Expert consensus on difficulty assessment of endodontic therapy.

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Regenerative endodontic therapy for external inflammatory lateral resorption following traumatic dental injuries: Evidence assessment of best practices.

BACKGROUND: External inflammatory lateral resorption (EILR) following dental trauma is a severe complication that can lead to significant root loss and tooth extraction. OBJECTIVE: The aim of this project was to review current evidence in the literature on regenerative endodontic therapy (RET) for EILR following traumatic injuries and assess the best treatment practices. METHODS: Publications appearing in PubMed, from January 1, 2001 to January 9, 2022 were studied. Inclusion criteria were: (a) Publications in English; (b) Publications on RET and EILR; (c) Teeth subjected to dental trauma; and (d) Presence of intracanal bleeding and blood clots. Exclusion criteria were: (a) Conference proceedings; (b) Lectures; (c) Abstracts; and (d) Letters to editor; (e) Non-English publications. RESULTS: 355 publications were analysed. Nine met all inclusion criteria. In 10 (58.8%) teeth, triple antibiotic paste was used for an average of 26 days. Double antibiotic paste was used in 3 (17.6%) teeth for an average of 14 days. In 3 (17.6%) cases, calcium hydroxide (Ca(OH)2 ) was used for 14 days and negative pressure irrigation was applied once on 1 (6%) tooth. DISCUSSION: Using RET to treat EILR has some advantages compared to long term CA(OH)2 dressing. RET requires shorter dressing time compared to CA(OH)2 . This can significantly improve patient compliance. Additionally, in immature teeth, RET helps to arrest root resorption leading to continued root maturogenesis and revascularization. It is recommended that a meticulous follow-up should be conducted when RET is performed to assure early detection of treatment failure. CONCLUSIONS: RET appears to be a good treatment modality producing biologic repair and improving prognosis in cases of EILR in post-traumatic tooth/pulp injuries. The key limitation of this study is that all publications included were either case reports or case series that usually tend to report successful outcome.

Analysis and Assessment of Pulp Vitality of 102 Intrinsically Stained Teeth in Dogs.

Our prospective study analyzed clinical, radiographic, and histological characteristics of 102 intrinsically stained teeth. Sixty-nine dogs ranging from one to fifteen years of age were included in this study. Little more than half of the intrinsically stained teeth had no evidence of coronal injury (53.9%, 55/102). We found that most intrinsically stained teeth were histologically nonvital (87.6%, 85/97) and approximately 2/3 of these (57.7%, 56/97) had no histological endodontic or periodontal inflammation at the time of evaluation. Radiographic evidence of endodontic disease was present in 57% (58/102) of the intrinsically stained teeth. Radiographic evidence of periodontal disease was present in 48% (49/102) of intrinsically stained teeth and 28% (29/102) had radiographic evidence of tooth resorption. 18.6% (19/102) of intrinsically stained teeth were radiographically normal. Evidence of pulp necrosis was common in these intrinsically stained teeth, while only occasional teeth (12.4%, 12/97) had histologically confirmed pulpitis. All teeth with radiographic evidence of periapical lucency had pulp necrosis. Based on our histological findings, the majority of intrinsically stained teeth 87.6% are truly nonvital.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial.

This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Assessment of pulp sensibility in the mature necrotic teeth using regenerative endodontic therapy with various scaffolds - Randomised clinical trial.

