Middle Third Research Articles

Characteristics of Middle 1/3 Facture Fractures Assessed with the Facial Injury Severity Scale at the Oral Surgery Policy of Dr Hasan Sadikin Hospital Bandung Period June 2019 - June 2021

Maxillofacial trauma is damage that affects the face and surrounding tissue, where traffic accidents are the main cause of trauma. The location of facial fractures can occur in the upper third, middle third and lower third of the face. The position of the maxilla which is located in the middle third of the face causes it to be protected by the prominent bones of the mandible, zygoma, nasalis and frontalis, so that maxillary fractures are rarely found compared to mandibular fractures. The prevalence of fractures in the middle third of the face is higher than fractures in other areas of the face (upper third and lower third). Keywords: MISS, FISS

Precision Rhinoplasty Cylindric Burrs - Sidewall Aesthetics.

The development of power instruments has led to great advances in Rhinoplasty. It has helped reduce operating time, minimize damage to the surrounding soft tissues and allow precision bony modification compared with the use of manual rasps. Burrs help ensure precise results by i) creating a smooth transition between the lateral nasal sidewall and the face, ii) treating bony asymmetries and iii) producing homogeneous upper and middle thirds that softy translate into the upper lateral cartilages. The aim of this paper is to show applications of cylindrical burrs in Rhinoplasty surgery to treat the dorsal upper and middle thirds as well as lateral sidewalls of the nose, regardless of whether the dorsal preservation or structure technique is used. This approach offers a safe, fast, and precise technique that can be used in conjunction with piezo osteotomy to obtain the optimal outcomes.

Treatment and Outcome of Supracondylar Humeral Fractures in Children Over 10 Years of Age at the Time of Injury: A Review of 60 Cases.

To assess the treatment and outcomes of supracondylar humeral fractures (SHFs) in children older than 10 years of age at the time of injury. The study analyzed clinical data from 60 patients who sustained SHF, all over the age of 10 years, were analyzed. The patients included 49 males and 11 females with a mean age of 10.9 ± 0.9 years (range, 10 to 14.5). All patients underwent surgical treatment under general anesthesia. Closed reduction (CR) and percutaneous fixation were the primary treatment, with open reduction and internal fixation being employed only in cases CR was unsuccessful. The study assessed the healing of fractures by measuring the radiographic angles, including the carrying angle (RCA), Baumann's angle (BA), and metaphyseal-diaphyseal angle (MDA) on anteroposterior radiographs of the elbow joint. In addition, the study evaluated whether the anterior humeral line (AHL) appropriately passed through the middle third of the capitellum. The final follow-up visit used the Mayo Elbow Performance Index score (MEPI) and Flynn's criteria to analyze the recovery of elbow function. There were 15 (25%) SHF type II, 17 (28.3%) type III and 28 (46.7%) type IV. Of the 60 patients, 56 (93.3%) underwent successful CR, whereas 4 (6.7%) required open reduction and internal fixation because of an unsuccessful CR. The final follow-up showed the average BA as 72° ± 5.3°, the average MDA as 88.3° ± 2.8°, and the average RCA as 9.6° ± 3.9°. The AHL bisected accurately the capitellum in 59 cases (98.3%). The average range of elbow flexion-extension was 146.6° ± 8.6°, whereas the average MEPI score was 99.9 ± 0.6; 98.3% (n=59) were rated as excellent and 1.7% (n=1) were rated as good. According to Flynn's criteria, 86.7% had an excellent outcome (n=52), 10% had a good outcome (n=6), and 3.3% had a poor outcome (n=2). Only 1 patient (1.7%) experienced redisplacement. Eight cases of nerve injury were reported, with 7 involving the radial nerve and 1 involving the ulnar nerve; all resolved spontaneously. CR and percutaneous fixation have been shown to be effective in treating SHF in 93.3% of children aged 10 years old and older at the time of injury, with favorable radiographic and functional outcomes and a low risk of secondary displacement. Open reduction should only be considered when CR is ineffective.

Micro-CT Imaging of Tracheal Development in Down Syndrome and Non-Down Syndrome Fetuses.

