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Aim: The aim of this clinical study was to evaluate the effect of low-level laser therapy, used in conjunction with conventional canal disinfection techniques, on post-operative pain after single- and multi-visit root canal treatments for chronic apical periodontitis. Methodology: 100 volunteers were randomly divided into 4 groups. The main inclusion criteria were radiographic evidence of apical periodontitis (minimum size of 2.0 × 2.0 mm) and a diagnosis of pulpal necrosis confirmed by a negative response to vitality tests. All the root canals were prepared using a standard shaping technique and irrigation procedure. In Groups I and III, the root canals were obturated during the first visit following chemo-mechanical preparation. In Groups II and IV, the root canals were medicated with calcium hydroxide and obturated during a second visit, 1 week later. In Groups III and IV, after the chemo-mechanical preparation, the root canals were additionally irradiated by an 810-nm diode laser at 1.5 W output for 20 seconds. A modified visual analogue scale was used to measure pain at 4, 8, 12, 24, and 48 hours and 7 days after the treatment. Results: There was no statistically significant difference between the groups in terms of post-operative pain at any time during the observation period (p > .05). Post-operative pain occurred only at 8 and 12 hours and at 1, 2, and 3 days in all groups. There was no correlation between the results regarding age, gender, periapical index scores, or tooth type. Conclusion: The use of low-level laser therapy had no significant effect on the incidence of post-operative pain, and single-visit root canal treatment may be a strong alternative to multi-visit treatment. How to cite this article: Özkan Özcan H, Haznedaroğlu F, Gökyay S. Comparison of the incidence of post-operative pain after low-level laser therapy between single- and multi-visit root canal treatments for chronic apical periodontitis: A prospective randomized clinical trial. Int Dent Res 2021;11(1):30-7. https://doi.org/10.5577/intdentres.2021.vol11.no1.6 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Aim: To evaluate and compare the antimicrobial efficacy of Chitosan, Ethylenediaminetetraacetic acid, Sodium Hypochlorite and Chlorhexidine against Enterococcus faecalis at room temperature of the irrigant, at warm temperature (60o Celsius) of the irrigant and after intracanal heating (180o Celsius) of the irrigant. Materials and method: A total of 120 extracted single-rooted teeth were infected for 21 days with E. faecalis after instrumentation with Pro Taper system. Before irrigation procedure, dentinal shavings were collected in 1 ml of sterile broth and incubated. The optical density of each broth was measured using digital colorimeter and initial readings were recorded. Samples were then divided into five groups of 24 teeth in each group– Group A: Sodium hypochlorite irrigation, Group B: EDTA irrigation, Group C: Chitosan irrigation, Group D: Chlorhexidine irrigation, Group E: Saline irrigation. Each group was further divided into three subgroups – (I) Room temperature of irrigant (II) Warm temperature of irrigant (III) Intracanal heating of irrigant. After irrigation, dentinal shavings were collected and optical density recorded. The values were analysed statistically with Student’s t test and analysis of variance followed by Post-Hoc Bonferroni’s correction test; p-value < 0.05 was considered to be statistically significant. Results: The post irrigation optical densities in all the groups were significantly lower than pre irrigation values. Sodium hypochlorite and Chlorhexidine demonstrated better antimicrobial efficacy followed by Chitosan and EDTA, whereas the least efficacy was shown by Saline which was the control group. Differences in optical density using different irrigants were found to be higher by intracanal heating of irrigants followed by warm irrigation and room temperature irrigation (p

The use of bentonite clay in addition to the rate of mineral fertilizers N150P105K75kg/ha before sowing winter wheat every year in a 1:1 system (cotton-grain) under conditions of typical gray soils of the Tashkent region with irrigation in the order of 60-70-60 and 70-80-70 % of pre-irrigated soil moisture, relative to LFMC, had a positive effect on the agrophysical properties of the soil, on the growth and development of the plant. Relative to the control variant, by the end of the growing season, the actual density of winter wheat increased to 54-59 m2/piece, growth to 4,3-6,8 cm, the number of common stems to 1,0-1,050 million/ha and the number of productive stems to 758,0-774,0 thousand/ha, achieved up to 12,5-13,4 center of additional grain yield.

Aim: To evaluate the efficacy of chitosan as a post- space irrigant on bond strength of glass fiber posts luted with self-adhesive resin cements. Methodology: thirty single rooted human mandibular premolars with similar dimensions were decoronated to a standard root length of 15mm, endodontically treated and subjected to post preparation to a 10mm length. Specimens were randomly divided in to 3 groups according to the post space irrigant (PSI) to be used in to group (Saline, EDTA, Chitosan) n=10 each. Following irrigation procedure glass fiber posts (GFP) (Glassix radiopaque, H Nordin, Chailly/Montyreux, Switzerlandand) were cemented using self-adhesive resin cement (RelyX U100). Specimens were sectioned perpendicular to the long axis into 1mm thick slices. Three slices (one representative of each root third) from each specimen were subjected to push- out test and bond strength in MPa was statistically analyzed. Results: the bond strength was significantly higher in both EDTA and Chitosan groups than saline group P < 0.001. Bond strength was significantly affected by the region of the root canal P< 0.001. Conclusion: PSI affects the bond strength of GFP luted with self-adhesive resin cements. Chitosan can serve as a safer alternative for EDTA as a chelating agent. Chitosan as a PSI has a positive influence on the bond strength of GFP luted with self-adhesive resin cements.

Aim: The objective was to formulate and characterize the nanoemulsion based on Cymbopogon citratus oil, intended for use in infected teeth root canal therapy. The investigation of the antioxidant and antibiofilm potential toward Enterococcus faecalis was aimed as well. Materials & methods: Characterization of oil (by GC/MS analysis) and nanoemulsion (by dynamic light scattering instrument), and determination of antibacterial (by microdilution assay), antibiofilm (by crystal violet assay) and antioxidant properties (by 2,2-diphenyl-1-picryl-hydrazyl-hydrate and thiobarbituric acid assay methods) were provided. Antibiofilm efficacy of irrigation procedure including nanoemulsion was screened on extracted teeth (by CFU-counting assay). Results: Notable antibacterial and antibiofilm activity, both against forming and preformed biofilms of oil, was observed. Irrigation involved nanoemulsion showed remarkable antibiofilm potential. Both substances induced some antioxidant activity. Conclusion: Results encourage further research with the aim of application of the nanoemulsion in dental practice.

Introduction: Apart from manual activation methods of irrigants during final irrigation procedure, multiple irrigant activation devices have been introduced which can influence the postoperative pain. Aim: To evaluate postoperative pain after final irrigation with open and closed-ended endodontic needles and Endoactivator during root canal treatment. Materials and Methods: This randomised controlled trial was conducted in Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, from June 2018 to August 2018. Total of 75 symptomatic irreversible pulpitis patients were randomly assigned into three groups. In group EN-1, final irrigation protocol was performed with 30-gauge notched tip needle (Pac-Dent, India), group EN-2 using side-vented, closed 30-gauge needle (Max-i-Probe, Dentsply, USA) and in group EA using Endoactivator (Dentsply, USA). Pain using Visual Analog Scale (VAS) was evaluated at 8, 24 and 48 hours. Participants were prescribed Non-steroidal Anti-Inflammatory Drugs (NSAIDs) as an escape medication. Comparison between the three groups at each time interval was done using Kruskal Wallis test followed by Mann-Whitney U test as post-hoc test. Change in VAS score over different time intervals (8, 24 and 48 hours) in each group was compared using Kruskal Wallis test and Mann-Whitney U test. The p-value less than 0.05 was considered statistically significant. SPSS version 20 was used for statistical analysis. Results: Mann-Whitney U test revealed significant difference between EN-1 and EN-2 (p=0.002) and between EN-1 and EA (p

