Search Results (3,530)

Objectives: The identification of novel antimicrobial agents for use in root canal treatment may provide opportunities to improve treatment outcomes. This study aimed to assess the antimicrobial efficacy of different molecular weights of chitosan (CS), and how modification with CS may impact on the antimicrobial, physico-mechanical and biological properties of Biodentine™, a calcium-silicate-based material used in endodontics. Methods: C. albicans biofilms were treated with either 3% sodium hypochlorite (NaOCl) or a 0.05% or 0.1% CS solution for 5 min. The growth medium was replenished, and cells were re-incubated for additional 72 h. Regrowth of biofilms was assessed using a colorimetric XTT assay. Additionally, multispecies biofilms were established and the regrowth of biofilms on Biodentine discs were quantified following the addition of 0.5 wt% and 1 wt% of CS powder using qPCR. The physico-mechanical and biological properties of the new composite of Biodentine and CS were also evaluated. Results: Viability readings revealed significant initial biofilm inhibitory effects of CS solutions, followed by significant regrowth after 72 h. Upon the addition of CS to Biodentine, significant reductions in multispecies biofilm regrowth were determined. Notably, the antibiofilm activity of CS was found to be increased as the molecular weight decreased. The addition of powdered CS of low molecular weight showed a reduction in the mechanical properties of Biodentine, whereas no detrimental effects on the other material properties were noted. Conclusions: Chitosan may not be useful as an alternative irrigant to NaOCl. Addition of CS to Biodentine represents a potential means of augmenting the antimicrobial activity of Biodentine against persistent microorganisms following endodontic therapy. Despite the reductions in mechanical properties of the material, the new composite still represents a viable material option when material strength and hardness are not critical. Full article

Background/Objectives: Half of diagnosed unilateral maxillary sinusitis may have odontogenic origin, and root canal treatment (RCT) can be beneficial as a single-mode treatment for full resolution of maxillary sinusitis of endodontic origin (MSEO) symptoms. The aim of the study was to investigate the influence of passive ultrasonic irrigation (PUI) on the healing of MSEO after non-surgical endodontic treatment. Methods: A single-center, retrospective study was conducted on CBCT data and medical records of 240 patients, who underwent non-surgical endodontic treatment, performed by the same operator between 2016 and 2025. One hundred and thirty-six teeth entered the study due to inclusion/exclusion criteria. Results: Complete healing was observed in 75.74% of the cases (n = 103). The tooth most frequently associated with MSEO was the first upper molar (52.21%, n = 71). PUI was applied in 66.91% of the treatments (n = 91). PUI was an independent predictor of MSEO healing (p = 0.001; 95% CI [1.768; 9.136]). When PUI was introduced in RCT, complete healing of MSEO was observed in 84.62% of the cases (n = 77). PUI was independently associated with higher odds of radiological resolution of MSEO in univariate logistic regression (OR = 4.019) and multiple logistic regression (OR = 12.388) models. Conclusions: PUI application in the irrigation protocol was associated with higher rates of MSEO healing after non-surgical endodontic treatment (p = 0.001; 95% CI [1.768; 9.136]). The rate of MSEO healing after non-surgical RCT is high (75.74%); therefore it should be considered as a single-mode treatment option in cases of unilateral maxillary sinusitis. Full article

Reconstruction of the ear and temporal region presents unique challenges due to the complex anatomy of the lateral skull base and the need to restore both structural integrity and auditory function. Historically managed as separate entities, auricular reconstruction and hearing rehabilitation are increasingly approached in an integrated manner, supported by advances in microsurgical techniques and implantable hearing technologies. This narrative review synthesizes contemporary evidence on microsurgical reconstruction of the ear and temporal region in conjunction with hearing rehabilitation, analyzing a wide range of existing surgical techniques in an integrative manner. Reconstructive techniques discussed include local and regional flaps, free tissue transfer, auricular framework reconstruction using autologous cartilage or alloplastic materials, external auditory canal reconstruction, and subtotal petrosectomy. Hearing rehabilitation options reviewed encompass bone-anchored hearing systems, active and passive transcutaneous devices, middle ear implants, and cochlear implantation. Simultaneous reconstruction and implantation may reduce surgical burden and enable earlier hearing restoration in carefully selected patients, while staged approaches remain advantageous in complex or high-risk scenarios, particularly in the presence of chronic infection or extensive temporal bone surgery. Multidisciplinary collaboration, meticulous preoperative planning, and long-term follow-up are essential to optimize outcomes. Full article

