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Duboki karijes zuba (Caries profunda) predstavlja leziju tvrdih zubnih tkiva koja se približila pulpi zuba toliko da postoji samo tanak sloj dentina između karijesne lezije i pulpe. Prvi korak u terapiji dubokog karijesa je uklanjanje karijesno promenjenog tkiva, koje može biti: neselektivno i selektivno. Regeneracija pulpodentinskog kompleksa odvija se procesom dentinogeneze tokom kog dolazi do formiranja tercijarnog dentina i može se indukovati primenom različitih sredstava, kao što su preparati kalcijum-hidroksida i kalcijum-silikatni cementi (mineralni trioksid-agregati – MTA). Lečenje duboke karijesne lezije može ići u pravcu indirektnog prekrivanja pulpe, jednoseansnog selektivnog uklanjanja karijesa, višeseansnog selektivnog uklanjanja karijesa, direktnog prekrivanja pulpe, biopulpotomije i pulpektomije. Sve navedene metode, osim pulpektomije, imaju za cilj očuvanje vitaliteta cele pulpe ili jednog njenog dela. Restauracijom kaviteta, kao završnom fazom u terapiji duboke karijesne lezije, zaustavlja se napredovanje karijesa, štiti se pulpa i zub se vraća u funkciju. Restauracija mora da obezbedi dobro rubno zaptivanje, koje se smatra važnijim faktorom u zaustavljanju karijesnog procesa nego kompletno uklanjanje karijesno promenjenog dentina, a takođe mora da bude dugotrajna, kako bi se izbegao retretman koji sa sobom nosi dodatno uklanjanje zubnog tkiva.

Introduction/Objective of this study is to use scanning electron microscopy (SEM) analysis to examine surfaces of new and same sets of Ni-Ti instruments after canal preparations, to check their suspectability to corrosion. Methods In this study, we used five different endodontic Ni-Ti instruments: K3, Mtwo, ProTaper Universal, HyFlex and BioRaCe. Instruments were analyzed before and after preparation of canals of different curvature, using SEM (150-2000 ×). Results Corrosion of the working part was observed in 5.5% of new Ni-Ti instruments of the K3 system (apical and middle segment), in 5.5% of Mtwo instruments (apical third), and in 11.1% of ProTaper Universal systems (apical and middle third). Corrosion was not observed on the new instruments of the HyFlex and BioRaCe kits. After instrumentation, disinfection, and sterilization, corrosion was observed in all sets of K3 and ProTaper Universal systems and in all HyFlex instruments of the first group. Corrosion was observed in the HyFlex system in the second group in 16.7% of instruments (apical and middle third) and in the third 83.3% in the apical and 66.7% in the middle segment. In the Mtwo set, corrosion was observed in 16.7% of instruments in the first (apical and middle third), in the second group in 33.3% of instruments in the apical part and 50% in the middle third, while in the third group, corrosion was observed in 16.7% of instruments in the middle third of instruments. Conclusion Rotary Ni-Ti instruments K3 and ProTaper Universal are susceptible to corrosion in a very high percentage. Ni-Ti systems with post-heat treatment of the working part (HyFlex) are somewhat more resistant to corrosion, while in Ni-Ti systems with electropolished surface (BioRaCe), corrosion is not observed., Uvod/Cilj Cilj istraživanja je bio da se primenom skenirajuće elektronske mikroskopije (SEM) analiziraju površine nekorišćenih i istih setova nikl-titanijmskih (Ni-Ti) rotirajućih instrumenata nakon preparacije kanala, odnosno da se proveri njihova podložnost za pojavu korozije. Metod U istraživanje je uključeno pet različitih setova mašinskih endodontskih Ni-Ti instrumenata: K3, Mtwo, ProTaper Universal, HyFlex i BioRaCe. Instrumenti su analizirani pre upotrebe i nakon preparacije kanala različite povijenosti, pomoću SEM-a (150-2000 ×). Svaki set instrumenata je korišćen za obradu 10 kanala u tri eksperimentalne grupe (pravi, blago i izrazito povijeni kanali). Rezultati Korozija radnog dela uočena je kod 5,5% novih Ni-Ti instrumenata sistema K3 (apikalni i srednji segment), kod 5,5% Mtwo instrumenta (apikalna trećina) i kod 11,1% sistema ProTaper Universal (apikalna i srednja trećina). Korozija nije uočena na novim instrumentima HyFlex i BioRaCe setova. Nakon instrumentacije, dezinfekcije i sterilizacije korozija je primećena kod svih setova sistema K3 i ProTaper Universal i kod svih HyFlex instrumenata prve grupe. Korozija je uočena kod HyFlex sistema u drugoj grupi kod 16,7% instrumenata (apikalna i srednja trećina), a u trećoj grupi kod 83,3% instrumenata u apikalnom i 66,7% u srednjem segmentu. Kod Mtwo seta korozija je uočena kod 16,7% instrumenata u prvoj grupi (apikalna i srednja trećina), u drugoj grupi kod 33,3% instrumenata u apikalnom delu i 50% u srednjoj trećini, dok je u trećoj grupi korozija primećena kod 16,7% instrumenata u srednjoj trećini instrumenata. Zaključak Rotirajući Ni-Ti instrumenti K3 i ProTaper Universal podložni su koroziji u veoma visokom procentu. Ni-Ti sistemi sa naknadnom termičkom obradom radnog dela (HyFlex) nešto su otporniji na koroziju, dok kod Ni-Ti sistema sa elektropoliranom površinom (BioRaCe) korizija nije uočena.

