Root and Canal Morphology of Mandibular Molars in a Selected Iranian Population Using Cone-Beam Computed Tomography

Introduction: The aim of this study was to evaluate the root canal morphology of mandibular first and second molars using cone-beam computed tomography (CBCT) in northern Iranian population and also to indicate the thinnest area around root canals. Methods and Materials: We evaluated CBCT images of 154 first molars and 147 second molars. By evaluating three axial, sagittal and coronal planes of each tooth we determined the number of root canals, prevalence of C-shaped Melton types, and prevalence of Vertucci configuration and inter orifice distance. Also the minimum wall thickness of root canals was determined by measuring buccal, lingual, distal and mesial wall thicknesses of each canal in levels with 2 mm intervals from apex to orifice. Results: Amongst 154 first mandibular molars, 149 (96.7%) had two roots, 3 (1.9%) had three roots and 2 (1.2%) had C-shaped root configuration. Of 147 second mandibular molars, 120 (81.6%) had two roots, 1 (0.6%) had three roots and 26 (17.6%) had C-shaped roots. There was no significant difference in the prevalence of Vertucci’s type between two genders. The most common configuration in mesial roots of first and second molars were type IV (57%-42.9%) and type II (31.5%-28%). Mesial and distal walls had the most frequency as the thinnest wall in all levels of root canals with mostly less than 1 mm thickness. In second molars the DB-DL inter orifice distance and in first molars the MB-ML distance were the minimum. MB-D in first molars had the maximum distance while ML-DL, MB-DB and ML-D had the same and maximum distance in second molars. Conclusion: Vertucci’s type IV and type I were the most prevalent configurations in mesial and distal roots of first and second mandibular molars and the thickness of thinnest area around the canals should be considered during endodontic treatments.Keywords: Cone-Beam Computed Tomography; C-Shaped Root Canals; Mandibular First Molar; Mandibular Second Molar; Root Canal Anatomy; Root Canal Morpholog

Cone-beam computed tomography performance and endodontic filling material influence in the diagnosis of horizontal root fracture

Introduction: The aim of this study was to investigate the accuracy of Cone-beam computed tomography(CBCT) in detecting the horizontal root fractures (HRFs) in teeth with and without gutta-percha. Materials & Methods: This in vitro study was performed on 100 mandibular and maxillary single-rooted teeth. In 55 samples, the canals were prepared. Then, the horizontal fracture was induced randomly in 56 (29 with gutta-percha, 27 without gutta-percha) samples. The samples were mounted on a wax rim, and the CBCT scan was provided. The scans were examined by two endodontists twice with two-week interval. Data were analyzed using IBM SPSS 20.0 software (IBM Corp., Armonk, IL, USA). Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR +, LR -) with 95% confidence interval were calculated. Results: The sensitivity and specificity were 72% and 100% for the group with gutta-percha as well as 89% and 100% for the group without gutta-percha, respectively. The coefficient of agreement for each observer within two observations was 0.940±0.034 and 0.960±0.028 (P<0.001). The inter observer agreement was 0.092±0.039 (P<0.001). Conclusion: The CBCT scans have high accuracy in diagnosis of horizontal root fracture and gutta-percha although they reduce the diagnostic accuracy with no significant effect

CBCT Evaluation of the Root Canal Filling Removal Using D-RaCe, ProTaper Retreatment Kit and Hand Files in curved canals

