International questionnaire study on systemic antibiotics in endodontics. Part 1. Prescribing practices for endodontic diagnoses and clinical scenarios.

OBJECTIVES: Part 1 of this two-part study aims to investigate systemic antibiotics (SA) prescribing practices for various endodontic diagnoses and clinical scenarios by general practitioners, post-graduate students and endodontists in Israel and the former Soviet Union (FSU) states. MATERIALS AND METHODS: A total of 7500 dentists from Israel and FSU states were invited to fill in an online questionnaire. The questionnaire consisted the SA prescribing for endodontic diagnoses and clinical scenarios (post operative pain, post apical surgery and post avulsion). The international guidelines of the European Society of Endodontology and the American Association of Endodontists were used as the standard of correct practice. RESULTS: A total of 1310 dentists (response rate of 17.46%, 498 Israeli and 812 FSU dentists) completed the survey. The rates of prescription SA among the Israeli and the FSU respondents for non-recommended diagnoses and clinical scenarios were 24.75% and 11.42% (P>0.05), 16.57% and 16.17% (P>0.05) respectively. The rates of prescription SA among the Israeli and the FSU respondents for recommended diagnoses and clinical scenarios were 63.39% and 62.9% (P>0.05), 27.2% and 13.9% (P>0.05) respectively. CONCLUSIONS: There are gaps between the recommended protocols for prescribing SA for patients with various endodontic diagnoses and clinical scenarios and the actual practices among Israeli and FSU dentists. Continuing education of dentists must be encouraged in order to improve SA prescription practice according to international guidelines. CLINICAL RELEVANCE: When not indicated, prescription of systemic antibiotics might lead to antimicrobial resistance, while non-prescription, when required, might have negative repercussions on the patient's health. Knowledge of the prescription habits of dentists in the endodontic practice will help prevent harmful situations.

Systemic antibiotics in endodontics-International questionnaire study: Choice of types, dosage, loading and duration.

The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.

Endoscopic approach to dental implantology.

OBJECTIVE: To describe an innovative miniature visualization surgical endoscope and endoscopic techniques applicable to dental implant procedures. MATERIALS AND METHODS: A newly developed modular dental implant endoscope is introduced, and the first impressions from its use in different implant procedures are reported. RESULTS: Details of the device that combines an endoscope, irrigation cannulas, and a surgical microinstrument channel are presented. The advantages of using it in dental implant procedures are described, and examples of how miniature visualization and surgical endoscopic techniques can be applied to increase the success of implantation are outlined. The new modular implant endoscope accurately identified all microanatomical and pathological structures, and simplified dental implant procedures. CONCLUSION: Endoscopy should be considered not only for intraoperative observation and assessment of implant sites, but also should be applied for active assistance during implant placement procedures.

Endoscopy in endodontics.

A successful outcome of endodontic treatment depends to a large extent on accurate intraoperative findings. Conventionally, micromirrors and microprobes have been used for this purpose. The dental operating microscope (DOM) has been implemented to enhance visibility during dental procedures. However, the microscope, a sizable tool, remains between operating field and the dental practitioner, making his ability to manipulate more complicated. Also, the interference of the hands and the handpiece with the visualization of the surgical field and inaccurate observation of the endodontic instruments during the procedure. Endoscopy reportedly provides the dentist with excellent vision and ease of use. It also provides a better intraoperative visualization in comparison with micromirrors. Further development of endoscopy made it possible to combine magnification, light, irrigation/suction and surgical microinstruments in one device. This combination could lead to an advanced root canal treatment technique.

Replantation of an immature permanent central incisor following pre-eruptive traumatic avulsion.

Tooth avulsion represents 0.5-16% of traumatic injuries. Avulsion of a pre-eruptive left permanent maxillary incisor in a 6-year-old boy is presented. The immature tooth was replanted after rinsing with saline following 10 min dry extra-oral time. This case report describes treatment and a 2-year follow-up of the tooth. During the follow-up period, continuation of root development, pulp revascularization, and irregular dentin formation were demonstrated. The tooth is vital, functional, and esthetic. To the best of our knowledge, no such case of replantation of a pre-eruptive tooth has been reported previously.

Rapidly progressive internal root resorption: a case report.

