Outcome of secondary root canal treatment: a systematic review of the literature.

UNLABELLED: AIMS (I): To investigate the effects of study characteristics on the reported success rates of secondary root canal treatment (2 degrees RCT or root canal retreatment); and (ii) to investigate the effects of clinical factors on the success of 2 degrees RCT. METHODOLOGY: Longitudinal human clinical studies investigating outcome of 2 degrees RCT which were published upto the end of 2006 were identified electronically (MEDLINE and Cochrane database 1966-2006 Dec, week 4). Four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology), bibliographies of all relevant papers and review articles were hand-searched. Two reviewers (Y-LN, KG) independently assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were: (i) Clinical studies on 2 degrees RCT; (ii) Stratified analyses available for 2 degrees RCT where 1 degrees RCT data included; (iii) Sample size given and larger than 10; (iv) At least 6-month post-operative review; (v) Success based on clinical and/or radiographic criteria (strict = absence of apical radiolucency; loose = reduction in size of radiolucency); and (vi) Overall success rate given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis which constituted the first strand of evidence. Secondly, the pooled weighted success rates by each study characteristic and potential prognostic factor were estimated using the random effect model. Thirdly, the effects of study characteristics and prognostic factors (expressed as odds ratios) on success rates were estimated using fixed and random effects meta-analysis with DerSimonean and Laird's methods. Meta-regression models were used to explore potential sources of statistical heterogeneity. Study characteristics considered in the meta-regression analyses were: decade of publication, study-specific criteria for success (radiographic, combined radiographic & clinical), unit of outcome measure (tooth, root), duration after treatment when assessing success ('at least 4 years' or '<4 years'), geographic location of the study (North American, Scandinavian, other countries), and qualification of the operator (undergraduate students, postgraduate students, general dental practitioners, specialist or mixed group). RESULTS: Of the 40 papers identified, 17 studies published between 1961 and 2005 were included; none were published in 2006. The majority of studies were retrospective (n = 12) and only five prospective. The pooled weighted success rate of 2 degrees RCT judged by complete healing was 76.7% (95% CI 73.6%, 89.6%) and by incomplete healing, 77.2% (95% CI 61.1%, 88.1%). The success rates by 'decade of publication' and 'geographic location of study' were not significantly different at the 5% level. Eighteen clinical factors had been investigated in various combinations in previous studies. The most frequently and thoroughly investigated were 'periapical status' (n = 13), 'size of lesion' (n = 7), and 'apical extent of RF' (n = 5) which were found to be significant prognostic factors. The effect of different aspects of primary treatment history and re-treatment procedures has been poorly tested. CONCLUSIONS: The pooled estimated success rate of secondary root canal treatment was 77%. The presence of pre-operative periapical lesion, apical extent of root filling and quality of coronal restoration proved significant prognostic factors with concurrence between all three strands of evidence whilst the effects of 1 degrees RCT history and 2 degrees RCT protocol have been poorly investigated

A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health.

AIM: To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. METHODOLOGY: This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. RESULTS: proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). CONCLUSIONS: Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments

Space-time in light of Karolyhazy uncertainty relation

General relativity and quantum mechanics provide a natural explanation for the existence of dark energy with its observed value and predict its dynamics. Dark energy proves to be necessary for the existence of space-time itself and determines the rate of its stability.Comment: 5 pages, Two misprints are correcte

The cardinality of the augmentation category of a Legendrian link

We introduce a notion of cardinality for the augmentation category associated to a Legendrian knot or link in standard contact R^3. This `homotopy cardinality' is an invariant of the category and allows for a weighted count of augmentations, which we prove to be determined by the ruling polynomial of the link. We present an application to the augmentation category of doubly Lagrangian slice knots

From computation to black holes and space-time foam

We show that quantum mechanics and general relativity limit the speed $\tilde{\nu}$ of a simple computer (such as a black hole) and its memory space $I$ to \tilde{\nu}^2 I^{-1} \lsim t_P^{-2}, where $t_P$ is the Planck time. We also show that the life-time of a simple clock and its precision are similarly limited. These bounds and the holographic bound originate from the same physics that governs the quantum fluctuations of space-time. We further show that these physical bounds are realized for black holes, yielding the correct Hawking black hole lifetime, and that space-time undergoes much larger quantum fluctuations than conventional wisdom claims -- almost within range of detection with modern gravitational-wave interferometers.Comment: A misidentification of computer speeds is corrected. Our results for black hole computation now agree with those given by S. Lloyd. All other conclusions remain unchange

