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Objective: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barre syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS). Methods: Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis. Results: Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this. Conclusions: Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions. Significance: Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.(c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

The dental historical literature is replete with the use of myriad of materials for root canal obturation; most notably, gutta-percha, silver cones, gold wires, orangewood sticks, gold foils, asbestos, a variety of paste/cement-type materials, iridioplatinum wires, lead points and a rather lengthy list of arbitrarily chosen substances based on the imagination and creativity of the treating professional.

Quite often in today's contemporary literature, phrases, or statements such as, or similar to the following, are often seen at the beginning of published manuscript

There is scant documentation of the origins of dentistry in countries of the Middle East. This paper aims to identify and detail the development of dentistry in one of the smaller countries in the Middle East, Kuwait that has played a pivotal role in a wide range of political and socio-economic developments in the past fifty years.

The historical development of Endodontics as a specialty in Colombia, South America was due primarily to the influence of a few key endodontists from the United States and the industriousness and dynamic vision of leading dental professionals from Bogotá and Medellín, Colombia.

Various forms of sealing cements have been used in root canal procedures since the mid-1800s to create an impervious seal of the root canal system. In the process both entrepreneurs and charlatans have risen to the challenge. During the first half of the 20

Statement of problem The release of titanium (Ti) particles from the surface of endosseous dental implants is not well understood. Purpose The purpose of this in vitro study was to evaluate the effect of thermocycling on the surface texture and release of Ti particles from the surface of dental implants. Material and methods Three MSI dental implants and 3 Ti alloy (Ti6Al4V) plates were divided into 6 subgroups (n=3). Specimens in each group were subjected to 0 (control group), 100, 200, 500, 1000, and 2000 thermocycles. After each cycling process, artificial saliva was collected, and the concentrations of released Ti particles were quantified by inductively coupled plasma-mass spectrophotometry (ICP-MS). The surfaces of the dental implants and Ti plates were evaluated before and after thermocycling by scanning electron microscopy (SEM), and SEM images were analyzed by using the ImageJ software program. Data were analyzed by mixed-model ANOVA and post hoc Tukey tests (α=.05). Results The greatest Ti release was seen after 2000 thermocycles. After increasing the number of cycles, additional Ti particles were released. SEM images of the surfaces of the dental implants and Ti plates displayed significant changes in surface texture. Conclusions Thermocycling continuously removed the protective TiO2 layer on the surface of dental implants, resulting in the release of Ti particles. The surface treatment and texture did not affect the release of Ti particles.

Background/purpose In clinical operations, qualitative differences in the texture and operational feeling of the regular type and soft type back-filled gutta-percha are readily discernible. This study aimed to investigate and compare the thermal behavior and physical properties of the two gutta-percha materials. Materials and methods The chemical compositions of regular and soft type Gutta-Percha Obturator® pellets were examined via energy dispersive X-ray spectroscopy. The thermal behaviors of the pellets during heating and cooling were evaluated using a differential scanning calorimeter. Finally, the viscoelastic properties of the two materials during cooling were assessed using a modular compact rheometer. Results The soft type gutta-percha contained a greater atomic percentage of zinc than the regular type material. In addition, the soft type gutta-percha exhibited exothermic peaks during cooling, whereas the regular type gutta-percha did not. The two materials exhibited different viscoelastic behaviors under cooling. In particular, the rate of change of the loss factor for the soft type gutta-percha was more than that of the regular type gutta-percha at temperature lower than 80°C. Conclusion The soft type gutta-percha underwent significant crystallization during cooling, and therefore exhibited pronounced volume shrinkage. Furthermore, the soft type gutta-percha underwent a greater rate of change in viscoelasticity under cooling than the regular type gutta-percha, and exhibited poorer physical stability. Consequently, in the back-packing procedure, soft type gutta-percha must be compacted more often over time than regular type gutta-percha to ensure the same quality of root canal obturation.

In the process of reading from a wide variety of both historical and contemporary sources, which is what an editor must do, I have found it painfully obvious when reading dental articles that claim to provide historical reviews, along with details of such that rarely are the original sources either identified or investigated thoroughly to provide accuracy in content. I will use the following example that is commonly seen and that focuses within my specialty, Endodontics.

