Correlation between Microleakage and Tubules Penetration of an Endodontic Sealer

Objective: The aim of the study was to verify the existence of a correlation between fluid filtration and tubular penetration of an endodontic sealer. Methods: Ten pairs of maxillary incisors with a single root canal, circular cross-section, similar sizes and dimensions were selected from a collection. Teeth from each pair were randomly divided in 2 groups. All canals were instrumented using NiTi WaveOne Primary instrument (#25) (Dentsply, Maillefer). In the group 1 all canals were irrigated with 1 mL of 5,25% NaOCl for 30s (Ogna, Muggi\uf2, Italy), followed by 0.5 mL of 10% EDTA for 30 s (Ogna). In the group 2 it\u2019s used the same protocol but without the EDTA. A final irrigation of 2.0 mL 5,25% NaOCl for 3m was performed. Root filling was performed with Thermafil-obturators (Dentsply Tulsa, Tulsa, OK) with TopSeal (Dentsply, Maillefer) mixed with 0.1 wt% alizarin to evaluate the penetration depth of the sealer into tubules with confocal microscope (Leica, Wetzlar, Germany). Microleakage i.e. the volume of a calcein solution infiltrated into the root canal and tubules were evaluated using a digital fluid flow-meter and a confocal microscope. Results: Confocal microscopy showed a penetration of the sealer into tubules in group 1 of approx. 370 \u3bcm at 3 mm from the apex and 630 \u3bcm at 5 mm while in group 2 of approx. 22 \u3bcm at 3 mm and 37 \u3bcm at 5 mm from the apex. The volume of the infiltrated fluid was 0.353 x 10-4 mm3 for group 1 and 0.397 x 10-4 mm3 for group 2. The data of calcein penetration into the root canal were in agreement with the fluid filtration results. Conclusion: A correlation seems to be present between sealer penetration into dentinal tubules and sealability of Thermafil-obturators and TopSeal in root canal shaped with WaveOne Primary file

Rééducation Posturale Globale in musculoskeletal diseases: scientific evidence and clinical practice

SUMMARY Several studies on the treatment of musculoskeletal diseases with physiotherapy and clinical experiences on the basis of a method called Rééducation Posturale Globale (RPG), have highlighted the usefulness of this treatment. Although such treatment technique is commonly used in physical therapy practice, only few studies support its therapeutic effectiveness. Objective: To search the literature for evidence of RPG effectiveness, in order to identify the most appropriate therapeutic contexts for its use. Methods: A review of the literature through the following databases: PubMed, Embase, Cinahl, Pedro, and Medscape. The keywords used for the search in the databases are: Rééducation Posturale Globale, Souchard, Posture, and Manual Therapy. The following clinical studies were selected: randomized controlled studies, non-randomized controlled studies, observation studies, and case reports, in English, Spanish, Portuguese, and Italian. Results: Out of 18 studies found, 9 were analyzed: 2 randomized controlled studies, 2 non-randomized controlled studies, 3 non-controlled studies, and 2 case reports. Conclusions: The RPG method has been shown to be an effective treatment technique for musculoskeletal diseases, in particular for ankylosing spondylitis, acute and chronic low back pain, and lumbar discherniation. Although the scarcity of rigorous experimental trials on a large scale does not allow the drawing of undisputable conclusions, the results gathered up to now are an encouragement to carry on research in the field of conservative treatment

Arginine-calcium carbonate professional treatment for tubules occlusion in hypersensitive dentin