The etiology of internal root resorption is not fully understandable, trauma and chronic pulpitis are considered the main risk factors. Usually the process is asymptomatic and diagnosed upon routine radiographic examination. This case report presents a rapid progression of internal resorption related directly to traumatic injury. A 16-year-old female arrived at the emergency room after a mild extrusion of the mandibular incisors. The initial treatment included repositioning and splinting of the teeth. Radiographs performed at repositioning and splinting demonstrated normal configuration of the incisor's roots. Ten months later progressive internal resorption of the left mandibular first incisor was diagnosed. While treating this tooth similar process was detected in the right mandibular second incisor and in the mandibular left second incisor. The lower right first incisor reacted inconsistently to vitality test. As a result of the severe and rapidly progressive nature of the process, root canal treatments were performed in all lower incisors. The follow-up radiographs demonstrate arrest of the internal resorption process.

The effect of CO2 Laser on the permeability of dentinal tubules: a preliminary in vitro study.

OBJECTIVES: The purpose of this in vitro study was to determine whether there is a change in dentin permeability following 9.6-microm CO(2) laser irradiation and high-speed drilling. MATERIALS AND METHODS: Twenty permanent, intact, non-carious molars were selected. The crowns were separated from the roots at the cemento-enamel junction. The teeth were randomly divided into two groups, control and experimental, each containing 10 teeth. After class I preparation using a high-speed drill, 9.6-microm CO(2) laser irradiation was applied to dentinal areas only on the experimental group. The samples were soaked in 0.5% methylene blue for 48 h; three independent examiners using scanning electron microscopy evaluated dye penetration through the specimens. RESULTS: The results of the three examiners were similar. There was a significant difference in dye penetration into dentin after laser irradiation versus controls (p < 0.05). CONCLUSIONS: The 9.6-microm CO(2) laser appears to be a promising tool in the clinical setting. However, further investigation is needed to ensure maximum effectiveness.

The effect of CO(2) laser on the microhardness of human dental hard tissues compared with that of the high-speed drill.

OBJECTIVE: The purpose of this study was to examine the effect of 9.6-microm CO(2) laser energy on the microhardness of human dental hard tissues compared with that of high-speed drill cavity preparation, and to determine the applicability of this laser in clinical treatment. MATERIALS AND METHODS: A total of 10 caries-free human single-rooted teeth were used for this study. The crowns were resected and the roots were longitudinally sectioned into two halves. In each slice one half of the enamel and the dentin were treated with 9.6-microm CO(2) laser irradiation, and in the other half the enamel and dentin were treated with a high speed drill, each half for 3 s. Following treatment, the samples were polished and tested for microhardness. The results were compared using analysis of variance. RESULTS: Statistically significant differences in dentin microhardness were found between specimens treated with 9.6-microm CO(2) laser energy as compared with specimens treated with the high-speed drill (p = 0.0156). There were no statistically significant differences in enamel microhardness between specimens treated with 9.6-microm CO(2) laser energy and specimens treated with the high-speed drill. CONCLUSION: The clinical use of 9.6-microm CO(2) laser energy for cavity preparation should be further analyzed, and compared with different types of lasers used in dentistry, such as 10.6-microm CO(2) or Er-YAG.

Retrieval of amalgam from the root canal space.

Removal of foreign objects from the root canal can be very frustrating. The use of a variety of instruments and techniques has been suggested for the retrieval of obstacles from root canals during endodontic treatment. This article describes a method for retrieving a large mass of amalgam restoration that was wedged into the root canal. The amalgam, which had served as the provisional restorative material during apexification of an immature ante rior tooth, was inadvertently pushed into the root canal. After the mass was bypassed, the amalgam was loosened with the aid of copious irrigation, chelation, and flotation. Hedstrom files twisted around the object allowed sufficient grip for its retrieval, enabling completion of the root canal treatment.

Evaluation of Time to Fracture and Vertical Forces Applied by a Novel Gentlefile System for Root Canal Preparation in Simulated Root Canals.

INTRODUCTION: A great number of studies performed in the last 3 decades have shown the superior mechanical features of nickel-titanium files as compared with stainless steel files. A novel file system recently developed, Gentlefile, defies these findings and claims to have superior qualities despite the fact it is made from stainless steel. METHODS: Three file systems were used in this experiment: ProTaper Next (X1, X2, and X3), RevoS (SC2, SC3, and AS30), and Gentlefile (GF1, GF2, and GF3). Time to fracture, rotations to fracture, and vertical forces applied to a simulated root canal, which was fabricated from a metal block with a Plexiglas cover, were measured. RESULTS: The GF system required significantly longer time and more rotations to fracture compared with the ProTaper and RevoS systems (P < .001). The GF system applied significantly less vertical force to the canal in comparison with the ProTaper and RevoS systems (P < .01). CONCLUSIONS: Under the limitations of this study the GF system showed better mechanical properties in comparison with the ProTaper and RevoS systems. Further investigation is needed to assess the clinical meaning of these findings.

