Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes.

Patients with spinal cord injuries are at increased risk of developing symptomatic urinary tract infections. Current evidence-based knowledge regarding prevention and treatment of urinary tract infection in the spinal cord injured population is limited. There are currently no urinary tract infection prevention and management guidelines specifically targeted towards elite spinal cord injured athletes. This position statement represents a set of recommendations intended to provide clinical guidelines for sport and exercise medicine physicians and other healthcare providers for the prevention and treatment of urinary tract infection in spinal cord injured athletes. It has been endorsed by the Australian Institute of Sport (AIS) and the Australian Paralympic Committee (APC).

Radiation dose reduction during endodontic therapy: a new technique combining an apex locator (Root ZX) and a digital imaging system (RadioVisioGraphy).

This study was undertaken on 14 teeth in order to evaluate a new technique for radiation dose reduction during endodontic therapy. After examination of the preoperative film, usually available in the patient file, an apex locator (Root ZX) was used to measure the working length. Complete chemomechanical debridement was then performed, and the master cone was evaluated by a digital imaging system (RadioVisioGraphy (RVG)). Obturation was performed when measurements of the electronic device and RVG were comparable. A postoperative image was made by the RVG system to evaluate the final obturation. A clinical and radiographic follow-up examination (follow-up period: 6 to 8 months) revealed satisfactory apical healing. These results indicated that a successful obturation technique can be performed by a single radiation exposure, using the RVG unit for master cone evaluation. This technique may be useful in medically compromised patients who need not to be exposed to excessive or repeated radiation during endodontic therapy.

The effect of ultrasonics on sealer distribution and sealing of root canals.

The purpose of this study was to compare the ultrasonic and hand methods of sealer placement using three types of sealers: Sultan "Grossman's formula," AH-26, and CRCS. The effect of these methods on radiographic density, sealer distribution, and on the apical seal of the different sealers was evaluated. The in vitro experiment was carried out using human extracted mandibular incisors and mesio-buccal roots of maxillary first and second molars. Following standardized canal instrumentation, 120 single canal mandibular incisors were randomly assigned to six groups, depending on the type of sealer and method of sealer placement (hand versus ultrasonic). An additional ten teeth were used as controls. In the molar groups 40 canals were randomly assigned to two groups, with the method of sealer placement as the variable. Eight canals were used as controls. Postsealer analyses using radiographic density scores transformed to mm of sealer indicated that ultrasonics was superior to manual placement only for CRCS. Taken together, our investigation suggests that ultrasonics may enhance the placement of some sealers (i.e. CRCS) but not of others (i.e. AH-26 or Sultan). Method of sealer placement had no effect on apical leakage and therefore apparently on apical seal.

Resistance of a novel root canal sealer to bacterial ingress in vitro.

A dentin-bonding root canal sealer (ZUT) has been developed, consisting of an experimental glass ionomer cement (KT-308) and an antimicrobial silver-containing zeolite (0.2% by weight). This in vitro study evaluated the ability of ZUT used with or without gutta-percha, to resist bacterial ingress of Enterococcus faecalis over a period of 90 days. Canals of 80 single-rooted teeth were prepared with apical patency and filled as follows (n = 10): KT-308 alone; KT-308 with a single gutta-percha cone (SCGP); ZUT alone; ZUT with SCGP; AH26 alone; AH26 with SCGP; positive control-no root canal filling; and negative control-no root canal filling, with the apices of this group sealed with C&B Metabond cement. Teeth were coated with nail polish except for the apical 2 mm, and each tooth was sealed in a 4-ml glass vial, with an 18-gauge needle inserted through the vial cover and bonded into the pulp chamber with C&B Metabond cement. After sterilization with 2.5 Mrad gamma-radiation, Brain Heart Infusion broth with phenol red was injected into each vial. An inoculum of E. faecalis was pipetted through the needle into the pulp chamber every 5 days, and the broth was monitored daily for color change and turbidity. When change occurred, the broth was cultured for growth of E. faecalis. Kaplan-Meier survival analysis and the log-rank test revealed no significant differences among the three sealers used. The presence of gutta-percha, however, significantly improved resistance to bacterial ingress through obturated root canals (X, p < 0.05). Under the conditions of this study, the hypothesized advantage of ZUT (0.2% zeolite) was not demonstrated.

Leakage along apical root fillings in curved root canals. Part I: effects of apical transportation on seal of root fillings.

