Separate Instruments Research Articles

Clinical and microbiological profiling of infections in open tibia fractures at Muhimbili Orthopaedic Institute

Background: Fracture-Related Infection (FRI) is a challenging complication after surgical fracture treatment. Consequences include reoperations, increased medical costs, loss of function and even amputation. Objectives: This study aimed to analyze the rate, predictors of infection, clinical-radiological presentation and microbial profiles of open tibia FRI. Methods: Between January 2022 and June 2022, a descriptive cross-sectional observational study was conducted at Muhimbili Orthopaedic Institute (MOI) involving patients aged 18 years and above with surgically managed open tibial shaft fractures in the preceding 12 months. Microbiological culture of three intraoperative tissue and bone specimens were taken by sterile techniques using separate and sterile instruments. Results: There were 190 patients between 18-72 years with a mean age of 35.6 ±10 years. After surgical debridement, all 190 (100%) were managed with either an external fixator or an intramedullary nail. It was found, 49 (25.8%) patients had FRI. A smoking history was identified as a predictor of infection (AOR= 2.21 95% CI 0.84-5.59, P value 0.108). Delayed union was a complication found in 70.3% of patients with infection attending 12th week follow-up and beyond. Almost all (96.5%) intraoperative tissue samples were culture positive, yielding most isolates as polymicrobial (57.9%) and the predominant pathogen identified being Gram-negative bacteria in delayed and late infections. Conclusion: About one-quarter of open tibial shaft fractures are at risk of FRI. The risk is higher among smokers. Intraoperative tissue sampling provides significant cultural yield with predominant gramnegative infection in delayed and late presentation.

Technical Note: A technique to convert NO2 to NO2− with S(IV) and its application to measuring nitrate photolysis

Abstract. Nitrate photolysis is a potentially significant mechanism for “renoxifying” the atmosphere, i.e., converting nitrate into nitrogen oxides – nitrogen dioxide (NO2) and nitric oxide (NO) – and nitrous acid (HONO). Nitrate photolysis in the environment occurs through two channels which produce (1) NO2 and hydroxyl radical (⚫OH) and (2) nitrite (NO2-) and an oxygen atom (O(3P)). Although the aqueous quantum yields and photolysis rate constants of both channels have been established, field observations suggest that nitrate photolysis is enhanced in the environment. Laboratory studies investigating these enhancements typically only measure one of the two photo-channels, since measuring both channels generally requires separate analytical methods and instrumentation. However, measuring only one channel makes it difficult to assess whether secondary chemistry is enhancing one channel at the expense of the other or if there is an overall enhancement of nitrate photochemistry. Here, we show that the addition of S(IV), i.e., bisulfite and sulfite, can convert NO2 to NO2-, allowing for measurement of both nitrate photolysis channels with the same equipment. By varying the concentration of S(IV) and exploring method parameters, we determine the experimental conditions that quantitatively convert NO2 and accurately quantify the resulting NO2-. We then apply the method to a test case, showing how an ⚫OH scavenger in solution prevents the oxidation of NO2- to NO2 but does not enhance the overall photolysis efficiency of nitrate.

Separation of ochratoxins by centrifugal partition chromatography

The present research work was dedicated to developing an efficient method based on liquid-liquid chromatography (centrifugal partition chromatography, CPC) applicable to routine purifications of ochratoxins (OT) from the liquid culture of the strain A. albertensis SZMC 2107. The crude extract contained numerous components in addition to OTA (90.1 %,) and OTB (1.1 %,) according to HPLC examinations. For the separation of OTs by CPC, several tertiary systems based on acetonitrile, acetone, and short-chain alcohols were examined to find the most applicable biphasic system. The hexane/i-propanol/water 35:15:50 system supplemented with 0.1 % acetic acid was found to be the most efficient for use in CPC separation. Using liquid–liquid instrumental separation, the two OTs, namely OTA (2.23 mg) and OTB (0.031 mg), were successfully isolated with 96.3 % and–72.8 % purity, respectively, from 1 L ferment broth. The identities and purities of the purified components were confirmed and the performance parameters of each separation step and the whole procedure were determined. The developed method could be used effectively to purify OTs for analytical or toxicological applications.