The effect of the distance between post and residual gutta-percha on the clinical outcome of endodontic treatment.

To determine whether the distance between the post and the residual gutta-percha influences the clinical outcome of endodontic treatment, 94 endodontically treated teeth following post and core restoration were evaluated radiographically. The teeth were divided into three groups: (I) no gap between the gutta-percha and the post; (II) a gap of >0 to 2 mm; (III) a gap of >2 mm. Treatment outcome was evaluated in follow-up radiographs, taken 1 yr after treatment and up to 5 yr posttreatment. In group I, 83.3% of the teeth were evaluated normal, 53.6% of group II, and only 29.4% of group III. A gap between the gutta-percha and the post was related to an increased rate of emerged disease in endodontically treated teeth restored with a post and core.

Chemical analysis and surface morphology of enamel and dentin following 9.6mu CO2 laser irradiation versus high speed drilling.

OBJECTIVES: The purpose of the present in vitro study was to determine whether there is a change in the chemical composition and surface morphology of enamel and dentin following 9.6mu CO2 laser irradiation and high-speed drilling. MATERIALS AND METHODS: Ten permanent, non-carious, young premolars, extracted for orthodontic reasons, were selected. The crowns were separated longitudinally into two equal parts at their mesiodistal axis. Two areas on the inner enamel surface of each specimen and two on the dentinal surface were selected. A high-speed drill and 9.6mu CO2 laser irradiation were applied to the selected enamel and dentinal areas. A random area on the unlased enamel and on the unlased dentin of each specimen served as controls. The morphology of the specimens was evaluated using scanning electron microscopy. Calcium, phosphorus and oxygen levels were measured using an energy dispersive spectrometer. RESULTS: Mineral analysis revealed no significant difference in the mineral content of the enamel and dentin after laser irradiation or high speed drilling versus the control. Use of the high-speed drill on enamel and dentin resulted in very clear cavity margins, with characteristic grooves, whereas laser irradiation of enamel and dentin did not produce clear margins and the floor of the cavity displayed an irregular surface. CONCLUSIONS: The 9.6mu CO2 laser appears to be a promising tool in the clinical setting. However, further investigation is indicated to ensure maximum effectiveness.

Lasers in endodontics.

With the rapid development of laser technology, new lasers with a wide range of characteristics are now available and being used in various fields of dentistry. In the past two decades, much experience and knowledge has been gained. This article provides an overview of the current and possible future clinical applications of lasers in endodontics, including their use in alleviating dentinal hypersensitivity, modification of the dentin structure, pulp diagnosis, pulp capping and pulpotomy, cleaning and shaping of the root canal system, and endodontic surgery. Endodontic procedures for which conventional treatments cannot provide comparable results or are less effective are emphasized.

The use of lasers in dentistry: principles of operation and clinical applications.

This article describes the principles of laser operation and the clinical application of laser technology in the different fields of dentistry. It discusses the use of the Er:YAG laser in restorative dentistry, pediatric dentistry, and periodontics, as well as the introduction of a new side-firing spiral tip for efficient cleaning of the root canal system by means of lateral laser irradiation. Although the Er:YAG laser is used mostly on enamel and dentin, the gingival depigmentation procedure using this laser also is described. Clinical applications of the CO2 and diode lasers on soft tissues, particularly in the fields of oral and maxillofacial surgery and perodontics, are explained. Because teeth whitening for esthetic reasons has gained increasing popularity in dentistry, the application of diode lasers for this purpose is discussed. All the dental laser procedures described in this article are conducted at the Hebrew University-Hadassah School of Dental Medicine and are further investigated in various clinical research projects.

Applying extrusive orthodontic force without compromising the obturated canal space.

