Retreatment Procedures Research Articles

INTENTIONAL REPLANTATION- A VIABLE SOLUTION FOR INSTRUMENT SEPARATION: A CASE REPORT

The fracture of an endodontic instrument is an obstacle in the completion of successful endodontic therapy. Non-surgical re-treatment and surgical endodontics are not always viable solutions. The various methods of re-treatment for a separated instrument include le bypass, le retrieval or the surgical method of Apicoectomy. However, the mode of treatment also depends on the position of the separated instrument in the tooth, the anatomy of the tooth and also the root. In certain cases, le bypass or retrieval is not advocated. In such cases, other options for re-treatment are needed to be considered. Intentional replantation is a treatment option considered by many as a procedure of last resort when non-surgical and surgical endodontics is contraindicated. This procedure is often indicated where the separated instrument is at or beyond the apex. The case report discussed in this paper presentation demonstrates the procedure of intentional replantation as a viable solution where other retreatment procedures are not possible.

Safety and Effectiveness of Additional Apical Preparation using a Rotary Heat-treated Nickel-Titanium file with Larger Diameter and Minimum Taper in Retreatment of Curved Root Canals.

Objective The aim of this study was to investigate the effect of additional apical preparation using the ProDesign Logic (PDL) 50/.01 rotary heat-treated nickel–titanium (NiTi) file with a larger diameter and minimal taper for retreatment of curved root canals. Materials and Methods Mesial curved root canals of 12 mandibular molars were prepared using PDL 25/.06 and filled using the continuous wave of condensation technique and AH Plus sealer. After retreatment using ProDesign S (PDS) 25/.08, PDL 25/.06 and PDL 35/05, a complementary procedure was performed with PDL 50/.01. Microcomputed tomography (micro-CT) scanning was performed before and after retreatment procedures. The cyclic fatigue resistance of unused PDS 25/.08, PDL 25/.06, PDL 35/.05 and PDL 50/.01 instruments ( n = 12) was evaluated in a stainless-steel device. Statistical Analysis Data on the volumes of the root canals and the remaining filling materials were submitted to the paired t-test. Cyclic fatigue resistance data was submitted to one-way ANOVA and Tukey’s tests (α = 0.05). Results Use of PDL 50/.01 decreased the remaining filling materials in the apical third ( p < 0.05). The root canal volume was similar in the cervical and middle thirds before and after preparation using PDL 50/.01 ( p > 0.05). PDL 50/.01 presented the highest cyclic fatigue resistance ( p < 0.05). Conclusions Use of the PDL 50/.01 instrument as an additional apical preparation for retreatment of curved root canals improved filling material removal in the apical third, while maintaining the dentin in the cervical and middle thirds. In addition, PDL 50/.01 presented high-flexural resistance.

A Comparative Study of the Efficacy of WaveOne and NeoEndo Retreatment File System for the Removal of Gutta Percha from the Root Canal.

Background:Teeth with apical periodontitis that either persisted or developed after initial root canal treatment is most often indicated for retreatment procedure. The present study was conducted to compare the WaveOne and NeoEndo retreatment file system for the removal of gutta-percha from the root canal.Materials and Methods:Fifty extracted mandibular first premolars with single straight roots were divided into two groups, Group I-WaveOne and Group II-NeoEndo. All samples were scanned with cone-beam computed tomography after the root filling and retreatment procedures. The decrease in the volume of filling material after each retreatment protocol was measured.Results:The mean volume of gutta-percha in Group I before retreatment was 5.6 and in Group II was 5.3, after retreatment in Group I was 2.7, and in Group II was 4.2. The mean percentage reduction in Group I was 45.2% and in Group II was 23.8%. The difference was significant (P < 0.05).Conclusion:Both systems failed to completely remove gutta-percha. WaveOne was significantly more effective than the NeoEndo retreatment system.

Characterization of the differential efficacy of austenitic vs martensitic NiTi rotary files in non-surgical root canal retreatment: a micro-CT analysis.

Aim: Our study aims to characterize the differential efficacy of martensitic and austenitic files in root canal retreatment regarding defiling ability, debris management and morphometric features. Materials and methods: A total of 10 human premolar teeth with two separate fully formed roots were selected, prepared with BioRace system (BR) up to a size BR2 (0.04/25). Root canals were filled and then divided according to the file type into two groups (n = 10). Two geometrically identical files have been used with the only difference between them is heat treatment; One Curve (OC) martensitic and One Shape (OS) austenitic. Preoperative and postoperative Micro-CT scans were done for all the samples, and the percent volume of residual filling materials was calculated. Canals reshaping and remaining debris in the canals were assessed by calculating the volume of the canals before and after retreatment using Micro-CT software. Results: The percentages of removed filling materials were similar between both groups (97.2% OC vs 97.8% OS). OS was significantly faster than OC (P < 0.05). Retreatment procedure did not significantly change volume, structure model index, surface area, and canal curvature. OS group transported the canals more than OC at the apical third (P < 0.05). There were no significant differences between both groups concerning un-instrumented surface area and accumulated hard tissue debris (AHTD) (P > 0.05). Conclusion: Under the circumstances of this study, neither file systems could completely remove the filling materials. However, OC resulted in less transportation than OS in the apical one third (P < 0.05). Also, OC resulted less AHTD than OS but with no statistical difference.

Retrievability of bioceramic-based sealers in comparison with epoxy resin-based sealer assessed using microcomputed tomography: A systematic review of laboratory-based studies.

Aim:The objective was to evaluate the retrievability of bioceramic sealers in comparison with epoxy resin-based sealers assessed using microcomputed tomography.Materials and Methods:Four reviewers independently conducted a systematic literature search in four electronic databases. The risk of bias was assessed using modified Joanna Briggs Institute Critical Appraisal tools for Quasi-Experimental Studies.Results:Ten articles were included in this review and all had a moderate risk of bias. The results across the included articles were inconsistent with some indicating easier/difficult removal of bioceramic sealers, while others indicate no difference. The studies varied in terms of the type of bioceramic sealer used, root canal anatomy, and retreatment techniques followed. Due to heterogeneity, only a qualitative analysis was performed and no meta-analysis was conducted.Conclusion:The quality of evidence is low and no definitive conclusion could be derived regarding the retrievability of bioceramic sealer/AH plus sealer from the root canals during retreatment procedures.

Impact of root canal curvature and instrument type on the amount of extruded debris during retreatment.

ObjectivesThe aim of the current study was to assess whether the amount of extruded debris differs for straight and severely curved root canals during retreatment using H-files, R-Endo, Reciproc and ProTaper Universal Retreatment (PTU-R) files. Additionally, the area of residual filling material was evaluated.Materials and MethodsSeverely curved (n = 104) and straight (n = 104) root canals of maxillary molar teeth were prepared with WaveOne Primary file and obturated with gutta-percha and AH Plus sealer. Root canal filling materials were removed with one of the preparation techniques: group 1: H-file; group 2: R-Endo; group 3: Reciproc; group 4: PTU-R (n = 26). The amount of extruded material and the area of the residual filling material was measured. The data were analyzed with 2-way analysis of variance (ANOVA) and 1-way ANOVA at the 0.05 significance level.ResultsExcept for Reciproc group (p > 0.05), PTU-R, R-Endo, and H-file systems extruded significantly more debris in severely curved canals (p < 0.05). Each file system caused more residual filling material in severely curved canals than in straight ones (p < 0.05).ConclusionsAll instruments used in this study caused apical debris extrusion. Root canal curvature had an effect on extruded debris, except for Reciproc system. Clinicians should be aware that the difficult morphology of the severely curved root canals is a factor increasing the amount of extruded debris during the retreatment procedure.

Retreatability of bioceramic and GuttaFlow bioseal root canal sealers using ProTaper universal system retreatment files: An Ex vivo study

Introduction: To evaluate the retreatability of Bioceramic and GuttaFlow Bioseal sealers using ProTaper Universal System Retreatment files aided by dental microscope analysis. Materials and Methods: Root canals of forty single-rooted human mandibular premolar teeth were prepared with ProTaper Next rotary system and obturated with single-cone obturation technique (n = 20 each) using EndoSequence Bioceramic root canal sealer (Group 1) and GuttaFlow Bioseal root canal sealer (Group 2). All specimens were retreated with ProTaper Universal Retreatment System files. The working time of retreatment procedure was calculated. Samples were sectioned, and the residual filling remnants were observed under dental operating microscope. Statistical analysis was performed using SPSS software. Results: The least total working time was observed in GuttaFlow Bioseal group (2.35 min). Overall, less residual filling materials was found in Bioceramic sealer group specimens in all root levels compared to GuttaFlow Bioseal group (P = 0.000, 0.022, and 0.000, respectively). Conclusion: The retreatment technique used was incapable of complete removal of filling material within root canal walls.

