Odontorizectomie: un case series a 12 anni

The study evaluates whether root amputation may be considered a valid alternative to or support for implant treatment in the long term. The series comprised 20 patients, observed from 1997 to 2007; all cases were of mandibular molars in which the distal root was preserved. Causes of the operation were: failure of orthograde therapy with fracture of mesial root, perforation of pulp chamber floor and internal-external mesial root resorption. After 10 years, the success rate was 70%. The encouraging results indicate that root amputation is still an effective method. From both biologic and economic standpoints, it may be considered as an alternative to and/or support for more expensive treatments, but must be employed following precise clinical indications

Mechanical and Metallurgical Evaluation of 3 Different Nickel-Titanium Rotary Instruments: An In Vitro and In Laboratory Study

An in-depth evaluation of the mechanical and metallurgical properties of NiTi instruments is fundamental to assess their performance and to compare recently introduced instrument with widespread ones. According to this, since there are no data on this topic, the aim of the study was to mechanically and metallurgically evaluate an instrument recently introduced into the market (ZenFlex (ZF)), by comparing it with two well-known instruments with similar characteristics: Vortex Blue (VB) and EdgeSequel Sapphire (EES). According to this, 195 instruments were selected: 65 ZF, 65 VB and 65 EES. Each group was divided in subgroups according to the mechanical tests (i.e., cyclic fatigue resistance, torsional resistance and bending ability; (n = 20)) and the metallurgical test (differential scanning calorimetry (n = 5)). A scanning electron microscopy was performed to verify the causes of fracture after mechanical tests (cyclic fatigue and torsional tests). According to results, VB showed the highest flexibility and cyclic fatigue resistance in comparison to the other instruments, with a statistically significant difference (p < 0.05). Regarding torsional resistance, EES showed the lowest value of torque at fracture, with a statistically significant difference, whilst the comparison between ZF and VB showed no statistically significant difference (p > 0.05). DSC analysis pointed out that VB had the highest austenite start and finish temperatures, followed by ESS and then ZF. ESS sample showed the highest martensite start and finish temperatures followed by VB and ZF. Considering the results, it can be concluded that VB showed the best mechanical performance during static tests in comparison to ESS and ZF. This is fundamentally due to the interaction of parameters such as instrument design and heat-treatments that are able to enhance its mechanical performance

3D Finite Element Analysis of Rotary Instruments in Root Canal Dentine with Different Elastic Moduli

The aim of the present investigation was to calculate the stress distribution generated in the root dentine canal during mechanical rotation of five different NiTi endodontic instruments by means of a finite element analysis (FEA). Two conventional alloy NiTi instruments F360 25/04 and F6 Skytaper 25/06, in comparison to three heat treated alloys NiTI Hyflex CM 25/04, Protaper Next 25/06 and One Curve 25/06 were considered and analyzed. The instruments’ flexibility (reaction force) and geometrical features (cross section, conicity) were previously investigated. For each instrument, dentine root canals with two different elastic moduli(18 and 42 GPa) were simulated with defined apical ratios. Ten different CAD instrument models were created and their mechanical behaviors were analyzed by a 3D-FEA. Static structural analyses were performed with a non-failure condition, since a linear elastic behavior was assumed for all components. All the instruments generated a stress area concentration in correspondence to the root canal curvature at approx. 7 mm from the apex. The maximum values were found when instruments were analyzed in the highest elastic modulus dentine canal. Strain and von Mises stress patterns showed a higher concentration in the first part of curved radius of all the instruments. Conventional Ni-Ti endodontic instruments demonstrated higher stress magnitudes, regardless of the conicity of 4% and 6%, and they showed the highest von Mises stress values in sound, as well as in mineralized dentine canals. Heat-treated endodontic instruments with higher flexibility values showed a reduced stress concentration map. Hyflex CM 25/04 displayed the lowest von Mises stress values of, respectively, 35.73 and 44.30 GPa for sound and mineralized dentine. The mechanical behavior of all rotary endodontic instruments was influenced by the different elastic moduli and by the dentine canal rigidit

Effect of biologically oriented preparation technique on the stress concentration of endodontically treated upper central incisor restored with zirconia crown: 3d-fea