Background Irrigation and debridement are frequently utilized in the management of surgical infections, but even with aggressive debridement, it is difficult to remove all the suture material from the tissues and retained suture material may harbor bacteria and/or biofilm. The degree to which barbed or braided sutures may differentially influence the risk of infection has not been defined in a well-controlled animal model. Questions/purposes We compared braided and barbed monofilament sutures after irrigation of an infected mouse air pouch model to determine whether the suture type influenced the effectiveness of the irrigation. After irrigation of infected pouches, sutures were compared for (1) bacterial adherence and bacterial retention; (2) qualitative and quantitative pouch thickness and cellular density; and (3) quantitative biofilm formation. Methods Soft tissue air pouches were created on the backs of 60 female, mature 10-week-old BALB/cJ mice by sequentially introducing air into the subcutaneous tissue and allowing the pouch to mature. The pouches were inoculated with Staphylococcus aureus and braided or barbed monofilament sutures were implanted. Pouch irrigation was performed Day 7 after suture implantation. Suture segments were collected before and after irrigation. After euthanasia on Day 14, pouch tissues with residual suture segments were collected for analysis: microbiologic analysis done using optical density as a measure of the concentration of bacteria in the culture (the larger concentration indicates higher number of bacteria) and histologic evaluation of the pouch tissues were semiquantitative, whereas environmental scanning electron microscopy (ESEM) and confocal analyses of the biofilm and bacteria on the sutures were qualitative. Results Histologic evaluation of pouch tissue showed all groups had inflammatory responses. Quantitatively microbiology showed no difference in bacterial number calculated from the optical density (OD) values between the two suture materials at any time point in the irrigation group. In the no-irrigation group, for the Day 7 time point, mean (± SD) OD was greater in the barbed than the OD in the braided sutures (0.52 ± 0.12 versus 0.37 ± 0.16, mean difference 0.43 [95% confidence interval, 0.08-0.13]; p = 0.007). Qualitatively, ESEM showed more bacterial retention by braided sutures before and after irrigation. Confocal imaging of the sutures demonstrated penetration of biofilm into the interstices of braided sutures and less adhesion in barbed monofilament sutures. The quantification of the biomass showed no differences between groups at all time points (before-irrigation biomass was 11.2 ± 9.3 for braided versus 5.2 ± 4.7 for barbed sutures, p = 0.196; and after-irrigation biomass was 7.2 ± 7.5 for braided versus 3.3 ± 4.3 for barbed suture, p = 0.259). Conclusions All sutures can retain bacteria and biofilm, but it is rarely possible to remove all suture material at the time of irrigation to treat infection. After an irrigation procedure, qualitatively braided sutures appeared to harbor more bacteria and to retain more biofilm than barbed monofilaments. Clinical relevance When saline irrigation was used to simulate infection treatment in an infected mouse air pouch model, bacteria/biofilm was not completely eliminated from either braided or barbed monofilament sutures. The irrigation appeared to clear more bacteria and biofilm from the monofilament despite having barbs. Unfortunately, current technologies do not allow direct quantitative comparisons of biofilm retention. Clinicians should be aware that in the face of infection, any retained sutures may harbor bacteria despite irrigation.

An extensive survey conducted in the Saïss plain of Morocco during the 2017–2018 growing season revealed that 35 out of 50 apple and pear orchards were infested with a pathogen that causes the decline disease. Morphological and phylogenetic tree analyses using the cox II gene allowed us to identify the pathogen as Phytopythium vexans. Interestingly, no Phytophthora and Pythium species were isolated. The occurrence and prevalence of the disease varied between locations, the most infested locations were Meknes (100%), Imouzzer (83%), and Sefrou (80%). To fulfill Koch’s postulate, a greenhouse pathogenicity test was performed on the stem and collar of one-year-old healthy seedlings of apple rootstock M115. Symptoms similar to those observed in the field were reproduced in less than 4 months post-inoculation with root rot disease severity ranging from 70 to 100%. The survey results evidenced that apple rootstocks, soil type, and irrigation procedure may contribute significantly to the occurrence of the disease. The disease was most prevalent in drip water irrigation and sandy-clay soil on wild apple rootstock. Accordingly, a rational drip advanced watering system and good sanitation practices could eliminate water stagnation and help prevent the onset of this disease. It was concluded that Pp. vexans occurrence may be strongly influenced by irrigation mode and type of soil. Therefore, the obtained findings of this study could help to better understand the recurrence of this disease and to develop a reliable integrated strategy for its management.

A 72-year-old woman who presented with right-sided epiphora and conjunctivitis underwent a probing and irrigation procedure with normal results. She improved with antibiotic-steroid drops. A swelling in the medial canthal region completely resolved. One year later, she returned with symptoms of dacryocystitis. An external dacryocystorhinostomy was performed. Characteristic dacryoliths were removed from the sac lumen, and biopsy of the sac wall showed spicules of lamellar bone within a fibrous stroma. Diagnosed as fibrous dysplasia of the lacrimal sac, this rare entity represents the second such case in the literature.The histopathology of an ossified lacrimal sac resembled fibrous dysplasia of bone and exemplifies the second case of this rare entity in the literature.

Purpose. To report the effectiveness of an intraoperative posterior chamber irrigation technique to enhance vitreous cavity support during postvitrectomy phacoemulsification cataract surgery. Methods. The irrigation technique was performed during phacoemulsification cataract surgery on 10 postvitrectomy eyes (9 patients) with moderate or hard density cataracts and with low vitreous cavity support. A cohesive viscoelastic tamponade was applied to pressurize the anterior chamber to start the procedure. The vitreous cavity was then irrigated using a 26-gauge flushing cannula injecting balanced salt solution under the iris through the zonules, until the vitreous cavity pressure balanced and exceeded the anterior chamber pressure and viscoelastic flowed out from the corneal incision. Intraoperative performance with the irrigation technique, postoperative visual acuity, and anatomy, and complications were retrospectively evaluated. Results. The irrigation procedure instantly enhanced posterior segment pressure before capsulorhexis in 4 eyes, before phacoemulsification in 4 eyes, after phacoemulsification in 2 eyes, before intraocular lens implantation in 6 eyes, and after implantation in 3 eyes. Phacoemulsification cataract surgery was facilitated by the irrigation technique, with a stabilized anterior chamber and robust vitreous cavity support. No complications occurred intraoperatively and postoperatively. At a 3-month follow-up, favorable visual and anatomic outcomes were achieved in all eyes. Conclusions. The irrigation technique balanced the pressure of anterior and posterior segments. Thus, vitreous cavity support and anterior chamber depth were well stabilized during phacoemulsification cataract surgery in postvitrectomy eyes.

The aim of this in vitro study was to evaluate the efficacy of different irrigation techniques including laser-activated irrigation using an erbium:yttrium-aluminum-garnet (Er:YAG) laser with a novel tip design (photon-induced photoacoustic streaming (PIPS)), Er:YAG laser with Preciso tip, sonic activation, and passive ultrasonic activation on the final irrigation solution penetration into dentinal tubules by using a laser scanning confocal microscope.In this study, 65 extracted single-rooted human mandibular premolars were instrumented up to size 40 and randomly divided into 5 groups (n = 13) based on the activation technique of the final irrigation solution as follows: conventional irrigation (control group), sonic activation, passive ultrasonic activation, Er:YAG-PIPS tip activation, and Er:YAG-Preciso tip activation. In each group, 5 mL of 5% NaOCl labeled with fluorescent dye was used during the activation as the final irrigation solution. Specimens were sectioned at 2.5 and 8 mm from the apex and then examined under a confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc tests (P = 0.05).Both Er:YAG laser (Preciso/PIPS) activations exhibited a significantly higher penetration area than the other groups (P 0.05). Additionally, passive ultrasonic activation had significantly higher penetration than the sonic activation group and the control group. Statistically significant differences were also found between each root canal third (coronal middle apical) (P 0.001).The results from the present study support the use of Er:YAG laser activation (Preciso/PIPS) to improve the effectiveness of the final irrigation procedure by increasing the irrigant penetration area into the dentinal tubules.The activation of the irrigant and the creation of the streaming with the Er:YAG laser have a positive effect on the irrigant penetration.

Introduction The aim of this study was to investigate the release of growth factors into root canal space after the irrigation procedure of regenerative endodontic procedure. Methods Sixty standardized root segments were prepared from extracted single-root teeth. Nail varnish was applied to all surfaces except the root canal surface. Root segments were irrigated with 1.5% NaOCl + 17% EDTA, 2.5% NaOCl + 17% EDTA, 17% EDTA, or deionized water. The profile of growth factors that were released after irrigation was studied by growth factor array. Enzyme-linked immunosorbent assay was used to validate the release of transforming growth factor (TGF)-β1 and basic fibroblast growth factor (bFGF) at 4 hours, 1 day, and 3 days after irrigation. The final concentrations were calculated on the basis of the root canal volume measured by cone-beam computed tomography. Dental pulp stem cell migration on growth factors released from root segments was measured by using Transwell assay. Results Total of 11 of 41 growth factors were detected by growth factors array. Enzyme-linked immunosorbent assay showed that TGF-β1 was released in all irrigation groups. Compared with the group with 17% EDTA (6.92 ± 4.49 ng/mL), the groups with 1.5% NaOCl + 17% EDTA and 2.5% NaOCl + 17% EDTA had significantly higher release of TGF-β1 (69.04 ± 30.41 ng/mL and 59.26 ± 3.37 ng/mL, respectively), with a peak release at day 1. The release of bFGF was detected at a low level in all groups (0 ng/mL to 0.43 ± 0.22 ng/mL). Migration assay showed the growth factors released from root segments induced dental pulp stem cell migration. Conclusions The root segment model in present study simulated clinical scenario and indicated that the current irrigation protocol released a significant amount of TGF-β1 but not bFGF. The growth factors released into root canal space induced dental pulp stem cell migration.

