This study evaluated the accuracy of the Joypex 5 multifrequency electronic apex locator (EAL) in determining working length in primary teeth. The working lengths of 25 root canals in 14 primary molars were measured directly using a file and microscope and electronically using the EAL. There was no statistically significant difference between the two measurement methods. The intraclass correlation coefficient showed almost perfect agreement between the direct and EAL measurements. The study concluded that the Joypex 5 EAL showed adequate accuracy in determining root length in primary teeth.
Micro-computed tomographic assessment of dentinal microcrack formation in str...DR.AJAY BABU GUTTI M.D.S
Micro-computed tomographic assessment of
dentinal microcrack formation in straight and
curved root canals in extracted teeth prepared
with hand, rotary and reciprocating instruments IEJ 2021
Comparison of root microcrack formation after root canal preparation using tw...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
This is a quick review of selected research papers related to ECTR, WALANT and OBSS. I have over 70 full abstracts. When negotiating with the carrier you may be asked about the safety and efficacy of your procedure in the OBSS.
Micro-computed tomographic assessment of dentinal microcrack formation in str...DR.AJAY BABU GUTTI M.D.S
Micro-computed tomographic assessment of
dentinal microcrack formation in straight and
curved root canals in extracted teeth prepared
with hand, rotary and reciprocating instruments IEJ 2021
Comparison of root microcrack formation after root canal preparation using tw...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
This is a quick review of selected research papers related to ECTR, WALANT and OBSS. I have over 70 full abstracts. When negotiating with the carrier you may be asked about the safety and efficacy of your procedure in the OBSS.
Subjective classification and objective analysis of the mandibular dental arc...EdwardHAngle
Our objective was to evaluate the relationship between subjective classification of dental-arch shape, objective analyses via arch-width measurements, and the fitting with the fourth-order polynomial equation.
Mandibular arch form the relationship between dental and basal anatomyEdwardHAngle
We investigated mandibular dental arch form at the levels of both the clinically relevant application points of the orthodontic bracket and the underlying anatomic structure of the apical base. The correlation of both forms was evaluated and examined to determine whether the basal arch could be used to derive a standardized clinical arch form.
Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–...Dr Ripunjay Tripathi
journal club Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1-Year Retrospective Study
Kniha at el , J Periodontol 2016;87:511-518.
PRE-EXTRACTION RECORDS ARE RELIABLE TOOL FOR COMPLETE DENTURE FABRICATION: AN...Kumari Kalpana
Pre-extraction records provide important clinical data for the continuing treatment of the complete denture patient. These data reveal the progressive changes which occur when natural teeth are extracted. Many methods of recording pre-extraction data have been advocated. Dentists use arbitrary methods while determining the vertical dimension of occlusion and arranging the maxillary anterior teeth. Though there are many advances in techniques and materials employed in the field of prosthodontics for recording vertical dimension at occlusion; still, there is no accurate method for assessing vertical dimension of occlusion in edentulous patients and henceforth difficulty is faced by clinician during denture fabrication. Prosthodontists who do not make use of pre-extraction records and consider the natural findings of the patient while denture fabrication lack the scientific component in denture fabrication, translating into compromised patient‟s satisfaction. Every denture should be characterized according to existing state rather than performing a pearl like arrangement of artificial teeth. Pre-extraction records provide a useful guide while fabricating denture and it should be preferred over arbitrary methods which are commonly used. Therefore, pre-extraction records serve as a reliable tool during denture fabrication.
Subjective classification and objective analysis of the mandibular dental arc...EdwardHAngle
Our objective was to evaluate the relationship between subjective classification of dental-arch shape, objective analyses via arch-width measurements, and the fitting with the fourth-order polynomial equation.
Mandibular arch form the relationship between dental and basal anatomyEdwardHAngle
We investigated mandibular dental arch form at the levels of both the clinically relevant application points of the orthodontic bracket and the underlying anatomic structure of the apical base. The correlation of both forms was evaluated and examined to determine whether the basal arch could be used to derive a standardized clinical arch form.
Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–...Dr Ripunjay Tripathi
journal club Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1-Year Retrospective Study
Kniha at el , J Periodontol 2016;87:511-518.