Effectiveness of Guttapercha/Bioceramic sealer removal during retreatment using different irrigation protocols

Objectives: The purpose of the study was to assess the amount of residual root canal filling materials (Guttapercha/Bioceramic sealer) after using different irrigation protocols. Methodology: FortyMandibular premolar teeth were mechanically instrumented using Protaper Next rotary system and obturated with guttapercha master cones (size 25, 0.06 taper) coated with Sure Seal bioceramic sealer (Sure Dent Corp., Gyeonggi-do, Korea). All specimens were incubated for 4 weeks then retreatment was performed using Protaper Universal retreatment system. The specimens were randomly divided into four equal groups (n=10) according to the final irrigation protocol as follow; Conventional needle irrigation, Endovac, UltraX, Passive ultrasonic irrigation. Roots were grooved buccolingualy into two halves. A digital camera connected to the stereomicroscope captured images to each half. The root canals were segmented into thirds (Apical, middle and coronal). Image-J softwarewas used to evaluate and measure the areas with the remaining filling material in each third. Data were analysed using One-way ANOVA followed by Tukey’s post hoc test for intergroup comparisons while One-way repeated measures ANOVA was used for intra group comparisons. Results: All groups showed residual filling material in the root canals. The amount of the residual filling materials was significantly reduced upon using passive ultrasonic irrigation (P<0.001). Conclusion: None of the irrigant activation methods was capable of completely removing the root canal filling material. Passive Ultrasonic irrigation enhanced the retreatment procedure of root canals previously obturated with gutta percha/bioceramic sealer.

Results of Buccal Mucosal Graft Urethroplasty in Management of Anterior Urethral Stricture – Experience in a Single Center

Objective: To share our experience with buccal mucosal graft (BMG) urethroplasty for the management of anterior urethral strictures in BIRDEM General Hospital, Dhaka. Materials and methods: This study was conducted from January 2013 to January 2018. Patients selected according to inclusion and exclusion criteria. The oral mucosal characteristics were assessed in all patients during the initial workup. Single stage dorsolateral onlay graft urethroplasty done in all patients. They were followed according schedule for outcome and complications. Result:Total 59 patients were studied. Overall success rate of BMG urethroplasty was 88.1% at 12th month. Complications include development of periurethral abscess (3.4%), restructure (8.5%) development of fistula (1.7%). Total 8 patients underwent retreatment procedures like drainage of periurethral abscess, dilatation, optical internal urethrotomy (OIU) and revision urethroplasty. Conclusion:The buccal mucosa is easy to obtain and handle, therefore BMG urethroplasty is a safe and effective in managing anterior urethral stricture. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.128-131

Micro–computed Tomographic Assessment of Supplementary Cleaning Techniques for Removing Bioceramic Sealer and Gutta-percha in Oval Canals

IntroductionThe aim of this study was to conduct a micro–computed tomographic assessment of the effectiveness of 3 supplementary cleaning techniques in reducing the residual volume of gutta-percha and a bioceramic sealer after performing endodontic retreatment procedures in teeth with oval canals. MethodsThirty-six mandibular premolars were instrumented with the ProTaper Next system (instruments X1–X3; Dentsply Maillefer, Ballaigues, Switzerland) and filled with gutta-percha and Bio-C Sealer (Angelus, Londrina, PR, Brazil) using the single-cone technique. The teeth were reinstrumented with the Reciproc R40 instrument (VDW, Munich, Germany) and divided into 3 groups according to the supplementary cleaning technique used (n = 12): ultrasonic-assisted irrigation (UAI), EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK) irrigation (EAI), or the XP-endo Finisher R system (XPR; FKG Dentaire, La Chaux-de-Fonds, Switzerland). Micro–computed tomographic imaging was used to quantify the residual volume of filling material. One-way analysis of variance complemented by the Tukey test was used to perform the statistical analysis (P < .05). ResultsSignificant reductions were obtained in the residual filling material after supplementary cleaning (P < .05). XPR (47.5%) led to significantly greater (P < .05) filling material removal than UAI (16.6%) or EAI (22.6%). The removal values of the 2 latter systems were not significantly different. ConclusionsXPR was more effective than UAI and EAI in removing filling material in mandibular premolars with oval canals. None of the tested supplementary cleaning techniques completely removed the residual filling material.

Technical and radiographic considerations for magnetic resonance imaging-guided focused ultrasound capsulotomy.

Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is an emerging treatment modality that enables incisionless ablative neurosurgical procedures. Bilateral MRgFUS capsulotomy has recently been demonstrated to be safe and effective in treating obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Preliminary evidence has suggested that bilateral MRgFUS capsulotomy can present increased difficulties in reaching lesional temperatures as compared to unilateral thalamotomy. The authors of this article aimed to study the parameters associated with successful MRgFUS capsulotomy lesioning and to present longitudinal radiographic findings following MRgFUS capsulotomy. Using data from 22 attempted MRgFUS capsulotomy treatments, the authors investigated the relationship between various sonication parameters and the maximal temperature achieved at the intracranial target. Lesion volume and morphology were analyzed longitudinally using structural and diffusion tensor imaging. A retreatment procedure was attempted in one patient, and their postoperative imaging is presented. Skull density ratio (SDR), skull thickness, and angle of incidence were significantly correlated with the maximal temperature achieved. MRgFUS capsulotomy lesions appeared similar to those following MRgFUS thalamotomy, with three concentric zones observed on MRI. Lesion volumes regressed substantially over time following MRgFUS. Fractional anisotropy analysis revealed a disruption in white matter integrity, followed by a gradual return to near-baseline levels concurrent with lesion regression. In the patient who underwent retreatment, successful bilateral lesioning was achieved, and there were no adverse clinical or radiographic events. With the current iteration of MRgFUS technology, skull-related parameters such as SDR, skull thickness, and angle of incidence should be considered when selecting patients suitable for MRgFUS capsulotomy. Lesions appear to follow morphological patterns similar to what is seen following MRgFUS thalamotomy. Retreatment appears to be safe, although additional cases will be necessary to further evaluate the associated safety profile.

The Efficacy of Rotary, Reciprocating, and Combined Non-Surgical Endodontic Retreatment Techniques in Removing a Carrier-Based Root Canal Filling Material from Straight Root Canal Systems: A Micro-Computed Tomography Analysis.

The aim of this study is to analyze and compare the efficacy of three non-surgical endodontic retreatment techniques in removing a carrier-based root canal filling material from straight root canal systems. The study was performed on 99 single-rooted extracted teeth using the ProTaper Gold endodontic rotary system up to the F2 file (Dentsply Maillefer, Baillagues, Switzerland), which were sealed with GuttaCore (Dentsply Maillefer, Ballaigues, Switzerland) and AH plus epoxy resin sealer (Dentsply DeTrey, Konstanz, Germany) and randomly assigned to the following non-surgical retreatment techniques: ProTaper Retreatment endodontic rotary instruments (D1–D3 files, Dentsply Maillefer, Ballaigues, Switzerland; n = 33, PTR), Reciproc Blue endodontic reciprocating instrument (R50, VDW, Munich, Germany; n = 33, RCB50), and a combined root canal retreatment technique between Gates-Glidden drills (sizes #3 and #2, Dentsply Maillefer, Ballaigues, Switzerland) and Hedstrom files (file size 35, 30, and 25, Dentsply Maillefer, Ballaigues, Switzerland; n = 33; H-GG). All of the teeth were submitted twice to a micro-computed tomography (micro-CT) scan, before and after non-surgical endodontic retreatment procedures. The volume of root canal filling material (mm3), volume of remaining root canal filling material (mm3), non-surgical endodontic retreatment working time (min), proportion of remaining root canal filling material (%), and efficacy of root canal filling material removal between the non-surgical endodontic retreatment techniques were analyzed using ANOVA one-way statistical analysis. Statistically significant differences were observed between the proportions of remaining root canal filling material of PTR and H-GG (p = 0.018), between the non-surgical endodontic retreatment working times (min; p < 0.001), and between the efficacies of root canal filling material removal by the non-surgical endodontic retreatment techniques (p = 0.009). However, the non-surgical endodontic retreatment systems allow for similar carrier-based root canal filling material removal.

Secondary Root Canal Treatment with Reciproc Blue and K-File: Radiographic and ESEM-EDX Analysis of Dentin and Root Canal Filling Remnants.

Secondary root canal treatment requires the complete removal of filling materials with different chemical-physical properties. A newly developed single-use NiTi instrument (Reciproc Blue, RB) may be more effective in root canal retreatment. The aim of the present study was to evaluate morphology and composition of remnants after retreatment with RB compared to traditional K-File technique, in canals obturated with Thermafil/AH Plus. Twenty-four single-rooted human teeth were shaped with NiTi obturated with AH-Plus/Thermafil and retreated using RB NiTi instruments or manual K-Files. Radiographs were taken to evaluate endodontic space and radiopacity of residual filling-material before/after procedures. After retreatment, samples were longitudinally split and observed by environmental scanning electron microscopy connected to energy dispersive X-Ray spectroscopy (ESEM-EDX) to analyze the debris/remnant position, microchemistry, and dentinal surface morphology. Time for retreatments was recorded and compared using one-way ANOVA (p-value = 0.05). Radiopaque filling residuals were found in both groups. RB system resulted statistically faster than manual K-File in retreatment procedure (p < 0.001). Root canal space radiographic appearance obtained after retreatment with RB was wider than K-File (p < 0.05). ESEM-EDX revealed 4 different morphological dentin area. Area-1: debris-free with typical Ca, P, and N composition of dentin and detected in 70% of the surface. Area-2: presence of deproteinized smear layer free from N and debris in 15% of the surface. Area-3: a thick packed smear layer N-free and with fine debris consisting of trace elements from sealer in 10% of the surface. Area-4: packed with debris and trace elements. No difference was observed between both instruments regarding root canal space appearance and ESEM-EDX analysis. Both systems were able to remove filling material but created a dentine morphology composed of packed debris and filling materials embedded into the smear layer. Dentin surface composition resulted in collagen depleted by irrigation procedures. The reciprocating system required less time to complete retreatment.

Accuracy and Reliability of Intraoral Radiographs in Determining the Cleanliness of Root Canals after Endodontic Retreatment.

Objective:This study aimed to evaluate the accuracy and reliability of periapical radiographs obtained with two different projections in determining the cleanliness of root canals in endodontic retreatment using the sectioned roots as a gold standard.Methods:The amount of residual root-filling material after endodontic retreatment procedures in 42 roots was assessed in radiographs and in microscopic photographs of the sectioned roots by five observers. Furthermore, the cleanliness of 80 roots was assessed based on orthogonal and mesio-angulated radiographs. Four parameters were used for the evaluation of cleanliness. Wilcoxon signed-rank tests and percentage agreement calculations were used for comparisons between the radiographs and the gold-standard observations and between the orthogonal and mesio-angulated radiographs, respectively. Intra- and interobserver reproducibility was tested using Kappa statistics and intra-class correlation tests. The statistically significance level was 0.05.Results:In general, significantly more residual root-filling material was detected in the photographs of the split roots (gold standard) than in the radiographs. Comparing orthogonal and eccentric projections, only slight differences in cleanliness were found. The intraobserver reproducibility was fair to almost perfect for radiographs and microscopic photographs. For all parameters, the reproducibility was better for the radiographs than for the microscopic photographs. The interobserver variability ranged from fair to almost perfect agreement for the radiographs.Conclusion:The accuracy of periapical radiographs was poor in determining the cleanliness of root canals after endodontic retreatment, whereas the reliability of the radiographs was fair. A mesio-angulated projection did not contribute essentially to the detection of residual root-filling materials.

Comparison of Obturation Removal Efficiency from Straight Root Canals with ProTaper Gold or Reciproc Blue: A Micro-Computed Tomography Study.

Background: The objective was to evaluate the efficiency of ProTaper Gold (PTG) and Reciproc Blue (RB) NiTi files in obturation material removal from straight root canals assessed by micro-computed tomography. Methods: Fifty-two anterior human teeth were shaped with a PTG rotary system until F2 (25/.08). Specimens were obturated with a continuous wave of condensation technique. For retreatment, specimens were randomly distributed in two experimental groups: PTG group (F4 file) and RB (R40 file). Micro-CT scans were performed before and after retreatment procedures. The percentage of the remaining obturation material compared to the original volume was calculated, as well as the retreatment time. The presence of separated files was recorded. A descriptive analysis was carried out, and nonparametric tests were employed. Results: The mean percentages of remaining obturation material in the PTG group and the RB group were 4.14 ± 4.30% and 4.18 ± 4.29%, respectively. The mean retreatment times for the PTG and RB groups were 144 ± 51 and 163 ± 88 s, respectively. There were no statistically significant differences, neither in removal efficiency (p > 0.05) nor in retreatment time (p > 0.05), between the two groups. The coronal and middle thirds presented significantly more remaining obturation material than the apical third (p < 0.05). No file separation occurred. Conclusions: ProTaper Gold and Reciproc Blue present with comparable efficiency in removing the obturation material, with a similar mean retreatment time.

