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1.
Aust Dent J ; 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38850075

RESUMEN

BACKGROUND: Decision-making in dentistry is a complex process, and this study evaluated factors that influence dentists' approaches in permanent mature teeth with irreversible pulpitis. METHODS: An online questionnaire was distributed to a group of dental practitioners. The questionnaire surveyed dentists' opinions about the management of vital permanent teeth with irreversible pulpitis including a case scenario. RESULTS: Data from 262 respondents were analysed. Barriers to perform vital pulp therapy (VPT) included presuming it an inappropriate long-term treatment (29.7%), lack of knowledge, insufficient access to materials, inadequate training and lack of confidence. Patient's preference (79.44%) and tooth restorability (91%) were the most frequently reported factors influencing treatment decisions. Dentists aged 25-35 years and who have 1-5 years of experience ranked extraction as a more successful treatment (P = 0.008; P = 0.003, respectively). Non-Australian graduates ranked pulpotomy to be a more successful procedure (P = 0.007), and public sector/hospital practitioners favoured extraction more than practitioners from other sectors (P = 0.003). Postgraduates/specialists preferred pulpotomy (P = 0.012) more than general dentists. Participants' clinical approaches for the management of symptomatic irreversible pulpitis: root canal treatment (45.0%), indirect pulp capping (22.9%), direct pulp capping (15.8%), pulpotomy (17.1%) and extraction (6.3%). CONCLUSIONS: Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants. © 2024 Australian Dental Association.

2.
Aust Dent J ; 68(2): 78-91, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-36661351

RESUMEN

AIMS: This systematic review aimed to compare the efficiency of orifice barriers in preventing coronal microleakage in vitro. METHODS: Articles published in English, German and Chinese were searched for studies describing microleakage assays for the bacterial penetration of root canal-treated teeth in vitro. The final sample included 18 articles for review and meta-analysis. Risk ratios and confidence intervals were determined for dichotomous variables. Ten publications using bacterial leakage models contributed to the meta-analysis. RESULTS: The addition of orifice barriers to a root canal filling was overall effective, shown by risk ratios (RR) and 95% confidence intervals (CI) demonstrating reduced microleakage with glass ionomer cement (GIC) (RR 0.37, 95% CI 0.26-0.53, P < 0.001), resin-modified GIC (RR 0.32, 95% CI 0.15-0.67, P = 0.01), composite resin (RR 0.54, 95% CI 0.38-0.75, P < 0.001), mineral trioxide aggregate (MTA) (RR 0.25, 95% CI 0.12-0.52, P < 0.001) and Cavit (RR 0.23, 95% CI 0.14-0.39, P < 0.001). There were no significant differences between GIC, resin-modified GIC, composite resin and MTA orifice barriers. CONCLUSIONS: Placement of an orifice barrier over the root canal filling is effective in the prevention of coronal microleakage in vitro. Other parameters may also affect the effectiveness of orifice barriers, including thickness and duration of exposure to the oral environment. © 2023 Australian Dental Association.


Asunto(s)
Filtración Dental , Materiales de Obturación del Conducto Radicular , Humanos , Cavidad Pulpar , Australia , Cementos de Ionómero Vítreo , Resinas Compuestas , Filtración Dental/prevención & control
3.
Aust Dent J ; 67 Suppl 1: S24-S30, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35505612

RESUMEN

BACKGROUND: General dental practitioners often perceive root canal treatments as complex, and specialist referrals are commonplace in general dental practice. Therefore, the aim of this study was to better understand the knowledge of Australian general dentists and their attitudes regarding endodontics in general, and specifically (RCT), to highlight barriers and facilitating factors in the provision of endodontic care. METHODS: A combined paper-based and online survey was sent to general dental practitioners. The questionnaire consisted of 27 items, presented as checkboxes and in Likert scale format. Responses were tabled and statistically contrasted using Chi-square tests and linear regression analysis. RESULTS: A significant proportion of surveyed dentists were not confident in their ability to provide endodontic care, specifically root canal treatments (RCT). Confidence depended on factors, such as time in practice, participation in continuing professional development as well as fear of litigation and type of treatment. Other factors such as the availability of appropriate instruments and referral options, had comparatively little impact on practitioner confidence. DISCUSSION: While almost all general dental practitioners (GDPs) surveyed in this study believe RCT is important for improving the long-term retention of a tooth, just over half of the GDPs say they feel confident in their knowledge and provision of root canal treatment procedures.


