Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial.

AIM: To evaluate three emergency procedures for their ability to alleviate clinical symptoms associated with symptomatic teeth having signs of (at least) partial irreversible pulpitis. METHODOLOGY: Sixty-six maxillary and mandibular molars were randomly assigned to a total pulpectomy group (TP; n = 22), partial pulpectomy group (PP; n = 22) or pulpotomy group (P; n = 22). Procedure durations were recorded. Patients answered a questionnaire on daily analgesic requirements and about clinical symptoms (pain intensity, chewing sensitivity and thermal sensitivity) after the anaesthetic effect had disappeared (Day 0) and on Days 1, 3 and 7 post-treatment. RESULTS: The total pulpectomy group was associated with the longest procedures (median, 24 min), followed by the partial pulpectomy and pulpotomy groups (P < 0.001 for all). In all three groups, pain intensity, thermal sensitivity and chewing sensitivity decreased significantly from the preoperative time-point to Day 7 (P < 0.001 for all). The total pulpectomy group reported greater reductions in pain intensity than the pulpotomy group between Days 0 and 7, Days 1 and 3, and Days 1 and 7 (P < 0.001 for all). No other intergroup differences were noted regarding reductions in pain intensity, and none were observed with respect to changes in prevalence of thermal sensitivity and chewing sensitivity. There were also no significant intergroup differences regarding the analgesic requirements throughout the 7 days. CONCLUSION: As emergency treatments for teeth having signs of irreversible pulpitis, pulpotomy, partial pulpectomy and total pulpectomy were comparable with respect to relieving clinical symptoms. Pulpotomy may be preferred because it requires significantly less time and is a simple technique that relieves symptoms quickly and effectively.

Intentional re-plantation of a vertically fractured tooth repaired with an adhesive resin.

AIM: To present the successful treatment of a vertically fractured tooth by intentional re-plantation after root canal treatment and repair with an adhesive resin. SUMMARY: Vertical root fracture is a challenging problem in respect of diagnosis and management options. In this case, a vertically fractured maxillary premolar was treated by intentional re-plantation after repairing it with 4-Methacryloxyethyl trimellitate anhyride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. At the 36-month follow-up, the tooth was asymptomatic, radiographically sound with reduced deep periodontal pockets and vertical bone loss. KEY LEARNING POINTS: • Intentional replantation after repairing fractured fragments with an adhesive resin extraorally is a treatment option. • Long-term follow-up is necessary to evaluate the outcome of this technique.

A conservative multidisciplinary approach for improved aesthetic results with traumatised anterior teeth.

A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the health of the periodontal tissues. If the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded by orthodontic forced eruption after root canal treatment. Extrusion enables the remaining root portion to be elevated above the epithelial attachment. Endodontic posts may be useful in exerting vertical forces to the root for extrusion without buccal tipping. The following case shows multidisciplinary management of a case of dental trauma. Orthodontic forced eruption is incorporated using endodontic posts and restoration with porcelain fused to metal crowns--leading to successful restoration of the traumatised teeth.

Local anesthetic efficacy for oral surgery: Comparison of diphenhydramine and prilocaine.

OBJECTIVE: Diphenhydramine has been suggested as an alternative local anesthetic agent for patients claiming allergy to local anesthetics. The present study attempted to determine the local anesthetic efficacy of diphenhydramine for oral surgery. STUDY DESIGN: Seventeen patients claiming allergy to local anesthetics were given diphenhydramine as anesthetic alternative and compared with seven nonallergic control patients treated with prilocaine. After determining an average value of vitality score of neighboring and contralateral teeth by electrical pulp stimulation, molar and premolar teeth were extracted and postextraction vitality scores determined. Visual analogue scale, anesthesia onset times, and the incidence of pulpal and soft tissue anesthesia were analyzed nonparametrically by means of Mann-Whitney U tests. RESULTS: The mean onset time of pulp anesthesia with diphenhydramine (range, 4 to 7.5 minutes), excluding one failure, was not significantly different from that of prilocaine; (range, 4 to 13 minutes). The duration of anesthesia was significantly longer and the visual analogue scale lower in the group receiving prilocaine in comparison with the group receiving diphenhydramine. CONCLUSION: In the small group studied, diphenhydramine administration provided adequate anesthesia before oral surgery; it may be useful as an anesthetic alternative in patients with histories of allergy to local anesthetics.

Frequency of root-filled teeth and prevalence of apical periodontitis in an adult Turkish population.

AIM: To report the frequency and distribution of root-filled teeth as well as the prevalence of apical periodontitis in an adult population in Turkey. SUMMARY: Digital panoramic radiographs of 1000 patients who were examined at the Baskent University Faculty of Dentistry between December 2004 and May 2005 were evaluated. Patients ageing <15 years and those with less than nine remaining teeth were excluded. The coronal and periapical status of all the teeth with the exception of third molars was examined according to the criteria proposed by De Moor et al. (2000). Statistical analysis was performed with the Rao and Scott adjusted chi-square test for the comparison of clustered binary data. In all, 24 433 teeth were examined. A total of 346 teeth (1.4%) had radiographic signs of apical periodontitis, and 812 were root filled (3.3%). Of the 812 root-filled teeth, 148 (18.2%) had apical periodontitis. Of the 23,621 nonroot-filled teeth, 198 (0.8%) had apical periodontitis. The number of root-filled teeth in male subjects was significantly less than that in female subjects (P < 0.001), but the presence of apical periodontitis in male subjects was significantly higher than that in female subjects (P < 0.05). KEY LEARNING POINTS: * The prevalence of apical periodontitis and the frequency of root-filled teeth with apical periodontitis were lower than in comparable populations in other countries. * The number of root-filled teeth was comparable to that found in other epidemiologic studies.

