3-step Technique Research Articles

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BackgroundHealthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).MethodsAn observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.ResultsWe observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments “before” tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments “after” tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.ConclusionsHH compliance was very low. Inappropriate glove use was associated with low compliance and the unit’s infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

An analysis of iris pattern as a risk factor for skin cancer development in immunosuppressed renal transplant recipients.

Renal transplant recipients are at increased risk of keratinocyte skin cancers with a tendency to have multiple, aggressive and difficult to treat tumours. The eye and the skin share the same embryological ectoderm. Iris pattern has recently been reported as a predictive risk factor for skin cancer in non-immunosuppressed Southern European (Grigore et al., J Eur Acad Dermatol Venereol, 2018, 1662) and Irish populations (Ridge et al., J Eur Acad Dermatol Venereol, 2022, e542). To analyse if an individual's iris pattern is an independent risk factor for the development of keratinocyte skin cancers in renal transplant recipients. Iris patterns of 110 renal transplant recipients were evaluated using the Simionescu visual three-step technique (iris periphery, colarette and iris freckling [Simionescu et al., Ann Res Rev Biol, 2014, 2525]). Established risk factors for skin cancer in transplant patients were recorded as confounding factors. Observational cross-sectional study including 110 renal transplant population. Thirty-one participants had skin cancer. In the skin cancer group, iris periphery was blue/grey in 74.3% (p = 0.053, OR 2.5), the colarette was light brown in 57.1% (p < 0.0043) and iris freckles were present in 55%(p = 0.044). Dark brown and blue colarettes were observed in controls. Binary Logistic Regression analysis showed light brown colarette is a significant independent risk factor for skin cancer (OR 4.54, p < 0.02, CI 1.56-10.57). Within this renal transplant population a blue iris periphery, light brown colarette and presence of freckling confers an independent risk for keratinocyte skin cancer. Iris pattern is a useful tool for identification of transplant patients at risk of keratinocyte skin cancer and an easy-to-use technique for risk evaluation in this cohort. This is the first study looking at iris pattern and keratinocyte skin cancer risk in renal transplant population.

PREDICTIVE ASSESSMENT OF POST-COVID-19 IMPACT USING ARTIFICIAL INTELLIGENCE NEURAL NETWORK MODELS

The novel COVID-19 pandemic has spread all over the world. Due to its easy transmission, it is crucial to develop techniques to accurately and efficiently identify the presence of COVID-19 and distinguish it from other forms of flu and pneumonia. Recent research has shown that the chest X-rays of patients suffering from COVID-19 depict specific radiography abnormalities. This study aims to construct a deep convolutional neural network (CNN) capable of performing feature extraction and binary classification of CT scans of COVID-19 patients from a publicly available dataset sourced from the University of California San Diego and Berkeley (UC San Diego &amp; UC Berkeley). This work presents a 3-step technique to fine-tune pre-trained VGG19, Xception, and Inception V3 architectures to improve model performance and reduce training time. It was achieved by progressively re-sizing input images to 224x224x3 pixels and fine-tuning the network at each stage. Among three selected pre-trained models, the VGG 19 outperformed with 0.99, 0.88, 0.85, 0.86, 0.83, 0.85, 0.85 for Train accuracy, validation accuracy, test accuracy, precision, recall, F1 Score, the area under the curve values, respectively. Keywords: SARS-CoV2, Coronavirus, Deep Learning, Transfer Learning, Convolutional Neural Network DOI: 10.7176/JNSR/14-6-06 Publication date: April 30 th 2023

Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review

This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques. Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138). Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P=.02), while another found no difference between these 2 techniques (P=.08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P=.021), but not in clinical practice (P=.629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P=.001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias. Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers' hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.