Endodontic treatment of severely curved root canals – A case series

Background: It is not uncommon for a dentist to encounter endodontic cases of severely curved root canals. Performing endodontic treatment on severely curved root canals can be a daunting task due to the notable risk of creating an iatrogenic error including ledge, perforation, or even instrument separation. Therefore, radiograph image analysis, proper endodontic treatment planning, selection of appropriate instruments and technique is essential to ensure success in endodontic treatment of severely curved root canals. Purpose: This case series aims to elaborate the instruments and technique to safely negotiate, clean, shape, and seal root canals with severe curvature. Cases: Three patients came to Universitas Airlangga Dental Hospital due to a severe toothache. After anamnesis and examination, diagnosis was established, and endodontic treatment was deemed necessary. During radiographic image analysis, it is visible that the root canal had a severe curvature. Case Managements: Access opening was performed to allow a straight-line access, orifices were preflared, root canals were negotiated, and glide path was established. Then, shaping, cleaning, and sealing can be performed conveniently until the root canal terminus. Subsequently, coronal restoration was fabricated to restore function and esthetics. Conclusion: With proper knowledge, case analysis, appropriate instruments and techniques, severely curved root canals can be safely and predictably negotiated, cleaned, shaped, and sealed.

Comparative evaluation of cyclic fatigue resistance of thermomechanically treated NiTi rotary instruments in simulated curved canals with two different radii of curvature: An in vitro Study.

This study aimed to compare the effect of heat treatment on the cyclic fatigue resistance of three different nickel-titanium rotary file systems: TruNatomy, HyFlex CM, and NeoEndo flex in simulated curved canals at two different radii of curvatures. A total of 60 NiTi rotary files of three types were used, and the samples were divided into three groups TruNatomy, HyFlex CM, and NeoEndo flex. All the instruments were subjected to cyclic fatigue testing using a stainless steel custom-made canal model with a 60° angle of curvature and two radii of curvature 5 mm and 3 mm; the number of cycles to fracture and length of the fractured segment was measured. The separated instruments were subjected to fractographic analysis under scanning electron microscope. The number of cycles to failure to fracture a file at a 3 mm radius of curvature is significantly less as compared to a 5 mm radius of curvature (HCM > TRN > NE). Within the limitation of the present study, there was a positive correlation between the radius of curvature and fatigue life of NiTi files.

Antimicrobial resistance in surgical infections: experience from open tibia fracture-related infection intraoperative tissue specimens

Background Antimicrobial resistance in surgical infections is known to have significant morbidity and mortality in extreme cases on top of increased costs in medical expenditure. This study aimed to analyze antimicrobial resistance patterns of microbes in open tibia fracture-related infection (FRI) using intraoperative tissue samples. Methods Between January and June 2022, a descriptive cross-sectional observational study was conducted involving patients aged 18 and above with open tibial shaft fractures. Microbiological culture and sensitivity of three intraoperative deep tissue and bone samples taken by sterile techniques using separate instruments in patients with infection. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method along with biomechanical tests for microbial identification. Results Fifty-seven deep tissue samples were taken from 19 patients with FRI who underwent surgery during the study period were analyzed. Almost all (96.5%) intraoperative tissue samples were culture-positive identifying 73 bacterial isolates out of which 57.9% were polymicrobial. The most frequent isolated bacteria were Gram-negative bacteria 56 (76.7%) with a predominance of Proteus spp 13 (17.8%). Methicilin Resistance Staphyaureus comprised 12 (16.4%) of the isolates whereas Inducible Clindamycin resistance was identified in 8 (57.1%) of Staphyloccus aureus isolates. More than half of the isolates 30 (53.6%) comprised of Extended Spectrum Beta Lactamase producing bacteria. There was high resistance to Cephalosporins and Amoxyclavulanic acid as the efficacy was low ranging from 28.2, 27.8, and 30.0% for cefotaxime, ceftazidime and amoxicillin/clavulanic acid, respectively. Almost all Gram-negative bacteria 47 (83.9%) had multidrug resistance pattern except for Pseudomonas aureginosa that had 77.8 to 88.9% susceptibility to all tested antibiotics. Conclusion High resistance to cephalosporins in patients with delayed or late infection in open tibia FRI is alarming and further studies to establish causes are indicated.

