Abstract Introduction Endodontic treatment is commonly based on nonspecific elimination of intraradicular microorganisms. Although some authors prefer single-visit root canal operations for ...endodontic treatment, several studies have shown the importance of intracanal medication between sessions to kill microorganisms that biomechanical preparations alone cannot achieve. The purpose of this study was to evaluate the efficacy of calcium hydroxide Ca(OH)2 and chlorhexidine gel on the elimination of intratubular Enterococcus faecalis. Methods Human uniradicular teeth contaminated with E. faecalis were treated with Ca(OH)2 , 2% chlorhexidine gel, Ca(OH)2 plus 2% chlorhexidine gel, or saline (0.9% NaCl) as a negative control. Samples obtained at a depth of 0 to 100 μm and 100 to 200 μm from these root canal preparations were analyzed for bacterial load by counting the number of colony-forming units (CFUs) and bacterial viability using fluorescence microscopy. Results A significant decrease in the number of CFUs and the percentage of viable E. faecalis was observed after treatment with either Ca(OH)2 or chlorhexidine when compared with the control group. Additionally, chlorhexidine gel had a significantly higher antimicrobial efficacy as measured by the number of CFUs and the percentage of viable cells than Ca(OH)2 . No differences were observed between the antimicrobial properties of chlorhexidine gel with and without the addition of Ca(OH)2. Conclusion Both Ca(OH)2 and chlorhexidine have antimicrobial effects on E. faecalis . Chlorhexidine had increased antimicrobial activity when compared with Ca(OH)2. Ca(OH)2 combined with chlorhexidine showed similar antimicrobial activity to chlorhexidine alone.
Aim
To investigate the effects of several decalcifying agents alone and in combination with sodium hypochlorite (NaOCl) on the organic and inorganic components of dentine using attenuated total ...reflectance in Fourier transform infrared spectroscopy (ATR‐FTIR).
Methodology
Dentine slices from bovine teeth were submitted to (n = 5) the following: 0.9% saline, 9% and 18% etidronic acid (HEDP), 5% and 10% tetrasodium EDTA (EDTANa4), 17% trisodium EDTA (EDTAHNa3), and 0.5% and 2.0% peracetic acid (PAA) for 0.5–10 min; and to the combinations: G1 – mixture 5% NaOCl + 18% HEDP (5 and 10 min); G2 – mixture 5% NaOCl + 10% EDTANa4 (5 and 10 min); G2 – 2.5% NaOCl (5 min) + 17% EDTAHNa3 (1 min); G3 – 2.5% NaOCl (5 min) + 0.5% PAA (1 min); G4 – 2.5% NaOCl (5 min) + 9% HEDP (5 min). Specimens of G2, G3 and G4 received final flushes with 2.5% NaOCl for 0.5–10 min. Amide III/phosphate and carbonate/phosphate ratios of the spectra collected from the dentine specimens before and after immersion in the solutions were determined. Data were submitted to one‐way repeated measures and one‐way anova.
Results
For the same decalcifying agent, the higher the concentration and immersion time the greater the removal of phosphate, exposure of collagen matrix and consequently the increases in amide III/phosphate ratio. However, significant differences were found only between the two concentrations of PAA (P < 0.05). PAA caused greater increases in this ratio, followed by EDTAHNa3, EDTANa4 and HEDP, and this order was retained in the combinations with NaOCl. This ratio was significantly reduced in G1 (P < 0.05) and not altered in G2 (P > 0.05). Due to collagen degradation, the amide III/phosphate ratio reduced significantly after the use of NaOCl in G3, G4 and G5 (P < 0.05). NaOCl required approximately 0.5 s to deproteinate the collagen matrix exposed after phosphate removal by EDTAHNa3 and PAA. The carbonate of dentine was removed more rapidly than phosphate by all decalcifying agents alone and in G3, G4 and G5. In the combinations with NaOCl, the last irrigant used defined the dentine amide III/phosphate and carbonate/phosphate ratios.
Conclusions
HEDP and EDTANa4 caused minor whilst EDTAHNa3 and PAA caused greater demineralization of dentine; both effects were time and concentration dependent. NaOCl degraded the dentine organic matrix more rapidly when it was exposed. Combinations of NaOCl and decalcifying agents can be used to create dentine surfaces with varying compositions for interaction with endodontic sealers.
