Postoperative Recall Research Articles

Ten-year follow-up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners

Objective: The aim of this study was to re-assess the adoption of certain endodontic technology and central treatment principles of root canal treatments as advocated by guidelines presented by the European Society of Endodontology.Material and methods: The questionnaire included the same questions in 2003 and 2013. The general dental practitioners (GDPs) anonymously reported how frequent (‘often’, ‘occasionally’, and ‘never’) they used certain endodontic technology and adhered to central treatment principles. The statistical analyses were performed using Chi-squared test and Goodman–Kruskal’s γ-coefficient as an association measure.Results: The overall response rate of the 2013 group was 46.5% (n = 531). The frequencies of GDPs reporting often use of rubber dam, apex locator and rotary NiTi instruments were significantly higher (p < .0001) than in 2003, as well as reporting the use of composite resin for coronal sealing (p < .019). Adoption was significantly influenced by the factors gender (p = .601) and time since graduation (p = .361), and the cluster analyses revealed the neglected use of rubber dam to be associated with no established postoperative recall system.Conclusions: After 10 years, there was a higher frequency of GDPs who had adopted certain endodontic technologies. However, progress towards high-quality root canal treatment might be obstructed as the majority of GDPs avoids consistent use of rubber dam, and routinely neglects recalls for postoperative controls of their endodontic treatments.

The Study of Intraoperative Consciousness after Tracheal Intubation.

Introduction:Awareness following noxious stimuli like intubation could be as high as 25% compared to postoperative recall. The isolated forearm technique (IFT) allows us to assess consciousness by verbal command to move isolated hand. Hence we conducted study to establish IFT responses following intubation under standard general anaesthesia.Methods:We enrolled 132 adult patients undergoing general anaesthesia. A tourniquet was applied on other arm. Following intravenous induction of anaesthesia, torniquet was inflated 100mmhg above systolic BP. After giving muscle relaxant, three minutes patients were ventilated with oxygen and inhalational agent. Before laryngoscopy first verbal command (Squeeze my hand) was given to the patient. Once intubation and tube confirmation done, second verbal command was given. Lack of paralysis in isolated hand was confirmed with TOF stimuli and tourniquet was deflated. Surgery was carried in routine manner. Postoperatively all patients were evaluated for any explicit recall using Modified Brice questionnaire. The primary outcome is number of patients who responded to verbal command postintubation. Secondary outcome is number of patients responded prelaryngoscopy and number of patients reporting explicit recall in the Modified Brice interview.Results:None of the patients had positive IFT response. On postoperative interview none reported awareness. 10.7% of patients had dreams which were pleasant. Worst thing about surgery was pain.(43%).Conclusion:Our study suggests that intraoperative consciousness after intubation and postoperative recall is an uncommon occurrence.

Comparison of anterograde amnesia produced by midazolam, propofol and dexmedetomidine when used to supplement sedation during neuraxial anesthesia

Objective To compare the anterograde amnesia produced by midazolam, propofol and dexmedetomidine when used to supplement sedation during neuraxial anesthesia. Methods Sixty patients of both sexes, aged 18-50 yr, with body mass index of 23-26 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective operation on lower limbs with neuraxial anesthesia, were divided into 3 groups(n=20 each)using a random number table: midazolam group(group M), propofol group(group P)and dexmedetomidine group(group D). When the height of anesthesia was kept below T10, midazolam in a loading dose of 0.05 mg/kg was intravenously injected in group M, propofol in a loading dose of 0.4 mg/kg was intravenously injected in group P, and dexmedetomidine in a loading dose of 0.6 μg/kg was intravenously injected in group D. The infusion rate of the 3 drugs was adjusted to maintain bispectral index value at 82-86.When Observer′s Assessment of Alertness/Sedation Scale scores achieved 3 or 4 after administration, anterograde amnesia was measured by postoperative recall of cards.The development of intraoperative hypotension, bradycardia and respiratory depression was recorded. Results Compared with group M, the incidence of global amnesia was significantly decreased in P and D groups(P 0.05). No patients developed hypotension, bradycardia or respiratory depression in three groups. Conclusion Midazolam produces better anterograde amnesia than propofol and dexmedetomidine when used to supplement sedation during neuraxial anesthesia. Key words: Midazolam; Propofol; Dexmedetomidine; Amnesia, anterograde

Incidence of Awareness with Recall under General Anesthesia in Rural India: An Observational Study.

