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An evaluation of nitinol and stainless steel files used by dental students during a laboratory proficiency exam.

Eighty-one dental students instrumented two curved canals in acrylic blocks with the use of stainless steel files in one block and nitinol files in the other. Overlay tracings were made of photographs taken before and after instrumentation of the acrylic blocks and differences between the tracings were measured along the canal walls. The canals instrumented with nitinol files were shaped better than those instrumented with stainless steel files; working length was maintained more often without ledging the canal walls and with less zipping of the apical foramen.

Alloys↗

Comparative trials in registration files of cardiovascular drugs: comparator drugs and dosing schemes.

Registration files of 13 cardiovascular drugs were analysed with respect to the number of double-blind phase-III clinical trials, the use of placebo and active comparator drugs and their dosing schemes. Half of the 146 double-blind trials used active comparator drugs. The majority of files included first-choice reference drugs, but we also found trials in three files with lower dosing schemes of comparator drugs and four files which included only placebo or active controlled double-blind trials. To allow a better interpretation of the information provided in European Public Assessment Reports, which are published for every product approved for marketing in the European Union, uniform reporting is recommended on basic details of trial design, such as comparator drugs used and dosing schemes.

Cardiovascular Agents↗

A survey of interfacial forces used during filing of root canals.

The pattern of dentine removal during endodontic instrumentation is influenced by many factors including the interfacial forces applied by the operator. The aim of this study was to investigate the influence of operators and different sizes and types of instruments on the magnitude of these interfacial forces. Single-rooted teeth were mounted on a cantilevered aluminium beam to which two pairs of single element strain gauges were joined in a half-bridge configuration and mounted at right angles to each other. The strain gauges were connected to an analogue-to-digital converter fitted in a micro-computer via conditioning amplifiers. This enabled strains to be recorded over a period of time. Twenty operators instrumented root canals using a series of hand instruments for 1 min each. The mean interfacial forces used by operators demonstrated a wide variation ranging from 9.06 g to 149.42 g (range of forces from 0-331 g) but there was a consistency in the relative magnitude for each operator. The 20 operators could be divided into 13 groups which were significantly different (alpha = 0.05) from each other. There were significant differences (alpha = 0.05) between the forces used for each of the K-Flex files (15, 25, 35, 45, and 70), the force increasing with the file size. There was also a significant difference (alpha = 0.05) in the forces used between the Flexofile (#25) and the #25 K-Flex and Hedström files. However, there was no significant difference between the K-Flex and Hedström files.

Amplifiers, Electronic↗

The effects of developer age on diagnostic accuracy: a study using assessment of endodontic file length.

OBJECTIVES: To examine the effects of developer age on image quality. METHODS: Endodontic files, size 10 and 15, were placed in upper and lower molars and premolars up to the root apex or 1.5 mm short. A series of radiographs were made with each of three film types: Dentus M2 (Agfa-Gevaert, Mortsel, Belgium), Ektaspeed Plus and Ultra-speed (Kodak Eastman Co, Rochester, USA). The films were processed bi-weekly using the same Agfa chemicals (Heraeus Kulzer, Dormagen, Germany) over a 6-week period. An additional set of Dentus M2 films was processed using Periomat chemicals (Dürr Dental, Bietigheim-Bissingen, Germany). The films were viewed by eight dentists who rated the position of the tip of the file using a 5-point confidence scale. ROC data were analysed by means of analysis of variance. Az value was the dependent variable, whereas observer age group was entered as between subject factor. The null hypothesis was rejected when P<0.05. RESULTS: The diagnostic accuracies of the three films were comparable during the first 4 weeks. In the sixth week Ultra-speed was significantly better than the other two films (P=0.046). The Periomat chemicals showed significantly greater consistency than the Agfa chemicals (P=0.004). Developer exhaustion significantly affected the performance of the older observers (P=0.008), especially when Agfa chemicals and file size 10 were used. CONCLUSION: Agfa chemicals older than 4 weeks significantly affect the assessment of endodontic file length. In earlier stages there are no significant differences between the three films tested. Dentus M2 and Ektaspeed Plus films should be used as they require lower exposures.

