A critical analysis of research methods and experimental models to study irrigants and irrigation systems

Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-computed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics

Present status and future directions - irrigants and irrigation methods

Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long-term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long-term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system

The evolution of public debt worldwide.The case of Greece: bankruptcy or debt restructuring?

Διπλωματική εργασία--Πανεπιστήμιο Μακεδονίας, Θεσσαλονίκη, 2022.This thesis deals with the evolution of the global financial system over the last two centuries and the creation of public debt worldwide with emphasis on the economic history and the public debt of Greece. Within the framework of this thesis, the main causes of the global financial crisis and the increase in the Greek public debt are analyzed and alternative approaches for the future course of the country are proposed

The Effect of the Ultrasonic Irrigant Activation Protocol on the Removal of a Dual-species Biofilm from Artificial Lateral Canals

Introduction: Lateral canals are particularly challenging to clean and disinfect. The aim of this study was to compare the removal efficacy of a dual-species biofilm from a lateral canal model by different ultrasonic irrigant activation protocols in vitro. Methods: Artificial root canal models with 270 simulated lateral canals were made of polydimethylsiloxane. A dual-species biofilm (Streptococcus oralis and Actinomyces naeslundi) was grown in vitro in the lateral canals using a constant depth film fermenter. Two percent NaOCl or demineralized water was delivered by a syringe and an open-ended needle for 30 seconds and subsequently activated by an ultrasonic file for a total activation time of 30, 60, or 90 seconds divided in 1 or 3 consecutive activation cycles. In the control groups, the irrigant was allowed to rest for 30, 60, or 90 seconds. The volume of the biofilm in the lateral canal was evaluated before and after the final irrigation protocol by optical coherence tomography. The results were analyzed by 3-way factorial analysis of variance (α = 0.05). Results: Irrigation with NaOCl rather than demineralized water resulted in more effective biofilm removal from the lateral canal (P < .001). Three cycles of intermittent ultrasonic activation were significantly more effective than no activation (P = .029). The total irrigant contact time did not affect biofilm removal (P = .403). Conclusions: The type of the irrigant and the ultrasonic activation protocol affected biofilm removal from artificial lateral canals. None of the compared protocols was able to eradicate the biofilm

Irrigant flow in the root canal during ultrasonic activation:A numerical fluid-structure interaction model and its validation

Aim: The aim of the study was (a) to develop a three-dimensional numerical model combining the oscillation of a tapered ultrasonic file and the induced irrigant flow along with their two-way interaction in the confinement of a root canal. (b) To validate this model through comparison with experiments and theoretical (analytical) solutions of the flow. Methodology: Two partial numerical models, one for the oscillation of the ultrasonic file and another one for the irrigant flow inside the root canal around the file, were created and coupled in order to take into account the two-way coupled fluid–structure interaction. Simulations were carried out for ultrasonic K-files and for smooth wires driven at four different amplitudes in air or inside an irrigant-filled straight root canal. The oscillation pattern of the K-files was determined experimentally by Scanning Laser Vibrometry, and the flow pattern inside an artificial root canal was analysed using high-speed imaging together with Particle Image Velocimetry. Analytical solutions were obtained from an earlier study. Numerical, experimental and analytical results were compared to assess the validity of the model. Results: The comparison of the oscillation amplitude and node location of the ultrasonic files and of the irrigant flow field showed a close agreement between the simulations, experiments and theoretical solutions. Conclusions: The model is able to predict reliably the file oscillation and irrigant flow inside root canals during ultrasonic activation under similar conditions

The spatial distribution of short-term rental listings in Greece: a regional graphic

JEL Classifications: R11; R12; R15; R31; R38; R51; R58; Z3.The home-sharing economy is growing on a global scale, enabling homeowners to short-term lease through online platforms such as Airbnb. These practices bear both positive and negative externalities at both regional and national levels. Positive externalities include job creation, rises in income and in the dwelling supply for touristic purposes, as well as increase in tax revenues. Negative externalities involve disruptions to local communities by raising rental prices and crowding-out long-term tenants, implying income redistribution from homeowners to renters, and the overall ‘touristification’ of traditional neighbourhoods [Gurran, N. (2018). Global home-sharing, local communities and the Airbnb debate: A planning research agenda. Planning Theory & Practice Planning Theory & Practice, 19(2), 298–304]. The regional graphic in this paper illustrates the fact that short-term listings in Greece are unevenly distributed, mainly concentrated in touristic regions and the capital city, but not in continental areas

Biofilm removal from a simulated isthmus and lateral canal during syringe irrigation at various flow rates:a combined experimental and Computational Fluid Dynamics approach