Irigacija kanala korena je postupak unošenja tečnih sredstava u kanalski sistem sa ciljem da se mehanička instrumencatija olakša, učini efikasnijom i smanji broj mikroorganizama. Omogućava se lakše manipulisanje instrumentima u kanalu rastvarajući organski i neorganski sadržaj dentina, zatim uklanjanje razmaznog sloja sa zidova kanala i deluje antiseptično na zaostale bakterije. Poteškoće koje se javljaju u toku endodontskog tretmana nastaju zbog kompleksne morfologije kanalskog sistema, zbog postojanja anastomoza, ramifikacija, dentinskih tubula, otežano je uklanjanje bakterijskog supstrata. Samo mehaničkim delovanjem nije moguće ukloniti mikoorganizme iz kanala korena. Hemijska sredstva su nezaobilazna u toku endodonstskog tretmana, jer omogućavaju prodiranje u delove do kojih kanalni instrumenti ne mogu doći. Najčešće korišćeni irigans je natrijum-hipohlorit koji ima organolitičko dejstvo, omogućava lakše pokretanje instrumenata u kanalu i deluje antiseptično. Za razlaganje neorganske suspstance koriste se EDTA i limunska kiselina, kao antiseptik se koristi hlorheksidin. Irigacija se sprovodi najčešće pomoću igle i brizgalice, poželjno je koristiti koferdam u toku irigacije zbog moguće iritacije tkiva, ili skupljanje irigansa pomću vaterolne i aktivne aspiracije. Razvojem tehnologije, razvijene su i druge metode irigacije uz prikmenu ultrazvuka, lasera, zvuka, negativne aspiracije čime se značajno pojačava efekat dezinfekcionih sredstava.

Introduction/Objective Irrigation has an important role in root canal cleaning and its efficiency depends on the type of irrigants, the amount, the technique and the irrigation protocol. The aim of this work was to estimate the efficiency of cleaning of the canal walls by using scanning electron microscope analysis after the instrumentation by rotary NiTi instruments with the use of three different irrigation solutions and two final irrigation protocols. Methods Sixty extracted human incisors were divided into two groups after the rotary instrumentation with the iRace instruments. In both groups, the same amount (1.5 ml) of three solutions (2% sodium hypochlorite solution, 2% chlorhexidine solution, and 10% citric acid solution) and total final irrigation time (90 seconds) was the same. The final irrigation in the first group was accomplished using the technique of continuous irrigation and in the second group it was done using the intermittent protocol. The roots were cut longitudinally and analyzed by thirds (coronal, middle, and apical) on a scanning electron microscope (JSM 6460LV, JEOL Ltd., Tokyo, Japan) with 1,000× magnification. Results the most efficient cleaning of the root canal walls in both groups was seen after the use of citric acid with the intermittent protocol of the final irrigation (90.7% clean walls), while the least efficient was the final irrigation by chlorhexidine with continuous irrigation (80.3%). The most efficient cleaning of the canal walls in both groups was observed in the coronal third and the largest amount of the smear layer in the apical third. Conclusion the most efficient cleaning of the canal was achieved by the use of citric acid and the intermittent protocol of the final irrigation. In all tested solutions, the intermittent protocol of irrigation was more efficient than continuous irrigation., Uvod/Cilj Irigacija ima važnu ulogu u čišćenju kanala korena, a njena efikasnost zavisi od vrste irigansa, količine, odnosno tehnike i protokola irigacije. Cilj ovog rada bio je da se analizom SEM proceni efikasnost čišćenja zidova kanala posle instrumentacije rotirajućim NiTi instrumentima uz primenu tri različita rastvora za irigaciju i dva protokola finalne irigacije. Metode Šezdeset ekstrahovanih humanih sekutića je posle mašinske instrumentacije iRaCe instrumentima podeljeno u dve grupe. U obe grupe su korišćena po tri rastvora - 2% rastvor natrijum-hipohlorita, 2% rastvor hlorheksidina i 10% rastvor limunske kiseline, u istoj količini (1,5 ml) i ukupnom vremenu finalne irigacije (90 sekundi). Finalna irigacija u prvoj grupi je realizovana tehnikom kontinuirane, a u drugoj tehnikom intermitentne irigacije. Korenovi su presečeni uzdužno i analizirani po trećinama (krunična, srednja i apikalna) na skenirajućem elektronskom mikroskopu (JSM 6460LV JEOL, Tokio, Japan) na uveličanju od 1000×. Rezultati Najefikasnije čišćenje zidova kanala korena u obe grupe uočeno je posle primene limunske kiseline uz intermitentni protokol finalne irigacije (90,7% čistih zidova), dok je najmanje efikasna bila finalna irigacija hlorheksidinom uz kontinuiranu irigaciju (80,3%). Najefikasnije čišćenje zidova kanala i u prvoj i u drugoj grupi uočeno je u kruničnoj trećini, a najviše razmaznog sloja u apikalnoj trećini. Zaključak Najefikasnije čišćenje kanala ostvareno je primenom limunske kiseline i intermitentnog protokola finalne irigacije. Kod svih testiranih rastvora intermitentni protokol irigacije je bio nešto efikasniji od protokola kontinuirane irigacije.

More certain therapeutic and significantly facilitated solution of everyday endodontic problems are provided by the introduction of NiTi rotary files in endodontic practice and their proper application. However, their widespread use has caused more and more frequent fractures and has become a significant frustrating factor that diminishes their numerous benefits. Torsional stress and cyclic fatigue are the main reasons for the occurrence of a fracture, and the frequency of NiTi file fractures is exactly proportional to the degree of bending of the canal, knowledge of the features of the file, ie. the skill and expertise of the therapist. The most dominant factor for the occurrence of fractures is the dentist who, in addition to manual dexterity, must have a good knowledge of the anatomy of various canal systems and file design in order to make the best choice for each individual case. Properly formed access cavity and knowledge of the working part of NiTi files enable maximum realization of endodontic skills, increased efficiency of intervention and reduced possibility of error during canal instrumentation. The special treatment of NiTi alloy and new solutions related to the design of the working part have significantly increased file flexibility and resistance to cyclic fatigue. Specific design (reduced number of threads, change of conicity, interruption of blade continuity), reduced engagement of file, ie. change of dynamics of movement in the canal (full rotation, reciprocal, eccentric, transaxial), as well as reduced number of processing files, have also significantly influenced the reduction of fracture risks. The aim of this paper was to analyze the most common reasons for the fracture of NiTi files and emphasize measures and factors that can increase their safe use and reduce complications during canal instrumentation., Uvođenjem NiTi rotirajućih instrumenata u endodontsku praksu i njihovom pravilnom primenom obezbeđena su izvesnija terapijska rešenja i znatno je olakšano rešavanje svakodnevnih endodontskih problema. Međutim, njihova široka primena uzrokovala je sve učestalije frakture i postala značajan frustrirajući faktor koji umanjuje njihove brojne benefite. Torziono naprezanje i ciklični zamor su glavni razlozi za nastanak frakture, a učestalost loma NiTi turpija je upravo srazmerna stepenu povijenosti kanala, poznavanju karakteristika instrumenta, odnosno veštini i stručnosti terapeuta. Najdominantniji faktor za nastanak fraktura je stomatolog, koji osim manuelne spretnosti mora dobro poznavati anatomiju različitih kanalskih sistema i dizajn turpije kako bi napravio najbolji izbor za svaki pojedinačni slučaj. Pravilno formiran pristupni kavitet i poznavanje radnog dela NiTi instrumenata omogućavaju maksimalnu realizaciju endodontske veštine, povećanu efikasnost intervencije i smanjenu mogućnost greške tokom obrade kanala. Poseban tretman NiTi legure i nova rešenja vezana za dizajn radnog dela značajno su povećali fleksibilnost turpije i otpornost na ciklični zamor. Specifičan dizajn (smanjen broj navoja, promena koničnosti, prekid kontinuiteta sečiva) i smanjena angažovanost instrumenta, odnosno promena dinamike kretanja u kanalu (puna rotacija, recipročna, ekcentrična, transaksijalna) i smanjenje broja turpija za obradu, uticali su i na značajno smanjenje rizika od preloma. Cilj ovog rada je bio da ukaže na najčešće razloge za pojavu fraktura NiTi turpija i apostrofira mere i faktore koji mogu povećati sigurnost instrumentacije i smanjiti moguće komplikacije tokom obrade kanala.

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. The brain natriuretic peptide (BNP) is a previously known marker of elevated cardiovascular risk in SSc, but the levels of BNP in various forms of SSc have not been investigated so far. Aim: The aim of our study was to evaluate the influence of SSc on the function of the right ventricle and the right atrium using the echocardiographic parameters. Moreover, we examined the levels of BNP in different forms of SSc as well as the association of disease severity with the plasma concentrations of BNP. Methods: We included 42 patients with newly diagnosed SSc and patients whose disease had been diagnosed earlier. SSc patients and non-SSc control patients were examined by using echocardiography and the concentrations of BNP were determined. Results: We analyzed differences in the parameters of right ventricle (RV) function and right atrium (RA) function between SSc patients and healthy controls. The two groups had similar distribution of gender, but SSc patients were significantly older than controls. RV wall thickness was increased in SSc patients (p lt 0.001), while right ventricular end-systolic area (RVEDA; p=0.408) and right ventricular end-diastolic area (RVEDA; p=0.368) did not differ among the examinees. In contrast, RA minor-axis dimension (p=0.001) and the tricuspid annular plane systolic excursion (TAPSE) (p=0.001) were significantly higher in SSc patients. Also, we analyzed differences in brain natriuretic peptide (BNP) concentrations between diffuse cutaneous systemic sclerosis (DSSc) and limited cutaneous systemic sclerosis (LSSc) patients. DSSc patients had significantly higher concentrations of BNP. We found that levels of BNP were in significant positive correl

Introduction the main objective of endodontic treatment is to eliminate infection from root canal and prevent re-infection by three-dimensional hermetic obturation of the canal system. Endodontic failure can occur due to inability of complete control and elimination of infection from the root canal. The aim of this study is to investigate, by PCR technique, microbiological status of previously endodontically unsuccessfully treated teeth immediately after the removal of obturation material. Material and Methods the analysis included 30 teeth indicated for endodontic retreatment. After removing previous root canal filling material, the bacteriological sample was taken by sterile instrument (# 15) and paper points. Standard PCR technique was used to analyze the incidence of E.faecalis, P.micros, P.intermedia, P. endodontalis and a.actinomycetemcomitans. Results Positive bacteriological findings were registered in 80% of cases, while bacteria were not identified in 20% of all samples (all taken from the root canals without significant changes in periapical tissue). From 24 canals with identified bacteria, 17 had affected apical periodontium. The most dominant microbe in root canals with positive bacteriological finding was E.faecalis (83.3% of the canals) and P.intermedia (75%). In case of teeth with chronic periapical changes, the most common was E. faecalis (94%) and P.intermedia (82.3%). Conclusion the presence of periapical lesions significantly affects microbiological status of endodontically treated teeth. The presence of bacteria was confirmed in most teeth with periapical lesions, while the most frequently identified bacteria were E. faecalis, P.intermedia and P.micros., Uvod Osnovni zadatak endodontskog tretmana je da eliminiše infekciju iz kanala korena I spreči reinfekciju trodimenzionalnom hermetičkom opturacijom kanalskog sistema. Usled nemogućnosti potpune kontrole I eliminacije infekcije iz kanala korena može doći do pojave endodontskog neuspeha. Cilj ovog rada je bio da se neposredno posle uklanjanja materijala za opturaciju kod zuba sa neuspelim endodontskim lečenjem PCR tehnikom proveri mikrobiološki status endodontski lečenih zuba. Metode Mikrobiološka studija je obuhvatila 30 zuba (osam višekorenih I 22 jednokorena) indikovanih za ponovljeni endodontski tretman. Posle dezinfekcije radnog polja I dezopturacije koja je urađena isključivo mehaničkim putem, uzorak je uzet sterilnim kanalnim instrumentom tipa pulpekstirpatora (#15) ili Hoedstrem-turpije (#15) I uz pomoć papirnih poena kojima je sušen kanal. Ependorfice su čuvane na temperaturi od -20˚C do mikrobiološke analize. Putem klasičnog PCR analizirana je zastupljenost bakterija: Enterococcus faecalis, Peptostreptococcus micros, Prevotela intermedia, Porphyromonas endodontalis I Actinobacilus actinomicetemcomitans. Rezultati Pozitivan bakteriološki nalaz registrovan je u 80% slučajeva, dok bakterije nisu identifikovane u 20% uzoraka. Svi negativni uzorci su uzeti iz kanala korena zuba bez značajnih promena u apeksnom periodoncijumu, dok je 17 od 24 kanala sa identifikovanim bakterijama pripadalo zubima sa oštećenim apeksnim parodoncijumom. Najprisutniji mikroorganizam u kanalima sa pozitivnim bakteriološkim nalazom bio je E. faecalis, koji je identifikovan u 83,3% kanala, zatim P. inermedia sa 75% I P. micros sa zastupljenošću od 58,3%. Kod zuba sa hroničnim periapikalnim promenama najzastupljeniji je bio E. faecalis, koji je identifikovan u 94% kanala, zatim P. intermedia, koja je bila prisutna u 82,3% uzoraka. Mikroorganizmi E. faecalis I P. intermedia su registrovani kod svih pacijenata sa nekim od simptoma. Zaključak Prisustvo periapikalnih lezija značajno utiče na

Introduction/Objective The application of nickel-titanium (NiTi) instruments in cleaning and shaping of the root canal system is a standard and a precondition for the success of endodontic treatment. The objective of this study was to use scanning electron microscopy (SEM) analysis in order to examine the efficiency of cleaning the apical third of the root canal system using two different NiTi systems with reciprocating movements. Methods The study included 20 single-rooted teeth (premolars) divided into two groups. In group 1, the canal preparation was realized with a single file UNICONE with reciprocating movements (MEDIN, Inc., Nové Město na Moravě, Czech Republic), and in group 2, with a RECIPROC BLUE instrument with reciprocating movements (VDW GmbH, Munich, Germany). The same quantities of 2% NaOCl solution and 17% EDTA solution were used as irrigation solutions. The samples prepared for SEM analysis of the smear layer in the apical third were evaluated on a scale of 1-5 and at a magnification of 1,000×. Results SEM analysis pointed to mostly clean canal walls in the apical segment in both tested groups. Slightly cleaner walls were observed after the application of the UNICONE file (78%) compared to the samples of the second group, where the instrumentation was realized by the RECIPROC BLUE file (76%), but without statistically significant differences. Conclusion Single-file reciprocating systems do not remove the smear layer completely, but provide efficient cleaning of the apical region of the canal., Uvod/Cilj Primena instrumenata od legure nikl-titanijum (NiTi) u čišćenju i oblikovanju kanala je standard i preduslov za uspeh endodontskog tretmana. Cilj ovog rada je bio da se analizom skenirajućim elektronskim mikroskopom (SEM) proveri efikasnost čišćenja apikalne trećine kanala primenom dva različita NiTi sistema sa recipročnim pokretima. Metode U istraživanje je uključeno 20 jednokorenih zuba (pretkutnjaka) podeljenih u dve grupe. Preparacija kanala u prvoj grupi je realizovana jednom turpijom sa recipročnim pokretima UNICONE (MEDIN, Nove Mjesto u Moravskoj, Češka), a u drugoj instrumentom sa recipročnim pokretima RECIPROC BLUE (VDW Gmbh, Minhen, Nemačka). Kao rastvori za irigaciju korišćene su iste količine 2% rastvora NaOCl i 17% rastvor EDTA. Uzorci pripremljeni za analizu SEM razmaznog sloja u apikalnoj trećini su evoluirani prema skali 1-5 i na uveličanju od 1000×. Rezultati Analiza SEM je ukazala na uglavnom čiste zidove kanala u apeksnom segmentu u obe testirane grupe. Nešto čistiji zidovi uočeni su posle primene turpije UNICON (78%) u odnosu na uzorke druge grupe, gde je instrumentacija realizovana turpijom RECIPROC BLUE (76%), ali bez statistički značajnih razlika. Zaključak Recipročni sistemi sa jednom turpijom ne uklanjaju potpuno razmazni sloj, ali obezbeđuju efikasno čišćenje apikalne regije kanala.

Introduction. The aim of this study was to analyze working surfaces of new hand endodontic instruments and to check possible existence of dirt or defects on working surface that resulted from manufacturing process using SEM. Material and methods. Three sets of new hand instruments: K-File (KF), (18 instruments) (Dentsply Maillefer, Switzerland) and Hedstorm Files (HF), (18 instruments) (SybronEndo Co, USA) were used. Instruments were analyzed by SEM method at 170× magnification while semi-quantitative EDS analysis was used to determine chemical composition of dirt particles. Fisher test (p < 0.05) was applied in statistical analysis. Results. Results showed that none of the instruments was defect-free. The most common defects were metal strips and fretting noticed at the surface of all tested instruments. Debris was present on all KF (100% in apical and middle third) and HF (56% in apical and 56% in middle third) instruments. Pitting was noticed in KF (33% in apical and 39% in middle third) and HF (11% in apical and 6% in middle third) instruments. Corrosion of working surface, metal flash and disruption of cutting edge were marked only in KF group. Conclusion. Manufacturing defects were noticed in all instruments and the most common type of irregularity were metal strips and fretting., Uvod Cilj ovog rada je bio da se primenom skenirajuće elektronske mikroskopije analiziraju površine novih ručnih endodontskih instrumenata i proveri eventualno postojanje proizvodnih nečistoća ili defekata na radnom delu. Materijal i metod U istraživanju su korišćena po tri seta novih ručnih instrumenata: K-File (KF), (18 instrumenata) (Dentsply Maillefer, Switzerland) i Hedstorm Files (HF), (18 instrumenata) (SybronEndo Co, USA). Instrumenti su podvrgnuti SEM analizi sa uvećanjem 170×, a semikvantitativnom EDXS analizom utvrđivan je hemijski sastav nečistoće. Statistička analiza je urađena primenom Fišerovog testa (p < 0,05). Rezultati Rezultati su pokazali da ne postoji nijedan instrument bez defekta. Najučestaliji tip defekta je bilo prisustvo metalnih opiljaka i žlebova, koji su uočeni na površini svih ispitivanih instrumenata. Debri je uočen na svim KF (100% apikalno i u srednjoj trećini) i HF (56% apikalno i 56% u srednjoj trećini). Prisustvo udubljenja zabeleženo je kod KF (33% apikalno i 39% u srednjoj trećini) i HF (11% apikalno i 6% u srednjoj trećini). Korozija radne površine, pojava uglačane površine i prekid sečivne ivice su uočeni samo u grupi KF. Zaključak Na svim ispitivanim ručnim instrumentima su uočeni proizvodni defekti, a najučestaliji tip nepravilnosti je bilo prisustvo metalnih opiljaka i žlebova.

Introduction/Objective. The objective of this study is to use scanning electron microscopy (SEM) to analyze working surfaces of new manual and rotary endodontic instruments and to check possible existence of manufacture dirt particles or defects on the working surface. Methods. In this study, we used three sets of new manual instruments: K-File, KF (Dentsply Maillefer, Switzerland) and Hedstorm Files, HF (SybronEndo Co, USA) and three sets of mechanical Ni-Ti instruments – type K3 (SybronEndo Co, USA) and BioRaCe (FKG DENTAIRE Swiss Dental Products, Switzerland). The instruments were analyzed using SEM method at 170 × magnification while semi-quantitative energy dispersive x-ray analysis was used to determine chemical composition of dirt particles. Fisher test (p < 0.05) was applied in statistical analysis. Results. Results showed that none of the instruments were defect-free. The most common defect type was the presence of metal strips, which were noticed at the surface of all tested instruments. Debris was present on all manual and only one type of mechanical instruments, K3 (39% in the apical and 33% in the middle third). Fretting was noticed in all manual KF and all mechanical instruments of the K3 group. Pitting was common in all manual instruments, KF (33% in the apical and 39% in the middle third) and HF (11% in the apical and 6% in the middle third). Corrosion of the working surface, metal flash, and disruption of the cutting edge were marked only in the KF group. Conclusion. Manufacture defects were noticed in all instruments and the most common type of irregularity were metal strips. Electropolished surface of BioRaCe instruments showed no debris of organic origin., Uvod/Cilj Cilj ovog rada je bio da se primenom skenirajuće elektronske mikroskopije (SEM) analiziraju površine novih ručnih i mašinskih endodontskih instrumenata i proveri eventualno postojanje proizvodnih nečistoća ili defekata na radnom delu. Metode U istraživanju su korišćena po tri seta novih ručnih instrumenata: K-File, KF (Dentsply Maillefer, Švajcarska) i Hedstorm Files, HF (SybronEndo Co, SAD) i po tri seta mašinskih Ni-Ti instrumenata, tipa K3 (SybronEndo Co) i BioRaCe (FKG DENTAIRE Swiss Dental Products, Švajcarska). Instrumenti su podvrgnuti SEM analizi sa uvećanjem 170×, a semikvantitativnom, EDXS analizom utvrđivan je hemijski sastav nečistoće. Statistička analiza je urađena primenom Fišerovog testa (p < 0,05). Rezultati Rezultati su pokazali da ne postoji nijedan instrument bez defekta. Najučestaliji tip defekta je bilo prisustvo metalnih opiljaka, koji su uočeni na površini svih ispitivanih instrumenata. Debri je uočen na svim ručnim i samo na jednom tipu mašinskih instrumenata, K3 (39% na apikalnoj i 33% na srednjoj trećini). Žlebovi su uočeni na svim ručnim KF i svim mašinskim instrumentima grupe K3. Prisustvo udubljenja zabeleženo je kod ručnih instrumenata, KF (33% apikalna i 39% srednja trećina) i HF (11% apikalna i 6% srednja trećina). Korozija radne površine, pojava uglačane površine i prekid sečivne ivice su uočeni samo u grupi KF. Zaključak Na svim ispitivanim instrumentima su uočeni proizvodni defekti, a najučestaliji tip nepravilnosti su metalni opiljci. Na elektropoliranoj površini instrumenata BioRaCe nije uočeno prisustvo organskog debrija.