BACKGROUND: Complicated tooth fractures can be the unfortunate result of orofacial trauma and can offer a therapeutic challenge for the dentist. A conservative solution for gaining supragingival sound tooth structure often includes orthodontic forced eruption. Usually, this procedure is carried out by applying extrusive force after placing a provisional acrylic Richmond crown on the tooth. However, this long-lasting dental treatment may jeopardize the coronal seal of the root canal space, leading to microleakage and endodontic failure. CASE DESCRIPTION: Orthodontic forced eruption demands application of force to an attachment connected to the remaining short clinical crown. In this article, the authors describe a case in which they used a new technique for orthodontic forced eruption of a traumatized tooth, using an extracanal attachment to apply extrusion force, and discuss its possible advantages and limitations. CONCLUSIONS: An extracanal attachment approach for orthodontic forced eruption without compromising the obturated canal space can be a solution for posttraumatic crown fracture. Practical Implications. The described procedure for forced eruption by using an extracanal pin attachment is efficient and convenient and does not require the clinician to apply force directly to the provisional crown. Therefore, during the application of force, there is less risk of loosening the provisional crown, and the canal space is kept intact with either the final restoration or dressing material.

Effect of Er:YAG laser-activated irrigation solution on Enterococcus Faecalis biofilm in an ex-vivo root canal model.

UNLABELLED: Abstract Objective: The purpose of this study was to evaluate mineral content and surface morphology of root canals coated with Enterococcus faecalis biofilm after treatment with several endodontic irrigation solutions, with and without Er:YAG laser-activated irrigation (LAI). BACKGROUND DATA: LAI has been introduced as a powerful method for root canal irrigation resulting in smear-layer removal from the root canal wall. METHODS: Distal and palatal roots from 60 freshly extracted human molars were used in this study. The coronal of each tooth was removed. Roots were split longitudinally and placed in an ultrasonic bath to remove the smear layer, creating conditions for the formation of E. faecalis biofilm. After incubation, the two halves were reassembled in impression material to simulate clinical conditions. Specimens were divided into two main groups: roots rinsed with irrigation solutions and roots subjected to laser irradiation combined with irrigation solutions. Solutions tested were 2% chlorhexidine and 17% ethylenediaminetetraacetic acid (EDTA) and saline. RESULTS: Surface morphology: 17% EDTA irrigant solution combined with Er:YAG laser showed the best results for removing bacteria from the root canal walls. Chemical analysis: all samples treated with combined laser irradiation and irrigation solution had low surface levels of Ca compared with samples treated with irrigation alone. The Ca/P ratio was highest in the laser-EDTA group. Overall, mineral changes caused by laser with irrigation solutions were minimal, and statistically nonsignificant. CONCLUSIONS: In vitro irrigation solutions, combined with Er:YAG laser irradiation, were effective in removing E. faecalis biofilm from root canal walls. Irrigation solutions without laser irradiation were less effective, leaving a layer of biofilm on the dentin surface.

A novel dental implant system with an internal port for endoscopic closed sinus augmentation: a feasibility study in pigs.

PURPOSE: This study describes the use of an innovative dynamic implant valve approach (DIVA) for dental implant placement and sinus augmentation procedures. MATERIALS AND METHODS: The DIVA implant system was tested in vitro for leakage and mechanical fatigue. A closed sinus elevation procedure with a gel-type bone substitute was performed using the DIVA implant in a swine model (n = 6). Implants were placed and evaluated radiographically and histologically. RESULTS: Elevation of the maxillary sinus membrane and augmentation were performed in a simple, minimally invasive fashion. Histologic analyses demonstrated complete sealing of the DIVA implant and excellent osseointegration. CONCLUSION: The DIVA can be used as a simplified viable option for dental implantation and augmentation procedures. Hermetic sealing of this implant system, which features an inner screw, renders it safe.

Is endodontic re-treatment mandatory for every relatively old temporary restoration? A narrative review.

OBJECTIVES AND BACKGROUND: In this review, the authors examine whether there is any decisive evidence to support the revision of root fillings that have been exposed to the oral environment for more than three months, undertaken solely because of suspicions of microleakage. Researchers in numerous endodontic studies have addressed the evaluation of coronal microleakage by using different tracers and techniques. The need to achieve a tight, permanent coronal seal as soon as possible after the completion of endodontic treatment is obvious. However, the clinical importance of microleakage studies recently has been questioned because of their wide range and even contradictory results, and findings from only a few clinical investigations have demonstrated a clear relationship between the endodontic success rate and failure rate owed to coronal microleakage in cases involving high-quality endodontic therapy. METHODS: The authors analyzed commonly cited articles regarding the clinical relevance of microleakage studies and the success rate of teeth with compromised restorations. CONCLUSIONS: In a review of the literature, the authors found no clear evidence to support immediate replacement of well-obturated endodontic treatment that has lasted more than three months solely because of suspicions of microleakage. It may be prudent in such cases to make a new coronal restoration immediately and to observe the tooth for at least three months before placing the permanent crown.