Search Results (279)

Background/Aim: Third molar impaction with the consequent root resorption of second molars often creates complexities in treatment planning and execution. In the past, the root canal treatment (RCT) of second molars was required in these cases to avoid pulp necrosis and infection. The aim of this paper is to report a surgical/retrograde approach for the maintenance of pulp vitality, proposed as retrograde vital pulp treatment (rVPT), in cases of asymptomatic or reversibly affected teeth with root resorptions caused by impacted adjacent teeth. Methods: A case report on the rVPT of two upper second molars with root resorption due to third molar impaction is presented. The chief complaint of the patient was a slight pain during bite involving the upper second molars. Heat and cold sensitivity tests were performed, suggesting a healthy pulp status. A cone beam computed tomography (CBCT) scan was performed to aid the diagnosis and treatment planning, showing bilateral upper third molar impaction and both distal roots of the upper second molars affected by external root resorption (ERR). In both cases, the third molar was surgically extracted, the surface of the root with ERR was smoothened and rVPT was carried out by performing a 3 mm retrograde preparation of the root canal and its retrograde sealing using a hydraulic calcium silicate-based cement (hCSCs). Results: Heat and cold sensitivity tests were performed 1 month, 3 months, 6 months and 1 year after the treatment. The patient reported no pain, and the pulp sensitivity was maintained in all follow-up periods. A CBCT scan was performed 24 months after the treatment, reporting a complete perirradicular endogenous bone apposition. Conclusions: Based on the successful clinical and radiographic outcomes observed in the present case after two years of follow-up, rVPT is proposed for the maintenance of pulp vitality in cases of asymptomatic or reversibly affected teeth with ERR caused by impacted adjacent teeth. Full article

The success rate of root canal treatment is high, but it can fail. In these cases, orthograde root canal retreatment is often the treatment of choice, for which numerous biomaterials are available on the market, including endodontic files. This systematic review aimed to study the endodontic files available on the market and establish their efficacy in root canal retreatment. An electronic search of six different databases was performed, and in vitro experimental studies that studied root canal cleaning, debris extrusion, retreatment time, or dentinal damage produced with any of the comparison methods were selected. The quality of the studies was assessed with the QUIN scale. In total, 78 studies were included for the analysis, of which 9 had a high risk of bias, 53 had a moderate risk, and 16 had a low risk. The methods used to evaluate the efficacy of endodontic files in root canal retreatment are heterogeneous. Manual files produce more apical extrusion than rotary files. PTUR files are the most studied endodontic files. It is the file system that leaves the least residual filling material in the canal, takes the least time during retreatment, and removes the greatest amount of dentine. However, no file system achieved the complete removal of the root canal filling material. No consistent pattern emerged across studies when comparing rotary files with continuous and reciprocating rotation in terms of the removal of the filling material, the time required for de-obturation, dentine damage produced, or apical extrusion. Full article

Background: Iatrogenic nerve injuries (NIs) are an under-recognized complication of urological surgery. Though less common than vascular or organ damage, they may cause lasting sensory and motor deficits, significantly affecting patients’ quality of life. With increasing complexity in pelvic procedures, a consolidated understanding of nerve injuries is essential. Purpose: This review aims to synthesize current knowledge regarding peripheral and autonomic NIs in urological surgery, highlighting mechanisms of injury, associated procedures, preventative strategies, and treatment options. Scope: Focused on common urological interventions such as radical prostatectomy, cystectomy, pelvic lymphadenectomy, and reconstructive techniques, the review explores injuries from positional compression, traction, and intraoperative transection to their surgical management. Key Findings: The review categorizes nerve injuries into crush and transection types and details intraoperative signs and repair techniques. Skeletonization of nerves, avoidance of energy devices near neural structures, and prompt end-to-end anastomosis using 7-0 polypropylene are central to management. Adoption of novel sutureless nerve coaptation devices have also been described with promising outcomes. Early repair offers a better prognosis. New intraoperative technologies like NeuroSAFE during robotic-assisted procedures may enhance nerve preservation. Conclusion: Iatrogenic NIs, although rare, are clinically significant and often preventable. Prompt intraoperative recognition and repair are critical. Further research is warranted to develop standardized preventative protocols and enhance intraoperative nerve monitoring. A multidisciplinary approach, extended across surgical specialties, could improve outcomes and guide timely treatment of nerve injuries. Full article

