Retreatment of a resected tooth associated with a large periradicular lesion by using a triple antibiotic paste and mineral trioxide aggregate: a case report with a thirty-month follow-up.

INTRODUCTION: Trauma to the teeth and supporting structures is a frequent problem among children. Endodontic treatment is necessary for 41.3% of traumatized teeth. Two of the most important criteria for successful endodontic treatment are the elimination of microorganisms and apical sealing. A combination of antibiotic drugs (metranidozole, ciprofloxacin, and minocycline) is used to eliminate target bacteria, which are possible sources of endodontic lesions. For cases in which apical sealing is difficult, specific materials to plug the apical region have been advocated. Mineral trioxide aggregate (MTA) has become the material of choice because it is biocompatible and has bacteriostatic action. METHODS: This case report describes the nonsurgical retreatment of a traumatized tooth that had already undergone unsuccessful apical resection associated with a large periradicular lesion. A combination of antibiotic drugs was used as an intracanal medicament, and MTA was used to obtain a hermetic seal of the lateral tooth that had undergone unsuccessful apical resection. RESULTS: On follow up, the tooth was clinically and radiographically asymptomatic for 30 months. CONCLUSIONS: The results of this case show that MTA and triple antibiotic paste can be used clinically in the treatment of an unsuccessfully resected tooth associated with a large periradicular lesion.

Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery-- a randomized double blind clinical study.

The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

The effect of irrigation with doxycycline or citric acid on leakage and osseous wound healing.

This study investigated the effect of doxycycline irrigation on wound healing and the apical seal of three filling materials. Part 1: 220 extracted teeth received root canal therapy followed by root resection (2 mm) and ultrasonic root end preparations (3 mm). Groups of 20 were irrigated with saline, citric acid, or doxycycline and filled with amalgam, Super EBA, or MTA. Leakage was measured (mm) after decalcification and clearing. Part 2: two defects were made on each side of the mandible of 10 New Zealand rabbits. On each side, one defect was irrigated with saline and one with either citric acid or doxycycline. The animals were killed in groups of five at 9 and 18 days. Sections of each defect were stained with hematoxylin and eosin for evaluation of healing and bone fill. Super EBA and MTA leaked significantly less than amalgam, regardless of irrigant. Leakage after irrigation with doxycycline compared to citric acid or saline was not significantly different for Super EBA or MTA but was lower for amalgam. There was no significant difference in healing or bone fill among irrigants at 9 or 18 days.

Are postoperative review appointments necessary following uncomplicated minor oral surgery?

This paper reports the results of a postal survey of all current BAOMS Fellows concerning their practice and opinion on the usefulness and desirability of reviewing all patients following uncomplicated minor oral surgery. It also reports the results of a separate postal survey of 500 patients who had recently undergone third molar removal. The overwhelming majority of Fellows routinely review all their patients following third molar removal and apicectomy but not after simple exodontia. There was no excess morbidity in patients who were not offered a follow-up appointment compared to those who had been seen postoperatively after removal of their third molars. Patients not followed up in hospital postoperatively did not seek help from their doctor or dentist more frequently than patients who were followed-up. Despite the lack of evidence showing objective benefit to patients from postoperative follow-up, given the choice the majority of patients wish to be reviewed postoperatively.

The effect of two different local anaesthetic solutions on pain experience following apicectomy.

Post-operative pain experience following apicectomy of a single maxillary anterior tooth was compared in two groups of patients having this treatment under local anaesthesia. Twenty patients received 3.6 ml of 2% lignocaine with 1:80,000 adrenaline and 23 patients the same volume of 1.5% etidocaine with 1:200,000 adrenaline, as the local anaesthetic agent. Although soft tissue anaesthesia lasted significantly longer when etidocaine with adrenaline was used, pain experience and analgesic intake did not differ between regimens. Lignocaine with adrenaline produced better operating conditions as haemorrhage control was more effective and the quality of operative anaesthesia was more satisfactory than with etidocaine and adrenaline. The use of etidocaine with adrenaline offered no advantages over lignocaine with adrenaline when administered as infiltration anaesthesia for apical surgery.