bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomic Endodontic Technology (AET) – a crown‐down root canal preparation technique: basic concepts, operative procedure and instruments
Authors: Riitano F. 
Published: July 2005

AbstractAim  To illustrate the conceptual basis and the operative procedure of the Anatomic Endodontic TechnologyTM (AET) technique and to illustrate the specific instruments used in each phase.Summary  The basic characteristics of the AETTM technique are reported. The instruments and procedure are described in three phases: coronal access, coronal‐middle preparation and apical preparation. In the first phase, correct cavity design is described. In the coronal‐middle phase, the use of four stainless steel shaping instruments, powered by a reciprocating handpiece is described, incorporating a brushing‐milling action against canal walls. During the apical phase, dedicated apical stainless steel and NiTi hand instruments are used to complete the preparation. The stainless steel apical files are used with a 1/4 turn and withdrawal movement whilst the NiTi are used in 360° rotary motion.Key learning points• Most current canal shaping techniques do not prepare all the canal walls and can result in over‐enlargement in some areas.• AETTM defines three regions of the canal: coronal (from the cavo‐surface of the access cavity), coronal‐middle, and apical.• Coronal‐middle instrumentation is undertaken with four mechanically driven stainless steel shaping instrument used in brushing‐milling action against canal walls.• Apical preparation is completed by hand and with the formation of a stop.
In vitro peroxide penetration into the pulp chamber from newer bleaching products
Authors: Gökay O. , Müjdeci A. , Algin E. 
Published: July 2005

AbstractAim  To investigate peroxide penetration from newer bleaching products into the pulp chamber.Methodology  Fifty extracted human maxillary central incisor teeth were separated into five groups (n = 10). All the teeth were sectioned 3 mm apical to the cemento‐enamel junction; the intracoronal pulp tissue was removed, and the pulp chamber filled with acetate buffer. Buccal crown surfaces of teeth in the experimental groups were subjected to either a whitening strip (containing 5.3% hydrogen peroxide‐G1) or one of three paint‐on liquid whiteners (containing 19% sodium percarbonate peroxide‐G2, 18% carbamide peroxide‐G3 and 8.7% hydrogen peroxide‐G4). The teeth in the control group (G5) were exposed only to distilled water. The acetate buffer solution in each tooth was then transferred to a glass test tube after 30 min and leuco‐crystal violet and enzyme horseradish peroxidase were added, producing a blue solution. The optical density of the resultant blue colour in the tubes was measured by a UV‐visible spectrophotometer at a wavelength of 596 nm. The values were converted into microgram equivalents of HP using a spectrophotometric calibration curve. Data were analysed statistically using the Kruskal–Wallis Analysis of Variance and the Mann–Whitney U‐test.Results  Statistically significant differences were found between all of the groups (P < 0.05). Pulpal peroxide was not observed in the control group. The amount of hydrogen peroxide (μg) found in the pulp chamber of G1 (0.726 ± 0.024) > G4 (0.443 ± 0.017) > G3 (0.231 ± 0.011) > G2 (0.175 ± 0.012).Conclusions  The peroxides from the whitening strip and paint‐on whiteners penetrated into the pulp chamber to varying degrees.
Fate of vital pulps beneath a metal‐ceramic crown or a bridge retainer
Authors: Cheung G. S. P. , Lai S. C. N. , Ng R. P. Y. 
Published: July 2005