Down syndrome (DS) is associated with airway abnormalities including a narrowed trachea. It is uncertain whether this narrowed trachea in DS is a consequence of deviant fetal development or an acquired disorder following endotracheal intubation after birth. This study aimed to compare the tracheal morphology in DS and non-DS fetuses using microfocus computed tomography (micro-CT). Twenty fetal samples were obtained from the Dutch Fetal Biobank and divided into groups based on gestational age. Micro-CT images were processed to analyze tracheal length, volume, and cross-sectional area (CSA). Mean tracheal length and tracheal volume were similar in DS and non-DS fetuses for all gestational age groups. Mean, minimum, and maximal tracheal CSA were statistically significantly increased in the single DS fetus in the group of 21-24 weeks of gestation, but not in other gestational age groups. In 90% of all studied fetuses, the minimum tracheal CSA was located in the middle third of the trachea. Tracheal development in DS fetuses was similar to non-DS fetuses between 13 and 21 weeks of gestation. This suggests that the narrowed tracheal diameter in DS children may occur later in fetal development or results from postnatal intubation trauma. The narrowest part of the trachea is in majority of DS and non-DS fetuses the middle third. Level 3 Laryngoscope, 2024.

Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication.

The hamstrings muscles are innervated by sciatic nerve branches. However, previous studies assessing which and how many branches innervate each muscle have yielded discrepant results. This study investigated the innervation patterns of hamstrings. Thirty-five cadaver limbs were investigated. The average age of subjects was 78.6 ± 17.2 years, with 48.6% male and 51.4% female, while 57.1% were right limbs and 42.9% left. The sciatic nerve, hamstrings and associated structures were dissected. The number of nerve branches for each muscle and the level where they penetrated the muscle were recorded. The sciatic nerve was connected by a fibrous band to the long head of the biceps femoris. This muscle was innervated by either one or two branches, which penetrated the muscle into its superior or middle third. The short head of the biceps femoris was innervated by a single nerve that usually penetrated its middle third, but sometimes inferiorly or, less commonly, superiorly. The semitendinosus was always innervated by two branches, the superior branch penetrating its upper third, the inferior mostly the middle third. The semimembranosus usually was innervated by a single nerve branch that penetrated the muscle at its middle or lower third. Four specimens revealed common nerves that innervated than one muscle. We have characterized hamstring innervation patterns, knowledge that is relevant to neurolysis, surgery of the thigh, and other procedures. Moreover, a mechanical connection between the sciatic nerve and biceps femoris long head was identified that could explain certain neuralgias.

Effect of material composition and thickness of orthodontic aligners on the transmission and distribution of forces: an in vitro study.

To investigate the effects of material type and thickness on force generation and distribution by aligners. Sixty aligners were divided into six groups (n = 10): one group with a thickness of 0.89mm using Zendura Viva (Multi-layer), four groups with a thickness of 0.75mm using Zendura FLX (Multi-layer), CA Pro (Multi-layer), Zendura (Single-layer), and Duran (Single-layer) sheets, and one group with a thickness of 0.50mm using Duran sheets. Force measurements were conducted using Fuji® pressure-sensitive films. The lowest force values, both active and passive, were recorded for the multi-layered sheets: CA Pro (83.1N, 50.5N), Zendura FLX (88.9N, 60.7N), and Zendura Viva (92.5N, 68.5N). Conversely, the highest values were recorded for the single-layered sheets: Duran (131.9N, 71.8N) and Zendura (149.7N, 89.8N). The highest force was recorded at the middle third of the aligner, followed by the incisal third, and then the cervical third. The net force between the incisal and cervical thirds (FI-FC) showed insignificant difference across different materials. However, when comparing the incisal and middle thirds, the net force (FI-FM) was higher with single-layered materials. Both overall force and net force (FI-FM) were significantly higher with 0.75mm compared to those with a thickness of 0.50mm. Multi-layered aligner materials exert lower forces compared to their single-layered counterparts. Additionally, increased thickness in aligners results in enhanced retention and greater force generation. For effective bodily tooth movement, thicker and single-layered rigid materials are preferred. This research provides valuable insights into the biomechanics of orthodontic aligners, which could have significant clinical implications for orthodontists. Orthodontists might use this information to more effectively tailor aligner treatments, considering the specific tooth movement required for each individual patient. In light of these findings, an exchangeable protocol for aligner treatment is suggested, which however needs to be proven clinically. This protocol proposes alternating between multi-layered and single-layered materials within the same treatment phase. This strategy is suggested to optimize treatment outcomes, particularly when planning for a bodily tooth movement.