Statement of problem The effects of different post space irrigation procedures on the bond strength of a self-adhesive resin cement to the root canal dentin are still unclear. Purpose The purpose of this in vitro study was to evaluate the effects of alternative post space irrigation procedures on the cement strengths of posts attached with a self-adhesive resin cement. Material and methods Forty single-rooted teeth were selected, and after root canal preparation and obturation, post spaces were prepared. The teeth were divided into 4 groups corresponding to the post space irrigation procedure and treated as follows: the distilled water (DW) group (control) received 15 mL of distilled water; the NaOCl+ethylenediaminetetraacetic acid (EDTA) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of distilled water; the chlorhexidine (CHX) group was treated with 15 mL of 2% chlorhexidine solution; and the phosphoric acid (PA) group treatment consisted of etching the walls of the prepared post holes with 35% phosphoric acid. Fiber posts were attached with a self-adhesive resin cement, and specimens were cut horizontally for push-out testing. The statistical evaluation consisted of 1-way ANOVA with the post hoc Tukey honest significant differences test (α=.05). Results The NaOCl+EDTA treatment yielded a significantly higher bond strength than those used in the other 3 groups ( P =.003). No statistically significant differences were found among any of the other groups, as different root regions showed similar bond strength values ( P >.05). Conclusions The results showed that EDTA in combination with NaOCl could be advantageous for post space irrigation when fiber posts are bonded with a self-adhesive resin cement.

Amaç: Bu çalışmanın amacı, Vibringe,EndoVac, pasif ultrasonik (PUI) ve geleneksel şırınga irrigasyonunun (GSI) kök kanallarından kalsiyum hidroksit(CH) uzaklaştırma etkinliklerinintaramalı elektron mikroskop (SEM) yardımı ile değerlendirilmesidir.Gereç ve Yöntem: Bu çalışma için 70adet tek köklü insan mandibular premolar diş kullanıldı. Örnekler ProTaperdöner sistem ile F4'e kadar prepare edildi ve kalsiyum hidroksit iledolduruldu. Bir hafta sonra, kalsiyum hidroksit kök kanallarından GSI (Grup 1), Vibringe (Grup 2) , EndoVac, (Grup 3) ve PUI (Grup 4) yöntemleri kullanılarakuzaklaştırıldı. İşlemler sırasında, herörnek için toplamda altı dakika boyunca (aktif ve pasif irrigasyon) 2.5 mL %2.5’lik NaOCI ve ardından 2.5 mL’lik % 17’lik EDTA kullanıldı. Kalan kalsiyumhidroksit miktarının değerlendirilmesi için kökler uzunlamasına ikiye ayrıldıve x50 ve x1000 büyütme altında SEM’de incelendi. Veriler Kruskal-Wallis veMann-Whitney U testleri ile istatistiksel olarak analiz edildi (α = 0.05).Bulgu: Çalışmada kullanılanyöntemlerinden hiçbirisi kök kanal duvarlarından kalsiyum hidroksit medikamentinitamamen uzaklaştıramadı..GSI sonrasında kanal duvarlarındaen fazla kalsiyum hidroksit artığına rastlanırken, Vibringe, EndoVac ve PUIyöntemleri arasında anlamlı fark tespit edilmedi.(p> 0.05) Bununla birlikteGSI yönteminde apikal bölgede, koronalve orta üçlüye göre anlamlı oranda daha fazla kalsiyum hidroksit artığınarastlanıldı. (p = 0.017) Vibringe, EndoVac ve PUI yöntemlerinin temizlemeetkinliği ise kanal üçlü bölgelerine göre anlamlı farklılık göstermedi.Sonuç: Kök kanallarından kalsiyumhidroksit uzaklaştırmada Vibringe, EndoVac ve PUI yöntemleri birbirlerinebenzer temizleme etkinliği göstermiş ve bu üç teknik de GSI metodundan daha başarılıbulunmuştur.Anahtar kelimeler: Kalsiyumhidroksit, Vibringe, EndoVac, Pasif Ultrasonik İrrigasyon, SEM Comparisonof Calcium Hydroxide Removal Activities from Root Canals of New Sonic SystemVibringe andDifferentIrrigation Systems ABSRACTObjectives:The aim of this study was to evaluate the removal efficiencies of calciumhydroxide (CH) from the root canals using Vibringe, EndoVac, passive ultrasonic(PUI) and conventional needle irrigation (GSI) by means of scanning electronmicroscopy (SEM).Materialsand Methods: Seventy single-rooted human mandibular premolar teeth were used forthis study. The samples were prepared with the Protaper rotary system up to F4and filled with calcium hydroxide. One week later, Calcium hydroxide wasremoved from the root canals with the several irrigation methods as follows: GSI(Group 1), Vibringe (Group 2), EndoVac (Group 3), PUI (Group 4). During the irrigation procedure, for eachsample, 2.5 mL of 2.5% NaOCl followed by 2.5 mL of 17% EDTA was used for sixminutes totally (active and passive irrigation). For the evaluation ofremaining calcium hydroxide, the roots were split longitudinally and evaluatedunder SEM at x50 and x1000. Data were analyzed statistically by Kruskal-Wallisand Mann-Whitney U tests (α=0.05). Results: Noneof the methods used in the study could completely remove the calcium hydroxidemedication from the root canal walls. Although the most residuel calciumhydroxide was observed on the canal walls after GSI irrigation, there was nosignificant difference between Vibringe, EndoVac and PUI methods (p> 0.05).However, GSI method showed significantly more calcium hydroxide residues in theapical region (p=0.017) than the coronaland middle area. The cleaning efficiency of the Vibringe, EndoVac and PUImethods were not significantly different in root canal areas.Conclusions: In terms of calcium hydroxide removal from rootcanals, Vibringe, EndoVac and PUI methods were found to be more effective thanthe GSI; however, there was no significant difference could be detected betweeneach other.KeyWords: Calcium Hydroxide, Vibringe, EndoVac,Passive Ultrasonic İrrigation, SEM

The consumptive use of water by irrigated crops is typically quantified using the crop coefficient–reference evapotranspiration (Kc–ETo) procedure; yet, recent results showed that Kc might change with ETo, in response to high atmospheric demand. It is not known if the reduced Kc at high ETo applies to other crops with different aerodynamic features of the canopies. This paper seeks to provide the Kc values for soybean, wheat and potato, and propose an adaptation to the Kc–ETo procedure, hypothesising that the inverse relation between Kc and ETo would be general for all types of crops. Our results showed average Kc values of 0.90, 1.18 and 1.28, respectively, for soybean, wheat and potato cropping systems in the Brazilian cropping systems. However, Kc decreased as ETo increased, for all crops considered in this study, because of the increase of internal plant resistances to vapour diffusion from the leaves to the atmosphere. When ETo was above > 4 mm d−1, the water use by such crops was lower than that prescribed by Allen et al. (JAMA, 1998). The time-based Kc curves in Allen et al. (JAMA, 1998) are inappropriate for the studied crops under high demanding conditions and, besides the considerations suggested by Allen et al. (JAMA, 1998) (i.e., crop development stage, presence or absence of weeds), Kc recommendations for practical irrigation management should be based on the average ETo values of the previous days of the irrigation procedure.

Background and Objective Varied physical and chemical characteristic of root canal sealers and different irrigant agitation systems can influence the depth of penetration. The aim of this in vitro study was to use a laser scanning confocal microscope in order to assess the dentinal tubules penetration of various sealers after the application of different final irrigation techniques. Study Design/Materials and Methods A total of 156 single-rooted extracted mandibular premolars were prepared up to size 40 and randomly distributed into four groups according to the sealer type (n = 39): AH Plus, iRoot SP, MTA Fillapex, and GF Bioseal. Each group was randomly subdivided into three groups according to the final irrigation protocol (n = 13): conventional needle irrigation (CI), photon-induced-photoacoustic streaming activation (PIPS), and passive ultrasonic irrigation (PUI). After the final irrigation procedures, the root canals were obturated with single gutta-percha and labeled sealer mixed with 0.1% fluorescent rhodamine B isothiocyanate. Specimens were sectioned at 2, 5, and 8 mm from the apex, and all the sections were examined under confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using three-way analysis of variance and Tukey's post hoc tests (P = 0.05). Results iRoot SP exhibited a significantly higher penetration area than the other groups (P 0.05). Er:YAG laser activation with PIPS and PUI had significantly higher penetration than CI (P middle > apical; P

The aim of this study is to compare the effect of a single diode laser application and agitation of EDTA with diode laser with different parameters at different time intervals on root fracture. Ninety mandibular incisors were instrumented except the negative control group. The specimens were divided randomly into 10 groups according to final irrigation procedure: (G1) non-instrumented; (G2) distilled water; (G3) 15% EDTA; (G4) ultrasonically agitated EDTA; (G5) single 1.5W/100 Hz Diode laser; (G6) single 3W/100 Hz Diode laser; (G7) 1.5W/100 Hz Diode laser agitation of EDTA for 20 s; (G8) 1.5W/100 Hz Diode laser agitation of EDTA for 40 s; (G9) 3W/100 Hz Diode laser agitation of EDTA for 20 s; and (G10) 3W/100 Hz Diode laser agitation of EDTA for 40 s. The specimens were filled, mounted in acrylic resin, and compression strength test was performed on each specimen. Statistical analysis was carried out using one way ANOVA and Tukey's post hoc tests (P = 0.05). The statistical analysis revealed that there were statistically significant differences among the groups (P

The main purpose of this paper is to explore the possibility of using a new irrigation device to achieve the goals of root canal preparation for endodontic procedures. A secondary goal is to introduce the never before used physical approach of two-phase, two-component irrigation flow in the root canal. Our simulation results show great efficiency of the irrigation procedure in terms of the irrigant volume fraction and wall shear stress at the wall of the root canal over entire working length.