The aim of this study was to evaluate the effect of biologically oriented preparation technique on the stress concentration of endodontically treated upper central incisors restored with zirconia crown (yttria-stabilized zirconia polycrystalline ceramic) through finite element analysis (FEA). Four models of maxillary central incisors containing enamel, dentin, periodontal ligament, cortical and medullary bone were created in CAD. Each model received a polymeric core-build up with nanofilled dental resin composite. The evaluated models were SM—preparation in shoulder 90°; CM—chamfer preparation; BOPT—biologically oriented preparation technique and BOPTB—BOPT preparation 1 mm below the cement-enamel junction. All models received zirconia crowns (5Y-TZP), fiberglass post and 1 mm ferrule. The models were imported into the analysis software with parameters for mechanical structural testing using the maximum principal stress and the tensile strength as the analysis criteria. Then, load of 150 N was applied at the cingulum with 45° slope to the long axis of the tooth, with the fixed base for each model. The type of marginal preparation affected the stresses concentration in endodontically treated teeth and in the zirconia crown margin. Considering the stress magnitude only, BOPT is a viable option for anterior monolithic zirconia crowns; however, with the highest stress magnitude at the restoration margin

Computer Aided Design Modelling and Finite Element Analysis of Premolar Proximal Cavities Restored with Resin Composites

This study evaluated the stress distribution in five different class II cavities of premolar models restored with conventional or bulk-fill flowable composite by means of finite element analysis (FEA) under shrinkage and occlusal loading. An upper validated premolar model was imported in the software, and five class II cavities with different occlusal extensions and dimensions were prepared: horizontal cavity on the mesial surface (horizontal slot), mesio-occlusal cavity, mesial cavity (vertical slot), tunnel type cavity and direct access cavity. The models were restored with conventional or bulk-fill flowable resin composite. The tested materials were considered as homogeneous, linear, and isotropic. The Maximum Principal Stress criteria was chosen to evaluate the tensile stress results. The lowest shrinkage stress value was observed in the direct access cavity restored with bulk-fill flowable resin composite (36.12 MPa). The same cavity, restored with conventional composite showed a score of 36.14 MPa. The horizontal slot cavity with bulk-fill flowable showed a score of 46.71 MPa. The mesio-occlusal cavity with bulk-fill flowable had a score of 53.10 MPa, while with conventional composite this was 55.35 MPa. Higher shrinkage stress was found in the vertical slot cavity with conventional resin 56.14 MPa, followed by the same cavity with bulk-fill flowable 56.08 MPa. Results indicated that the use of bulk-fill flowable composite resin more significantly decreased the polymerization shrinkage stress magnitude. The larger the cavity and the volume of material necessary to restore the tooth, the greater the residual stress on enamel and dentin tissue

Influence of Polymeric Restorative Materials on the Stress Distribution in Posterior Fixed Partial Dentures: 3D Finite Element Analysis

This study evaluated the effect of interim restorative materials (acrylic resin (AR), resin composite (RC) or polyetheretherketone (PEEK) for dental computer-aided design/computer-aided manufacturing (CAD/CAM)) on the stress distribution of a posterior three-unit fixed partial denture

Mechanical Behavior of Different Restorative Materials and Onlay Preparation Designs in Endodontically Treated Molars

This study evaluated the effect of the combination of three different onlay preparation designs and two restorative materials on the stress distribution, using 3D-finite element analysis. Six models of first lower molars were created according to three preparation designs: non-retentive (nRET), traditional with occlusal isthmus reduction (IST), and traditional without occlusal isthmus reduction (wIST); and according to two restorative materials: lithium-disilicate (LD) and nanoceramic resin (NR). A 600 N axial load was applied at the central fossa. All solids were considered isotropic, homogeneous, and linearly elastic. A static linear analysis was performed, and the Maximum Principal Stress (MPS) criteria were used to evaluate the results and compare the stress in MPa on the restoration, cement layer, and tooth structure (enamel and dentin). A novel statistical approach was used for quantitative analysis of the finite element analysis results. On restoration and cement layer, nRET showed a more homogeneous stress distribution, while the highest stress peaks were calculated for LD onlays (restoration: 69-110; cement layer: 10.2-13.3). On the tooth structure, the material had more influence, with better results for LD (27-38). It can be concluded that nRET design showed the best mechanical behavior compared to IST and wIST, with LD being more advantageous for tooth structure and NR for the restoration and cement layer

Association of Variants in the SPTLC1 Gene With Juvenile Amyotrophic Lateral Sclerosis