Mountain regions across Europe face demographic decline and institutional fragmentation that hinder sustainable tourism development. This study analyzes the territorial governance system of the Val Canale and Canal del Ferro valleys (Italian Alps) with the aim of designing a stakeholder-based Organizational Model (OM) to strengthen sustainable tourism coordination in a peripheral mountain context. A qualitative single-case study approach integrates Stakeholder Analysis, Actor-Linkage Matrix, Appreciative Inquiry, and spatial contextualization to examine relational, institutional, and territorial dynamics. The findings reveal a territory rich in environmental and cultural assets—characterized by protected areas and extensive trail networks—yet constrained by fragmented inter-municipal cooperation and limited supra-municipal coordination. Governance fragmentation, rather than resource scarcity, emerges as the primary barrier to coherent territorial development. In response, the proposed multi-level Organizational Model introduces a valley-level coordination unit designed to institutionalize collaborative governance, enhance administrative capacity, and align local initiatives with regional strategies. By operationalizing stakeholder theory within a structured territorial framework, the study contributes to place-based governance literature and offers transferable insights for peripheral mountain regions facing similar coordination challenges. Full article

Background: Turner syndrome is a genotypic disorder in females characterized by the total or partial absence of an X chromosome. While cardiovascular issues and sensorineural hearing loss are well-documented, vestibular system involvement remains understudied. This study aims to examine vestibular system involvement in patients with Turner syndrome and assess if they exhibit a higher prevalence of peripheral vestibular pathology compared to the general population. Methods: A retrospective longitudinal study was conducted with 21 Turner syndrome patients and 21 age-matched controls. Evaluations included clinical history, otoscopy, pure tone audiometry, the Video Head Impulse Test (vHIT) to measure vestibulo-ocular reflex gain, and computerized dynamic posturography, specifically the Sensory Organization Test (SOT) and Stability Limits Analysis. Results: Turner syndrome patients showed significantly higher hearing thresholds across all frequencies compared to controls (p < 0.001). In the vHIT, 30% of the Turner group presented pathological results, with significant gain reductions in the right horizontal and left posterior semicircular canals. Posturography revealed a significant reduction in overall stability (p = 0.006) and a significantly lower vestibular index (p = 0.011) in the Turner group. Additionally, patients with Turner syndrome demonstrated significant impairments in directional control, reaction time, and excursion points during Stability Limits Analysis. Conclusions: Patients with Turner syndrome are more likely to experience vestibular disorders, a finding likely associated with estrogen deficiency and the loss of its protective effect on the inner ear. These results highlight the necessity of including vestibular and posturographic assessments in the routine clinical follow-up of these patients to facilitate early detection and rehabilitation, even in the absence of overt symptoms like vertigo. Full article

Evaluating the aquatic ecological and environmental consequences of dredging projects with precision is essential for reconciling engineering objectives with the long-term health of aquatic ecosystems. This study establishes an evaluation system for the aquatic ecological and environmental impacts of dredging engineering based on the Pressure–State–Response (PSR) analytical framework, and constructs a comprehensive assessment system through Velocity Pausing Particle Swarm Optimization–Projection Pursuit (VPPSO-PP) coupled with fuzzy pattern recognition. Taking the Pinglu Canal project as a case study, the objective weights of indicators are obtained via the VPPSO-PP method, and the impact levels are determined by combining the fuzzy pattern recognition model. Case studies show that the quality of discharged residual water is the most critical factor affecting the aquatic ecological environment, ranking highest with a weight of 0.0839, followed by the proportion of aquatic ecological restoration investment at 0.0685. Among the five typical dredging sections of the Pinglu Canal, the Shaping River section and the Offshore Estuary Section were rated as having a “mild impact.” In contrast, the Main Stream of Qinjiang River section, the Watershed section, and the Qinzhou urban section were rated as having a “moderate impact.” These evaluation results are consistent with the actual engineering conditions. The model developed in this study enables a quantitative and objective assessment of the aquatic ecological impacts of dredging projects. It provides a scientific basis and a practical tool for ecological management and decision-making in dredging operations. Full article