Microleakage of three different combinations of adhesive and composite resins

Aim The aim of the present study was to evaluate the influence of 3 adhesive systems on microleakage of direct composite restorations with proximal margins under the cement-enamel junction (CEJ) and in the enamel. Materials and methods In 30 extracted molars standardized MOD (mesio-occlusal-distal) cavities were prepared with a proximal margin located 1 mm under the cement-enamel junction and another one in the enamel, and subsequently randomly divided in 3 groups of 10 using 3 different adhesives and the same composite: Flowable (G-aenial Universal Injectable, GC) + universal adhesive (G2-Bond universal, GC) with selective-etch technique (Group 1); Flowable (G-aenial Universal Injectable, GC) + self-etch adhesive (Clearfil SE Bond 2, Kuraray) with 2-step technique (Group 2); Flowable (G-aenial Universal Injectable, GC) + total-etch adhesive (Optibond FL, Kerr) with 3-step technique (Group 3). Samples were tested for microleakage using silver nitrate and infiltration was classified in 5 levels. The differences in microleakage were statistically evaluated with significance set at P<0.05. Results In the margin located in the enamel, group 1 showed an average of 0 microleakage, group 2 an average of 0.2 and group 3 an average of 0.1. In the margin located in the dentin, group 1 showed an average score of 1.1, group 2 of 2.15 ang group 3 of 1.25. No statistically significant difference was found in the enamel. Conclusion The combination of adhesive G2-Bond universal and Optibond FL showed the highest sealing ability both in margins located in the enamel and margins located in the dentin. The adhesive interface in the enamel produced a very good seal, while the adhesive interface in the dentin showed varying degrees of microleakage in all groups.

Biological outcomes and patient-reported outcome measures (PROMs) of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions by means of the "3-step technique": part 2 of the 6-year outcomes of a retrospective clinical study.

To evaluate biologic and esthetic outcomes, as well as the patient-reported outcome measures (PROMs), of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique. Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS). A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment tooth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2). Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibit very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high.

Retrospective clinical study of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions following the "3-step technique". Part 1: 6-year survival rates and technical outcomes of the restorations.

To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05. A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Hybrid Repair With Endovascular Debranching of the Aberrant Right Subclavian Artery for Complicated Type B Aortic Dissection in Patients With Kommerell’s Diverticulum

Purpose: Aberrant right subclavian artery (ARSA) associated with Kommerell’s diverticulum (KD) is a common congenital arch anomaly. It can be complicated by type B aortic dissection (TBAD) or aneurysmal formation at its ostium. Recently, hybrid repair with thoracic endovascular aortic repair (TEVAR) has appeared to be more favorable. Due to the normal anatomic proximity of the ARSA to the left subclavian artery (LSA) orifice in KD, coverage of the bilateral subclavian arteries (SCAs) to obtain an adequate proximal landing zone (PLZ) is usually required, and double cervicotomy for SCA revascularization potentially increases the risk of complications. Technique: This technique was demonstrated on a 50-year-old man presenting with progressive aneurysmal formation of KD with ARSA after chronic TBAD. A 3-step technique, namely left cervical debranching with a left common carotid artery to LSA bypass graft, TEVAR, and an LSA-to-ARSA endovascular debranching with a self-expanding covered stent by a through-and-through wire from the right brachial artery to the bypass graft, was performed in a 1-stage repair to cover the primary tear of TBAD and preserve the bilateral SCAs. The postoperative course was uneventful. Conclusion: This technique can prevent complications from double cervicotomy and achieve an adequate PLZ with preservation of the bilateral SCAs for TEVAR.

Operational Implementation of Satellite-Rain Gauge Data Merging for Hydrological Modeling