Push-out bond strengths: the Epiphany-Resilon endodontic obturation system compared with different pairings of Epiphany, Resilon, AH Plus and gutta-percha.

AIM: To assess the bond strength of the new resin-based Epiphany-Resilon root canal filling system, and to compare this with bond strengths of different pairings of AH Plus, gutta-percha, Epiphany and Resilon. METHODOLOGY: A total of 65 extracted human single-rooted teeth were used. All teeth were instrumented using a set of ProTaper rotary instruments. Irrigation was performed with 15 mL of 1.25% NaOCl between each instrument and the smear layer was removed during and after instrumentation with 5 mL of 17% EDTA. The canal spaces were filled with different combinations of core and sealer using lateral condensation, as follows: group 1, AH Plus + gutta-percha; group 2, AH Plus + Resilon; group 3, Epiphany + Resilon; group 4, Epiphany + gutta-percha; group 5 (control), gutta-percha only. Cylinders of root dentine 1.13 (0.06)-mm long were prepared from the coronal sections of the 65 teeth. The test specimens were subjected to the push-out test method. After adhesion testing, the remaining sections were examined under a stereomicroscope at x 25 magnification to determine the nature of bond failure. The values of bond strength were analyzed by one-way analysis of variance (ANOVA) and the post hoc Tukey's test, with significance set at P < 0.05. RESULTS: The respective mean push-out test values for groups 1-5 were: 2.000 +/- 0.369, 1.380 +/- 0.154, 1.706 +/- 0.340, 2.857 +/- 0.523 and 0.078 +/- 0.027 MPa. Significant difference (P < 0.001) occurred between the groups. Multiple paired comparisons (Tukey's test) revealed that group 4 (Epiphany + gutta-percha) had significantly (P < 0.001) greater bonding strength than all the other groups; group 1 (AH Plus + gutta-percha) had significantly (P < 0.05) greater bonding strength than group 2 (AH Plus + Resilon); and group 5 (control) had significantly (P < 0.05) lower bonding strength than all the other groups. Inspection of the surfaces revealed the bond failure to be mainly adhesive to dentine for all groups. CONCLUSIONS: The Epiphany-Resilon combination (group 3) was not superior to that of the AH Plus-gutta percha combination (group 1).

In vitro comparison of different types of sodium perborate used for intracoronal bleaching of discoloured teeth.

AIM: To compare the bleaching efficacy of three different types of sodium perborate (SP) commonly used for intracoronal bleaching of discoloured non-vital teeth. METHODOLOGY: Sixty-five extracted human maxillary central incisors with intact crowns were used. Following obturation with gutta-percha and a root canal sealer using a lateral condensation technique, the coronal aspects of the root canal fillings were covered with a 1-mm thick protective base placed to a level 1 mm apical to the labial cemento-enamel junction (CEJ). The teeth were than stained artificially with fresh blood over a period of 18 days. One or other of the bleaching materials (group 1: SP monohydrate + water, group 2: SP trihydrate + water, group 3: SP tetrahydrate + water, group 4: SP monohydrate + hydrogen peroxide (HP), group 5: SP trihydrate + HP, group 6: SP tetrahydrate + HP) were placed in the pulp chamber of the discoloured teeth and sealed with Cavit for 21 days. They were replaced with fresh preparations after 3, 7 and 14 days. The shades of the tooth crowns were evaluated at baseline and at 7, 14 and 21 days. Comparison of tooth shades was completed at each interval and analysed statistically using the chi-squared test. RESULTS: There was no statistically significant difference between the groups at 7, 14, 21 days. Period of bleaching significantly affected the outcome (P < 0.01). No colour changes were noted in the control teeth. CONCLUSION: The data obtained from this study demonstrate that sodium perborate can be used mixed with water rather than with hydrogen peroxide for bleaching discoloured teeth.

Interleukin-1beta and tumour necrosis factor-alpha levels in periapical exudates.

AIM: The aim of this study was to determine IL-1beta and TNF-alpha levels in periapical exudates and to evaluate their relationship with clinical and radiological findings. METHODOLOGY: Periapical exudates were collected from root canals of 35 single-rooted teeth using absorbent paper points. IL-1beta and TNF-alpha levels were determined by enzyme-linked immunosorbent assays. The samples were divided into two groups according to the presence or absence of clinical signs including swelling and/or fistula, pain on palpation and/or percussion, and pus discharge from canals. Periapical exudate samples were divided into two groups according to size of periapical radiolucent area. RESULTS: The mean concentration of IL-1beta (72.79 ng mL-1) in periapical exudates was approximately 12-fold higher than TNF-alpha(6.17 ng mL-1). There was no significant correlation between these cytokines (P > 0.05). IL-1beta levels in canals with larger radiolucent areas (long axis > or =1 cm) were significantly higher than those with small areas (P < 0.05). There was a tendency toward higher levels of IL-1beta in groups with clinical signs, but the differences were not significant (P > 0.05). CONCLUSIONS: Periapical exudate levels of both cytokines failed to reflect periapical disease state.