(1) Background: In this study, the efficacy of cone-beam computed tomography (CBCT) in detecting dental posts was compared to periapical radiography. (2) Methods: A retrospective evaluation of 53 patients’ periapical radiographs and CBCT images was performed. The presence and type of the intra-canal dental post were initially determined on the periapical images (PA) radiographs’ examination and were then compared to the observer’s ability to detect the dental post on a CBCT image. The effect of the post’s type (metal cast or prefabricated) on its detection on CBCT images was determined. (3) Results: 10.5% of teeth that were identified as having a post on a PA radiograph were not identified as having a post on the CBCT examination (p < 0.05). Approximately 17.6% of teeth that were identified as not having a post on a PA radiograph were identified as having a post on the CBCT examination (p < 0.05). Moreover, 16.3% and 50% of teeth with a prefabricated or cast posts on PA radiographs were falsely identified on the CBCT examination, respectively (p < 0.05). (4) Conclusions: A CBCT image is an insufficient tool for the identification of metal prefabricated and cast posts. A PA image is the recommended radiographic tool for achieving information about the post-endodontic restoration status of teeth candidates for endodontic retreatment in patients with a former CBCT scan.

This cross-sectional study, conducted from July 2023 to January 2024, examines injury patterns and associated risk factors among Krav Maga athletes to develop tailored prevention strategies for this unique martial art. A survey of 109 participants revealed that 65 injuries were reported, with 59.6% caused by actions from another individual and 24.8% (27 cases) being self-inflicted. The most frequently injured areas were the lower limbs (42 participants, 38.5%), torso (19 participants, 17.4%), and upper limbs (19 participants, 17.4%). Sprains or ligament tears were the most common diagnosis, accounting for 35 cases (32.1%), followed by fractures in 24 cases (22%). Participants ranged in age from 10 to 65 years, with males (95 participants, 87.2%) experiencing more injuries than females. Significant disparities were noted in injury rates based on training intensity (p < 0.05). Recovery periods varied, with 21 participants (19.3%) reporting durations exceeding 30 days. These findings underscore specific injury patterns and risk factors in Krav Maga, highlighting the importance of tailored prevention strategies focusing on flexibility, strength, and proper techniques to reduce injury risks.

A wide range of surgical techniques has been described for breast conservation treatment (Oncoplasty) based on breast size and shape, as well as tumor size and location. However, there is a lack of standardization regarding the indications for oncoplastic reconstruction. This study aims to identify the presurgical parameters associated with poor cosmetic outcomes post-breast conserving treatment. We hope this preoperative model can assist in evaluating whether there is a need for oncoplastic intervention. The study group involved 136-adult females (age 35–77) who previously undergone breast conserving surgery and radiation, without oncoplastic intervention between 2007 and 2017. Patient demographics, medical and physical parameters were collected, and each patient filled Breast-QTM-questionnaire and six angles’ photographs were taken. Patients’ photographs were evaluated by 15 board-certified plastic surgeons. Both univariate and multivariate logistic regression analysis was performed to identify potential confounders for poor outcome in each of the experts' and patients’ average-grades. Our analysis identified several variables correlated with poor surgical outcome: high BMI, high chest-wall-circumference, high breast-width and larger volume-removed. The general-aesthetic-result as evaluated by our experts was favorably influenced by an upper lateral quadrant tumor while the breast shape was negatively influenced by a lower medial quadrant tumor. Interestingly, no correlation was found between the patients' and panel's evaluations, nor did we find any clinically significant parameter related to the patients' reported well-being. Patients with high BMI, high chest-wall-circumference, large breast-width and larger inferomedial tumors could benefit from early plastic surgery evaluation and intervention. Patient’s psychosocial well-being as well as sexual well-being are independent from positive surgical outcome evaluated by plastic surgeons. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Plastic surgery is a broad field that requires a mixed skillset. Therefore, it is important that students be exposed to all its various subspecialties to make informed career decisions and to properly refer patients in different clinical situations. A nationwide survey was conducted of Israeli medical students to investigate their knowledge and perceptions regarding the field of plastic surgery and its subspecialties, and the impact of a clinical rotation in plastic surgery on these factors. A total of 300 subjects responded. Approximately, 61% of the cohort was female and 70% were enrolled in a 6-year program. About one-third stated that their field of interest was surgical rather than medical. Significant variability was noted in the accuracy of responses to questions about different procedures encompassed in the scope of plastic surgery. Although 90% of the students were aware of some common plastic surgery procedures that are also often thought to be well known to the public, only 50% were able to correctly identify lesser-known surgeries performed by plastic surgeons. Knowledge about plastic surgery was unrelated to an interest in the field. We recommend adjusting preclinical instruction and clinical rotations in plastic surgery to better prepare students to select a specialty best suited to their future goals, as well as to improve their ability to refer patients to other specialists as necessary.

The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.

Rare reports linking textured breast implants to anaplastic large-cell lymphoma have generated controversies regarding their relative advantage over smooth implants. To evaluate trends in implant use in Israel, we sent a seven-item questionnaire to all active board-certified breast plastic surgeons in the country. About half responded. Approximately 60% of responders reported a moderate-to-considerable decrease in both the relative number of augmentation mammoplasty procedures and the use of implants during mastopexies in the last year. Nearly 40% had switched from textured to smooth implants to some extent. More than 40% still used textured implants for aesthetic procedures, and reconstructive procedures. Surgeons with more experience demonstrated a greater preference for smooth implants. The uncertainty regarding the safety of textured breast implants has led to a partial transition to the use of smoother implants and, importantly, to a general reduction in all breast-implant-based procedures.

Breast reconstruction incidence increased, including preventive surgery. In this context, providing women best surgical care and results is crucial, with minimum complications, such as wound dehiscence and skin flap necrosis. Tension-free closure of skin flaps is mandatory for successful healing. However, since this is not always possible, various techniques have been developed to reduce tension from wound margins, facilitate primary wound closure, and minimize and improve scarring. These techniques have not been investigated in breast surgeries. The aim of this study was to describe our experience with the Tension-Relief System in mastectomy and breast reconstructive patients, and the advantages of using this technique. The retrospective cohort consisted of 13 breasts of 11 women aged 29-74 years who underwent surgery with primary wound closure using the System, in 2019-2020 in our department. It was applied averagely 19.7 days, demonstrated effectiveness in preventing complications and as secondary treatment following complications. This enabled avoiding further and more extensive surgeries, including donor-site morbidity when needed. In mastectomy and breast reconstruction, the system minimizes complications and yields satisfactory esthetic and functional outcomes, with minimal inconvenience to the patient, and good pain control. The technique is low-cost, simple to use, and does not require special settings, surgical equipment, or particular skills.

Abstract Introduction: The present study aimed to evaluate the influence of the quality of root canal treatment and different coronal restoration materials on the periapical status of endodontically treated teeth.Methodology: 2498 radiographs were included in this study. For each radiograph, the quality of the root canal treatment was judged as adequate or faulty and the periapical status was judged as healthy or diseased according to a study by Ray & Trope (1995). Radiographs with Fixed Partial Dentures, temporary coronal restoration, a post and core type of restoration, or teeth with caries lesions were excluded from the study. Cases, where no definitive diagnosis could be made, were excluded from the study. Statistical analysis was conducted using SPSS software.Results: The results showed that teeth with a good endodontic filling (GE) were more likely to have an absence of periradicular Inflammation (API) regardless of the core material OR=2.00 (95% CI 1.78-2.26). Teeth with an amalgam core were more likely to have an API, regardless of the quality of root canal treatment OR=1.11 (95% CI 1.03-1.2). Teeth with an amalgam core and GE had an OR of 1.16 (95% CI 1.04-1.29) to have an API, whilst teeth with a composite core and an GE had an OR of 0.83 (95% CI 0.74-0.94) (p<0.05).Conclusions: GE was found as the major contributing factor for the lack of periradicular pathosis, whilst the core material made little difference in teeth with PE. Teeth with GE and good restoration (GR) seem to benefit from an amalgam core.