Clarifying the dynamic response characteristics of buildings and pile foundations under the action of blasting vibration is of great significance to ensure the safety and stability of the buildings adjacent to the underwater drill blasting project in the waterway. Based on the blasting construction project of the HD13 section of the Western Land-Sea New Passage (Pinglu) Canal Waterway Project, the attenuation law of the blasting vibration along the riverbank was obtained through the on-site blasting vibration monitoring. Based on on-site blasting vibration monitoring results, the dynamic response characteristics of residential buildings in the adjacent waterway were analyzed using the LS-DYNA dynamic finite element analysis method. The numerical results show that the roof’s peak vibration velocity decreases with increasing height from the foundation within the same building, and the peak attenuation is 67.76%. The peak vibration velocity and the maximum principal stress of the pile foundation increase with increasing pile depth. Based on the numerical analysis results, a linear relationship formula is established between the peak vertical vibration velocity of the pile body and the peak maximum principal stress. It is calculated that the safe control threshold value of pile foundation blasting vibration within the parameter range of this study is 13.92 cm/s. Full article

Freeze–thaw cycles frequently cause damage to canal slopes in cold regions, which has become a potential adverse factor leading to slope failure. This study investigates the coupled thermo-hydro-mechanical (THM) behavior and stability evolution of canal slopes under freeze–thaw cycle conditions through integrated physical model tests and numerical simulations. The evolution processes of temperature distribution, maximum frozen depth, unfrozen water content, deformation, and safety factor of canal slopes were evaluated. The results showed that both the maximum frozen depth and deformation increased continuously within a reasonable service life of 20 years. The maximum deformation concentrated in the middle of the slope, and the maximum unfrozen water content on the slope surface decreased by 0.06. The stability of a canal slope is subject to the dual influences of service time and seasonal variations. Overall, the safety factor decreases with the increase in service time. The safety factor is influenced by the degree of slope freezing. Compared to November, the safety factor in March of the following year increases by 0.15. As slope failure initiates at the slope toe, necessary engineering measures must be implemented at the slope toe in the design of canals to maintain slope stability. This research provides data support for frost damage mitigation and stability assessment of canals in cold regions. Full article

Background: Temporomandibular joint (TMJ) ankylosis is an uncommon condition in the modern world, yet it remains a significant treatment challenge. One of the main intraoperative difficulties is accurately and safely resecting the ankylotic mass. Objective: This study seeks to share our clinical experience with various types of complications and to review the literature on the clinical and technological evidence regarding the accuracy of surgical detachment of the ankylotic mass from the skull. Methods: A literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Search strategies were categorized into search 1 for evaluating 3D-printed technology and search 2 for computer-assisted surgical navigation. Results: One study was selected for search 1 and 2 for search 2. Also, three cases of intraoperative surgical complications associated with the resection of the ankylotic mass were presented. The 3D surgical cutting guides were found to be accurate in guiding the superior, inferior, and depth of the osteotomy. Angulation control was less than optimal. Navigation guiding proved accurate in maintaining the planned thickness of the skull base and the anterior wall of the external auditory canal. Conclusion: Navigation guiding is a superior method for achieving predictable anatomical resection of the ankylotic mass. Full article

Objective: This study aimed to determine the relationship between sigmoid sinus dehiscence (SSD), sigmoid sinus topography, mastoid pneumatization, and adjacent temporal bone structures in patients with pulsatile tinnitus (PT). Methods: A retrospective analysis was performed on 344 temporal bone cone-beam computed tomography (CBCT) scans (172 PT patients and 172 age- and sex-matched controls). The degree of mastoid pneumatization, presence and size of SSD, sinus topography, and distances between the sigmoid sinus and key landmarks—the lateral semicircular canal (LSCC), jugular bulb (HJB), and external auditory canal (EAC)—were measured. Quantitative and qualitative characteristics were compared between groups, and independent predictors of PT were identified using multivariate logistic regression. Results: Compared to controls, SSD was substantially more common in the PT group (115/172 vs. 44/172, p < 0.001). Patients with PT had significantly larger anteroposterior and vertical sigmoid sinus dehiscence diameters (4.61 ± 0.99 mm vs. 3.87 ± 0.25 mm and 3.37 ± 0.47 mm vs. 2.92 ± 0.14 mm, respectively; both p < 0.01). Additionally, in the PT group, the sigmoid sinus was situated closer to the lateral semicircular canal, jugular bulb (JB), and external auditory canal (all p < 0.01). Conclusions: Venous pulsatile tinnitus was substantially correlated with sigmoid sinus dehiscence, sinus topography, and decreased sinus–EAC distance. Quantitative CBCT evaluation of these anatomical relationships could help with surgical planning and enhance diagnostic evaluation. Full article

