Restoration of Endodontically Treated Molars Using All Ceramic Endocrowns

Clinical success of endodontically treated posterior teeth is determined by the postendodontic restoration. Several options have been proposed to restore endodontically treated teeth. Endocrowns represent a conservative and esthetic restorative alternative to full coverage crowns. The preparation consists of a circular equigingival butt-joint margin and central retention cavity into the entire pulp chamber constructing both the crown and the core as a single unit. The case reports discussed here are moderately damaged endodontically treated molars restored using all ceramic endocrowns fabricated using two different systems, namely, CAD/CAM and pressed ceramic

In Vitro

Root canal sealers that possess good antimicrobial property can prevent residual and recurrent infection and contribute to successful endodontic therapy. This study evaluated the antimicrobial activity of four endodontic sealers, AH Plus, Tubliseal EWT, EndoRez, and iRoot SP, against three different microorganisms, E. faecalis, C. albicans, and S. aureus, by direct contact test. 10 μL microbial suspensions were allowed to directly contact the four endodontic sealers for 1 hr at 37°C. Subsequently microbial growth was measured spectrophotometrically every 30 min for 18 hours. The microbial suspensions were simultaneously tested to determine the antimicrobial effect of components which are capable of diffusing into the medium. The results revealed that AH Plus and iRootSP had significantly higher antimicrobial activity against E. faecalis. AH Plus and Tubliseal EWT showed significantly higher antimicrobial activity against C. albicans and S. aureus compared to iRoot SP and EndoRez. EndoRez showed the least antimicrobial activity against all the three microorganisms. Inhibition of microbial growth is related to the direct contact of microorganisms with the sealers. In conclusion AH Plus had significantly higher antimicrobial activity against E. faecalis, C. albicans, and S. aureus

CBCT in diagnosis of vertical root fracture

The clinical presentation and radiographic appearance of a vertical root fracture frequently pose a diagnostic dilemma to the clinician. Lack of definitive diagnosis often leads to unnecessary invasive surgery and/or extraction of the tooth. Often exploratory surgery is resorted in order to visualize the fracture. Conventional two-dimensional radiography, including periapical and bitewing radiograph and currently cone-beam computerized tomography (CBCT) are being used to detect vertical root fractures. This article reviews the role of CBCT in detecting vertical root fractures

Red Blood Cell Transfusion in the Intensive Care Unit

Importance: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice. Objective: To evaluate and describe ICU RBC transfusion practices worldwide. Design, setting, and participants: International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks. Exposure: ICU stay. Main outcomes and measures: The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused. Results: Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL. Conclusions and relevance: RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices