Access Opening Research Articles

Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study.

There is a dearth of studies to assess the effectiveness of cryotherapy as a possible adjuvant in anesthesia. Therefore, this study aimed to compare the impact of pretreatment intraoral ice packs, application of Endo-ice, and a combination of Endo-ice and intrapulpal ice sticks use on the effectiveness of pulpal anesthesia as an adjunct in the management of pain and dental anxiety in mandibular second molars with symptomatic irreversible pulpitis (SIP) against traditional inferior alveolar nerve block (IANB) technique. The randomized controlled double-blind clinical study comprised of 200 subjects within the age group of 20-45 years with SIP involving mandibular second molars and divided into four groups of 50 each. Conventional IANB was administered in group 1. Intraoral compact ice packs, Endo-ice, and combined use of Endo-ice and intrapulpal ice sticks were employed following conventional IANB in groups 2, 3, and 4, respectively. The intensity of pain and anxiety before and after the intervention was documented using Heft-Parker visual analog scale (HP-VAS) and Corah's Dental Anxiety Scale-Revised (DAS-R). The average age of the overall study sample was 30.8±2.08 years, and the differences in age and gender distribution were found to be statistically insignificant. The mean HP-VAS scores on access opening and pulpectomy, using ANOVA paired with Tukey's post hoc multiple comparison tests were evaluated to be statistically highly significant (p<0.001). The greatest reduction in HP-VAS score was observed in group 4 receiving combined use of both Endo-ice and intrapulpal ice sticks. While the pretreatment DAS-R score was determined to be statistically insignificant between groups, group 1 subjects had the highest DAS-R score postoperatively (p<0.001). The effectiveness of pulpal anesthesia was found to be 84%, 96%, 92%, and 98% for groups 1 through 4, respectively, and demonstrated a statistically significant difference. The combined use of Endo-ice and intrapulpal ice sticks used as an adjuvant to local anesthesia (LA) was found to be significantly effective in lowering pain compared to the control groups in molars with SIP. Cold administration before and during the procedure was more effective than conventional LA in lowering intraoperative anxiety. Furthermore, the use of Endo-ice and intrapulpal cold after IANB significantly improves the effectiveness of pulpal anesthesia in mandibular second molars with SIP.

Management of Hot Irreversible Pulpitis with Radix Entomolaris: An Uphill Battle for a Pediatric Dentist. A Case Report.

Background: Hot tooth with Radix Entomolaris anomaly is rarely occurring condition. To achieve anesthesia satisfactorily in patients with a Hot tooth, especially in pediatric cases, can be seriously challenging for the pediatric dentist. Hot Irreversible pulpitis is most commonly found in permanent mandibular first molars, where the patient may experience severe or intense acute pain during the access opening procedure, even after the anesthetic block. The present case report describes the hot tooth, causes for anesthetic failure and some of its management techniques with a case report.&#x0D; Keynote: To the best of our knowledge, this Case report is the first report of Hot tooth Syndrome with Radix Entomolaris treated under multiple Pain and Anxiety control methods.

Comparative evaluation of apical debris extrusion during root canal preparation using three different rotary file systems

Background: Endodontic success depends on the complete cleaning and shaping of the root canal. In order to achieve this goal, debris removal is essential. Even with improvements in instrument design, apical debris extrusion continues to be a cause of periradicular inflammation. The current study aimed to compare the amount of apically extruded debris throughout the canal instrumentation with TruNatomy, ProTaper Next, 2Shape rotary systems. Methods: A total of 60 freshly extracted single‑rooted mandibular premolars were use. An access opening was made, and a working length was estimated. The samples were arbitrarily allocated into three groups i.e. Group I: TruNatomy (n = 20), Group II: ProTaper Next (n = 20), Group III: 2Shape (n = 20). During the canal instrumentation, the extruded debris were collected in preweighed Eppendorf tubes. Post-instrumentation, the tubes were placed in a hot air oven at 140°C for five hours. For calculating the dry debris weight, the tube’s pre-instrumentation weight was deducted from the post-instrumentation weight. The data was analysed using one‑way analysis of variance and post hoc Tukey’s test. Results: Extrusion of debris was noted in all the specimens. TruNatomy rotary system showed least debris extrusion in comparison to ProTaper Next and 2Shape (P &lt; 0.05). However, the results were statistically non-significant between ProTaper Next and 2Shape (P &gt; 0.05). Conclusions: It was noted that all instruments apically extruded debris, with TruNatomy system being related to minimum extrusion.

REPRESENTASI PEREMPUAN DI POLITIK

The political representation of women sticks out in the midst of domination and hegemony of patriarchal culture in various dimensions of life, especially in the political space. There is a kind of socio-political obstacle that forces women to double their capital and power, which must be spent more heavily and complicated than men when they enter politics. This study wants to see how far the role of women legislators in the NTT Provincial DPRD for the 2019-2024 period is in carrying Political parties and are in accordance with the interests of the categorization of women members of the legislature. The strategy for dividing positions for women is also quite diverse. Women have political hopes that are placed on increasing access power and opening up political opportunities to occupy strategic positions such as important positions or involvement in the decision-making process in political parties. The hope for increasing access is related to increasing the capacity of individual women and youth in political parties. Increasing women's access to strategic positions in political parties. This political hope emphasizes the importance of women and youth to have economic, social and political capacities. Economic capacity relates to financial resources, social capacity refers to social relations and networks, and political capacity relates to political knowledge and skills

Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Chlorhexidine, and Triple Antibiotic Paste in Different Combination Forms as Intracanal Medicaments against Enterococcus faecalis in Primary Teeth: An In Vivo Randomized Clinical Trial.

To compare and evaluate the antimicrobial efficacy against Enterococcus faecalis (E. faecalis) between a mix of calcium hydroxide [Ca(OH)2] powder and normal saline, a mix of Ca(OH)2 powder and 2% chlorhexidine (CHX) gluconate solution, a mix of triple antibiotic powder (TAP) and normal saline, and mix of TAP and 2% CHX gluconate solution. A total of 60 teeth were included in the study. The first sample (S1) was collected after access opening from the widest canal of the tooth by inserting sterile absorbable paper point no 20 up to the full length of the canal for 1 minute. The second sample (S2) was collected after the chemomechanical preparation and irrigation. After that, subjects were randomly divided into four groups-group I-a mix of Ca(OH)2 and normal saline; group II-a mix of Ca(OH)2 and 2% CHX; group III-a mix of TAP and normal saline; and group IV-a mix of TAP and 2% CHX. Assigned intracanal medicaments were placed in the canals, and the teeth were temporarily sealed with a temporary restorative material. On the 7th day, canals were reopened and irrigated, and a third bacteriological sample (S3) was taken out. Later, canals were filled with suitable obturating material, followed by the placement of the permanent restoration. There was a very highly significant (p < 0.005) difference in E. faecalis count in all the groups on day 7 after placement of intracanal medicament, being highest in group IV followed by group II, group III, and group I. Triple antibiotic powder (TAP) mixed with 2% CHX gluconate solution has superior antimicrobial efficacy against E. faecalis in primary teeth. Qamar S, Jayanna R, Ahuja VR. Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Chlorhexidine, and Triple Antibiotic Paste in Different Combination Forms as Intracanal Medicaments against Enterococcus faecalis in Primary Teeth: An In Vivo Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(3):448-452.

Using intraoral scanners and STL files to study endodontic access openings.

Journal of Dental EducationAccepted Articles ADVANCING THROUGH INNOVATION Using intraoral scanners and STL files to study endodontic access openings Shiva Farrahi, Shiva Farrahi DMD student, College of Dentistry, University of Saskatchewan, Saskatoon, SK, CanadaSearch for more papers by this authorDiego Machado Ardenghi, Diego Machado Ardenghi orcid.org/0000-0001-5368-7975 Associate Professor, Division of Restorative Dentistry, Dept. of Oral Health Sciences, Faculty of Dentistry, University of British Columbia (UBC), Vancouver, BC, CanadaSearch for more papers by this authorRenata Grazziotin-Soares, Corresponding Author Renata Grazziotin-Soares [email protected] orcid.org/0000-0002-7843-4103 Assistant Professor, Division of Endodontics, Dept. of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia (UBC), Vancouver, BC, Canada Correspondence Renata Grazziotin, Faculty of Dentistry, J.B. Macdonald Building, The University of British Columbia, 320-2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada. Email: [email protected]Search for more papers by this author Shiva Farrahi, Shiva Farrahi DMD student, College of Dentistry, University of Saskatchewan, Saskatoon, SK, CanadaSearch for more papers by this authorDiego Machado Ardenghi, Diego Machado Ardenghi orcid.org/0000-0001-5368-7975 Associate Professor, Division of Restorative Dentistry, Dept. of Oral Health Sciences, Faculty of Dentistry, University of British Columbia (UBC), Vancouver, BC, CanadaSearch for more papers by this authorRenata Grazziotin-Soares, Corresponding Author Renata Grazziotin-Soares [email protected] orcid.org/0000-0002-7843-4103 Assistant Professor, Division of Endodontics, Dept. of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia (UBC), Vancouver, BC, Canada Correspondence Renata Grazziotin, Faculty of Dentistry, J.B. Macdonald Building, The University of British Columbia, 320-2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada. Email: [email protected]Search for more papers by this author First published: 06 June 2023 https://doi.org/10.1002/jdd.13293 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as https://doi.org/10.1002/jdd.13293 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Comparative Evaluation of a Dynamic Navigation System versus a Three-dimensional Microscope in Retrieving Separated Endodontic Files: An In Vitro Study