Background: Posterior decompression with instrumented fusion (PDF) is a conventional surgical procedure performed in patients with massive ossification of the posterior longitudinal ligament (OPLL); however, it is invasive to the posterior cervical tissues. In this report, we introduce a novel PDF technique, exoscopic minimally invasive open-door laminoplasty with pedicle screw fixation (exLAPPS), to treat cervical OPLL, while minimizing posterior tissue damage. Methods: ExLAPPS was indicated for patients with K-line (−) OPLL or a canal occupying a ratio of ≥50%, allowing decompression from C3 to C7. A small midline incision was used for the navigation reference placement and exoscopic minimally invasive open-door laminoplasty, whereas bilateral lateral incisions were utilized for posterior fixation, including pedicle screw insertion, based on the minimally invasive cervical pedicle screw technique. Results: A total of 7 patients with K-line (-) or a canal occupancy ≥50% underwent exLAPPS for cervical OPLL. The mean operative time was 248 min (range, 165–342 min) and the mean blood loss was 320 mL (range, 50–740 mL). Postoperative imaging demonstrated adequate spinal cord decompression in all patients. A total of 52 pedicle screws were inserted, with a pedicle screw deviation rate of 1.9%. Conclusions: ExLAPPS is a minimally invasive surgical technique designed for posterior decompression and fixation in patients with cervical OPLL. In this preliminary case series, the procedure was successfully performed with acceptable operative time, blood loss, and screw placement accuracy. Although the present study did not include a direct comparison with conventional procedures, these preliminary observations suggest that ExLAPPS is a feasible surgical option for selected patients with cervical OPLL. Full article

We compared fish assemblage structure and total mercury (THg) bioaccumulation between a natural floodplain lake and a constructed irrigation canal in central Brazil. A total of 473 individuals representing 34 species were recorded, and dorsal muscle samples from 62 specimens representing shared species or species occupying comparable trophic positions were analyzed for THg (Curimatella immaculata, Hemiodus microlepis, Astyanax aff. bimaculatus, Triportheus albus, Geophagus sveni, Pimelodus blochii, Pygocentrus nattereri, Lycengraulis batesii, and Cichla kelberi). The floodplain lake exhibited higher species richness, diversity, and evenness, whereas the irrigation canal supported a simplified assemblage dominated by fewer species. Total Hg concentrations were significantly higher in the lake than in the irrigation canal; however, this pattern was observed only for the carnivorous guild (t = 5.384, p < 0.0001) and the detritivorous guild (t = 4.183, p = 0.0001). THg increased significantly with trophic level in both systems, from detritivores to carnivores (F₂,₄ = 15.127, p = 0.009), yielding comparable trophic magnification slopes (lake: 1.46, 95% CI: 1.11–1.81; canal: 1.36, 95% CI: 0.94–1.77). Despite lower diversity and THg concentrations in the irrigation canal, Hg transfer efficiency across trophic levels was conserved between systems. Full article

Background/Objectives: This study aims to compare two techniques for the removal of Thermafil obturators, evaluating the influence of operator experience in two different typologies of samples. Methods: Sixty single-rooted extracted teeth with round canals and sixty 3D-printed teeth reproducing a maxillary central incisor were obturated with Thermafil obturators. Retreatment was undertaken under a dental operating microscope by an experienced endodontist and a novice operator using either the braiding technique or Reciproc. The removal time was recorded. Results: Considering natural teeth, seven failures were registered, and 60 carriers were removed successfully (90%). Removal time was significantly shorter for the experienced operator than for the novice (Braiding technique: p < 0.001; Reciproc: p = 0.001). No statistically significant difference emerged in the expert operator between braiding and reciprocating techniques (p = 0.403), while a longer carrier removal time emerged in the novice operator using the manual instrumentation (p = 0.019). Considering 3D-printed teeth, eight failures were registered, and 60 carriers were removed successfully (88%). There was no significant difference in removal time between novice and experienced operators. Carrier removal time was significantly lower in the braiding technique for the novice compared to the experienced operator (p = 0.017). This difference was not observed for the reciprocating instrumentation (p = 0.244). Regarding experience, in both operators, removal time was shorter with reciprocating instrumentation than with the braiding technique (p < 0.001). Conclusions: The braiding technique and Reciproc are effective in the retreatment of straight, round-section canals filled with Thermafil. Within the limits of this in vitro study, restoration of the working length can be undertaken quickly and with favourable outcomes. Experience significantly affects the removal time of carrier-based obturations. The removal technique did not influence retrieval time in the experienced operator, while the Reciproc proved to be an effective aid for the novice operator. Full article