Evaluation of filling material remnants after basic preparation, apical enlargement and final irrigation in retreatment of severely curved root canals in extracted teeth.

To compare the retreatment ability of several rotary and reciprocating file systems in curved root canals of extracted teeth and to evaluate the influence of additional apical enlargement performed after a basic retreatment on the amount of remaining filling material. A total of 65 round curved root canals were used. The root canals were prepared with the ProTaper Next rotary system to size 25, .06 taper and filled with an epoxy resin-based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. The canals were randomly divided into four groups according to the retreatment system used: Group I. ProTaper Universal Retreatment system+ProTaper Gold (PTG) instrumentation system up to PTG F2; Group II. Reciproc Blue system up to the instrument RB25; Group III. Reciproc system up to the instrument R25; Group IV. Wave One Gold (WOG) system up to the instrument WOG25. After the basic retreatment, additional apical enlargement was performed in each group with an instrument that was one size larger: in Group I, II and III up to apical size 40, and in Group IV up to 35. The final irrigation protocol included the following: 15% ethylenediaminotetraacetic acid followed by NaOCl irrigation. The volume of filling material was measured using an industrial micro-CT four times: after root canal filling (Volume I), after basic retreatment with size 25 files (Volume II), after additional root canal enlargement with larger instruments (Volume III), and after the final irrigation protocol (Volume IV). The decrease in the amount of filling material after each retreatment protocol was analysed using a Kruskal-Wallis test. Intergroup analyses were performed with a Kruskal-Wallis test and between-group differences were further analysed with Mann-Whitney U test. There were no significant differences amongst the systems tested in the amount of remaining filling material, or the reduction rates after each phase of the retreatment procedures (P>0.05). Intragroup analysis indicated that the use of a larger final instrument removed significantly more filling material in all groups (P<0.001). The four tested instrumentation systems were equally effective in removing filling materials from curved root canals in extracted teeth. Additional apical enlargement with larger files improved the removal of filling remnants after basic retreatment.

Phototherapeutic Keratectomy in Macular and Granular Dystrophy: Two-year Results

ABSTRACT Purpose To evaluate two-year outcomes of phototherapeutic keratectomy in granular and macular dystrophy and to investigate the effects of dystrophy type on results. Methods Sixty-three patients who underwent phototherapeutic keratectomy (PTK) for granular and macular dystrophy in the cornea funit of the University of Health Sciences Beyoglu Eye Research and Training Hospital were evaluated retrospectively. Patients under 18 years of age, patients with a follow-up period of less than 24 months, and patients who had previously undergone corneal surgery or excimer laser treatment were excluded from the study. Treatment values (ablation depth, optical zone, mitomycin-C (MMC) application time) and complications during and after treatment were recorded. Patients who had a decrease of two or more lines in their BCVA and those with recurrent or increased corneal opacities were considered to have severe recurrences. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded preoperatively and postoperatively at the 12th and 24th months. The values obtained before and after the PTK were compared with statistical methods. Results A total of 41 eyes (27 with granular dystrophy and 14 with macular dystrophy) were included in this study. There were no statistically significant differences between patients with granular dystrophy and macular dystrophy in terms of preoperative UCVA and BCVA, MMC application time, and follow-up period (p > .05). The mean age of patients with macular dystrophy was statistically smaller than that of patients with granular dystrophy (p = .04). The amount of ablation applied to macular dystrophy was statistically higher than for granular dystrophy (p = .03). The mean UCVA and BCVA showed statistically significant improvements at the 24th postoperative month (p < .5). There was no statistically significant difference between the UCVA and BCVA values of the patients with granular and macular dystrophy at the 12th and 24th months after the procedure. No recurrence was observed in any patient after 24 months. However, when the follow-up continued, severe recurrence was encountered in 2 patients with macular dystrophy at 26th and 40th months. Re-treatment procedures were needed in these two patients who had severe recurrence. Conclusions Phototherapeutic keratectomy is an effective and safe option for treatment in both granular and macular corneal dystrophy. Recurrence is a more common problem in patients with macular dystrophy, and recurrent therapies or keratoplasty methods are needed more frequently.