This chapter shows the status of mine-impacted agricultural lands under Japanese regulation and the phytotechnology-based countermeasures to lower the risks of hazardous substances. The three hazardous substances, cadmium, copper, and arsenic, had been determined in Japanese act for an agricultural land. The Japanese government reported the countermeasures for 92.7% of all designated areas have been completed at the end of fiscal year 2015. The risk management for the mine-impacted agricultural land requires the widely applicable countermeasures including continuous implementation of the existing countermeasures, e.g., soil dressing, well-controlled irrigation procedure, maintaining adequate soil pH, and additional introduction of technique recently developed to reduce the concentration of the hazardous substances. In Japan, the phytoextraction of Cd is well-developed phytotechnology that could meet to farmer's benefit. There are two strategies for the Cd phytoextraction to be developed that the utilization of existing crop cultivar accumulating relatively high Cd or newly seeking a plant species hyperaccumulating Cd. The actual development processes according to these strategies are introduced that the phytoextraction using rice plant cultivars for the example of the former and the cultivation method establishment of the Cd hyperaccumulator for that of the latter. The efficacy criterion of plant selection for the phytoextraction purpose is not only the tolerance to toxic heavy metals but also the high biomass production to ensure the total removal of metals. Basically, the hyperaccumulators are the wild plants living in a natural habitat, thus the practices of utilization must include a process for the domestication of the hyperaccumulators.

Objectives To review the success and technical aspects of pulmonary valve (PV) perforation using chronic total occlusion (CTO) hardware in patients with pulmonary atresia and intact ventricular septum (PA-IVS). Background Interventional therapy is possible in selected patients with PA-IVS. Among the various interventional options available, radiofrequency and laser assisted perforation may be more successful, but require expertise and may be substantially costly. Methods We describe the technique of mechanical catheter PV perforation using currently available coronary hardware meant for coronary CTO in nine cases with PA-IVS. After complete echocardiographic evaluation and informed parental consent was obtained, patients were electively intubated, mechanically ventilated, adequately heparinized and were placed on intravenous prostaglandin infusion. Basic steps involved were—localizing the atretic segment and accomplishing coaxial alignment of catheters using biplane fluoroscopy, crossing the atretic segment with the soft end of perforating guidewire, stabilizing the assembly and performing graded balloon dilatation with the balloon size never exceeding 130% of pulmonary annulus diameter. For crossing the atretic PV, a retrograde approach was used in one patient where the antegrade approach was not possible. Results The procedure was successful in 8/9 cases (89%). Valve opening was achieved in all eight patients with immediate fall in right ventricular (RV) systolic pressures. One neonate died following surgery after catheter induced RV perforation. All surviving cases were discharged from the hospital in good general condition with no evidence of heart failure and a room air oxygen saturation of >85%. No patient required an additional pulmonary irrigation procedure. Conclusion With appropriate patient and hardware selection, PV perforation using readily available coronary hardware is feasible in PA-IVS. © 2014 Wiley Periodicals, Inc.

Background Neurogenic bowel dysfunction in children is a lifelong condition often resulting in the need for active bowel management programmes, such as transanal irrigation. Parents are central in the decision-making process to initiate and carry out treatments until such a time their child becomes independent. Minimal research has focussed on examining parents' experiences of undertaking transanal irrigation with their child. This study aimed to explore parents' experiences of learning about and using irrigation with their child and how parents motivated their children to become independent. Methods Semi-structured telephone interviews were conducted with parents with experience of using transanal irrigation with their child. Interviews were undertaken by a parent researcher. Data were analysed using qualitative content analysis. Results Eighteen telephone interviews (16 mothers, 1 father and 1 carer) were conducted. Parents shared how they had negotiated getting started and using transanal irrigation with their child. They discussed a sense of success derived from their confidence in using and mastering irrigation, the process of making decisions to continue or stop using irrigation and how they motivated themselves and their child to continue with the irrigation regime. Challenges included minimizing their child's distress during the irrigation procedure and how they negotiated and moved towards their child becoming independent. Conclusion Despite the emotional difficulty parents experienced as a result of the invasive nature of transanal irrigation most parents reported an improvement in their child's faecal continence which positively impacted on the child and family's lives. The child's physical ability and emotional readiness to develop independent irrigation skills in the future concerned some parents. The experiences shared by parents in this study has the capacity to inform transanal irrigation nursing and medical care.

Aim To evaluate the wetting behaviour of three different classes of endodontic sealers, silicone (Roekoseal Automix)-, epoxy-resin (2Seal, AH Plus)- and methacrylate-based sealers (EndoRez, RealSeal, RealSeal SE, Seal 3D) on dentine specimens with and without chemical pre-treatment. Methodology Eighty caries-free molar teeth were used for the preparation of 160 dentine discs. Half of the discs were rinsed with distilled water, and the remainder were treated with 3% NaOCl, followed by 17% EDTA and 2% CHX to simulate the final rinse under clinical-like conditions. For both irrigation methods, 10 droplets of each sealer were analysed. Data were statistically analysed using multivariate anova (general linear model, α = 0.05) that assessed the effects of material, irrigation procedure and time on the measured contact angle as well as their interaction. Results Contact angle was primarily influenced by the material (P

The irrigation procedure in agriculture is a key factor in achieving good yields and plant performance. Water stress at critical times in the development of the blueberry crop can dramatically affect fruit yield and quality. However, blueberry plants may not show visual signs of stress. An automatic system of irrigation management is essential to long-term plant health. This paper presents a system capable of controlling an irrigation system autonomously. By acquiring humidity and temperature data, the system is capable of deliver proper quantity of water at the most advisable period, through the usage of a Programmable Logic Controller, optimising the water supply. The system is also accessible on the webpage created for it. The project includes wireless communication between the sensors boards and the main control board allowing the user to easily place the sensors wherever he wants.

Objectives The purpose of this study was to evaluate the temperature changes during implant osteotomies with a combined irrigation system as compared to the commonly used external and internal irrigation under standardized conditions. Material and methods Drilling procedures were performed on VII bovine ribs using a computer-aided surgical system that ensured automated intermittent drilling cycles to simulate clinical conditions. A total of 320 drilling osteotomies were performed with twist (2 mm) and conical implant drills (3.5/4.3/5 mm) at various drilling depths (10/16 mm) and with different saline irrigation (50 ml/min) methods (without/external/internal/combined). Temperature changes were recorded in real time by two custom-built thermoprobes with 14 temperature sensors (7 sensors/thermoprobe) at defined measuring depths. Results The highest temperature increase during osteotomies was observed without any coolant irrigation (median, 8.01°C), followed by commonly used external saline irrigation (median, 2.60°C), combined irrigation (median, 1.51°C) and ultimately with internal saline irrigation (median, 1.48°C). Temperature increase with different drill diameters showed significant differences (P

This study presents a novel investigation of long-term apparent steady state conditions under a prescribed leaching fraction criterion. The research was carried out during a 7-year investigation of date palm ( Phoenix dactylifera L., cv. Medjool) trees exposed to elevated levels of irrigation water salinity. High resolution weighing lysimeters were designed and constructed to generate an accuracy of ±0.0075 mm. The lysimeters were equipped with precision flux data acquisition that measured the oscillations of their daily water storage difference (Δ W ) and evapotranspiration. The leaching fraction was kept constant throughout the study. The results generally confirmed that the assumption of apparent steady state conditions under the preprogrammed irrigation procedure was correct, even though inter- and intra-seasonal climate variations were observed. Measured Δ W oscillated slightly around zero even under high evapotranspiration demands. Drainage water electrical conductivity and leaching fraction were also found to stay fairly constant. The evapotranspiration of the date trees was found to be a function of the potential evapotranspiration, and rather insensitive to changes in the soil water storage (Δ W ). Our analysis also indicates that for most practical purposes of monitoring and sustaining apparent steady state conditions, simple low-cost lysimeters, without weighing capability, can serve to monitor and sustain apparent steady state conditions, as long as there is water outflow from the lysimeters. However, the high resolution (high cost) weighing lysimeters proved to be an efficient system for accurate data acquisition, which is necessary for accurate modeling. An annual numerical crop yield model, modified for a date palm field study, was successfully calibrated using data from a 2 month period, and subsequently validated against measured data from the following 8 months. The modified model closely predicted the daily oscillations of drainage water salinity and actual leaching fraction throughout the eight-month period.