IntroductionThis study aimed to compare the effectiveness of a dynamic navigation system and a three-dimensional microscope in retrieving broken rotary Nickel-Titanium files when using trepan burs and the extractor system. Materials and MethodsThirty maxillary first bicuspids with 60 separate roots were split into 2 comparable groups based on a comprehensive cone beam computed tomography analysis of the root length and curvature. After standardized access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated Nickel-Titanium rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time, and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05. ResultsThe microscope-guided group had a higher success rate than the dynamic navigation system guidance, but the difference was insignificant (P > .05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, shorter time to retrieve the fragments and less change in the root canal volume (P < .05). ConclusionAlthough dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.

Minimally invasive access cavities in endodontics

Background: The access cavity is a critical stage in root canal therapy and it may influence the subsequent steps of the treatment. The new minimally invasive endodontic access cavity preparation concept aims to preserve sound tooth structure by conserving as much intact dentine as possible including the pulp chamber's roof, to keep the teeth from fracturing during and after endodontic treatment. While there is great interest in such access opening designs in numerous publications, still there is a lack of scientific evidence to support the application of such modern access cavity designs in clinical practice. This review aims to critically examine the literature on minimal access cavity preparations, explain the effect of minimally invasive access cavity designs on various aspects of root canal treatment, and identify areas where additional research is required. Data: An electronic search for English-language articles was performed using the following databases: Google Scholar, PubMed, and Research Gate. The following keywords were used: "minimally invasive access cavity", "conservative endodontic cavity ", and "classification of access cavity". Study selection: 64 papers that were the most relevant to the topics in this review were selected between 1969 to 26 February 2022. Conclusions: Minimally invasive access cavities can be classified into conservative, ultraconservative, truss access, caries and restorative-driven cavities. There is a deficiency of proof that a minimally invasive access cavity maintains the resistance to fracture of endodontically treated teeth greater than traditional access cavities. There was no difference in the percentage of untouched walls and debris removal in teeth with conservative vs traditional access cavities, however, truss and ultraconservative access cavities resulted in poor irrigation efficacy compared to traditional ones. Also, the lower cyclic fatigue resistance of rotary instruments and root canal obturation with voids were associated with minimally invasive access cavities. The studies about minimally invasive access cavities still have a wide range of methodological disadvantages or register unsatisfactory or inconclusive results. Therefore, further research on this topic is needed especially with the everyday advancement of techniques and armamentarium used in endodontics.

Analysis of Multiple Usages of Protaper Rotary Instruments before Initial Signs of Failure: An In-vitro Study

Aim: The study aimed to evaluate the number of canals safely enlarged with Protaper instruments before the instrument showed initial signs of failure.&#x0D; Materials and Methods: Freshly extracted 100 human molar teeth with canal curvature &lt; 200 were included in the study. Group 1(PTU SX files) (n=50): Instrumentation was done with Pro taper Universal files, Group 2 (PTG SX files) (n=50): Instrumentation was done with Pro taper gold rotary files. The total number of root canals considered for instrumentation in each group was 150. After the access opening of all teeth, canal patency was checked and the SX files of PTU were instrumented in 50 teeth, and the SX files of PTG were instrumented in another 50 teeth. The SX files were checked for any signs of failure after each use under the Dental operating microscope. The number of canals enlarged before showing the signs of failure was noted.&#x0D; Statistical Analysis: The data were analyzed with the independent t-test.&#x0D; Results: The difference was statistically significant with a p value of 0.006 in the number of canals enlarged by PTU SX files and PTG SX files without showing any signs of failure. The mean number of canals enlarged using PTG SX files was 10 ± 1.054 compared to PTU SX files (8.6 ± 0.966).&#x0D; Conclusions: PTG SX files were used in more canals than PTU SX files, before showing initial signs of failure thereby showing the more efficiency of gold files.