Introduction: The aim of the present in vitro study was to evaluate the efficacy of D-RaCe, ProTaper retreatment kit and hand H-files in removal of obturating materials (OM) from the curved root canals using cone-beam computed tomography (CBCT). Materials and methods: Sixty extracted molars were prepared and obturated. The samples were divided into three groups (n=20). In each group the OM was removed using hand H-files, D-RaCe and ProTaper retreatment kit. All the samples underwent CBCT imaging. The amount of OM was evaluated in CBCT sagittal cross-sections and scored. The maximum concentration of residual OM was recorded. The duration of the procedure (including the required time for reaching working length=T1 and total working time=TT) and procedural errors were also recorded. Data were analyzed using one-way ANOVA, Tukey’s post hoc test, Fisher’s exact test and Kruskal-Wallis test. The level f significance was set at 0.05. Results: No significant differences were observed in the residual OM among the three groups. T1 and TT were not significantly different in all the groups. There were no significant differences in concentration of OM between the groups (P&lt;0.05). In relation to procedural errors, 4 and 5 cases of file fracture were recorded in the ProTaper and D-RaCe groups, respectively, with no significant differences. Conclusion: Rotary and hand files had similar efficacy in removing root canal filling materials but instrument fracture occurred more frequently in rotary files

Study of liver in HBV-related hepatocellular carcinoma: Stereology shows quantitative differences in liver structure

Hepatocellular carcinoma is one of the main consequences of liver chronic disease. Hepatocellular carcinoma-related changes may be seen in patients with chronic hepatitis B. The aim of the current study was to quantitate liver tissue elements by stereological technique in patients with hepatitis B-related cancer and compare the results with control and only hepatitis B group. Needle liver biopsies from 40 patients with only chronic hepatitis B infection, from 41 patients with only early hepatocellular carcinoma, from 40 patients with early hepatitis B-related cancer and 30 healthy subjects (control group) were analyzed by stereological method using systematic uniform random sampling method. Haematoxylin and eosin stained sections were used. The numerical density of hepatocytes, hepatocyte volume, numerical density of Kupffer cells, volume density of the connective tissue in the portal space, and volume density of the connective tissue were assessed. Quantitative analysis of liver samples indicated that there were statistically significant differences in the numerical density of hepatocytes, hepatocyte volume, numerical density of Kupffer cells, volume density of the connective tissue in the portal space, and volume density of the connective tissue between control and hepatitis B-related cancer and hepatitis B groups. Quantitative, stereological technique is simple and reliable for evaluating HCC in chronic hepatitis B. It is useful for assessing the liver tissue parameters. Stereology is recommended for the diagnosis of people prone to cancer in patients with chronic hepatitis B

Comparing the Coronal Flaring Efficacy of Five Different Instruments Using Cone-Beam Computed Tomography

Introduction: Fearless removal of tooth structure during canal preparation and shaping has negative effects on the prognosis of treatment. On the other hand, sufficient pre-enlargement facilitates exact measurement of the apical size. The present in vitro study aimed to compare the efficacy of Gates-Glidden drills, K3, ProTaper, FlexMaster and RaCe instruments in dentin removal during coronal flaring using cone-beam computed tomography (CBCT). Methods and Materials: A total of 40 mandibular molars were selected and the coronal areas of their mesiobuccal and mesiolingual root canals were randomly prepared with either mentioned instruments. Pre- and post-instrumentation CBCT images were taken and the thickness of canal walls was measured in 1.5- and 3-mm distances from the furcation area. Data were analyzed using the one-way ANOVA. Tukey’s post hoc tests were used for two-by-two comparisons. Results: At 1.5-mm distance, there was no significant difference between different instruments. However, at 3-mm distances, Gates-Glidden drills removed significantly more dentin compared to FlexMaster files (mean=0.18 mm) (P&lt;0.02); however, two-by-two comparisons did not reveal any significant differences between the other groups. Conclusion: All tested instruments can be effectively used in clinical settings for coronal pre-enlargement.Keywords: Cone-Beam Computed Tomography; Coronal Flaring; Coronal Pre-Enlargement; Root Canal Treatment; Root Canal Preparatio

Prevalence of congenital anomalies and related factors in live births in Zahedan, Southeast of Iran: A cross-sectional study