Most people commonly think that a potato is a vegetable, and they would be half right as botanically it is considered as a fruit. So, one might ask what does this vegetable/fruit have to do with a dental faux paux? Reaching into dental historical vaults of 1892 we find that our forefathers were very creative in managing challenging, and potentially embarrassing situations.

This study assessed the shape and anatomical relationship of the mental foramen (MF) to mandibular posterior teeth in an Indian sub-population.In total, 475 existing cone-beam computed tomography records exhibiting 950 MFs and including the bilateral presence of mandibular premolars and first molars were assessed. Images were evaluated 3-dimensionally to ascertain the position, shape, and anatomical proximity of MFs to mandibular teeth. The position and shape of MFs were measured and calculated. The Pythagorean theorem was used to calculate the distance between the root apex of the mandibular teeth and the MF.MFs exhibited a predominantly round shape (left: 67% and right: 65%) followed by oval (left: 30% and right: 31%) in both males and females and in different age groups. The root apices of mandibular second premolars (left: 71% and right: 62%) were closest to the MF, followed by distal to the first premolars and mesial to the second premolars. The mean vertical distance between the MF and the nearest tooth apex calculated on sagittal sections was 2.20 mm on the right side and 2.32 mm on the left side; no significant difference was found according to sex or age. The distance between the apices of the teeth and the MF was ≥ 4 mm (left; 4.09 ± 1.27 mm and right; 4.01 ± 1.15 mm).These findings highlight the need for clinicians to be aware of the location of the MF in treatment planning and while performing non-surgical and surgical endodontic procedures.

Microbial control and tooth retention in dentistry have been paramount for all clinicians for over 130 years. However, in the late 1800s and early 1900s the dental profession was challenged to devise methods to eradicate microbial species from the root canal system if teeth were to be retained in symptom-free function. One system that was devised was electrosterilization and its variations, the roots and methods of which will be explored in this paper.

Leonard Koecker was outspoken in 1821 when he criticized the procedure of pulp extirpation and tooth retention, a procedure that had been advocated and practiced by Fauchard and others. He again registered his thoughts on this issue in 1826 in the publication of his textbook entitled

For decades dentists have faced the challenge of achieving profound anesthesia in the presence of a severe tooth ache. Frequently this challenge was more acute when the tooth or teeth in question were mandibular molars. Over a 125 years ago this clinical dilemma was managed by using cocaine, both directly on an exposed dental pulp and often times using a solution of such injected directly into the pulp. Both clinical applications were considered as achieving "pressure anesthesia" sufficient to permit pulp extirpation. This historical perspective will focus on both the origins of this approach and its contemporary counterparts.

The purpose of this systematic review was to examine if, in adult patients, the absence or presence of smoking influenced the prevalence of periapical periodontitis (PP). Databases were searched, and original research manuscripts up to June 2019 were identified by two reviewers. The Newcastle-Ottawa Scale (NOS) was used for risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. A meta-analysis was performed using RevMan 5 software. Risk ratio (RR) was used for the cohort studies, and odds ratio (OR) was used for the case-control studies with 95% confidence interval (CI). All the studies had many covariates and confounding variables. Three longitudinal cohort articles discussed radiographic findings as they related to the prevalence of PP in root-filled teeth. The RR of smoking and the prevalence of PP was 2.11 (95% CI 0.88–5.05, p = 0.09). Nine case-control studies focused on the prevalence of PP and smoking. There was a positive association between smoking and the prevalence of PP with an OR of 2.78 and a 95% confidence interval of 2.23–3.48, with p value < 0.05. The quality of the studies was fair per NOS, and the certainty of the literature assessment was moderate per GRADE. The current best available evidence suggests that smoking was associated with the prevalence of PP but more studies are needed to report this association in the longitudinal cohort studies. Smoking has a positive association with the prevalence of PP.