Eucalyptus Extrusion Injury: not such an Essential Oil?

Eucalyptus oil is an essential oil commonly used as a solvent to remove old gutta-percha when performing endodontic re-treatment procedures. Although commonly used by dentists, evidence for its safety is lacking. This report outlines a previously undocumented case of a 44-year-old male who attended the Oral and Maxillofacial Surgery department with sudden onset facial swelling in response to extrusion of eucalyptus oil through the apex of a tooth during root canal re-treatment by his dentist. The management of this case is discussed and the important safety aspects with regard to the chemicals used in endodontic treatments are reviewed. CPD/Clinical Relevance: This paper highlights that the risk of extrusion injury during endodontic treatment is not limited to the use of sodium hypochlorite but also to other chemicals such as, and in our case, eucalyptus oil.

The retreatment abilities of ProTaper Next and F6 Skytaper: a micro-computed tomography study.

The aim of this study was to evaluate the retreatment abilities of the ProTaper Next (PTN) and F6 SkyTaper (F6) systems by using micro-computed tomography (microct), radiographic and microscopic imaging techniques. The root canals of twenty-six extracted mandibular premolar teeth were prepared and obturated. For the retreatment procedure, the teeth were randomly divided into two equal groups according to endodontic instruments: PTN (X4) and F6 (#40/.06). Pre- and post-operative filling material volumes were measured with micro-ct, and areas were measured with radiographic and microscopic imaging techniques. The percentages of residual material were calculated, and then statistically compared. The significance level was set at p<0.05. There was no statistically significant difference between F6 and PTN for retreatment efficacy in the micro-ct and radiographic imaging techniques (p>0.05). PTN demonstrated better cleaning ability when evaluated by microscopic imaging. (p<0.05). The correlation was moderate between micro-ct and radiographic, and micro-ct and microscopic imaging groups; however, it was strong between radiographic and microscopic imaging methods. The PTN and F6 files had similar effects in the removal of filling material with microct evaluation. The radiographic imaging method gave similar results with micro-ct imaging.

Factors affecting recurrence and management of recurrent cerebral aneurysms after initial coiling.

To investigate factors affecting recurrence and effects and safety of endovascular retreatment for aneurysms recurrent after embolization. Among 815 aneurysms treated with embolization, recurrence was in 114 aneurysms (14.0%). Forty-three recurrent aneurysms were managed with re-embolization. Procedural complications, angiographic, and clinical results of retreatment were analyzed. Patients with recurrent aneurysms were significantly (P < 0.01) younger than without recurrence (51.09 ± 10.46 vs. 53.88 ± 9.61 years). Recurrent aneurysms (n = 114) were significantly (P = 0.00) greater (11.12 ± 8.35 vs. 5.81 ± 3.44 mm) with a significantly (P = 0.00) greater neck (4.34 ± 2.26 vs. 2.90 ± 1.44 mm) than without recurrence. The rupture status of aneurysms significantly (P = 0.00) affected recurrence at follow-up. Significantly (P = 0.00) more aneurysms without recurrence were treated with advanced embolization techniques (81.0% vs. 62.3%) and got complete occlusion at the first embolization than those with recurrence (93.7% vs. 36.8%). In treating 43 recurrent aneurysms, stent-assisted recoiling was used in 48.8% in the first retreatment and 50% in the second and third retreatment procedures. Angiographic follow-up in 38 (88.4%) cases showed complete or near complete occlusion in 30 aneurysms, with the rest eight aneurysms experiencing a second recurrence (21.1%). Of the eight aneurysms with the second recurrence, five underwent the second endovascular retreatment, with complete aneurysm occlusion achieved in three cases (60%), near-complete occlusion in one (20%), and incomplete occlusion in one case at immediate angiography and six-month follow-up. Procedure-related complications occurred in three patients. Endovascular retreatment of recurrent previously coiled aneurysms is safe and effective even though advanced embolization techniques are frequently involved especially for large and giant aneurysms.