Conventional Hand Instruments Research Articles

Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized control study.

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p-value of 0.019, have the least pain perception with a p-value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration.

Initial experience with 3D laparoscopic choledochal cyst (CDC) excision and hepatico-duodenostomy (HD) in 21 children.

Minimal access surgery has gradually become the standard of care in the management of choledochal cysts (CDC). Laparoscopic management of CDC is a technically challenging procedure that requires advanced intracorporeal suturing skills, and hence, has a steep learning curve. Robotic surgery has the advantages of 3D vision, articulating hand instruments making suturing easy and thusis ideal. However, the non-availability, high costs and necessity for large-size ports are the major limiting factors for robotic procedures in the paediatric population. Use of 3D laparoscopy incorporates the advantage of 3D vision and at the same time allows the use of small-sized conventional laparoscopic instruments. With this background, we discuss our initial experience with the use of 3D laparoscopy using conventional hand instruments in CDC management. To study our initial experience in the management of CDC in paediatric patients with 3D laparoscopy in terms of feasibility and peri-operative details. All patients under 12years of age treated for choledochal cyst in a period of initial 2years were retrospectively analysed. Demographic parameters, clinical presentation, intra-operative time, blood loss, post-operative events and follow-up were studied. The total number of patients were 21. The mean age was 5.3years with female preponderance. Abdominal pain was the most common presenting symptom. All patients could be completed laparoscopically. No patient needed conversion to open procedure or re-exploration. The average blood loss was 26.67ml. None of the patients required a blood transfusion. One patient developed a minor leak postoperatively and was managed conservatively. 3D laparoscopic management of CDC in the paediatric age group is safe and feasible. It offers the advantages of depth perception aiding intracorporeal suturing, with the use of small-sized instruments. It is thus a 'bridging the gap' asset between conventional laparoscopy and robotic surgery. Treatment study level IV.

Evaluation of instrumentation and pedicle screw design for posterior lumbar fixation: A pre-clinical in vivo/ex vivo ovine model.

Stabilization procedures of the lumbar spine are routinely performed for various conditions, such as spondylolisthesis and scoliosis. Spine surgery has become even more common, with the incidence rates increasing ~30% between 2004 and 2015. Various solutions to increase the success of lumbar stabilization procedures have been proposed, ranging from the device's geometrical configuration to bone quality enhancement via grafting and, recently, through modified drilling instrumentation. Conventional (manual) instrumentation renders the excavated bony fragments ineffective, whereas the "additive" osseodensification rotary drilling compacts the bone fragments into the osteotomy walls, creating nucleating sites for regeneration. This study aimed to compare both manual versus rotary Osseodensification (OD) instrumentation as well as two different pedicle screw thread designs in a controlled split animal model in posterior lumbar stabilization to determine the feasibility and potential advantages of each variable with respect to mechanical stability and histomorphology. A total of 164 single thread (82 per thread configuration), pedicle screws (4.5× 35 mm) were used for the study. Each animal received eight pedicles (four per thread design) screws, which were placed in the lumbar spine of 21 adult sheep. One side of the lumbar spine underwent rotary osseodensification instrumentation, while the contralateral underwent conventional, hand, instrumentation. The animals were euthanized after 6- and 24-weeks of healing, and the vertebrae were removed for biomechanical and histomorphometric analyses. Pullout strength and histologic analysis were performed on all harvested samples. The rotary instrumentation yielded statistically (p= 0.026) greater pullout strength (1060.6N ± 181) relative to hand instrumentation (769.3N ± 181) at the 24-week healing time point. Histomorphometric analysis exhibited significantly higher degrees of bone to implant contact for the rotary instrumentation only at the early healing time point (6 weeks), whereas bone area fraction occupancy was statistically higher for rotary instrumentation at both healing times. The levels of soft tissue infiltration were lower for pedicle screws placed in osteotomies prepared using OD instrumentation relative to hand instrumentation, independent of healing time. The rotary instrumentation yielded enhanced mechanical and histologic results relative to the conventional hand instrumentation in this lumbar spine stabilization model.

Quality of root canal treatment performed by undergraduate students using nickel-titanium reciprocating versus hand instruments.

