Endodontic prognosis assessment.

There are several variables which must be considered before initiating endodontic treatment, including assessing the feasibility of endodontic treatment, addressing past, present and future periodontal concerns, determining the restorability of the tooth, and detecting root fractures. If these parameters are not carefully evaluated, then short- or long-term endodontic success may be questionable. Endodontic prognosis assessment is often subjective, based on objective finding, but ultimately determined by the experience of the operator. Although dentists must rely upon evidence-based research to determine the best modality of treatment, good clinical judgment and experience may override the most objective findings. This article discusses the objective and subjective criteria which must be evaluated for determining the potential prognosis of endodontic treatment.

Risk management in clinical practice. Part 4. Endodontics.

Endodontic procedures are challenging and technically demanding. In the UK standards of treatment have been shown to have fallen short of acceptable guidelines, laying many dentists open to litigation on questions of clinical negligence by patients who understand and know what should be considered as current best practice in this area. Failure to communicate with patients about the procedure and not obtaining consent for treatment is a key area of complaint, as is inadequate record keeping. When treatment is undertaken within the framework of accepted guidelines it would be very difficult for a patient to open a claim for clinical negligence should a failure occur. This article looks at potential dento-legal problems in endodontics and how, through compliance with best practice, they may be avoided.

DIAGNOdent laser fluorescence assessment of endodontic infection.

INTRODUCTION: Real-time assessment of the microbial status of the root canal system would be useful in clinical endodontic practice for determining endpoints of biomechanical treatment. This laboratory study used an existing laser fluorescence device, the DIAGNOdent (KaVo, Biberach, Germany), in a proof-of-concept study. METHODS: Visible laser red light (wavelength 655 nm) was used to elicit fluorescence emissions in the near-infrared range from infected and uninfected root canals. A prototype sapphire tip designed for periodontal assessment was used to analyze the pulp chamber and coronal third of the root canal system in extracted teeth. The fluorescence properties of bacterial cultures, monospecies biofilms in root canals, pulpal soft tissues, and sound dentin were also evaluated, together with 50 extracted teeth with known endodontic pathology. RESULTS: Sound dentin and healthy pulpal soft tissue gave an average fluorescence reading of 5 (on a scale of 100), whereas biofilms of Enterococcus faecalis and Streptococcus mutans established in root canals showed a progressive increase in fluorescence over time. Fluorescence readings reduced to the "healthy" threshold reading of 5 when root canals were endodontically treated, and the experimentally created bacterial biofilms were removed completely. High fluorescence readings were recorded in the root canals and pulp chambers of extracted teeth with radiographic evidence of periapical pathology and scanning electron microscopy evidence of bacterial infection. CONCLUSIONS: The use of the DIAGNOdent fluorescence approach for the assessment of the status of the pulp chamber and root canal system holds promise for clinical application; once more, flexible tips can be developed for gaining greater penetration into middle and apical thirds of the root canal.

Assessment of pulp vitality: a review.

BACKGROUND: One of the greatest diagnostic challenges in clinical practice is the accurate assessment of pulp status. This may be further complicated in paediatric dentistry where the practitioner is faced with a developing dentition, traumatized teeth, or young children who have a limited ability to recall a pain history for the tooth in question. A variety of pulp testing approaches exist, and there may be confusion as to their validity or appropriateness in different clinical situations. AIM: The aim of this paper is to provide the clinician with a comprehensive review of current pulp testing methods. A key objective is to highlight the difference between sensitivity testing and vitality testing. A biological basis for pulp testing is also provided to allow greater insight into the interpretation of pulp testing results. The rationale for, and methods of, assessing pulpal blood flow are described.

Endodontic considerations in the geriatric patient.

Endodontic needs of today's and tomorrow's growing older adult population present increasing challenges for dental care providers. Biologic and anatomic differences in the dental tissues between older and younger patients must be understood and considered in treatment planning and performance for appropriate endodontic procedures. These differences generally do not contraindicate treatment, which, when performed correctly, will be successful in the elderly patient.

A treatment need index: a pilot study.

The traditional caries index, DMF, provides inadequate information to assess dental treatment needs of a community. Dental health planners are often called upon to estimate the treatment needs, costs, time and personnel required for a proposed programme. A treatment needs index (TNI) is presented which provides important data for dental health planning. The index defines seven basic levels of treatment: (0) no treatment needed; (1) preventive treatment; (2) fissure sealants; (3) initial conservative restorations; (4) moderate conservative restorations; (5) advanced conservative restorations; and (6) radical treatment, including pulp therapy, prosthetic restorations and extractions. A pilot study and an example comparing data of both DMF and TNI demonstrates the values of the latter index. The Treatment Needs Index provides a more accurate description of caries severity and extent than does the traditional DMF index, and can be used to estimate the time required to treat a community.

The assessment of pulpal vitality.

This is a review of methods of assessing dental pulp vitality in order to assist the clinician in diagnosis and treatment planning. It covers the patient's history, clinical examination, assessment of radiographs, thermal tests, electrical tests, test cavities, use of anaesthesia, and the recent application of laser Doppler flowmetry.

Long term clinical assessment of direct pulp capping.

Appropriate definitions, history and success rates of direct pulp capping procedures are reviewed. Two of the disadvantages of this form of treatment are infection of the pulp, either preoperatively or postoperatively due to a non-sterile procedure or bacterial leakage at the capping site. Past results of directly capping potential inflamed pulps have been unsatisfactory, but now an increasing number of endodontists advocate capping when conditions are favourable. Direct capping should only be used on vital pulp which has been accidentally injured and shows no other symptoms. Direct capping with calcium hydroxide should not be used on pulp which has been exposed as a result of penetrating caries. Clinical studies 2338 cases have shown that the risk of failure is increased if the pulp is diseased before capping, but that the age of the tooth does not have an adverse effect. It also appears that capping performed by skilled practitioners is more successful than that performed by students. The results of a re-examination of 110 patients, a minimum of 4 years after they had received direct capping treatment from students, showed a success rate of 80 per cent. In skilled hands, the success rate for direct capping with calcium hydroxide is now 90 per cent provided that a hermetic seal is obtained.