OBJECTIVES:To evaluate the incidence of retrograde peri-implantitis (RPI) generally and the incidence of RPI with an endodontic-treated adjacent tooth and/or a periapical radiolucency. METHOD:The retrospective case-control study included the follow-up periapical images of single dental implants. Two calibrated graduate endodontic residents evaluated simultaneously the presence of RPI and the adjacent teeth status (a previous root canal treatment (RCT) and the periapical status). RESULTS:Six hundred and eleven dental implants were included in this study. Twenty-three implants with RPI were detected (the incidence of RPI was 3.7%). Thirty-one adjacent teeth to the implants with RPI were recognized. Out of them, seven teeth had a previous RCT and periapical radiolucency or no RCT and periapical radiolucency. The odds ratios for RPI in an implant with periapical radiolucency or with RCT at the adjacent tooth are 6.67 (95% CI 2.7-16.5), P < 0.05; and 0.11 (95% CI 0.007-1.9), P > 0.05 respectively. CONCLUSIONS:Based on periapical radiographs, the RPI incidence was 3.7% in the present study. The incidence of RPI increased in cases with adjacent teeth that had periapical radiolucency. Previous RCT in teeth adjacent to implants without apical radiolucency is not correlated with RPI.

BACKGROUND/AIMSelf-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers.MATERIAL AND METHODSData from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers.RESULTSThe study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers.CONCLUSIONMilitary divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

The authors have requested that this preprint be removed from Research Square.

OBJECTIVES:Part 1 of this two-part study aims to investigate systemic antibiotics (SA) prescribing practices for various endodontic diagnoses and clinical scenarios by general practitioners, post-graduate students and endodontists in Israel and the former Soviet Union (FSU) states.MATERIALS AND METHODS:A total of 7500 dentists from Israel and FSU states were invited to fill in an online questionnaire. The questionnaire consisted the SA prescribing for endodontic diagnoses and clinical scenarios (post operative pain, post apical surgery and post avulsion). The international guidelines of the European Society of Endodontology and the American Association of Endodontists were used as the standard of correct practice.RESULTS:A total of 1310 dentists (response rate of 17.46%, 498 Israeli and 812 FSU dentists) completed the survey. The rates of prescription SA among the Israeli and the FSU respondents for non-recommended diagnoses and clinical scenarios were 24.75% and 11.42% (P>0.05), 16.57% and 16.17% (P>0.05) respectively. The rates of prescription SA among the Israeli and the FSU respondents for recommended diagnoses and clinical scenarios were 63.39% and 62.9% (P>0.05), 27.2% and 13.9% (P>0.05) respectively.CONCLUSIONS:There are gaps between the recommended protocols for prescribing SA for patients with various endodontic diagnoses and clinical scenarios and the actual practices among Israeli and FSU dentists. Continuing education of dentists must be encouraged in order to improve SA prescription practice according to international guidelines.CLINICAL RELEVANCE:When not indicated, prescription of systemic antibiotics might lead to antimicrobial resistance, while non-prescription, when required, might have negative repercussions on the patient's health. Knowledge of the prescription habits of dentists in the endodontic practice will help prevent harmful situations.

