Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Objective:To explore the effect of early pulmonary rehabilitation management model in elderly critically ill patients with mechanical ventilation.Methods:Using convenience sampling, 64 elderly critically ill patients with mechanical ventilation in the Intensive Care Unit (ICU) of the First People's Hospital of Hefei from June to December 2019 were selected as the control group, and 64 elderly critically ill patients with mechanical ventilation in the ICU of the First People's Hospital of Hefei from January to July 2020 were selected as the experimental group. The control group carried out routine nursing, and the experimental group implemented the early pulmonary rehabilitation management model on the basis of routine nursing. The pulmonary function indicators, invasive mechanical ventilation time, ICU stay and cost, delirium incidence, ventilator associated pneumonia (VAP) incidence, outcome and satisfaction of patients and their families were compared between the two groups.Results:The pulmonary function indicators of patients in the experimental group were better than those in the control group, and the difference was statistically significant ( P<0.01) . The invasive mechanical ventilation time and ICU stay of the experimental group were shorter than those of the control group, and the ICU cost was lower than that of the control group, and the differences were statistically significant ( P<0.01) . The incidence of delirium and VAP in the experimental group was lower than those in the control group, and the number of outcome cases was more than that in the control group, and the differences were statistically significant ( P<0.05) . The satisfaction of patients and their families in the experimental group was higher than that in the control group with a statistically significant difference ( P<0.05) . Conclusions:The implementation of the early pulmonary rehabilitation management model can effectively improve the pulmonary function of the elderly critically ill patients with mechanical ventilation, reduce the occurrence of complications and the patient's family financial burden, and increase the satisfaction of patients and their families, which is feasible and extendable.

Objective To evaluate the palatal rugae individual-specific properties and stability before and after orthodontic treatments for investigating the reliability of palatal rugae for individual identification of forensic dentistry based on the palatal rugae model ananlysis. Methods Maxillary models of 70 patients were obtained before and after orthodontic treatments respectively. Palatal rugae morphologic changes and individual identification were examined by model analysis including changes in number, orientation, shape, and length of palatal rugae, as well as mesial and distal endpoint displacement in the anterioposterior(AP) and mesiodistal (MD) direction. Furthermore, The examination of palatal rugae average match accuracy(%) was performed between the pre-treatment and post-treatment orthodontics models and post-treatment and duplicated post-treatment orthodontics models. Results ① The palatal rugae morphological changes were found and the incidence of palatal rugae changes were showed in length(28.6%), segmenta-tion(4.3%); unification(2.9%); orientation(1.4%) and shape(1.4%) after orthodontic treatment. Also the displacement of the distal endpoint of palatal rugae was 45.7% for anterioposterior indirection, 40% for mesiodistal indirection after orthodontic treatment, while the anterioposterior displacement of the mesial endpoint of palatal rugae was 32.9% and mesiodistal displacement was 17.1%. ② The identical palatal rugae patterns were not found both the pre-treatment and post-treatment groups. ③ The palatal rugae average match accuracy was 92.19% between pre-treatment and post-treatment groups, however, the rate had increased by 99.05% when matching the palatal rugae patterns of post-treatment groups to their duplicates. Conclusion Palatal rugae patterns have the high specific properties to each indivi-dual. Although there are some changes in morphology of palatal rugae after orthodontic treatment, it still can be used as a novel method for individual identification in forensic dentistry.

Objective To analyze the morphological matching rate with a digital image recognition system in pre-and post-orthodontic treatments,and to provide forensic dentistry evidence for individual identification.Methods High-resolution digital images of the palatal rugae were taken under particular conditions from each patient in pre-and post-orthodontic treatments.Features of each digital image were extracted using a digital image recognition system and collected in the palatal rugae database.Data of the palatal rugae werematched by MATLAB software system.Results From the matching results,the accuracy rate of individual identification of orthodontic patients was 100％.The accuracy rate in matching palatal rugae patterns in pre-and post-orthodontic treatments was 95.67％.The results were statistically significant with P＜0.05.Conclusion Palatal rugae pattern is highly individual-specific.The morphologyofpalatal rugaecould bechangedby theorthodontic treatment,however,these changes may not greatly influence individual identification in forensic dentistry,providing a new potential to individual identification.

Objective To select the largest non-toxic leaching solution concentration through the experimental observation of the cytotoxicity of the ostrich acellular corneal stromal leaching solution to the Chinese hamster lung fibroblasts cells(CHL) for the further chromosome distortion experiment.Methods The leaching solution made from the ostrich acellular corneal stromal material was diluted with concentrate of 1 ∶ 2,1 ∶ 4 and the original concentration were used to culture with the CHL cells,the negative and positive control were also set up at the same time,to evaluate the impact on cell growth after 24 hour by MTT colorimetric method.Results The leaching solution diluted with 1∶4 was non-toxic,and could promote the growth of the cells.Conclusion Combined with the results of classification and cell morphological features,this cytotoxicity test can be used to screen the best benchmark non-toxic concentrations for the chromosome aberration test of the CHL cells.

Objective To establish a digital system for forensic identiifcation of the palatal rugae and evaluate its application effects. Methods High-resolution digital images of the palatal rugae were harvested under the standard condition and processed including data collection, noise reduction, contrast enhancement, image segmentation, feature extraction, edge detection, and information matching. Apply an MATLAB software system to develop a digital system for forensic identiifcation of the palatal rugae ,and its application effects were evaluated. Results A digital system for forensic identification of the palatal rugae was successfully established. The digital system had an accuracy rate of 100%. Conclusion Establishing a digital system for forensic identiifcation of the palatal rugae provides a novel method for forensic identiifcation.

Acupuncture Therapy ; Cerebral Hemorrhage ; complications ; Cerebral Infarction ; etiology ; therapy ; Humans ; Male ; Middle Aged