Comparative evaluation of the efficacy of the Pro AF Baby Gold and Kedo-S pediatric endodontic files for canal instrumentation, transportation, and centering ratio - A systematic review and meta-analysis.

Traditionally, pediatric endodontics lacked access to the full potential of rotary instruments. These instruments, designed for the permanent root canal system, often presented limitations when used in primary teeth. To address this, exclusive pediatric rotary files with regular improvements have been introduced, featuring superior cutting efficiency with a focus on precise alignment. This design offers the advantage of reduced risk of ledges, perforations, instrument separation, and canal transportation. This study aimed to compare and evaluate the effectiveness of Pro AF Baby Gold and Kedo-S rotary files in preparing primary tooth root canals during pulpectomy procedures through a meta-analysis. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review searched electronic databases from 2000 to February 2024 for studies evaluating the efficacy of Pro AF Baby Gold and Kedo-S files in terms of canal instrumentation, transportation, and centering ratio. The Cochrane risk of bias (ROB)-2 tool assessed quality, with analyses conducted using RevMan software version 5.3. The standardized mean difference (SMD) served as the summary with a random effects model (P < 0.05). Out of the five studies identified through the eligibility criteria, three were deemed suitable for a meta-analysis, while all five were included in a qualitative synthesis. The quality assessment revealed a presence of moderate-to-low ROB. The pooled analysis using SMD did not show any statistically significant differences between the files, except for the centering ratio in the mesiobuccal canal, where the Kedo-S file performed slightly better. In addition, the absence of any significant asymmetry in the funnel plot suggests that there is likely no publication bias present in the data. Pro AF Baby Gold files can be used as an alternative adjunct in pediatric endodontics to Kedo-S files and manual files.Prospero Registration: CRD42023469406.

Management of Separated Endodontic Instrument in Mandibular Second Molar with Bypass Technique

One of the most common mishaps in root canal treatment is a separated endodontic instrument. Bypass technique is an effective alternative besides file retrieval while clinical conditions have lack of access and visibility. Other than, this technique gives a more conservative outcome because it prevents more dentin removal. The aim of this case report was to describe management of separated endodontic instruments in the mandibular second molar with bypass technique during endodontic treatment. A 3,5 mm F1 ProTaper Hand Use file was separated in the mesiobuccal canal of the mandibular second molar. Radiograph examination was taken to make sure the level of fragment. Bypass was performed with #10 until #25 K-File to pass the separated instrument through the gap between it and the root canal wall. Obturation has been done with gutta percha and resin-based sealer using cold lateral condensation technique. Direct restoration was chosen as final restoration after 6 days follow up. Bypass technique can be performed as management of separated instrument considering the risks involved fragment extrusion to apical region, secondary separated instrument, and conservative aspect.

Predicting early endodontic treatment failure following primary root canal treatment

