Allergic reaction to the tetracycline component of Ledermix paste: a case report.

AIM: Allergy to materials used during root canal treatment is well recognized in the endodontic literature. However, allergy to Ledermix paste, a compound containing triamcinolone (a corticosteroid) and demeclocycline (a tetracycline antibiotic), has not been reported apart from one very recent case in a Letter to the Editor of a journal. The aim of this report is to describe a proven allergic reaction to tetracycline following the use of Ledermix paste as a root canal medicament. SUMMARY: A 33-year-old female patient undergoing root canal retreatment of her right mandibular second premolar tooth experienced symptoms of type 1 allergy following the placement of an intracanal medicament containing a mixture of Ledermix paste and calcium hydroxide [Ca(OH)2 ]. Signs of the type 1 allergy included urticaria, pruritus all over the body, general malaise and fever. These all subsided after removing and flushing out the Ledermix paste-Ca(OH)2 mixture and redressing the root canal with Ca(OH)2 alone. Allergic scratch tests were performed, and these confirmed that the patient was allergic to tetracycline, one of the components of Ledermix paste.

[Revascularization: a new treatment method in endodontics].

Recently a number of published articles concerning a new treatment method in traumatized young permanent teeth with a wide open apex that have lost vitality, with or without periapical lesions have shown success. This new treatment is entitled "Revascularization" and its aim is to promote root maturation in infected immature teeth with open apices. This procedure stimulates the formation of hard tissue as well as elongation and thickening of the dentinal walls and closure of the root apex. Sometimes the vitality of the teeth is regained. The aim of the present publication is to describe the revascularization technique and to clarify the indications of its use.

Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF).

PURPOSE: Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls. CASE SERIES RESULTS: Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening. CONCLUSION: REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.

Conservative treatment of root perforations using apex locator and thermatic compactor--case study of a new method.

Endodontic perforation, a serious complication in dental practice, is among the most common problems associated with endodontic procedures. Recommended methods of treatment are surgical or conservative using calcium hydroxide paste. A method in which perforations can be obturated immediately after their detection is described. The method utilizes an apex locator for measurement and detection of the perforation and a two-step treatment of thermatic compaction for filling the root canal as well as the perforation. A number of cases with a long follow-up are presented.

Hypersensitivity to sodium hypochlorite.

Sodium hypochlorite (NaOCl), the most commonly used irrigant in endodontics, is known to produce allergic reactions. This fact, however, is rarely mentioned in endodontic texts. Until now, only two cases of adverse reaction describing accidental injection of NaOCl have been reported. In the current study a case is presented in which hypersensitivity to household bleach was proven with skin patch tests. The clinician was warned of the possible health hazard from using NaOCl in this patient by the past medical history. Endodontic therapy was carried out with an irrigant not containing NaOCl after the allergy to NaOCl was verified. Treatment was uneventful. It is suggested that before any endodontic treatment in which sodium hypochlorite is to be used, the patient should be asked about hypersensitivity to household bleaching materials.

Root invagination treatment: a conservative approach in endodontics.

The occurrence of dens invaginatus, a developmental anomaly, is reported to be 0.04 to 10%. Treatment modalities, such as extraction, endodontic surgery, and conventional instrumentation of the defect and/or the pulp canal, have been reported. Most suggested treatment modalities are based on the assumption that the tissue inside the invagination communicates with the pulp tissue. However, histological studies show that depending on the type of invagination, the entrapped tissue is mostly connective tissue which may or may not contain pulp tissue components. In situations where the invaginated tissue is contaminated and yet no communication with the pulp cavity exists, it is possible to instrument and disinfect the invagination without affecting the pulp and sacrificing tooth vitality. Such treatment will be referred to as "root invagination treatment." A case is described where tooth vitality was preserved when only the invagination was treated.

Life and AH26 as sealers in thermatically compacted gutta-percha root canal fillings: leakage to a dye.

Calcium hydroxide-containing root canal sealers may encourage apical obturation by cementum. Hard-setting bases with calcium hydroxide induce calcification, but set too quickly to permit lateral condensation of gutta-percha. Since thermatic compaction requires less time than lateral condensation, the possibility of using this method with Life as a sealer was investigated. Seventy roots were prepared and filled with gutta-percha using the Engine Plugger for thermatic compaction. In one group of 20 Life was used as a sealer. AH26 was used in another group of 20. The remainder served as controls. Leakage was tested by linear penetration of Procion B Blue dye measured after clearing the teeth. In the Life group the mean dye penetration was 0.575 mm versus 1.025 mm in AH26, but the difference was not statistically significant. The results indicated that Life could be used in thermatic compaction of gutta-percha and that it provided a seal comparable to that obtained with AH26.

Determination of location of root perforations by electronic apex locators.

