Root Canal Filling Quality Comparison of a Premixed Calcium Silicate Endodontic Sealer and Different Carrier-Based Obturation Systems.

BACKGROUND: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in curved root canals filled with Thermafil, GuttaCore, GuttaFusion and lateral compaction with AH Plus and EndoSequence BC sealer, by means of percentage of gutta-percha and sealer filled area. METHODS: 200 curved canals of mandibular molars were divided in five groups (n = 40). Each specimen was evaluated at 3, 6 and 9 mm from the apex. A total of 600 samples were analyzed. Obturation was performed with either Thermafil (TH), GuttaCore (GC), GuttaFusion (GF) or lateral compaction (LC), using AH Plus as sealer. In another group EndoSequence BC sealer (BC) was used. Subgroups (n = 20) were made depending on the use of sonic activation during the placement of the sealer. The percentage of total obturation material was analyzed as an indirect measurement of percentage of voids. RESULTS: GF showed a better performance at the apical level, while GC showed the higher percentage of total obturation at the coronal area. No differences were observed for the activation of sealers in any of the groups. Statistical analysis was performed by using two-way ANOVA. Statistical significance was set at CI: 95% (p < 0.05). CONCLUSIONS: Sonic activation of sealers did not show any benefit to avoid the presence of voids within obturation of curved canals. Following the manufacturer recommendations, we found that TH did not show benefits when applied to curved canals.

Effectiveness of Nd:YAG Laser on the elimination of debris and Smear Layer. A comparative study with two different irrigation solution: EDTA and QMix® in addition to NaOCl.

BACKGROUND: The aim of this study was to evaluate the effectiveness in dentin debris and smear layer removal from root canal walls using EDTA and QMix® alone and also activated with Nd:YAG laser. MATERIAL AND METHODS: 50 single-rooted teeth were instrumented and divided in 5 groups according to irrigation protocol: 17% EDTA, QMix®, Nd:YAG laser alone, and combination of 17% EDTA - Nd:YAG laser and QMix® - Nd:YAG laser. Samples were evaluated using SEM. Statistical analysis was done using Chi-Square Fisher exact test and McNemar test. RESULTS: Dentinal debris analysis showed statistically significant differences when comparing 17% EDTA vs Laser and Laser vs QMix® in combination with Laser at the apical third. The Smear Layer analysis also showed statistically significant differences at the apical third when comparing 17% EDTA vs Laser, QMix® vs QMix® in combination with Laser and Laser vs QMix® in combination with Laser. CONCLUSIONS: 17% EDTA was the most efficient irrigant showing the best results. Laser alone was not effective removing either dentinal debris or smear layer. Key words:Laser, endodontics, Smear Layer.

Relationship of patient complaints and signs to histopathologic diagnosis of pulpal condition.

The correlation between the histopathologic examination of pulp biopsy specimens and patients' complaints and signs was investigated. The sensitivity, specificity and reliability of each complaint and sign, and the characteristics of pain that are associated with treatable and untreatable pulp states is proposed. Pulp specimens were obtained from teeth that required endodontic treatment. Clinical data were recorded to identify each patient's complaints. The pulp specimens were processed and the histopathologic diagnoses were categorised and correlated with the patients' complaints. Of the 240 cases, 100 (41.7%) were diagnosed as atrophic pulp or pulposis; 4 (1.7%) as acute pulpitis; 64 (26.7%) as transitional stage; 56 (23.3%) as chronic pulpitis, and 16 (6.7%) as acute pulpitis superimposed on a chronic pulpitis. Results showed that previous pain (p < 0.05), spontaneous pain (p < 0.01), and prolonged pain on cold stimuli (p < 0.05), were significantly more frequent in the patients with chronic pulpitis compared to those with pulposis or transitional stage. We concluded that clinicians must consider the sensitivity and specificity of patient complaints and signs in order to perform a diagnosis based upon clinical evidence.

Proposal of a "Checklist" for endodontic treatment.

OBJECTIVES: On the basis of the "Surgical Checklist" proposed by the WHO, we propose a new Checklist model adapted to the procedures of endodontic treatment. STUDY DESIGN: The proposed document contains 21 items which are broken down into two groups: those which must be verified before beginning the treatment, and those which must be verified after completing it, but before the patient leaves the dentist's office. RESULTS: The Checklist is an easy-to-use tool that requires little time but provides, order, logic and systematization by taking into account certain basic concepts to increase patient safety. DISCUSSION: We believe that the result is a Checklist that is easy to complete and which ensure the fulfillment of the key points on patient safety in the field of endodontics. Key words:Checklist, endodontics, patient safety, adverse event.

Antibiotic use by members of the Spanish Endodontic Society.

INTRODUCTION: The purpose of this study was to determine the prescribing habits of active members of the Spanish Endodontic Society (AEDE) with regard to antibiotics. METHODS: A one-page questionnaire was sent to the active members of the AEDE. Of the 508 surveys mailed, 158 surveys were returned, and 140 were found to be usable. The overall response rate was 31.1%. The data were analyzed by using descriptive statistics and chi-square tests of independence. RESULTS: The average duration of antibiotic therapy was 6.8 +/- 1.8 days. In patients with no medical allergies, most of the responders (86.1%) selected amoxicillin as the first-choice antibiotic, alone (44.3%) or associated with clavulanate (41.8%); metronidazole-spiramycin and clindamycin were prescribed by 7.6% and 3.7% of the respondents. The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (63.2%) followed by metronidazole-spiramycin (23.7%). For cases of irreversible pulpitis, 40.0% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 52.9% prescribed antibiotics. Almost 21.5% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract. CONCLUSIONS: For the most part, the majority of the members of the AEDE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.

Single-rooted maxillary first molar with a single canal: endodontic retreatment.

This case report presents an unusual root canal system in a maxillary first molar tooth: a single canal in a single root. The endodontic access cavity displayed only 1 canal orifice. This case demonstrated that: 1) clinicians must have adequate knowledge about root canal morphology and its variations; 2) the location and morphology of root canals should be identified radiologically before the root canal treatment; and 3) careful examination of radiographs and the internal anatomy of teeth is essential.