Context:Awareness under anesthesia is a rare but extremely unpleasant phenomenon. There are very few studies in the developing world and none from rural areas where incidence of intraoperative awareness may be higher due to increased patient load, limited patient knowledge and lack of trained hospital staff, reliance on older, cheaper but less effective drugs, and lack of proper equipment both for providing anesthesia, as well as monitoring the patient.Aims:To assess the incidence of intraoperative awareness during general anesthesia among patients in rural India and any factors associated with the same.Settings and Design:Prospective, nonrandomized, observational study.Subjects and Methods:Patients undergoing elective surgical procedures in various specialties under general anesthesia from over a period of 1 year were considered for this study. Approximately, after 1 h of arrival in postanaesthesia care unit, anesthesiologist (not involved in administering anesthesia) assessed intraoperative awareness using a modified form of Brice questionnaire.Statistical Analysis Used:Data were collected on a Microsoft Excel® sheet and analyzed using Statistical Package for the Social Sciences® version 23 (SPSS Inc., Chicago, IL, USA) for windows.Results:A total of 896 patients completed the questionnaire. Postoperatively, in response to the questionnaire, seven patients reported to have remembered something under anesthesia. Out of these, three patients described events that were confirmed by operation theater staff to have occurred whereas they were under anesthesia.Conclusions:Incidence of definite awareness under anesthesia with postoperative recall was found to be 0.33% (three patients out of total 896) in our study.

Anaesthetic interventions for prevention of awareness during surgery.

General anaesthesia is usually associated with unconsciousness. 'Awareness' is when patients have postoperative recall of events or experiences during surgery. 'Wakefulness' is when patients become conscious during surgery, but have no postoperative recollection of the period of consciousness. To evaluate the efficacy of two types of anaesthetic interventions in reducing clinically significant awareness:- anaesthetic drug regimens; and- intraoperative anaesthetic depth monitors. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, ISSUE 4 2016); PubMed from 1950 to April 2016; MEDLINE from 1950 to April 2016; and Embase from 1980 to April 2016. We contacted experts to identify additional studies. We performed a handsearch of the citations in the review. We did not search trial registries. We included randomized controlled trials (RCTs) of either anaesthetic regimens or anaesthetic depth monitors. We excluded volunteer studies, studies of patients prior to skin incision, intensive care unit studies, and studies that only randomized different word presentations for memory tests (not anaesthetic interventions).Anaesthetic drug regimens included studies of induction or maintenance, or both. Anaesthetic depth monitors included the Bispectral Index monitor, M-Entropy, Narcotrend monitor, cerebral function monitor, cerebral state monitor, patient state index, and lower oesophageal contractility monitor. The use of anaesthetic depth monitors allows the titration of anaesthetic drugs to maintain unconsciousness. At least two authors independently scanned abstracts, extracted data from the studies, and evaluated studies for risk of bias. We made attempts to contact all authors for additional clarification. We performed meta-analysis statistics in packages of the R language. We included 160 studies with 54,109 enrolled participants; 53,713 participants started the studies and 50,034 completed the studies or data analysis (or both). We could not use 115 RCTs in meta-analytic comparisons because they had zero awareness events. We did not merge 27 of the remaining 45 studies because they had excessive clinical and methodological heterogeneity. We pooled the remaining 18 eligible RCTs in meta-analysis. There are 10 studies awaiting classification which we will process when we update the review.The meta-analyses included 18 trials with 36,034 participants. In the analysis of anaesthetic depth monitoring (either Bispectral Index or M-entropy) versus standard clinical and electronic monitoring, there were nine trials with 34,744 participants. The overall event rate was 0.5%. The effect favoured neither anaesthetic depth monitoring nor standard clinical and electronic monitoring, with little precision in the odds ratio (OR) estimate (OR 0.98, 95% confidence interval (CI) 0.59 to 1.62).In a five-study subset of Bispectral Index monitoring versus standard clinical and electronic monitoring, with 34,181 participants, 503 participants gave awareness reports to a blinded, expert panel who adjudicated or judged the outcome for each patient after reviewing the questionnaires: no awareness, possible awareness, or definite awareness. Experts judged 351 patient awareness reports to have no awareness, 87 to have possible awareness, and 65 to have definite awareness. The effect size favoured neither Bispectral Index monitoring nor standard clinical and electronic monitoring, with little precision in the OR estimate for the combination of definite and possible awareness (OR 0.96, 95% CI 0.35 to 2.65). The effect size favoured Bispectral Index monitoring for definite awareness, but with little precision in the OR estimate (OR 0.60, 95% CI 0.13 to 2.75).We performed three smaller meta-analyses of anaesthetic drugs. There were nine studies with 1290 participants. Wakefulness was reduced by ketamine and etomidate compared to thiopental. Wakefulness was more frequent than awareness. Benzodiazepines reduces awareness compared to thiopental, ketamine, and placebo., Also, higher doses of inhaled anaesthetics versus lower doses reduced the risk of awareness.We graded the quality of the evidence as low or very low in the 'Summary of findings' tables for the five comparisons.Most of the secondary outcomes in this review were not reported in the included RCTs. Anaesthetic depth monitors may have similar effects to standard clinical and electrical monitoring on the risk of awareness during surgery. In older studies comparing anaesthetics in a smaller portion of the patient sample, wakefulness occurred more frequently than awareness. Use of etomidate and ketamine lowered the risk of wakefulness compared to thiopental. Benzodiazepines compared to thiopental and ketamine, or higher doses of inhaled anaesthetics versus lower doses, reduced the risk of awareness.

Spectral entropy monitoring for adults and children undergoing general anaesthesia.

Spectral entropy monitoring for adults and children undergoing general anaesthesia.

Post-Treatment Radiographic and Clinical Evaluation of Matched-Taper Single-Cone versus Warm Vertical Compaction Technique: a One-Year Follow up Study

Objectives: This study evaluated the long-term post-treatment response of two root canal filling techniques. Materials and Methods: Thirty-two mandibular first molars in patients diagnosed with pulp-periapical pathosis were instrumented and filled with either: (1) Matched-taper single- cone technique using Pro Taper gutta-percha or (2) Warm vertical compaction technique with gutta-percha. AH Plus sealer was used in both groups. Periradicular alveolar bone density of the preoperative radiographs was compared to one-year postoperative recall radiographs using digital x-ray software. One-year postoperative subjective and objective pain assessments were evaluated and pain index was formulated. Results: Matched-taper single-cone technique showed a higher change in bone density (-1.67) than the warm vertical compaction technique (+0.99), a difference that was statistically non- significant. Gutta-percha warm vertical compaction exhibited less pain index than the matched- taper single-cone technique. Conclusion: Radiographically, both techniques had similar changes in periradicular bone density. Most of the recorded teeth with pain had periodontal problems or absence of permanent restorations.

Healthy subjects’ knowledge of surgical complications: a hospital-based survey

There is an ongoing debate about how much a patient should know about serious or frequently occurring risks of their surgery. In this study, we evaluated healthy subjects' perspectives on knowledge of serious surgical complications. Three hundred and thirty healthy subjects (151 women, 179 men; mean age: 43.6 ± 17.3 years) were surveyed with the study questionnaire. Social profile, surgical history of the healthy subjects, and presence of a relative while giving preoperative consent were assessed. Only 23.5% (39/166) of the subjects were informed about all the potential complications of their previous surgical operation and 44.9% (73/166) did not get any preoperative consent on surgical complications. A statistically significant percentage of subjects who did not get proper information about the serious complications involved in their surgery indicated a desire for preoperative informed consent (97.0%, 128/132, P = 0.0001). The results indicated that a significant percentage of the subjects wanted to be informed of the potential complications of a surgery in the presence of a relative (73.9%, 192/260, P = 0.009). Involving a relative in preoperative consent may have a positive effect on the patient and can increase the level of postoperative recall of the risks.

