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Aim: To evaluate the current situation of undergraduate endodontic teaching in Spanish dental schools. Methodology: An online version, translated into Spanish, of a survey conducted in the UK (Int Endod J 52, 2019, 1077) was sent via email to the undergraduate endodontic programme leads in all 23 Spanish dental schools. Results: The response rate was 96%. In 95% of dental schools, endodontics is taught in the fourth year. Students treat simple root canal treatment cases in 100% of schools and only in 40% treat moderate cases. In 65% of schools, students are supervised by full‐time professors who are specialists in Endodontics, significantly more frequently in private dental schools (P = 0.002). Spanish dental schools use both rotary and reciprocating instrumentation systems during endodontic training, with consistency on methods of working length determination, use of silicate‐based endodontic cements, irrigating solutions, inter‐visit medicaments and canal filling techniques. No type of magnification is used in 90% of dental schools, and only 25% use ultrasonic instruments. Private dental schools have a significantly better staff: student ratio during clinical practice (P = 0.041), spend significantly more hours in clinical training (P = 0.04) and have significantly greater number of clinical areas specifically dedicated to Endodontics (P = 0.010). Conclusions: Undergraduate endodontic teaching in Spanish dental schools follows the key recommendations of the ESE Undergraduate Curriculum Guidelines (Int Endod J 46, 2013, 1105), being, in most respects, comparable to that carried out in the UK (Int Endod J 52, 2019, 1077). The use of magnification and ultrasonic instruments needs to be increased. Private schools reported better results than public schools in some of the variables that were analysed. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether dental anxiety influences the intraoperative pain felt by patients during root canal treatment. Methodology: In a cross‐sectional design, 180 patients (90 men and 90 women) were included. Pre‐operative anxiety levels were assessed using the short‐form Dental Anxiety Inventory (S‐DAI). Pain during root canal treatment was evaluated using a 10‐cm visual analogue scale (VAS) that ranked the level of pain between 'Absence of pain' and 'Unbearable pain'. The minimal sample size was determined using the software of the National Center for Advancing Translational Sciences (NIH, UK). Multivariate logistic regression analysis was used to identify relationships between variables. Results: Mean pain level during root canal treatment was 2.2 ± 2.1. The mean anxiety S‐DAI score was 27.2 ± 12.5. Fifty percent of men had mild anxiety levels, while in 70% of women anxiety was moderate or high (P = 0.017). Anxiety correlated positively with intraoperative pain (R = 0.406). Multivariate logistic regression analysis revealed that anxiety was significantly associated with intraoperative pain felt by patients (OR = 4.0; 95% C.I. = 1.7–9.3; P = 0.001). Conclusions: Anxious patients were more than twice as likely to feel moderate or intense intraoperative pain during root canal treatment. To know the patient´s degree of anxiety could help the dentist to decide whether to use anxiolytic premedication and/or supplemental local anaesthesia to assure better control of pain during root canal treatment. [ABSTRACT FROM AUTHOR]

Previous studies have found an association between the outcome of root canal treatment (RCT) and diabetic status. This systematic review and meta‐analysis aimed to analyse the potential relationship between diabetes and the occurrence of extracted root filled teeth (RFT). The clinical PICO question was as follows: in adult patients with RFT, does the absence or presence of diabetes influence the prevalence of RFT extraction? The key words used in the systematic search were as follows: (Diabetes OR Diabetes Mellitus OR Hyperglycaemia OR Diabetic) AND (Endodontic OR Endodontics OR Endodontic Treatment OR Root Canal Treatment OR Root Canal Preparation OR Root Canal Therapy OR Root Filled Teeth OR Endodontically Treated Teeth) AND (Extraction OR Retention OR Survival OR Success OR Failure OR Outcome). The primary outcome variable was odds ratio (OR) for the frequency of extracted RFT in diabetics and healthy subjects. The method of DerSimonian–Laird with random effects was used to calculate the overall OR. Three hundred titles were identified, and three studies achieved the inclusion criteria. Data from 54 936 root canal treatments, 50 301 in nondiabetic control subjects and 4635 in diabetic patients, were analysed. The calculated overall odds ratio (OR = 2.44; 95% CI = 1.54–3.88; P = 0.0001) implies that diabetics had a significantly higher prevalence of extracted RFT than healthy nondiabetic subjects. The results of available studies indicate a significant relationship between DM and increased frequency of nonretained root filled teeth. Diabetes mellitus should be considered an important preoperative prognostic factor in root canal treatment. [ABSTRACT FROM AUTHOR]

