Objective:The aim of this in vitro study was to evaluate the antimicrobial effect of oregano extract solution (OES) against Enterococcus faecalis within root canals and dentin tubules, and its effect on smear layer.Materials and Methods:A total of 180 human maxillary central incisors was selected. After removal of coronal part of the teeth, root canals were prepared using ProTaper rotary files (Dentsply, Tulsa Endodontics, OK, USA) to #F3 with the crown-down manner. The roots were randomly assigned to 15 groups (n = 12 for each). In the first seven groups, the antimicrobial effects of the test groups were evaluated. Suspensions of E. faecalis cultures were adjusted to 1.0 McFarland (1 × 108 colony-forming unit [CFU]/ml), and sterilized teeth were placed in Eppendorf tubes and kept at 37°C for 4 weeks. Samples were then taken from the root canals before irrigation using three sterile paper points. Dentin samples were taken from root canals with ProTaper #F4 and #F5 series rotary instruments after irrigation. The aliquots of samples were placed into the brain heart infusion and incubated at 37°C for 48 h and then the CFUs were counted. In the other eight groups, the efficacy of the irrigation solutions on removing the smear layer was evaluated using scanning electron microscope (Leo 440, Oxford Microscopy Ltd., Cambridge, England) analysis. Statistical evaluation of the microbiological data was performed using the Kruskall–Wallis and Mann–Witney U-test (P < 0.05).Results:There was a statistically difference between the groups (P < 0.05). Chlorhexidine gluconate (CHX), 5% and 2% OES wasn’t found to be statistically significant regarding their antibacterial activities against E. faecalis (P > 0.05). 1% OES and NaOCl showed similar antimicrobial effect (P > 0.05), and 1% OES and NaOCl were better than ethylenediaminetetraacetic acid (EDTA) and saline (P < 0.05) but not as successful as CHX. According to the results obtained from dentin, CHX is the most effective solution within dentinal tubules. Different concentrations of OES were not achieved smear layer removal alone but OES in conjunction with 17% EDTA was the final irrigating solution achieved the smear layer removal without dentin erosion.Conclusions:Within the limitations of this study, OES appears to be a possible alternative to NaOCl as a root canal irrigant on the eradication of E. faecalis and removal of smear layer.

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Significance and Impact of the Study: The present study handles different perspectives on chemomechanical preparation of root canals. Ozone and low-temperature atmospheric pressure plasma (LTAPP) were investigated to determine whether they could be an alternative for NaOCl. Up to now, chemical solutions (NaOCl, chlorhexidine digluconate, etc.…) have been used to disinfect the root canals. When the reported effects of LTAPP on biological and chemical decontamination were taken into consideration, a question rose whether it has antimicrobial efficacy in root canals infected with E. faecalis. According to the findings of the present study, LTAPP may constitute a promising aid in endodontics in disinfection of root canals. AbstractThis study aimed to compare the antimicrobial efficacy of low-temperature atmospheric pressure plasma (LTAPP) design and gaseous ozone delivery system with 2Á5% NaOCl on Enterococcus faecalis in root canal walls and dentine tubules. The samples were divided into LTAPP (n = 12), ozone (n = 12), NaOCl (positive control, n = 12) and saline (negative control, n = 6) groups. Microbial samples were collected using paper points and dentin chips from root canals. Antimicrobial efficacy was assessed by counting the colonyforming units of Ent. faecalis before and after each irrigation protocol. Data were analysed using Kruskal-Wallis, Wilcoxon signed-rank, Friedman and Bonferroni t (Dunn's test)-tests (P = 0Á05). The microbial sampling with paper points showed antibacterial efficacy of NaOCl, LTAPP, ozone and saline in descending order, respectively (P < 0Á05). The microbial sampling with dentin chips demonstrated a superior efficacy of LTAPP compared with NaOCl in the middle third (P < 0Á05), while both had similar effects in coronal and apical thirds (P > 0Á05). NaOCl and LTAPP were better than ozone at the coronal and middle parts of the root canals (P < 0Á05). These findings led us to suggest that LTAPP, which has no thermal and chemical effects, may be of great aid in endodontic treatment.

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Diagnosis and measuring the level of increase in intracranial pressure (ICP) is critical, especially for the management of trauma patients in the emergency department and intensive care unit. However, measurements are operator-dependent as in all of the sonographic diagnoses. The aim of this study is to assess the operator variations in the measurement of optic nerve sheath diameter (ONSD). There were four emergency medicine specialists involved in the study. Each had at least 1 year of experience of ultrasound scans and performed at least 25 prior ocular scans examining the ONSD. Two measurements were made 1 week apart from both axial and longitudinal planes. Sixty healthy adults were involved in the study and every investigator obtained four measurements from each. Intra-interobserver reliabilities were tested. The investigators performed 60 ocular ultrasounds on individual healthy adults and obtained two measurements in axial and longitudinal planes 1 week apart. Therefore, 960 measurements were analyzed. The levels of compatibilities for most of the measurements were found at acceptable levels statistically. However, it is not possible to say that there was a perfect compatibility among the sonographers according to the previously conducted reliability studies of ultrasound measurements. According to our results, it is hard to say that sonographic measurement of the ONSD is a highly reliable method both in longitudinal and transverse planes.