Porous organizational boundaries and associated states: introducing memberness in international organizations.

The current binary understanding of membership in international organizations (IOs), especially regional organizations (ROs), creates blind spots and biases in our understanding of who matters in IOs, as well as why and how they matter. Existing scholarship primarily looks at full member-states or non-state actors to capture who influences such organizations. Associated states are often portrayed as passive receivers of IO rules instead of active contributors. We address this blind spot and resulting analytical bias by exploring what types of association relationships exist and how they impact IOs. We propose a novel conceptualization of membership that we call memberness. On the level of IOs, memberness is based on the relative openness of organizational boundaries and stratified access via material and ideational contributions. On the level of states, memberness captures associated states' individual choices to contribute materially and/or ideationally to an IO. Memberness moves away from a purely rights-based understanding of membership (or who you are in an IO) to include a capacity-based understanding (or what you do in an IO). This shift in focus uncovers new channels of influence on IOs. Associated states' material and ideational contributions to IOs constitute three memberness types: payroller, sponsor, and advisor. We argue that these memberness types impact IOs' vitality, design, and performance in previously unrecognized ways. We illustrate these types with empirical examples from ROs across the globe and discuss the implications of memberness for IO research programs.

GLOBAL TEACHER FORUM: ROLE AND IMPACT FOR ENGLISH TEACHER

&lt;p&gt;The openness of access to information supported by an adequate infrastructure of technology systems makes barriers between countries disappear. The internet has indirectly united the world's citizens in one network. The internet provides unlimited information that can be utilized by every user, including teachers as educators. In its development, a global teacher forum emerged which was designed as a medium of communication, collaboration, and various other purposes. This study aims to look at the role and impact of global teacher forums on English teachers using a qualitative descriptive method. Data was collected using the SLR (Systematic Literature Review) technique from various sources. To sharpen the findings, researchers also collect data through interviews with English teachers. The results of the study reveal that global teacher forums have an educational role, a teaching resource role, and a collaborative role among various stakeholders. Meanwhile, at the impact level, research reveals that the global teacher forum has an impact on increasing collaboration, teaching quality, strengthening communities, encouraging innovation, and representing the interests of teachers globally&lt;/p&gt;

Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules.

The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage. Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM. The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05). SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

ФІНАНСОВИЙ РИНОК ЯК РУШІЙ ГЛОБАЛІЗАЦІЙНИХ ЗМІН ТА ЙОГО ЗВ’ЯЗОК ІЗ РІВНЕМ ФІНАНСОВОЇ БЕЗПЕКИ

The study focuses on the lack of effective implementation in connecting financial security and the functioning of the financial market, which leads to potential losses in solving socio-economic problems. To comprehensively consider the set of determinants that form the general course of development of financial security and the financial market, the special role of globalization is indicated. Globalization has a deep impact on world social relations and occupies an important and decisive place in solving major problems of national security. At the same time, the role of the financial market as a driver of globalization processes dictates the need for practical implementation of fundamental foundations and changes in the organization of the financial market related to globalization. The financial market has an inherent system-forming function regarding the financial system, and its integration into the financial space indicates its ability to contribute to or pose a threat to the stability of the financial system and the strengthening of financial security. It is argued that discovering ways to accumulate the potential of both spheres is associated with the opening of additional access within the financial market to organic sources of strengthening financial security, in addition to mechanical sources. Mechanical sources are characteristic of financial security and the financial market in the plane of relatively isolated systems, while organic sources are actively generated by horizontal links within the bounds of alternative ways of development of the financial market and financial security. It is emphasized that the conceptual transformation of relations in the "financial security – financial market" chain lies in the plane of dialectical interaction between them, based on the controlled integration of their strategic goals and potential. This transformation actively affects the functional and organizational models of financial security and financial market functioning, contributing to the overall transformation of their development mechanism from the currently prevailing mobilization one into an innovative one that asserts the advanced characteristics of development by activating intensive sources.

Comparative evaluation of effect of different premedication agents on efficacy of Articaine: A randomized contol trial.