Clinical and radiological aspects of the forearm in children with congenital radioulnar synostosis: a cohort study

Introduction The upper limb functional limitations in congenital radioulnar synostosis may significantly affect the daily activities of patients. Classifications of the condition are descriptive and have limited practical application.Purpose Determine a functionally significant quantitative criterion for anatomical changes in the forearm.Material and methods 92 children (136 forearms) with congenital radioulnar synostosis were examined for  limitations in activities of daily living (ADL), health-related quality of life measured with  PedsQL questionnaire; pronation of the forearm and radiographic parameters. A comparative and  correlation analysis, ROC analysis were performed to determine the relationship between the forearm pronation and limitations of ADL.Results Statistically significant correlations were revealed between symptoms and the forearm alignment (p < 0.01, rxy = 0.5); subluxation of the ulnar head and forearm alignment (p < 0.001, rxy = 0.6); bowing deformity of the radius, forearm alignment and subluxation of the ulnar head and between the length of the forearm bones and bowing deformity of the radius (p < 0.05, rxy = 0.4 and rxy = 0.5). A statistically significant inverse correlation was revealed between symptoms and PedsQL scores (p = 0.038, rxy = –0.4). Pronation of 45° was the threshold value of the forearm alignment with a high risk of ADL limitation. The area under the ROC curve corresponding to the relationship between symptoms and the forearm alignment was 0.955 ± 0.021 (95 % CI: 0.915–0.995). There was a statistically significant (p < 0.01) decrease in the lumen of the medullary canal in the middle third of the ulnar shaft with the radius lumen being unchanged. Dorsal subluxation of the ulnar head was detected In 30 % of cases.Discussion The characteristics identified demonstrated changes in the forearm bones with functional impairments being correlated with the forearm pronation.Conclusion The correlation between the patient’s symptoms and the forearm alignment must be taken into  account in the classification and when determining indications for surgical treatment distinguishing between functional (< 45° pronation) and dysfunctional (≥ 45° pronation) options.

Large adenomatoid odontogenic tumor: Case report

The adenomatoid odontogenic tumor (AOT) is an uncommon, benign neoplasm of odontogenic epithelial origin, believed to have originated from two remnants of the dental lamina or enamel organ, representing 2-7% of all odontogenic tumors. Clinically, they are slow growing, asymptomatic and rarely exceed 3.0 cm in diameter. TOA presented three different clinicopathological variants without relevant clinical and radiographic differences: intraosseous follicular (associated with dental impaction, generally comprising 70% of the two cases); extra-follicular intraosseous (present between erupted teeth, representing 25% of the two cases); and peripheral (extra-osseous, 5% two cases). The aim of this paper is to report a case of a large and aggressive adenomatoid odontogenic tumor. Patient, male, 13 years old, undergoing direct increase in maxillary volume with evolution of 01 month. Upon physical examination, an increase in volume in the middle third of the face was observed, directly causing facial asymmetry. normal appearance, absence of unit, tooth 13, stable dental occlusion, poor mouth opening, poor oral hygiene. On imaging (face tomography) there was a hypodense image in the maxillary region directly, osteolytic, well circumscribed, with a radiopaque halo, causing expansion of the cortical bones without breaking them, associated with the impacted and included dental unit 13. Enucleation and complete healing of the lesion and associated extraction of unit 13 were performed, with a lesion presenting a fibrous capsule in the non-transoperative period. The patient is being followed up by a team, weeks of recurrence at the moment. In this way, a rapid and aggressive evolution appears, being clinically perceptible and confused with the behavior of an amelolastoma, however, the histopathological diagnosis of TOA was confirmed, although the lesion responded to a conservative surgical technique through enucleation and dressing, presenting a excellent result.

Diagnostic value of Achilles tendon shear wave elastography in patients with ankylosing spondylitis: A case-control study.