AbstractAim  To investigate the incidence of and factors associated with pulpal necrosis in vital teeth restored with metal‐ceramic crowns (CMCs) or crowned as part of a fixed–fixed bridge.Methodology  Patients who had a CMC or bridge retainer (BR) placed on a tooth with no previous history of root canal treatment from 1981 to 1989 were retrieved from computer records. The collated patients were randomly selected and their clinical records examined. Those who satisfied the inclusion criteria were contacted and offered a review. After clinical examination, long‐cone paralleling periapical radiographs were taken of the selected teeth, which were then assessed by two precalibrated operators to ascertain the pulpal status. Factors that might contribute to loss of pulp vitality and the tooth type were also recorded. The collected data were analysed statistically using the chi‐square test and subject to Bonferroni adjustment where indicated.Results  The numbers of preoperatively vital teeth in the CMC and BR groups were 122 and 77, and the mean observation periods were 169 ± 25 (SD) and 187 ± 23 months, respectively. In the CMC group, 19 failed cases (15.6%) were due to an endodontic reason; total number of failures was 34. In the BR group, 25 (32.5%) showed signs of pulpal necrosis; a significant association with maxillary anterior teeth was noted. The survival rates for pulp vitality were 84.4% (CMC) and 70.8% (BR) after 10 years, and 81.2% (SC) and 66.2% (BR) after 15 years. The difference between the two groups was significant.Conclusion  The survival of the vital pulp in teeth restored with a single‐unit CMC was significantly higher than those serving as an abutment of a fixed–fixed bridge. Maxillary anterior teeth used as bridge abutments had a higher rate of pulpal necrosis than any other tooth types.
The effect of high‐frequency electrical pulses on organic tissue in root canals
Authors: Lendini M. , Alemanno E. , Migliaretti G. , Berutti E. 
Published: July 2005

AbstractAims  To evaluate debris and smear layer scores after application of high‐frequency electrical pulses produced by the Endox Endodontic System (Lysis Srl, Nova Milanese, Italy) on intact pulp tissue and organic and inorganic residues after endodontic instrumentation.Methodology  The study comprised 75 teeth planned for extraction. The teeth were randomly divided into two groups (60 teeth) and a control group (15 teeth): group 1 (30 teeth) was not subjected to instrumentation; group 2 (30 teeth) was instrumented by Hero Shaper instruments and apical stops were prepared to size 40. Each group was subdivided into subgroups A and B (15 teeth); two electrical pulses were applied to subgroups 1A and 2A (one in the apical third and one in the middle third, respectively, at 3 and 6 mm from the root apices); four electrical pulses were applied to subgroups 1B and 2B (two in the apical third, two in the middle third). The control group (15 teeth) was prepared with Hero Shapers and irrigated with 5 mL of EDTA (10%) and 5 mL of 5% NaOCl at 50 °C but not subjected to the electrical pulse treatment. Roots were split longitudinally and canal walls were examined at 80×, 200×, 750×, 1500× and 15 000× magnifications, using a scanning electron microscope. Smear layer and debris scores were recorded at the 3 and 6 mm levels using a five‐step scoring scale and a 200‐μm grid. Means were tested for significance using the one‐way anova model and the Bonferroni post‐hoc test. The differences between groups were considered to be statistically significant when P < 0.05.Results  The mean value for debris scores for the three groups varied from 1.80 (±0.77) to 4.50 (±0.68). The smear layer scores for group 2 and the control specimens varied from 2.00 (±0.91) to 2.33 (±0.99). A significant difference was found in mean debris scores at the 3 and 6 mm levels between the three groups (P < 0.001). The Bonferroni post‐hoc test confirmed that the difference was due to group 1. In the two subgroups treated with four high‐frequency pulses (1B and 2B) a substantial reduction in mean debris scores was found at the 3 and 6 mm level; subgroup 2B was practically free of organic residue. No significant differences for mean smear layer and debris scores were recorded between group 2 and the control group at the two levels; a significant difference was found only for mean smear layer scores at the 3 mm level between subgroup 2B and the control group (P < 0.05).Conclusions  The Endox device used with four electrical pulses had optimal efficacy when used after mechanical instrumentation. Traditional canal shaping and cleaning was essential to ensure an effective use of high‐frequency electrical pulses in eliminating residues of pulp tissue and inorganic debris.
In vitro antimicrobial activity of Fill Canal, Sealapex, Mineral Trioxide Aggregate, Portland cement and EndoRez
Authors: Sipert C. R. , Hussne R. P. , Nishiyama C. K. , Torres S. A. 
Published: July 2005