Systems exposed to hydroclimatic variability, such as the integrated electric system in Uruguay, increasingly require real-time multiscale information to optimize management. Monitoring of the precipitation field is key to inform the future hydroelectric energy availability. We present an operational implementation of an algorithm that merges satellite precipitation estimates with rain gauge data, based on a 3-step technique: (i) Regression of station data on the satellite estimate using a Generalized Linear Model; (ii) Interpolation of the regression residuals at station locations to the entire grid using Ordinary Kriging and (iii) Application of a rain/no rain mask. The operational implementation follows five steps: (i) Data download and daily accumulation; (ii) Data quality control; (iii) Merging technique; (iv) Hydrological modeling and (v) Electricity-system simulation. The hydrological modeling is carried with the GR4J rainfall-runoff model applied to 17 sub-catchments of the G. Terra basin with routing up to the reservoir. The implementation became operational at the Electricity Market Administration (ADME) on June 2020. The performance of the merged precipitation estimate was evaluated through comparison with an independent, dense and uniformly distributed rain gauge network using several relevant statistics. Further validation is presented comparing the simulated inflow to the estimate derived from a reservoir mass budget. Results confirm that the estimation that incorporates the satellite information in addition to the surface observations has a higher performance than the one that only uses rain gauge data, both in the rainfall statistical evaluation and hydrological simulation.

A novel technique for laser-assisted revascularization: an in vitro pilot study.

The common limitation of surgical revascularization procedures for severe tissue ischemia due to cardiovascular diseases is the need to interrupt blood flow during the intervention. We aim to introduce a new technique that allows a sutureless, non-occlusive revascularization. A 3-step technique was developed using rabbit's aorta to simulate a side-to-side anastomosis model. It enables the creation of a bypass circuit for revascularization. The first step was the soldering of 2 vessels in a side-to-side fashion based on the laser-assisted vascular anastomosis (LAVA) principle using a diode laser emitting irradiation at 810 nm with an albumin-based solder patch between them, followed by the creation of a channel within the patch using either a holmium-doped yttrium aluminum garnet laser (Ho:YAG) at λ = 2100 nm or a xenon-chloride excimer laser (XeCl) at λ = 308 nm. Thereby, a bypass circuit was created, thus allowing a non-ischemic revascularization. The system was deemed functional when a flow was observed across the anastomosis. The highest average tensile strength recorded after side-to-side LAVA using a diode laser power of 3.2 W for 60 s was 2278.6 ± 800 mN (n = 20). The Ho:YAG laser created the channels with less tension on the anastomosis than the excimer laser. Histological analysis showed limited thermal damage and good patch-tissue adaptation. The preliminary results of this feasibility study outline the foundations for an entirely sutureless laser-assisted revascularization procedure. The next studies will evaluate the rheological parameters across the bypass circuit to optimize the post-anastomotic flow.

Nasal Reconstruction With Two Stages Versus Three Stages Forehead Fap: What is Better for Patients With High Vascular Risk?

In nasal reconstruction, it is necessary to replace all anatomic layers in order to reinstate correct aesthetics. The most apt donor site to use in order to cover the nose has been recognized as forehead skin. Traditionally 2 phases are required to reconstruct the forehead flap; however, an intermediate third phase was described by Millard which is between transfer of the flap and division of the pedicle. These methods will be compared in this study with regard to both complication rates and aesthetic results in high vascular risk patients.46 patients were enrolled in the study, all of whom were undergoing either total or subtotal nasal reconstruction from January 2001 to March 2018. The 2-step technique (2S Group) was performed on 30 patients and the 3-step technique (3S Group) was performed on 16. Evaluation questionnaires were completed by patients and a plastic surgeon who was extraneous to the study to evaluate aesthetic satisfaction. Complications other than flap necrosis such as infection, wound dehiscence and hematoma were recorded. VAS and Likert mean values, used to evaluate aesthetic satisfaction, were examined with a Student t test and were discovered to be relevant. Complication rates studied with Fisher exact test showed no statistically significant difference between the 2 groups. The 3-phase method for nose reconstruction using a forehead flap represents a better functional and aesthetic option for patients at high vascular risk.

Simplifying the World Health Organization Protocol: 3 Steps Versus 6 Steps for Performance of Hand Hygiene in a Cluster-randomized Trial.