PRE-EXTRACTION RECORDS ARE RELIABLE TOOL FOR COMPLETE DENTURE FABRICATION: AN...Kumari Kalpana
Pre-extraction records provide important clinical data for the continuing treatment of the complete denture patient. These data reveal the progressive changes which occur when natural teeth are extracted. Many methods of recording pre-extraction data have been advocated. Dentists use arbitrary methods while determining the vertical dimension of occlusion and arranging the maxillary anterior teeth. Though there are many advances in techniques and materials employed in the field of prosthodontics for recording vertical dimension at occlusion; still, there is no accurate method for assessing vertical dimension of occlusion in edentulous patients and henceforth difficulty is faced by clinician during denture fabrication. Prosthodontists who do not make use of pre-extraction records and consider the natural findings of the patient while denture fabrication lack the scientific component in denture fabrication, translating into compromised patient‟s satisfaction. Every denture should be characterized according to existing state rather than performing a pearl like arrangement of artificial teeth. Pre-extraction records provide a useful guide while fabricating denture and it should be preferred over arbitrary methods which are commonly used. Therefore, pre-extraction records serve as a reliable tool during denture fabrication.
Periodontitis is considered one of the most prevalent immune-inflammatory diseases of the oral cavity. It derives from a specific pathogenic bacteria–host interaction and leads to periodontal tissue destruction [1,2]. The progression of periodontitis is often characterized by irregular phases of increased activity and dormant remission [3,4,5]. Traditional clinical periodontal assessment methods, such as pocket probing depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), and radiological assessment of the alveolar bone volume, are widely used and documented [1,2]. However, these traditional periodontal classification parameters fail to provide noteworthy information on current disease activity, severity and extent of breakdown, future progression and therapy response [2,6]. More importantly, the biological phenotype of the patient is not properly reflected by the clinical assessment methods [7] and the host response to periodontal bacteria and the subsequent inflammatory burden, i.e., the influence of biological phenotype, may largely determine periodontitis progression. Further, an early diagnosis may lead to more successful treatment [8,9].
Periodontitis is considered one of the most prevalent immune-inflammatory diseases of the oral cavity. It derives from a specific pathogenic bacteria–host interaction and leads to periodontal tissue destruction [1,2]. The progression of periodontitis is often characterized by irregular phases of increased activity and dormant remission [3,4,5]. Traditional clinical periodontal assessment methods, such as pocket probing depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), and radiological assessment of the alveolar bone volume, are widely used and documented [1,2]. However, these traditional periodontal classification parameters fail to provide noteworthy information on current disease activity, severity and extent of breakdown, future progression and therapy response [2,6]. More importantly, the biological phenotype of the patient is not properly reflected by the clinical assessment methods [7] and the host response to periodontal bacteria and the subsequent inflammatory burden, i.e., the influence of biological phenotype, may largely determine periodontitis progression. Further, an early diagnosis may lead to more successful treatment [8,9].
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
1. Evaluation of the multifrequency electronic
apex locator Joypex 5 in primary teeth
E. J. N. L. Silva, D. R. Herrera,
E. J. Souza-Júnior & T. P. Rosa
European Archives of Paediatric
Dentistry
ISSN 1818-6300
Eur Arch Paediatr Dent
DOI 10.1007/s40368-013-0065-0
1 23
2. Your article is protected by copyright and
all rights are held exclusively by European
Academy of Paediatric Dentistry. This eoffprint is for personal use only and shall not
be self-archived in electronic repositories. If
you wish to self-archive your article, please
use the accepted manuscript version for
posting on your own website. You may
further deposit the accepted manuscript
version in any repository, provided it is only
made publicly available 12 months after
official publication or later and provided
acknowledgement is given to the original
source of publication and a link is inserted
to the published article on Springer's
website. The link must be accompanied by
the following text: "The final publication is
available at link.springer.com”.