Ankylosing spondylitis (AS) can cause peripheral arthritis, tendinitis, enthesitis, and axial skeletal involvement. This study aims to determine early tendon damage by shear wave elastography (SWE) for the Achilles tendon in AS patients. 48 AS patients and 48 asymptomatic individuals were included in the study. Participants were systematically examined with B-mode, power Doppler, and SWE using a high-resolution linear 6-15 MHz probe. Bilateral Achilles tendon stiffness, thickness, and vascularity were evaluated. Measurements were taken from the middle third of the Achilles tendon in the sagittal plane. Difference between the two groups was evaluated with statistical methods. Receiver operating characteristic analysis was performed to test the diagnostic performance of Achilles tendon stiffness. Additionally, the Spearman correlation test examined the relationship between Achilles tendon stiffness and disease duration. The difference between the two groups regarding Achilles tendon stiffness was statistically significant (p < 0.05). It was observed that Achilles tendon stiffness decreased in the patient group compared with the control group. The diagnostic value of Achilles tendon stiffness measured by SWE was found to be high. A negative correlation was detected between disease duration and tendon stiffness (p < 0.05). In patients diagnosed with AS, deterioration in the Achilles tendon structure was observed, and a significant decrease in tendon stiffness compared with the healthy population. It has been determined that these changes in the Achilles tendon are related to the duration of the disease.

Effect of the timing of primary endodontic treatment and dosage of radiation therapy on the filling material removal.

This study investigated the effect of the timing of primary endodontic treatment and dosage of radiotherapy on the remaining filling material (RFM) during endodontic reintervention. 60 single-rooted human mandibular premolars were distributed into five groups (n = 12), according to the timing and dosage of radiation (55Gy or 70Gy): NegativeCG-non-irradiated teeth; Endo-pre-RT55/70-obturation before irradiation (55Gy or 70Gy); Endo-post-RT55/70-obturation and reintervention after irradiation (55Gy or 70Gy). Roots were cleaved and analysed under stereomicroscope and Scanning Electron Microscope to quantify (%) the RFM. Experimental groups had a significantly greater amount (p < 0.05) of RFM in the middle and apical thirds than the control group, except for Endo-pre-RT55 in the middle third (p < 0.0001). The apical third had greater amount of RFM (p < 0.05). Radiation therapy, before and after primary endodontic treatment, increased the amount of RFM, regardless of the dose delivered. When necessary, reintervention preferably must be performed before radiation therapy.

Is Using a Ring External Fixator in the Treatment of Congenital Pseudarthrosis of the Tibia Associated With Better Results or Using a Locking Plate?

Congenital pseudarthrosis of the tibia (CPT) is a rare disease. CPT is often unilateral and occurs between the middle and distal third of the tibia. Concurrent involvement of the fibula is present in more than half of cases. histologic studies indicate the presence of fibrous hamartoma tissue and a sick periosteum, which leads to recalcitrant bone fracture and, eventually, pseudoarthrosis. Although there are various surgical techniques, we intend to compare the 2 methods of external fixation versus internal plating. Demographic data were collected from 26 patients with frank pseudoarthrosis. After exclusion criteria, patients were compared in groups A (12 patients) and B (11 patients). Resection of hamartoma and sclerotic bone, intramedullary rodding and autologous bone, and periosteal grafting were performed for all patients. In group A, we used a ring external fixator for compression and rotational stability, but in group B, a locking plate was used for these purposes. Plating takes less time to use during surgery. In group A, the primary bony union was obtained in 67% of patients, while in group B, 82% of patients had a primary union. Meanwhile, the average time till the final union in group A was 6 months, while in group B, this time was 3.5 months. Positive union mass was obtained in 58% of the patients in group A and 82% of group B. In addition, plating prevented ankle valgus deformity in group B. Permanent intramedullary rodding is a surgical requirement for correction of deformity and refracture prevention, but additional stability can be achieved with the use of a ring external fixator or internal plate. Cross union and positive union mass are 2 important factors in the treatment of pseudoarthrosis; these results are achieved to a greater extent and in a shorter period of time using the plate. level IV - case series.

An in-vitro study on effects of laser activation on dye penetration in human root dentin.