Introduction Development of inflammatory lesions or their persistence after primary treatment is considered endodontic failure. The reason for failure can be complex anatomy of the canal system and numerous iatrogenic factors. The objective of this study was to analyze, clinically and radiographically, the causes of primary endodontic treatment failure and assess possibilities for retreatment of teeth with failed endodontic treatment. Method The study included 79 teeth (36 multirooted and 43 singlerooted tooth) indicated for repeated endodontic treatment. Based on the radiographic assessment of the status of periapical structures, teeth were divided into two groups. The first group included teeth without periapical lesions, i.e. the healthy periodontal tissues (PAI score of 1 and 2) in which retreatment was required for prosthodontic reason due to the poor quality of obturation (28 teeth), and the second group included teeth with visible signs of periapical tissue damage (PAI scores 3, 4 and 5) (51 teeth). In both groups, quality of obturation, coronal sealing and the presence or absence of clinical symptoms was analyzed. Results The most common radiographic finding of definitive obturation was short filling (65.8% of cases); “forgotten” canals (25.3%); non-homogeneous obturation with correct length (5.1%) and fractured instrument (3.8%). There was significant difference between healthy periodontal ligament and adequate restoration (P lt 0.001). In 95% of patients with symptoms, changes in the periapical tissue were observed. Also, there was significant difference in the presence of symptoms after primary treatments, between the teeth with healthy apical periodontal tissue and teeth with periapical lesions (P = 0.019). Conclusion The outcome of the root canal treatment is significantly affected by the quality (density) of obturation and the presence and quality of coronal restoration. In patients with symptoms there were changes in the periapical tissue., Uvod Neuspehom endodontskog lečenja smatra se pojava radiografskog nalaza inflamatorne lezije, odnosno njeno perzistiranje ili uvećanje posle preduzete primarne endodontske terapije. Razlog za neuspeh mogu biti kompleksna anatomija kanalnog sistema, ali i brojni jatrogeni faktori. Cilj ovog rada je bio da se kod zuba sa neuspelim endodontskim lečenjem klinički i radiografski analizira uzrok neuspeha primarnog endodontskog tretmana i procene mogućnosti za ponovni endodontski zahvat. Metod rada U ovo istraživanje je uključeno 79 zuba (36 višekorenih i 43 jednokorena zuba) indikovanih za ponovljeni endodontski tretman. Na osnovu radiografske ocene stanja periapikalnih struktura zubi su podeljeni u dve grupe: prvu grupu su činili zubi bez periapikalnih promena, tj. sa zdravim parodoncijumom (PAI skor 1 i 2) kod kojih je retretman bio neophodan iz protetskih razloga – zbog lošeg kvaliteta definitivne opturacije (28 zuba), a drugu zubi sa vidljivim znacima oštećenja apeksnog parodoncijuma (PAI skor 3, 4 i 5) (51 zub). U obe grupe analiziran je kvalitet opturacije, kvalitet kruničnog zaptivanja i prisustvo ili odsustvo kliničkih simptoma. Rezultati Najčešći radiografski nalazi kvaliteta definitivne opturacije kanala bili su: kratko punjenje (65,8% slučajeva), “zaboravljeni” kanali (25,3%), klinički nehomogeno punjenje uz korektnu dužinu definitivnog punjenja (5,1%) i frakturiran instrument (3,8%). Nađe- na je statistički visoko značajna razlika između adekvatne restauracije i zdravog parodoncijuma, odnosno pojave mikrocurenja zbog neadekvatne restauracije i periapikalnih promena (p lt 0,001). Kod 95% pacijenata sa simptomima uočene su promene u apeksnom parodoncijumu. Takođe, nađena je statistički značajna razlika u prisustvu simptoma nakon primarne endodontske terapije između zuba sa zdravim parodoncijumom i zuba sa periapikalnim lezijama (p = 0,019) Zaključak Na ishod endodontskog lečenja značajno utiču kvalitet (hermetičnost) opturacije kanala korena, odnosno prisusutvo

Background/Aim: The aim of this study was to evaluate the efficacy of new rotary NiTi instrument XP-endo SHAPER (XPS) used with two irrigation protocols on the root canal cleaning in the apical area. Material and Methods: The research was conducted on 30 single-rooted teeth extracted for orthodontic reasons which were divided into the two groups. Instrumentation of the canals was conducted with XPS instrument and 2% solution of NaOCl was used as irrigant. Instrumentation in the first group was performed using a conventional continuous irrigation, in the second group, protocol of final irrigation was performed intermittently in 3 cycles. The SEM analysis of the apical third of the canal was performed on longitudinal root cross-section standardized photomicrography with a magnification of 2000X. Results: Results showed that a thicker smear layer was observed in the first group and with continuous irrigation protocol (2,10) in relation to the intermittent irrigation protocol in 3 cycles (1,96), but without significant differences. The walls of the root canal in the apical third of the samples of the second group were slightly cleaner (73.3%) in comparison with the teeth of the first group (64, 7%), but also without significant differences. Conclusions: The use of XPS and 2% solution of NaOCl in the root canal enables efficient cleaning of the apical third of tooth. The final irrigation protocol in three cycles improves the efficiency of the smear layer removal in the apical segment of the canal.

