Clinical Study of Antimicrobial Efficacy of Laser Ablation Therapy with Indocyanine Green in Root Canal Treatment.

INTRODUCTION: Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment. METHODS: Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05). RESULTS: There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05). CONCLUSIONS: LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Avulsion of permanent teeth: theory to practice.

This paper presents clinical protocols for the emergency, early and post treatment complications of the avulsed tooth. The biological basis for these protocols is presented so that the reader understands the clinical decisions that have been made. Most of the protocols described in this article, but not all, have been adopted in the official guidelines of the International Association of Dental Traumatology. Some experimental results are promising and they have therefore been included in the review to stimulate colleagues to further research.

Permanent tooth replantation following avulsion: using a decision tree to achieve the best outcome.

An avulsion injury is a challenge to manage and there are many treatment options to consider to obtain the best prognosis depending on the avulsion scenario. In 2001, Lee et al published decision analysis paradigms for the management of avulsed permanent teeth to provide busy clinicians with user-friendly, referenced-based flowcharts to facilitate the best possible outcomes for managing these teeth in children and adolescents. The flowchart was updated in 2007 by McIntyre et al. The purpose of this paper is to update the 2001 and 2007 flowcharts and decision analyses with current concepts, recent literature-based findings, new treatment philosophies, and expert consensus from the 2008 AAPD Dental Trauma Symposium.

Microbial control: the first stage of root canal treatment.

The critical step for successful treatment of an infected root canal system is to treat the root canal in such a way as to remove as many microbes as possible (in the case of a necrotic tooth) or to maintain the sterility of the canal (in the case of a vital tooth); this is called the microbial control phase of root canal treatment. This article describes the steps required for adequate microbial control. The rationale for minimal apical file sizes and irrigation and antimicrobial medicaments required are described in detail.

Effectiveness of dental trauma education for elementary school staff.

The purpose of this study was to assess the knowledge of elementary school staff members regarding the management of traumatic dental injuries (TDI) before and after an educational intervention aimed to increase TDI knowledge. Using a newly developed reliable survey instrument, we tested our elementary school staff participants about TDI before (time(0)), immediately after (time(1)), and three months after (time(2)) the intervention. Schools were randomized into three groups: no intervention/control (C), pamphlets (P), and pamphlets + lecture (P + L). Outcomes of interest were TDI knowledge over time relative to the interventions vs controls. Statistical analysis involved a repeated measures linear model. At time(0), TDI knowledge was low among all three groups. At time(1), knowledge increased among all groups and is given by P > P+L > C. For time(2) vs time(1), the P + L group retained the knowledge while in both the C and P groups the knowledge level decreased. Between time(1) and time(2), significant differences were found between both intervention groups when compared with the control (P vs C and P + L vs C: both P < 0.05). In summary, both P and P + L groups significantly improved TDI knowledge among elementary school staff, and this difference held up over time. These interventions have the potential to improve TDI management by elementary school staff when faced with such injuries.

Elementary school staff knowledge about dental injuries.

Elementary school staff can play a crucial role in managing traumatic dental injuries (TDIs) because they are often in proximity to children and are frequently called upon to assist with children's accidents. International studies reveal that elementary school personnel have little knowledge about emergency dental care and management. The purpose of this study was to assess the knowledge, practice and experience regarding TDIs among a sample of elementary school personnel in the USA. Assessment was performed using a demographic questionnaire and a newly developed TDI survey instrument. Results revealed a wide distribution of responses. Overall, dental trauma knowledge among this group was poor. The majority of respondents were not well-versed regarding TDIs, their management, the benefits of timely care or treatment costs. However, staff reported a keen interest in receiving more TDI information and training. TDI education and management are needed among all elementary school staff members to improve the prognosis of these accidents when they occur.

Root fractures in children and adolescents: diagnostic considerations.

The objectives of this study were to (i) characterize epidemiologic trends in anterior permanent tooth trauma in a sample of children and adolescents (ii) examine the relationship of crown fractures (CF) and concomitant root fractures (RF) to determine if CFs are protective against RFs and (iii) examine the radiographic evidence of RFs to determine the value of obtaining three vertical periapical radiographic projections. This was an 8-year cross-sectional study of patients aged 6-18 with anterior permanent tooth trauma. We examined cases involving maxillary central/lateral incisors for which three clearly diagnostic periapical radiographs were obtained during the initial emergency visit. Two trained and calibrated dentists served as expert examiners for the radiographic assessments. Kappa statistics were used to determine reliability. Tests for association of concomitant crown and root fractures were performed using Likelihood Ratio Chi-Square tests. The final sample included 185 teeth in 114 children. Our demographic and epidemiologic findings were comparable to those of previous studies. Experts reached this consensus: 22 RFs were detected, 9.6% (eight out of 83) teeth exhibited root fractures when no CFs was documented, and 13.7% (14 out of 102) teeth had both CFs and RFs as separate entities. Good examiner reliability was reached confirming the presence of RFs (Kappa = 0.81). The association of concomitant RFs and CFs was odds ratio = 1.97 (P = 0.052). CFs were not protective against RFs; indeed, teeth with CFs were twice as likely to have an RF as those without CFs. As the number of radiographic projections increased, RFs were identified more often; however, our data suggest that there is no reason to suspect a complete RF in preteen children unless the root exhibits clinical signs such as luxation or severe mobility. This study provides solid evidence to support obtaining multiple radiographic projections at different vertical angulations to rule out RFs in children and adolescents when RFs are suspected.

Regenerative potential of dental pulp.

The regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. However, our improved understanding of pulpal inflammation and repair and improved dental materials and technologies make vital pulp therapy a viable alternative to root canal treatment. This article explores our knowledge in this regard and the future potential of saving or even regenerating the pulp as a routine dental procedure.

