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Introduction: Gender variation in critically ill adults after resuscitation is reported in many studies. However, this variation is not well established when evaluating the physiological instability in this population. This study aimed to prospectively evaluate the gender variation in serious outcomes by the difficult airway physiological score (DAPS) among critically ill patients requiring endotracheal intubation (ETI). Methods: This is a cohort study conducted from August 2021 to December 2022 in the emergency department of Aga Khan University. The prospective validity of the difficult airway physiological score was derived using retrospective data and includes 12 variables: sex, age, time of intubation, hypotension, respiratory distress, vomiting, shock index >0.9, pH < 7.3, fever, anticipated decline, Glasgow Coma Scale (GCS) < 15, and agitation. The serious outcomes were cardiac arrest, mortality (within 1 hour after intubation in emergency), hypotension (systolic blood pressure <90 mmHg), and oxygen desaturation (SpO2 < 92%). The difference between males and females was assessed using the chi-square test, and the association of gender and serious outcomes was explored using Cox and logistic regression analysis. ROC curve analysis and area under the curve assessed score validity separately in males and females with serious outcomes. Results: We enrolled 326 patients with a mean age of 50.3 (±17.8), with 123 (33.7%) females and 203 (62.2%) males. 198 (60.7%) patients were >45 years old, of which 136 (67%) were male and 62 (50.4%) female. Cardiac arrest was observed in 56 (17.2%), with 24 (19.5%) females and 32 (15.8%) males, p value 0.348. Hypotension after intubation was observed in 132 (40.5%) patients, 56 (45.5%) females and 76 (37.4%) males, p value 0.149. Oxygen saturation (<92%) was observed in 80 (24.5%) patients, 32 (26%) females and 48 (23.6%) males, p value 0.630. In females, the DAPS of 11 had an area under the curve of 0.863 (0.74-0.91). The sensitivity of the score was 84.8%, the specificity was 71.9%, the PPV was 77.8%, and the NPV was 80.4% with an accuracy of 78.9%. In males, the DAPS score of 14 had an area under the curve of 0.892 (0.57-0.75). The sensitivity of the score was 67%, the specificity 93.8%, the PPV 92.2%, and the NPV 72.2% with an accuracy of 79.8%. Conclusions: The Difficult Airway Physiological Score (DAPS) predicts the risk of serious outcomes after intubation with high precision and reliability with different score cutoffs between the two sexes, highlighting the gender variation of a difficult airway.

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Objective: To determine the efficacy of preoperative Tranexamic Acid (TXA) in reducing perioperative allogenic blood transfusion frequency in patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS). Methods: We conducted this placebo controlled double-blinded randomized trial in Orthopaedics & Traumatolgy Division Lady Reading Hospital, Peshawar from 1st January 2020 to 25th December 2022. All patients with intertrochanteric hip fractures fulfilling the inclusion criteria were treated with Dynamic Hip Screw (DHS) and were randomly divided into two equal groups. One group was administered single dose IV Tranexamic Acid (TXA) in a dose of 15mg/kg body weight in 100ml of saline while the other group (Placebo) was given 100 ml normal saline preoperatively. Post-operative Hemoglobin was measured on first, second and third day. The frequency of allogenic blood transfusions in the perioperative period was determined in both groups based upon the transfusion trigger (Hemoglobin 9g/dl). Categorical variables were compared with Chi-square test and mean with Independent sample t-test. P value of <0.05 was considered significant. Results: The total number of patients in our trial were 200 which were equally but randomly allocated into TXA group and Placebo group each containing 100 patients. The mean age of the patients in TXA group was 48.16±1.75 years and the age of patients in the Placebo group was 48.35±1.60. The baseline demographic and clinical variables of both groups were identical (p< 0.05). The average preoperative hemoglobin was 11.5±4.2 g/dl in TXA group and 11.3±2.4g/dl in the Placebo group (p>0.05). The frequency of allogenic blood transfusion was significantly lower (p<0.05) in TXA group (13%, n=13) than in the Placebo group (41%, n=41). Conclusion: Tranexamic acid (TXA) significantly reduces the frequency of peri operative allogenic blood transfusion in patients undergoing Dynamic Hip Screw (DHS) for intertrochanteric fractures.