To evaluate the penetration of a dye in root dentin after activation with different laser wavelengths. Palatal roots of 38 human molars were enlarged and disinfected. Irrigation activation was performed with an Er:YAG laser: @50 mJ, 15 Hz (Er:YAG); a 9.3 µm CO2 laser: @40% power (CO2); diode lasers 455 nm/970 nm: @0.8 W, 15 Hz (D455, D970) and 808/980 nm: @1 W (D808, D980) and compared to positive control: etching with 35% H3PO4 (POS); negative control: water (NEG) and conventional needle irrigation: NaOCl and ethylenediaminetetraacetic acid (EDTA) (CONV). Methylene blue solution was introduced in the canal and laser-activated or left untouched for 100 s before the roots were dried and cut into horizontal slices. Dye penetration was automatically calculated by color recognition of two samples per root third (n = 8 per group in each coronal, middle and apical root thirds). The presence and absence of a smear layer was checked in two additional samples of the negative and positive control under scanning electron microscopy (SEM). Full-depth infiltration was not achieved in any group. Dye penetration in CONV was significantly less than in Er:YAG, CO2, POS, D455, D970, D808 and similar to NEG and D980 when results of different root thirds were pooled. Laser activation using certain parameters enhanced dye penetration compared to conventional needle irrigation with NaOCl and EDTA (CONV).

Posterior Tibial Artery Perforator Flap for Reconstruction of Soft Tissue Defects in the Middle and Lower Thirds of Leg and Ankle Region: A Prospective Observational Study

Posterior Tibial Artery Perforator Flap for Reconstruction of Soft Tissue Defects in the Middle and Lower Thirds of Leg and Ankle Region: A Prospective Observational Study

Tendinopathy of the superficial flexor of the finger in horses: morphological changes in the middle third of the pastern

A feature of the training process in riding sports horses is the repeated uneven maximum weight loads on the limbs and, in particular, on their tendon-ligamentous apparatus. The study used the tendons of the superficial flexor of the pectoral and pelvic extremities of sports horses that died from causes unrelated to tendon injuries. Tendinopathy was diagnosed in all animals during their lifetime. Isolated hands of the thoracic limb and feet of the pelvic limb were selected, as well as samples of the tendon of the superficial flexor of the finger of 15 sports horses aged 6 to 15 years. Histological studies were carried out according to a generally accepted technique: the material was fixed in a 10% formalin solution, poured into paraffin, sections were prepared, which were stained with hematoxylin and eosin to identify the general morphological picture, according to Van Gieson to assess the condition of bundles of collagen fibers and alcyan blue to identify glycosaminoglycans. The micropreparations were studied using Jenamed-2 and MicroScreen microscopes. As a result of the conducted research, original data were obtained. Signs of chronic inflammation, numerous foci of tissue destruction in combination with moderate reactive changes in the tissue indicate a long, long-term course of the pathological process. Since the tendon is a moderately vascularized tissue, insufficient perfusion does not allow maintaining redox processes at the required level. Therefore, in conditions where metabolism is restored in well-vascularized skeletal muscles, this process has not yet been completed in tendons. The conditions of hypoxia themselves create a background for the development of connective tissue and sclerosis. It is possible that this is how the signs of sclerosis gradually increase in the epithenonia and perithenonia, as well as in the walls of blood vessels, which were identified in our studies.

Three-Dimensional Measurement of Obturation Quality of Bioceramic Materials in Filling Artificial Internal Root Resorption Cavities Using Different Obturation Techniques: An In Vitro Comparative Study