To compare the technical quality of root canal treatment (RCT) depending on the incidence of procedural errors performed by undergraduate students using nickel-titanium reciprocating and conventional hand instrumentation techniques, and to assess the impact of case difficulty and localization of the teeth (maxillary or mandibular molars). Dental records and periapical radiographs of molars that were treated with either hand or reciprocating WaveOne (WO) instruments were evaluated retrospectively. The technical quality of RCTs, the incidence of ledge formation, perforation, instrument fracture, overinstrumentation, underfilling, overfilling, inadequate root canal filling, and the effects of case difficulty and tooth localization were compared using the chi-square test with a significance of 5% (α=0.05). While overinstrumentation was more frequent in the WO group (247 teeth), the incidence of inadequate root canal fillings was higher in the hand instrumentation group (245 teeth) (p<0.01). No significant difference was observed in the incidence of other procedural errors (p>0.05). The number of teeth with acceptable technical quality in preparation and obturation was 172 (69.6%) in the WO group, whereas it was 142 (58%) in the hand instrumentation group, presenting a significant difference between the instrumentation techniques (p<0.01). Higher technical quality rates were observed with WO instrumentation in the high difficulty category and in maxillary teeth (p<0.01). Higher technical quality in preparation and obturation can be achieved with WO reciprocating instruments and file-matched greater tapered gutta-percha cones. No significant difference was observed between the groups in the incidence of procedural errors except for overinstrumentation and insufficient root canal filling. WO instrumentation and obturation with file-matched greater tapered gutta-percha cones provided better technical quality in the high difficulty category and in maxillary teeth.

Post-Endodontic Pain after Root Canal Treatment of Symptomatic Teeth with Mtwo and Safe Sider Multiple File Systems: A Randomized Clinical Trial

Background: Considering the increasing popularity of rotary files among dental clinicians and the emergence of several types of rotary systems, clinical trials are necessary to compare these systems from various aspects. Objectives: This study compared post-endodontic pain following the use of Mtwo and Safe Sider multiple file system. Methods: A total of 150 maxillary and mandibular molars with symptomatic irreversible pulpitis were selected. Their root canals were randomly instrumented with hand files, Mtwo and Safe Sider instruments. The severity of postoperative pain was assessed using a Visual Analog Scale (VAS) at 6, 12, 24, 48 and 72 hours. The data were analyzed using repeated measures ANOVA. P&lt;0.05 was considered statistically significant. Results: The mean postoperative pain score significantly decreased in all three groups over time. The mean pain score at 12 and 24 hours post-treatment was significantly higher in the Safe Sider group compared to the other two groups. At 6, 48 and 72 hours, no significant difference was noted in the severity of pain among the three groups. Conclusions: Postoperative pain is significantly higher at 12 and 24 hours following endodontic treatment with Safe Sider compared to the conventional hand instruments and Mtwo system.

The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy.

AimTo assess the efficacy of the adjunct use of a subgingival erythritol powder air‐polishing device (EPAP) in comparison to conventional subgingival instrumentation alone during initial non‐surgical periodontal therapy.Materials and MethodsTwenty‐one patients with generalized Stages 2 and 3 grade B periodontitis were included in this single centre, single blinded, split‐mouth, randomized clinical trial. Teeth on the control side were treated with conventional hand and ultrasonic instrumentation, while those on the contralateral test side was treated using EPAP as adjunct to conventional subgingival instrumentation with hand and ultrasonic instruments. Three months after initial instrumentation, persisting pockets of ≥4 mm were re‐treated, in both control and test sides, again with the respective treatment approach—subgingival instrumentation alone on control, and subgingival instrumentation + EPAP on test side. Clinical parameters such as probing pocket depth (PPD), bleeding on probing, and relative attachment level were recorded at baseline and 3 and 6 months following the initial instrumentation. Subgingival plaque samples were collected at baseline, immediately post surgery, as well as at 1 week, 1 month, 3 months, and 6 months after initial instrumentation.ResultsIn the test group after 6 months, a significantly larger number of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow (PPD ≤ 3.4 mm), and a larger attachment gain was observed. No statistically significant microbiological differences could be found between test and control group.ConclusionsThe results of the present study indicate that the adjunct use of subgingival airflow therapy with EPAP during initial non‐surgical periodontal therapy might be beneficial in initially deep pockets (PPD ≥ 5.5 mm).