Aim (i) To quantify biofilm removal from a simulated isthmus and a lateral canal in an artificial root canal system during syringe irrigation with NaOCl at different concentrations and delivered at various flow rates (ii) to examine whether biofilm removal is further improved by a final high-flow-rate rinse with an inert irrigant following irrigation with NaOCl. (iii) to simulate the irrigant flow in these areas using a computer model (iv) to examine whether the irrigant velocity calculated by the computer model is correlated to biofilm removal. Methodology Ninety-six artificial root canals with either a simulated isthmus or lateral canal were used. A dual-species in vitro biofilm was formed in these areas using a Constant Depth Film Fermenter. NaOCl at various concentrations (2, 5 and 10%) or adhesion buffer (control) was delivered for 30 s by a syringe and an open-ended needle at 0.033, 0.083, or 0.166 mL s(-1) or passively deposited in the main root canal (phase 1). All specimens were subsequently rinsed for 30 s with adhesion buffer at 0.166 mL s(-1) (phase 2). The biofilm was scanned by Optical Coherence Tomography to determine the percentage of the remaining biofilm. Results were analysed by two 3-way mixed-design ANOVAs (alpha = 0.05). A Computational Fluid Dynamics model was used to simulate the irrigant flow inside the artificial root canal system. Results The flow rate during phase 1 and additional irrigation during phase 2 had a significant effect on the percentage of the remaining biofilm in the isthmus (P = 0.004 and P <0.001). Additional irrigation during phase 2 also affected the remaining biofilm in the lateral canal significantly (P 0.05). Irrigant velocity in the isthmus and lateral canal increased with increasing flow rate and it was substantially correlated to biofilm removal from those areas. Conclusions The irrigant flow rate affected biofilm removal in vitro more than NaOCl concentration. Irrigant velocity predicted by the computer model corresponded with the pattern of biofilm removal from the simulated isthmus and lateral canal

PRILE 2021 guidelines for reporting laboratory studies in Endodontology: A consensus-based development

Reproducible, skilfully conducted and unbiased laboratory studies provide new knowledge, which can inform clinical research and eventually translate into better patient care. To help researchers improve the quality and reproducibility of their research prior to a publication peer-review, this paper describes the process that was followed during the development of the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines and which used a well-documented consensus-based methodology. A steering committee was created with eight individuals (PM, RO, OP, IR, JS, EP, JJ and SP), plus the project leaders (PD, VN). The steering committee prepared an initial checklist by combining and adapting items from the modified Consolidated Statement of Reporting Trials checklist for reporting in vitro studies of dental materials and the Clinical and Laboratory Images in Publications principles as well as adding several new items. The steering committee then formed a PRILE Delphi Group (PDG) and PRILE Online Meeting Group (POMG) to provide expert advice and feedback on the initial draft checklist and flowchart. The members of the PDG participated in an online Delphi process to achieve consensus on the items within the PRILE 2021 checklist and the accompanying flowchart for clarity and suitability. The PRILE checklist and flowchart developed by the online Delphi process were discussed further by the POMG. This online meeting was conducted on 12 February 2021 via the Zoom platform. Following this meeting, the steering committee developed a final version of the PRILE 2021 guidelines and flowchart, which was piloted by several authors when writing up a laboratory study for publication. Authors are encouraged to use the PRILE 2021 guidelines and flowchart to improve the clarity, completeness and quality of reports describing laboratory studies in Endodontology. The PRILE 2021 checklist and flowchart are freely available and downloadable from the Preferred Reporting Items for study Designs in Endodontology website (http://pride-endodonticguidelines.org/prile/)

Apical transportation associated with ProTaper® Universal F1, F2 and F3 instruments in curved canals prepared by undergraduate students

Objective: This study evaluated apical transportation associated with ProTaper® Universal F1, F2 and F3 rotary files in curved canals prepared by undergraduate students. Material and Methods: Twenty mesial roots of mandibular molars with curvatures ranging between 25° and 35° were selected. Mesiobuccal canals were instrumented by twenty students with the ProTaper® system (Dentsply-Maillefer, Ballaigues, Switzerland) according to the manufacturer’s instructions. Pre-flaring was performed with S1 and SX files. A #15 K-file was inserted into the root canal up to the working length (WL), and an initial digital radiograph was taken in a buccolingual direction (baseline). Afterwards, the S1, S2, F1, F2, and F3 files were employed up to the WL. Other radiographies were taken in the same orientation of the baseline after the use of the F1, F2, and F3 files, with each file inserted into the root canal. The radiographic images were overlapped, and the Image J software was used to measure the distance between the rotary files’ ends and the #15 K-file’s end, characterizing the apical transportation. Data were analyzed by Repeated Measure ANOVA and by the SNK post hoc test (P<0.05). Results: It was verified that file size affected apical transportation significantly (P<0.001). The F3 file showed higher apical transportation than F1 and F2, while between these last files there was no difference. Conclusion: The undergraduate students produced lower apical transportation in curved canals when they did not use the F3 rotary file

The effect of apical preparation size on irrigant flow in root canals evaluated using an unsteady Computational Fluid Dynamics model

Aim  To evaluate the effect of apical preparation size on irrigant flow inside a root canal during final irrigation with a syringe and two different needles types, using a Computational Fluid Dynamics (CFD) model. Methodology  A validated CFD model was used to simulate the irrigant flow from either a side-vented or a flat 30G needle positioned inside root canals having sizes of 25, 35, 45 and 55, all with a .06 taper, at 3 mm short of working length (WL). Velocity, pressure and shear stress in the root canal were evaluated. Results  Different preparation sizes resulted in minor differences in the flow pattern in the apical root canal. Major differences were observed between the two needle types. The side-vented needle could not achieve irrigant replacement to the WL even in a size 55, .06 taper root canal. Significant irrigant replacement was evident almost to the WL in size 35, 45 and 55, .06 taper root canals with the flat needle. The maximum shear stress decreased as the preparation size increased. The flat needle developed higher mean pressure at the apical foramen. Both needles led to a similar gradual decrease in apical pressure as the preparation size increased. Conclusions  Apical preparation size affected irrigant replacement, the shear stress on the canal wall and the pressure at the apical foramen. Root canal enlargement to sizes larger than 25 appeared to improve the performance of syringe irrigation. Adequate space between the needle and the canal wall should be ensured to allow for an effective reverse flow of the irrigant towards the canal orific