Adult↗

The effects of different image file formats and image-analysis software programs on dental radiometric digital evaluations.

OBJECTIVES: To determine if variations in radiodensity data are introduced by lossy Joint Photographic Experts Group (JPEG) compression and/or the use of three software programs. METHODS: An occlusal film with an aluminium step wedge was exposed, processed and digitized under standard conditions. Before the image was saved, the coordinates and the gray-scale value for each pixel in a 20 x 20 pixel area near the middle of the thickest step were recorded. These pixel coordinates and gray-scale values served as Truth 1. In addition, a digital simulated-radiographic image with assigned gray-scale values for each pixel was created and served as Truth 2. The digital data for the scanned radiograph and the simulated radiograph were saved as Tagged Image File Format (TIFF) and lossy JPEG files. Each file was opened with three software programs and the gray-scale values of homologous pixels were recorded. For these pixels in each image type, the mean gray-scale values and standard deviations were calculated. The pixel gray-scale values for each homologous pixel were also individually compared. RESULTS: When the TIFF images were opened with the three software programs, one program resulted in gray-scale values that were not concordant with truth. All JPEG images resulted in gray-scale values that were not concordant with truth. CONCLUSIONS: One software program added a column of 0s to data files. Lossy JPEG compression introduced potentially deleterious variations to radiodensity data, and at least two of the software programs performed JPEG image decompression differently.

Absorptiometry, Photon↗

Comparison of measurements obtained with hand files or the Canal Leader attached to electronic apex locators: an in vitro study.

AIM: The aim of the present in-vitro study was to combine directly the Canal Leader handpiece (SET, Olching, Germany) with the electronic apex locators ROOT ZX (Morita, Kyoto, Japan) and JUSTY (Yoshida, Tokyo, Japan) to find out whether the working length values thus obtained were identical to those resulting from the combination of the same electronic devices with hand files. METHODOLOGY: A total of 50 natural extracted teeth with single canals and mature apices were used. A radiograph was used as a control and the distance from the radiographic apex to the tip of the file was measured and compared with the results of the electronic length determination. RESULTS: For both electronic devices the differences amongst the distribution of the measurements were not statistically significant under the specified conditions (P > 0.05), indicating that the measurements with hand files and with the Canal Leader were identical for the majority of the cases. CONCLUSIONS: Under the conditions of this study the working length of canals obtained with electronically assisted hand files were similar to those obtained with the electronically assisted mechanical handpiece Canal Leader.

Dental Equipment↗

Quantec SC rotary instruments versus hand files for gutta-percha removal in root canal retreatment.

AIM: The purpose of this study was to compare Quantec SC rotary instruments and hand files for removal of gutta-percha during retreatment. METHODOLOGY: Twenty maxillary central incisors with a single straight canal were selected. The canals were instrumented and filled before the teeth were randomly divided into two groups of 10 specimens each. In group 1 Quantec SC rotary instruments were used for filling removal and in group 2, hand files and solvent. The following factors were evaluated: time taken to reach working length, time for gutta-percha removal, total time, apically extruded material during filling removal and number of fractured instruments. Radiographs were taken and the teeth were grooved longitudinally and split. The canal walls of each half and the radiographs were evaluated visually for cleanliness. They were then digitized using a scanner and the residual debris assessed. The analysis was carried out in the cervical, middle and apical thirds separately as well for the whole canal. RESULTS: The time for root filling removal was significantly less when Quantec SC was used (P < 0.05). The amount of apically extruded material was not significantly different between the groups (P > 0.05). Direct evaluation of the canal walls revealed that hand files and solvent demonstrated better cleanliness in the cervical third and in whole canal (P < 0.05). Radiographic analysis demonstrated that hand files performed significantly better when viewed in a mesiodistal direction (P < 0.05). CONCLUSIONS: Although Quantec SC instruments took less time, hand instruments and solvent cleaned canals more effectively.

Dental Pulp Cavity↗

Preparation of curved root canals with rotary FlexMaster instruments compared to Lightspeed instruments and NiTi hand files.