Background: The term congenital anomalies (CAs) refers to structural or functional abnormalities at the time of conception. Approximately 12 deaths related to congenital disabilities occur in every 10,000 babies born. Objective: This study aimed to evaluate the prevalence and associated factors of single and multiple CAs in live births in Zahedan, Southeast Iran. Materials and Methods: This cross-sectional study was conducted on 59,087 live births in a referral hospital in Zahedan located in the southeast of Iran from 2009 to 2019. All live births were examined by pediatricians and the CAs and categorized based on the international classification of diseases. Results: Of 59,085 live births, at least 883 had a significant anomaly, and the prevalence rate of CAs was about 149 per 10,000. Anomalies of the nervous (24.1%) and cardiovascular systems (21.10%) were the most frequent, occurring in 213 and 187 of the live births, respectively. Spina bifida is the most common anomaly of the central nervous system. The most common anomalies in the cardiovascular system were unspecified heart malformations (17.1%), cardiovascular malformations (18.7%), and patent ductus arteriosus (11.7%). Significant correlations were found between the parent’s consanguinity marriage, the mother’s age, an existing anomaly in the family, and relatives in single and multiple CAs (p = 0.02, p = 0.02, p &lt; 0.001, p = 0.01, respectively). Conclusion: The prevalence of CAs was 149 per 10,000 live births. The highest prevalence of CAs was related to the central nervous system. Increasing the public’s knowledge about fetal defects can reduce the prevalence of CAs. Key words: Congenital anomalies, Hospitalization, Iran, Live birth, Prevalence, Risk factors

Association of FAS and FAS Ligand Genes Polymorphism and Risk of Systemic Lupus Erythematosus

FAS/FASL pathway plays a critical role in maintaining peripheral immune tolerance; therefore, the apoptosis genes, Fas and Fas ligand (FasL), could be suitable candidate genes in human SLE susceptibility. Materials and Methods. In this case-control study, 106 SLE patients and 149 sex, age, and ethnicity matched healthy controls were genotyped for the Fas A-670G and FasLC-844T polymorphisms by polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Results. The frequency of -670AA genotype was significantly higher in SLE patients than control group and the risk of SLE was 2.1-fold greater in subjects with AA genotype (P=0.03). The frequency of -670A allele was significantly higher in SLE patients than in controls too (58% versus 49%, P=0.03). The -844CC genotype frequency was significantly higher in SLE patients than in healthy controls and the risk of SLE was 2.8-fold greater in these subjects (P=0.01). The C allele frequency was significantly higher in patients than in controls (69% versus 49%, P=0.001). Increased SLE risk was observed in individuals with combined effect of Fas-670AA and FasL-844CC genotypes (P=0.001). Conclusion. Fas-670AA and FasL-844CC genotypes were associated with SLE risk, and combined effect of -670AA and -844CC genotypes might increase SLE susceptibility

Association between the organic cation transporter 3 methylation and hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the deadliest cancers in the world and has a high death rate in the world. This research while examining the expression of OCT3 at the mRNA level has also studied gene methylation profile in patients with HCC in comparison with people without HCC. The volunteers were: patients with HCC (n=81) and a healthy control group (n=90). The expression of OCT3was studied using the qRT-PCR method. The methylation profile was evaluated by genomic DNA using methylation specific PCR (MSP) method. The expression level of OCT3 marker mRNA in patients has decreased significantly compared to healthy individuals (0.58 ± 0.311 vs 1.20 ± 0.355, P &lt;0.001). No significant statistical relationship was found between demographic data and OCT3 expression in participants (P &gt;0.05). The amount of methylation (UM + MM) in cancer patients has raised vs controls (P &lt;0.001) and has increased the risk of cancer (OR=0.379, 95% CI=1.171-2.839, P &lt;0.001, and OR=2.727, 95% CI=1.251-5.945, P &lt;0.001, respectively).Changes in OCT3 levels appear to be associated with HCC. Also, changing the methylation pattern of this gene can reveal HCC pathology

Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran

<p>Abstract</p> <p>Background</p> <p>One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings.</p> <p>Methods</p> <p>In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO) standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis.</p> <p>Results</p> <p>The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral.</p> <p>Conclusions</p> <p>Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give appropriate consideration to the ethical and cultural concerns of the women. Appropriate management of financial and insurance-related issues can help midwives and mothers make a rational decision when complications arise.</p