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Objective

To assess the state of endodontic practices and identify factors influencing the use of modern endodontic techniques among dental practitioners in Croatia.

Materials and Methods

A questionnaire was distributed to all dental offices in Croatia, yielding 819 responses (27% response rate). Data were descriptively analyzed and statistically modeled.

Results

Nearly 74% of endodontic treatments in Croatia are performed by general practitioners (17 teeth per month per practitioner), while endodontic specialists handle the highest number of treatments per specialist (67 teeth per month, representing 15% of total treatments). 56% of respondents use radiography before the procedure "always" or "almost always" with intra-oral periapical radiography being the most commonly used technique. Rubber dams are used "never" to "rarely" by 74% of respondents. Apex-locators are highly prevalent, used "almost always" to "always" by 83% of practitioners. Magnifiers are rarely used, with 63% of respondents reporting they "never" use them. Lasers are never used by 92% of respondents, whereas 59% frequently use engine-driven instrumentation. 76% of respondents "always" or "almost always" determine the working length of the root canal. Sodium hypochlorite is the most common irrigant (88%), and EDTA for smear layer removal is used by 36% of respondents. The cold lateral condensation is the most popular obturation technique (64%). CBCT is unused by 59% of responders, most probably because it is not accessible.

Conclusions

Croatian endodontic practices are comparable to those in countries with similar economic status, but there is substantial potential, particularly among general practitioners, to enhance knowledge and awareness of modern technologies through continuous education. Underused techniques in Croatia include rubber dams, magnifiers, lasers, and CBCT.

Synthesizing a 12-lead electrocardiogram (ECG) from non-standard lead systems is increasingly relevant due to the widespread use of wearable ECG devices. This study investigates the synthesis of a 12-lead ECG using three bipolar leads derived from a 35-electrode multi-lead ECG (MECG) system, with a focus on optimizing electrode placement and transformation accuracy. A dataset comprising recordings from 20 healthy volunteers and 27 cardiac surgery patients was analyzed. The best three-lead combinations were identified using an exhaustive search approach, maximizing the minimum correlation coefficient between synthesized and target leads. Two synthesis approaches were evaluated: a universal approach, using a single transformation matrix for all subjects, and a combined approach, which incorporates personalized transformation matrices. Results indicate that only a small subset of lead combinations yield high-quality ECG synthesis, but sufficient flexibility exists for practical applications. The combined approach significantly outperforms the universal method, achieving higher correlation coefficients, improved STsegment accuracy, and better myocardial ischemia detection performance. These findings demonstrate the feasibility of optimizing lead selection for wearable ECG devices, enhancing diagnostic reliability while maintaining ergonomic and practical considerations.

Objective: to analyze a single-visit endodontic treatment together with root canal detection practices in Croatia and investigate their relationship with reported postoperative pain, medication prescrip-tion, magnifying devices, rubber dam, radiographical checks before the procedure, cone-beam com-puted tomography (CBCT) and engine-driven instrumentation. Materials and Methods: A structured questionnaire was distributed via email to all Croatian dental practitioners, with 819 responses analyzed corresponding to an estimated 27% response rate. Statistical analyses included descriptive analysis and regression modelling. Results: Among Croatian practitioners, 27.9% frequently performed single-visit endodontic treatments. Male practitioners, practitioners with continuing education and ample experience, endodontic specialists, and those working in polyclinics or academic set-tings were more likely to adopt this approach. It correlated positively also with the use of advanced diagnostic and treatment tools (e.g., magnification devices, rubber dam, CBCT) and a reduction in antibiotic prescription. However, it was associated with increased reported analgesic prescription and a larger number of reported vertical tooth fractures. Practitioners reported less frequently using single-visit endodontic treatments for multi-rooted teeth and those with associated sinus tracts or periradicular lesions. Furthermore, practitioners more often performing single-visit endodontic treatment rate themselves better in finding additional canals, which is positively influenced by usage of radiography and magnification devices. In addition, continuing education has a positive effect on the root-finding abilities, but it decreases with years of their clinical experience. Conclusions: Single-vis-it endodontic treatment practice in Croatia is influenced by practitioner education, experience, and access to advanced equipment. While it offers benefits such as reduced antibiotic prescription, clinical attention and further research is needed to address potentially associated complications such as vertical tooth fractures and reliance on analgesics. Root finding abilities are positively influenced by continuing education. These findings underscore the role of education and resources in optimiz-ing endodontic outcomes.

AIM: This study aims to assess the state of endodontic continuing education (ECE) among dental practitioners in Croatia and identify factors influencing participation in such education.

METHODS: A questionnaire was sent to all dental offices in Croatia, yielding 819 responses. The data were analyzed descriptively and statistically modeled.