AIM: To compare the recently introduced rotary FlexMaster instruments with Lightspeed instruments and NiTi hand files in preparing curved root canals. METHODOLOGY: Root canals of extracted molars were shaped with rotary FlexMaster instruments ('FM': n = 45), Lightspeed instruments ('LS': n = 46), and NiTi hand files (n = 45) using the balanced-force technique. The apical preparation size was 40. Root canal instrumentation was carried out in a phantom head under clinical conditions. A re-assembly technique allowed a comparison of the canal outline before and after preparation. Root sections 2.5 mm short of working length were used to calculate the percentage of prepared canal outline (= PPO) and the amount of root canal transportation. Loss of working length, fracture rate and time spent on complete preparation were also recorded. RESULTS: The highest PPO values were found in the LS group (mean = 63% [95% CI: 55%; 70%]). Although not statistically significant, lower PPO values were detected for FM instruments (mean = 55% [95% CI: 49%; 62%]) and for hand files (mean = 53% [95% CI: 47%; 59%]). The incidence of root canal transportation exceeding 0.1 mm was significantly lower in the LS group than in the FM group. Loss of working length of 0.5 mm occurred in five cases (LS group: 4x; FM group: 1x). Two LS instruments fractured. Half the time was needed for root canal preparation with FM instruments than with hand files. CONCLUSIONS: Rotary FM instruments are suitable for preparing curved root canals. They provided results similar to LS instruments with minimal risk of instrument fracture but increased risk of root canal transportation.

Dental Alloys↗

Bursts in single-file motion mediated conduction.

We present a cellular automaton (CA) model of particles in a single-file motion with free particle exchange at the boundaries of a one-dimensional channel connected to two infinite reservoirs in order to study the self-transmission of particles with excluded mutual passage. The parallel, local and homogeneous rule sets of the CA algorithm consider two different interactions of varying strength between particles, without any specific particle-channel interaction. CA model results suggest that one hallmark of single-file motion is the conduction bursts at a particular time scale, which have thus far only been discovered for hydrogen bond networked water translocation. The cumulative transport probabilities of particles through single-file channels of different length follow a single profile, which can be obtained through proper scaling of time. The universal features of our results suggest new experiments in single-file channel with fluids other than water.

Journal Article↗

Evaluation of digital and geometric unsharpness in dental radiographs using an endodontic file model.

OBJECTIVE: We sought to compare the effects of geometric and digital unsharpness. STUDY DESIGN: Endodontic files of sizes 6, 8, 10, and 15 were placed in the root canal of an extracted lower incisor in 3 different positions at 2-mm increments. Radiographs were taken with a GE 100 x-ray unit at magnification factors of 1.0, 1.1, 1.2, and 1.3. With the use of a flatbed scanner, each radiograph was digitized at resolutions of 75, 150, 300, and 600 dpi. Ten observers viewed the digital images and identified the positions of the end of the files and the end of the roots, as well as assessed image quality. RESULTS: No significant differences were found between the resolutions of 300 and 600 dpi, nor between the magnifications of 1.0 and 1.1. Significant differences were found between the magnification of 1.3 and the others and the resolution of 75 dpi and the others for all of the files. CONCLUSION: Geometric unsharpness has little relevance in clinical dental radiography. Increasing scanning resolution to 600 dpi did not improve accuracy with respect to recognizing the position of endodontic files.

Analysis of Variance↗

A comparison of phosphor-plate digital images with conventional radiographs for the perceived clarity of fine endodontic files and periapical lesions.

OBJECTIVE: We sought to compare digital images with radiographs for the perceived clarity of small endodontic file tips at 2 different working lengths, as well as for the visualization of periapical bone lesions. STUDY DESIGN: Standardized conventional radiographic and phosphor-plate digital images were taken of 20 extracted permanent mandibular molars with 06 K-files placed in the distal root canal either 2 mm short or flush with the apical foramen. Similar images were obtained from mandibles with teeth that demonstrated large (n = 10) or small (n = 10) periapical lesions. Four evaluators ranked the clarity of the digital image with that of the radiograph. Results were analyzed by using the 2-sided sign test, ordinal logistic regression, and the kappa test. RESULTS: The perceived clarity of an endodontic file tip, at any position, and of a small or large periapical lesion was significantly (P < .01) less on all digital images compared with conventional films. CONCLUSION: Evaluator ratings indicated that the perceived clarity of fine endodontic files and periapical lesions was significantly less with phosphor-plate digital images than with conventional radiographs.