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INTRODUCTION: Profile GT files have been redesigned and are now marketed as GTX nickel-titanium rotary files. METHODS: A double-digital radiographic technique was used to compare apical transportation (AT) and change in working length (CWL) between Profile GT and GTX rotary files. Mesiobuccal canals of 40 extracted mandibular molars were instrumented by either rotary system. The central axes of preoperative (15 K) and master apical rotary file (30/.04) were digitally superimposed. AutoCAD was used to measure AT at 0, 1, and 3 mm from WL. The distance from the file tip to the set WL indicated any CWL. Analysis of variance test showed no significant differences between groups in AT. RESULTS: CWL in GTX (-0.25 +/- 0.42) group was significantly greater than in Profile GT group (0.17 +/- 0.30). CONCLUSIONS: The AT results indicate that the newly designed GTX rotary instruments are as effective as the older Profile GT instruments.

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INTRODUCTION: The aim of this study was to evaluate apical transportation and working length changes after instrumentation using EndoSequence (Brasseler USA, Savannah, GA) and Guidance V-taper (Guidance Endo, Albuquerque, NM) rotary files. METHODS: Forty-four mesiobuccal and mesiolingual canals of extracted mandibular first and second molars were instrumented by using EndoSequence or Guidance NiTi rotary files. Group 1 (n = 22) was instrumented with EndoSequence #30/.06, #25/.06, and #20/.06 files in a crown-down technique until apical enlargement with #25/.06 was achieved at the working length. Group 2 (n = 22) was instrumented with Guidance #30/.10, #25/.08, and #20/.06 files in a crown-down method until apical enlargement with #25/.08 was reached. A double digital radiographic technique was used to measure the loss of working length and canal transportation at 0, 1, and 3 mm from the working length. Measurements were analyzed by using repeated-measures analysis of variance. RESULTS: The average amount of transportation at 0, 1, and 3 mm was 0.077 mm, 0.039 mm, and 0.040 mm for the EndoSequence group and 0.066 mm, 0.046 mm, and 0.05 mm for the Guidance group, respectively. The loss of working length was 0.001 mm for the EndoSequence group and -0.002 mm for the Guidance group. CONCLUSION: There was no statistically significant difference in the loss of working length or transportation at the measured level between EndoSequence and Guidance rotary files.

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Osseointegrated implants have affected the decision-making process for prosthodontic, periodontic, and endodontic treatment planning. As a result, the traditional endodontic care model has undergone a paradigm shift. As with any emerging technology, there is concern that the initial enthusiasm surrounding implants could supersede quality of patient care issues, especially since there is no consensus about whether it is better to restore or replace a compromised tooth. The results of a number of meta-analyses show no statistical difference in terms of the long-term outcomes for single -tooth implants and endodontically treated teeth. Obviously, the decision to treat a tooth endodontically or replace it with a single-tooth implant should be based on other criteria. This article compares how certain variables affect the outcome of cases in which teeth are treated using either root canal treatment or single-tooth implants and explores the beneficial synergistic relationship between these two viable alternatives.

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The purpose of this study was to report results of the initial six years of experience utilizing a nonsurgical root canal treatment (NSRCT) database; to compare patient characteristics, operative procedures, and patient outcomes observed in the database to those observed in other studies; and to discuss the potential benefits of a clinical endodontic database. A total of 7,372 NSRCT cases performed by endodontic residents at the University of Pennsylvania from 2000 to 2006 were evaluated. The odds ratio (OR) for caries and trauma being causative agents for NSRCT in