Background/Objectives: The aim of this systematic review was to identify the role of orthodontics in patients undergoing tumor-ablative surgery, in collaboration with maxillofacial prosthodontic rehabilitation in a multidisciplinary fashion. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024582050). The focused question was constructed using the PICO (participant, intervention, comparison, and outcome) approach. A three-stage search was performed in PubMed, Scopus, and Web of Science using Medical Subject Heading (MeSH) terms. To assess the risk of bias, the National Institute of Health (NIH) “Quality Assessment Tool for case series/reports” was used. All data was synthesized qualitatively, according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results: The initial search yielded 624 articles, of which 22 met the inclusion criteria after screening and eligibility assessment, with most being single-patient case reports and one case series involving 12 patients. The included studies primarily involved tumors in the mandible (64.5%) and maxilla (32.3%). Orthodontic treatment was initiated at various time points, ranging from one month pre-surgery to 19 years post-surgery, primarily utilizing fixed appliances (77.8%). In some studies, orthodontic appliances were used to enhance the stability of maxillofacial prostheses. The results of this study indicate that orthodontic treatment may facilitate prosthetic rehabilitation by improving conditions prior to prosthetic intervention and increasing the retention of the obturator prosthesis. Conclusions: Orthodontic treatment can enhance maxillofacial prosthetic rehabilitation after tumor-ablative surgery by optimizing jaw growth, improving occlusion, and facilitating prosthetic retention or space creation. Further research is needed to establish treatment guidelines. Orthodontic miniscrews may improve temporary prosthesis retention before final implant placement, when indicated. Full article

Background/Objectives: Prostate cancer ranks as the second-most prevalent cancer globally, and is the fifth-ranking cause of cancer-related mortality. Radical prostatectomy presents a significant risk of postoperative sequelae, including erectile dysfunction. Postoperative erectile dysfunction adversely affects the patient’s quality of life and can severely impact total treatment satisfaction. Nomograms have demonstrated efficacy in forecasting diverse outcomes in urology. We sought to create a nomogram to facilitate a more precise, evidence-based, and individualized prediction of erectile function outcomes following radical prostatectomy. Between January 2018 and January 2022, one hundred and eleven prostate cancer patients had robot-assisted radical prostatectomy, excluding those who had undergone prior transurethral prostatectomy, radiotherapy, or hormone therapy. Demographics, medical records, preoperative and postoperative erectile function statuses, and IIEF scores (≥17 indicating retained erections, <17 indicating full erectile dysfunction) were evaluated. Outcomes: Patients’ ages ranged from 45 to 76 years, with an average of 61.18 ± 6.72 years. Patients in the emergency department were considerably older (p = 0.004; p < 0.01) and exhibited elevated Charlson Comorbidity Indices (3.63 ± 0.85; p = 0.004; p < 0.01). Preoperative IIEF scores in ED patients were lower (14.29 ± 5.34), although obturator internus thickness (20.61 ± 2.91) and intraprostatic urethra length (36.48 ± 9.3) were considerably elevated. Altered surgical techniques were linked to maintained erections (p = 0.002; p < 0.01), but traditional approaches were connected with erectile dysfunction (p = 0.007; p < 0.01). Bilateral nerve-sparing procedures were more prevalent among patients preserving erectile function (p = 0.003; p < 0.01). Conclusions: The nomogram, which includes age, Charlson Comorbidity Index, preoperative IIEF, obturator internus thickness, intraprostatic urethra length, surgical technique, and degree of nerve preservation, provides clinicians with a pragmatic instrument for forecasting postoperative erectile dysfunction in prostate cancer patients. Full article