Dental Instruments↗

Sharing digital micrographs and other data files between computers.

It ought to be easy to exchange digital micrographs and other computer data files with a colleague even on another continent. In practice, this often is not the case. The advantages and disadvantages of various methods that are available for exchanging data files between computers are discussed. When possible, data should be transferred through computer networking. When data are to be exchanged locally between computers with similar operating systems, the use of a local area network is recommended. For computers in commercial or academic environments that have dissimilar operating systems or are more widely spaced, the use of FTPs is recommended. Failing this, posting the data on a website and transferring by hypertext transfer protocol is suggested. If peer to peer exchange between computers in domestic environments is needed, the use of Messenger services such as Microsoft Messenger or Yahoo Messenger is the method of choice. When it is not possible to transfer the data files over the internet, single use, writable CD ROMs are the best media for transferring data. If for some reason this is not possible, DVD-R/RW, DVD+R/RW, 100 MB ZIP disks and USB flash media are potentially useful media for exchanging data files.

Computer Communication Networks↗

Neural network detection of files of suicidal patients and suicidal profiles.

The optimal configuration of backpropagation (BP) neural networks was determined after 35 trials with different BP configurations evaluating the total detection rate. Ten different training and testing sets were used to identify optimal samples. All trials included sample files of patients with medically serious suicidal attempts (MSSA) and those of non-suicidal patients. Fifty files were used in each group for training and 49 files for testing with no overlap between the samples. The target variable for training was seriousness of suicide attempt (0 = non-suicidal, 1 = MSSA). The input set included 44 demographic, clinical and patient-history variables. The optimal results showed that 93.8% of MSSA and 89.8% of the non-suicidal patient files were detected. Total success rate (TSR) was 91.8% and positive and negative prediction values (PPV, NPV) were 92% and 95.6%, respectively. Living alone (6.76), treatment compliance (5.86), drug abuse or dependence (2.8), global assessment of functioning (GAF) score (1.49), non-paranoid delusions (1.22) and suicide of first degree relative (1.1) were highly associated with MSSA according to the Garson calculation. However, logistic regression attributed high importance to hallucinations (p < 0.0001), diagnosis (p < 0.002), number of children (p < 0.006), GAF score (p < 0.006), employment status (p < 0.02) and stressors (p < 0.03). It was shown that: backpropagation neural networks are very successful in identifying records of MSSA patients; a high GAF score is associated with high risk of MSSA and is the only common variable identified by both methods; and backpropagation identified two non-specific factors (living alone and treatment compliance) whereas statistics found specific factors (hallucinations and diagnosis) highly associated with MSSA.

Adolescent↗

How to find a wombmate: validation of an algorithm to identify twin pairs in Linked Birth/Infant Death Files.

Linked Birth/Infant Death Files available from the National Center for Health Statistics identify an infant as a twin, but do not identify twin pairs. An algorithm based on maternal, paternal, and infant characteristics has been used to identify twin pairs, but the validity of this algorithm has never been tested. The Missouri linked birth/infant death file from 1980 to 1990 identifies twin pairs by a sequence number. The authors tested the rate and accuracy with which the algorithm identified true pairs in the Missouri file and whether estimates of risk and possible risk factors calculated from pairs of twins identified by the algorithm agreed with these characteristics as calculated from known twin pairs. The algorithm identified 96% (8,273 of 8,620) of true pairs and one false pair. Despite incomplete pair identification, and even identification of a false pair, estimates from the subset identified by the algorithm generally agreed well with characteristics measured from all twin pairs. Nonetheless, incorporation of a multiple birth sequence number into Linked Birth/Infant Death Files would enhance their utility.

Algorithms↗

The effect of instrumentation with two different file types, each with 2.5% NaOCl irrigation on the microhardness of root dentin.