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OBJECTIVE: The objective of this study was to identify the most commonly retreated tooth at a postgraduate endodontics program and to compare this result with teeth requiring primary root canal treatment as well as those that required further surgical endodontic treatment. STUDY DESIGN: The study population consisted of 6,894 patients treated between 2000 and 2005 by endodontic postgraduate students at the University of Pennsylvania School of Dental Medicine. Data regarding tooth type and endodontic treatment rendered were obtained from the Penn Endo database. RESULTS: Initial root canal treatment was most commonly done on mandibular molars. Anterior teeth were 1.411 times more likely to undergo NSRT than molars. Maxillary molars were 1.048 times more likely to undergo conventional retreatment than mandibular molars. Maxillary anterior teeth were 3.032 times more likely than mandibular molars to undergo surgical treatment. CONCLUSIONS: Mandibular molars may most commonly receive initial root canal treatment but it is the anterior teeth that are more likely to undergo surgical and nonsurgical retreatment. Maxillary molars are more likely to receive surgical intervention than mandibular molars. These data call for further investigation into the reasons for such discrepancy.

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The aim of this study was to evaluate the ability of Obtura II (Obtura Spartan, Fenton, MO) and Calamus (Densply, Tulsa, OK) to fill artificially created lateral canals in simulated plastic teeth using standard gutta-percha, Flow 150 gutta-percha (Obtura Spartan, Fenton, MO), and Resilon (Resilon Research, LLC, North Branford, CT). Lateral canals were created at 2, 4, 6, 8, 10, and 12 mm from the apex in plastic teeth. The teeth were divided into eight groups. In group 1, teeth were filled with a single increment of Calamus; in group 2, canals were filled with Calamus in three increments. In group 3, Obtura II was used with a single increment of standard gutta-percha, whereas in group 4 Obtura II was used in three increments. Groups 5 and 6 were similarly filled as in the preceding groups. A multiple-comparison analysis of variance test followed by a Tukey post-hoc test were used to compare filling material penetration into the lateral canals and the experimental groups (p < 0.05). The results indicated that the flow of the filling material into lateral canals is a function of the viscoelastic properties of the filling material rather than the mechanical properties of the delivery systems. Our data also suggest that the Resilon filling material flows better into lateral canals when a single backfill technique is used.

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One of the major issues confronting the contemporary dental clinician is the treatment decision between extracting a tooth with placement of a dental implant or preserving the natural tooth by root canal treatment. The factors that dictate the correct selection of one procedure over the other for each particular case are not yet established by randomized controlled studies. The aim of this review is to evaluate key factors allowing the clinician to make clinical decisions on the basis of the best evidence and in the patient's best interests. General considerations are discussed that will help the reader analyze clinical studies focused on this problem. Importantly, the major studies published to date indicate that there is no difference in long-term prognosis between single-tooth implants and restored root canal-treated teeth. Therefore, the decision to treat a tooth endodontically or to place a single-tooth implant should be based on other criteria such as prosthetic restorability of the tooth, quality of bone, esthetic demands, cost-benefit ratio, systematic factors, potential for adverse effects, and patient preferences. It can be concluded that endodontic treatment of teeth represents a feasible, practical, and economical way to preserve function in a vast array of cases and that dental implants serve as a good alternative in selected indications in which prognosis is poor.

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The purpose of this investigation was to evaluate the concomitant influence of several variables on the number of root canals clinically detected in maxillary molars. The study used multiple logistic regression analysis on data from 1328 patients, aged 6-82 years, who received nonsurgical root canal treatment on maxillary molars at the University of Pennsylvania from 2000-2006. The number of canals was used as the dependent variable, whereas tooth type, age, caries, referral source, restoration, and pulpal and periapical diagnosis were used as independent variables. One was 0.98 times less likely to detect more canals when the age increased by 1 year. Similarly, one was 1.4 times more likely to detect canals in teeth with caries than teeth without caries. When these independent variables were controlled, only age of the individual was significantly related to number of root canals detected.