Comparison of the Potency of Different Propofol Formulations

Several commercial formulations of propofol are available. The primary outcome of this study was the required dose of propofol alone or combined with lidocaine to achieve induction of general anesthesia. This multicenter, double-blinded trial randomized patients (American Society of Anesthesiologists physical status I-III) just before elective surgery with the use of a computer-generated list. Three different propofol 1% formulations-Diprivan (Astra-Zeneca, Cheshire, United Kingdom), Propoven (Fresenius-Kabi AG, Bad Homburg, Germany), and Lipuro (B-Braun, Melshungen AG, Germany)-were compared with either placebo (saline solution) or lidocaine 1% mixed to the propofol solution. Depth of anesthesia was automatically guided by bispectral index and by a computerized closed-loop system for induction, thus avoiding dosing bias. The authors recorded the total dose of propofol and duration of induction and the patient's discomfort through a behavioral scale (facial expression, verbal response, and arm withdrawal) ranging from 0 to 6. The authors further evaluated postoperative recall of pain using a Visual Analog Scale. Of the 227 patients enrolled, 217 were available for analysis. Demographic characteristics were similar in each group. Propoven required a higher dose for induction (2.2 ± 0.1 mg/kg) than Diprivan (1.8 ± 0.1 mg/kg) or Lipuro (1.7 ± 0.1 mg/kg; P = 0.02). However, induction doses were similar when propofol formulations were mixed with lidocaine. Patient discomfort during injection was significantly reduced with lidocaine for every formulation: Diprivan (0.5 ± 0.3 vs. 2.3 ± 0.3), Propoven (0.4 ± 0.3 vs. 2.4 ± 0.3), and Lipuro (1.1 ± 0.3 vs. 1.4 ± 0.3), all differences significant, with P < 0.0001. No adverse effect was reported. Plain propofol formulations are not equipotent, but comparable doses were required when lidocaine was concomitantly administered.

Awareness and apgar score in elective Cesarean section under general anesthesia with propofol or Isoflurane: A prospective, randomized, double-blinded clinical trial study.

Background:Awareness is a postoperative recall of events experienced under general anesthesia. In this study, we compared the incidence of awareness between two routine methods used, inhalation (Isoflurane) and intravenous protocol (Propofol), in elective Cesarean section, and also evaluated the effect of these two different methods on the apgar score of newborns.Materials and Methods:In this prospective, clinical trial study, 90 pregnant women candidates for elective Cesarean section were randomly enrolled, after taking written consent. Induction of anesthesia in both groups was provided by propofol and succinylcholine in the same manner, and maintenance of anesthesia in Group 1 was provided by propofol 100 μg/kg/minute and in Group 2 with isoflurane 1 MAC, to maintain the bispectral index (BIS) between 45 and 60. Blood pressure, heart rate, electrocardiography (ECG), and also Etco2 and o2sat were recorded throughout the surgery and finally analyzed and compared.Results:From 90 patients, four cases of confirmed awareness were found in the propofol group and three cases in the Isoflurane group (8/9% vs. 6/7%), but the apgar scores were comparable between the two groups. Meanwhile there were no significant differences between the two groups in basic information, neonatal apgar scores, hemodynamic changes, and BIS, Electromyography (EMG), and signal quality index (SQI) values.Conclusion:According to the patient's state, diagnosis of the anesthesiologist, and other criteria like price and its availability, we could use these drugs in general anesthesia during Cesarean section, although it is recommended that more studies be done to compare the effect of these two drugs in larger groups.

The quality of the wake-up test in patients undergoing corrective spinal surgery ( a comparison of two different anesthetic techniques)

