Influence of remaining axial walls on of root filled teeth restored with a single crown and adhesively bonded fibre post: A systematic review and meta-analysis

Objectives To synthesise evidence on structural failures and prevalence of post-treatment endodontic disease (PTD) in anterior and posterior root filled teeth with a single crown and adhesively bonded fibre post with regards to the number of axial walls. Data An electronic search was performed, no language constraints or restriction on the year of publication were applied. Sources PubMed, Medline, Cochrane and Scopus on 13th of July 2021. Study selection Clinical studies that reported the remaining number of axial walls for permanent anterior and posterior root filled teeth (RFT) restored with single crowns and adhesively bonded fibre posts with a minimum of 1 year follow-up were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [1] were used. The number of axial walls and the success/failures were analysed as follows: fibre post and/or core decementation, post and/or core fracture and post treatment endodontic disease, and root fracture. Conclusions A total of 811 studies were identified with 5 meeting the inclusion criteria. The two randomized controlled trials included had ‘some concerns’ as determined by the Cochrane risk-of-bias 2 tool while the Newcastle-Ottawa scale found low risk of bias for the remaining three studies. The random effects model for subgroup meta-analysis revealed failures for posterior RFT increased with decreasing numbers of remaining walls. Failures for 0 remaining walls were 23% (95% CI = 10% - 36%) and for one remaining wall 15% (CI: 3% -26%), irrespective of follow-up times. Fibre post debonding and PTD increased with decreasing numbers of walls. Relative & catastrophic failure of posterior teeth restored with a fibre post and single crown after root canal treatment increased with decreasing numbers of remaining axial walls. Clinical significance This synthesis is unique as it minimizes the presence of confounding factors by reviewing evidence of failures and post-treatment endodontic disease associated with teeth restored with single crowns. Therefore, it provides valuable predictive evidence of potential coronal restoration catastrophes and post-treatment endodontic disease associated with root filled teeth

The CORDEX Flagship Pilot Study in southeastern South America: a comparative study of statistical and dynamical downscaling models in simulating daily extreme precipitation events

The aim of this work is to present preliminary results of the statistical and dynamical simulations carried out within the framework of the Flagship Pilot Study in southeastern South America (FPS-SESA) endorsed by the Coordinated Regional Climate Downscaling Experiments (CORDEX) program. The FPS-SESA initiative seeks to promote inter-institutional collaboration and further networking with focus on extreme rainfall events. The main scientific aim is to study multi-scale processes and interactions most conducive to extreme precipitation events through both statistical and dynamical downscaling techniques, including convection-permitting simulations. To this end, a targeted experiment was designed considering the season October 2009 to March 2010, a period with a record number of extreme precipitation events within SESA. Also, three individual extreme events within that season were chosen as case studies for analyzing specific regional processes and sensitivity to resolutions. Four dynamical and four statistical downscaling models (RCM and ESD respectively) from different institutions contributed to the experiment. In this work, an analysis of the capability of the set of the FPS-SESA downscaling methods in simulating daily precipitation during the selected warm season is presented together with an integrated assessment of multiple sources of observations and available CORDEX Regional Climate Model simulations. Comparisons among all simulations reveal that there is no single model that performs best in all aspects evaluated. The ability in reproducing the different features of daily precipitation depends on the model. However, the evaluation of the sequence of precipitation events, their intensity and timing suggests that FPS-SESA simulations based on both RCM and ESD yield promising results. Most models capture the extreme events selected, although with a considerable spread in accumulated values and the location of heavy precipitation.Thanks to CORDEX for endorsing the FPS-SESA. This work was supported by the University of Buenos Aires 2018- 20020170100117BA grant; JMG, MLB, SAS, RPR funding from the Spanish Research Council (CSIC) I-COOP+ Program “reference COOPB20374”. JMG, JF and AL-G acknowledge support from the Spanish R&D Program through projects MULTI-SDM (CGL2015-66583-R) and INSIGNIA (CGL2016-79210-R), co-funded by the European Regional Development Fund (ERDF/FEDER). AL-G acknowledges support from the Spanish R&D Program through the predoctoral contract BES-2016-078158. Universidad de Cantabria simulations have been carried out on the Altamira Supercomputer at the Instituto de Física de Cantabria (IFCA-CSIC), member of the Spanish Supercomputing Network. MB acknowledges support from the Simons Associateship of the Abdus Salam International Centre for Theoretical Physics. RH acknowledges support from the project LTT17007 funded by the Ministry of Education, Youth, and Sports of the Czech Republic

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020–June 19, 2020) and late 2020 (June 20, 2020–December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p <.001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46–0.98, p =.016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p <.001 and 50/571 [8.8%] vs. 213/402 [52.2%], p <.001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p <.001 and 73/571 [12.8%] vs. 5/402 [1.2%], p <.001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study

COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study

Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p =.02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p =.032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0–2.6, p =.04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0–11.3, p =.05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality

Psychoneuroendocrine interventions aimed at attenuating immunosenescence: a review

There is evidence suggesting that immunosenescence can be accelerated by external factors such as chronic stress. Here we review potential psychoneuroendocrine determinants of premature aging of the immune system and discuss available interventions aimed at attenuating immunosenescence. Chronic stress may accelerate various features of immunosenescence by activating key allostatic systems, notably the hypothalamic-pituitary-adrenal axis. The immunological impact of such neuroendocrine dysregulation may be further amplified by a dramatic decline in dehydroepiandrosterone (DHEA) levels, acting in part as an endogenous glucocorticoid antagonist. Stress-buffering strategies show beneficial effects on various biomarkers in elderly populations. Likewise, supplementation of DHEA, melatonin or growth hormone has yielded significant beneficial effects in a number of studies, including: increased well-being, memory performance, bone mineral density and improved immunocompetence as evidenced by results of in vitro (T cell proliferation, cytotoxicity, cytokine production), and in vivo immune challenges. However, the side-effects of hormonal supplementation are also discussed. Finally, moderate exercise via the promotion of cortisol/DHEA balance or epigenetic modifications, is associated with lower serum pro-inflammatory cytokines, greater lymphoproliferative responses and lower counts of senescent T cells. Taken together, these data suggest that immune system is plastic and immunosenescence can be attenuated psychoneuroendocrine interventions