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In this study, the authors present a technique for code acquisition in optical code-division multiple-access systems using the recently introduced random optical codes. In these systems, the communication is divided in two parts: a synchronisation process and the data transmission. The main target of the study is to describe and analyse the new algorithm of synchronisation using Markov processes. Once described the code acquisition technique and established an estimation for the probability of false alarm (FA) of the proposed scheme, two different proposals for the optimisation of the code parameters are described. They are based on two different estimators for the probability of FA. The first one considers the expected value for the probability of FA. The second one is very much restrictive. It guarantees that the probability of FA is in a confidence interval. It takes the upper bound of the confidence interval as estimator for the probability of FA. Although the second one presents worse acquisition time, the authors consider that the gain provided by the first method is not sufficient enough to assume its loss in the reliability. Thus, the authors propose to guarantee the probability of FA in a confidence interval. A compromise between reliability and acquisition time is obtained with this second method. [ABSTRACT FROM AUTHOR]

Introduction: This study describes the behavior of the cardiac rhythm variability (CRV) in the frequency domain, during the accomplishment of an incremental test until the exhaustion point, with the use of the Fourier Fast Transform (FFT) and auto-regressive models (AR). The Wavelet is the time-frequency methodology more useful in the CRV analysis; this will be used to explain in details the CRV kinetic in an incremental workload. Materials and methods: There had been used 8 males track bikers (age 17.12 ± 1.11 years), through an effort test in an ergonometric cycle of electromagnetic brake, with scale of 25W 1000W and minimum increments of 1W/s. The Wavelet Transform was adopted by being the most powerful tool for the accomplishment of a time-frequency analysis of a not-stationary secular series, as the cardiac frequency, after having been treated for the methods detrending, softness and filtering. Discussion: The analyses had been made in three zones of effort: zone 1 (Z-1), with frequencies below 150 beats for minute (bpm), zone 2 (Z-2), with frequencies below 185 bpm and zone 3 (Z-3), above of these values. [ABSTRACT FROM AUTHOR]

The stock and recruitment (SR) relationship in Baltic cod is studied. In light of the field data, the authors suggest that the SR relationship oscillates at two levels of stability (cycles) due to the interaction between density-dependent compensation and depen-sation. Furthermore, density-independent transitions between equilibrium states are assumed due to fishing mortality and medium and long-term periodicities in the abiotic environment which may induce compensatory and depensatory effects upon stock and recruitment. These mechanics are related to concepts such as variable carrying capacity, multiple equilibria, minimum viable population and inverse density dependence. Carrying capacity is regarded as a critical threshold between different equilibrium states and the minimum viable population as an unstable equilibrium below which the SR relationship may not rehabilitate. A modelling approach is put forward where the SR-relationship is regarded as a system or summation of non-linear functions with dynamic features ranging from chaos (the ceiling, when external conditions are extremely benign), going through a range of relatively stable, converging cycles (as external stress increases), to a quasi-standstill state with no clear oscillations (when the minimum viable population is being approached) which may lead to inverse density-dependence (depensatory dynamics). This SR-system is considered as highly flexible as it has the capacity to, persistently, evolve and return within a range of equilibrium states. Also, it is proposed that the SR relationship is, at the present time, nearby the minimum viable population due to the combined effects from high fishing mortality and negative effects from external perturbations. However, a SR rehabilitation towards a low equilibrium state is expected, during the coming years likely due to positive trends in external perturbations. A simple numerical simulation is put forward where the SR system is perturbed by a sinusoidal external variable at three constant levels of mortality. [ABSTRACT FROM PUBLISHER]

An optical code-division multiple access (OCDMA) scheme based on cyclic shift extension of a base code is proposed to enable asynchronous multi-user optical wireless communications for very populated scenarios. This multiple access method is convenient for low- medium data rate communications of a large number of simultaneous transmitters. An expression to obtain a tight upper bound of the biterror probability of the new scheme is provided which is also confirmed by experimental results. A variant of the proposed communication method which allows the encoding of several bits per symbol is also presented, although its analysis demonstrates that the first simpler strategy reaches similar performance with a significantly lower receiver complexity. [ABSTRACT FROM AUTHOR]

The article reports on the characteristics of El Greco's designs which show his conceptions of the altarpieces. El Greco's designs use the architectural structure of the altarpieces to enclose a particular canvas within and make it clearly visible from a distance. They are also employed using a Spanish format with two horizontal stories divided by columns into central and lateral sections. El Greco also added an attic in his designs which contains another painting of large dimensions. The designs of El Greco which show his conceptions of the retable includes the high altar of Santo Domingo el Antiguo, high altar of the Chapel of St. Joseph in Toledo, Talavera la Vieja and the high altar of the Hospital of the Illescas.

