lower molars and premolars to inferior alveolar nerve make endodontic treatment even more challenging. During endodontic treatment, an inferior alveolar nerve may become traumatized and symptoms may vary from mild neurosensory dysfunction to a complete loss of sensation in the innervation area of damaged nerve. The aim of this paper is to present a clinical case of endodontic treatment of lower second molar with C-shaped root canal in a patient with paraesthesia of inferior alveolar nerve due to endodontic origin.

Dental fear represents a significant social concern. Therefore, an individual approach to each patient and timely recognition and elimination of dental stress are necessary in order to provide adequate and successful treatment. The aim of this paper was to present possible application of music therapy in dentistry and its role in reducing dental fear. Music has shown great prospective as an alternative therapy method in various fields of medicine. Music therapy is painless and noninvasive anxiolytic method that reduces dental anxiety as it provides relaxation and distraction. Music in dental office creates positive atmosphere among patients and their company as well as dental staff.

Introduction. Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. Objective. The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. Methods. Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2) while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5). Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. Results. Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. Conclusion. Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions.

Introduction The aim of this study was to evaluate using SEM analysis the effectiveness of a new instrument XP-endo Finisher in cleaning root canal walls after instrumentation with BioRaCe NiTi rotary instruments. Material and Methods This in vitro study was conducted on 30 extracted single rooted teeth divided in two groups. Instrumentation of all canals was done using basic BioRaCe NiTi rotary instruments with copious irrigation of 2% NaOCl. In the first group, after complete instrumentation smear layer was removed using XP-endo Finisher, while the other group served as negative control. The roots were then after longitudinally cut and SEM analysis was performed. The presence of smear layer in the coronal, middle and apical third was assessed. The data were statistically analyzed using Mann-Whitney U-test (p

Dental anxiety might be the cause of serious health problems. Avoiding dental visits can lead to complications with functional, esthetic and sociological consequences. In order to have a simple and efficient dental procedure, it is very important to diagnose dental anxiety and to react adequately. The aim of this paper is using available literature to present most frequent causes, consequences as well as treatment options for dental anxiety. Treating dental anxiety and choosing the right treatment is not always easy, however, it is important for dental practitioners to be able to assess patient's behavior, possible causes of such behavior and select adequate therapy methods. Individual approach is very important as well as timely recognition and gradation of dental anxiety in order to apply adequate and successful dental treatment.

Intoduction. Endoperiodontal lesions are frequent in clinical practice and may require complex therapy. It is very important to determine differential diagnosis and the origin of the lesion, because the treatment plan is based on aetiology and stadium of the development of the lesion. Objective. The aim of this clinical study was to analyze the efficacy of endodontic treatment in different types of endodontic- periodontal lesions. Methods. Thirty patients and 42 teeth with diagnosed endoperiodontal lesions were included in the study and divided in two groups. Vital pulp therapy was applied to 18 vital teeth where the diagnosis was perio-endodontic lesions. The therapy of infected canal system was applied to 24 teeth with endodontic- periodontal or combined lesions. Standard endodontic procedure consisted of cleaning and shaping of the root canal system and between sessions filling with calcium-hydroxide paste. Obturation was made by lateral compact of the guttapercha and Apexit paste. Efficiency was evaluated clinically and radiographically three, six and twelve months later. Results. Radiographic and clinical follow-up showed a significant radiographic improvement and absence of subjective symptoms in a very high percentage of the treated vital and avital teeth. The results of this study showed that in the observation period of 12 months endodontic therapy was successful in 88.89% of vital teeth, and in the group of avital teeth the percentage was 91.67%. Conclusion. Endodontic treatment of the endoperiodontal lesions was sufficient and it was the basic condition to achieve a complete healing of endodontic-periodontal lesions. Such therapy ensures significant improvement or even complete healing of both types of lesions, of endodontic and periodontal origin.