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Modern developments in instrument design and obturation techniques have greatly improved the efficiency of conventional endodontic therapy. Nickel titanium rotary instruments allow the practitioner to prepare canals more quickly and predictably. However, apical preparations by such instruments fail to address the anatomical complexity of the root canal system. Morphologic studies consistently show that canals are mostly oval or irregular in shape; therefore, round preparations by instrumentation result in uninstrumented areas of the root canal system. This is of particular importance in the apical third and in cases of preexisting periapical pathology, where residual bacteria may reside and cause persistent infections. How beneficial are these new instrumentation and obturation techniques to the basic purpose of root canal therapy in eradicating bacteria? This article presents the shortcomings of current instrumentation and obturation techniques and offers possible solutions to improve the outcome of endodontic therapy.

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Nine hundred fifty-one emergency and 997 nonemergency patients seeking endodontic treatment were the basis of this study. Variables of interest were 10 pain descriptors, percussion and palpation tests, causative factors, and paired pulpal and periapical diagnoses. A higher number of patients suffering from symptomatic pulpal conditions sought emergency care. Odds of caries being a causative factor were high in symptomatic pulps compared with asymptomatic pulpal and periapical conditions. Higher odds ratios were obtained for sharp pain in symptomatic pulps versus symptomatic periapical conditions. Conversely, odds ratios for dull pain were higher in symptomatic periapical conditions compared with asymptomatic periapical conditions. Percussion and palpation tests were significant in differentially diagnosing between pulpal and periapical conditions. In conclusion, caries was associated with painful pulpitis. The results confirm the differential diagnostic power of sharp and dull pain and percussion and palpation tests. Several symptoms previously believed to have differential diagnostic power were found insignificant.

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This case report presents clinical and morphological features of severe invasive cervical resorption (ICR) involving a maxillary first molar. Surface morphology of the ICR defect that extended into enamel was studied using a scanning electron microscope. The topography and morphology of resorbed enamel and pulpal surfaces are described. The pulpal space was characterized by proliferation of fibrovascular tissue invaded by a number of > or = 15-microm-large dentinoclastlike cells. The vertical orientation and hexagonal geometric outlines of enamel rods indicated that the resorptive defect had extended into the outer surface of enamel. Preferential odontoclastic dissolution of interprismatic enamel was noted. Deposits of a cementumlike substance were noticed on enamel surfaces, indicating that resorptive process was coupled with repair. Complete destruction of dentin was associated with no response by the tooth to cold stimulus, supporting the hydrodynamic theory of dentinal sensitivity. The results of this study indicate that in addition to predentin and cementum, the outer surface enamel may be resistant to the resorptive process as well.

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The authors report on data from a self-assessment questionnaire filled out by 199 patients undergoing periradicular microscopic surgery at two private endodontic offices and at graduate endodontic clinics of the University of Pennsylvania. Regression analysis was performed using pain and swelling as dependent variables and age, sex, type of teeth, location, periapical lesion, and remedication as independent variables. Pain and swelling were significantly related to females and younger patients (p < 0.05). The results supported Etodolac as a pre- and postoperative analgesic and use of antibiotics restricted to high-risk patients. Maximum pain and swelling were reported at night and day 1 of the surgery, respectively. Generally, swelling was more often reported than pain. Surgeries in anterior maxilla were related to more pain and swelling. A majority of the patients (67%) rated surgical endodontics more pleasant than expected and found it less painful (46%) or the same (38%) as nonsurgical treatment. The results also point out that patients in general have negative beliefs and limited knowledge about periradicular surgery.

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In a major design change LightSpeed Technologies Inc. has replaced the U-shape blade design with a spade-shape design in LightSpeed LSX root canal rotary instruments. A double-digital radiographic technique was used to compare apical transportation (AT) and length control (LC) between the two instrument designs. Thirty simulated plastic root canals were instrumented by each rotary system. Digital radiography and AutoCAD 2007 were used to determine the central axes of files at 20, 35, 50, and 70 ISO sizes. By superimposition of central axes with a baseline at size 20, the degree of AT was measured at 0, 1, and 3 mm from working length (WL). The distance from file tips to set WL indicated any loss of LC. ANOVA test showed no significant differences between groups with respect to the degree of AT or LC. No instrument separation was noted. The results indicate that newly designed Lightspeed LSX instruments maintain the same effectiveness regarding AT and LC as that of the LightSpeed LS1 instruments.