AIM: This study aimed to evaluate and compare the possibility of regaining pulp sensibility and objectives of regeneration procedure in mature necrotic teeth using regenerative endodontics. MATERIALS AND METHODS: A total of 36 mature necrotic teeth were selected and a regenerative endodontic procedure was performed. A total of four groups, each involving n = 9 teeth per group were randomly grouped as (1) periapical bleeding, (2) platelet-rich fibrin (PRF), (3) collagen, and (4) hydroxyapatite. Pulp testing and radiographic assessment of periapical healing (PH) were recorded at every 3-month interval for 1 year. Readings were compared as qualitative data using the Kruskal-Wallis test to see the inter-group significant difference. RESULTS: Readings of pulp sensibility revealed non-significant results in all intervals. At 3 and 6 months, 22.3% in the PRF group and 11.15% in collagen group; and at 9 months, 44.4% in PRF group, 33.3% in the collagen group and 22.2% in hydroxyapatite group; and at 12-months, 66.6% in PRF, 44.4% in the collagen group, 33.3% in the hydroxyapatite group and 11.1% in the periapical bleeding group showed a positive response to the cold test. But all groups did not show a positive response to heat and electric pulp testing and showed good PH in all groups at the end of 12 months. CONCLUSIONS: The presence of sensibility to cold test is indicative of the formation of vital pulp-like tissues, which was the highest in the PRF group, followed by the collagen, hydroxyapatite and periapical bleeding groups.

Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis.

INTRODUCTION: The purposes of this review were to appraise the level of evidence of the existing regenerative endodontic therapy (RET) publications, perform a meta-analysis on the survival and healing rates of necrotic immature permanent teeth treated with RET, and run a meta-analysis on the quantitative assessment of the root development of those teeth. METHODS: Electronic searches were performed in Web of Science, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The analyses were performed on the clinical outcomes (ie, survival, healing, and root development) of the procedure. RESULTS: Eleven articles were included in the qualitative and quantitative syntheses. Three studies were randomized controlled trials, 6 were prospective cohort studies, and 2 were retrospective cohort studies. The pooled survival and healing rates were 97.3% and 93.0%, respectively. The pooled rates of root lengthening, root thickening, and apical closure were 77.3%, 90.6%, and 79.1%, respectively. However, if 20% radiographic changes were used as a cutoff point, there were only 16.1% root lengthening and 39.8% root thickening. CONCLUSIONS: Within the limitations of the present study, it can be concluded that RET yielded high survival and healing rates with a good root development rate. However, clinical meaningful root development after RET was unpredictable.

Quantitative Assessment of Intracanal Regenerated Tissues after Regenerative Endodontic Procedures in Mature Teeth Using Magnetic Resonance Imaging: A Randomized Controlled Clinical Trial.

INTRODUCTION: The present study quantitatively assessed tissue regeneration after regenerative endodontic procedures (REPs) with 2 different apical preparation sizes in mature teeth using magnetic resonance imaging (MRI). METHODS: Eighteen maxillary anterior mature necrotic teeth with periapical lesions were selected for the study. The teeth were randomly allocated into 2 groups. Canal preparation was performed using Protaper Next files (Dentsply Sirona, York, PA) until size X3 and X5 in the test and control groups, respectively. REPs were performed, and Biodentine (Septodont, Saint-Maur-des-Fossés, France) was used as the cervical plug material. In both groups, MRI was used to measure the signal intensity (SI) of the regenerated tissue at 3, 6, and 12 months at both the middle and the apical thirds of the canal. The SI between the normal contralateral teeth and each successive interval was compared. Clinical examination, sensibility tests, and digital periapical radiographs were also performed at successive time intervals. Statistical analysis was performed using the Student t test and Cochran test. The level of significance was set at P ≤ .05. RESULTS: All 18 teeth were symptom free with healing of the periapical lesions. Regarding the SI measurements, there was no statistically significant difference between the SI of the normal contralateral teeth and that of the regenerated tissues in the treated teeth after a 12-month follow-up. In both groups, more than 60% of the cases regained pulp sensibility after 12 months. CONCLUSIONS: Vital pulplike tissue could be successfully regenerated in mature teeth using REPs, which was not significantly affected by the size of the apical diameter. MRI could successfully assess this tissue in a quantitative, noninvasive manner.

Histological assessment of human regenerative endodontic procedures (REP) of immature permanent teeth with necrotic pulp/apical periodontitis: A systematic review.

