This novel tip-tracked EMN system incorporating both ENB and EMTTNA can guide biopsy and FM placement with a high degree of success and with a low complication rate. Multicentered prospective trials are required to develop algorithmic approaches to combine ENB and EMTTNA into a single procedure.

©Operative Dentistry, 2010, 35-1, 20-28 JP Miles • AH Gluskin D Chambers • OA Peters Clinical RelevanceCarious pulp exposures present a therapeutic challenge for clinicians. Mineral trioxide aggregate (MTA) is a treatment option that may provide successful outcomes for the capping of carious pulp exposures in adult patients. However, the success measured as pulp survival over a period of one and two years of pulp caps performed by undergraduate dental students may be low. This study provides data regarding the impact of exposure sizes and other pre-operative variables on outcomes of MTA pulp caps in adults. SUMMARYThe current study estimated pulpal vitality after MTA pulp caps were performed by undergraduate student clinicians. At recall after 12 to 27 months, 51 pulp caps were clinically and radiographically assessed. Kaplan-Meier analyses were used to estimate overall success at 12 and 24 months, determined as the presence of a vital pulp, as well as impact of preoperative variables on pulp vitality at recall. Overall, one-year pulp survival was 67.7%, while the two-year survival rate was 56.2%. Tarone-Ware statistics indicated that neither age of the patient nor size of the exposure ("minimal" or "moderate") and the amount of bleeding ("none," "minimal" or "moderate") had a significant effect on survival rates.Within the limitations of the current study on procedures performed by student clinicians, it may be concluded that, for MTA pulp caps applied to carious exposures in adults, certain preoperative conditions-patient age, exposure size and amount of bleeding-are not predictive of clinical outcome. Considering the comparatively low success rate for the current cohort, more research is needed to define predictive criteria for successful pulp capping with MTA.

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Background Current medical society guidelines recommend a procedural number for obtaining electromagnetic navigational bronchoscopy (ENB) competency and for institutional volume for training. Objective To assess learning curves and estimate the number of ENB procedures for interventional pulmonology (IP) fellows to reach competency. Methods We conducted a prospective multicenter study of IP fellows in the United States learning ENB. A tool previously validated in a similar population was used to assess IP fellows by their local faculty and two blinded independent reviewers using virtual recording of the procedure. Competency was determined by performing three consecutive procedures with a competency score on the assessment tool. Procedural time, faculty global rating scale, and periprocedural complications were also recorded. Results A total of 184 ENB procedures were available for review with assessment of 26 IP fellows at 16 medical centers. There was a high correlation between the two blinded independent observers (rho = 0.8776). There was substantial agreement for determination of procedural competency between the faculty assessment and blinded reviewers (kappa = 0.7074; confidence interval, 0.5667–0.8482). The number of procedures for reaching competency for ENB bronchoscopy was determined (median, 4; mean, 5; standard deviation, 3.83). There was a wide variation in the number of procedures to reach competency, ranging from 2 to 15 procedures. There were six periprocedural complications reported, four (one pneumomediastinum, three pneumothorax) of which occurred before reaching competence and two pneumothoraces after achieving competence. Conclusion There is a wide variation in acquiring competency for ENB among IP fellows. Virtual competency assessment has a potential role but needs further studies.

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