The Flexible Combined Imager (FCI), developed as the next-generation imager for the European Organisation for the Exploitation of Meteorological Satellites (EUMETSAT) Meteosat Third Generation (MTG) satellite series, represents a significant advancement over its predecessor, SEVIRI, on the Meteosat Second Generation (MSG) satellites. FCI offers more spectral bands, higher spatial resolution, and faster imaging capabilities, supporting a wide range of applications in weather forecasting, climate monitoring, and environmental analysis. On 13 January 2024, the FCI onboard MTG-I1 (renamed Meteosat-12 in December 2024) experienced a critical anomaly involving the failure of its onboard Calibration and Obturation Mechanism (COM). As a result, the use of the COM was discontinued to preserve operational safety, leaving the instrument dependent on alternative calibration methods. This loss of onboard calibration presents immediate challenges, particularly for the infrared channels, including image artifacts (e.g., striping), reduced radiometric accuracy, and diminished stability. To address these issues, EUMETSAT implemented an external calibration approach leveraging algorithms from the Global Space-based Inter-Calibration System (GSICS). The inter-calibration algorithm transfers stable and accurate calibration from the Infrared Atmospheric Sounding Interferometer (IASI) hyperspectral instrument aboard Metop-B and Metop-C satellites to FCI’s infrared channels daily, ensuring continued data quality. Comparisons with Cross-track Infrared Sounder (CrIS) data from NOAA-20 and NOAA-21 satellites using a similar algorithm is then used to validate the radiometric performance of the calibration. This confirms that the external calibration method effectively compensates for the absence of onboard blackbody calibration for the infrared channels. For the visible and near-infrared channels, slower degradation rates and pre-anomaly calibration ensure continued accuracy, with vicarious calibration expected to become the primary source. This adaptive calibration strategy introduces a novel paradigm for in-flight calibration of geostationary instruments and offers valuable insights for satellite missions lacking onboard calibration devices. This paper details the COM anomaly, the external calibration process, and the broader implications for future geostationary satellite missions. Full article

Background/Objectives: Partial maxillectomy frequently results in severe impairments of oral functions, such as difficulties in chewing, speech, swallowing, and facial appearance. Immediate prosthetic rehabilitation is challenging because soft tissue healing is typically required before impression taking. This study aimed to (1) develop a comprehensive digital workflow for fabricating immediate obturator prostheses using preoperative data and (2) assess their early clinical effectiveness in restoring oral functions after surgery. Methods: In this prospective clinical study, 20 patients undergoing partial maxillectomy from January 2023 to January 2025 were enrolled. A digital workflow combining cone-beam computed tomography (CBCT), intraoral scanning, CAD/CAM design, and 3D metal printing was implemented. Obturator prostheses were digitally designed preoperatively and inserted immediately post-resection. Functional outcomes were postoperatively evaluated after one month using the Obturator Functioning Scale (OFS), which measures functional, speech, esthetic, and psychosocial aspects. Results: The digitally fabricated immediate obturator prostheses were successfully placed intraoperatively in all patients. Most participants reported mild to moderate difficulties, with speech-related issues being the most common, while esthetic concerns were minimal. Masticatory function was satisfactorily restored in 75% of cases, and 60% of patients experienced minimal fluid leakage during swallowing. No significant differences were found between genders. Patients with larger defects tended to report greater functional challenges. Conclusions: The digitally planned immediate obturator prosthesis provides a practical and effective solution for early rehabilitation following partial maxillectomy. This digital workflow reduces patient discomfort, restores key oral functions, and facilitates psychosocial recovery. Full article