Objective: To test the tubules occlusion of an arginine-based professional treatment for hypersensitive dentin. Method: Dentin segments/discs were prepared from erupted sound molars. Elmex sensitive professional desensitizing paste (GABA Int. by Colgate Oral Pharmaceuticals, Dallas, USA) containing arginine 8% and calcium carbonate was applied on EDTA-treated dentin for 20s at 1000rpm using a prophy cup, following the manufacturer directions. The excess was removed using a microbrush then the dentin disc was gently rinsed and immersed in 20mL of simulated body fluid (Hank\u2019s Balanced Salt Solution, HBSS) at 37\ub0C. After 24h, 7 and 28d the dentin surface was analyzed by ESEM-EDX to evaluate the tubules occlusion and the mineral content. Elmex paste mixed with calcein solution 1% was used to evaluate its penetration depth into the tubules by confocal microscopy. Result: After 24h in HBSS, ESEM-EDX analyses on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules, relevant amount of N(16-19 wt%, demonstrating the presence of arginine and Ca/P molar ratio 653.0. Confocal microscopy showed a penetration of the paste into the dentinal tubules to a mean depth of approx 50 microns (maximum depth penetration 100 microns). ESEM showed the presence of many tubules still obturated by material after 7d in HBSS; EDX found N (approx 19 wt%) and Ca/P molar ratio was 2.43. After 28d in HBSS a coating of calcium phosphate deposits covered the dentin surface so tubules were not visible; EDX detected N (6-7 wt%) and showed a Ca/P molar ratio of 2.14. Conclusion: Elmex sensitive professional paste can obturate the dentinal tubules and adhere to the dentin surface. Evidences of mineralizing properties have been found by the deposition of calcium and phosphate-containing minerals within the dentinal tubules and the formation of a calcium phosphate protective layer on the dentin surface

Arginine-Based Toothpaste Induces Calcium-Phosphates Deposits on Dentin Surface and Tubules

Objective: To test the ability of a calcium carbonate-containing toothpaste for dentinal hypersensitivity to occlude the exposed open tubules of dentin surface. Method: Dentine slices (0.9±0.1 thick) and crown segments (1.5±0.3 cm thick) from human third molars were used. Elmex Sensitive Professional toothpaste (GABA Int AG, Therwill, Switzerland) containing as main active ingredients arginine (8%), sodium monofluorophosphate (1450 ppm Fˉ) and calcium carbonate, was applied (3 min) on coronal dentin surface. Fluid flow/permeation through the dentin thickness (i.e. permeability or hydraulic conductance, Lp in microliters/min) was evaluated using a digital fluid flow-meter after smear layer formation, after EDTA treatment, after Elmex toothpaste treatment (t=0) and after soaking for 1, 7, 28 days in simulated body fluid (HBSS). Tubules occlusion, elemental analysis and mineral content were studied by ESEM-EDX. Toothpaste penetration inside dentinal tubules was analyzed by laser confocal microscopy using calcein as tracer. Result: Lp of EDTA-treated dentin significantly decreased after treatment with Elmex toothpaste (-73,32% at t=0) and after soaking in HBSS the Lp values further decreased (-77,69% at 24h, -78,18% at 7d, -83,01% at 28d). After 24h and 7d in HBSS, ESEM on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules; EDX revealed N (from arginine) and F (from monofluorophosphate) of the toothpaste. Lp remained significantly lower (-78,18%) than EDTA- treated control dentin. After 28d in HBSS, a calcium phosphate layer was detected on dentin surface so tubules were not visible. EDX detected F and no N. No CaP deposits were found on EDTA-treated dentin soaked in HBSS. Confocal microscopy showed an average penetration depth of the toothpaste into the dentinal tubules of ~85 microns. Conclusion: Elmex sensitive toothpaste can reduce the fluid movement into the exposed dentinal tubules and favour the formation of calcium phosphate minerals

Influence of the activation mode on long-term bond strength and endogenous enzymatic activity of dual-cure resin cements