Chlorhexidine In Endodontics

Chemical auxiliary substances (CAS) are essential for a successful disinfection and cleanness of the root canals, being used during the instrumentation and if necessary, as antimicrobial intracanal medicaments. Different CAS have been proposed and used, among which sodium hypochlorite (NaOCl), chlorhexidine (CHX), 17% EDTA, citric acid, MTAD and 37% phosphoric acid solution. CHX has been used in Endodontics as an irrigating substance or intracanal medicament, as it possesses a wide range of antimicrobial activity, substantivity (residual antimicrobial activity), lower cytotoxicity than NaOCl whilst demonstrating efficient clinical performance, lubricating properties, rheological action (present in the gel presentation, keeping the debris in suspension); it inhibits metalloproteinase, is chemically stable, does not stain cloths, it is odorless, water soluble, among other properties. CHX has been recommended as an alternative to NaOCl, especially in cases of open apex, root resorption, foramen enlargement and root perforation, due to its biocompatibility, or in cases of allergy related to bleaching solutions. The aim of this paper is to review CHX's general use in the medical field and in dentistry; its chemical structure, presentation form and storage; mechanism of action; antimicrobial activity including substantivity, effects on biofilms and endotoxins, effects on coronal and apical microbial microleakage; tissue dissolution ability; interaction with endodontic irrigants; effects on dentin bonding, metalloproteinases and collagen fibrils; its use as intracanal medicament and diffusion into the dentinal tubules; its use as disinfectant agent of obturation cones; other uses in the endodontic therapy; and possible adverse effects, cytotoxicity and genotoxicity.24289102Abou-Rass, M., Piccinino, M.V., The effectiveness of 4 clinical irrigation methods on the removal of root-canal debris (1982) Oral Surg Oral Med Oral Pathol, 54, pp. 323-328Gomes, B.P., Ferraz, C.C., Vianna, M.E., Berber, V.B., Teixeira, F.B., Souza, F.J., In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis (2001) Int Endod J, 34, pp. 424-428Rocha, A.W., de Andrade, C.D., Leitune, V.C., Collares, F.M., Samuel, S.M., Grecca, F.S., Influence of endodontic irrigants on resin sealer bond strength to radicular dentin (2012) Bull Tokyo Dent Coll, 53, pp. 1-7Prado, M., Simão, R.A., Gomes, B.P., Impact of different irrigation protocols on resin sealer bond strength to dentin (2013) J Endod, , in pressGomes, B.P., Souza, S.F., Ferraz, C.C., Teixeira, F.B., Zaia, A.A., Valdrighi, L., Effectiveness of 2% chlorhexidine gel and calcium hydroxide against Enterococcus faecalis in bovine root dentine in vitro (2003) Int Endod J, 36, pp. 267-275Vianna, M.E., Horz, H.P., Conrads, G., Zaia, A.A., Souza, F.J., Gomes, B.P., Effect of root canal procedures on endotoxins and endodontic pathogens (2007) Oral Microbiol Immun, 22, pp. 411-418de Souza-Filho, F.J., de Soares, A.J., Vianna, M.E., Zaia, A.A., Ferraz, C.C., Gomes, B.P., Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials (2008) Braz Dent J, 19, pp. 28-33Tomás, I., Rubido, S., Donos, N., In situ antimicrobial activity of chlorhexidine in the oral cavity (2011) Formatex, pp. 530-541Lang, N.P., Brecx, M.C., Chlorhexidine digluconate: An agent for chemical plaque control and prevention of gingival inflammation (1986) J Periodontal Res, 21, pp. 74-89Davies, G.E., Francis, J., Martin, A.R., Rose, F.L., Swain, G., 1:6-di-4'- chlorophenyldiguanidohexane ("Hibitane"). 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substantivity in root canal dentin (2004) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 98, pp. 488-492Mohammadi, Z., Abbott, P.V., The properties and applications of chlorhexidine in endodontics (2009) Int Endod J, 42, pp. 288-302Carrilho, M.R., Carvalho, R.M., Sousa, E.N., Nicolau, J., Breschi, L., Mazzoni, A., Substantivity of chlorhexidine to human dentin (2010) Dent Mater, 26, pp. 779-785Baca, P., Junco, P., Arias-Moliz, M.T., Castillo, F., Rodriguez-Archilla, A., Ferrer-Luque, C.M., Antimicrobial substantivity over time of chlorhexidine and cetrimide (2012) J Endod, 38, pp. 927-930Costerton, J.W., Stewart, P.S., Greenberg, E.P., Bacterial biofilms: A common cause of persistent infections (1999) Science, 21, pp. 1318-1322Spratt, D.A., Pratten, J., Wilson, M., Gulabivala, K., An in vitro evaluation of the antimicrobial efficacy of irrigants on biofilms of root canal isolates (2001) Int Endod J, 34, pp. 300-307Clegg, M.S., Vertucci, F.J., Walker, C., Belanger, M., Britto, L.R., The effect of exposure to irrigant solutions on apical dentin biofilms in vitro (2006) J Endod, 32, pp. 434-437Martinho, F.C., Chiesa, W.M., Zaia, A.A., Ferraz, C.C., Almeida, J.F., Souza-Filho, F.J., Comparison of endotoxin levels in previous studies on primary endodontic infections (2011) J Endod, 37, pp. 163-167Buck, R.A., Cai, J., Eleazer, P.D., Staat, R.H., Hurst, H.E., Detoxification of endotoxin by endodontic irrigants and calcium hydroxide (2001) J Endod, 27, pp. 325-327de Oliveira, L.D., Jorge, A.O., Carvalho, C.A., Koga-Ito, C.Y., Valera, M.C., In vitro effects of endodontic irrigants on endotoxins in root canals (2007) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 104, pp. 135-142Tanomaru, J.M., Leonardo, M.R., Tanomaru, F.M., Bonetti, F.I., Silva, L.A., Effect of different irrigation solutions and calcium hydroxide on bacterial LPS (2003) Int Endod J, 36, pp. 733-739Silva, L.A., Leonardo, M.R., Assed, S., Tanomaru, F.M., Histological study of the effect of some irrigating solutions on bacterial endotoxin in dogs (2004) Braz Dent J, 15, pp. 109-114Signoretti, F.G.C., Gomes, B.P., Montagner, F., Tosello, F.B., Jacinto, R.C., Influence of 2% chlorhexidine gel on calcium hydroxide ionic dissociation and its ability of reducing endotoxin (2011) Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 111, pp. 653-658Gomes, B.P., Martinho, F.C., Vianna, M.E., Comparison of 2.5% sodium hypochlorite and 2% chlorhexidine gel on oral bacterial lipopolysaccharide reduction from primarily infected root canals (2009) J Endod, 35, pp. 1350-1353Gomes, B.P., Endo, M.S., Martinho, F.C., Comparison of endotoxin levels found in primary and secondary endodontic infections (2012) J Endod, 38, pp. 1082-1086Endo, M.S., Martinho, F.C., Zaia, A.A., Ferraz, C.C., Almeida, J.F., Gomes, B.P., Quantification of cultivable bacteria and endotoxin in post-treatment apical periodontitis before and after chemo-mechanical preparation (2012) Eur J Clin Microbiol Infect Dis, 31, pp. 2575-2583Gomes, B.P., Sato, E., Ferraz, C.C., Teixeira, F.B., Zaia, A.A., Souza-Filho, F.J., Evaluation of time required for recontamination of coronally sealed canals medicated with calcium hydroxide and chlorhexidine (2003) Int Endod J, 36, pp. 604-609Oliveira, D.P., Gomes, B.P., Zaia, A.A., Souza-Filho, F.J., Ferraz, C.C., In vitro assessment of a gel base containing 2% chlorhexidine as a sodium perborate's vehicle for intracoronal bleaching of discolored teeth (2006) J Endod, 32, pp. 672-674Oliveira, D.P., Gomes, B.P., Zaia, A.A., Souza-Filho, F.J., Ferraz, C.C., Ex vivo antimicrobial activity of several bleaching agents used during the walking bleach technique (2008) Int Endod J, 41, pp. 1054-1058de Oliveira, D.P., Teixeira, E.C., Ferraz, C.C., Teixeira, F.B., Effect of intracoronal bleaching agents on dentin microhardness (2007) J Endod, 33, pp. 460-462Marley, J.T., Ferguson, D.B., Hartwell, G.R., Effects of chlorhexidine gluconate as an endodontic irrigant on the apical seal: 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In Vitro Antimicrobial Activity Of Calcium Hydroxide Pastes And Their Vehicles Against Selected Microorganisms.

