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Aim The aim of present study was to compare cyclic fatigue resistance of three modern Ni–Ti instruments used with continuous rotation. Materials and methods For this study 3 groups of rotating instruments with continuous rotation (HyFlex EDM, Twisted File Adaptive, Revo S SU) have been used, each group consisted of 20 files. The various groups were subjected to cyclic fatigue testing through an artificial metal device. A statistical analysis with Kruskal–Wallis test and Mann–Whitney test was performed. Results There were statistically significant differences between the three groups. The HyFlex EDM instruments have a fracture resistance slightly higher than the Twisted file and far higher than Revo S SU. Conclusions Modern Ni–Ti alloys increase resistance of the rotating instruments to cyclic fatigue.

This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca’ Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care.

Aim Today, thanks to modern technologies as operative microscope, ultrasonic tips, devices to activate irrigation and tridimensional obturation performed with thermo plasticized gutta-percha, excellent results could be obtained. Materials and methods In this study, we present 5 patients with the presence of periapical lesions in molars and incisors with history of pain. Modern endodontic technologies were used. The rationale of using these technologies was to obtain a chemo-mechanical cleansing and obturation of the entire endodontic system and to gain the lesion resolution with a non-surgical approach. Results A success rate of 100% was obtained. Radiographs and clinical examinations were done until 10 years. All the cases highlighted the success achieved in the short and long term through the complete resolution of the lesions and therefore the reconstitution of the lamina dura. Conclusions The positive results highlighted by these clinical cases demonstrate how the use of modern technologies is essential to avoid iatrogenic damage and to gain safe and reproducible results.