BackgroundUnderstanding when and why endodontic treatments fail could help clinicians make prognoses and thus improve treatment outcomes. This study was aimed to assess potential predictors of early endodontic treatment failure. We explored factors contributing to the failure of initial root canal treatment were explored, with a specific emphasis on evaluating the influence of the time elapsed since the initial treatment.MethodsThis retrospective cohort study enrolled 1262 patients who sought endodontic treatment at our department and 175 patients were included for analysis. Potential causes of endodontic treatment failure were investigated, such as inadequate obturation quality, inadequate coronal status, the presence of additional untreated canals, anatomical complexity, instrument separation, iatrogenic perforation, cracks, and endodontic-periodontal lesions. The patients were divided into “short-term” and “long-term” groups depending on the time that had passed since the initial treatment (i.e., < 5 and > 10 years, respectively). The causes of failure in the short-term and long-term group were analyzed and compared using logistic regression analyses. Subgroup analysis was performed according to the number of years since the initial treatment in the short-term group to further investigate the association between the time and cause of failure (i.e., < 1, 2, 3, and 4 years, respectively).ResultsUntreated additional canals were present in 21.7% of all cases, and in 36.9 and 6.4% of cases in the short-term and long-term groups, respectively. Multivariable analysis showed that the presence of untreated additional canals was significantly associated with short-term compared to long-term failure. Untreated additional canals were also associated with endodontic failure within 1, 2, 3, and 4 years.ConclusionsThe presence of untreated additional canals was a predictor of endodontic failure within 5 years following initial root canal treatment. To optimize long-term prognosis, it is important to detect and treat all root canals during the initial treatment.

Management of Intracanal Separated Instrument Using Bypassing and Braiding Techniques: Case Reports

The separation of an endodontic instrument during a root canal procedure is a complication that can significantly hinder successful treatment. Separated instruments blocked access to the apical portion of the root, impeding adequate apical canal debridement and potentially compromising disinfection efficacy, thereby jeopardizing the long-term success of the endodontic therapy. Recent advancements in endodontic technology and methodology have facilitated the management of separated instruments (SIs), potentially enhancing treatment prognosis This article presents a case series of the management of SI using bypassing and braiding techniques. Separated instruments were lodged at various levels in the middle and apical third of the maxillary and mandibular incisor and canine teeth. Today, the majority of broken instruments can potentially be removed safely and effectively. However, instrument removal techniques lead to significant loss of tooth substances, which increases the risk of tooth fracture. The choice of the most appropriate technique for removing the fractured fragment depends on several parameters. The two techniques used in these clinical cases are conservative, simple and less invasive for instrument removal.

Opinions and Attitudes of Dental Practitioners towards Intracanal Separation of Endodontic Instruments

Objective: To investigate the opinions and attitudes of dental practitioners towards intracanal separation of endodontic instruments and to create awareness regarding the management of separated instruments Study Design: Cross-sectional survey Place and Duration of Study: Department of Operative Dentistry Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Mar to Apr 2021. Methodology: An online questionnaire was circulated among 374 dentists of private and public hospitals in Rawalpindi and Islamabad. The questionnaire consisted of close-ended questions related to demographic details, dentists' awareness of instrument separation, the frequency of separated instruments, the causes of separation, the management of separated instruments, and the retrieval strategies if used. Results: Out of 374 study participants, 307(82.1%) of the participants thought that operator-related factors such as improper or overuse of the instrument were considered the most common factors for instrument separation during root canal procedures. 205(54.8%) thought unwinding, defective flutes and shiny areas were the most common factors affecting instrument separation. 241(64.4%) of the instruments are separated during cleaning and shaping. 135(36.1%) K files and 119(31.8%) H files were separated in this survey. Conclusion: Most dentists of Rawalpindi and Islamabad face the problem of endodontic instrument separation during rootcanal preparation.

Phacoemulsification combined with goniosynechialysis versus phacoemulsification alone for patients with primary angle‑closure disease: A meta-analysis.