The aim of this study was to investigate in vitro the antimicrobial activity of calcium hydroxide in combination with several vehicles against some microorganisms commonly isolated from root canals. Antimicrobial activity was determined by the agar diffusion method. Stainless-steel cylinders were placed on each inoculated agar medium. The test medicaments and their controls were placed inside the cylinders. The zones of growth inhibition were measured and recorded after incubation for each plate and the results were analyzed statistically (ANOVA). The in vitro antimicrobial effects of the medications were ranked from strongest to weakest as follows: Ca(OH)2 + CMCP + glycerine, Ca(OH)2 + CMCP, Ca(OH)2 + glycerine, Ca(OH)2 + anesthetic, Ca(OH)2 + saline, Ca(OH)2 + H2O, Ca(OH)2 + polyethyleneglycol. The pastes with oily vehicles showed significantly larger mean zones of inhibition compared to those with aqueous or viscous vehicles. It was concluded that diffusion and antimicrobial activity of calcium hydroxide were affected by the type of vehicle used.13315516

Comparação entre sessão única e a utilização do "curativo de demora" no tratamento endodôntico em cães: aspectos histopatológicos e microbiológicos Comparison of the application of temporary endodontic dressing in teeth of dogs: histopathological and microbiological aspects

No tratamento endodôntico a presença de bactérias é a maior preocupação. A presença de bactérias nos túbulos dentinários, foraminas apicais e no delta apical é considerado como falha de procedimento. Alguns estudos revelam que após o tratamento endodôntico em sessão única, bactérias ainda permanecem em estruturas dentais. O objetivo do presente estudo foi avaliar o tratamento endodôntico em uma ou duas sessões, usando hidróxido de cálcio associado ao paramonoclorofenol canforado (PMCC) como "curativo de demora". Foram utilizados quatro cães, onde dois animais foram submetidos a tratamento em sessão única e os outros em duas sessões. Foram utilizados no estudo 40 dentes: segundo e terceiro pré-molares superiores e segundo, terceiro e quarto pré-molares inferiores divididos em dois grupos. Foi realizada abertura coronária dos dentes, expondo a câmara pulpar por 60 dias. Após este período o grupo tratado em sessão única foi obturado com guta-percha e óxido de zinco e eugenol e o grupo tratado em duas sessões recebeu o PMCC que permaneceu no canal por 30 dias e, após, foi obturado com o mesmo material do outro grupo. Controle clínico e radiográfico foram realizados quinzenalmente e após 60 dias foi retirado um bloco contendo dente e periodonto para análise histopatológica e microbiológica. A análise histopatológica revelou intensa resposta inflamatória em todos os grupos. A análise microbiológica apresentou redução microbiana mais acentuada no grupo tratado em sessão única. Contudo, bactérias ainda foram observadas nos dois grupos evidenciando que nenhum tratamento utilizado foi totalmente eficiente.<br>During a root canal therapy the microbiota is the major concern. Bacteria present in dentinal tubules, apical foramens and apical delta is related to failure of this procedure. Some studies reveal that during endodontic treatment in one session bacteria still remain in dental structures. The aim of the present study was to evaluate the endodontic treatment in one or two sessions, using calcium hydroxide plus camphorated paramonochlorophenol (CMCP) with temporary endodontic medicaments. Four dogs were used, and two animals were submitted the treatment in one session only and the others in two sessions. Premolar teeth were used in this study: second and third upper premolar teeth and second, third and fourth lower premolar teeth were divided into two groups. Opening of the pulp chamber was performed with burns, and the pulp was exposed for 60 days. After this period the group treated in only session was obtured with gutta-percha and zinc oxide and eugenol, and the group treated in two sessions received the CMCP that remained in the canal per 30 days and was afterwards obtured with the material of the other group. Clinical and radiographical control was performed twice a week, and after 60 days a small block containing the teeth, surrounding periapical tissues and the periodontium was removed for histological and microbiological study. Histological analysis revealed intense inflammatory response in both groups. Microbiological analysis showed a more severe microbial reduction in the group treated in one session. However, bacteria were still observed in the two groups, indicating that none of the treatments presented total efficiency