Background To apply the intraoperative wake-up test, the anesthetic regimen needs to enable rapid and smooth patient recovery, an immediate neurological examination, as well as adequate postoperative amnesia. In this study, we aimed to investigate two different anesthetic regimens (sevoflurane/dexmedetomidine vs. sevoflurane/fentanyl) in patients undergoing spinal surgery with respect of the quality and the profile of the wake-up test and postoperative recall. Patients and methods Forty patients (ASA II) aged between 18 and 60 years, undergoing corrective spinal surgery, were included in this single-blind randomized study. They were divided into two groups, both which were anesthetized using sevoflurane in O 2 /N 2 O: the first group (Dex group) was administered an intraoperative infusion of dexmedetomidine (1 μg/kg/h) for 10 min as a loading dose, which was then reduced to 0.5 μg/kg/h for up to 30 min before the wake-up test and then reduced to 0.1 μg/kg/h during the test; the second group (Fent group) was administered an intraoperative fentanyl infusion (2 μg/kg/h) for up to 30 min before the wake-up test; this was stopped during the test. Time from stoppage of anesthesia to spontaneous breathing (T1), time from return of spontaneous breathing to eye opening (T2), and time from eye opening to hand and feet movement (T3) were recorded in both groups. In addition, the quality of the wake-up test was evaluated on a three-point rank scale. Recovery and extubation times were recorded for the postoperative wake-up test. On the second day, postoperative recall was evaluated by assessing the memory for a given color during the test. Results T1, T2, and T3 in the Dex group (6.2±3.1, 3.6±2.2, and 1.1±1.2 min, respectively) were significantly shorter those in the Fent group (8.9±2.1, 5.7±3.2, 1.8±0.8 min, respectively). No significant difference was observed between the two groups in terms of the quality of the wake-up test. No patient of the Dex group could recall intraoperative events, whereas four patients of the Fent group could, two of whom could recall the color presented intraoperatively. Postoperative recovery and extubation were significantly faster in the Dex group than in the Fent group. Conclusion Sevoflurane/dexmedetomidine anesthesia can result in faster recovery and a higher degree of postoperative amnesia compared with sevoflurane/fentanyl anesthesia, as shown from the wake-up test performed during corrective spinal surgery.

Propofol enjeksiyon ağrısı önlenebilir mi?

Can propofol injection pain be avoided? Objective: The main purpose of this study is to investigate the most effective and reliable method for prevention of propofol injection pain. Material and Methods: In this prospective, randomized, double-blind trail we gave one of the six drugs of penthotal, lidocaine, saline, ketamine, ondansetron and decort by using wrist tourniquet. Then we evaluated arm withdrawn, grimace, verbal rating scale (VRS) and postoperative recall the pain during propofol injection. Results: Evaluation of VRS data between six groups revealed that the lidocaine group was the most painless group (86%). These findings were followed respectively by ondansetron (82%), decort (72%), penthotal (52%), ketamine (46%) and saline (12%).

The topography of awareness: a classification of intra‐operative cognitive states

The topography of awareness: a classification of intra‐operative cognitive states

Inferior Alveolar Nerve Sensory Disturbance After Impacted Mandibular Third Molar Evaluation Using Cone Beam Computed Tomography and Panoramic Radiography: A Pilot Study

To measure sensory disturbances of the inferior alveolar nerve (IAN) after removal of impacted mandibular third molars using cone beam computed tomography (CBCT) and dental panoramic radiography (PAN) for preoperative assessment in a randomized controlled trial and to measure the efficacy of the observers' prediction of IAN exposure at surgery based on CBCT compared with PAN. The sample consisted of 86 impacted third molars (from 79 consecutive patients) in close relation to the IAN as determined by PAN and judged as showing a "moderate" risk of IAN damage. Cases presenting with no close relation between the IAN and roots and extremely risky cases with an obvious interrelation were excluded. Potential neurosensory disturbances of the lip and chin were assessed before surgery and during the postoperative recall by measuring the function of the IAN with the light-touch sensation method. Postoperative sensory disturbances occurred in 1 patient in the CBCT group and 1 patient in the PAN group. The light-touch sensation test showed no significant differences at the lip (P = .10) and chin (P = .17) levels for CBCT- versus PAN-based surgery. Significant differences in making a correct diagnosis of neurovascular bundle exposure at the extraction of impacted teeth were found between the 2 modalities (P = .029). Within the limits of the present pilot study, CBCT was not superior to PAN in predicting postoperative sensory disturbances but was superior in predicting IAN exposure during third molar removal in cases judged as having "moderate" risk.