An in vitro comparative evaluation of dentinal crack formation caused by three different nickel-titanium rotary file systems in primary anterior teeth.

Cleaning and shaping of the canals damages the root dentin which becomes a gateway to dentinal cracks and thereby causes failure of the treatment. The aim of this study was to assess and compare dentinal crack formation caused by three different nickel-titanium (NiTi) rotary file systems in primary anterior teeth. The present in vitro study is an experimental, comparative study. One hundred fifty extracted primary anterior teeth were included in this study. The teeth were randomly divided into five groups. Group 1: Pedoflex rotary file system, Group 2: Prime Pedo™ rotary file system, Group 3: Kedo-S2 rotary file system, Group 4: K-files, and Group 5: no instrumentation. Roots were sectioned and viewed under a stereomicroscope for the presence of any cracks. The data were analyzed using the Chi-square test and Kruskal-Wallis test. In the coronal, middle, and apical thirds, Group 2 showed a maximum number of crack formations in the middle third (57%), followed by Group 3 (43.3%) and Group 1 (36.7%). Groups 4 and 5 showed no crack formation in all the root sections. The middle third showed a maximum number of crack formations compared to the coronal and apical thirds. Rotary systems render various benefits with an acceptable success in comparison to conventional hand instrumentation. Within the limitation of this study, it was found that Pedoflex rotary file system was the best with the least number of crack formations.

Endodontic Treatment in Switzerland. A National Survey

The purpose of this study was to collect information about current treatment protocols of endodontic procedures among general practitioners (GP), endodontically interested practitioners (EI) and endodontic specialists (ES) in Switzerland and to compare them with available endodontic quality guidelines and former surveys. A questionnaire was distributed to 1,522 attendees of two national conferences (Swiss Dental Association, 2015; Swiss Society for Endodontology, 2016) addressing socio-demographic characteristics and specific questions about root canal treatments (RCT) including techniques and materials used. Five hundred and six surveys were collected comprising data of 81.8% GP, 14.4% EI and 3.8% ES (response rate: 33.2%). The majority of respondents was male (59.9%), 40–59 years old (55.9%) with &gt;20 years of clinical experience (54.3%). 498 participants (98.4%) stated to perform RCT. Rubber dam was always used in 52.2% of GP, 69.9% of EI and 89.5% of ES, while never-user accounted for 14.1%. Overall, 63.9% used loupes and 13.7% microscopes (mostly by ES). Rotating instruments were selected in 43.2%, followed by conventional hand-instruments (37.8%) and reciprocating instruments (19%). GP rarely activated irrigants and applied NaOCl in lower concentrations (&gt;0.5–1%) compared to ES. GP preferred lateral compaction (57%), ES performed vertical compaction in 89.5%. 92% completed RCT after two or more visits. The majority of dentists in Switzerland follow the available quality guidelines and the present findings are coherent with internationally published surveys. Nonetheless, discrepancies are still present between daily practice and endodontic quality guidelines, especially with the routine use of rubber dam and working length determination, predominantly within the endodontic non-specialists.

Effect of three different rotary instrumentation systems on crack formation in root dentin: An in vitro study

Introduction: Biomechanical preparation (BMP) of root canal damages the root dentin which becomes a gateway to dentinal cracks and thereby causing failure of the treatment. Therefore, there is a need of best instruments to minimize the failure of endodontic treatment. Aims and Objective: The objective of this study is to compare the incidence of cracks observed in the root dentin after root canal preparation with three different rotary instrument systems. Material and Methods: Seventy-five freshly extracted permanent maxillary incisors were randomly selected. Teeth were divided into five groups (n = 15), Group 1 – Untreated (negative control group), Group 2 – BMP done with nickel–titanium K-files (positive control group), Group 3 – BMP done with ProTaper Universal files, Group 4 – BMP done with ProTaper Next files, and Group 5 – BMP done with HyFlex EDM files. Roots were sectioned horizontally at 2 mm, 4 mm, and 6 mm from the apex. All slices were then viewed under stereomicroscope. All findings were analyzed using Chi-square test. Observations and Results: In the apical third, Group 5 had maximum number of fracture cases while Group 4 had lesser number and Group 3 had the least. In the middle third, Group 3 had maximum number of fracture cases while Group 4 and Group 5 showed lesser number of fractures. In the cervical third, Group 3 and Group 4 showed equal and maximum number of fracture cases. Group 5 showed no fracture cases. Group 1 and Group 2 showed no fracture cases in all the root sections. Conclusion: Conventional hand instrumentation is the best as compared to rotary instrumentation. However, rotary systems render various benefits with an acceptable success in comparison to the conventional hand instrumentation. In our study, we found that HyFlex EDM rotary system was the best with least number of fracture as compared to other systems used.