Apstrakt: Uvod. Sistemska skleroza(SC) je autoimuna bolest vezivnog tkiva koja utiče na različita tkiva i organe, uključujući kožu, pluća, bubrege, gastrointestinalni trakt i kardiovaskularni sistem. Komplikacije na srcu su najčešće prepoznat problem i značajan uzrok morbiditeta. Pacijenti i metode istraživanja: Studijsku populaciju čini 42 bolesnika oba pola, sa novootkrivenom sistemskom sklerozom, kao i bolesnike kod kojih je bolest ranije dijagnostikovana, a dolazili su tokom 2016. godine na kontrolne preglede. Pored njih, obavio se ultrazvučni pregled srca jednakom broju ispitanika odgovarajućeg pola i godina, koji su do trenutka ispitivanja bili potpuno zdravi (kontrolna grupa). Rezultati: Naši rezultati nisu pokazali korelaciju težine bolesti sa većinom ehokardiografskih parametara funkcije desne komore i desne pretkomore. Dobijeni rezultati sugerišu da bi BNP mogao biti čak i osetljiviji na procenu mogućih kardiovaskularnih komplikacija u različitim oblicima SSc. S obzirom na dobijene rezultate u našoj studiji, laboratorijsko određivanje BNP- a može biti korisno za diferenciranje različitih oblika sistemske skleroze, kao i za predviđanje težine bolesti i budućih kardiovaskularnih komplikacija. Elektrokardiografske promene u našem radu nisu pokazale značajnost u smislu pokazatelja težine bolesti i poremećaja funkcije desne komore i pretkomore, iako je postojao trend porasta QTc intervala i nastanak inkompletnog bloka desne grane kod pacijenata sa difuznim oblikom SSc. U našoj studiji zaključili smo da nije bilo značajne razlike u parametrima plućne funkcije kod pacijenata sa SSc i opstruktivnim nalazom na plućima i bez opstruktovnog nalaza na plućima registrovanim spirometrijom. U našoj studiji koncentracije CRP-a bile su značajan prediktor zahvaćenosti pluća kod pacijenata SSc. Zaključak: Bez obzira na veliki napredak u lečenju pacijenata sa sistemskom sklerozom, procenat kardiovaskularnih komplikacija kod ovih pacijenata je i dalje relativno visok. Rano otkr, Introduction: Systemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. Patiens and methods: The study population included 42 patients with both sexes, with newly diagnosed systemic sclerosis, as well as patients in whom the disease was diagnosed earlier, and came in 2016 for screening. In addition, echocardiographic examination was performed with an equal number of subjects of the appropriate sex and age, who were completely healthy (control group) until the time of the examination. Results: Our results did not show a correlation of the severity of the disease with most echocardiographic parameters of the right ventricular function and right atrium. The obtained results suggest that BNP could be even more sensitive to the assessment of possible cardiovascular complications in different forms of SSc. Laboratory determination of BNP can be useful for differentiating different forms of systemic sclerosis, as well as for predicting the severity of the disease and future cardiovascular complications. Electrocardiographic changes in our study did not show significance in terms of the severity of the disease and the disorder of the right ventricle and right atrial, although there was a trend of QTc interval growth and the incidence of an incomplete right bundle branch block in patients with diffuse SSc. In our study, we concluded that there was no significant difference in in the SSc patients with the obstructive pulmonary pattern revealed by spirometry and without obstructive pulmonary pattern. CRP concentrations were a significant predictor of lung involvement in SSc patients. Conclusion: Regardless of the great progress in the treatment of patients with systemic sclerosis, the percentage of cardiovascular complications in these pat

Introduction Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. Objective The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. Methods Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2) while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5). Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. Results Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. Conclusion Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions., Uvod Endodontski retretman je kompleksna intervencija koja zahteva detaljnu analizu indikacija, odnosno perfektnu praktičnu realizaciju ovakvog zahvata. Cilj rada Cilj ovog rada je bio da se na osnovu kliničkih i radiografskih kriterijuma proceni ishod ponovljene endodontske terapije nakon perioda od dve godine kod pacijenata sa različitim endodontskim indikacijama. Metode rada Klinička studija je obuhvatila 49 zuba indikovanih za ponovljeni endodontski tretman, koji su na osnovu PAI (periapikalni indeks) skora podeljeni u dve grupe. U prvu grupu su svrstani zubi bez periapikalnih promena (PAI skor 1 i 2), dok su drugu grupu činili zubi sa vidljivim znacima oštećenja apeksnog parodoncijuma (PAI skor 3, 4 i 5). Ponovljeno endodontsko lečenje podrazumevalo je medikaciju 2% rastvorom hlor-heksidina i suspenzijom kalcijum-hidroksidom u trajanju od dve nedelje u obe grupe zuba. Ishod preduzete terapije procenjivan je na kliničkim i radiografskim kontrolama 12-24 meseca nakon definitivne opturacije. Rezultati Ponovljena endodontska terapija u grupi zuba sa zdravim parodontalnim tkivima nakon 24 meseca bila je upešna u 93,3% slučajeva. U grupi sa periapikalnim promenama radiografski delimično poboljšanje zabeleženo je u 14,7%, a potpuno izlečenje u 52,9% slučajeva. S obzirom na odsustvo kliničkih znakova i subjektivnih simptoma, ponovljena terapija smatrana je uspešnom u oba slučaja, dakle u ukupno 67,6% zuba kod kojih su postojale hronične periapikalne lezije. Zaključak Ponovljena endodontska terapija je bila uspešna u visokom procentu i kod zuba bez izraženih kliničkih i radiografskih simptoma i sa njima.