RESULTS: Most respondents had participated in some form of ECE during their careers. However, in the past 5 years, only about 78% had engaged in such education, with participation decreasing by 2% for each additional year of practice. Male practitioners had significantly less continuing education in the past 5 years, particularly in private clinics, dental clinics with concession contracts, and certain regions. Practitioners who performed more endodontic treatments reported higher levels of continuing education. The endometer was the only modern technique consistently used by about 60% of practitioners with continuing dental education.

CONCLUSION: Continuing education in endodontics should be more strongly promoted among practitioners with longer careers, particularly men.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

Respiratory rates were estimated from single lead ECG measurements, obtained on 30 patients during dental surgery, by using the Toolbox of Respiratory Rate Algorithms, from the Respiratory Rate Estimation (RRest) project. The purpose was to find the best performing among more than 300 algorithms implemented in the toolbox. Since the dataset does not contain a reference respiratory signal, respiratory rate extraction algorithms were compared with respect to the mean respiratory rate calculated from applying all the algorithms. The investigation found one algorithm that estimates respiratory rates within tolerance of ± 2 breaths/min in at least 50% of the recordings' lengths, for 27 of the total 30 measurements. The selected algorithm has not satisfied the criteria on 3 patients, possibly because of the big variation in the shape of the recorded ECGs, but also because the patch ECG device was not in the position where ECG amplitude modulation, caused by respiration, is expected. The selected algorithm is the smart fusion of respiratory rates obtained by peak detection and zero-crossings of respiratory signals, that are calculated from ECG features.

Surgical procedures are accompanied with anxiety and stress for both patients and surgeons. This paper investigates the utility of various heart rate variability parameters, estimated from Savvy patch ECG recordings, obtained on patients during surgical extraction of impacted lower third molars under local anesthesia, to estimate psychological state of the patient, as well as pain levels, in real time. This could be particularly beneficial for patients with chronic conditions, such as cardiovascular diseases, that can deteriorate under psychophysical stress. Statistical analysis showed significant correlation between several heart rate variability parameters and changes in autonomous nervous system functionality. Additionally, there was a significant correlation between several heart rate variability parameters on one side, and patient reported anxiety, pain levels, and the procedure difficulty, on the other.

The online pupillometry-based feedback system is intended as a cognitive training and rehabilitation system developed at Mälardalen University. The purpose of the system is to engage a person in a cognitive computer task whose difficulty is adjusted in real time depending on the person's cognitive load. Previous research has uncovered a significant correlation between cognitive load and pupil dilation, suggesting that electroencephalogram usage for estimating cognitive load can be eliminated. The online pupillometry-based feedback system is measuring the pupil-diameter in real time to classify cognitive load using a neural network. The classification of cognitive load is used to modulate the difficulty level of the cognitive task, with the purpose of challenging the participant and to optimize the cognitive training. At the current state the system is fully integrated, but possesses no fault-tolerant features to produce a long-term reliable service. This paper proposes a fault-tolerant architecture for the online pupillometry-based feedback system, for which internal repairs and failure rates are modeled using continuous-time Markov chains. The results show adequacy of the extended architecture, assuming slightly optimistic failure rates. Even though the system is specific, the reliability approach presented can be applied on other medical devices and systems. 

The first attempts to modeling relationships between electrocardiographic leads, were based on measuring lead vectors by using models of human torso (deterministic approach), and by estimating liner regression models between leads of interest (statistical models). Among the most recent attempts, one of the most prominent is the state-space models approach, because of better noise immunity compared to mean squared error estimated statistical models. This study uses state-space models to synthesize precordial leads and Frank leads, from leads I, II, and V1. The synthesis was evaluated with the linear correlation coefficient (CC) on 200 measurements from the Physionet's PTB diagnostic ECG database. The results show better performance of regression models (mean CC between 0.88 and 0.96) than the state-space models (mean CC between 0.78-0.86). The leads were not pre-aligned for the R-peaks, which can be the main cause for the lower performances of state-space models, as a previous study has also shown. Residual baseline wander (after filtering) was the dominant reason for not obtaining better synthesis results with both methods. 

This study aimed to evaluate cardiac activity changes during lower third molar surgery concerning gender and anxiety levels. Thirty healthy subjects who required lower third molar surgery filled out Norman Corah dental anxiety scale (DAS) before surgery. A patch ECG device (Savvy, Institute ''Jožef Stefan'', Ljubljana, Slovenia) was applied to the patient to evaluate heart rate (HR) and heart rhythm. These parameters were assessed in 8 different intervals. Periods of the highest mean HR values-incision and flap elevation compared to the period with minimal mean HR values-during suturing showed statistical significance difference (p<0.05). The most common outstanding ECG finding was sinus tachycardia, especially in anxious compared to non-anxious patients. Extraction difficulty score was correlated with the procedure duration time and with the abnormal ECG findings in the period of tooth extraction. Significant cardiac activity changes are detected during surgery. Physiological manifestations of anxiety may be evaluated successfully using a patch ECG device. Copyright