The aim of this study was to systematically review the histological evidence of the neo-formed tissues inside the root canals of human teeth having previously received regenerative endodontic treatment. An electronic research was performed in the MEDLINE, Web of Science, Scopus and Cochrane Library databases using controlled vocabulary. The retrieved studies were screened by two reviewers according to the predetermined inclusion and extrusion criteria and were full-text-evaluated. Research resulted in 160 studies. Among them, twelve fitted the inclusion criteria and were critically appraised. The tissues formed in the root canals of immature human teeth treated with REP indicate repair or a combination of repair and regeneration. Pulp remnants and healthy periapical tissues seem to improve regeneration. The level of available evidence was low. Further clinical studies are needed in order to establish the appropriate treatment protocol related to the pretreatment status of the dental pulp and the periapical tissues.

Assessment of Regaining Pulp Sensibility in Mature Necrotic Teeth Using a Modified Revascularization Technique with Platelet-rich Fibrin: A Clinical Study.

INTRODUCTION: The aim of the present study was to evaluate the possibility of regaining pulp sensibility in mature necrotic teeth using modified regenerative endodontic procedures by inducing bleeding in root canals and using platelet-rich fibrin (PRF). METHODS: Fifteen patients with necrotic pulp with symptomatic or asymptomatic apical periodontitis were included. At the first visit, the tooth was anesthetized, and an access cavity was performed. Mechanical preparation of root canals was performed using the standardized technique reaching apical canal preparation to K-file size #60-80. Double antibiotic paste was injected into the canal, and the cavity was temporarily sealed using glass ionomer cement. Three weeks from the first visit, regenerative endodontic procedures were performed by inducing bleeding, and a freshly prepared PRF membrane was placed in the canal. White mineral trioxide aggregate was placed directly over the PRF matrix, and the tooth was restored with a glass ionomer cement base and resin composite restoration. The electric pulp test was used to record if the teeth included in the study regained sensibility or not every 3 to 12 months follow-up. Readings at different times were compared as categoric qualitative data using the chi-square test and compared as means and standard deviations using the analysis of variance test. RESULTS: Readings of tooth sensibility revealed a highly significant difference (P < .0001) between baseline and the 12-month follow-up period. CONCLUSIONS: The presence of sensibility is indicative of the formation of vital pulplike tissue. Reestablishing real pulp tissue after regenerative endodontic treatment is debatable and still needs high level of evidence with large-scale investigations.

Clinical and Radiographic Assessment of the Efficacy of a Collagen Membrane in Regenerative Endodontics: A Randomized, Controlled Clinical Trial.

INTRODUCTION: Recent reviews confirm a general lack of randomized, controlled clinical studies on the efficacy of regenerative endodontics in immature teeth affected by pulp and periapical diseases. Moreover, we have no evidence of the curative efficacy of collagen membranes used as scaffolds in regenerative endodontics. Here, we evaluated whether a Bio-Gide collagen membrane (Geistlich Pharma AG, Wolhusen, Switzerland) has efficacy in promoting dentin formation in regenerative endodontics. METHODS: Forty-three patients yielding a total of 46 nonvital immature teeth were divided randomly into 2 groups. Subsequent to chemomechanical preparation, regenerative endodontics with (the experimental group) and without (the control group) Bio-Gide were performed. All cases were followed up clinically and radiographically every 3 months for at least 6 months. Quantitative analyses using an imaging program yielded percentage changes in root dimensions based on a comparison between preoperative and recall radiographs. RESULTS: The results of 40 patients (43 teeth) were included in the final analyses. All patients from both groups showed clinical success with complete resolution of signs and symptoms. Radiographically, the thickness of the dentin wall at the middle third of the root was higher for the experimental group than the control group. However, other indicators were comparable between both groups. CONCLUSIONS: The use of the Bio-Gide collagen membrane promoted the development of the dentin wall in the middle third of the root in patients undergoing regenerative endodontic procedures. The convenience of operation and the assured positioning of the sealing material make the Bio-Gide collagen membrane especially suitable for handling wide root canals.

Histological assessment of regenerative endodontic treatment in animal studies with different scaffolds: A systematic review.