The aim of endodontic treatment is to eliminate the infection from the root canal, to prevent reinfection and to prevent the possible occurrence of periapical periodontal inflammation by three-dimensional hermetic obturation. After appropriate completion of the treatment, it is expected periapical lesions healing and the reduction or disappearance of the radiolucency over time. The most common reasons that lead to the failure of endodontic treatment are complicated anatomy of the root canal system, inadequate control of infection, complications during endodontic treatment in the form of perforation or fracture of the root canal instruments , inadequate instrumentation and obturation, and microleakage of temporary or definitive coronal restoration. Sometimes failure can occur when the endodontic treatment correctly conducted and all procedures are fully satisfied. The reason for this is the complex anatomy of the canal system and the numerous ramifications and anastomoses between the main and accessory canals that can not be adequately treated nor obturated by contemporary instruments, materials and techniques as well. Region of endodontic space that couldn’t be reached can contain bacteria and necrotic tissue even when it seems that the canal obturation is correct on intraoral X-ray. The microbiological status of endodontically treated teeth is significantly different compared to untreated infected root canal. Only a few bacterial species was found in the canals of teeth with adequate endodontic treatment and persistent asymptomatic apical periodontal inflammation. These are mainly Grampositive cocci, bacilli and filaments with an equal distribution of facultative and obligate anaerobes. Techniques of cultivation of bacteria and PCR analysis identified Enterococcus, and Streptococcus, Actinomyces then, Peptostreptococus, Propionibacterium (previously Arachnia) and Lactobacillus. There are some extraradicular factors that could adversely affect the postoperative heal, Cilj endodontskog tretmana je da eliminise infekciju iz kanala korena, da prevenira reinfekciju i trodimenzionalnom hermetičkom obturacijom spreči eventualnu pojavu zapaljenja apikalnog parodoncijuma. Nakon adekvatno sprovedenog tretmana, očekuje se zalečenje odnosno zarastanje periapikalne lezije i smanjenje ili iščezavanje rasvetljenja tokom vremena. Najčešći razlozi koji vode neuspehu endodontskog lečenja su komplikovana anatomija kanalnog sistema, neadekvatna kontrola infekcije, komplikacije tokom endodontskog tretmana u vidu perforacije korena ili frakture kanalnih instrumenata, neadekvatna instrumentacija i obturacija kanala, odnosno mikrocurenje privremenih ili definitivnih koronarnih restauracija. Ponekad se neuspeh može javiti i onda kada je endodontska terapija korektno vodjena i sve procedure u potpunosti ispoštovane. Razlog za to je kompleksna anatomija kanalnog sistema i brojne ramifikacije i anastomoze izmedju glavnog i akcesornih kanala koje se ne mogu adekvatno obraditi niti obturisati postijećim instrumentima, materijalima i tahnikama. Neinstrumentirane regije endodontskog prostora mogu sadržati bakterije i nekrotično tkivo čak i onda kada se čini da je opturacija kanala radiografski korektna. Mikrobiološki status endodontski lečenih zuba se značajno razlikuje u odnosu na netretirani inficirani kanal korena. Pronađeno je svega nekoliko bakterijskih vrsta u kanalima zuba sa adekvatnim endodontskim tretmanom i perzistirajućim asimptomatskim zapaljenjem apeksnog parodoncijuma. To su uglavnom Gram-pozitivne koke, bacili i filamenti sa jednakom distribucijom fakultativnih i obligatnim anaeroba. Tehnikama kultivisanja bakterija i PCR-analizom identifikovani su Enterococcus i Streptococus, zatim Actinomyces, Peptostreptococus, Propionibacterium (ranije Arachnia) i Lactobacillus...

Introduction Efficient cleaning and canal design present a basic precondition for successful endodontic treatment. The aim of this study was to evaluate, using SEM analysis, the efficacy of cleaning the apical third of the canal with one instrument in both reciprocating motion and full rotation systems. Materials and methods Thirty (30) single-rooted teeth (upper incisors), extracted due to periodontal problems, were used and selected in 2 groups. In the group 1, instrumentation was done with a single instrument UNICONE with reciprocal movements (MEDIN, Czech Republic), while in the group 2, a single instrument XPS endo SHAPER (XPS) (FKG, Dentaire, Swiss) with full rotation was used. 2% solution of NaOCl and 17% EDTA solution were used as irrigation agents in both groups. SEM analysis of the smear layer in the apical third was done at standard magnification of 1000x and presented on a scale of 1-5. Results showed mostly clean canal walls and no smear layer in the apical region in both tested groups. Canal walls were somewhat cleaner after using UNICONE with reciprocal movements (80%) compared to the canals instrumented with XPS ENDO SHAPER (76%), but this difference was not statistically significant. Conclusion Single-file NiTi systems did not remove smear layer completely, but provided efficient cleaning in the api-cal part of the canal. UNICONE file with reciprocal movements was somewhat more efficient in removing the smear layer compared to the full rotation XPS ENDO SHAPER file., Uvod Efikasno čišćenje I oblikovanje kanala je osnovni preduslov za uspeh endodontskog tretmana. Cilj ovog rada je bio da se SEM analizom proveri efikasnost čišćenja apikalne trećine kanala jednim instrumentom kod sistema sa recipročnim pokretima I sistema sa punom rotacijom. Materijal I metode Korišćeno je 30 jednokorenih zuba (gornji sekutići) ekstrahovanih zbog parodontalnih problema I podeljenih u dve grupe. U prvoj grupi preparacija kanala je realizovana instrumentom sa recipročnim pokretima - UNICONE (MEDIN, Czech Republic), a u drugoj instrumentom sa punom rotacijom - XP-endo Shaper (XPS) (FKG, DENTAIRE, Swiss). Kao sredstvo za irigaciju u obe grupe korišćen je 2% rastvor NaOCl I 17% rastvor EDTA. SEM analiza razmaznog sloja apikalne trećine je urađena na standardnom uvećanju od 1000× I procenjivana prema skali od 1 do 5. Rezultati Istraživanje je ukazalo na uglavnom čiste zidove kanala I bez razmaznog sloja u apikalnoj regiji u obe testirane grupe. Zidovi kanala su bili nešto čistiji posle primene instrumenta sa recipročnim pokretima - UNICONE (80%) u odnosu na kanale druge grupe gde je korišćen instrument sa punom rotacijom - XPS (76%), ali bez statistički značajnih razlika. Zaključak NiTi sistemi sa samo jednom turpijom ne uklanjaju potpuno razmazni sloj, ali obezbeđuju efikasno čišćenje apikalnog dela kanala. Turpija sa recipročnim pokretima UNICONE je bila nešto efikasnija u uklanjanju razmaznog sloja u odnosu na XPS turpiju sa punom rotacijom.