Introduction: Hypercementosis is characterized by an excessive deposit of dental cementum. While it is considered a benign pathology, it can sometimes be associated with a chronic pulpal or periapical infection. Furthermore, its management is complex, because establishing an accurate apical limit for a root canal procedure is not always possible. Methods: When a periapical lesion is present, a conservative, surgical approach to remove the inflammatory tissue from the periapical lesion can be considered as a treatment option. Conclusion: This paper reports on the management of a tooth with hypercementosis accompanied by an asymptomatic apical periodontitis affecting a left mandibular second molar.

There are several cardiovascular interventions that need special considerations in the provision of treatments within the scope of endodontics. If these interventions are not carefully identified, diagnosed, and considered in the overall treatment plan for the patient, they may result in fatal conditions. These include hypertension that causes fatal cardiac disorders, such as angina pectoris, ischemic heart diseases, and myocardial infarction, and also cerebrovascular diseases; congestive heart failure; infective endocarditis, valvular diseases, and carrying pacemakers; and the use of antiplatelet and anticoagulant drugs that are commonly prescribed for patients who have experienced heart stroke. The aim of this article is to review the newest recommendations for patients with these disorders who require endodontic treatments.

In the late 1800s, subsequent to the identification of the role of oral bacteria in the demise of the dental pulp by Willoughby D. Miller, the dentist was faced with the major challenge of removing gangrenous pulp tissue from the small root canal spaces in the tooth. Under these clinical circumstances, investigators viewed the root canal contents as a test tube filled with gelatinous, decaying matter along with being overwhelmed by a wide range of bacterial species. One of the first attempts to eradicate the root canal contents was achieved through the use of kalium (potassium) and natrium (sodium) in their metallic state and with that approach the sparks did fly.

Present study evaluated the efficacy of laser activation to control intra- and post-operative pain in single-visit root treatment for mandibular molar teeth with acute irreversible pulpitis following 2% lignocaine inferior alveolar nerve block. Ninety-eight patients presenting with pain were randomly divided into two anesthetic groups. Group-I inferior alveolar nerve block plus buccal infiltration and intra-ligamentary injections, Group-II inferior alveolar nerve block followed by laser irradiation focused directly on the pulp tissue. Intra- and post-operative pain intensities were assessed on a 10-point scale.The mean intra-operative pain scores in group-I was 6.62 ± 1.6 and in group-II before and after laser irradiation pain scores was 6.94 ± 2.1 and 1.3 ± 2.04, respectively. Post-operative pain scores at 24-hrs in the laser group were significantly higher. Laser irradiation applied directly on pulp tissue for control of intra-operative pain was effective, thereby negating the need for additional local anesthesia.Clinical relevanceLaser activation was effective method to control intra-operative pain in irreversibly inflamed pulp.Laser irradiation did not cause adverse post-operative pain.

Objective: The aim of the present study was to evaluate the effect of different pHs (4.4, 5.4, 6.4, 7.4, 8.4, and 9.4) and three different particle sizes of bismuth oxide on diametral tensile strength (DTS) of white Mineral Trioxide Aggregate (WMTA). Methods: Thirty cylindrical moulds were divided into six groups of five; WMTA was mixed, placed inside the moulds, and wrapped in pieces of gauze soaked in synthetic tissue fluid (STF) with pH values of either 4.4, 5.4, 6.4, 7.4, 8.4, 9.4. For bismuth oxide, eighteen similar molds were divided into three groups of six (n=6). Then bismuth oxide with three particle sizes, including fine (120 nm), medium (200 nm), and coarse (10 μm), were provided and added to the Portland cement, which did not have any bismuth oxide to create WMTA. Then WMTA was mixed, placed inside cylindrical molds. After incubation at 95% humidity for 48 hours, samples were subjected to DTS testing by an Instron Universal testing machine with a crosshead speed of 1 mm/min. Then, one sample from each group was subjected to scanning electron microscope (SEM) analysis. Data were analysed by ANOVA and Tukey tests (α=0.05). Results: The comparison of DTS in pH groups were: 8.4>7.4>9.4>6.4>5.4>4.4 (P medium particles > coarse particles (P