Occurrence of apical transportation (AT) may complicate the root filling procedure and result in a compromised seal. In part I of this study, human mandibular premolars with single, curved (21 to 39 degrees), or straight canals were prepared by Lightspeed or a step-back hand filing technique. An AT index was determined using a double exposure radiographic technique. The prepared canals were obturated using lateral condensation of gutta-percha. Leakage along the apical 3 mm of root filling was measured with a fluid transport model. After hand filing, AT and perforation occurred in 87% of the curved canals. The AT indices were > or = 0.4 mm. After Lightspeed preparation, AT occurred in only 19% of the curved canals. The hand filing/curved group leaked statistically significantly more than the hand filing/straight and Lightspeed/curved groups (p = 0.002). We conclude that occurrence of AT is a factor that negatively influences the apical seal when curved canals are obturated by lateral condensation of gutta-percha.

[The efficacy of preparations with antioxidant action in the combined treatment of phlegmons of the maxillofacial area]. / Effektivnost' preparatov antioksidantnogo deistviia v kompleksnom lechenii flegmon cheliustno-litsevoi oblasti.

The efficacy of hexamethylene tetramine (urotropin) was studied in 62 patients with maxillofacial phlegmons. The resultant good effect is explained by the pathogenetic action of the drug. The antiinflammatory effect of urotropin may be explained, on the one hand, by its known antiseptic effect, and, on the other hand, by its membrane-protective effect on the cellular elements, this creating the optimal conditions for the wound reparation.

Root canal re-treatment of a mandibular second premolar with three root canals: a case report.

Accurate diagnosis of root canal morphology and anatomy is essential for thorough shaping and cleaning of the entire root canal system and consequent successful root canal treatment. Mandibular premolars show a wide variety of root canal anatomy. This paper describes a case of mandibular second premolar with three root canals that has previously received an incomplete root canal treatment.

Periapical reactions to calcium hydroxide-containing sealers and AH 26 in monkeys.

The long-term effect on periapical healing (8-14 months) of CRCS and Sealapex was compared with that of AH 26. Vital pulpectomy and root canal filling by the hybrid thermomechanical method were performed in teeth of 3 young monkeys. Ten roots with CRCS, 10 with Sealapex and 7 roots with AH 26 were examined after demineralization and routine histological processing. Hematoxylin and eosin and Brown & Brenn staining for micro-organisms were employed. Mild to severe inflammatory lesions were found at the apical foramina of the roots filled with AH 26 and CRCS. Most of the Sealapex specimens showed no inflammatory cells, except macrophages with sealer particles. A striking finding was a tendency towards apical obliteration with calcified tissue in roots filled with Sealapex, apparently following resorption of the sealer. Such a tendency was seldom observed with the other sealers. However, both AH 26 and Sealapex were irritating for a long time when pushed into bone. Despite the interesting results with Sealapex, additional research is needed before its use can be unconditionally recommended. This sealer has not yet been tested in infected cases and its ability to be resorbed, which is an advantage when it precedes replacement by calcified tissue, may become a disadvantage if it is not followed by apical obliteration.

An in-vitro comparative evaluation of temperature rise at the root surface caused by two thermoplasticized gutta percha obturation techniques.

This study measured and compared the heat generated at the apical 2 mm of the outer root surface of extracted human anterior teeth during obturation of the root canal with thermally softened gutta percha. The teeth were divided into four groups of ten teeth each. In the first group, the teeth were obturated with obtura II system with a sealer. In the second group, the teeth were obturated with obtura II and the sealer was not used. The third group was filled with gutta percha and sealer using Endotec endodontic condenser. In the fourth group, the teeth obturated with the same technique as group III but without the use of a sealer. The highest temperature recorded was 5.9% C with Endotec technique without the use of a sealer and the lowest temperature measured was 3.3 degrees C with obtura II system and a sealer. The use of sealer seems to lower the temperature generated to the outer root surface. The results of this study indicated that the temperature rise on the outer surface of the root during obturation with thermally softened gutta percha was minimal and might not be damaging to the supporting tissues.

Leakage along warm gutta-percha fillings in the apical canals of curved roots.

The aim of this study was to investigate the leakage along the apical portion of warm gutta-percha obturated curved canals. Human mandibular premolars with single, curved (21 degrees-40 degrees) canals were prepared using the Lightspeed technique. Two groups of prepared canals, matched according to curvature and prevalence of apical transportation, were obturated by two techniques. Coronal gutta-percha was removed immediately after root obturation was completed to simulate the procedure for post space preparation. Leakage along the apical 3 mm of root filling was measured with a fluid transport device. Vertical condensation of warm gutta-percha and Pulp Canal Sealer provided less leakage than Thermafil plastic obturators and AH26 sealer (P = 0.002).