In an experimental setting, a simplified, 3-step hand hygiene technique for applying alcohol-based hand rub was non inferior in terms of reduction of bacterial counts, as compared to the conventional World Health Organization 6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice. We performed a cluster-randomized trial from October-November 2015 at the University Hospital Basel, Switzerland: a tertiary, academic care center (ISRCTN45923734). We randomly assigned 12 wards to either the 3-step technique or the conventional 6-step technique of hand rubbing. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on the hands of health-care workers. Overall, 2923 hand hygiene indications were observed, and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, respectively, as compared to 12.7% (116/915) and 65.0% (915/1407) on wards assigned to the 6-step technique (P < .001). The reduction factor (RF) of bacterial colony counts did not differ between techniques (median RF 0.97 log10 colony-forming units [CFU] [interquartile range 0.39-1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49-1.52] for the 6-step technique; P = .629). In a clinical setting, the simpler hand hygiene technique, consisting of 3 steps, resulted in higher compliance with both hand hygiene indications and technique, as compared to the 6 steps. As the results of the microbiological analyses exclude inferiority, the conventional 6 steps could be safely replaced by a simpler hand hygiene technique. ISRCTN45923734.

Kidney access device.

Introduction:Percutaneous nephrolithotomy is the most complicated stone surgery technique to learn. The steep learning curve is related mainly to obtaining precise renal access by puncturing the targeted calyx. A minimally misaligned puncture may lead to torrential bleeding, failure of the surgery, and complications. Renal puncture can take a long time, and the increased fluoroscopic time is a hazard for the patient and surgeon.Methods:To aid in renal puncture and overcome the learning curve associated with learning the renal puncture technique, we designed a kidney access device (KAD), which helps align the 3-dimensional targeted calyx under fluoroscopy for precise needle placement. The KAD allows access to calyces at all angles. A 3-step puncture technique was formulated for puncturing the kidney using the KAD in a porcine model (with comparable renal size and anatomy with humans). To evaluate the practicality of the KAD and its possible advantages and limitations, the KAD was used to puncture 3 targeted calyces of bilateral kidneys in 4 pigs. Guidewires were inserted into the renal collecting system through the placed needle.Results:Mean time per puncture was 4 ± 2 minutes (n = 24). Necropsy showed no retroperitoneal hematoma, visceral organ injury, or active bleeding from kidneys in any of the pigs. Kidneys were dissected and precise intrarenal placements of guidewires in relation to targeted calyces were noted at all 24 sites.Conclusions:The KAD with the 3-step technique aids in the safe and accurate renal puncture, even in novice hands, while drastically reducing operative and fluoroscopy time. The KAD may also be used to access other organs and has potential applications in minimally invasive surgery.

Ruminal disappearance, intestinal digestibility, and plasma tryptophan response of rumen-protected tryptophan in Cashmere goats

The objectives of this study were to evaluate the ruminal disappearance and intestinal digestibility of a rumen-protected tryptophan (RPT) product; and to assess the response of plasma tryptophan (Trp) concentration to the RTP product supplementation during the cashmere fast growth period (July–November 2009) and the cashmere non-growth period (February–June 2010). Four Liaoning Cashmere goat wethers were used to study ruminal digestibility using the Dacron polyester bag technique, and intestinal digestibility of the RPT product was evaluated by the in vitro modified 3-step technique. Liaoning Cashmere goat wethers (n=36; 24.5±0.27kg) aged 1.0year-old were stratified by weight and assigned at random to three treatments: control, group I and group II fed 0, 2.0 and 4.0g RPT product per head per day, respectively. Blood samples were collected twice per day at 10.00h and 22.00h prior to the start of the RPT product supplementation and at the end of every month in each experimental period. Assay of the RPT product supplement showed that it contained 33% L-Trp in a protected form. Less than 30% of the Trp disappeared during rumen incubation for ≤12h. Intestinal digestibility of Trp ranged from 78 to 89% with an average value of 85%. The RPT product supplementation increased plasma Trp concentrations and the increases were significant for the sample taken at 22.00h during both periods of the experiment (P<0.05). In conclusion, the RPT product used in this study was an effective means of increasing the supply of Trp post-ruminally to Cashmere goats. Under the conditions of this trial, the optimum level of the RPT product supplementation observed was 2.0g/goat/d during the cashmere non-growth period, and 4.0g/goat/d during the cashmere fast growth period.