IMPORTANCE: Adolescent severe obesity is usually not effectively treated with traditional lifestyle modification therapy. Meal replacement therapy (MRT) shows short-term efficacy for body mass index ...(BMI; calculated as weight in kilograms divided by height in meters squared) reduction in adolescents, and financial incentives (FIs) may be an appropriate adjunct intervention to enhance long-term efficacy. OBJECTIVE: To evaluate the effect of MRT plus FIs vs MRT alone on BMI, body fat, and cardiometabolic risk factors in adolescents with severe obesity. DESIGN, SETTING, AND PARTICIPANTS: This was a randomized clinical trial of MRT plus FIs vs MRT alone at a large academic health center in the Midwest conducted from 2018 to 2022. Participants were adolescents (ages 13-17 y) with severe obesity (≥120% of the 95th BMI percentile based on sex and age or ≥35 BMI, whichever was lower) who were unaware of the FI component of the trial until they were randomized to MRT plus FIs or until the end of the trial. Study staff members collecting clinical measures were blinded to treatment condition. Data were analyzed from March 2022 to February 2024. INTERVENTIONS: MRT included provision of preportioned, calorie-controlled meals (~1200 kcals/d). In the MRT plus FI group, incentives were provided based on reduction in body weight from baseline. MAIN OUTCOMES AND MEASURES: The primary end point was mean BMI percentage change from randomization to 52 weeks. Secondary end points included total body fat and cardiometabolic risk factors: blood pressure, triglyceride to high-density lipoprotein ratio, heart rate variability, and arterial stiffness. Cost-effectiveness was additionally evaluated. Safety was assessed through monthly adverse event monitoring and frequent assessment of unhealthy weight-control behaviors. RESULTS: Among 126 adolescents with severe obesity (73 female 57.9%; mean SD age, 15.3 1.2 years), 63 participants received MRT plus FIs and 63 participants received only MRT. At 52 weeks, the mean BMI reduction was greater by −5.9 percentage points (95% CI, −9.9 to −1.9 percentage points; P = .004) in the MRT plus FI compared with the MRT group. The MRT plus FI group had a greater reduction in mean total body fat mass by −4.8 kg (95% CI, −9.1 to −0.6 kg; P = .03) and was cost-effective (incremental cost-effectiveness ratio, $39 178 per quality-adjusted life year) compared with MRT alone. There were no significant differences in cardiometabolic risk factors or unhealthy weight-control behaviors between groups. CONCLUSIONS AND RELEVANCE: In this study, adding FIs to MRT resulted in greater reductions in BMI and total body fat in adolescents with severe obesity without increased unhealthy weight-control behaviors. FIs were cost-effective and possibly promoted adherence to health behaviors. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03137433
Aim
To evaluate the volume of remaining filling material in the mesial root canals of mandibular molars after root canal retreatment with different procedures performed sequentially.
Methodology
The ...mesial root canals of 12 human first mandibular molars were instrumented using the BioRace system until a size 25, .06 taper instrument. The mesial roots were filled with gutta‐percha and AH‐Plus using a vertical compaction technique. The specimens were scanned using microcomputed tomography with a voxel size of 16.8 μm before and after the retreatment procedures. To remove the filling material, the root canals were enlarged until the size 40, .04 taper instrument. The second step was to irrigate the root canals with xylene in the attempt to clean the root canals with paper points. In the third step, the passive ultrasonic irrigation technique (PUI) was performed using 2.5% sodium hypochlorite. The initial and residual filling material volume (mm3) after each step was evaluated from the 0.5 to 6.5 mm level. The obtained data were expressed in terms of percentage of residual filling material. Statistical analysis was performed using the Friedman test (P < 0.05).
Results
All specimens had residual filling materials after all retreatment procedures. Passive ultrasonic irrigation enhanced the elimination of residual filling material in comparison with the mechanical stage at the 0.5–2.5 mm and 4.5–6.5 mm levels (P < 0.05). No significant difference was found between xylene and PUI methods.
Conclusions
Filling materials were not completely removed by any of the retreatment procedures. The use of xylene and PUI after mechanical instrumentation enhanced removal of materials during endodontic retreatment of anatomically complex teeth.
To improve the management of overweight and obesity in the primary care setting, an analysis of patient perceptions of weight status and predictors of weight loss attempts for those with overweight ...and obesity is needed.
Primary care patients (n=949) across 5 health systems in the Mid-Atlantic region of the U.S. were surveyed in 2015; data analysis was performed in 2018. Survey data was combined with data via the electronic health record to understand patients’ perceptions of weight, factors associated with weight loss efforts, and provider counseling practices.
Most participants with overweight or obesity perceived themselves as weighing too much and reported trying to lose weight. Furthermore, most participants with obesity reported receiving advice to lose weight by a provider in the past 12 months. However, less than half of patients with overweight reported receiving advice to lose weight, maintain weight, or develop healthy eating and physical activity patterns from a health professional in the past 12 months. Among participants with overweight and obesity, multivariable logistic regression analysis demonstrated that the perception of being overweight and receiving healthcare advice to lose weight had the highest odds of reporting attempted weight loss (OR=5.5, 95% CI=2.7, 11.2 and OR=3.9, 95% CI=1.9, 7.9, respectively).
The findings emphasize the importance of provider attention to weight management counseling and identifies patients with overweight as needing increased attention by providers.