BACKGROUND/AIM: The concept of regenerative endodontic procedures remains controversial. The aim of this study was to evaluate the histology of the tissues formed in immature animal teeth with necrotic and infected pulps after attempted endodontic regeneration procedures using different scaffolds. DESIGN: A systematic electronic literature search was performed in PubMed, Web of Science, Scopus, EMBASE, DOSS, and Cochrane Library databases. The terms used were a combination of the following: "immature permanent necrotic tooth or teeth" or "open apex or apices" and "regeneration or revitalization or revascularization" and "histology." The inclusion criteria comprised animal studies with histological examination following regenerative endodontics in immature necrotic-infected permanent teeth. RESULTS: From 123 screened studies, 13 met the inclusion criteria. Formation of dentin-like tissue on the dentinal walls was reported in only 4% of teeth treated with blood clot scaffold and 2% treated with blood clot with additional materials. Cementum-like hard tissue was found in 64% of teeth with blood clot, 80% treated with blood clot with additional materials, 50% treated with alternative scaffolds, and 5% that were left empty. Bone-like tissue was reported in 10% of teeth treated with blood clot, 2% treated with blood clot with additional materials, and 4% treated with alternative scaffolds. The tissues in the canal space were found to be connective tissue with infiltration of fibroblast-like cells and blood vessels. Forty-six percent of the studies reported formation of periodontal ligament-like tissues. CONCLUSIONS: None of the regeneration protocols resulted in the predictable formation of a true pulp-dentin complex.

Efficiency and Reliability of Thermal and Electrical Tests to Evaluate Pulp Status in Primary Teeth with Assessment of Anxiety Levels in Children.

OBJECTIVE: Assessing the pulp status plays a vital role in diagnosis and treatment planning in dentistry especially in children, who may not be able to verbalize their dental symptoms. Pulp sensibility test is used as a valuable investigation to evaluate the state of pulp. The aim of this study is to assess the efficiency and reliability of thermal and electrical pulp tests in primary teeth and to rule out the anxiety level involved in each tests. STUDY DESIGN: 30 children aged between 6 to 8 years with carious primary molar teeth in need of conservative pulp therapy were included in this study. 3 tests at random were employed on each tooth which includes cold, heat, electrical pulp test. The sensitivity, specificity, positive predictive value and negative predictive value were evaluated based on the clinical visual examination on access opening and the accuracy for each test was calculated. The Facial Image Scale (FIS) was used to assess the state of dental anxiety in children due to these pulp sensibility tests. RESULTS: The highest accuracy rate was calculated for EPT (0.814) followed by cold test (0.777) and heat test (0.759). CONCLUSION: No significant association was found between the accuracy of all the three tests. (P value > 0.05). Cold test is the most reliable test due to its simplicity and ease to perform. (FIS -1.53).

Analysis of professional malpractice claims in implant dentistry in Italy from insurance company technical reports, 2006 to 2010.

PURPOSE: The aim of the study was to analyze the characteristics of implant dentistry claims in Italy based on insurance company technical reports for malpractice claims. MATERIALS AND METHODS: One hundred twenty-one technical reports of cases of professional malpractice in implant dentistry between 2006 and 2010 were included in the study. Data included the sex and age of the patient and dentist, the kind of negligence claimed, and the damages awarded as a consequence of the alleged misconduct. RESULTS: Of the cases examined in this study, 9.9% went to court. The patients were female in 73.6% of the cases. Most of the technical errors were committed during implant insertion (82.6%). In 50.4% of cases, the technical error involved the surrounding structures, such as damage to the inferior alveolar nerve (32.2%) or the lingual nerve (2.5%), invasion of the maxillary sinus (9.1%), or pulpal dental necrosis in adjacent teeth (6.6%). Incomplete clinical documentation was apparent in 54.5% of cases. In 9.9% of cases, a civil suit had already been filed before a visit, and medicolegal advice from the insurance expert had been procured. CONCLUSION: The discrepancy between the total number of cases examined and those that went to court indicates that implant malpractice claims in Italy are most often settled out of court. The large number of intraoperative errors seen and the high proportion of injuries to surrounding structures suggest that implant dentists would benefit from further specific training. Also, clinical documentation vital to a defense against any claims relating to professional misconduct was incomplete or absent in more than half of the cases.