Comparison of in vivo with in situ mobile bag and three step enzymatic procedures to evaluate protein disappearance of alfalfa hay and barley grain

Summary Ruminal, post-ruminal and total tract crude protein disappearance of alfalfa hay and barley grain were measured using in vivo, in situ mobile bag and three-step in situ/in vitro enzyme procedures (3-step). For in vivo, four Baluchi lambs (49.4 ± 3.5 kg, body weight) were used in a 2 × 2 Latin square design within 2 periods (24 days of each period). Experimental diets were made of two alfalfa hay: barley grain ratios (DM basis) as 1.0:0.0 and 0.5:0.5. Diets were fed to animals for 24 days, with 7 days of feces collection. In situ mobile bag technique was followed by 12 h rumen incubation and then intestinal movement of the bags in rumen and post-rumen cannulated Holstein steers. The three-step procedure was followed by rumen incubation of samples for 12 h (using polyester bags) and enzymatic incubation of ruminal undegradable samples. In vivo total tract crude protein disappearance of alfalfa hay and barley grain (0.74 and 0.69, respectively) was significantly (P<0.01) lower than in situ mobile nylon bag (0.89 and 0.96, respectively) and the 3-step procedure (0.81 and 0.89, respectively). Total tract crude protein disappearance from in situ mobile bag was significantly (P<0.01) higher than the 3-step technique. Post-ruminal disappearance of ruminal undegradable crude protein from alfalfa hay and barley grain using in situ mobile bag method (0.69 and 0.86, respectively) was significantly (P<0.01) higher than the 3-step enzymatic method (0.49 and 0.56, respectively). Results of the present study showed that there was a significant difference between in vivo, in situ mobile bag and 3-step methods when total tract crude protein disappearance of barley grain and alfalfa hay was evaluated.

Three-step technique for staining the anterior lens capsule with indocyanine green or trypan blue

A 3-step technique for staining the anterior lens capsule was developed to optimize the use of a capsule dye (trypan blue or indocyanine green) during capsulorhexis. After the injection of a viscoadaptive ophthalmic viscosurgical device (OVD) (sodium hyaluronate 2.3% [Healon ®5]), which fills the anterior chamber, balanced salt solution (BSS ®) is gently injected onto the anterior capsule, creating a wafer-thin, fluid-filled space beneath the OVD. The dye is slowly injected through a 27-gauge cannula (Duckworth & Kent), selectively mixing with the BSS and allowing relatively accurate painting of the anterior capsule, approximating the size and shape of the intended capsulorhexis. This 3-step technique avoids the use of air as well as the uncontrolled dispersion and excessive accumulation of dye within the OVD.

Clinical evaluation of a new technique for interdental enamel reduction.

In orthodontics, reduction of tooth-size by grinding interproximal surfaces (stripping) of teeth is a common procedure. In order to achieve perfectly smooth surfaces, clinicians have carefully tested various methods and progressively improved this therapeutic procedure. In this in-vivo study we used scanning electron microscopy (SEM) to evaluate the morphologic effect of a 3-step technique using an oscillating perforated diamond-coated disc for enamel reduction and 2 Sof-Lex XT discs for polishing. This technique was applied in 32 patients with an average age of 15.5 years. A total of 296 interproximal surfaces was treated and replicas were produced for scanning electron microscopy evaluation. The scanning electron microscopy investigations demonstrated that more than 90% of the reproximated surfaces were very well or well polished, resulting in polished enamel surfaces smoother than untreated enamel. This technique proved to be clinically expedient as it finished each interproximal surface within about 2.2 minutes. At the same time, it was demonstrated to be safe and comfortable for the patient, eliminating the need for lip or cheek protectors and making injuries unlikely.