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PURPOSE: The clinical question this systematic review aimed to answer was "What are the differences in outcomes of restored endodontically treated teeth compared to implant-supported restorations? Therefore the aim of this study was to use systematic review to compare the survival of compromised teeth restored with either root canal therapy followed by a crown, or placement of a single-tooth implant. MATERIALS AND METHODS: MEDLINE, EMBASE, and PubMed databases were searched for studies dealing with survival of single-tooth implants and restored endodontically treated teeth. A 2-step screening procedure was used to identify articles that met the inclusion/exclusion criteria. Fifty-five studies related to single-tooth implants and 13 studies related to restored root canal-treated teeth were included. The endpoint analyzed in these studies was the survival rate of the treated tooth or implant. RESULTS: The 95% confidence intervals for the pooled estimates for the single-tooth implants and restored endodontically treated teeth were found overlapping in forest plots for all follow-up periods. This indicated no significant differences in survival between restored root canal-treated teeth and single-tooth implants. CONCLUSIONS: The results of this systematic review indicate that the decision to treat a tooth endodontically or replace it with an implant must be based on factors other than the treatment outcomes of the procedures themselves. Both nonsurgical root canal therapy followed by an appropriate restoration and single-tooth implants are excellent treatment modalities for the treatment of compromised teeth.

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This study investigated the incidence of hand and rotary instrument separation (IS) in the endodontics graduate program at the University of Pennsylvania between 2000 and 2004. In 4,865 endodontic resident cases the incidence of hand and rotary IS was 0.25% and 1.68%, respectively. The odds for rotary IS were seven times more than for hand IS. The probability of separating a file in apical third was 33, and 6 times more likely when compared to coronal and middle thirds of the canals. The highest percentage of IS occurred in mandibular (55.5%) and maxillary (33.3%) molars. Furthermore, the odds of separating a file in molars were 2.9 times greater than premolars. Among the ProFile series 29 rotary instruments, the .06 taper # 5 and # 6 files separated the most. There was no significant difference in IS between the use of torque controlled versus nontorque controlled handpieces, nor between first and second year residency.

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This study compared three methods for creating the most centered staging platform (SP) around separated instruments (SI) in curved canals. Green .04 ProFiles, notched at D(3), were separated in the apical third of 42 mesiobuccal canals of maxillary and mandibular molars. Teeth were divided into three groups. SPs were prepared in group 1 with Gates Gliddens (GG) to a size #3; group 2 with LightSpeed to a size 90; and group 3 with incrementally cut rotary .06 ProFiles to size 82. Pre- and postoperative digital radiographs were imported into AutoCAD to measure the deviation of SP from the head of the separated instrument. Pearson's correlation showed a positive relationship between deviation of the SP and the distance of the SI from the elbow of the canal. ANOVA showed that LightSpeed instruments were significantly more effective in preparing a centered staging platform around separated instruments in curved canals when compared to GG drills and ProFiles (p < 0.05).

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The present case report describes the treatment of complicated crown fractures using mineral trioxide aggregate (MTA). MTA was used as pulp-capping material after partial pulpotomy to preserve the vitality of the pulpal tissues in two cases. Follow-up examinations revealed that the treatment was successful in preserving pulpal vitality and continued development of the tooth.

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BACKGROUND: The maxillary central incisor is considered to be the least difficult subject for a clinical endodontic experience. However, the internal anatomy of maxillary central incisors can present a number of variations, including multiple accessory canals. CASE DESCRIPTION: This article highlights the clinical significance and management of accessory canals located in the apical one-third of maxillary central incisors. The authors present two case reports in which failure to detect the accessory canals led to root canal failure and subsequent surgical intervention. Another two case reports present the serendipitous discovery and nonsurgical management of accessory canals during the initial treatment of maxillary incisors. CONCLUSIONS AND CLINICAL IMPLICATIONS: It is important for the clinician to be able to detect the signs suggesting the presence of accessory canals in maxillary central incisors. Failure to do so may lead to a less-than-optimal endodontic treatment outcome.

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