Diabetes mellitus (DM) may affect the physical and mechanical properties of dentin, which could potentially have an impact on root canal procedures. This study aimed to compare the amount of dentin removed by an endodontic rotary file, comparing dentin from diabetic patients with dentin from control patients under laboratory conditions.The amount of dentin removed was tested using new F3 ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) files applied against the surface of prepared dentin discs for 3 different groups: diabetic type 1 (D1), diabetic type 2 (D2), and nondiabetic (normal). The dentin removed was determined by measuring the depth of penetration of the file using a digital caliper and by measuring the weight loss. Data were analyzed using Kolmogorov-Smirnov, analysis of variance, post hoc Tukey, and Pearson correlation tests (P.05).Significantly more dentin was removed, and the penetration of the F3 instrument was significantly higher (P.05) in DM specimens. The statistical analysis revealed significant differences between the D1, D2, and normal groups (P.05) for the weight loss of the specimen as well as the penetration depth at point B (P.05). Both the weight loss and depth of penetration showed a very high positive correlation (P.05).The dentin of patients suffering from both D1 and D2 exhibited an increased amount of dentin removed compared with the nondiabetic dentin specimens. This can be observed by the increased penetration of the rotary instruments into dentin. Under certain circumstances, this may impact instrumentation, increasing procedural accidents and leading to subsequent weakening of root canal-treated teeth in diabetic patients.

Medical students need to understand core neuroscience principles as a foundation for their required clinical experiences in neurology. In fact, they need a solid neuroscience foundation for their clinical experiences in all other medical disciplines also because the nervous system plays such a critical role in the function of every organ system. Because of the rapid pace of neuroscience discoveries, it is unrealistic to expect students to master the entire field. It is also unnecessary, as students can expect to have ready access to electronic reference sources no matter where they practice. In the preclerkship phase of medical school, the focus should be on providing students with the foundational knowledge to use those resources effectively and interpret them correctly. This article describes an organizational framework for teaching the essential neuroscience background needed by all physicians. This is particularly germane at a time when many medical schools are reassessing traditional practices and instituting curricular changes such as competency-based approaches, earlier clinical immersion, and increased emphasis on active learning. This article reviews factors that should be considered when developing the preclerkship neuroscience curriculum, including goals and objectives for the curriculum, the general topics to include, teaching and assessment methodology, who should direct the course, and the areas of expertise of faculty who might be enlisted as teachers or content experts. These guidelines were developed by a work group of experienced educators appointed by the Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN). They were then successively reviewed, edited, and approved by the entire UES, the AAN Education Committee, and the AAN Board of Directors.

The aim of this study was to evaluate pain perception, pain medication intake, and sealer extrusion after single-visit root canal treatment of asymptomatic teeth with or without foraminal enlargement. The correlation between sealer extrusion and pain was also investigated.One hundred forty necrotic, single-rooted teeth were divided into 2 groups (n = 70): foraminal patency (FP), in which treatment was performed up to 1 mm short of the apex, and foraminal enlargement (FE), in which treatment was performed up to the apex. The canals were instrumented using WaveOne Gold files (Dentsply Maillefer, Ballaigues, Switzerland), irrigated with 2.5% sodium hypochlorite, and filled using the single-cone technique and AH Plus sealer (Dentsply Maillefer). A visual analog scale was used to record pain 24, 48, and 72 hours and 1 week postoperatively. The presence or absence of sealer extrusion was recorded.Pain levels were significantly higher for FE than FP at 24 hours (P .05), namely 0.3 ± 0.9 versus 0.1 ± 0.1; no difference was found at 48 hours, namely 0.1 ± 0.5 versus 0.0 ± 0.0 (P .05). No pain was reported 72 hours or 1 week postoperatively in either group. Although all patients requiring pain medication at 24 hours were from the FE group, the difference between FE and FP was not statistically significant with respect to this variable (P .05). Nevertheless, the intake amount was significantly higher in FE than in FP at this time point (P .05). Sealer extrusion occurred more frequently in FE than FP, namely 57.14 % versus 14.29% (P .05). There was no association between pain and sealer extrusion (P .05) or between pain and sex, age, or tooth type (P .05).FE was related to higher pain levels 24 hours postoperatively and to higher rates of filling material extrusion; however, there was no association between filling material extrusion and postoperative pain.