Introduction: Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. Ultrasonic irrigation can be performed with or without simultaneous ultrasonic instrumentation. Existing literature reveals that ultrasonic irrigation may have a very positive effect on chemical, biological and physical debridement of the root canal system as investigated in many in vitro studies. Objective: The purpose of this review article was to summarize and discuss the available information concerning ultrasonic irrigation in endodontics. Methods: This article presents an overview of ultrasonic irrigation methods and their debridement efficacy. In this paper the relevant literature on passive ultrasonic irrigation is reviewed. Information from original scientific papers or reviews listed in MEDLINE and Cochrane were included in the review. Results: The use of ultrasound in the irrigation procedure results in improved canal cleanliness, better irrigant transfer to the canal system, soft tissue debridement, and removal of smear layer and bacteria. There are many in vitro studies, but there is a need to standardize protocols, and correlate the clinical efficacy of ultrasonic devices with improved treatment outcomes. Understanding the basis of ultrasonic irrigation is fundamental for clinicians and researchers to improve the design and use of ultrasonic irrigation. Key words:Ultrasonic irrigation, ultrasound, smear layer, endodontics.

Rodig T, Sedghi M, Konietschke F, Lange K, Ziebolz D, Hulsmann M. Efficacy of syringe irrigation, RinsEndo® and passive ultrasonic irrigation in removing debris from irregularities in root canals with different apical sizes. International Endodontic Journal, 43, 581–589, 2010. Abstract Aim To compare of the efficacy of syringe irrigation, RinsEndo® (Durr Dental, Bietigheim, Germany) and passive ultrasonic irrigation (PUI) in the removal of dentinal debris from simulated irregularities in root canals with different apical sizes. Methodology Thirty extracted human pre-molars were randomly divided into three groups (n = 10) followed by root canal preparation with rotary FlexMaster® NiTi instruments (VDW, Munich, Germany) to size 30, 0.02 taper (group 1), size 40, 0.02 taper (group 2) or size 50, 0.02 taper (group 3). The teeth were split longitudinally, and a standard groove and three hemispherical-shaped cavities were cut into the root canal halves. Grooves and cavities were filled with dentinal debris before each irrigation procedure and the root halves were reassembled. In all groups three different irrigation procedures were performed with 30 mL NaOCl (1%) and (i) syringe, (ii) RinsEndo® and (iii) PUI. The amount of remaining debris was evaluated under a microscope with 30× magnification and a four score system. The data were analysed with a non-parametric analysis of covariance and multiple comparisons using the Tukey adjustment (P = 0.05). Results Passive ultrasonic irrigation removed debris significantly better from the artificial canal irregularities than RinsEndo® and syringe irrigation irrespective of the root canal diameter. Only in group 1 (30, 0.02 taper) the difference between PUI and RinsEndo® was not statistically significant (P = 0.99). RinsEndo® demonstrated significantly better results than syringe irrigation in all groups (P

Introduction: The cleaning mechanisms and characteristics of passive ultrasonic irrigation (PUI) are not yet completely understood. The aim of this study was to investigate whether the oscillatory direction of the ultrasonically driven file had an influence on dentin debris removal from artificially made grooves in standardized root canals. Methods: Each of 20 ex vivo root canal models with a standard groove in the apical portion of one canal wall filled with dentin debris received PUI repeatedly, either with file oscillation toward the groove or with file oscillation perpendicular to the groove. After each irrigation procedure, the amount of dentin debris in the groove was evaluated by photographs of the groove and by scoring. The oscillations of the ultrasonic file were also visualized in vitro by using high-speed imaging at a time scale relevant to the cleaning process, order 10 microseconds. Results: A nonparametric analysis showed significantly more dentin debris reduction when the file oscillated toward the groove (P = .002). High-speed imaging showed that the oscillation of the file is in a single plane, resulting in high-velocity jets emanating from the file tip in the direction of the oscillations. Conclusions: Oscillation of the ultrasonically driven file toward the groove is more effective in removing dentin debris from the groove than oscillation perpendicular to the groove, which can be related to the fact that there is a high-velocity jet from the file tip in a single direction following the file oscillation and a relatively slow inflow in the perpendicular direction. (I Endod 2010;36:1372-1376)

Chemical eye injury is considered an emergency that needs immediate nursing intervention because prognoses depend, not only on severity of injury, but also on the promptness and effectiveness of eye irrigation. Many nurse practitioners working in emergency care settings have limited knowledge of chemical eye injuries and may understand only partially what course of action to take. This article explains briefly the effects of chemicals on ocular tissues and how to carry out an irrigation procedure before referring patients to ophthalmologists.

BASIC PROBLEM AND AIM OF STUDY The quality of life for patients who have undergone total rectal resection for carcinoma is impaired by the artificial intestinal stoma. Their psychosocial disorders were analysed in relation to the method of looking after the stoma (with or without controlled stool emptying by intestinal irrigation) and compared with patients who had a after continence-preserving operation for rectal carcinoma. PATIENTS AND METHODS Of the 205 patients (aged 58.6 +/- 8.1 years; 72 women and 133 men) 78 had a continence resection (group 1), 127 had a colostomy (irrigation in 81, group 2a; merely looking after the colostomy bag in 46, group 2b). Their personality characteristics were tested prospectively with the State-Trait Anxiety Inventory (STAI) and quality of life parameters with a standardized questionnaire. RESULTS While personality traits were similar, significantly fewer patients in group 2a complained about disturbances of self esteem (32.9 vs 60.0%; P < 0.01), and had pessimistic future expectations (20.5 vs 46.5; P < 0.01) than those in group 2b. There was no significant difference in these two parameters between groups 1 and 2a. The irrigation procedure was taught to 60.5% of patients during their hospital stay. Accepting irrigation was more common when rehabilitation was begun early rather than delayed (72.9 vs 42.9%; P < 0.01). Disturbances of erection occurred in 69.9% of men younger than 60 years after the operation. CONCLUSIONS Compared with conventional bag care, regular irrigation improves the quality of life for patients with a colostomy. Postoperatively disordered erection is an independent risk factor for any abnormal self esteem and depression. They should be stressed more during history taking and therapeutically.

International audience; The pervasiveness property of wireless sensor network technology makes it suitable to collect heterogeneous sensor data in the application field of precision agriculture. On the basis of the collected data, smart and adaptive irrigation strategies have been proposed to estimate the optimal water quantity needed by cultures. This paper is aimed at presenting a wireless system architecture for smart irrigation, which adaptively evaluates the irrigation time according to the environmental conditions. A selected set of experimental results are presented to show the potentialities of the system to adaptive control the irrigation procedure toward water saving and product quality optimization.

Introduction The purpose of this study was to evaluate the amount of calcium hydroxide (Ca[OH] 2 ) removed by irrigation with different volumes and activation methods. Methods One hundred thirty extracted straight, single-rooted human teeth were instrumented to size 45/.04. One hundred twenty teeth were filled with radioactively marked Ca(OH) 2 and a gutta-percha point; 10 teeth with only gutta-percha served as a negative control. All specimens were stored in saline solution (7 days at 35°C). After storage, teeth were randomly divided into 12 groups ( n = 10). The gutta-percha was taken out, and Ca(OH) 2 was removed either by irrigation with different volumes (0 mL, 0.5 mL, 1 mL, 2 mL, 4 mL, or 8 mL) or mechanical activation with a 2- or 4-mL volume using a file (Instr) (FlexMaster size 45/.04; VDW, Munich, Germany), a brush (CanalBrush [CB]; Coltene/Whaledent, Langenau, Germany), or passive ultrasonic irrigation (PUI, smooth wire). Irrigation was performed by alternating 40% citric acid and 3% sodium hypochlorite. Residual Ca(OH) 2 was measured by scintillation and expressed as a percentage of the original Ca(OH) 2 . Results Increasing the irrigation volume led to a significant decrease ( P 2 (0 mL [98.5%], 0.5 mL [21.7%], 1 mL [16.5%], 2 mL [12.9%], 4 mL [8.7%], 8 mL [5.0%], and negative control [0.0%]). Activation led to less residual Ca(OH) 2 (2 mL Instr [12.0%], 2 mL CB [11.7%], 2 mL PUI [9.1%], 4 mL Instr [8.5%], 4 mL CB [7.4%], and 4 mL PUI [6.2%]), with significant differences according to the PUI ( P Conclusions No irrigation procedure was able to remove Ca(OH) 2 completely. PUI was the most effective activation method. However, irrigation with an 8-mL volume was the most effective.