Comparison of different techniques for obturating experimental internal resorptive cavities.

Forty extracted maxillary central incisors were instrumented at the working length to a #50 file. The roots were sectioned transversely with a diamond disk at 7 mm from the anatomical apex. At the opening of the root canal of each section, hemicircular cavities were drilled with a specially designed bur. The corresponding root sections were cemented with glue, thus obtaining root canals with similar cavities that simulated internal resorptions. Teeth were embedded in plaster casts to facilitate their handling. The specimens were randomly separated into four groups of 10. The following obturation techniques were evaluated: lateral compaction (group A), hybrid technique (group B), Obtura II (group C), and Thermafil (group D). AH26 was used as the sealer. After obturation, the plaster was removed and the teeth were radiographed in buccolingual and mesiodistal directions to evaluate the quality of the obturation at the IRC. The incisors were then cut with a scalpel at the same level as the previous section, to examine, under a stereomicroscope, the type of material that filled the IRC. Obtura II gave the best results and in most of the specimens obturated with this technique, the IRC were filled mainly with gutta-percha. Statistical analysis of the data indicated that the differences between group C and the other groups were significant (P < 0.05).

The effect of root canal preparation on microleakage within endodontically treated teeth: an in vitro study.

AIM: The purpose of this study was to evaluate the effects of smear layer and canal instrumentation on leakage in root-filled teeth. METHODOLOGY: Six groups (n = 12) of freshly extracted human canines and premolars with closed apices and single roots were used. Groups A, B, C, and D were instrumented with engine-driven rotary nickel-titanium MCXIM files and Groups E and F were instrumented with conventional stainless steel hand files. Groups A, C, and E were flushed with 3.0 mL of 17.0% REDTA to remove the smear layer prior to obturation. All teeth were flushed with 5.25% NaOCl, then obturated with AH-26 sealer and either the lateral condensation (Groups C-E) or thermomechanical compaction technique (Groups A and B). Copper wire was placed coronally in contact with the gutta-percha in each tooth and, after immersion in 0.9% NaCl solution, a 10 volt dc voltage was connected between each tooth and a stainless steel electrode. The current flow in the circuit was observed for 45 days. One way ANOVA and Duncan's Multiple Range Test were used to compare Groups A-F at time intervals of 10, 20, 30 and 45 days and identify statistically significant differences. RESULTS: Significantly less microleakage occurred when the smear layer was removed and when the canals were obturated with thermoplasticized gutta-percha. Canals instrumented with engine-driven NiTi files exhibited less leakage than hand-instrumented canals irrespective of obturation method. CONCLUSIONS: Smear layer removal is beneficial to root canal sealing. Obturation with thermoplasticized gutta-percha provides a superior seal whilst canal instrumentation with engine-driven NiTi files reduces the extent of microleakage in root canals.

Bacterial leakage in obturated root canals following the use of different intracanal medicaments.

The aim of this study was to examine whether intracanal medication prior to root canal obturation has an inhibitory effect on corono-apical penetration of bacteria. 93 single rooted teeth were instrumented and sterilized with ethylene oxide. They were assigned to three control groups and four test groups with n = 20 each. For one week, they were dressed with different medicaments: The first group with a 5% chlorhexidine gel, the second with Ledermix, the third with a fresh mix of calcium hydroxide and water and the fourth without any medication. After obturation (lateral condensation, AH26) the roots were fixed between a top and a bottom chamber. The top chamber contained 3 mL trypticase soy broth with 10(8) Staphylococcus epidermidis CFU's/mL, whereas the bottom chamber contained sterile trypticase soy broth. For one year, the mounts were incubated at 37 degrees C. They were checked on a regular basis for turbidity in their bottom chambers indicating bacterial growth. None of the test samples leaked for three months. After one year, the calcium hydroxide group had only 6 leaking samples whereas the chlorhexidine group had 14, the Ledermix group 15, and the unmedicated group had 13 leaking samples. It may be concluded that under the conditions of this study, calcium hydroxide was the medicament of choice to avoid bacterial penetration of the root canal. Ledermix did not perform better than no premedication. Chlorhexidine was superior to Ledermix in the second third of the observation period.

The management of indwelling catheters.