Authors' Response

We read with interest and disagree with the letter of Mr McIlwain on the potential disadvantages of the use of procedure-specific consent forms (PSCFs) in surgery. There is increasing evidence highlighting both the benefits of PSCFs and the weaknesses of conventional consent forms (CCFs) in consenting practice. In a recent randomised-controlled trial, Finch et al.1 revealed that patients consented for transurethral prostate resection by use of PSCFs recalled more accurately the predicted risk of re-operation than patients who signed the CCFs. Similarly, Kondziolka et al.,2 using PSCFs, demonstrated high postoperative recall rates (ranging between 97–100%) regarding diagnosis, planned treatment, alternatives and relevant risks of specific neurosurgical procedures. On the other hand, various studies have evaluated the current conventional consenting process and emphasised the high variation in the quality of obtained consent for common general surgery procedures such as inguinal hernia repair.3 The British Orthopaedic Association has endorsed a website allowing surgeons free access to PSCFs ( ). There is a wide choice of procedures, and all forms have been written following UK Department of Health (DH) guidelines using simple language explaining the procedure, alternatives and risks (graded).4 Similarly, numerous NHS trusts are now currently using PSCFs.5 These could be used as models for wider application in surgical practice in the UK. Undoubtedly, there is scope for improvement, potentially by creating a blank space on the PSCF, where individualised details could be recorded and where evidence of discussion of patient-specific issues should be documented. Meanwhile, more randomised controlled trials are needed to compare PSCFs and current CCFs, particularly regarding information recall rates and patient satisfaction; subsequently, further modification could be undertaken centrally (DH) with a view to develop nationally uniform PSCFs. We emphasise the importance of consenting being a continuous process commencing in the out-patient clinic, through the pre-admission stage and completed on the day of the procedure, and agree there is no substitute for an unhurried, direct patient–surgeon communication, where all necessary individual issues are discussed before ‘signing on the dotted line’. However, the consenting process is operator-dependent and, therefore, it is unlikely that malfunctions can be completely extinct, irrespectively of the form used. Currently, the evidence suggests that a detailed procedure-specific consent form can offer adequate information and ensure legibility and consistency that seem to be missing from our consenting practice.

Radicular Cyst With Actinomycotic Infection in an Upper Anterior Tooth

Actinomycosis is an infection caused by filamentous, branching, Gram-positive anaerobic bacteria. It rarely infects the jawbone. This case report describes a patient with a left maxillary central incisor with an apical lesion and actinomycotic infection. A 23-year-old male patient underwent conventional root canal treatment of tooth 21, in a local dental clinic for about 1 year. However, percussion pain and a sinus tract that originated from tooth 21 were still present after treatment. Nonsurgical root canal treatment of tooth 21 was performed again but failed to relieve the symptoms. Therefore, apicoectomy and retrograde filling of the apical root canal with mineral trioxide aggregate were carried out. Periradicular bony defect was grafted by biocompatible material, and postoperative antibiotics (250 mg amoxicillin) were given three times daily for 5 days. Pathological examination of the removed periapical tissue showed a radicular cyst with actinomycosis. At the 9-month postoperative recall, the sinus tract had disappeared and radiographic examination showed healing of the apical lesion. Periradicular actinomycosis is one important reason for failure of nonsurgical endodontic treatment. Clinically, if the tooth shows a recurrent sinus tract and poor response to conventional root canal treatment combined with antibiotic control, apical actinomycotic infection should be highly suspected, and an alternative endodontic surgical approach is needed for successful treatment.

Time delay of electroencephalogram index calculation: analysis of cerebral state, bispectral, and Narcotrend indices using perioperatively recorded electroencephalographic signals

Monitoring of anaesthetic depth with EEG-derived indices may detect EEG changes associated with awareness and thereby help to decrease the incidence of intraoperative awareness with postoperative recall. All currently available monitors need varying time periods to calculate a new index when reacting to changes in anaesthetic depth. The exact time delay for calculation of new index values is unknown. In a previous study, we used simulated EEG signals and found considerable time lags for the cerebral state index (Danmeter, Odense, Denmark), the bispectral index (Aspect Medical Systems Inc., Newton, MA, USA), and the Narcotrend index (MonitorTechnik, Bad Bramstedt, Germany). The aim of this study was to investigate whether the time delays observed with simulated EEG signals also applied to real EEG data. We used perioperatively recorded EEG data from a database corresponding to the awake state, general anaesthesia, and suppression of cortical activity, respectively. After a switch from one state of consciousness to another, the time necessary for all indices to adjust the index value to the underlying input signal was measured. We found time delays for all indices between 24 (7) and 122 (23) s before the new state was indicated. In accordance with our previous results, these time delays were not constant and depended on the particular starting and target index value. Results were different for decreasing and increasing values. Our results may show a limitation of the value of electronic EEG indices in prevention of awareness with recall. Furthermore, due to different time delays for ascending and descending values, the results of pharmacodynamic studies may be influenced by this phenomenon.