AbstractAim  To determine in vitro the antimicrobial activity of Fill Canal, Sealapex, Mineral Trioxide Aggregate (MTA), Portland cement and EndoRez on various species of microorganisms.Methodology  The diffusion method on Müller–Hinton agar (MH) was employed. A base layer was made using MH agar and five wells were made by removing agar at equidistant points. Sealers were placed into the wells immediatelly after manipulation. The microorganisms Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Micrococcus luteus ATCC 9341, Staphylococcus aureus ATCC 25923, Staphylococcus epidermidis ATCC 12228, Pseudomonas aeruginosa ATCC 27853 and Candida albicans ATCC 10231 were seeded by pour plate. The plates were kept at room temperature for 2 h for prediffusion and then incubated at 37 °C for 24 h. Aliquots of 10 mL of 0.05% triphenyltetrazolium chloride gel were added for optimization and the zones of inhibition were measured.Results  Sealapex and Fill Canal demonstrated antimicrobial activity for all strains. For MTA and Portland cement, only E. coli was not inhibited. No antimicrobial activity was detected for EndoRez.Conclusions  In this laboratory study, Fill Canal, Sealapex, MTA and Portland cement presented antimicrobial activity whilst EndoRez did not.
Defects in ProTaper S1 instruments after clinical use: longitudinal examination
Authors: Peng B. , Shen Y. , Cheung G. S. P. , Xia T. J. 
Published: July 2005

AbstractAim  To evaluate defects in ProTaper shaping instrument S1 after a defined schedule of clinical use.Methodology  Among all ProTaper files discarded from an endodontic clinic at a stomatological school in China over a period of 17 months, 122 S1 instruments were collected. They were ultrasonically cleaned, autoclaved and then examined in the laboratory. Any instrument separation was noted; the average length involved was determined. The 0.5 mm region on either side of this length of discarded but intact instruments was examined circumferentially by scanning electron microscope. The region adjacent to the broken end of the fractured instruments was also examined in the same way.Results  One specimen was lost during processing. Of the remaining 121 instruments, 27 were separated with a mean fracture length of 3.67 mm from the tip. Of these, two files showed macroscopically torsional fracture and the others showed signs of flexural fatigue. Only one file that had not fractured showed visible unwinding defects. Examination of the 3.1–4.1 mm region of other unfractured instruments revealed the presence of microcracks, surface debris, pitting and/or wear of their cutting edges. Some debris particles seemed to have been trapped in crack‐like structures.Conclusions  Multiple use of ProTaper S1 pre‐disposed the instrument to microcrack formation and wear of the cutting edges. There was a low prevalence of plastic deformation and most ProTaper S1 instruments failed without discernible sign of unwinding of the flutes. Further studies should address the mode of failure and the role of debris particles in the fracture mechanism.
The isthmuses of the mesial root of mandibular molars: a micro‐computed tomographic study
Authors: Mannocci F. , Peru M. , Sherriff M. , Cook R. , Pitt Ford T. R. 
Published: July 2005

AbstractAim  To investigate the prevalence of root canal isthmuses in the apical 5 mm of the mesial root of mandibular molars by means of micro‐computed tomography (MCT) and to describe the morphology of the isthmuses.Methodology  Twenty extracted mandibular first molars that had fully formed roots were selected. The mesial roots were sectioned from the distal roots and subjected to MCT. The number of sections showing isthmuses in each of the apical 5 mm of the root canals was recorded. In each one of the apical 5 mm of the 20 roots examined, 40 sections were observed, giving a total of 800 sections observed in each group. Data were analysed as a contingency table using the chi‐square statistic to test the null hypothesis that location of the sections in each of the apical 5 mm and presence of the isthmus were independent.Results  Isthmuses were found to be present at all levels with prevalence figures between 17.25 and 50.25%. The chi‐square test indicated a significant difference in the distribution of isthmuses with section (P = 0.001). It was found that sections in the first millimetre from the apex had fewer isthmuses than expected and that sections in the third millimetre from the apex had more isthmuses than expected under the null hypothesis. Calcifications were found to be present in most isthmuses, occasionally lateral canals originated from the central part of the isthmuses.Conclusions  Isthmuses were present in the vast majority of roots observed. The third millimetre from the apex showed more isthmuses than expected. The results of clinical and surgical endodontic procedures performed in the mesial root of mandibular molars may be affected by this aspect of the root canal anatomy.
Microhardness changes in dentine after neonatal capsaicin application
Authors: Krage T. L. , Stiefel A. , Stephan B. M. , Zimmer S. , Lambrichts I. , Raab W. H.‐M. 
Published: July 2005