Background and Objectives: Obturator reflex during transurethral resection of bladder tumors (TURBT) can cause serious complications, such as bladder perforation, hemorrhage, and incomplete resection. Although obturator nerve block (ONB) is routinely recommended under spinal anesthesia, it is often omitted under general anesthesia (GA) based on the assumption that neuromuscular blockade (NMB) alone prevents adductor muscle contractions. However, clinical observations suggest that the obturator reflex may still occur under deep NMB. This study aimed to determine whether adductor longus muscle (ALM) contraction persists under GA with deep NMB during TURBT. Materials and Methods: Thirty patients scheduled for TURBT under GA were prospectively enrolled. A selective ONB was performed under ultrasound and nerve stimulator guidance. After establishing the baseline current intensity for ALM contraction, neuromuscular monitoring was initiated, and rocuronium (0.6 mg/kg) was administered. Stimulation thresholds required to induce ALM contraction were sequentially assessed at decreasing Train-of-Four ratio (TOFr) stages (90% to 10%) and Train-of-Four count (TOFc) stages (3 to 0). Final measurements were repeated 1 min after achieving TOFc 0. Changes in stimulation intensity were analyzed using a linear mixed-effects model (LMM). Results: As NMB deepened, the current intensity required to provoke ALM contraction progressively increased: 0.51 ± 0.25 mA at TOFr 90%, 1.66 ± 0.53 mA at TOFr 10%, 2.04 ± 0.66 mA at TOFc 0, and 2.61 ± 0.29 mA at 1 min after TOFc 0. Notably, all patients demonstrated ALM contraction at TOFc 0 and thereafter, confirming the persistence of the obturator reflex despite complete NMB. LMM analysis revealed a significant trend of increasing stimulation thresholds with progressive NMB depth (β = 0.133, p < 0.001). Conclusions: Adductor muscle contractions in response to obturator nerve stimulation persist even under deep NMB. These findings raise concerns that deep NMB alone may be insufficient to prevent obturator reflex and suggest that ONB should be considered as an adjunctive practice during TURBT under GA in patients at risk. Full article

Background and objectives: Post-operative pain (POP) is a common complication after root canal treatment and is influenced by various clinical and patient-related factors. The present study evaluated the incidence and intensity of POP following root canal treatment using a bioceramic sealer performed by operators with different levels of experience. Methods: A total of 115 patients were included in this prospective observational study. Patients were treated by operators with different levels of experience: postgraduate students (PGSs) and endodontic specialists (ESs). Standardized protocols were used in two distinct appointments: an instrumentation visit and an obturation visit. Obturation was performed using the continuous wave condensation technique and Total Fill Hi-Flow BC Sealer (TFHF). POP, mastication discomfort, and sleep disturbance were assessed at 24, 48, and 72 h after the instrumentation and obturation phases using a numeric rating scale (NRS). Results: The results indicate significantly higher POP after the instrumentation phase, compared to the obturation phase (p < 0.001). The pain intensity progressively decreased over time for both phases. No significant differences were observed between the PGS and ES groups regarding POP, mastication discomfort, or sleep disturbance at any time. Sealer extrusion did not significantly impact POP (p > 0.05). Conclusions: This study found that operator experience does not significantly influence POP when a standardized protocol is followed. The use of TFHF with the continuous wave condensation technique was associated with minimal POP. Full article

This study evaluated the chemical composition and subcutaneous tissue biocompatibility of C-Point, a root canal filling material, compared to ProTaper gutta-percha cones (control). Material characterization was conducted using scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS). For biocompatibility assessment, both materials were implanted subcutaneously in the dorsal connective tissue of sixteen albino rats (n = 8 per group). Histological evaluation of inflammatory infiltrate intensity was performed at 30 and 60 days post-implantation, with statistical analysis (significance set at p < 0.05). SEM-EDS analysis revealed distinct elemental compositions: C-Point primarily contained zirconium and cobalt ions, while gutta-percha cones demonstrated a strong zinc signature with trace amounts of barium, aluminum, and sulfur. Both materials exhibited similar particulate morphology with radiopaque inclusions. Histologically, no significant difference in inflammatory response was observed between C-Point and gutta-percha at any time point (p > 0.05). All specimens developed a fibrous encapsulation. The inflammatory profile showed temporal dynamics, with lymphocyte predominance during early stages that progressively diminished by the study endpoint. These findings demonstrate that while C-Point possesses a unique elemental profile dominated by zirconium, its tissue biocompatibility parallels that of conventional gutta-percha obturation materials. However, due to the absence of mechanical testing and the limited in vivo follow-up period, the long-term stability of the material remains uncertain. Full article