This meta-analysis aims to systematically compare the efficacy between phacoemulsification (PE) combined with goniosynechialysis (GSL) and PE alone for primary angle-closure disease (PACD) patients. All the data were searched from the PubMed, EMBASE and the Cochrane Library. The Cochrane Handbook was used to evaluate the quality of the included studies. Additionally, this meta-analysis was performed by using the Revman 5.4 software. Nine randomized controlled trials (RCTs) were included in this study. Compared with PE alone group, PE+GSL could result significant reduction in the IOP (MD, 1.81; p = 0.002). In the instrumental subgroup, also more reduction of IOP was shown in the PE+GSL group (MD, 2.11; p = 0.02). In the viscogonioplasty (VGP) subgroup, there was not no statistical difference between PE alone group and PE+GSL group (MD, 1.53; p = 0.11). Also, more reduction of peripheral anterior synechiae (PAS) was shown in the PE+GSL group (MD,59.15; p<0.00001). For the change in angle open distance (AOD)500, AOD 750, trabecular-iris space (TISA)500, number of glaucoma medications and best corrected visual acuity (BCVA), there was no difference between two groups (p = 0.25, 0.35, 0.17, 0.56, 0.08). For TISA 750, more improvement was shown in the PE+GSL group (p<0.00001). Instrumental separation had better effect on lowering IOP when it combined with PE. Both instrumental separation and VGP could reduce postoperative PAS. The operation of GSL has no obvious effect on postoperative vision.

Influence of operator’s experience on complications of root canal treatment using contemporary techniques: a retrospective study

BackgroundEndodontic treatment has benefited from the development of new techniques and equipment. Few clinical studies have been published on the complications associated with root canal preparations performed by doctors with different working experiences using contemporary techniques. This study aimed to analyze the complications of endodontic treatment performed by residents and endodontic specialists in a teaching stomatology hospital using contemporary techniques.MethodsCases of root canal treatment (RCT) and non-surgical root canal retreatment (ReRCT) performed by residents with 1–3 years of experience and endodontic specialists with 5–7 years of experience were collected from the electronic medical system of the Department of Endodontics, Beijing Stomatology Hospital, from September 1, 2020 to August 31, 2021. The cases were examined in terms of patient age, sex, type of tooth, diagnosis, treatment modality (RCT or ReRCT), number of appointments, whether an operating microscope was used, presence of ledges, canal transportation, perforations, missed canals, separated instruments, flare-ups and clinical incidence of second mesiobuccal (MB2) root canal in the maxillary molars.ResultsIn total, 859 teeth from 820 patients were included in the analysis. The overall incidence of complications in the resident group was significantly higher than that in the specialist group. More ledges and flare-ups were observed in the resident group (p < 0.05). The clinical incidence of MB2 was significantly higher in the specialist group (p < 0.05). There were no significant differences in root canal transportation, perforation, or instrument separation between the two groups (p < 0.05). Multivariate analysis showed that the incidence of root canal preparation complications was related to operator experience, tooth type and treatment modality.ConclusionsTechnical advancements could reduce the effect of working experience on RCT complications between residents and endodontic specialists in a teaching stomatology hospital.

The association of endodontic prognostic factors with the presence of periapical lesion, its volume, and bone characteristics in endodontically treated molars: a cross-sectional study

BackgroundThis study intended to evaluate the association between several endodontic prognostic factors with the presence of periapical lesions (PLs), their volume, and bone characteristics including cortical bone destruction (CBD) and buccal plate bone height (BPBH) in root-filled molar teeth using cone-beam computed tomography.MethodsA collection of 143 scans of endodontically treated maxillary/mandibular first or second molars recorded over 8 years, were obtained from a specialized radiology center. Data on prognostic factors including tooth number, gender, jaw type, the status and number of missed canals, obturation length, restoration type, presence of a separated instrument, presence of a post or screw in the canals, and presence of perforation were collected. The assessed outcomes included PL presence, PL volume, CBD, and BPBH. The association between prognostic factors and outcomes was evaluated using multiple logistic regression models with adjusted covariates and multifactorial ANOVA at a significance level of 0.05.ResultsA total of 282 molars from 82 women and 50 men with a mean age of 40.6 ± 12.27 were included. Among those, 139 teeth presented PL with a mean volume of 18.68 mm3. CBD was prevalent in 137 teeth and the mean BPBH appeared to be 9.45 mm. The presence of a missed canal (OR = 10.022, P < .05), underfilled canal (OR = 3.725, P < .05), overfilled canal (OR = 15.859, P = .018), and perforation (OR = 15.261, P = .013) was significantly associated with PLs. None of the prognostic factors could considerably contribute to the CBD (P > .05). The presence of a missed canal was positively associated with the PL volume (P < .05). Similarly, missed canals (P < .05), perforation (P < .05), and separated instruments (P = .004) were associated with a significantly reduced BPBH.ConclusionsOverfillings, perforations, missed canals, and underfillings were identified as remarkable predictors of PL, arranged in descending order of their respective impact. The only factor capable of significantly increasing the PL volume was the missed canal. In brief, obturation length errors, perforations, missed canals, and separated instruments were robustly correlated with endodontic failure, which highlights the importance of mitigating the potential for errors by following the fundamentals of endodontics.