AbstractAim  To determine if desensitization of the nociceptive innervation in the dental pulp has an effect on odontoblast function in the rat.Methodology  Neonatal systemic application of capsaicin was used to selectively eliminate nociceptive innervation. 12 capsaicin‐treated rats were intravitally perfused at 150 days of life with 4% formaldehyde and jaws were prepared for Vicker's microhardness (VMH) measurement. As a control, 12 rats were injected with vehicle on the 3rd day of life and intravital perfusion was carried out exactly as those used for the experimental group. Immunohistological labeling of CGRP was carried out in both groups to assure the efficiency of desensitization in the experimental group. The VMH was measured in the incisors of each animal for a quantitative analysis of dentine quality.Results  Vicker's microhardness was significantly higher in the control rats compared with the capsaicin‐treated rats (P < 0.001).Conclusions  Neonatal systemic application of capsaicin produces changes in the quality of dentine in the rat over time and therefore it is suggestive that selective elimination of the nociceptive innervation in pulpal tissue may effect odontoblast function.
Older people specific health status and quality of life: a structured review of self‐assessed instruments
Authors: Haywood Kirstie L. , Garratt Andrew M. , Fitzpatrick Raymond 
Published: July 2005

AbstractObjectives  To review evidence relating to the measurement properties of older people specific self‐assessed, multi‐dimensional measures of health status.Design  Systematic literature searches to identify instruments. Pre‐defined criteria relating to reliability, validity, responsiveness, precision and acceptability.Results  A total of 46 articles relating to 18 instruments met the inclusion criteria. Most evidence was found for the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), CARE, Functional Assessment Inventory (FAI) and Quality of Life Profile – Seniors Version (QOLPSV). Most instruments have been evaluated in single studies. Four instruments have evidence of internal consistency and test–retest reliability – LEIPAD, Philadelphia Geriatrics Centre Multilevel Assessment Inventory, Perceived Well‐being Scale, Wellness Index (WI). Two instruments lack evidence of reliability – Brief Screening Questionnaire, Geriatric Quality of Life Questionnaire (GQLQ). Older people contributed to the content of the GQLQ, QOLPSV and WI. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio‐demographic variables. Limited evidence of responsiveness was found for five instruments – GQLQ, OMFAQ, PGCMAI, QOLPSV, Self‐Evaluation of Life Scale (SELF).Conclusion  Although most evidence was found for the OMFAQ this was largely for the ADL domain; evidence for reliability and responsiveness is limited. Limited evidence of reliability, validity and responsiveness was found for the PGCMAI, QOLPSV and SELF. The lack of evidence for measurement properties restricts instrument recommendation. Instrument content should be assessed for relevance before application and the concurrent evaluation of specific and widely used generic instruments is recommended. Several instruments, including the BSQ and EASY‐Care, were developed recently and further evidence of instrument performance is required.
Using discrete choice experiments to go beyond clinical outcomes when evaluating clinical practice
Authors: Ryan Mandy , Major Kirsten , Skåtun Diane 
Published: July 2005