Burns are a major trauma source in the civilian and military settings, with huge impact on patient's well-being, health system and operation status of the force in the military setting. The purpose of our study was to summarize characteristics of all burn cases seen by the Israel Defense Forces primary care physicians during the years 2008-2016. This can help understand what causes most burns, in what units, at which stages and settings and consequently will allow commanders to make decisions regarding safety-rules, protective-equipment and uniforms, medical educations for soldiers, etc.Data were collected from the military database system. All burn related visits were analyzed using a designated big data computerized algorithm that used keywords and phrases to retrieve data from the database. 12,799 burn injuries were found presented in 65,536 burn related visits were analyzed according to the demographics, burn mechanism and military unit.It was observed that most of the burns (70.7%) occurred during routine non-combat setting and there was a gradual decrease in burn injuries during the investigated period, from 17.6% of the cases in 2008 to 2.3% in 2016. Most of the burns occurred in the Air-Force (19.4%), and the leading etiology was Chemical (35%). Average Total Body Surface Area (TBSA) was 7.5%.Since most of the burns occurred in a routine setting and were occupational related, investment in education, and improving fire-protection has proven itself, leading to the decrease in burn prevalence, we recommend that more emphasis should be given on proper handling of chemicals.

BACKGROUND:Macromastia (breast hypertrophy) has a significant influence on patients' quality of life (QoL), and surgical treatment therefore offers clear medical benefits.Rapid improvements in musculoskeletal complaints are being reported long before final aesthetic results are traditionally evaluated. OBJECTIVES:The aim of this study was to use the RAND Health Status Survey, in modified validated Short Form 36 (SF-36), to analyze patient QoL after breast reduction, and examine whether QoL changes as a function of postoperative time. METHODS:This cross-sectional study included 50 consecutive selected female patients who underwent breast reduction surgery by the same technique performed by a single surgeon between January 2016 and December 2019. Changes in QoL were reported based on a modified SF-36 survey, with scores standardized according to the mean of the general population. Time intervals between the operations and surveys were recorded. RESULTS:The patients were divided into 3 categories according to time since their operation (<3 months, 3-12 months, and >12 months), and assessed pre- and postoperatively. The mean [standard deviation] weight of breast tissue removed was 479.97 [159.38] g per breast. Mean follow-up time was 15.02 [14.3] months. All patients were satisfied with the shape of their new breasts and none reported to have suffered major complications postoperatively. For all 3 groups, patients' scores in the SF-36 survey post- compared with preoperation indicated improvement unrelated to time elapsed since operation. CONCLUSIONS:Breast reduction improves symptoms and well-being, unrelated to amount of tissue removed or to time elapsed postsurgery. This improvement is rapid and may lead to better coverage from medical insurance providers. LEVEL OF EVIDENCE: 4:

The aim of the current study was to determine the accuracy of electronic apex locator (EAL) measurements when using files of different sizes in roots with wide apical foramina while considering a new parameter of stability of EAL reading. Ten teeth with straight roots were subjected to a sequential widening of the apical foramen to 0.6, 0.7, and 0.8 mm. The roots were embedded after each enlargement stage in an alginate mold and subjected to EAL readings. Measurements were done using sequential K-file sizes and the self-adjusting file (SAF). Measurement stability was introduced as a new additional parameter. As the difference between the file size used and the apical diameter of the canal decreases, the results obtained were more accurate and stable. The stability and accuracy of the measurements coincided with each other in a statistically significant manner. Within the limitations of the present ex vivo study, it may be concluded that in straight canals with wide apical foramina of 0.6–0.8 mm, both SS K-files which fit snugly to the walls of apical foramen and the SAF file may offer both accurate and stable EAL measurements.

Background: Endodontic motors with an integrated electronic apex locator have been tested for its accuracy mostly on single-rooted teeth. Multirooted teeth may create interferences on the readings created by the irrigation solution in the pulp chamber and additional canals. This study aimed to examine in vitro the accuracy of an integrated endodontic motor with an EAL attached in multirooted teeth. Methods: Extracted teeth on a model specially developed to test EALs were tested. The actual working length (WL) was measured with a 5x microscope and K-Files, EAL working length was measured with the pulp chamber flooded with sodium hypochlorite and the measure obtained shaping root canals with the auto apical reverse (AAR) mode, (an endodontic motor that attached to an EAL starts auto-reverse mode when the working length defined