Eighteen geriatric patients with indwelling catheters were observed for a total of 393 weekly urine specimens. The effects of a 1 week course of antibiotics/chemotherapeutic agent followed by urinary antiseptics for 6 weeks, and also of regular bladder washouts, were noted. All urine specimens were infected except 24% during antibiotic treatment and 9% during antiseptics and 6% after washouts. Only washouts reduced the extent of catheter blockage. There was little difference in the time in situ between silastic and latex Foley catheters--only 31% of silastic remaining for longer than 4 weeks. Bard-Roberts catheters were the least satisfactory. Catheter leakage was not affected by urinary pH. Further development in long-term catheter management are needed.

Long-term prophylaxis of urinary infections in women: comparative trial of trimethoprim, methenamine hippurate and topical povidone-iodine.

We randomized 64 patients with a history of recurrent urinary tract infections among 3 regimens of long-term (1 year) prophylactic treatment: 20 were given 100 mg. trimethoprim at night, 25 received 1,000 mg. methenamine hippurate every 12 hours and 19 were asked to cleanse the perineum (especially the periurethral area) twice daily with povidone-iodine solution. The progress of patients in terms of urinary symptoms and/or bacteriuria, changes in periurethral flora, side effects, and hematological and biochemical profiles was followed at regular intervals. All treatments were effective in reducing the incidence of symptomatic attacks when compared to the 12 months immediately before therapy and there was little to choose between the individual regimens on this account. However, trimethoprim was tolerated better than were the other 2 treatment regimens. In the group given trimethoprim most of the breakthrough infections (71.4 per cent) that occurred were caused by trimethoprim-resistant organisms (usually Escherichia coli), while in the other 2 groups the incidence of trimethoprim-resistant organisms causing infection was low (2.7 per cent). Treatment with trimethoprim reduced significantly the periurethral colonization of Escherichia coli.

A primary observation on the preparation and obturation of oval canals.

AIM: The aim of this study was to observe the existence and assess the quality of obturation of uninstrumented recesses in oval canals. METHODOLOGY: The balanced force technique was used in two groups of oval canals in human mandibular incisors. The canals in group 1 were enlarged to conventional sizes, whereas canals in group 2 were enlarged more widely. All canals were obturated with cold laterally condensed gutta-percha. Two horizontal sections were cut in the apical portion of each filled root. Images of the cross-sections were scanned and analysed using the KS100 Imaging system. RESULTS: Uninstrumented recesses appeared in 13 (65%) oval canals. The recesses in five of these 13 canals were obturated without visible voids. The recesses in the other eight canals were either obturated with visible voids or completely unfilled. The percentage of filled area was significantly higher in group 1 than in group 2 (P < 0.05). CONCLUSIONS: Uninstrumented recesses may be left in many oval canals after preparation using the balanced force technique and these recesses may often not be completely obturated with cold laterally condensed gutta-percha.

Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions.

AIM: The aim of this study was to evaluate the fate of microorganisms in root canals of teeth with infected pulps and periapical bone lesions with and without the use of calcium hydroxide medication. METHODOLOGY: Endodontic samples were cultured and microorganisms were counted and identified in 43 teeth before (sample 1) and after (sample 2) treatment during the first visit and before (sample 3) and after (sample 4) treatment during the second visit. In the first visit teeth were instrumented and half of the teeth were filled with a thick slurry of calcium hydroxide in sterile saline. The other teeth were obturated with gutta-percha and AH-2 6 sealer. After 4 weeks the teeth with calcium-hydroxide were accessed again and after microbiological sampling they were obturated with gutta-percha and AH-26 sealer. RESULTS: The mean total colony forming unit (CFU) counts of positive samples dropped significantly as a result of canal preparation during the first visit from 1.0 x 10(6) to 1.8 x 10(3) (between samples 1 and 2) but increased to 9.3 x 10(3) in the period between the two visits (sample 2 and 3). There was no difference in mean total CFU counts of positive samples between the end of the first (sample 2) and the end of the second visit (sample 4). The most frequently isolated species were Prevotella intermedia, Capnocytophaga spp.. Actinomyces odontolyticus. Propionibacterium acnes and Peptostreptococcus micros. CONCLUSIONS: Although a calcium hydroxide paste was placed in the prepared canals, the number of positive canals had increased in the period between visits. However, the number of microorganisms had only increased to 0.93% of the original number of CFU (sample 1). It is concluded that a calcium hydroxide and sterile saline slurry limits but does not totally prevent regrowth of endodontic bacteria.