1 23
3. Author's personal copy
Eur Arch Paediatr Dent
DOI 10.1007/s40368-013-0065-0
ORIGINAL SCIENTIFIC ARTICLE
Evaluation of the multifrequency electronic apex locator
Joypex 5 in primary teeth
´
E. J. N. L. Silva • D. R. Herrera • E. J. Souza-Junior
T. P. Rosa
•
Received: 16 February 2013 / Accepted: 19 June 2013
Ó European Academy of Paediatric Dentistry 2013
Abstract
Aim To evaluate ex vivo the accuracy of the multifrequency electronic apex locator (EAL) Joypex 5 in primary
molars.
Methods Fourteen primary molars were selected for a
total of 25 root canals. Working length measurements were
performed by direct observation (DO), using a 15 K-file
into the root canal until its tip was visible at the apical
foramen and electronically using the EALs Joypex 5. Data
were analysed statistically using the intraclass correlation
coefficient (ICC). To assess whether a significant difference in accuracy of the electronic apex locator existed, the
Student’s t test was performed at 5 % significance.
Results No statistical difference was observed between
the direct observation and the EAL measurement
(p 0.05). The ICC confirmed the agreement of different
methods to measure canal length. The R2 coefficient was
close to 1, denoting a strong agreement between measures
obtained with Joypex 5 and DO.
Conclusion The multifrequency EALs Joypex 5 showed
adequate accuracy in the root length determination of
primary teeth.
E. J. N. L. Silva
Endodontics Department, Grande Rio UniversityUNIGRANRIO, Rio de Janeiro, Brazil
E. J. N. L. Silva (&)
Rua Herotides de Oliveira,
´
´
61/902, Icaraı, Niteroi, RJ CEP 24230-230, Brazil
e-mail: nogueiraemmanuel@hotmail.com
´
D. R. Herrera Á E. J. Souza-Junior Á T. P. Rosa
Endodontics Department, Piracicaba Dentistry School,
Campinas State University-UNICAMP, Campinas, Brazil
Keywords Endodontics Á Electronic apex locator Á
Primary teeth
Introduction
Pulpectomies are indicated in cases of irreversible pulpitis,
necrosis or infections in primary teeth with at least 2/3 of
intact roots. The determination and maintenance of the
working length (WL) is an important step in root canal
treatment, ensuring an efficient chemo-mechanical preparation and a hermetic sealing of the root canal system
(Ricucci 1998). It is especially critical in primary teeth,
since over-instrumentation and over-filling of a primary
tooth can damage the permanent tooth germ and underinstrumentation and underfilling, on the other hand, is also a
risk factor that accounts for persistence of apical infection
(Kielbassa et al. 2003; Angwaravong and Panitvisai 2009;
Leonardo et al. 2009).
The most widely used method for the measurement of
working length for primary teeth is the use of conventional
and digital radiography. Several studies have demonstrated
the limitations of radiographs that include inconsistent
working length determination due to image distortion,
superposition of roots and adjacent anatomical structures
(e.g. permanent tooth germ), radiation exposure and patient
management (Katz et al. 1996; ElAyouti et al. 2001). The
advent of electronic apex locators (EALs) provides an
additional feature to the endodontic arsenal for determining
the correct odontometry. The latest generation of EALs
operates by measuring changes in impedance (alternating
current). For this, two or more different frequencies are
used and processed using different mathematical algorithms (Nekoofar et al. 2006). Many studies report a high
efficacy achieved by new generations of electronic apex
123
4. Author's personal copy
Eur Arch Paediatr Dent
locators, even in adverse situations like the presence of
irrigating solutions, blood, and the existence of large
foramens as in primary teeth (Kielbassa et al. 2003;
Angwaravong and Panitvisai 2009; Leonardo et al. 2008;
Leonardo et al. 2009; Beltrame et al. 2011).
Recently, a new EAL has been introduced (Joypex 5,
Denjoy Dental Corporation, Changsha City, China). This
EAL adopts multiple frequencies and according to the
manufacturer it works more accurately than others EALs in
dry or wet canals (www.denjoy.cn). Although a recent
study demonstrated that this EAL is accurate in determining the working length in permanent teeth (Soares et al.
2013), little is known about the efficiency and accuracy of
this EAL in primary tooth. Therefore, the aim of this study
was to evaluate the accuracy of the EALs Joypex 5 in
primary molar teeth. The null hypothesis was that there
was no significant difference in the direct and EAL
measurement.