INTRODUCTION: Endodontic sealers play a vital role in the obturation of root canal space. The aim of this study was to evaluate the utility of a recently developed polyurethane expandable sealer (PES), along with its cytotoxicity and dimensional changes. METHODS: L929 fibroblasts and an cell viability assay (MTS assay) were used to determine the cytotoxicity of dental sealers (AH Plus [Dentsply Maillefer, Ballaigues, Switzerland], Sure-Seal Root [Sure Dent Corporation, Gyeonggi-do, South Korea], and the PES) at 24, 48, 72, and 96 hours. An advanced choroidal neovascularization model was used to assess the effect of these sealers on angiogenesis. Thirty-six extracted single-rooted human teeth were prepared and randomly divided into 3 groups (n = 12). Obturation was performed with gutta-percha and a sealer using lateral compaction as follows: group 1, AH Plus; group 2, Sure-Seal; and group 3, PES. The average depth of sealer penetration into dentinal tubules was measured with a scanning electron microscope. Data were analyzed using 1-way analysis of variance and post hoc Tukey tests (level of significance, P < .05). RESULTS: The values of MTS, choroidal neovascularization, and the penetration depth of PES were significantly higher than in other experimental groups (P < .05). The lowest values were noted in specimens of AH Plus, whereas the highest were detected in the PES group. CONCLUSIONS: PES showed promising results in terms of biocompatibility and dentinal tubule adaptation and penetration.

Ingenious dental professionals created teeth separators over 130 years ago that enabled the effective access to and restoration of interproximal tooth decay. Many companies claimed superiority in their products and key individuals expounded on their use. Because separators were often intertwined with matrix bands, confusion was present as both the separators and matrix bands were often referred jointly as matrices in textbooks, journal publications and dental catalogues. However, these authors who focused exclusively on teeth separation for restorative purposes, detailed the concepts of separation quite clearly. In time the use of these entities was replaced by other methods to manage these secluded tooth surfaces. However, orthodontic tooth movement picked up on the use of different types of non-mechanical separators in the early 1900s in their simplicity to create space to facilitate band placement. Further evolution coincided with material development that enabled ease of placement for both the dentist and the patient.

For decades the dismantling of previous dental work to correct inferior root canal procedures or to address recurrent dental caries has provided a significant amount of work for the restorative dentist. When coupled with teeth that have been root treated and also have an intraradicular post or dowel, the clinician was often presented with the challenge of post removal, without fracturing the root, and revision (retreatment) of the root canal procedures. While today's contemporary dentistry has the wherewithal to use ultrasonic devices to loosen and remove the post, this was not always the case historically, and creativity in this process was the hallmark of many of our predecessors.

Tooth retention has always been the major goal of all dental professionals when possible. In the mid 1800s this attainment was a major challenge due to problems in dealing with deep caries and the potential for exposed and infected dental pulps. Although the diagnostic skills of the clinician during that era were not as honed as they might be today, they were still cognizant of dealing with compromised pulp tissue and its elimination from the root canal when necessary, however demanding. This historical perspective will present a rather unique way in which Dr. Josiah Foster Flagg opted to manage these types of clinical challenges.