Comparison of working length control consistency between hand K-files and Mtwo NiTi rotary system.

BackgroundThe purpose of this study was to investigate the consistency of working length control between hand instrumentation in comparison to engine driven Mtwo nickel-titanium rotary files.Material and MethodsForty extracted maxillary molars were selected and divided onto two parallel groups. The working lengths of the mesiobuccal root canals were estimated. The teeth were fixed in a phantom head. The root canal preparation was carried out group 1 (n=20) with hand K-files, (VDW, Munich, Germany) and group 2 (n=20) with Mtwo instruments (VDW, Munich, Germany). Vestibulo-oral and mesio-distal directional x-ray images were taken before the preparation with #10 K-file, inserted into the mesiobuccal root canal to the working length, and after preparation with #25, #30 and #40 files. Working lenght changes were detected with measurements between the radiological apex and the instrument tips.ResultsIn the Mtwo group a difference in the working competency (p<0.05) could be noticed only in the vestibulo-oral direction from #10 to #40 file. The hand instrument group showed a significant difference in working length competency for each larger file size (p<0.05) (ANOVA). Regression analysis in the hand instrumentation group indicated a working length decrease with a mean of 0,2 mm after each consecutive file size (p<0.01).ConclusionsThe outcome of our trial indicated a high consistency in working length control for root canal preparation under simulated clinical condition using Mtwo rotary files. Mtwo NiTi rotary file did therefore proved to be more accurate in comparison to the conventional hand instrumentation. Key words:Working length, Mtwo, nickel-titanium, hand preparation, engine driven preparation.

An in vitro study to determine fracture resistance of tooth roots after different instrumentation techniques

Aim: The aim was to study the influence of rotary and hand instruments techniques on the susceptibility of the root to fracture. Materials and Methods: Forty extracted human maxillary permanent first and second molars without any defects were selected as sample. Teeth were randomly divided into four groups of ten teeth in each group. Palatal canals were instrumented depending on the instrumentation techniques used in the groups. Group 1: 0.02 taper K-files and Gates Glidden drills (Mani Inc., Japan); group 2: Hand ProTaper (Dentsply-Maillefer, France); group 3: Rotary ProTaper (Dentsply-Maillefer, France); and group 4: Endowave (J. Morita, Japan). After instrumentation, palatal roots were resected and apical 7 mm sectionally obturated. Obturated roots were embedded in putty impression material and mounted on Universal testing machine (Lloyd instruments, UK). Vertical load was applied by means of a spreader inserted into the canal and load at fracture was recorded for each tooth. Fractured roots were embedded in self-cure resin, sectioned horizontally, and viewed under operating microscope to determine the direction of fracture line: Maximum and minimum remaining dentin thickness was measured at coronal, middle, and apical thirds. Statistical analysis of data was accomplished by one-way ANOVA and post-hoc tests with Tukey honest significant difference. Results: Mean fracture loads was 20.6 ± 3.8 kg (group 1), 9.5 ± 2.4 kg (group 2), 8.4 ± 1.4 kg (group 3), and 13.4 ± 3.1 kg (group 4). There was statistical significance in the values between group 1 and groups 2, 3, and 4 (P Conclusion: Preparation of canals with a conventional hand instrumentation technique using 0.02 taper K-files showed highest fracture resistance with least amount of dentin removed at all levels followed by Endowave, ProTaper Hand, and Rotary files.