AbstractBackground  This study builds on the results of a randomized controlled trial concerned with examining the effect of reducing waiting times on the health status of patients referred for non‐urgent rheumatology opinion. No difference in clinical outcomes was found between a ‘fast‐track’ and ‘ordinary’ appointment system. This suggests that rationing by waiting times is not detrimental to health. However, such an approach ignores the value patients attach to reducing waiting time.Objectives  To estimate the monetary value of reducing waiting time, as well as changes in duration of appointment and the introduction of a pain management service, in the provision of rheumatology services.Methods  Discrete choice experiment (DCE).Setting  The main outpatient clinic of the rheumatology service for the Lothian and Borders region.Subjects  262 patients who had received a specialist rheumatology opinion – 73 had received fast‐track treatment, 65 standard care and 124 were non‐trial patients.Results  A response rate of 71% was achieved. Patients valued a 9‐week reduction in waiting time at £131. However, the introduction of a pain management service was valued at £209. Thus, the latter is of more value to respondents. Evidence was also found of the internal consistency and theoretical validity of the DCE approach.Conclusions  The reduction of waiting times is a central plank of NHS policy. Whilst a reduction in waiting time is of value, a pain management service is of more benefit than a 9‐week reduction in waiting time. DCE were shown to be a potentially useful technique for valuing different aspects of health care interventions.
Provider adherence to COPD guidelines: relationship to organizational factors
Authors: Ward Marcia M. , Yankey Jon W. , Vaughn Thomas E. , BootsMiller Bonnie J. , Flach Stephen D. , Watrin Shea , Doebbeling Bradley N. 
Published: July 2005

AbstractRationale, aims and objectives  A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline.Methods  We administered a survey to key informants that assessed adherence to the COPD guideline, approaches to disseminating and implementing the COPD guideline, providers’ views of the COPD guideline and guidelines in general, and attitudes about the organizational climate.Results  Surveys were returned by 242 key informants (58%) at 130 of the 143 VHA hospitals (91%). Adherence to the COPD clinical practice guideline is perceived by quality managers within the VHA to be good. The final multivariable predictor model identified five measures that were related to provider adherence with the COPD guideline (R2 = 0.43): responsibilities were changed to support adherence to the COPD guideline, physicians believe that guidelines implemented in the past year were applicable to their practice, patient care providers consistently participate in activities to improve the quality of care, the regional network office monitors the pace at which guidelines are implemented, and there is a system to provide feedback on routinely collected guideline adherence data collected in addition to External Peer Review Program data.Conclusions  Organizations can play an important role in providing a supportive climate to facilitate their providers’ adherence to guidelines by implementing processes and culture changes that involve these five measures.
Low utilization and wide interhospital variation in investigation of patients after acute myocardial infarction: inadequate resources or insufficient evidence?
Authors: Williams R. Ian , Fraser Alan G. , West Robert R. 
Published: July 2005

AbstractBackground  Guidelines for the management of patients with acute myocardial infarction are available, but implementation may be difficult when resources are limited.Objective  The aim of this study was to investigate whether resources, manpower or access to specialist facilities affect care following myocardial infarction.Patients and methods  A representative sample of 1595 patients in all 19 district general hospitals in Wales was analysed for differences in use of investigations and prescription of secondary prevention and how these factors were related to provision of cardiologists and coronary care beds and distance from specialist cardiac services.Results  Inpatient investigation rates were low and there were wide interhospital variations for exercise testing [mean 42%; interquartile range (IQR) 27–59%] and echocardiography (mean 46%; IQR 33–66%). In comparison, prescription of secondary prevention was similar to European standards and showed less interhospital variation (beta blockers mean 48%; IQR 44–54%; angiotensin‐converting enzyme inhibitors mean 59%; IQR 43–63%). There was little association between investigation or secondary prevention rates and cardiac services, but overall rates and provision were low.Conclusion  Delivery of care after acute myocardial infarction for stratifying risk and preventing recurrence was unrelated to relative provision or distance from specialist centres. Low use of investigations and high interhospital variability could imply limited access to resources such as echocardiography. Higher rates of prescription of drugs, with less variation between hospitals, argues against low utilization because of insufficient evidence.
The seduction of general practice and illegitimate birth of an expanded role in population health care
Authors: Buetow Stephen , Docherty Barbara 
Published: July 2005

AbstractTo reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. They appear to disregard implications of the policy for redefining the nature and scope of their discipline (and of public health), including their own role as providers of personal care. This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The ex‐ample of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.