Effect of educational intervention on adoption of new endodontic technology by general dental practitioners: a questionnaire survey

To survey the clinical endodontic protocols of general dental practitioners (GDPs) in public dental clinics and to assess the effect of an educational intervention on the adoption of a nickel-titanium (Ni-Ti) rotary system. General dental practitioners in a Swedish Intervention County (IC), underwent an educational programme in endodontics. A follow-up questionnaire was posted to 98 GDPs in the IC and to 97 GDPs in a Control County (CC), where no specific training had been provided. The questionnaire concerned demographics, clinical endodontic protocols and instrumentation techniques. The response rate to the questionnaire was 87%. More than 90% of all GDPs reported they always or generally used rubber dam, determined working length, used the canal irrigant 0.5% buffered NaOCl and calcium hydroxide as an interappointment dressing. Two of three GDPs reported, they generally or always informed the patient of the prognosis. Every second GDP reported routines for postoperative recall and follow-up. The Ni-Ti rotary technique was reported to be completely adopted by 77% of the GDPs in the IC, significantly higher than in the CC (6%), P < 0.001. In the IC 79% of the GDPs reported they completed instrumentation in one treatment session, compared with only 32% in the CC, P < 0.001. The 'single-cone' mode of canal filling was reported to be significantly more frequent amongst GDPs in the IC, P < 0.001. General dental practitioners in both counties reported using contemporary clinical endodontic protocols. GDPs who had undergone an educational programme in Ni-Ti rotary instrumentation reported they had successfully integrated the technique into daily clinical practice.

Endodontic treatment of bilateral dens evaginatus premolars with large periapical lesions

Dens evaginatus is a developmental anomaly characterized by the presence of an accessory cusp composed of enamel and dentine, usually containing pulp tissue. This condition is clinically important because of fracture or wear of the tubercle, which can frequently lead to the major complication of pulp necrosis and periapical infection. Treatment varies according to pulp condition, tubercle integrity, and stage of root development. Here we report a case of bilateral dens evaginatus with large periapical lesions. Non-surgical root canal treatment using calcium hydroxide medication was performed for both mandibular second premolars. At the 3-year postoperative recall examination, the teeth were asymptomatic and radiographically showed healing of the periapical lesions.

Awareness and memory function during paediatric anaesthesia

Previous research indicates a much higher incidence of awareness during anaesthesia in children than in adults. The present study is the first large-scale, intraoperative assessment of awareness during paediatric anaesthesia using the isolated forearm technique, and the first large-scale study of memory function during paediatric anaesthesia. One hundred and eighty-four children, 5-18 yr, underwent the isolated forearm technique during the first 17 min of surgery while receiving volatile anaesthesia. The isolated forearm technique was modified to accommodate brief or no paralysis. Bispectral index was monitored in a subset of 54 patients. Sixteen neutral words were played 20 times during surgery and, on recovery, implicit memory for these words was tested with a word identification task. Explicit memory for the surgical period was tested with a structured interview. Behavioural changes were assessed with age-appropriate questionnaires. No child had explicit recall of intraoperative events on recovery, and there was no evidence of implicit memory for words presented during anaesthesia. Two of 184 children made unambiguous and verified responses on the modified isolated forearm technique, an incidence of intraoperative awareness of 1.1%. One of these children reported that he was uncomfortable and not completely unconscious during surgery. Neither child had implicit memory for the neutral words, or adverse behaviour change. The incidence of awareness during surgery in children is approximately eight times that measured in adults by postoperative recall. In contrast to adults, there is no evidence for preserved memory priming during anaesthesia.