This study aimed to evaluate, by means of scanning electron microscopy (SEM), the cleaning of flattened root canals, varying irrigation/aspiration protocols during biomechanical preparation. Thirdy human mandibular incisors were distributed into three groups (n = 10) according to the aspiration/irrigation protocols: conventional, conventional + brush, and apical negative pressure irrigation. Irrigation procedure was performed with 5 mL of 1% NaOCl at each change of instrument; final irrigation was conducted with 17% EDTA for 5 min. After biomechanical preparation, the roots were sectioned and prepared for SEM analysis. The images obtained were evaluated under 35× and 1,000× magnification by three calibrated examiners, following a double-blind design. All data were analyzed using Kruskal–Wallis and Dunn’s post hoctests (α = 0.05). Canals wherein the conventional method and apical negative pressure irrigation were employed revealed less debris, statistically different from the conventional + brush group (p < 0.05). Regarding the presence of smears, apical negative pressure irrigation was more effective in cleaning, showing lowest scores (p < 0.05), compared with the other tested protocols. Comparing each root canal third revealed that the apical portion was difficult to clean as all the tested protocols showed similar high scores (p > 0.05), both for the presence of debris and smear layer. In conclusion, although none of the studied irrigation/aspiration protocols have completely cleaned flattened root canals, apical negative pressure irrigation was more effective in smear layer removal, whereas the conventional + brush protocol was the least effective in removing the debris and smear layer.

Objectives To report the outcomes of graft take and wound healing in the first reported series in which fibrin sealant was used as a tissue glue in the reconstruction of complex genital skin loss. Methods Between July 2001 and July 2005, 18 men requiring complex genital reconstruction underwent repair by two surgeons at our medical centers. Skin graft reconstruction was required in 6 men. Complete scrotal disassembly with extensive scrotal or thigh flaps was required for reconstruction of 12 others. In the skin graft cases, a thin layer of dilute fibrin sealant was sprayed on the recipient site immediately before graft apposition. In flap cases, fibrin sealant was injected beneath the flap to promote tissue adherence and prevent fluid accumulation. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Results The 6 skin graft patients required a total of nine split-thickness skin grafts, all of which had 100% take. Of the 12 patients requiring flap reconstruction, 11 had excellent results. One flap case had a partial wound breakdown, but this reconstruction was performed immediately subsequent to a significant debridement and irrigation procedure in the same setting. Overall, 17 (94.4%) of 18 patients had no wound infection, seroma, hematoma, or other complications. Conclusions Fibrin sealant performs very well as a tissue glue and appears to be a useful adjunct in cases of complex genital skin loss reconstruction.

Concentrations of Na, K, Rb, Ca, Mg, Fe, Cu, Zn and Mn were determined in eight cultivars of potatoes harvested in Tenerife. The traditional cultivars presented higher K, Fe, Cu and Zn concentrations and lower ratio Na/K than recently imported cultivars. The cultivar Cara showed the highest and lowest mean concentration for Na and K, respectively. The highest mean concentrations of Fe, Cu and Zn were found in the cultivars Azucena, Palmera and Peluca, and the lowest concentrations in Cara. The trace elements significantly correlated with all the metals. The behaviour of Na was opposite to the rest of the metals, showing negative correlations. Applying factor analysis, the first three factors explaining 70.4% of the total variance were extracted. The first factor is related to Zn, the second factor is associated with Mn and K, and the third factor is negatively related to Na. Factor analysis and cluster analysis tend to separate the potato samples according to location and irrigation procedure. Traditional and recently imported potatoes were well separated when the factor analysis was applied on the samples of Solanum tuberosum.

Background The aim of this study was to evaluate large bowel transport following antegrade colonic irrigation with a new scintigraphic technique. Methods Ten patients (eight with severe constipation, two with faecal incontinence; median age 47 (range 41–66) years) treated with antegrade colonic irrigation took 111In-labelled polystyrene pellets to label the bowel contents. 99mTc-labelled diethylenetriamine penta-acetate was mixed with the irrigation fluid to map its distribution within the large bowel. Scintigraphy was performed before and after a standardized irrigation procedure. The large bowel was divided into four segments. Assuming ordered evacuation of the large bowel, the contribution of each colonic segment to total evacuation was expressed as a percentage of original segmental count. The segmental contributions were added to reach a total defaecation score (range 0–400). Results The median defaecation score was 350, corresponding to complete emptying of the rectosigmoid, descending colon, transverse colon, and half of the caecum and ascending colon. The retained irrigation fluid was located throughout the large bowel. Back-flow to the ileum was observed in four patients. Conclusion This study used a new scintigraphic technique to assess large bowel transport following antegrade colonic irrigation. Antegrade colonic irrigation induces highly effective emptying even in patients with severe constipation.

The root canal system of a tooth is a complex geometrical entity, consisting not only of the main root canal, but also of accessory and lateral canals. Bacteria can reside up to hundreds of micrometers inside those channels and may be difficult to reach for the antimicrobial agents with which root canals are irrigated during a root canal treatment. A combined numerical and experimental study was performed to assess the penetration rate of a root canal irrigant into the lateral canals and tubules, considering both diffusion and convection. The numerical model was validated experimentally using a fluorescent dye. Convection was studied separately using a Computational Fluid Dynamics model, validated with Particle Imaging Velocimetry experiments. Both diffusion and convection were found to be slow on the timescale of an irrigation procedure. The contribution of convection was limited to two canal diameters from the canal entrance, making diffusion the main irrigant transport mechanism. More than 10 min of fresh irrigant delivery was required to obtain an 86 % concentration of the irrigant at the far end of a tubule, in the ideal case of a straight tubule without reaction taking place. Diffusion was even slower when the concentration at the lateral canal entrance was not kept constant, as in the case of a single delivery, which suggests that frequent irrigant replenishment and/or irrigant activation during a root canal treatment are beneficial. Alternative methods should be considered to improve irrigant penetration into lateral canals and tubules.

A 47-year-old man was referred to our hospital under the diagnosis of chronic subdural hematoma. Initial symptoms upon admission were headache, vomiting, and mild consciousness disturbance. Given the diagnosis with bilateral occurrence, a burr hole and irrigation procedure was performed. However, the patient's consciousness disturbance worsened later. T2WI MRI revealed marked swelling of the brain stem with a high-intensity lesion within, which enlarged along with the consciousness exacerbation. Based on a clinical diagnosis of brain stem encephalitis, high-dose steroid therapy was administered. His consciousness level was restored to normal and the lesion on MRI decreased in size promptly. Brain stem encephalitis is conceived to be a disease which mainly affects the brain stem. It has not yet been defined by either mechanism or cause, but is basically diagnosed from clinical symptoms and pathological findings. There are two types: chronic type, which usually has a poor outcome; and acute progressive type, which is also known as Bickerstaff type. Brain stem encephalitis is not a common disease in the field of emergency medicine. In this case, the pattern of disease progression, the diagnostic procedure, and the roentgenographical changes were not typical of acute-type brain stem encephalitis. Further insight into the mechanisms of and accurate diagnostic methods for this disease are needed.

Purpose Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases. Materials and methods Two patients complaining of pain and swelling in the parotid gland during meals who underwent sialography were diagnosed as having sialodochitis with sialadenitis. Intraductal irrigation was then performed on the parotid gland on the side of the complaint. The irrigation procedure was conducted in the same manner as the sialography procedure, except that saline was used as the filling solution. Symptom severity was evaluated with a numerical rating scale (NRS) at the initial visit and a month after the irrigation. Results The initial NRS value of patient 1 was 10. The value decreased to 6 and then to 0 after 2 irrigation procedures. The NRS value of patient 2 regarding the symptoms involving the left parotid gland decreased from 4-5 to 1 after 4 irrigation procedures performed at 1-month intervals. Conclusion Intraductal irrigation of the salivary gland may be a simple, safe, and effective treatment option for patients with obstructive and inflammatory disease of the salivary gland that is capable of resolving their symptoms.

Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however the effective ability of this procedure to avoid recurrent infection is still debated.In this systematic review of the literature we reviewed full-text papers published from 1970 through 2011, that reported the success rate of infection eradication after debridement and irrigation with prosthesis retention for the treatment of early septic complications (within six weeks from surgery) or late acute haematogenous infections after hip or knee prosthesis. In all, 14 original articles, reporting the results of 710 patients were retrieved. The average success rate has been, respectively, 45.9% and 52% after a single or repeated debridement and irrigation procedures, at a mean follow-up of 53.3 months.The methodological limitations of this study and the heterogeneous material in the reviewed papers notwithstanding, this systematic review shows that debridement and irrigation procedure is associated with a rather poor outcome, even in a population of patients selected on the basis of symptoms’ duration and patients should be adequately informed prior to undergo this salvage procedure.

Introduction The purpose of this in vitro study was to compare a continuous ultrasonic irrigation device (VPro StreamClean System [VSS], Vista Dental Products, Racine, WI) with conventional needle irrigation when used as a final irrigation procedure to debride the apical region of the root canal. The null hypothesis that there is no difference was tested. Methods Root canals of matched pairs (N = 20) of extracted human teeth were prepared to an apical size of 36/.04 using Profile series 29/.04 rotary files (Dentsply Tulsa Dental, Tulsa, OK) with 6% sodium hypochlorite (NaOCl) irrigation. One tooth of each pair was randomly assigned to receive final irrigation with either VSS or conventional needle irrigation. The gauge of the needle (#30), the irrigation cycles (ie, 5 mL NaOCl, 5 mL 15% EDTA, and 5 mL NaOCl), the irrigant flow rate (5 mL/min), and needle depth placement (1 mm from the working length [WL]) were experimental constants. Serial sections were obtained at 1 and 3 mm from the WL, stained with hematoxylin-eosin, and viewed at 100× magnification for the presence of debris. The percentage of debris in the canal lumen after VSS or conventional needle irrigation was compared by using the Wilcoxon matched pairs test. Results There was significantly less debris in the VSS group compared with the conventional needle irrigation group at the 1-mm level (1.50% [VSS] vs 9.90% [conventional needle irrigation], P = .0001) and the 3-mm level (0.45% [VSS] vs 5.16% [conventional needle irrigation], P = .0014). The null hypothesis was rejected. Conclusions Final irrigation with the VSS compared with conventional needle irrigation delivery resulted in significantly less debris present in root canals at 1 and 3 mm from the WL.

IntroductionThe aim of this study was to evaluate the removal of dentin debris from artificially made grooves in standardized root canals by 6 different final irrigation techniques.MethodsConventional syringe irrigation, manual dynamic activation (MDA) with tapered or nontapered gutta-percha (GP) cones, the Safety Irrigator system, continuous ultrasonic irrigation (CUI), and apical negative pressure (ANP) irrigation were tested ex vivo in 20 root canals with a standardized, debris-filled groove in the apical portion of one canal wall. After each irrigation procedure, the groove was photographed, and the residual amount of dentin debris was scored.ResultsThere was no significant difference between the MDA with a nontapered GP cone, the Safety Irrigator, and the ANP irrigation. These techniques produced better cleaning efficacy than syringe irrigation (P < .005) but significantly worse than the MDA with a tapered cone (P < .05). CUI was significantly better than all the other techniques tested in this study (P < .001).ConclusionsCUI was the most effective technique in dentin debris removal from the apical irregularities, and syringe irrigation alone was the least effective. MDA technique was more effective with a tapered GP cone than with a nontapered one.

The effects of intranasal zinc sulfate (ZnSO4) irrigation on the morphology of the olfactory epithelium and olfactory bulb were studied in mice with short survival times (as early as 1 day) and with long survival times (up to 593 days) after the irrigation procedure. As in several previous studies, the olfactory epithelium was completely destroyed within a few days after the ZnSO4 treatment. Within 2-4 days, the septum and turbinates were covered by a new, cuboidal epithelium, the cells of which differed significantly from any cells normally seen in the olfactory epithelium. Slowly, over several months, small areas of the olfactory epithelium regenerated in many of the animals. The ultrastructural changes occurring in the olfactory bulb from 1 to 25 days (the reactive stage) were characterized by degenerating olfactory axons and axon terminals, hypertrophy of astroglial cell processes, and proliferation of or extravasation by phagocytic cells. By 25 days after intranasal ZnSO4 irrigation, the number of reactive glial processes and phagocytic cells returned to normal. In some mice with survival times of 150 days or longer, there was reinnervation of small areas of the olfactory bulb by regenerated olfactory axons. These new olfactory axons innervated only superficial glomeruli or the outer portions of deeper glomeruli, but they formed synaptic contacts with mitral/tufted cells and periglomerular cells that did not differ from control animals. These findings were supported by tract-tracing experiments with 3H-amino acids and by behavioral analysis. In summary, the ultrastructural changes observed in the olfactory bulb in this study were not significantly different from those observed after surgical lesions of the olfactory epithelium or nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction: Multiple activations of the irrigant by using pulsed ultrasound may enhance the removal of dentin debris because of repeated acceleration of the irrigant. The aim of this study was to evaluate the effect of pulsed ultrasound on passive ultrasonic irrigation (PUI) in its ability to remove artificially placed dentin debris from a simulated apical oval extension within standardized root canals. Methods: Each of 20 in vitro root canal models with a standard groove in the apical portion of one canal wall filled with dentin debris received Phi repeatedly, either without pulsation (group1) or with pulsation (730 milliseconds on/100 milliseconds off in group 2, 400 milliseconds on/400 milliseconds off in group 3, and 100 milliseconds on/670 milliseconds off in group 4), corresponding to duty cycles of 100%, 88%, 50%, and 13%, respectively. After each irrigation procedure, the amount of dentin debris in the groove was evaluated by taking photographs of the groove and scoring. The irrigation procedures were also visualized in vitro using high-speed imaging performed in glass root canal models. Results: The debris score was significantly lower only in group 3 (p = 0.023). The in vitro visualization showed increased streaming and cavitation during the start-up phase of each pulse. Conclusions: PUI with a pulsation pattern of 400 milliseconds on/400 milliseconds off and a duty cycle of 50% is more effective in removing dentin debris from a simulated apical oval extension in standardized root canals than continuous ultrasonic activation. Duty cycles of 13% and 88% showed no difference compared with continuous oscillation. (J Endod 2010;36:1887-1891)

Objectives: Irrigation and debridement constitute an important part of treatment of open fractures. We investigated the efficiency of different irrigation methods and durations in cleansing contaminated bovine femur cancellous bone samples and the extent of tissue damage associated with irrigation.Methods: A total of 72 samples of 4x4x1 cm size were obtained from fresh frozen bovine distal femoral cancellous bone. The top surface of the samples were sawed to a 2-mm depth to create four squares equal in size. All the samples were contaminated with construction sand using the same method and were then randomized to three irrigation groups (bulb syringe irrigation, high pressure pulsatile lavage, and low-pressure pulsatile lavage), each consisting of 24 samples. The duration of irrigation was set as 3, 6, or 9 minutes for every eight samples of each group. After the irrigation procedure, the images were transferred to a computer screen with a video-microscope camera and the number of sand particles on the samples were counted and irrigation-related macroscopic bone damage was assessed.Results: The lowest number of sand particles was found on the samples irrigated by high-pressure pulsatile lavage (p0.05). The least irrigation-related bone damage was observed in samples irrigated by low-pressure pulsatile lavage for 3 minutes (p0.05).Conclusion: Our findings showed that the most efficient method of cleansing contaminated bone samples was high-pressure pulsatile lavage and that prolonged irrigations did not enhance the efficiency of the irrigation method; however, high-pressure irrigation of 3 minute duration resulted in the greatest bone damage., Amaç: Açık kırıklarda yıkama ve debridman, tedavinin önemli bir bölümünü oluşturur. Bu çalışmada, farklı yıkama yöntemlerinin ve farklı sürelerde yıkamanın kirletilmiş sığır femur spongiöz kemik örneklerinin temizlenmesindeki etkinliği ve yıkamaya bağlı oluşabilecek kemik hasarı araştırıldı.Çalışma planı: Taze donmuş sığır distal femurundan 4x4x1 cm boyutlarında 72 adet spongiöz kemik örneği alındı ve her bir örneğin üst yüzeyi 2 mm derinliğinde oyularak eşit büyüklükte dört kare oluşturuldu. Bütün kemikler aynı yöntem kullanılarak inşaat kumu ile kirletildi. Örneklerden rastgele seçimle 24 adetlik üç grup oluşturuldu. Bir gruba 20 ml’lik plastik şırınga ile yıkama uygulanırken, bir gruba düşük basınçlı (DBY), bir gruba yüksek basınçlı (YBY) yıkama uygulandı. Yıkama her bir gruptaki sekizer örneğe farklı sürelerde (3, 6 ve 9 dakika) uygulandı. Yıkama işleminden sonra kemik örneklerinin görüntüleri video-mikroskop kamera ile bilgisayar ekranına aktarılarak üzerinde kalan kum tanecikleri sayıldı ve yıkama sonrası kemikte oluşan makroskobik doku hasarı değerlendirildi.Sonuçlar: Yüksek basınçlı yıkama uygulanan örneklerde, diğer iki yönteme göre anlamlı derecede düşük sayıda kum taneciği bulundu (p0.05). Yıkama sonucu kemikte en az doku hasarı 3 dk’lık yıkamada DBY yönteminde görüldü (p0.05).Çıkarımlar: Bulgularımız, kum taneciklerinin temizlenmesinde en etkili yöntemin YBY olduğunu ve yıkama süresini artırmanın ek yarar sağlamadığını; ancak, YBY yönteminin 3 dakikalık yıkamada kemik dokusuna en fazla zarar veren yöntem olduğunu göstermiştir.