Obesity is a complex disease influenced by many neurohormonal pathways which regulate body weight toward homeostasis. Presently, the disease of obesity effects over a billion individuals worldwide ...with scalable treatment options in dire need. Pharmacologic interventions for obesity have been developed to help promote weight loss in individuals with obesity. This area is rapidly developing and will only exponentially increase to serve the demand for persons with obesity seeking biologically orientated solutions to treat their disease. Therefore, understanding the cardiovascular risks and benefits of these weight loss medications is of particularly importance due to obesities strong association with cardiovascular (CV) disease risk. Moreover, past experiences with pharmacotherapy agents with weight loss properties have demonstrated an association with adverse CV outcomes, leading to market removal, in most cases and concerns over using similar medications. To better understand the CV risks and benefits pharmacotherapy agents used for weight loss, this review will discuss medications which are FDA-approved for weight loss, as well as medications commonly used off-label for this indication. The goal is to provide an overview of the risks and benefits many of these medications can offer to help guide clinical decision making and patient education.
Ordinola‐Zapata R, Bramante CM, Cavenago B, Graeff MSZ, Gomes de Moraes I, Marciano M, Duarte MAH. Antimicrobial effect of endodontic solutions used as final irrigants on a dentine biofilm model. ...International Endodontic Journal, 45, 162–168, 2012.
Aim To evaluate the residual biovolume of live bacterial cells, the mean biofilm thickness and the substratum coverage found in mixed biofilms treated with different endodontic irrigant solutions.
Methodology Twenty‐five bovine dentine specimens were infected intraorally using a removable orthodontic device. Five samples were used for each irrigant solution: 2% chlorhexidine, 1% sodium hypochlorite (NaOCl), 10% citric acid, 17% EDTA and distilled water. The solutions were used for 5 min. The samples were stained using the Live/Dead technique and evaluated using a confocal microscope. Differences in the amount of total biovolume (μm3), number of surviving cells (μm3), mean biofilm thickness (μm) and substratum coverage (%) of the treated biofilms were determined using nonparametric statistical tests (P < 0.05).
Results Similar values of biovolume total, biovolume of live subpopulations and substratum coverage were found in 2% chlorhexidine, 10% citric acid, 17% EDTA and distilled water‐treated biofilms (P > 0.05). The lower values of the studied parameters were found in 1% NaOCl‐treated dentine (P < 0.05) with the exception of the mean biofilm height criteria that did not reveal significant differences amongst the irrigant solutions (P > 0.05).
Conclusions One per cent sodium hypochlorite was the only irrigant that had a significant effect on biofilm viability and architecture.
Aim
To evaluate the internal and external morphologies of fused‐rooted maxillary second molars by means of micro‐computed tomography (micro‐CT) analysis.
Methodology
A total of 100 fused‐rooted ...maxillary second molars from a Brazilian subpopulation were divided into six groups according to the root morphology. The samples were scanned at a resolution of 19.6 μm and evaluated with regard to the external morphology of the roots, the root canal configuration, the percentage frequency of C‐shaped canals and isthmuses, as well as the morphology of the root canal system at 1, 2 and 3 mm from the anatomical apex of the fused roots.
Results
The most prevalent root canal fusions were type 1, mesiobuccal root fused with distobuccal root (32%), followed by type 3, DB root fused with P root (27%), and type 4, MB root fused with DB root, and P root fused with MB or DB roots (21%). The prevalence of C‐shaped root canal systems were 22%. Depending on the type of root fusion, the percentage frequency of isthmuses in the apical level varied from 9.3% to 42.8%, whilst the presence of apical deltas ranged from 18.5% to 57.1% of teeth.
Conclusions
The root canal system of maxillary second molars with fused roots may have a high incidence of merging canals, isthmuses, apical deltas and C‐shaped configurations.
There are limited data comparing the relative associations of various BMI metrics with adiposity and cardiometabolic risk factors in youth.
Examine correlations of 7 different BMI metrics with ...adiposity, cardiometabolic risk factors, and biomarkers (i.e. blood pressure, waist circumference, cholesterol, leptin, insulin, high molecular weight adiponectin, high-sensitivity c-reactive protein (hsCRP)).
This was a cross-sectional analysis of youth in all BMI categories. BMI metrics: BMI z-score (BMIz), extended BMIz (ext.BMIz), BMI percentile (BMIp), percent of the BMI 95th percentile (%BMI
), percent of the BMI median (%BMI
), triponderal mass index (TMI), and BMI (BMI). Correlations between these BMI metrics and adiposity, visceral adiposity, cardiometabolic risk factors and biomarkers were summarized using Pearson's correlations.
Data from 371 children and adolescents ages 8-21 years old were included in our analysis: 52% were female; 20.2% with Class I obesity, 20.5% with Class II, and 14.3% with Class III obesity. BMIp consistently demonstrated lower correlations with adiposity, risk factors, and biomarkers (r = 0.190-0.768) than other BMI metrics. The %BMI
and %BMI
were marginally more strongly correlated with measures of adiposity as compared to other BMI metrics. The ext.BMIz did not meaningfully outperform BMIz.
Out of all the BMI metrics evaluated, %BMI
and %BMI
were the most strongly correlated with measures of adiposity. %BMI
has the benefit of being used currently to define obesity and severe obesity in both clinical and research settings. BMIp consistently had the lowest correlations. Future research should evaluate the longitudinal stability of various BMI metrics and their relative associations with medium to long-term changes in adiposity and cardiometabolic outcomes in the context of intervention trials.
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