Pulp revascularization of immature dog teeth with apical periodontitis.

This study examined the ability of a collagen solution to aid revascularization of necrotic-infected root canals in immature dog teeth. Sixty immature teeth from 6 dogs were infected, disinfected, and randomized into experimental groups: 1: no further treatment; 2: blood in canal; 3: collagen solution in canal, 4: collagen solution + blood, and 5: negative controls (left for natural development). Uncorrected chi-square analysis of radiographic results showed no statistical differences (p >or= 0.05) between experimental groups regarding healing of radiolucencies but a borderline statistical difference (p = 0.058) for group 1 versus group 4 for radicular thickening. Group 2 showed significantly more apical closure than group 1 (p = 0.03) and a borderline statistical difference (p = 0.051) for group 3 versus group 1. Uncorrected chi-square analysis revealed that there were no statistical differences between experimental groups for histological results. However, some roots in each of groups 1 to 4 (previously infected) showed positive histologic outcomes (thickened walls in 43.9%, apical closure in 54.9%, and new luminal tissue in 29.3%). Revascularization of disinfected immature dog root canal systems is possible.

Clinical efficiency of 2% chlorhexidine gel in reducing intracanal bacteria.

This study evaluated the clinical efficacy of 2% chlorhexidine (CHX) gel on intracanal bacteria reduction during root canal instrumentation. The additional antibacterial effect of an intracanal dressing (Ca[OH](2) mixed with 2% CHX gel) was also assessed. Forty-three patients with apical periodontitis were recruited. Four patients with irreversible pulpitis were included as negative controls. Teeth were instrumented using rotary instruments and 2% CHX gel as the disinfectant. Bacterial samples were taken upon access (S1), after instrumentation (S2), and after 2 weeks of intracanal dressing (S3). Anaerobic culture was performed. Four samples showed no bacteria growth at S1, which were excluded from further analysis. Of the samples cultured positively at S1, 10.3% (4/39) and 8.3% (4/36) sampled bacteria at S2 and S3, respectively. A significant difference in the percentage of positive culture between S1 and S2 (p < 0.001) but not between S2 and S3 (p = 0.692) was found. These results suggest that 2% CHX gel is an effective root canal disinfectant and additional intracanal dressing did not significantly improve the bacteria reduction on the sampled root canals.

Clinical outcome of teeth treated endodontically with a nonstandardized protocol and root filled with resilon.

The purpose of this study was to evaluate the clinical outcomes of root canal treatment in private practice and filled with Resilon. Immediate postoperative radiographs were compared to follow-up radiographs of at least 1 year in 82 randomly selected primary endodontic cases treated according to a nonstandardized protocol but root-filled with Resilon. The Periapical Index (PAI) and the Clinical Impression of Healing (CIH) quantification procedures were used to determine the status and change in the condition of the teeth. The PAI evaluation revealed that 90% of the teeth that were healthy at the initial reading (PAI, 1or 2) maintained the condition at follow-up evaluation. Of those teeth that were unhealthy (PAI, 3-5) at the initial reading, 73.3% were judged healthy (50%) or improved (23.3) at the last evaluation. In contrast, the proportion of healthy or healing with the CIH evaluation was 89.4%. The findings of this study support the contention that regardless of treatment protocol, healing rates for Resilon-filled teeth in private practice were within the range of success rates for studies with uniform treatment techniques mostly in university settings with gutta-percha root filling.

Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature.

The purpose of this report was to present the case of a patient wherein revascularization of the necrotic infected pulp space of an immature permanent maxillary central incisor tooth was induced in vivo by stimulation of a blood clot from the periapical tissues into the canal space. This was achieved after disinfection of the canal space with a topical antibiotic paste followed by a blood clot scaffold induced from the periapical tissues. This treatment approach offers clinicians great potential to avoid the need for traditional apexification with calcium hydroxide or the need to achieve an artificial apical barrier with mineral trioxide aggregate. Furthermore, this treatment approach can help rescue infected immature teeth by physiologically strengthening the root walls.

Management of avulsed permanent incisors: a comprehensive update.

An avulsion injury is a challenge to manage, and there are many factors to consider to obtain the best prognosis in each scenario. In 2001, Lee and colleagues published decision analysis paradigms for the management of avulsed permanent teeth for the purpose of providing busy clinicians with user-friendly, reference-based flow-charts to facilitate the best possible outcomes for managing these teeth in children and adolescents. The purpose of this article was to update the 2001 flow-charts and decision analyses with: (1) current concepts; (2) recent literature-based findings; and (3) new philosophies.

Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of Permanent Teeth.

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate orurgent care of avulsed permanent teeth.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Detection and quantitation of E. faecalis by real-time PCR (qPCR), reverse transcription-PCR (RT-PCR), and cultivation during endodontic treatment.

Enterococcus faecalis is frequently recovered from refractory endodontic infections and has been implicated in endodontic treatment failures. This study compared real-time quantitative PCR (qPCR) assay to cultivation for E. faecalis detection and quantitation during endodontic treatment. A reverse-transcription PCR (RT-PCR) assay was also developed to detect the bacterium clinically in the viable but nonculturable (VBNC) state. Intra-canal samples (n = 87) were collected upon access, post-instrumentation/irrigation and postcalcium hydroxide treatment from 15 primary and 14 refractory infections involving 29 single-rooted teeth, and analyzed by the three methods. The bacterium was up to three times more prevalent in refractory than primary infections at each collection step. Overall, qPCR detected significantly more E. faecalis-positive teeth and samples than cultivation (p < 0.001). VBNC E. faecalis was detected by RT-PCR in four samples that were negative by cultivation. These findings support qPCR and RT-PCR as more sensitive methods than cultivation for detecting E. faecalis in endodontic infections.