Materials and methods
Tooth selection and preparation
Fourteen primary molars were selected for a total of 25 root
canals. Tooth extraction was necessary as a result of one of
the following reasons: prolonged retention (no spontaneous
exfoliation), orthodontic purposes or no possibility of restoration after caries excavation. All selected teeth did not
show resorption more than 1/3rd the root length. Teeth
were stored in saline solution until use. Preliminary
radiographs were taken after extraction to evaluate root
canal anatomy, identify the radiographic apex and exclude
teeth with calcification, whose main canal was not visible
radiographically. The roots were numbered and stored in
sterile saline until use. After endodontic access cavity
preparation, a K-file (Dentsply Maillefer, Ballaigues,
Switzerland) with diameter compatible with that of the
canal diameter was passively introduced up to the apical
foramen or the most coronal limit of root resorption to
verify canal patency. No root canal preparation was
performed.
Direct measurement
For direct measurement of working length, a reference
point was first marked at the most coronal portion of the
tooth crown using a fine paint marker. Then, a 15 K-file
(Dentsply Maillefer, Ballaigues, Switzerland) with a silicon stop was passively introduced into the root canal until
its tip was visible at the apical foramen under a stereomicroscope at 948 magnification. After this, the file was
123
withdrawn until its tip lay tangential to the apical foramen.
The silicon stop was tangentially positioned to the occlusal
reference edge, which was recorded previously, and the file
was then removed. The distance between the file tip and
silicon stop was measured using a digital calliper with
0.01-mm resolution. Each procedure was repeated three
times, and the average was calculated and computed.
Electronic determination of working length
The electronic working length determination was undertaken using the Joypex 5 (DenjoyÒ, China). The teeth were
embedded in a plastic device containing 0.9 % saline.
Cotton pellets were used to remove excess saline from the
pulp chamber. The labial clip was inserted into the saline
solution, and a 15 K-file was adapted to the file holder. The
file holder was always positioned between the handle of the
file and the silicon stop. The file was introduced slowly into
the root canal until the EAL displayed the ‘0.0’ mark. The
silicon stop was shifted to the occlusal reference edge,
which was recorded previously, and the file was then
removed. The distance between file tip and silicon stop was
measured using a digital caliper with 0.01-mm resolution.
Each procedure was repeated three times, and the average
was calculated and computed.
Statistical analysis
The measurements (in mm) of direct and electronic
determination of the working length were made by an
experienced examiner, and were recorded in specific charts
for further comparison of the methods. Data were analysed
statistically using the intraclass correlation coefficient
(ICC). Mean and standard deviations of direct and electronic means were also calculated. To assess whether a
significant difference in accuracy of the electronic apex
locator existed, the Student’s t test was performed at 5 %
significance, using version 17 SPSS (Chicago, IL, USA).
Results
Figure 1 compares graphically the actual and electronic
working length measurements and shows a high intraclass
correlation (ICC = 0.98) between the direct and electronic
methods.
Table 1 shows the difference between the WL values by
direct measurement and EAL measurement. In 19.2 % of
the canals a full precision (difference of 0.0 mm) was
observed and, only in two cases, a difference[1.0 mm was
verified.
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Eur Arch Paediatr Dent
Fig. 1 Direct measurements and electronic measurements in the
primary molar teeth. The intraclass correlation represents the
intersection of the two measurements that is indicated on the axes
X (direct measurement) and Y (electronic measurement). The dots that
coincide with the line represent that the two measurements had the
same values
Discussion
Root length determination is a crucial factor for a successful root canal treatment, especially in primary teeth
because of the unpredictable root anatomy (Fuks and
Eidelman 1991). Radiography as a method of determining
the working length has numerous shortcoming in which it
depends on the child’s co-operation, as well as the operator’s proficiency. In addition, minor degrees of resorption
may not be visible, and overlapped by adjacent anatomical
structures that could obscure the clarity of the image
(Kielbassa et al. 2003). Another problem associated with
intra-oral periapical radiographs is the positioning of the
film inside the child’s mouth. Furthermore, radiographic
assessment is difficult, particularly in cases where the
physiological resorption in primary teeth occurs on buccal
or lingual aspects of the root. Recently, electronic methods
for determining the root canal length, in both permanent
and primary teeth, have gained popularity amongst dentists
because of the hazards of radiation, the technical problems
associated with radiographic techniques and to avoid overinstrumentation beyond the root canal terminus (Fuks and
Eidelman 1991; ElAyouti et al. 2001; Brunton et al. 2002;
Schaeffer et al. 2005).