OBJECTIVES: This study was conducted to evaluate the accuracy of two electronic apex locators, the Sono Explorer Mark 2 Junior (Hakusui, Osaka, Japan) and Apit 2 (Osada, Tokyo, Japan) in detecting root perforations. The adequacy of radiographs for identifying root perforations was also assessed. STUDY DESIGN: Thirty-two extracted human teeth were perforated in the middle third of the root and embedded in alginate. Determination of all perforations were carried out with K-files no. 25 attached to the apex locators tested. Two radiographs were taken at two angulations after each electronic measurement. The actual location of the file tip in relation to the perforation was determined with a stereomicroscope. A total of 512 radiographs were evaluated to attempt to identify root perforations. RESULTS: The mean distance of the file tip from the external outline of the root surface was short for both instruments. A statistical difference (p < 0.05) was found between the two apex locators in dry canals or if saline solution was present. There was no significant difference between the two instruments in the presence of sodium hypochlorite. Evaluators radiographically identified 45% of the root perforations when located in buccal-lingual directions. CONCLUSION: Under the in vitro conditions of this study, both devices determined the location of the perforations in an acceptable clinical range short of the root surface. Radiographs were found to be less reliable in identification of perforation locations.

The use of dequalinium acetate as a disinfectant and chemotherapeutic agent in endodontics.

Dequalinium compounds are known as chemotherapeutic and bactericidal agents. They are used in various areas of medicine and oral medicine for combating cases of mixed infections. Until now, results of basic research studies have been published whose objective was to examine the suitability of dequalinium preparations as cleansing agents and intracanal dressings for endodontic use. This article presents for the first time a number of selected cases from a clinical research study in which widespread periapical lesions revealed before the start of treatment were treated with a preparation whose active ingredient was dequalinium acetate. The results of treatment and follow-up are given. These case reports show that healing of the periapical lesions occurs relatively quickly and is generally completed within a period of 9 months.

Intentional replantation of a maxillary molar. A 4-year follow-up.

A 4-year follow-up of a case treated by intentional replantation has been presented. A maxillary molar with a metal core was diagnosed as having acute apical periodontitis, endodontic treatment was determined to be impractical, and the tooth was extracted. Three roots canals which could not be detected roentgenologically were discovered and, after apicoectomy and reversed amalgam filling, the tooth was replanted in its socket. The follow-up reveals periapical repair with no signs of root resorption or ankylosis.

An enigmatic sinus tract origin.

Diagnosis of the origin of a sinus tract is very complex. In this case report, a sinus tract stoma appeared above the left maxillary incisor, but the causative tooth was the right maxillary incisor. Incorrect diagnosis led to endodontic treatment of a healthy tooth followed by apicoectomy, which was also ineffective. An endodontic consultation revealed the true origin of the sinus tract. Five days after completing conservative endodontic treatment of the right maxillary incisor, the sinus tract disappeared. This case confirms the need to include a diagnostic tracing radiograph as part of routine diagnostic procedures.

Quantitative evaluation of the influence of dequalinium acetate and sodium hypochlorite on human dentition.

The effect of 5 percent DA, 2.5 percent and 5.5 percent sodium hypochlorite, and saline on the solubility of organic matrix of the dentin was studied on extracted human teeth. The results showed that sodium hypochlorite dissolved collagen from the canal walls, while DA did not dissolve any collagen into the media. It is concluded that the root-canal-cleansing effect of DA is achieved by another mechanism, most likely by surface activity.

Comparative study of the configuration and the cleanliness level of root canals prepared with the aid of sodium hypochlorite and bis-dequalinium-acetate solutions.

Bis-dequalinium acetate (BDA), a quaternary ammonium compound, was introduced as a bactericidal and chemotherapeutic agent for endodontic use. This study was undertaken to compare the efficacy of this compound to 5.25% sodium hypochlorite in the cleansing and shaping of root canals. One hundred twenty freshly extracted teeth were divided into three groups. Each group was treated with the aid of the test material; saline solution was used as a control. After completion of the endodontic preparation, a silicone imprint of the canals was performed and the teeth were decalcified. The imprints were examined three-dimensionally to determine the amount of debris and canal configuration due to defective preparation and anatomic variation. No significant difference could be observed between the tested materials with respect to cleanliness and the shape of the canals. At the apical third, however, the BDA-treated canals showed more favorable results with respect to cleanliness. On the basis of the present and previous findings, it was concluded that BDA might be a favorable replacement for sodium hypochlorite as an irrigation solution.

The microbiologic approach in endodontics.

The results of an investigation of the microbiologic flora of gangrenous teeth are presented. The rationale of the concept of the microbiologic approach is discussed. A possible explanation for the small differences in the success of endodontically treated teeth obturated after positive and negative bacteriologic cultures is suggested.

Tooth length determination: a review.

Tooth length determination is a crucial step in endodontic treatment. Until the late 1970s, tooth length determination was based mainly on radiographic interpretation. The advent of apex locators, which identify the difference in the electrical resistance between the root canal and the periodontal membrane, ushered in a new era for measuring tooth length. However, the accuracy of these devices has been questioned. Pertinent literature is discussed with the aim of providing information on the development of the concept, techniques, and devices for tooth length determination.