A study of factors that influence the number of visits following traumatic dental injuries.

OBJECTIVE: To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. METHOD: A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. RESULTS: 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). CONCLUSION: Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

Contemporary management of horizontal root fractures to the permanent dentition: diagnosis--radiologic assessment to include cone-beam computed tomography.

Historically, obtaining several periapical radiographs has been recommended to diagnose horizontal root fractures. Assessing the 3-dimensional orientation of a fracture is correlated to treatment and outcome. However, conventional radiography yields only limited information for accurate diagnosis. Cone-beam computed tomography (CBCT) is a relatively new and useful technology, which provides an auxiliary imaging modality to supplement conventional radiography for evaluating horizontal root fractures. Despite the increasing application of this technology as well as a growing body of evidence supporting its value in diagnosing horizontal root fractures, there are no specific guidelines for its use. This article aimed to provide such preliminary guidelines for cases of suspected horizontal root fracture as a result of trauma. From a database search it was concluded that CBCT is most useful in cases in which conventional radiography yields inconclusive results or shows a fracture in the middle third of a root. In such cases CBCT may rule out false negatives, ie, a suspected root fracture not visualized with conventional radiography. For a root fracture in the middle third, CBCT may rule out or confirm an oblique course of fracture involving the cervical third in the labiolingual dimension. Although there are considerable advantages when CBCT is included in the assessment of horizontal root fracture and its possible sequelae, more experimental and clinical studies are warranted to determine the exact impact on outcomes.

A eficácia do hidróxido de cálcio no tratamento endodôntico de decíduos: seis anos de avaliação / Efficacy of calcium hydroxide in the endodontic treatment of primary teeth: six years of follow-up

Objetivo: avaliar os resultados clínicos e radiográficos da utilização do hidróxido de cálcio no tratamento endodôntico em decíduos (com necrose pulpar, associada ou não à lesão periapical ou interradicular). Método: o grupo teste foi composto por 33 dentes decíduos, sendo 17 dentes anteriores e 16 posteriores de 31 crianças, com idade variando de um a 11 anos. O grupo-controle foi o de dentes homólogos àqueles tratados endodonticamente e seus sucessores permanentes. O atendimento clínico foi realizado por dois profissionais experientes e previamente calibrados. Os dentes foram abertos e durante o preparo mecânico-químico fez-se uma irrigação copiosa com hipoclorito de sódio a 1%. Nos casos de dentes tratados em duas sessões (casos de necrose pulpar associada à lesão periapical e/ou interradicular), utilizou-se uma medicação intracanal (pasta de base de hidróxido de cálcio p.a e soro fisiológico) por 30 dias. Após esse período, os dentes foram obturados utilizando-se a pasta L&C®, também à base de hidróxido de cálcio. Em seguida, realizaram-se controles periódicos, por até 72 meses, até a esfoliação do decíduo e a erupção do dente permanente sucessor. Resultados: os resultados foram satisfatórios em 32 dos 33 dentes avaliados no grupo teste, ou seja, 97% dos dentes tratados apresentaram-se sem sinais clínicos e radiográficos de lesões periapicais e interradiculares. Observaram-se resultados similares quanto ao grau e ao padrão de rizólise dos decíduos, bem como de desenvolvimento e irrompimento do sucessor permanente ao se comparar os dois grupos (teste e controle). Esses resultados permitiram considerar como sucesso a terapia endodôntica instituída, demonstrando a efetividade do protocolo utilizado. Conclusões: o hidróxido de cálcio é efetivo no tratamento endodôntico de dentes decíduos, não necessitando que seja associado a outros agentes antimicrobianos.