INTRODUCTION:Mandibular premolars usually have one root and one root canal. Different studies found that up to 30% of mandibular premolars have more than one root canal, and up to 24% of mandibular premolars have C-shape canals. The purpose of this study was to investigate the root anatomy and the prevalence of complex root canal morphology in mandibular premolars in Israeli population.METHODS:A total of 1020 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1835 mandibular first premolars and 1678 mandibular second premolars were examined. Irregular root anatomy and different root canal morphologies were recorded and analyzed.RESULTS:The overall prevalence of complex root morphology (types II-VIII) in mandibular first and second premolars was 21% and 2.8%, respectively. The bilateral prevalence of complex root morphology in mandibular first and second premolars was 46% and 29%, respectively. The prevalence of radicular grooves in mandibular first and second premolars with complex root morphology was 48% and 36%, respectively. No significant difference was found according to gender or the side of occurrence. However, complex root canal morphology was significantly found in mandibular premolars with radicular grooves.CONCLUSIONS:Complex root canal morphology frequently occurs in mandibular first premolars in the population of Israel. Radicular groove existence in mandibular first and second premolars is significantly related to complex root canal morphology.

An oral cutaneous sinus tract is a relatively uncommon condition that is generally associated with long-standing periapical inflammation. The traditional process of oral cutaneous sinus tract diagnosis is an invasive method based on the insertion of a lacrimal probe or wire. The present article describes the use of cone-beam computed tomographic imaging as a noninvasive assistant tool for the verification of the odontogenic origin.

Aim To describe a case of autotransplantation nine weeks after the extraction of a hopeless tooth with a large periradicular lesion, which enabled the healing of the recipient site. A 19-year-old male in generally good health was referred for evaluation of tooth 46. Clinically, there were class III mobility and sensitivity to percussion and palpation. There was a mesio-lingual swelling and a single narrow deep pocket of 15 mm at the disto-lingual aspect. CBCT imaging revealed a radiolucent area over 15 mm in diameter that extended from the mesial aspect of the mesial root of tooth 47 to the distal aspect of tooth 45. The radiolucent area was in proximity to the inferior alveolar canal and penetrated the buccal and the lingual cortical plates. The tooth was diagnosed with previously treated tooth, acute apical abscess and vertical root fracture. Tooth 46 was extracted, and a delicate curettage and drainage were performed. Nine weeks afterwards, a second surgery was performed: extraction of the impacted immature third molar (tooth 48). Immediately after the extraction, the tooth was replanted in the healing socket of tooth 46, and sufficient initial stability achieved. At a 1-year follow-up, the tooth had normal mobility, no sensitivity to palpation and percussion, and responded to thermal pulp testing. The soft tissue was normal, probing depths up to 3-mm, without swelling or sinus tract. Radiographically, periapical healing at the recipient site was observed. Compared to the post-operative periapical radiography immediately after the procedure, there was no change in the distal root dimensions. In the mesial root, development of the root length and a closed apex was demonstrated.

Aim: To evaluate the centering ability of ProTaper Next (PTN) and 2Shape (TS) nickel—titanium (NiTi) instruments in terms of maintaining the original root canal configuration in a simulated tooth with severe curvature. Methodology: Twenty standardized simulated curved root canals were prepared to an apical size of 0.25 mm using PTN and TS (n = 10 canal/group) nickel-titanium files. A gig was constructed to enable reproducible image acquisition using a photographic camera. Pre- and post-instrumented images were recorded and superimposed using a computer software. The ability of the instruments to remain centered in the canal was determined by calculating a centering ratio at three independent points of the simulated canal: coronal, middle and apical third of the curvature, using a computer software. Statistical analysis was performed using one-way analysis of variance (ANOVA) followed by independent sample t-test at 5% significance level. Results: No significant difference was found between the two systems (p > 0.05). At the apical third, the mean centering ratio was significantly higher than the centering ratio of the coronal and the middle thirds in both TS and PTN (p < 0.05). Conclusions: There were no significant differences in the centering ability of the ProTaper Next and 2Shape systems in simulated severe curved canals. Both systems exhibited some degree of transportation, especially in the apical third.