ASPECTE ALE TRATAMENTULUI BIOMECANIC DE CANAL – TEHNICA STEP-BACK. STUDIU IN VITRO

Evaluation of post-operative root canal shape have been performed using simulated root canals in resin blocks and magnification analysis (stereomicroscope) have been used for the study. The technique selected was stepback with conventional hand stainless steel instruments. The aim of studies on post-operative root canal shape is to evaluate the conicity, taper and flow and maintenance of original canal shape and to record the degree and frequency of straightening, apical transportation, ledging, zipping, teardrops, elbows. Ideal preparation forms for the root canals can be possible without any preparation errors with circular incorporation of the original canal cross section – if the technique starts with adequately precurved negotiating files. Preparation errors (zips, canal transportation, apical perforations, elbows, teardrops, etc) can occur mostly when stainless steel hand instruments (K-file) are used for moderate to severe curved of root canals, especially K-file with cutting tips and not prebent. Ideal preparation shape without any preparation errors could be a final shape and adequate shape even for conventional hand files and step-back technique. For the first area of step back technique, even for the begining, we can usually use various prebent stainless steel hand instruments for pathfinding. In many cases, conventional hand instruments produces adequate shapes for the root canals. For this final shape, is important to use adequately precurved negotiating files. Conventional stainless stell are rigid enough that thay should be precurved to match the curvature of the canal during instrumentation. Conventional hand instruments has two basic design, Kerr-file and Kerr-reamer. Kerr-file could be used to enlarge the canal with a longitudinal filing action. Kerr-reamer may used in a same fashion, but is much more flexible instrument than K-file. Noncutting tip follow the canal better than instruments with active tips – clinically usefull element.

Microbiological Assessment of Root Canals Following Use of Rotary and Manual Instruments in Primary Molars

To assess the microflora of root canals in primary molars following use of rotary NiTi files and conventional hand NiTi and stainless steel files. This randomized clinical trial consisted of a total of 60 first and second primary molars requiring root canal treatment, who were selected from children aged 5-9 years. Based on type of root canal instrumentation, the teeth were randomly assigned to three groups of twenty teeth each; Group A: Rotary NiTi files, Group B: Hand NiTi files and Group C: Hand stainless steel files. Following administration of local anesthesia, isolation with rubber dam was carried out. For the purpose of instrumentation and sampling, the palatal canal of maxillary molars and the distal canal of mandibular molars were selected. Prior to sampling, the orifices of other canals in these teeth were sealed, so as to prevent any contamination. Instrumentation was carried out in each group using respective instruments along with intermittent saline irrigation. Root canal samples were obtained both before and after instrumentation, using sterile absorbent paper points and transferred to a sterile vial with transport fluid. Serial dilutions were prepared and cultured on suitable agar media. Both aerobic and anaerobic microbial counts were made. Data obtained was subjected to statistical analysis using Wilcoxon signed rank test and one-way Analysis of variance. In all three groups, there was a significant reduction in both aerobic and anaerobic mean microbial count following root canal instrumentation. (p < 0.001). Rotary NiTi files were as efficient as conventional hand instruments in significantly reducing the root canal microflora.

A comparative scanning electron microscopy study between hand instrument, ultrasonic scaling and erbium doped:Yttirum aluminum garnet laser on root surface: A morphological and thermal analysis

Background and Objectives:Scaling and root planing is one of the most commonly used procedures for the treatment of periodontal diseases. Removal of calculus using conventional hand instruments is incomplete and rather time consuming. In search of more efficient and less difficult instrumentation, investigators have proposed lasers as an alternative or as adjuncts to scaling and root planing. Hence, the purpose of the present study was to evaluate the effectiveness of erbium doped: Yttirum aluminum garnet (Er:YAG) laser scaling and root planing alone or as an adjunct to hand and ultrasonic instrumentation.Subjects and Methods:A total of 75 freshly extracted periodontally involved single rooted teeth were collected. Teeth were randomly divided into five treatment groups having 15 teeth each: Hand scaling only, ultrasonic scaling only, Er:YAG laser scaling only, hand scaling + Er:YAG laser scaling and ultrasonic scaling + Er:YAG laser scaling. Specimens were subjected to scanning electron microscopy and photographs were evaluated by three examiners who were blinded to the study. Parameters included were remaining calculus index, loss of tooth substance index, roughness loss of tooth substance index, presence or absence of smear layer, thermal damage and any other morphological damage.Results:Er:YAG laser treated specimens showed similar effectiveness in calculus removal to the other test groups whereas tooth substance loss and tooth surface roughness was more on comparison with other groups. Ultrasonic treated specimens showed better results as compared to other groups with different parameters. However, smear layer presence was seen more with hand and ultrasonic groups. Very few laser treated specimens showed thermal damage and morphological change.Interpretation and Conclusion:In our study, ultrasonic scaling specimen have shown root surface clean and practically unaltered. On the other hand, hand instrument have produced a plane surface, but removed more tooth structure. The laser treated specimens showed rough surfaces without much residual deposit or any other sign of morphological change.