IntroductionPathologic conditions such as internal root resorption (IRR) may complicate root canal filling. This study aimed to evaluate and compare the obturation quality by measuring the percentage of obturation volume (POV) in root canals with artificial IRR obturated with different materials and techniques using cone beam computed tomography (CBCT). MethodsForty single canal extracted mandibular premolars were decoronated to standardize their length to 14 mm. Following instrumentation, the roots were cut horizontally, and artificial IRR cavities were made at the level of 7 mm from the apex. The root halves were joined using cyanoacrylate adhesive. The samples were randomly assigned to 4 groups (n = 10), and the canals were filled as follows: single-cone technique (SC), bulk-fill Bio-C Sealer (BF), and Bio-C Repair for the coronal and middle third (BCR) + cold lateral condensation technique (CLC) for the apical third and continuous wave compaction technique (CWC). The pre- and postobturation volumes and the POV were measured in the total canal and for the apical, middle, and coronal thirds separately using CBCT and Mimics Medical software. The results were analyzed statistically using one-way ANOVA and Tukey HSD test, and statistical significance was set at P < .05. ResultsBF group resulted in significantly lower total, coronal, middle and apical POV values compared to SC, BCR + CLC, and CWC groups (P < .05), respectively. Also, at the apical third, the BCR + CLC group showed significantly lower POV than the SC and CWC groups (P < .05), respectively. The intra-group comparison showed that BF and BCR + CLC groups had a significantly lower POV in the apical third compared to the middle third (P < .05). Conversely, the CWC group had a significantly higher apical POV than the middle third (P < .05). ConclusionsThe maximum POV was obtained using the CWC technique, Bio-C Repair, and SC technique with Bio-C Sealer, making their application in IRR more preferable than the BF Bio-C Sealer.

Assessment of different irrigation techniques on the penetration depth of different sealers into dentinal tubules by confocal laser scanning microscope: An in vitro comparative study

Abstract Background: The effective disinfection of the entire root canal system aids in the penetration of irrigants into the dentinal tubules further improving sealer penetration and achieving a three-dimensional seal in endodontically treated teeth. Various final irrigation techniques can be employed to achieve this goal. Therefore, this study intended to assess and compare the efficacy of three final irrigation techniques on the depth of penetration of two root canal sealers into dentinal tubules using confocal laser scanning microscope (CLSM). Methods: Forty-eight single-rooted mandibular premolars were selected and decoronated to a length of 12 mm. All the samples were prepared using ProTaper Gold rotary files and divided into three groups: Group 1 – Conventional syringe irrigation (CSI), Group 2 – passive ultrasonic irrigation (PUI), and Group 3 – Pro-agitator tip system (PATS). Each group was divided into two subgroups: Subgroup A – AH Plus and Subgroup B – GuttaFlow Bioseal (GFB). Then, sealers were mixed with 0.1% rhodamine B dye and the samples were obturated. All the samples were sectioned at 2 mm and 5 mm from the apex and visualized under confocal laser scanning microscope (CLSM) (10×) for maximum mean penetration depth and percentage of sealer penetration. Statistical analysis was done using the independent t-test and one-way analysis of variance test, followed by Tukey’s Post hoc analysis. Results: PUI performed better in the apical third, whereas PUI and PATS showed comparable results in the middle third for both depth and percentage of sealer penetration. Among the two sealers, GFB performed better than AH Plus in both the apical and middle third. These values were statistically significant. (P &lt; 0.05). Conclusion: Final irrigation activation with PUI or PATS can significantly improve sealer penetration. The average depth of penetration of GFB both at the middle and apical third of the root was significantly superior to AH Plus.

Comparative Evaluation of Volume and Homogeneity of Obturation with Four Different Obturation Systems Using Micro-Computed Tomography: An In vitro Study

ABSTRACT Aim: To evaluate and compare volume and homogeneity of the three different root canal obturation systems. Materials and Methods: Single-rooted premolar (n = 24) teeth samples were selected, and crowns were removed for standardization. Four groups are divided randomly as (n = 6), namely: For group I (single-cone gutta-percha obturation), group II (Beefill 2 in 1 obturation), group III (GuttaCore obturation), group IV (GuttaFlow bioseal obturation) and the root canal were subjected to prepare till X3 (protaper next) and subjected to micro-CT imaging. After completion of obturation, the image was taken by using micro-CT imaging. This is to evaluate the volume of filled obturation material in the canal space and the voided area sections, viz. the apical, middle, coronal, and third sections. Results: Group III (GuttaCore obturation) showed the least significant mean of the difference in relation to the volume of the canal obturation (81.148). The least mean significant difference in area of voids in the canal region for apical (0.00133), middle (0.00233), and coronal thirds (0.00533). The most statistically significant difference is in the apical and middle thirds root canal space. Conclusion: All the experimental groups showed significant differences in volume and voids in the obturation at three different levels, and the GuttaCore obturation systems occupied more of the volume with less voids in the prepared root canal space.