The Philadelphia Root Canal Study Club was formed in 1939

OBJECTIVES: To study the effects of polyphenol resveratrol on TNFα-induced inflammatory signaling as well as the underlying mechanism in human dental pulp stem cells (DPSCs). MATERIALS AND METHODS: Human DPSCs were cultured and treated by TNFα in the presence or absence of resveratrol. NF-κB and mitogen-activated protein kinase (MAPK) signaling pathways were analyzed by Western blotting and immunofluorescence staining. Interleukin 6 (IL6) and interleukin 8 (IL8) mRNA levels were analyzed by reverse transcription polymerase chain reaction. For the mechanistic study, autophagy was examined and further manipulated by gene silencing of Atg5 using siRNAs. Statistical analysis was performed by Student’s t-test, and values of p < 0.05 were considered significant. RESULTS: Upon TNFα treatments, neither degradation of IκBα nor the phosphorylation and nuclear translocation of p65 NF-κB were inhibited by resveratrol at different concentrations. In contrast, resveratrol dramatically inhibited TNFα-induced phosphorylation of c-Jun N-terminal kinase (JNK) MAPK. Furthermore, resveratrol activated autophagy, as evidenced by the accumulated autophagic puncta formed by lipid bound LC3B in resveratrol-treated cells. Intriguingly, both resveratrol and JNK inhibitor SP600125 suppressed TNFα-induced IL6 and IL8 mRNA expression (P < 0.05). Silencing autophagy gene Atg5 led to the hyper-activation of JNK and augmented TNFα-induced IL6 and IL8 mRNA expression (P < 0.05). CONCLUSIONS: The results suggest that resveratrol suppresses TNFα-induced inflammatory cytokines expressed by DPSCs through regulating the inhibitory autophagy-JNK signaling cascade. Resveratrol might be beneficial to ameliorate pulpal damage during the acute phase of inflammation in vital pulp therapy.

Management of symptomatic attrited molar teeth presents various challenges. Aim of the study was to manage and evaluate the outcome of sensitive, attrited molar teeth using three different treatment options, including bioglass-containing desensitising toothpaste, Gluma desensitiser and coronal a pulpotomy using a calcium silicate-based product, Biodentine. A total of 61 attrited molar teeth, for which the patients had expressed tooth sensitivity, were included. Depending on the pulp status, treatment groups were allotted using block randomisation. Post-treatment sensitivity was assessed at 48 h, 4 and 12 weeks using 10-point visual analog scale (VAS) and Schiff Cold Air Sensitivity Scale (SCASS). Data were analysed using non-parametric statistical tests. Pulpotomies achieved significantly the least post-treatment sensitivity scores at all scheduled recalls. This interim 12-week report on management concludes that a pulpotomy, using Biodentine, was able to achieve significantly higher number of asymptomatic teeth when compared to other treatment choices.

Aim This prospective clinical study evaluated the incidence of instrument fracture observed after single-file root canal treatment of molars using WaveOne Gold instruments. Methodology Three standardized, experienced and calibrated specialists treated 750 maxillary and mandibular molars with curvatures less than 45° (2691 root canals) over a 12-month period. All the treatments were performed in a single session. A total of 1104 WaveOne Gold instruments were used, including 38 small, 750 primary, 228 medium and 88 large instruments. Intracanal procedures were performed according to the manufacturer's recommendations, and each instrument was used in a single clinical case. The instruments were examined after their removal from the canal, under an operating microscope at 8× magnification. Results No fractures were observed in any of the 1104 instruments used. Conclusions No fractures of WaveOne Gold reciprocating instruments occurred during root canal preparations performed in maxillary and mandibular molars with curvatures less than 45° when used strictly according to the manufacturer's recommendations and applied in a single clinical case.

When the concept of Focal Infection was thrust upon the dental profession by medical profession in the early 1900s, often there was a polarization of philosophies and professionals, which caused a great amount of consternation amongst the dental community. While some followed the dictates of the "medicine men", others searched for scientific proof that would satisfy their profound, professional curiosity. One of those individuals who stood out amongst the rest was Dr. Thomas B. Hartzell. This presentation will take a look at his active participation in the burning controversy of Focal Infection.

Prior to the effective use of local anesthetics to achieve profound pulpal anesthesia before extirpation, whether in the form of a nerve block or infiltration, or in some cases the use of intrapulpal injections

While the vast majority of teeth displaying a periapical lesion were extracted due to the overwhelming emphasis on their contribution to systemic disease during the Focal Infection era, some clinicians opted to retain these teeth using both nonsurgical and surgical root canal procedures. The main concern was the elimination of the "infected area" noted on teeth that displayed discernible periapical lesions. One such approach used a surgical trephination procedure that was done with precision due to the development of an instrument to facilitate an accurate access to the periapical lesion-called the Apicolocater.