Original Research. To comparatively evaluate the effect of different premedication agents on the efficacy of 4% Articaine in teeth with symptomatic irreversible pulpitis. The primary objective of our study is to evaluate the effect of premedication agents on efficacy of Articaine as an oral anesthetic. Our secondary objective is to comparatively evaluate the efficacy of Diclofenac patch, Ibuprofen tablet, Paracetamol tablet and Placebo as a premedication agent. Patients with 25-40 years age, no systemic disease, no history of medication for that complaint, with pain on Heft Parker Visual Analog Scale between 55mm and 170mm (VAS), no tenderness on percussion, cold test and EPT negative- Positive, giving proper consent, coming to the Department of Conservative Dentistry and Endodontics were allowed to participate. The exclusion criteria include the following- Non-vital teeth, pregnant and lactating women, allergic to Articaine and NSAIDs, active systemic disease, immune-compromised patients, taken analgesics in last 24h, root fractures, restoration extending to pulp10 and periapical pathologies (except periodontal ligament widening).Preoperatively pain was recorded using Heft Parker VAS (Visual Analog Scale). Cold testing, palpation, percussion and EPT were carried out. 40 patients having symptomatic irreversible pulpitis were randomly divided into 4 groups: group 1 Placebo (n=10), group 2-Diclofenac patch (n=10), group-3 Ibuprofen tablets (n=10), group 4-Paracetamol tablets (n=10). After 1h of premedication, all patients were administered IANB injection using 4% Articaine (Septanest with adrenaline 1/100000, Septodont, France) containing epinephrine 1:100000. 15 mins after administration of IANB, patients were asked about symptomatic numbness and was tested with Endo frost and EPT and Outcome was recorded. If lip numbness was present, Electric Pulp Testing and Cold Test give negative result then endodontic access opening was performed and pain was recorded using visual analog scale. The study was conducted for a period of 1.5 years. During the access cavity preparation only 1 subject in the Group III reported pain while in other groups none of the subjects reported pain of any type. When the intergroup comparison was made of intensity of pain 15min after LA and during access cavity preparation, the difference between the groups was statistically non-significant when analyzed using One Way ANOVA. The intragroup comparison between three time intervals revealed significant reduction in the pain scores from the pre-treatment levels in all the four groups. The results of the study showed that there is no significant effect of different premedication agents on the efficacy of 4% Articaine in teeth with symptomatic irreversible pulpitis.

Incidence and Intensity of Pain Following Endodontic Treatment by Different Instrumentation Techniques in Teeth With Periapical Lesion.

This study was carried out to compare the effectiveness of hand and rotary instrumentation techniques on postoperative pain in asymptomatic necrotic premolars with periapical lesions and instrumented by a modified step-back technique using a K file, crown down by continuous rotary motion technique using ProTaper Universal (Dentsply Mailefer, Ballaigues, Switzerland), and with the reciprocation technique using WaveOne (Dentsply Sirona, Charlotte, NC, USA). For this study, 66 premolars with single roots and canals were chosen. The procedure was completed in a single visit. Following access opening, the working length was initially determined using an apex locator and then confirmed after inserting K file #10 by radiograph. The canal was cleaned and shaped using a grouping system. After the masterapical preparation, the canal was dried by paper point and obturated with gutta-percha and AH plus sealer, an epoxide-amine resin pulp canal sealer. In order to confirm the obturation, a radiograph was taken. After that, a permanentrestoration material was used to seal the access cavity. Following that, patients to whom the visual analog scale (VAS) had already been explained were contacted by phone at six, 12, 24, and 48 hours. In this study, compared to a stainless steel instrumentation technique, WaveOne instrumentation caused more noticeable pain. The results of the current study showed that, on average, postoperative pain scores decreased over the course of the 12to 48-hour period, reaching a minimum or a maximum at 48 hours (p<0.01). Postoperative pain was produced by all instrumentation methods used in the study. In comparison to ProTaper and WaveOne, instrumentation using the modified step-back technique with K files caused less pain, especially over the course of a 24-hour period.

Return on investment from service transformation for young people experiencing mental health problems: Approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi-site pan-Canadian youth mental health project.

Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings. As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses. Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care. Complex interventions such as AOM aim to shift care "upstream": away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.