The aim of this study was to measure root-dentin microhardness after instrumentation with two types of files and using irrigation with 2.5% sodium hypochlorite. Thirty roots were instrumented with irrigation: 10 roots had the pulp extirpated only; 10 roots were instrumented with stainless steel files, and 10 roots were instrumented with rotary nickel-titanium (NiTi) files. Additionally, five roots were extirpated only without irrigation and served as a control. The roots were sliced and root-dentin microhardness was determined at depths of 500 microm and 1000 microm from the pulp-dentin interface. Significant differences were found between the microhardness at 500 microm and 1000 microm (p < 0.001) in all groups. Instrumentation with NiTi rotary files affected dentin microhardness significantly to a lesser extent.

Analysis of Variance↗

Casimage project: a digital teaching files authoring environment.

The goal of the Casimage project is to offer an authoring and editing environment integrated with the Picture Archiving and Communication Systems (PACS) for creating image-based electronic teaching files. This software is based on a client/server architecture allowing remote access of users to a central database. This authoring environment allows radiologists to create reference databases and collection of digital images for teaching and research directly from clinical cases being reviewed on PACS diagnostic workstations. The environment includes all tools to create teaching files, including textual description, annotations, and image manipulation. The software also allows users to generate stand-alone CD-ROMs and web-based teaching files to easily share their collections. The system includes a web server compatible with the Medical Imaging Resource Center standard (MIRC, http://mirc.rsna.org) to easily integrate collections in the RSNA web network dedicated to teaching files. This software could be installed on any PACS workstation to allow users to add new cases at any time and anywhere during clinical operations. Several images collections were created with this tool, including thoracic imaging that was subsequently made available on a CD-Rom and on our web site and through the MIRC network for public access.

CD-ROM↗

Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs.

OBJECTIVES: This study examined the reliability of Department of Veterans Affairs' health information databases concerning patient demographics, use of care, and diagnoses. METHODS: The Department of Veterans Affairs' Patient Treatment files for Main, Bed-section (PTF) and Outpatient Care (OCF) were compared with medical charts and administrative records (MR) for a random national sample of 1,356 outpatient visits and 414 inpatient discharges to Department of Veterans Affairs' facilities between July 1 and September 30, 1995. Records were uniformly abstracted by a focus group of utilization review nurses and medical record coders blinded to administrative file entries. RESULTS: Reliability was adequate for demographics (kappa approximately 0.92), length of stay (agreement=98%), and selected diagnoses (kappa ranged 0.39 to 1.0). Reliability was generally inadequate to identify the treating bedsection or clinic (kappa approximately 0.5). Compared with medical charts, Patient Treatment Files/Outpatient Care Files reported an additional diagnosis per discharge and 0.8 clinic stops per outpatient visit, resulting in higher estimates of disease prevalence (+39% heart disease, +19% diabetes) and outpatient costs (+36% per unique outpatient per quarter). CONCLUSIONS: In the absence of pilot work validating key data elements, investigators are advised to construct health and utilization data from multiple sources. Further validation studies of administrative files should focus on the relation between process of data capture and data validity.

Adult↗

Shaping of simulated root canals in resin blocks using the step-back technique with K-files manipulated in a simple in/out filling motion.

A total of 60 simulated root canals in clear resin blocks of various lengths and degree of curvature were prepared by hand with K-files using a step-back enlargement technique. The instruments were manipulated exclusively with a simple in/out filing or rasping motion with no attempt at rotation or twisting. The preparation technique was assessed by instrumentation time, deformation and fracture of instruments, and loss of working distance. The shape of the prepared canals was assessed by direct inspection and from composite photographic prints produced by superimposing negatives of the canals obtained before and after preparation. In general, the preparations were time-consuming and tedious to complete. Deformation and separation of instruments occurred mainly in those canals with short, severe curves. Loss of working distance was a universal finding and was associated to a degree with the straightening of curved canals inherent in their preparation. Prepared straight canals displayed a continuously tapering form being narrowest at their end-point. On the other hand, prepared curved canals were invariably hourglass in shape. Under the conditions of this study the manipulation of K-files in a simple in/out filing motion proved an unsatisfactory method of preparing simulated curved root canals in resin blocks.

Dental Pulp Cavity↗