The therapy of non-caries cervical lesions is an important problem in restorative dentistry, for the ambiguous aetiology, clinical diagnoses and for the selection of restorative procedure. Aim: The aim of this work was to clinically check the efficiency of non-caries cervical lesions restoration depending on materials used for restorative fillings. Materials and methods: Clinical researches covered 62 teeth of different morphology group at the patients of both gender and of different age. The restoration of gingival lesions, with no previous preparation, was done with composite adhesive system SINGLE BOND/Valux Plus (3M) (30 teeth) and with campomer DYRACT AO (Dentsplay) (32 teeth). The fillings were estimated on the checkups which took place on 3,6 and12 months applying modified criteria according to Ridge and Cvar. Results: The acquired results showed that after 3 to 6 months there were no changes at none of examined parameters and all the fillings got maximal mark A. 12 months latter, in the two cases with composite filling, the marginal adaptation got the mark B (607%). The marginal adaptation at two teeth restored with compomers got the mark B (6.3%) Postoperative sensitiveness phenomenon, marginal discoloration and secondary caries weren’t registered in none of the cases after the observation period of 12 months. Conclusion: For the restoration of non-caries cervical lesions, composite materials with suitable adhesive system and the new generation of compomers could be used. .

Background/Aim. Systemic sclerosis (SSc) is a chronic systemic disease of the connective tissue. It is characterized by diffuse microangiopathy, increased activity and creating deposits of collagen in the skin and internal organs. Involvement of the lung function disturbances in SSc is a bad prognostic sign. The aim of our study was to investigate the association between smoking habits and lung function disorder in the SSc patients. Methods. The testing was conducted at the Clinic for Rheumatology and Immunology of the Military Medical Academy in 2016. In this study, we included 42 patients with the newly diagnosed SSc and the patients whose disease had been diagnosed earlier. Results. The patients were classified according to the smoking habits, 14 (33.3%) patients were nonsmokers, while 28 (66.7%) patients were current (23 patients) or ex-smokers (5 patients). We found no significant differences in examined parameters among smokers and nonsmokers. In addition, distribution of the patients with the obstructive pulmonary pattern revealed by spirometry was uniform between smokers and nonsmokers. The concentrations of C reactive protein (CRP) were significantly higher in the SSc patients with the obstructive pulmonary pattern. The patients with the obstructive pattern on spirometry had significantly lower values of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, diffusing lung capacity for carbon monoxide (DLCO) and FVC/DLCO ratio. Conclusion. In our study, we concluded that in the SSc patients with the obstructive pulmonary pattern revealed by spirometry, there were no significant differences between smokers and nonsmokers. CRP is a significant predictor of the lung involvement existence in the SSc patients. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. The brain natriuretic peptide (BNP) is a previously known marker of elevated cardiovascular risk in SSc, but the levels of BNP in various forms of SSc have not been investigated so far. Aim: The aim of our study was to evaluate the influence of SSc on the function of the right ventricle and the right atrium using the echocardiographic parameters. Moreover, we examined the levels of BNP in different forms of SSc as well as the association of disease severity with the plasma concentrations of BNP. Methods: We included 42 patients with newly diagnosed SSc and patients whose disease had been diagnosed earlier. SSc patients and non-SSc control patients were examined by using echocardiography and the concentrations of BNP were determined. Results: We analyzed differences in the parameters of right ventricle (RV) function and right atrium (RA) function between SSc patients and healthy controls. The two groups had similar distribution of gender, but SSc patients were significantly older than controls. RV wall thickness was increased in SSc patients (p<0.001), while right ventricular end-systolic area (RVESA; p=0.408) and right ventricular end-diastolic area (RVEDA; p=0.368) did not differ among the examinees. In contrast, RA minor-axis dimension (p=0.001) and the tricuspid annular plane systolic excursion (TAPSE) (p=0.001) were significantly higher in SSc patients. Also, we analyzed differences in brain natriuretic peptide (BNP) concentrations between diffuse cutaneous systemic sclerosis (DSSc) and limited cutaneous systemic sclerosis (LSSc) patients. DSSc patients had significantly higher concentrations of BNP We found that levels of BNP were in significant positive correlations with age (p=0.007), disease duration (p=0.023), C reactive protein (CRP) (p=0.032), right ventricle fractional area change (FAC) (p=0.022), pulmonary vascular resistance (PVR) and Rodnan score (p=0.019). Conclusions: Given the obtained results, the laboratory determination of BNP could be useful in differentiating different forms of systemic sclerosis as well as in predicting the severity of the disease and future cardiovascular complications. [ABSTRACT FROM AUTHOR]