Rotary instruments in the treatment of chronic periodontitis: A randomized clinical trial

Background:The study aimed at comparing the effectiveness of rotary instruments with hand instruments in non-surgical treatment of chronic periodontitis.Materials and Methods:Thirty-eight patients with chronic periodontitis, enrolled to this randomized, controlled clinical trial, were divided into two groups. Patients in the control group received scaling and root planing with hand instruments, whereas patients in the test group received treatment with rotary instruments. Clinical assessment by plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level was made prior to and at 6 months after treatment. Differences in the clinical parameters were analyzed using the Wilcoxon signed rank test and Mann–Whitney U test.Results:Both treatments resulted in a significant improvement in all clinical recordings, but no differences in any of the investigated parameters were observed at baseline between the two groups.Conclusion:Non-surgical periodontal therapy with the tested rotary instruments may lead to clinical improvements comparable to those obtained with conventional hand instruments.

Gastroözofageal Reflü Hastalığı Tedavisinde Konvansiyonel Aletler ile Tek Kesi Laparoskopik Nissen Fundoplikasyon

Objective: Since the early 1990s with the development of minimally invasive techniques, laparoscopic Nissen fundoplication has become the gold standard intervention for the surgical treatment of gastroesophageal reflux disease (GERD), and antireflux surgical treatment of GERD can be performed by the single incision laparoscopic technique. In this study, we aimed to assess the safety and feasibility of single incision laparoscopic Nissen fundoplication (SILNF) with a new liver retraction technique. Material and Methods: Ten patients underwent single incision laparoscopic Nissen fundoplication between October 2011 and March 2012. In all patients, upper gastrointestinal endoscopy was performed. Ambulatory 24-h pH impedance monitoring was performed in all patients. The skin, subcutaneous tissue and fascia were incised with a 20 mm vertical midline incision above the umbilicus, and a SILS-Port TM (Covidien Corp, Mansfield, MA, USA) was placed with conventional laparoscopic hand instruments. Results: The procedure was successfully performed in all ten patients. The mean Johnson-DeMeester score was 29±7.9. The mean operation time was 93±14.1 minutes. The hiatal area was clearly visible with the new liver retraction technique which was applied in this study. None of the patients required conversion to an open procedure. Two patients required the insertion of an additional port. There were no intraoperative or early postoperative complications. Conclusion: SILNF is safe and technically feasible, and it can be performed with conventional laparoscopic instruments.

Keyless Abdominal Rope-lifting Surgery (KARS)

Keyless Rope-lifting Surgery (KARS) is a novel, single incision, gasless laparoscopic surgery technique. Various operations including adnexal cyst excision, oophorectomy, diagnostic laparoscopy, tubal ligation, hysterectomy and cholecystectomy may be performed through the intra-umbilical transverse incision without using CO2 pneumoperitoneum and thus the trocars (keyless). In KARS the abdominal cavity is accessed through the 1.5-2 cm intra-umbilical transverse incision. The anterior abdominal wall is elevated by the sutures loaded into the Veress cannula. The elevation creates room for the operations. All operations are performed through the intra-umbilical incision by using laparoscopic and/ or conventional hand instruments. Here in this paper, the KARS technique and the preliminary results of the specific gynecological procedures are presented.