Does it always necessitate retrieving files? Management of separated files using the bypass method: Report of two cases

Abstract Fractured instruments, particularly endodontic files, are a frequent issue encountered in everyday dental practice. There are two main methods for handling a separated instrument: bypassing and retrieval. A broken file obstructs the canal, hindering the cleaning and shaping procedure, during which clinicians typically attempt to recover the file. However, when trying to eliminate the separated file, there are multiple challenges that can decrease the probability of future success and lead to clinical failure. Thus, bypassing the separated instrument is frequently the prudent and minimally intrusive approach. This case report discusses the management of separated instruments utilizing the bypass method, which has been shown to be a conservative strategy.

Targeted endodontic microsurgery of a mandibular first molar with a separated instrument using the 3D-printed guide and trephine bur: A case report with a 2-year follow-up

Targeted endodontic microsurgery of a mandibular first molar with a separated instrument using the 3D-printed guide and trephine bur: A case report with a 2-year follow-up

АМОРТИЗАЦІЯ В ЗНАЧЕННІ ІНСТРУМЕНТАРІЮ ВІДТВОРЕННЯ ВЛАСНИХ ІНВЕСТИЦІЙНИХ РЕСУРСІВ

The paper examines depreciation as an effective tool for replenishing one’s investment resources. The theoretical foundations of depreciation and its significance in business management and financial management are discussed here based on the processes of simple and expanded capital reproduction of the company. The significant features of simple and expanded reproduction, which lie precisely in the possibility of capitalization of financial resources invested in production funds, are separately noted. The place and role of depreciation at various stages of social production reproduction are determined. Depreciation in this case serves as a tool for capitalizing resources. The circulation process of the main production capital (MPC) at various stages, namely, circulation, production, and circulation, is examined. The peculiarity of creating the final material product, which precisely allows for the capitalization of financial resources, is highlighted, and the secondary role of expenditure processes in circulation without which the realization of the finished product is not possible is determined. It is determined that the useful value of the main production capital (MPC) is the means of labor that have useful properties for production: they participate in the process of creating new useful value. MPC as value is social labor embodied. The activation of the reproduction of the main capital implies, first of all, the acceleration of its real circulation, which is manifested in the reduction of the reproduction cycle. And since the reproduction cycle of the main capital includes stages of innovative production, industrial production, testing, operation, and replacement, its reduction contributes to the renewal, modernization of means of labor, optimal use of available production capacities, which allows increasing capital productivity and production efficiency as a whole. All possible alternative sources of forming investment resources of enterprises are considered in the study, where separate instruments that can be applied to the reproduction process are distinguished. It is determined that leasing deserves separate attention as a tool of amortization reproduction, since it has certain features of depreciation accrual and its accounting on the company’s accounts depending on the methods of depreciation and the chosen type of leasing. The problem of effective reproduction of the company’s capital is considered from various points of view and at different levels of management.

Detection of the separated endodontic instrument on periapical radiographs using a deep learning-based convolutional neural network algorithm.