Introduction Efficient cleaning and canal design present a basic precondition for successful endodontic treatment. The aim of this study was to evaluate, using SEM analysis, the efficacy of cleaning the apical third of the canal with one instrument in both reciprocating motion and full rotation systems. Materials and methods Thirty (30) single-rooted teeth (upper incisors), extracted due to periodontal reasons, were used and selected in 2 groups. In the group 1, instrumentation was done with a single instrument UNICONE with reciprocal movements (MEDIN, Czech Republic), while in the group 2, a single instrument XPS endo SHAPER (XPS) (FKG, Dentaire, Swiss) with full rotation was used. 2% solution of NaOCl and 17% EDTA solution were used as irrigation agents in both groups. SEM analysis of smear layer in the apical third was done at standard magnification of 1000x and presented on a scale of 1-5. Results showed mostly clean canal walls and no smear layer in the apical region in both tested groups. Canal walls were somewhat cleaner after using UNICONE with reciprocal movements (80%) compared to the canals instrumented with XPS ENDO SHAPER (76%), but this difference was not statistically significant. Conclusion Single-file NiTi systems did not remove smear layer completely, but provided efficient cleaning in the apical part of the canal. UNICONE file with reciprocal movements was somewhat more efficient in removing smear layer compared to the full rotation XPS ENDO SHAPER file. [ABSTRACT FROM AUTHOR]

Root canal (endodontic) treatment is demanding and complex procedure. A variety of difficulties can occur in different phases of endodontic procedure. Complex anatomorphological tooth structure, curved canals, close proximity of lower molars and premolars to inferior alveolar nerve make endodontic treatment even more challenging. During endodontic treatment, an inferior alveolar nerve may become traumatized and symptoms may vary from mild neurosensory dysfunction to a complete loss of sensation in the innervation area of damaged nerve. The aim of this paper is to present a clinical case of endodontic treatment of lower second molar with C-shaped root canal in a patient with paraesthesia of inferior alveolar nerve due to endodontic origin. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. The brain natriuretic peptide (BNP) is a previously known marker of elevated cardiovascular risk in SSc, but the levels of BNP in various forms of SSc have not been investigated so far. Aim: The aim of our study was to evaluate the influence of SSc on the function of the right ventricle and the right atrium using the echocardiographic parameters. Moreover, we examined the levels of BNP in different forms of SSc as well as the association of disease severity with the plasma concentrations of BNP Methods: We included 42 patients with newly diagnosed SSc and patients whose disease had been diagnosed earlier. SSc patients and non-SSc control patients were examined by using echocardiography and the concentrations of BNP were determined. Results: We analyzed differences in the parameters of right ventricle (RV) function and right atrium (RA) function between SSc patients and healthy controls. The two groups had similar distribution of gender, but SSc patients were significantly older than controls. RV wall thickness was increased in SSc patients (p< 0.001), while right ventricular end-systolic area (RVesa; p= 0.408) and right ventricular end-diastolic area (RVEDa; p= 0.368) did not differ among the examines. In contrast, RA minor-axis dimension (p=0.001) and the tricuspid annular plane systolic excursion (TAPSE) (p= 0.001) were significantly higher in SSc patients. Also, we analyzed differences in brain natriuretic peptide (BNP) concentrations between diffuse cutaneous systemic sclerosis (DSSc) and limited cutaneous systemic sclerosis (LSSc) patients. DSSc patients had significantly higher concentrations of BNP. We found that levels of BNP were in significant positive correlations with age (p= 0.007), disease duration (p= 0.023), C reactive protein (CRP) (p= 0.032), right ventricle fractional area change (FAC) (p= 0.022), pulmonary vascular resistance (PVR) and Rodnan score (p= 0.019). Conclusions: Given the obtained results, the laboratory determination of BNP could be useful in differentiating different forms of systemic sclerosis as well as in predicting the severity of the disease and future cardiovascular complications.