Objective: The aim of this work was to evaluate, clinically and radiographically, the efficacy of calcium hydroxide in the endodontic treatment of primary teeth with pulp necrosis associated or not with periapical or interadicular lesions. Method: The test group comprised 33 primary teeth, being 17 anterior teeth and 16 posterior teeth, from 31 children aged 1 to 11 years. The control group consisted of 33 homologous teeth to those treated endodontically and their permanent successors. The patients were treated by two previously calibrated experienced professionals. Endodontic access cavities were made and the chemomechanical preparation was performed under copious irrigation with 1% sodium hypochlorite. When a two-appointment root canal therapy was necessary (teeth with necrotic pulps associated with periapical and/or interadicular lesion), a calcium hydroxide and saline paste was used as an intracanal dressing for 30 days. After this period, the root canals were filled with L&C® calcium hydroxide-based cement. Posttreatment periodic controls were carried out during a follow up period of 72 months until the exfoliation of the primary teeth and eruption of the permanent successor. Results: Adequate outcomes were obtained in 32 out of the 33 teeth evaluated in the test group, i.e., 97% of the treated teeth did not present clinical or radiographic evidence of periapical or interadicular radiolucencies. Comparison between the test and control groups revealed similar results with respect to the stage and pattern of physiological root resorption of the primary teeth, as well as the development and eruption of the permanent successors in both groups. These results indicate endodontic success and demonstrate the efficacy of the employed treatment protocol. Conclusion: Calcium hydroxide is effective in the endodontic treatment of primary teeth, requiring no combination with other antimicrobial agents.

Microbial culture and checkerboard DNA-DNA hybridization assessment of bacteria in root canals of primary teeth pre- and post-endodontic therapy with a calcium hydroxide/chlorhexidine paste.

AIM: To investigate the root canal microbiota of primary teeth with apical periodontitis and the in vivo antimicrobial effects of a calcium hydroxide/chlorhexidine paste used as root canal dressing. DESIGN: Baseline samples were collected from 30 root canals of primary teeth with apical periodontitis. Then, the root canals were filled with a calcium hydroxide paste containing 1% chlorhexidine for 14 days and the second bacteriologic samples were taken prior to root canal filling. Samples were submitted to microbiologic culture procedure to detect root canal bacteria and processed for checkerboard DNA-DNA hybridization. RESULTS: Baseline microbial culture revealed high prevalence and cfu number of anaerobic, black-pigmented bacteroides, Streptococcus, and aerobic microorganisms. Following root canal dressing, the overall number of cfu was dramatically diminished compared to initial contamination (P <0.05), although prevalence did not change (P > 0.05). Of 35 probes used for checkerboard DNA-DNA hybridization, 31 (88.57%) were present at baseline, and following root canal dressing, the number of positive probes reduced to 13 (37.14%). Similarly, the number of bacterial cells diminished folowing application of calcium hydroxide/chlorhexidine root canal dressing (P = 0.006). CONCLUSION: Apical periodontitis is caused by a polymicrobial infection, and a calcium hydroxide/chlorhexidine paste is effective in reducing the number of bacteria inside root canals when applied as a root canal dressing.

Pattern of antibiotic prescription in the management of endodontic infections amongst Spanish oral surgeons.

AIM: To identify antibiotic prescription practices in the treatment of endodontic infections amongst Spanish oral surgeons. METHODOLOGY: Members of the Spanish Oral Surgery Society (SECIB) were surveyed on antibiotic prescription on six different pulpal and periapical diagnoses. A total of 200 questionnaires were delivered with 127 returned (64%). RESULTS: The average duration of antibiotic therapy was 7.0 +/- 1.0 days. Ninety five percent of respondents selected amoxicillin as the first choice antibiotic in patients with no medical allergies, alone (34%) or associated to clavulanate (61%). The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (65%), followed by azithromycin (15%) and metronidazole-spiramycin (13%). For cases of irreversible pulpitis, 86% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis and no swelling, 71% prescribed antibiotics. Almost 60% of respondents prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract; in this clinical situation, odontologists prescribed more frequently antibiotics compared to stomatologists (P = 0.0080; odds ratio = 8.0; C. I. 95% = 1.7-37.1). CONCLUSIONS: The majority of the members of the SECIB were selecting the appropriate antibiotic for use in endodontic infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.