The study evaluated the diagnostic performance of an artificial intelligence system to detect separated endodontic instruments on periapical radiograph radiographs. Three hundred seven periapical radiographs were collected and divided into 222 for training and 85 for testing to be fed to the Mask R-CNN model. Periapical radiographs were assigned to the training and test set and labelled on the DentiAssist labeling platform. Labelled polygonal objects had their bounding boxes automatically generated by the DentiAssist system. Fractured instruments were classified and segmented. As a result of the proposed method, the mean average precision (mAP) metric was 98.809%, the precision value was 95.238, while the recall reached 98.765 and the f1 score 96.969%. The threshold value of 80% was chosen for the bounding boxes working with the Intersection over Union (IoU) technique. The Mask R-CNN distinguished separated endodontic instruments on periapical radiographs.

Endodontic file separation and its management among dentists in Punjab, Pakistan

The study aimed to find the incidence and awareness of endodontic instrument separation and its management among dental house officers, postgraduate trainees, demonstrators, consultants, and general dentists. Methods: This online questionnaire-based cross-sectional study was conducted with the approval of the IRB in private and public dental hospitals and dental clinics in Punjab. The authors developed the survey tool, which comprises 24 closed-ended items regarding demographics, the incidence of file separation, and awareness about its management. The data were analyzed using IBM SPSS version 24. The Chi-Square Test was used to compare percentages of categorical variables. Results: Postgraduate trainees experienced the most instrument separations (43.6%), made the most retrieval attempts (49.2%), and experienced the most secondary errors during retrieval (52.1%) (p&lt;0.001). Around four out of ten respondents always informed the patients (39.6%) and department (41.6%) about errors. Manual files (69.8%), stainless steel files (75.8%), and short files (60.4%) were more frequently separated, and the most frequent cause was older fatigue files (57.7%). Manual files were more frequently broken in public dental institutes (p=0.003). Two-thirds of the file separations (72.5%) occurred during cleaning and shaping in the apical third of molars (65.1%), especially in mesiolingual canal (56.4%). Bypass attempt was the most common in symptomatic teeth (47.7%). Conclusions: Preventive approaches such as limiting file reuse and constructing a glide path can reduce the occurrence of file separation. Operators should be familiar with the number of uses of the instrument before fatigue and should be trained through workshops and refresher courses.

Qualitative differences in perspective on children’s quality of life between children with cerebral palsy and their parents

BackgroundCerebral palsy (CP) is one of the most common childhood disabilities, impacting many areas of a child’s life. Increasingly, quality of life (QOL) measures are used to capture holistic wellbeing of children with CP. However most validated QOL measures for children are based on adult perspective only, with limited focus on child perspective. Conceptual differences between children’s and adults’ definitions of QOL may reflect different underlying QOL models which contribute to measurement score divergence. This qualitative study investigated the conceptual meaning of QOL for children with CP, comparing child and parent perspectives. Eighteen families completed 8 child interviews and 18 parent interviews. Children (11 boys, 7 girls) represented the spectrum of motor functioning, with comorbidities including epilepsy, intellectual disability, and communication impairments. Child and parent interviews were analysed separately using constructivist grounded theory methods and then findings were integrated to examine similarities and differences.ResultsAll participants sought child inclusion in social activities, education, and recreation, requiring negotiation, adaptations, and advocacy. Five conceptual categories emerged from child interviews: socialising, play, negotiating limitations, self-identity, and developing agency. This reflected an individual model of QOL supporting child development goals. Parent interview findings revealed concepts related to child-specific QOL (day-to-day functioning and enabling child goals), as well as parent and family functioning concepts aligned to models of “family QOL”, embracing impacts of family relationships and the interdependence of QOL among family members.ConclusionsThis study identified similarities and differences in child and parent perceptions of QOL for the child with CP. Children provided insights into the importance of play and peer support, and their developing self-identity and sense of agency. Self-directed free play, especially, was identified by children but not parents as a central everyday activity promoting wellbeing and social inclusion. Parents discussed family functioning and aspects outside of child sight, such as managing time and financial resources. Relying on parents’ perspective alone to model child QOL misses valuable information that children contribute. Equally, child report alone misses parent experiences that directly influence child QOL. There is value in incorporating family QOL into parent reports while developing a conceptually separate child self-report QOL instrument.