Evaluation of the Effectiveness of Er:YAG Laser and Conventional Periodontal Treatment in a Patient with Acute Streptococcal Gingivitis: A 2-Year Follow-Up

The aim of this study was to evaluate the effectiveness of Er:YAG laser and conventional periodontal therapy in the treatment of acute streptococcal gingivitis both clinically and microbiologically. This case report describes a 2-year follow-up of a 30-year-old, female, chronic periodontitis patient, presenting severe gingival inflammation, sensitivity, pain, and acute gingival lesions that were treated with Er:YAG laser and conventional hand and ultrasonic instruments. Before the initial periodontal treatment, microbiological samples were taken from the lesion sites with sterile paper points from the sulcuses bilaterally, and excisional biopsies were obtained from the lesions. Following diagnostic tests, the lesions were identified as acute streptococcal gingivitis. Following the measurement of clinical indices, initial periodontal therapy was performed with Er:YAG laser on the right side and conventional hand and ultrasonic instruments on the left side, which were performed as two sessions at weekly intervals. As an adjunct to mechanical periodontal therapy, 500 mg amoxicillin was prescribed t.i.d. for a week. Microbiological samples grew mostly Streptococcus sp. and black pigmented obligate anaerobic bacteria. The histopathological examination revealed acanthosis, papillomatosis, and spongiotic lesions in the keratinized stratified squamous epithelium; infiltration of polymorphonuclear neutrophils, lymphocytes, and macrophages and plasma cells in the connective tissue; infiltration and accumulation of polymorphonuclear neutrophils in the epithelium, especially in the spongiotic lesions; and formation of microabscess-like clusters. After the initial periodontal treatment, clinical and microbiological measurements were repeated and reductions in clinical indices and the number of microorganisms were observed. both treatment modalities gave similar results, and no recurrences were observed during the 2-year follow-up. Er:YAG laser seems to be promising and as effective as conventional periodontal therapy in the treatment of acute streptococcal gingivitis.

Gingival curettage study comparing a laser treatment to hand instruments

The purpose of this clinical study was to examine nonsurgical treatments of periodontal disease comparing a diode laser to subgingival curettage with conventional hand instruments. The study group comprised 18 patients with moderate periodontal degradation who were treated without local anesthesia. Each quadrant was randomly allocated in a split-mouth design either to treatment with a 810-nm diode laser using an energy of 2 W (test group) or to gingival curettage using hand instruments (control group). Clinical data, including plaque index (PI), gingival index (GI), sulcus bleeding index (SBI), pocket depth (PD), clinical attachment level (CAL) and visual analog scale (VAS) score were acquired prior to and 4 weeks after treatment. The treatment time for each tooth was also recorded. The results demonstrated a statistically significant reduction of the GI, SBI and PD and a significant gain in CAL in both groups after 4 weeks. However, there were no significant differences between the test and control groups for the above data. The score for the degree of treatment discomfort was significantly lower and the average treatment time was significantly less in the test group than in the control group. Diode laser subgingival curettage resulted in statistically significant improvements in PD, SBI, GI and CAL with less discomfort and treatment time compared to treatment with the hand instruments.

Effects of root planing procedures with hand instrument or erbium, chromium:yttrium–scandium–gallium–garnet laser irradiation on the root surfaces: a comparative scanning electron microscopy study

The purpose of this study was to investigate the efficiency of hand instrumentation and laser irradiation on calculus removal from the root surfaces, in vitro. Thirty-two human teeth, extracted for periodontal reasons, were used in this study. Root surfaces of single-rooted teeth were treated by different methods including (1) conventional hand instruments; (2) hand instruments and tetracycline-hydrochloride (Tet-HCl); (3) erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation, setting I (short pulse); (4) Er,Cr:YSGG laser irradiation, setting II (long pulse). Three premolar teeth, extracted for orthodontic reasons, served as control. The morphology of the root surfaces was evaluated by light and scanning electron microscopy. Energy dispersive X-ray (EDX) analysis was performed to compare the mineral content of root surfaces treated with hand instrumentation and lasing procedures. The results of this study demonstrated that all treatments were efficient in calculus removal from the root surfaces. Thermal changes, including melting and carbonization, were not observed in either lasing procedure. The surface was rougher in the laser groups than in the groups treated with hand instruments. Moreover, roughness was greater in the long-pulse laser setting than in the short-pulse setting. While increased calcium (Ca) and decreased phosphate (P) (weight concentration percent) were observed in all treatments when compared with the control, laser procedures resulted in a more similar mineral content than in the groups treated with hand instruments. Based on these findings, laser procedures, when used in appropriate settings, are capable of performing scaling and root planing in the treatment of periodontitis. It may be concluded that short pulse laser may be more suitable for the micro-morphology of the root surface. However, additional in vitro and clinical studies are necessary to clarify the success of laser in periodontal therapy.