Several studies have reported the accuracy of EALs in
determining the WL, validating its clinical use as a simple
and effective alternative and optimising endodontic therapy
(Kielbassa et al. 2003; Leonardo et al. 2008; Angwaravong
and Panitvisai 2009; Leonardo et al. 2009; de Vardasca
Oliveira et al. 2010; Beltrame et al. 2011]. Recently, the
Joypex 5 was launched and according to the manufacturer
(www.denjoy.cn) it has an advanced electronic T-surge
circuit and uses multiple frequencies alternating current
rather than the dual frequency alternating current incorporated in the Root ZX II (Nekoofar et al. 2006; Soares
et al. 2013). Moreover, in the Joypex 5, the calculations of
the position of the file tip are based on measurements of
root mean square values of the signal, which expresses the
energy of the measured signal and is more immune to
various noises or signal distortions than the other parameters of the signal, such as amplitude or the different phases
used in other devices (Majeed and Subhi 2011). According
to the manufacturer, these combinations can increase the
measurement accuracy and the reliability of the device
(www.denjoy.cn).
The apical endpoint of root canals in primary teeth is
often uncertain as they do not always have a well-defined
apical constriction and physiological and pathological
resorptions occur (Azar and Mokhtare 2011; Ruschel et al.
2011). Owing to those inherent problems when using
EALs, many authors consider it acceptable for the measurement to be ±0.5 mm between the working length
obtained directly and that obtained electronically (Angwaravong and Panitvisai 2009; Leonardo et al. 2008;
Leonardo et al. 2009), whereas others have quoted a difference of ±1 mm (Kielbassa et al. 2003; Mello-Moura
et al. 2010). In the present study, the accuracy of the EAL
was assessed by taking into account both differences
(±0.5 mm and ±1 mm). The null hypothesis of the present
study was upheld because no significant difference was
observed in the direct and EAL measurements. This result
confirms the efficacy of this device to determine the WL. In
23 of 25 measurements, the difference between direct and
EAL measurement was lower than ±1.0 mm. In addition,
only two cases showed a greater difference than 1.0 mm,
demonstrating high efficacy of the Joypex 5 for determining WL. In this study, it was also possible to observe an
almost perfect correlation (ICC = 0.98) between the
results of this EAL with those of the direct method. In the
same way, previous reports using different EALs found
high correlations in primary teeth (Tosun et al. 2008;
Nelson-Filho et al. 2011; Saritha et al. 2012). The results
obtained for Joypex 5 in a previous study in permanent
teeth (ElAyouti et al. 2001) and those obtained in this study
Table 1 Difference distribution (in mm) of WL by direct measurement and EAL measurement
Difference
-1.50
1.00
0.50
0
0.50
1.00
1.50
Direct 9 EAL
2 (8.00 %)
2 (8.00 %)
6 (24.00 %)
5 (20.00 %)
7 (28.00 %)
3 (12.00 %)
0 (0.00 %)
Positive values represent a higher direct observation measurement and negative values represent a higher EALs measurement
123
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Eur Arch Paediatr Dent
for primary teeth indicate its usefulness, and because of the
low cost of this device compared with traditional EALs.
Previous reports showed that the presence of root resorption did not interfere with the accuracy of EALs; therefore,
this variable was not tested in the present study (Kielbassa
et al. 2003; Mello-Moura et al. 2010; Tosun et al. 2008;
Nelson-Filho et al. 2011; Saritha et al. 2012).
Conclusion
The result of this study supports the use of Joypex 5 to
determine root length in primary teeth that require pulpectomy. The use of the electronic apex locator is quick,
comfortable, accurate, safe, painless, and does not involve
unnecessary radiation.
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