Background/Objectives: Pelvic lymph node dissection during radical cystectomy has been established to be important for staging and therapeutic purposes. However, there is uncertainty regarding the optimal extent of nodal dissection. This study aimed to assess the impact of an extended pelvic lymphadenectomy template compared to a standard template in patients with bladder cancer undergoing radical cystectomy. Methods: We performed a systematic review and meta-analysis of randomised studies comparing extended pelvic lymph node dissection to standard pelvic lymph node dissection in patients undergoing radical cystectomy. A search of multiple databases was performed up to October 2024. The standard template was defined as including at least the obturator and internal and external iliac nodes. An extended template was defined as a standard template plus the removal of proximal nodal packets. The primary outcomes were overall survival and major Clavien–Dindo complications. Results: Two studies encompassing a total of 933 participants met the eligibility criteria. There was no observed improvement in overall survival with extended lymph node dissection compared to limited dissection [HR 0.95, 95%CI 0.66–1.4]. In addition, extended lymph node dissection was associated with an increased risk of grade ≥3 Clavien–Dindo complications compared to limited nodal dissection [RR 1.2, 95%CI 1.02–1.37]. There was also an increased risk of lymphoceles requiring intervention with extended lymphadenectomy. Conclusions: Extended pelvic lymphadenectomy does not improve oncological outcomes and is associated with increased morbidity compared to a standard template in bladder cancer patients undergoing radical cystectomy. Full article

The aim of this study is to evaluate the apical sealing ability of novel bioceramic-based (BCB) and widely used resin-based (RB) root canal sealers in combination with traditional or bioceramic-coated gutta-percha points. A total of 92 human single-root extracted teeth were endodontically treated and divided into three groups (A, B, and C) of 30 samples based on the endodontic sealer/type of gutta-percha points/obturation method used. One tooth sample was used for the negative and positive controls (each). Group A: BCB sealer BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France)/bioceramic-impregnated gutta-percha TotalFill BC points (FKG Dentaire, La Chaux-de-Fonds, Switzerland)/cold hydraulic single-cone. Group B: BioRoot RCS (Septodont, France)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, Charlotte, NC, USA)/cold hydraulic single-cone. Group C: RB sealer AdSeal (Meta Biomed, Cheongju, Republic of Korea)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, USA)/warm vertical condensation. A dye penetration method was applied, and the length of apicocoronal penetration was measured using a surgical microscope. The data were statistically analyzed to evaluate differences at the 0.05 significance level. A significant difference was found between groups A and C, p = 0.0003, and groups B and C, p = 0.003. The data analysis proved that the BCB sealer using the cold hydraulic single-cone method ensured a substantially better seal than the RB sealer using the warm vertical condensation method. The choice of the type of gutta-percha points (bioceramic-coated or regular) appeared to be unimportant. No statistical significance was found between groups A and B, which indicates that using bioceramic-coated gutta-percha points does not bring any considerable benefit in view of a no-gap root canal obturation. Full article

This study compared the efficacy of different solutions in achieving patency in teeth filled with AH Plus Bioceramic sealer. Eighty-five premolars with a straight canal were prepared. After sealer placement, a master gutta-percha cone was introduced 2 mm short of the working length. The teeth were stored at 37 °C and 100% humidity for five weeks before retreatment. Filling materials were removed up to the gutta-percha cone’s length. The canals were then randomly assigned to groups: G1 (control, no solution), G2 (5.25% NaOCl), G3 (17% EDTA), G4 (10% citric acid), and G5 (10% formic acid). The apical patency was attempted with a 10 K file within a period of 10 min, by a blinded operator. Additionally, sealer samples were immersed in the solutions, followed by scanning electron microscopy analysis. The Kruskal–Wallis test was used for statistical analysis. Patency was achieved in all canals except one in the control and one in the NaOCl groups. No significant differences were found in the time required to achieve patency. Acid solutions had a greater impact on the sealer’s structural integrity, and a decalcifying effect of EDTA and citric acid was registered. Apical patency in straight canals obturated with AH Plus Bioceramic sealer was consistently achieved regardless of the solution used. Full article