Importance: Juvenile amyotrophic lateral sclerosis (ALS) is a rare form of ALS characterized by age of symptom onset less than 25 years and a variable presentation.Objective: To identify the genetic variants associated with juvenile ALS.Design, Setting, and Participants: In this multicenter family-based genetic study, trio whole-exome sequencing was performed to identify the disease-associated gene in a case series of unrelated patients diagnosed with juvenile ALS and severe growth retardation. The patients and their family members were enrolled at academic hospitals and a government research facility between March 1, 2016, and March 13, 2020, and were observed until October 1, 2020. Whole-exome sequencing was also performed in a series of patients with juvenile ALS. A total of 66 patients with juvenile ALS and 6258 adult patients with ALS participated in the study. Patients were selected for the study based on their diagnosis, and all eligible participants were enrolled in the study. None of the participants had a family history of neurological disorders, suggesting de novo variants as the underlying genetic mechanism.Main Outcomes and Measures: De novo variants present only in the index case and not in unaffected family members.Results: Trio whole-exome sequencing was performed in 3 patients diagnosed with juvenile ALS and their parents. An additional 63 patients with juvenile ALS and 6258 adult patients with ALS were subsequently screened for variants in the SPTLC1 gene. De novo variants in SPTLC1 (p.Ala20Ser in 2 patients and p.Ser331Tyr in 1 patient) were identified in 3 unrelated patients diagnosed with juvenile ALS and failure to thrive. A fourth variant (p.Leu39del) was identified in a patient with juvenile ALS where parental DNA was unavailable. Variants in this gene have been previously shown to be associated with autosomal-dominant hereditary sensory autonomic neuropathy, type 1A, by disrupting an essential enzyme complex in the sphingolipid synthesis pathway.Conclusions and Relevance: These data broaden the phenotype associated with SPTLC1 and suggest that patients presenting with juvenile ALS should be screened for variants in this gene.</p

A Qualitative Exploration of the Use of Contraband Cell Phones in Secured Facilities

Offenders accepting contraband cell phones in secured facilities violate state corrections law, and the possession of these cell phones is a form of risk taking behavior. When offenders continue this risky behavior, it affects their decision making in other domains where they are challenging authorities; and may impact the length of their incarceration. This qualitative phenomenological study examined the lived experience of ex-offenders who had contraband cell phones in secured correctional facilities in order to better understand their reasons for taking risks with contraband cell phones. The theoretical foundation for this study was Trimpop\u27s risk-homeostasis and risk-motivation theories that suggest an individual\u27s behaviors adapt to negotiate between perceived risk and desired risk in order to achieve satisfaction. The research question explored beliefs and perceptions of ex-offenders who chose to accept the risk of using contraband cell phones during their time in secured facilities. Data were collected anonymously through recorded telephone interviews with 8 male adult ex-offenders and analyzed using thematic content analysis. Findings indicated participants felt empowered by possession of cell phones in prison, and it was an acceptable risk to stay connected to family out of concern for loved ones. The study contributes to social change by providing those justice system administrators, and prison managers responsible for prison cell phone policies with more detailed information about the motivations and perspectives of offenders in respect to using contraband cell phones while imprisoned in secured facilities

Le basi razionali per il successo in Endodonzia

Lo svilupparsi delle nuove tecnologie applicate all’Endodonzia, ed in particolare la strumentazione rotante in NiTi dei canali (Ruddle, 2001), la misurazione elettrica della lunghezza di lavoro (Fan, 2006), l’utilizzo della videoradiografia, la sagomatura con conicità specifiche del canale principale (Castellucci, 2003), e l’introduzione di interessanti metodiche di sigillo a base di guttaperca termoplasticizzata o di polimeri resinosi (Trope, 2005), hanno contribuito in modo determinante a diffondere metodiche operative e materiali per una Endodonzia sempre più predicibile in termini di successo clinico e di prognosi a lungo termine (Fig. 1). Spesso, però, si può correre il rischio –penalizzando una didattica più razionale- di trascurare il corretto inquadramento del problema endodontico (Weine, 1982), la cui soluzione non è squisitamente tecnicistica o strumentale, bensì necessita di una diagnosi clinica e biologica corrette da parte dell’Odontoiatra, essendo la patogenesi del problema stesso strettamente legata almeno a due concetti, quello dello spazio endodontico e dell’infezione batterica. Di conseguenza, è necessario non solo svuotare macroscopicamente il sistema dei canali radicolari dal tessuto pulpare e dare una forma adeguata al canale principale, in previsione della successiva otturazione (Schilder, 1967), ma al tempo stesso è opportuno sottolineare come la detersione-disinfezione del sistema rimanga il punto cruciale della terapia endodontica stessa. Infatti, se è dimostrato in fisica che non si può riempire un volume che non sia stato preventivamente svuotato è altrettanto vero che il contenuto presente nei canali radicolari vitali, e necrotici a maggior ragione, per la sua natura chimica e biologica rappresenta spesso un limite al successo ed alla prognosi se non viene accuratamente rimosso ed allontanato dall’endodonto e se lo spazio endodontico al contempo non è accuratamente disinfettato (Siqueira, 2001)