Efficiency of Canal Brush and Ultrasonic Activated Irrigation in Smear Layer Removal Using Two Different Chelating Agents (In Vitro Study)

Objective: This study aims to evaluate the efficiency of two different activation methods after using two different chelating agents inthe removal of the smear layer.&#x0D; Methods: In this study, seventy single-rooted mandibular premolar teeth were included, and divided into six study groups and onecontrol group according to the chelating agents and activation methods used. In groups 1,3, and 5, EDTA was used as the chelatingagent, where it was activated by Canal Brush in G3 and by Ultra Smart in G5. In groups 2,4, and 6, 7% Maleic acid was used insteadand activated by Canal Brush in G4 and Ultra Smart in G6. While in G1 and G2, no activation systems were used. The 7th group wasa negative control and purposed to verify the internal microstructure, so only distal water was irrigated (no activation and no chelatingagent was used). Samples were sectioned longitudinally and prepared for Scanning Electron Microscope (SEM) analysis in the coronal,middle, and apical parts. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. The level of significancewas set to 0.05 (P &lt; 0.05).&#x0D; Results: Although the G5 (Ultra Smart +EDTA) median score showed the best smear layer removal score, it was not statisticallysignificant in comparison with the other 5 study groups. In all groups (whether Maleic acid or EDTA were used), smear layer removalwas effective in the coronal and middle thirds while less effective in the apical third, with no statistically significant difference betweenthe chelating agents.&#x0D; Conclusions: Under the limitations of this in vitro study, no activation system was able to remove the smear layer from the root canalwall completely. However, NaOCl and EDTA's irrigation sequence combined with Ultra Smart (ultrasonic activation) obtained betterresults than the other techniques.

An in vitro evaluation of Icon resin infiltrant penetration into demineralized enamel lesions using an indirect staining technique with confocal laser scanning microscope analysis in dual fluorescence mode

Abstract Context: White spot lesion is the first clinical sign of a caries lesion and represents mineral loss from the enamel subsurface. Aim: The aim of this study was to evaluate the penetration depth (PD) of Icon resin infiltrant into artificially demineralized enamel lesions using confocal laser scanning microscope (CLSM) analysis in dual fluorescence mode. Settings and Designs: The design of the study was an in vitro study. Materials and Methods: 22 extracted human permanent maxillary central incisor teeth were collected, and enamel sections were obtained from the coronal middle third. All enamel specimens were exposed to demineralization and remineralization solutions for 14 days. On positive confirmation of enamel demineralization by scanning electron microscope analysis, 20 specimens were then subjected to Icon resin infiltration following manufacturer instructions. Specimens were processed with indirect staining technique using rhodamine B and sodium fluorescein dyes and examined under CLSM at ×10 magnification in dual fluorescence mode using ImageJ software to evaluate PD of resin infiltrant into demineralized enamel lesions. Statistical Analysis Used: Obtained data were analyzed using an independent t-test. P ≤0.05 was considered statistically significant. Results: The maximum depth of demineralized enamel lesion was 590 μm, and the mean depth was 290.78 ± 14.80 μm. The maximum depth of resin infiltrant penetration was 580 μm, and the mean depth was 279.08 ± 13.88 μm; P = 0.006. The percentage penetration of resin infiltrant was 95.99%. Conclusion: Icon resin infiltrant was highly effective in its depth of penetration into demineralized enamel lesions. The use of indirect staining and CLSM analysis in dual fluorescence mode is more reliable and accurate technique to evaluate the PD of resin infiltrant.

‘Methodism Alive’: Mass Observation's Worktown Perspective

Abstract This paper explores the potential of the Mass Observation Archive at the University of Sussex for studying the history of Methodism in Bolton (aka ‘Worktown’) during the middle third of the twentieth century, with particular reference to the years 1937–40 and 1960, demonstrating its value for recording the lived experience of Methodism. An appendix contains three key documents, two of them relating to the work of the Victoria Hall in the Bolton Mission circuit, which was much lauded by Mass Observation.