Objective: To investigate the long-term microtensile bond strength (µTBS), interfacial nanoleakage expression (NL), and adhesive stability of dual-cure resin cements with/out light activation to dentin. Materials and methods: Composite overlays (N = 20) were luted to deep dentin surfaces with RelyX Ultimate (RXU, 3M) or Variolink EstheticDC (VAR, Ivoclar-Vivadent). A universal adhesive was used for bonding procedures (iBond universal, Heraeus Kulzer). The resin cements were either self-cured (SC; 1 h at 37 °C) or dual-cured (DC; 20s light-cure followed by 15 min self-cure at 37 °C). Specimens were submitted to µTBS immediately (T0) or after 1 year of laboratory storage (T12). The fracture pattern was evaluated using scanning electron microscopy (SEM). Data were statistically analyzed with two-way ANOVA/Tukey test. Further, the NL was quantified and analyzed (chi-square test) and in situ zymography was performed to evaluate the endogenous enzymatic activity within the hybrid layer (HL) at T0 and T12 (Mann–Whitney test). The significance level for all statistical tests was set at p = 0.05. Results: DC resulted in higher bond strength and decreased fluorescence at the adhesive interface, irrespective of the material and the storage period (p < 0.05). Significantly lower bonding performances (p < 0.05) and higher endogenous enzymatic activity (p < 0.05) were observed within the HL at T12 compared to T0 in all tested groups. Conclusions: Light-curing the dual-cure resin cements, more than the cement materials, accounted for good bonding performances and higher HL stability over time when used with a universal adhesive. Clinical significance The curing condition influences the bonding performances of dual-cure resin cements to dentin when used with a universal adhesive

Isolated Testicular Metastasis from Prostate Cancer

Prostatic adenocarcinoma is the most frequently diagnosed carcinoma in the male population; the most common sites of secondary lesions are nodes, bones, and lungs. We report the clinical case of a 58-year-old man presenting with a single metastasis in the left testis after a radical prostatectomy/lymphadenectomy for prostate cancer. CASE REPORT This clinical report focuses on a 58-year-old man with prostate cancer who developed an uncommon single metastasis in the left testis after radical surgery and adjuvant pelvic radiation therapy. CONCLUSIONS Prostate-specific antigen (PSA) levels are important in the follow-up of prostate cancer. At the same time, physical examination of all possible sites of metastasis and proper evaluation of all signs/symptoms are indispensable in the process of identifying recurrence and for the selection of patients undergoing adjuvant therapy

Glutaraldehyde-based desensitizers’ influence on bonding performances and dentin enzymatic activity of universal adhesives

Objectives: To evaluate the influence of two glutaraldehyde-based desensitizers (L: GLUMA Desensitizer, Heraeus Kulzer and G: GLUMA Desensitizer PowerGel) prior to the adhesive procedures on microtensile bond strength (μTBS) to dentin and endogenous enzymatic activity. Methods: Noncarious human third molars (N = 48) were cut to expose middle coronal dentin. Six experimental groups were formed according to the dentin pre-treatment (L or G) and the universal adhesives (IBU - iBond universal, Kulzer or AU - Adhese Universal, Ivoclar Vivadent) used in the self-etch mode (n = 8): 1) L/IBU; 2) G/IBU; 3) IBU; 4) L/AU; 5) G/AU; 6) AU. Specimens were cut into sticks and stressed until failure after 24 h (T0) or 1 yr of aging (T12). Additional 4 teeth were used for in situ zymography evaluation and data were statistically analyzed (α = 0.05). Results: Dentin pre-treatment, adhesive and aging statistically influenced bond strength and enzymatic activity (P<0.001). AU demonstrated higher bond strength values than IBU (P<0.001). The L resulted in higher bond strength compared to the G and control groups (P<0.001). aging statistically influenced bonding performance, especially when no dentin pre-treatment was performed (P<0.001). In situ zymography revealed that at baseline the control groups exhibited lower interfacial fluorescence compared to the experimental groups, irrespective of the adhesive used (P<0,001). However, after 1 yr of artificial storage, no differences were found among the groups (P>0.05). Conclusions: : Glutharldeadeyde-based products increased bond strength and determined a stabilization of the adhesive interface over time apparently not related to the MMPs inhibition. Clinical Significance: The results of this in vitro study suggest that the application of glutaraldehyde-based desensitizers prior to the adhesive procedures when associated with universal adhesives could result in increased bond strength and stabilization of the adhesive interface over time

Physico-mechanical properties of two different heat treated Nickel-Titanium instruments: in-vitro study

Aim: This study aimed to define physico-mechanical properties of recently introduced thermally treated Edge Taper Platinum (ET Platinum) Nickel-Titanium (NiTi) instruments compared to conventional NiTi Edge Taper (ET) to disclose improvements obtained by heat-treatments. Methods: ET and ET Platinum instruments (n=30/each) were rotated until fracture in a stainless-steel canal with 90°curvature angle and 5mm curvature radius. Time to fracture (TtF) and number of cycles to fracture (NCF) were calculated and results were analyzed using Mann-Whitney test (p=0.05). Fractured instruments underwent fractographic analysis under Field-Emission-Gun Scanning Electron Microscope (FEG-SEM). Superficial features of additional new ET and ET Platinum instruments were analyzed under SEM at increasing magnification with standardized angulations and positions. After inspection, ET and ET Platinum instruments were used in extracted teeth to shape 4 straight canals each to simulate clinical conditions and re-evaluated under SEM at the same points to detect superficial wear features. ET and ET Platinum brand new instruments were examined by differential scanning calorimetry (DSC) to assess transformation temperatures. Results: Cyclic fatigue test showed a significant increase of fatigue resistance on ET Platinum compared to ET instruments (p=0.05). Fractographic analysis demonstrated a pattern of fatigue propagation on both instruments. SEM analysis on brand new instruments revealed a more regular surface of ET Platinum compared with ET and both instruments appeared with minimal alterations after the simulated clinical use. DSC analysis demonstrated higher amounts of martensite at 37°C in ET Platinum compared to ET instruments. Conclusions: ET Platinum instruments displayed an improved mechanical behavior, possibly related to modified phase transformation temperatures induced by thermal treatment of the alloy during manufacturing process. These results suggest a safe use in clinical conditions

Neoadjuvant eribulin mesylate following anthracycline and taxane in triple negative breast cancer: Results from the HOPE study

Background Eribulin mesylate (E) is indicated for metastatic breast cancer patients previously treated with anthracycline and taxane. We argued that E could also benefit patients eligible for neoadjuvant chemotherapy. Methods Patients with primary triple negative breast cancer 2 cm received doxorubicin 60 mg/m2 and paclitaxel 200 mg/m2 x 4 cycles (AT) followed by E 1.4 mg/m2 x 4 cycles. Primary endpoint was pathological complete response (pCR) rate; secondary and explorative endpoints included clinical/metabolic response rates and safety, and biomarker analysis, respectively. Using a two-stage Simon design, 43 patients were to be included provided that 4 of 13 patients had achieved pCR in the first stage of the study. Results In stage I of the study 13 women were enrolled, median age 43 years, tumor size 2–5 cm in 9/13 (69%), positive nodal status in 8/13 (61%). Main grade 3 adverse event was neutropenia (related to AT and E in 4 and 2 cases, respectively). AT followed by E induced clinical complete + partial responses in 11/13 patients (85%), pCR in 3/13 (23%). Median measurements of maximum standardized uptake value (SUVmax) resulted 13, 3, and 1.9 at baseline, after AT and E, respectively. Complete metabolic response (CMR) occurred after AT and after E in 2 and 3 cases, respectively. Notably, 2 of the 5 (40%) patients with CMR achieved pCR at surgery. Immunostaining of paired pre-/post-treatment tumor specimens showed a reduction of β-catenin, CyclinD1, Zeb-1, and c-myc expression, in the absence of N-cadherin modulation. The study was interrupted at stage I due to the lack of the required patients with pCR. Conclusions Despite the early study closure, preoperative E following AT showed clinical and biological activity in triple negative breast cancer patients. Furthermore, the modulation of β-catenin pathway core proteins, supposedly outside the domain of epithelial–mesenchymal transition, claims for further investigation. Trial registration EU Clinical Trial Register, EudraCT number 2012-004956-12