Salivary cortisol response developed in Patients undergoing Dental treatment

Aims and objective: The stress control is essential in patients to elude the loss of motivation for Dental procedures .The present study was conducted to estimate salivary cortisol response to stress developed in patients undergoing Dental treatment Methodology : 36 patients had their salivary cortisol levels measured; 30 of them were in the study group and had had root canal, apicoectomy, tooth preparation, and impression-making procedures for the fixed prosthesis. Six of the patients were healthy individuals who didn’t need any dental treatment.The groups demarcated were as follows. Group 1: Control group with no treatment and just the saliva sample was taken. Group 2 ; The patients undergone access opening, Biomechanical preparation and obturation Group 3 ; The patients undergone apicoectomy procedure Group 4 ; The patients undergone tooth preparation and impression making for fixed prosthesis . The salivary cortisol levels were evaluated using Salivary Cortisol Enzyme Immunoassay Kit. Results : The salivary cortisol level was highest in Group 3,followed by Group 2 ,Group 4 and least in Group 1. Conclusion The stress level was lowest in healthy patient and highest when patient underwent apicoectomy procedure in appointment .

Comparison of the temperature changes in pulp using monophasic light-emitting diode curing unit at different exposure times: An in vivo study

This invivo study evaluated the temperature changes in the pulp chamber at different exposure times using a monophasic light-emitting diode curing unit. Forty-five patients (aged 13-25 years) requiring extraction of maxillary first premolars for orthodontic reasons were included in the study. After access opening, the temperature rise was recorded when exposed to monophasic light-emitting diode curing light (Elipar 3M ESPE; Pymble, New South Wales, Australia) at 5, 10, 15, and 20 seconds with K-type thermocouple probe. Teeth were atraumatically extracted on the same day. The results were analyzed with an analysis of variance and the Bonferroni test. There was a significant increase of 2.1°C ± 0.5°C of pulpal temperature in the maxillary first premolar tooth during exposure to a light curing unit from baseline to 20 seconds. The mean baseline temperature was 35.7°C ± 0.52°C. The highest mean temperature was recorded at 20 seconds (37.8°C ± 0.57°C), and the lowest mean temperature was recorded at 5 seconds (36.1°C ± 0.61°C). There were significant differences among each group (P<0.001) with a mean increase in pulpal temperature from baseline to exposure mode of 5, 10, 15, and 20 seconds. The study results reveal a statistically significant increase in pulpal temperature with a monophasic curing light, which can be used for up to 20 seconds without causing any detrimental effects on the pulp.

Degree of conversion of light-polymerized composite resin in implant prosthesis screw access opening.

The mechanical and physical properties of implant screw access opening deteriorate if composite resin is not polymerized properly. Therefore, this study aimed to analyze the effect of using composite resin in implant access opening on the degree of conversion (DC). Two prosthetic materials (Co-Cr and zirconia), two types of composite resin (low and high viscosity), two light-cured resin depths (2 and 3mm), and two polymerization methods (max-mode 10s and mid-mode 20s: 16 and 22J/cm2 , respectively) were considered (n=192). The DC of the polymerized composite resin was measured through Fourier-transform infrared spectroscopy. The top and bottom surfaces of the polymerized composite resin body were observed through scanning electron microscopy. Multiple linear regression analysis and analysis of variance were used to identify significant differences in DC (α=0.05). The DC was lower when the low-viscosity composite resin (β=-0.431), light-polymerized resin depth of 2mm (β=-0.430), zirconia prosthesis (β=-0.191), and mid-mode polymerization method (β=-0.164) were used. The resin type, depth of resin to be light-cured, prosthesis material, and polymerization method had an effect on the DC. Low-viscosity composite resin should be polymerized at a low irradiance and long polymerization time (such that the light-cured resin depth does not exceed 2mm) to ensure proper composite resin polymerization in implant screw access opening.

The Urgency of Agrarian Reform Policy: A Study of the Impact of Land Access on Farmer Household Welfare

Abstract: Inequality of land ownership is caused by unequal access to land. This study examined the impact of land access on total farmer's household expenditure. The Agrarian reform policy assumed open and expand access to land for groups of landless or near landless farmer households. Through state-led and market-led approaches, this research provided a categorization of access to land in two ways, which are access opening and access expansion variables with each sample coverage. Using the two periods difference-in-difference (DID) method, this study analyzed the impact of opening and expanding access to the total expenditure of farmer households using IFLS 2007 and 2014 data. The results showed that there is a significant difference in the total expenditures of farmer households due to the opening and expansion of access referring to the land distribution scheme (state-led approach), and there is no significant difference through the market-led approach. Therefore, agrarian reform policies need to be carried out by emphasizing the role of the state in implementing land redistribution to landless and small farmers. Keywords: Agrarian reform, state-led approach, market-led approach, impact of land access, total farmer household expenditure