Background: The first tooth to erupt is the first mandibular molar, which is the tooth with the highest number of retreatments. Several factors are responsible for the failure of the endodontic success and one of the most important being the particular pulp anatomy of each tooth. To aim was determine the prevalence of the middle mesial (MM) canal in first mandibular molars and to study if there are predisposing factors to the presence of this canal by retrospectively analyzing cone-beam computed tomography (CBCT) images in vivo., Material and Methods: CBCT images of 100 patients were selected. A total of 206 first mandibular molars were examined. The CBCTs were analysed using Careastream CS 3D imaging software. Findings of MM canals were recorded along the variables sex and left/right side. Prevalence was compared using the Chi-square test ( P < 0.05) and Cramer's V was used to indicate the effect size between the variables., Results: Of the 206 teeth analysed, the prevalence of MM canals was 33.11% (49 teeth). There was no statistically significant difference between sex and prevalence of the MM canal. There was a significant difference between sex and the distance between the mesial canals was found, being the most common range in women was 1-2 mm (35.8%) and 2-3 mm (51%) in men. The most common range of distance between the mesial canals where the MM canal was localized was 3-4 mm (50%), being statistically significant ( p <0,05)., Conclusions: This cross-sectional study showed a high prevalence of MM canals (33.11%) in first mandibular molars. The prevalence of the MM canal was significantly higher when the distance between mesiobucal and mesiolingual canals was 3-4mm. This knowledge let direct the clinicians in locating MM canal for improving endodontic prognosis. Key words: Cone-beam computed tomography, middle mesial canal, prevalence., Competing Interests: The authors declare that they have no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not- for- profit sectors., (Copyright: © 2024 Medicina Oral S.L.)

Background: The aim of this systematic review and meta-analysis was to analyze the scientific evidence about the association between osteoporosis in postmenopausal women and the prevalence of apical periodontitis, assessed radiographically., Material and Methods: PRISMA Guidelines have been followed. The research question was: In adult women, does the presence or absence of osteoporosis affect the prevalence of AP, radiographically diagnosed? A systematic search was performed in PubMed/MEDLINE, Web of Science, Scopus and EMBASE. The meta-analyses were calculated with the Open Meta Analyst software. Risk of bias was assessed using the Newcastle Ottawa Scale. The certainty of evidence was assessed by GRADE., Results: Four studies were selected. Meta-analysis showed an overall OR = 2.2 (95% CI = 0.94 - 4.97; p = 0.07), indicating that osteoporotic women had approximately twice the probability of having periapical lesions, compared to control women, although the difference was only marginally significant. The overall risk of bias of the included studies was moderate, and the certainty of evidence was low., Conclusions: Apical periodontitis, assessed as periapical lesion, is more frequently diagnosed in osteoporotic women, who are twice as likely to have periapical radiolucent lesions.

Aim: To investigate the outcome of elective full pulpotomy, using calcium silicate-based cements (CSBC), after 2 years, in symptomatic mature permanent teeth with carious lesions, diagnosed as irreversible pulpitis, and analyse the capacity of Wolters et al. (2017) classification to predict the likelihood of treatment failure., Methods: The treatment records of 56 patients with symptomatic mature teeth with carious lesions, diagnosed as irreversible pulpitis and treated by elective full pulpotomy, using CSBCs as pulp capping materials, were reviewed. Thirteen teeth were excluded. The remaining 43 teeth were evaluated retrospectively at 24 months. Fisher`s exact test with the Lancaster's mid-P adjustment was used to assess different outcomes amongst the diagnostic categories., Results: Four of the cases failed before 24 months and required root canal treatment (RCT). Overall success rate at 2 years was 90.7% (39 of 43). An inverse, but non-significant, correlation was observed between the severity of pulpitis according to the Wolters classification and the treatment success rate (p > 0.05). The type of CSBC used was associated to the success rate (OR = 10.5; 95% C.I. = 0.5 - 207.4; p = 0.027), being 82% with Endosequence and 100% with Biodentine. Postoperative pain associated significantly to lower success rate (66.7%) (Odds ratio = 8.0; 95% C.I. = 0.7 - 95.9; p = 0.047)., Conclusions: Elective full pulpotomy using a CSBC was a successful choice for the treatment of mature permanent teeth with symptoms indicative of irreversible pulpitis. There were no significant differences between the success rate of mild, moderate and severe pulpitis. Postoperative pain could be considered a risk marker for failure of full pulpotomy. The term "irreversible pulpitis" should be re-signified to indicate the need for access to the pulp chamber, rather than an indication for extraction or RCT., (© 2024. The Author(s).)

Competing Interests: Conflict of interest: F.J.G.-F. received research contract from Biotronik and honoraria from lectures and speaker’s fees from Medtronic, Boston, and Abbott; E.T. received speakers’ bureau/honoraria research grant fellowship support from Abbott, Biotronik, and Medtronic, and consulting and speaker fees from Abbott, Biotronik, and Medtronic. All remaining authors have declared no conflicts of interest.

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease., Objectives: The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease., Methods: PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE., Results: The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low., Conclusions: Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.

Introduction and Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain., Methods: The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers., Results: A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P <.001); ICD (75.6% vs 94.2%; P <.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P <.001), and implantable loop recorders (50.2% vs 68.7%; P <.001)., Conclusions: The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)