Assessment of the prevalence of radix entomolaris and distolingual canal in mandibular first molars in 15 countries: a multinational cross-sectional study with meta-analysis

Aim: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. Methods: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. Results: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P .05). Conclusion: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications

EurOP2E – the European Open Platform for Prescribing Education, a consensus study among clinical pharmacology and therapeutics teachers

Purpose Sharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers. Methods CPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting. Results Data from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources. Conclusion Key challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system

Post-endodontic reconstruction of dental crown

Uspjeh endodontskog liječenja postiže se uklanjanjem ili značajnim smanjenjem broja bakterija, prevencijom ponovne bakterijske kontaminacije, zatvaranjem korijenskih kanala te kvalitetnom postendodontskom rekonstrukcijom zubne krune. Protokol kojim liječimo zub uključuje čišćenje i širenje korijenskih kanala zbog čega je narušena stabilnost samog zuba te su izmijenjena njegova mehanička i fizikalna svojstva. Upravo kako bi očuvali zubnu strukturu i osigurali joj dugotrajnost unutar stomatognatnog sustava koji je pod konstantnim opterećenjem vanjskih sila, bitno je provesti adekvatnu rekonstrukciju krune tog zuba. Uz temeljito provedenu dijagnostiku koja uključuje uzimanje anamnestičkih podataka pacijenta, detaljnu analizu radioloških snimki i provođenje intraoralnog i ekstraoralnog pregleda te određenih testova pristupamo kreiranju plana terapije. Ovisno o stanju preostalog zubnog tkiva, parodonta, smještaju zuba te ostalih zuba u ustima, suvremena stomatologija nam nudi brojne materijale kojima možemo opskrbiti krunu zuba. Također, bitan aspekt nam čine i pacijentove želje i mogućnosti koje svakako ne smijemo ignorirati. Kao postendodontsku opskrbu nude nam se izravne i neizravne restauracije te protetski nadomjesci. Od materijala možemo birati između kompozita, staklenoionomernog cementa, cirkona, keramike te drugih rjeđe zastupljenih u praksi. Nerijetko kod liječenih zubi je potrebno napraviti i nadogradnju radi povećavanja kliničke krune zuba koja može biti individualna ili konfekcijska. Postendodontska rekonstrukcija zubne krune predstavlja spektar brojnih postupaka i mogućnosti koje nam stoje na raspolaganju kako bi zubu vratili njegovu formu, funkciju, estetska svojstva te u konačnici i ulogu u stomatognatnom sustavu.The success rate of endodontic treatment is achived by removing or significantly reducing the number of bacteria, preventing repeated bacterial contamination, filling root canals, and highquality post-endodontic reconstruction of dental crowns. Protocol used to treat the tooth includes cleaning and enlargement of root canals, due to whichstability of the tooh itself is impaired and its mechanical and physical properties are changed. To preserve dental structure and ensure its longevity within the stomatognathic system, whichis under constant load from external forces, it is essential to carry out an adequate reconstruction of the crown of that tooth. Through thoroughly performed diagnosis, which includes obtaining the patient's anamnestic data, detailed evaluation of radiological images, and conducting intra- and extraoral examination as well as particulat tests, one approaches the creation of a therapy plan. Depending on the condition of the remaining dental tissue, periodontium, position of the tooth, and other teeth in the mouth, modern dentistry offers numerouos materials that can suppy the crown of the tooth. Moreover, the patient's wishes and possibilities are an imperative aspect that cannot be ignored. Direct and indirect restorations and prosthetic restorations are offered as post-endodontic care. One can choose from composite or glass ionomer resins, zirconia, ceramics, and others that are not common practice. Often in treated teeth, it is necessary to make the post-and-core system to increase the clinical crown of the tooth, which can be individual or ready-made. Post-endodontic reconstruction of the crown of the tooth represents a spectrum of numerous procedures and possibilities available to restore the tooth to its form, function, aesthetic properties, and, ultimately, its role in the stomatognathic system