Background: Persistent endodontic infections remain a significant challenge in root canal therapy, primarily due to the complexity of root canal anatomy and the formation of resistant microbial biofilms. Conventional irrigants, including sodium hypochlorite and chlorhexidine, show limited penetration into dentinal tubules and reduced efficacy against mature biofilms, contributing to treatment failure. Electrically charged lipid nanoparticles (ECLNs), such as cationic solid lipid nanoparticles, nanostructured lipid carriers, and liposomes, have emerged as potential adjunctive systems to enhance intracanal antimicrobial delivery. This focused narrative review, informed by a structured literature search, aimed to synthesize and critically evaluate preclinical and exploratory clinical evidence regarding the use of electrically charged lipid nanoparticles for antibiotic delivery and biofilm control in root canal disinfection. Methods: A structured literature search of PubMed, Scopus, and Web of Science (2010–2026) identified 312 records, of which 20 studies met the inclusion criteria and were included in qualitative synthesis. The majority of included studies were in vitro investigations, followed by ex vivo studies using extracted human teeth, with only a limited number of exploratory animal or clinical studies. Overall, the level of evidence was predominantly preclinical. Results: Across studies, ECLNs demonstrated enhanced antimicrobial efficacy compared with free antibiotics or non-charged formulations, with improved biofilm interaction, enhanced penetration into dentinal tubules, and sustained antimicrobial release. However, most investigations relied on mono-species Enterococcus faecalis biofilm models, and substantial heterogeneity in nanoparticle formulation and methodology was observed. Clinical evidence remains scarce. Conclusions: Although these findings about ECLNs suggest a promising experimental adjunct for root canal disinfection, current evidence remains largely preclinical and insufficient to support routine clinical application. Standardized formulations, clinically relevant multispecies biofilm models, and well-designed controlled clinical trials are required to establish safety, efficacy, and translational feasibility. Full article

Background: Although magnetic resonance imaging (MRI) provides excellent soft-tissue contrast for most spinal evaluations, computed tomography (CT) is still always required for preoperative planning to assess osseous anatomy and determine surgical device size, increasing the radiation exposure and workflow complexity. CT-like images enable visualization of precise bone morphology without ionizing radiation. In addition, these images often provide CT myelography-like contrasts, allowing the simultaneous depiction of the spinal canal area (SCA). This study aimed to evaluate whether CT-like images provide measurement accuracy equivalent to conventional CT and MRI for pedicle screw planning and spinal canal area assessment. Methods: We retrospectively analyzed paired lumbar CT and MRI datasets obtained within ≤1 month in 51 patients. Pedicle width and length were measured on CT and CT-like images, whereas SCA was measured on T2 weighed-images and CT-like images. A total of 224 vertebrae were analyzed. Annotated images were independently evaluated by two readers in a randomized order. Inter-modality agreement was assessed using intraclass correlation coefficients (ICCs) and a Bland–Altman analysis. Results: CT-like images demonstrated an excellent agreement with CT for pedicle measurements (ICCs: 0.968–0.985 for width; 0.922–0.966 for length). Mean differences were ≤0.1 mm for pedicle width and approximately 1 mm for pedicle length, which are unlikely to affect screw selection. The agreement with T2WI for SCA was good to excellent (ICCs: 0.766–0.945). Conclusions: CT-like images provide comparable performance for quantitative pedicle assessment and show high agreement for SCA evaluation, supporting comprehensive preoperative assessment with a single MRI examination. Full article