Possible Constraints on the Duration of Inflationary Expansion from Quantum Stress Tensor Fluctuations

We discuss the effect of quantum stress tensor fluctuations in deSitter spacetime upon the expansion of a congruence of timelike geodesics. We treat a model in which the expansion fluctuations begin on a given hypersurface in deSitter spacetime, and find that this effect tends to grow, in contrast to the situation in flat spacetime. This growth potentially leads to observable consequences in inflationary cosmology in the form of density perturbations which depend upon the duration of the inflationary period. In the context of our model, the effect may be used to place upper bounds on this duration.Comment: 21 pages, no figures; Sect. IV rewritten and expanded, several comments and references adde

Inorganic nitrogen availability alters Eucalyptus grandis receptivity to the ectomycorrhizal fungus Pisolithus albus but not symbiotic nitrogen transfer.

Forest trees are able to thrive in nutrient-poor soils in part because they obtain growth-limiting nutrients, especially nitrogen (N), through mutualistic symbiosis with ectomycorrhizal (ECM) fungi. Addition of inorganic N into these soils is known to disrupt this mutualism and reduce the diversity of ECM fungi. Despite its ecological impact, the mechanisms governing the observed effects of elevated inorganic N on mycorrhizal communities remain unknown. We address this by using a compartmentalized in vitro system to independently alter nutrients to each symbiont. Using stable isotopes, we traced the nutrient flux under different nutrient regimes between Eucalyptus grandis and its ectomycorrhizal symbiont, Pisolithus albus. We demonstrate that giving E.&nbsp;grandis independent access to N causes a significant reduction in root colonization by P.&nbsp;albus. Transcriptional analysis suggests that the observed reduction in colonization may be caused, in part, by altered transcription of microbe perception genes and defence genes. We show that delivery of N to host leaves is not increased by host nutrient deficiency but by fungal nutrient availability instead. Overall, this advances our understanding of the effects of N fertilization on ECM fungi and the factors governing nutrient transfer in the E.&nbsp;grandis-P.&nbsp;microcarpus interaction

The Complex Wind Torus and Jets of PSR B1706-44

We report on Chandra ACIS imaging of the pulsar wind nebula (PWN) of the young Vela-like PSR B1706-44, which shows the now common pattern of an equatorial wind and polar jets. The structure is particularly rich, showing a relativistically boosted termination shock, jets with strong confinement, a surrounding radio/X-ray PWN and evidence for a quasi-static `bubble nebula'. The structures trace the pulsar spin geometry and illuminate its possible relation to SNR G343.1-2.3. We also obtain improved estimates of the pulsar flux and nebular spectrum, constraining the system age and energetics.Comment: To appear in the Astrophysical Journal. 15pp, 4 figures in 7 file

Quantum Stress Tensor Fluctuations of a Conformal Field and Inflationary Cosmology

We discuss the additional perturbation introduced during inflation by quantum stress tensor fluctuations of a conformally invariant field such as the photon. We consider both a kinematical model, which deals only with the expansion fluctuations of geodesics, and a dynamical model which treats the coupling of the stress tensor fluctuations to a scalar inflaton. In neither model do we find any growth at late times, in accordance with a theorem due to Weinberg. What we find instead is a correction which becomes larger the earlier one starts inflation. This correction is non-Gaussian and highly scale dependent, so the absence of such effects from the observed power spectra may imply a constraint on the total duration of inflation. We discuss different views about the validity of perturbation theory at very early times during which currently observable modes are transplanckian.Comment: 31 pages, 1 figure, uses LaTeX2epsilo

Nonlinear dynamics of voices in esophageal phonation

The present study investigated the difference in voice perturbation measures and parameters obtained from nonlinear dynamic analysis between normal laryngeal phonation and standard esophageal (SE) phonation. Jitter, shimmer, correlation dimension and Kolmogorov entropy were measured from 10 SE and 10 normal male speakers of Cantonese. Jitter and shimmer values were significantly higher for SE than laryngeal voice. But jitter values were found to be significantly different when length of sound samples was altered. In addition, both correlation dimension and Kolmogorov entropy values were significantly higher for SE than laryngeal voice and sample length did not appear to affect the result. These results suggest that SE voices are more chaotic than laryngeal voice. It follows that the technique of nonlinear dynamic analysis may be more reliable and stable for evaluating the acoustic characteristics of SE voices. © 2011 IEEE.published_or_final_versio