Post-endodontic reconstruction of dental crown

Uspjeh endodontskog liječenja postiže se uklanjanjem ili značajnim smanjenjem broja bakterija, prevencijom ponovne bakterijske kontaminacije, zatvaranjem korijenskih kanala te kvalitetnom postendodontskom rekonstrukcijom zubne krune. Protokol kojim liječimo zub uključuje čišćenje i širenje korijenskih kanala zbog čega je narušena stabilnost samog zuba te su izmijenjena njegova mehanička i fizikalna svojstva. Upravo kako bi očuvali zubnu strukturu i osigurali joj dugotrajnost unutar stomatognatnog sustava koji je pod konstantnim opterećenjem vanjskih sila, bitno je provesti adekvatnu rekonstrukciju krune tog zuba. Uz temeljito provedenu dijagnostiku koja uključuje uzimanje anamnestičkih podataka pacijenta, detaljnu analizu radioloških snimki i provođenje intraoralnog i ekstraoralnog pregleda te određenih testova pristupamo kreiranju plana terapije. Ovisno o stanju preostalog zubnog tkiva, parodonta, smještaju zuba te ostalih zuba u ustima, suvremena stomatologija nam nudi brojne materijale kojima možemo opskrbiti krunu zuba. Također, bitan aspekt nam čine i pacijentove želje i mogućnosti koje svakako ne smijemo ignorirati. Kao postendodontsku opskrbu nude nam se izravne i neizravne restauracije te protetski nadomjesci. Od materijala možemo birati između kompozita, staklenoionomernog cementa, cirkona, keramike te drugih rjeđe zastupljenih u praksi. Nerijetko kod liječenih zubi je potrebno napraviti i nadogradnju radi povećavanja kliničke krune zuba koja može biti individualna ili konfekcijska. Postendodontska rekonstrukcija zubne krune predstavlja spektar brojnih postupaka i mogućnosti koje nam stoje na raspolaganju kako bi zubu vratili njegovu formu, funkciju, estetska svojstva te u konačnici i ulogu u stomatognatnom sustavu.The success rate of endodontic treatment is achived by removing or significantly reducing the number of bacteria, preventing repeated bacterial contamination, filling root canals, and highquality post-endodontic reconstruction of dental crowns. Protocol used to treat the tooth includes cleaning and enlargement of root canals, due to whichstability of the tooh itself is impaired and its mechanical and physical properties are changed. To preserve dental structure and ensure its longevity within the stomatognathic system, whichis under constant load from external forces, it is essential to carry out an adequate reconstruction of the crown of that tooth. Through thoroughly performed diagnosis, which includes obtaining the patient's anamnestic data, detailed evaluation of radiological images, and conducting intra- and extraoral examination as well as particulat tests, one approaches the creation of a therapy plan. Depending on the condition of the remaining dental tissue, periodontium, position of the tooth, and other teeth in the mouth, modern dentistry offers numerouos materials that can suppy the crown of the tooth. Moreover, the patient's wishes and possibilities are an imperative aspect that cannot be ignored. Direct and indirect restorations and prosthetic restorations are offered as post-endodontic care. One can choose from composite or glass ionomer resins, zirconia, ceramics, and others that are not common practice. Often in treated teeth, it is necessary to make the post-and-core system to increase the clinical crown of the tooth, which can be individual or ready-made. Post-endodontic reconstruction of the crown of the tooth represents a spectrum of numerous procedures and possibilities available to restore the tooth to its form, function, aesthetic properties, and, ultimately, its role in the stomatognathic system

Harmonizing and improving European education in prescribing: An overview of digital educational resources used in clinical pharmacology and therapeutics.

AIM: Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re-used widely across a variety of educational systems, they may be ideally suited for this purpose. METHODS: With a cross-sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. RESULTS: Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e-learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge-based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in-part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. CONCLUSION: Digital educational resources, ranging from e-learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real-life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care