Based on the agricultural geophysical classification and the land use and land cover (LULC) type map, the satellite data of multi-time, multi-spatial and multi-spectrum was used to identify the irrigation areas and their geographical locations of crops, plantations and pasture when the up-coming South-to North Water Transfer Engineering (SNWTE) is completed by 2030. The thermal-dynamics of the soil in the irrigated area was figured out depending on not only the satellite data deduction, but also on the on-site field measurements, the data of the nearby agro-meteorological and/or hydrological stations, which was used to calculate the variation regularity of soil moisture, soil temperature, albedo etc during each irrigation procedure. With reference of the methodology of pseudo-hydrodynamics in agro-hydrology, a new model module was designed to calculate the exchange and transfer process of water and heat energy in the soil-plant-atmosphere continuum (SPAC) under the condition of irrigation, which was coupled with the regional climate model RegCM3 and make it to include the irrigation effect. The new climate model was then used to simulate the regional climate change in north China as if SNWTE is completed. The preliminary simulation results show that: The large-scale agriculture irrigation might cause significant regional climate change not only in Northern China where the irrigation is implemented, but in the whole numerical domain as well. During the most possible irrigation time of summer months from June to August, the ground temperature, sensible heat flux in the boundary layer decreased within irrigated region and the adjacent areas; while the low-level air humidity, latent heat flux, and precipitation are all increased. Large-scale agricultural irrigation not only changes the water vapor factors such as soil moisture and air humidity, but also the thermal factors such as temperature and sensible heat flux and the dynamic factors of potential height and wind field in the atmosphere, which cause regional climate change in the whole numerical domain.

Boutsioukis C, Lambrianidis T, Kastrinakis E, Bekiaroglou P. Measurement of pressure and flow rates during irrigation of a root canal ex vivo with three endodontic needles. International Endodontic Journal, 40, 504‐513, 2007. Aim Tomonitorexvivointra-canalirrigationwiththree endodontic needles (25, 27 and 30 gauge) and compare them in terms of irrigant flow rate, intra-barrel pressure, duration of irrigation and volume of irrigant delivered. Methodology A testing system was constructed to allow measurement of selected variables with pressure and displacement transducers during ex vivo intracanal irrigation with a syringe and three different needles (groups A, B, C) into a prepared root canal. Ten specialist endodontists performed the irrigation procedure. Each operator performed ten procedures with each needle. Data recorded by the transducers were analysed using Friedman’s test, Wilcoxon Signed Rank test, Mann‐Whitney U-test and Kendall’s Tb test. The level of significance was set to 95%. Results Significant differences were detected among the three needles for most variables. Duration of delivery and flow rates significantly decreased as the needle diameter increased, whilst pressure increased up to 400‐550 kPa. Gender of the operator had a significant impact on the results. Experience of the operators (years) were negatively correlated to volume of irrigant (all groups), to the duration of delivery (groups A, B) and to the average flow rate (group A). Conclusions Finer diameter needles require increased effort to deliver the irrigant and result in higher intra-barrel pressure. The syringe and needles used tolerated the pressure developed. Irrigant flow rate should be considered as a factor directly influencing flow beyond the needle. Wide variations of flow rate were observed among operators. Syringe irrigation appears difficult to standardize and control.

Objective: This study assessed the in vivo antimicrobial activity of NaOCl, Chx, Ca(OH)2, and H2O2 against five different microorganisms: Enterococcus faecalis, Porphyromonas endodontalis, Streptococcus salivarius, Lactobacillus sp., and S. aureus. Study design: Eighty infected teeth in seventy patients with pulpal or periapical pathology were studied. After preparing a standard access cavity. Sterilized paper points were used to take samples from the root canals. These were incubated in test tubes at 37°C for 72 hours. Of the resulting bacteria, the five most frequent strains were examined. The teeth were divided into four equal groups. After preparing the root canal using the step-back technique until a number 55 file, each group was subjected to one of the following irrigation solutions: 2% chlorhexidine gluconate (Chx), 5% NaOCl, Ca(OH)2 in distilled-water, or 3% H2O2. After irrigation, a temporary filling was placed in each cavity. The same irrigation procedure was repeated three and six days later. Then, the microbiologic sampling was also repeated. The chi-squared test was used for statistical comparisons. Results: Of the irrigants tested in this in vivo study, chlorhexidine was the most effective against all the microorganisms isolated from infected root canals, followed by NaOCl, Ca(OH)2, and H2O2. However, differences among the three groups were not statistically significant, except against Enterococcus faecalis (p>0.05). Conclusions: Our results did highly confirm the fact from previous studies that chx with 2% percent is the most effective antibacterial agent after three consecutive irrigations. Furthermore, in vitro and in vivo studies are necessary to assess whether the Chx imparted substantive dissolve organic material. © 2006 Taylor and Francis Group, LLC.

BACKGROUND: Meningitis, termed as foreign material collection in the subarachnoid space, leads to various meningeal, cerebral and spinal cord pathologies. Meningitis still remains a problematic disease with severe complications in spite of advanced medical technology. AIMS: In this study, we aimed to investigate the role of cisternal irrigation in the prevention of meningitis complications. SETTING AND STUDY DESIGN: Experimental study was done in the Social Security Hospital of Erzurum. Histopathological specimens were evaluated in the Pathology Department in the Ataturk University Research Hospital, Erzurum, Turkey. MATERIALS AND METHODS: This study was conducted on twelve lambs. Experimental meningitis was achieved with streptococcus pneumonia. Two animals were not treated. Ten animals were given CefotaximeR (4x1 g/day) for 20 days, and additionally half of these animals underwent cisternal irrigation. Then, all animals were sacrificed and brains were observed histopathologically. RESULTS: Massive purulent CSF formation, hemorrhagic cortical lesions, vascular congestion, leptomeningeal and cortical adhesions and brain edema were observed in the non-irrigated group, but these findings were observed slightly or absent in the irrigated group. CONCLUSION: Meningitis can affect all central neural tissues, consequently serious central nervous system lesions may develop. The irrigation procedure may decrease the percentage and severity of meningitis complications by way of the excretion of inflammed purulent collection from the subarachnoid spaces.

Objective To evaluate the efficacy of 2 ceruminolytic products, Cerumenex Eardrops (Purdue Frederick Company, Norwalk, Conn) and Murine Ear Drops (Abbott Laboratories, Abbott Park, Ill), in subjects with partial or complete occlusion of the ear canal due to cerumen. Design Randomized, subject- and observer-blind, placebo-controlled, clinical trial. Setting Corporate research clinic. Participants From among 230 volunteers screened, 74 subjects (age, 22-66 [mean, 45] years) were enrolled in the study. Participants had baseline occlusion levels of mild (n = 10), moderate (n = 26), or complete (n = 38) impairment of tympanic membrane visualization. Interventions Subjects were randomly assigned to 1 of 3 treatments: Cerumenex (10% triethanolamine polypeptide oleate-condensate), Murine (6.5% carbamide peroxide), and a placebo, BSS Sterile Irrigating Solution (Alcon Laboratories Inc, Ft Worth, Tex). The test medication was instilled into 1 occluded ear for up to two 15-minute applications. Following the treatment, the subject's ear was irrigated with 50 mL of lukewarm water delivered at low pressure via a WaterPik irrigator equipped with a Grossan irrigator tip. Main Outcome Measure The degree of occlusion, measured against a previously established 4-point scale, was assessed and recorded at baseline and after each instillation and irrigation procedure. Results Neither Cerumenex nor Murine was superior to saline placebo. By the end of treatment, 29.2%, 15.4%, and 41.7% of subjects treated with Cerumenex, Murine, and placebo, respectively, experienced resolution of cerumen occlusion. These values were not statistically significantly different from one another. Conclusion The currently marketed ceruminolytic products, Cerumenex and Murine, are no more effective than a saline placebo in removing earwax.