Background and Clinical significance: Apical fenestration is a rarely reported clinical finding that may be associated with apical periodontitis. However, its diagnosis can often be complicated by overlapping clinical and radiographic features. While management traditionally involves a combination of endodontic and surgical interventions, there is limited documentation regarding successful outcomes achieved through non-surgical treatment alone. Therefore, further reporting and investigation of such cases are warranted to enhance clinical understanding and inform decision-making. Case Presentation: This case report describes the non-surgical management of a 20-year-old patient presenting with symptomatic apical periodontitis and a labial apical fenestration in a previously treated maxillary left central incisor (tooth #21) exhibiting an open apex. Diagnosis was confirmed using cone-beam computed tomography (CBCT), which revealed a bone defect in the facial cortical plate. The treatment protocol involved conservative canal debridement, intracanal placement of calcium hydroxide, and final obturation using an apical plug of calcium silicate-based hydraulic cement (CSBHC) and the monoblock technique. Over a follow-up period of two years and eight months, clinical and radiographic assessments demonstrated resolution of symptoms, healing of the sinus tract, and complete regeneration of the buccal cortical bone. Conclusions: This case highlights the potential for complete healing of apical fenestration associated with apical periodontitis in an open apex tooth through non-surgical endodontic treatment alone. Full article

The evolution of regional anesthesia in total hip arthroplasty (THA) has significantly impacted perioperative management, particularly in older adults, where age-related physiological vulnerability requires optimized strategies. Adequate pain control is crucial in enhancing recovery, minimizing opioid consumption, and reducing complications. Traditional nerve blocks such as lumbar plexus and femoral nerve blocks have long been the mainstay of analgesia. However, they are associated with significant motor impairments, which delay mobilization and increase the fall risks. Introducing motor-sparing regional anesthesia techniques represents a substantial advancement in optimizing postoperative pain management while preserving muscle function. Motor-sparing techniques, including the pericapsular nerve group (PENG) block, supra-inguinal fascia iliaca block (SI-FIB), erector spinae plane block (ESPB), and quadratus lumborum block (QLB), have been developed to provide adequate analgesia without compromising motor control. The PENG block selectively targets the articular branches of the femoral, obturator, and accessory obturator nerves, ensuring superior pain relief while minimizing quadriceps weakness. Similarly, the SI-FIB provides extensive sensory blockade with minimal motor involvement, allowing for earlier ambulation. The ESPB and QLB extend analgesia beyond the hip region while preserving motor function, reducing opioid consumption, and facilitating early rehabilitation. Compared to traditional motor-impairing blocks, these newer techniques align with Enhanced Recovery After Surgery (ERAS) protocols by promoting early mobility and reducing the hospital length of stay. Studies suggest that motor-sparing blocks lead to improved functional recovery, lower postoperative pain scores, and decreased opioid requirements, which are critical factors in geriatric THA patients. Moreover, these techniques present a safer alternative, reducing the risk of postoperative falls—a significant concern in elderly patients undergoing hip replacement. Despite their advantages, motor-sparing nerve blocks are still evolving, and further research is necessary to standardize the protocols, optimize the dosing strategies, and evaluate the long-term functional benefits. Integrating these techniques into routine perioperative care may significantly enhance patient outcomes and revolutionize pain management in geriatric THA. As regional anesthesia advances, motor-sparing techniques will improve postoperative recovery, ensuring patient safety and functional independence. Full article