Asunto(s)
Endodoncia , Conocimientos, Actitudes y Práctica en Salud , Humanos , Actitud del Personal de Salud , Australia , Odontología General , Tratamiento del Conducto Radicular , Derivación y Consulta , Encuestas y Cuestionarios , Odontólogos , Pautas de la Práctica en Odontología
4.
Br Dent J ; 216(6): 347-53, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24651341

RESUMEN

The primary goal of endodontic therapy is the long-term retention of a functional tooth by preventing or treating apical periodontitis. However, there are many other factors that impact endodontic outcomes such as the quality of the restoration and structural integrity of the tooth after root canal preparation. Contemporary research efforts are currently directed to better understanding dentin behaviour and structure during aging and function. An alternative approach is to minimise structural changes during root canal therapy, which may result in a new strategy that can be labelled 'minimally invasive endodontics'. This review addresses current clinical and laboratory data to provide an overview of this new endodontic paradigm.


Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos , Preparación del Conducto Radicular/métodos , Envejecimiento/fisiología , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Preparación del Conducto Radicular/instrumentación , Diente no Vital/fisiopatología , Diente no Vital/terapia
5.
Int Endod J ; 38(12): 889-95, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16343116

RESUMEN

AIM: To study the effect of different apical shapes in prepared simulated root canals on the application of a commercially prepared calcium hydroxide paste by a syringe or lentulo spiral. METHODOLOGY: Three different types of root canal preparation were performed in 90 simulated canals: group A to an apical size 20 and a 0.10 taper using hand and rotary instruments, group B to an apical size 30 and a 0.08 taper using GT rotary instruments and group C to an apical size 40 and a 0.04 taper using ProFile 0.04 instruments. The insertion of calcium hydroxide [Ca(OH)2] paste was accomplished using either a lentulo spiral or a syringe. After 1 week of simulated fluid pressure applied to the apical end of the canal using physiological saline solution, the solution was evaluated for released Ca(OH)2. The specimens were weighed initially, after preparation, after insertion of Ca(OH)2 paste, after temporization with Cavit and after 1 week of simulated fluid pressure. Digital radiographs of the filled canals were taken and canal areas in mm2, gray values of the Ca(OH)2 dressings, total area of voids in mm2, as well as location of voids in the apical, middle or coronal thirds of the root canals were measured. Analyses of variance, with Scheffe's post-hoc tests, as well as chi-square tests were performed. RESULTS: Canals in group C had significantly fewer (P < 0.01) radiographic voids than canals in groups A and B. Using a lentulo spiral resulted in significantly (P < 0.05) fewer voids compared with the injection technique. More voids were detected coronally compared with middle and apical root canal thirds (P < 0.05). CONCLUSIONS: Canal shape and method of application had an impact on the amount and radiodensity of calcium hydroxide dressings in simulated root canals. Canals prepared to an apical size 40 and a taper of 0.04 had the least number of voids; Ca(OH)2 was placed with significantly fewer voids using a lentulo spiral compared with the injection technique.


Asunto(s)
Hidróxido de Calcio/administración & dosificación , Materiales de Obturación del Conducto Radicular/química , Hidróxido de Calcio/química , Sulfato de Calcio/administración & dosificación , Sulfato de Calcio/química , Cementos Dentales , Cavidad Pulpar/anatomía & histología , Cavidad Pulpar/diagnóstico por imagen , Combinación de Medicamentos , Humanos , Inyecciones/instrumentación , Modelos Anatómicos , Polivinilos/administración & dosificación , Polivinilos/química , Presión , Radiografía , Obturación del Conducto Radicular/instrumentación , Preparación del Conducto Radicular/métodos , Solubilidad , Propiedades de Superficie , Jeringas , Ápice del Diente/anatomía & histología , Ápice del Diente/diagnóstico por imagen , Óxido de Zinc/administración & dosificación , Óxido de Zinc/química
6.
Int Endod J ; 37(12): 849-59, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15548276

RESUMEN

AIM: To investigate clinical results of root canal treatment performed with the aid of nickel-titanium (NiTi) rotary instruments. SUMMARY: A total of 179 patients underwent root canal treatment with either (A) Lightspeed, or (B) ProFile .04 or (C) ProFile .04 and .06 or GT rotary instruments to create tapered preparations. In groups A and B, laterally condensed gutta-percha and AH Plus were used. Canals in group C were obturated with System B, Obtura II and Roth's 801 sealer. Initial and recall radiographs were assessed using the periapical index (PAI). Outcomes were analysed using chi-square tests, event-time analyses and logistic regression models. Two hundred and thirty-three teeth were radiographically assessed after a mean interval of 25.4 +/- 11.8 months. Favourable outcome of treatment, defined as PAI < 3 at recall was 86.7%. Logistic regression analysis and univariate analyses indicated that teeth with preoperative PAI scores >2 and retreated teeth had a significantly lower chance of healing compared with periapically healthy teeth and primary treatments, respectively. Preparation technique, length of fill and the type of sealer did not significantly affect healing rates. KEY LEARNING POINTS: Root canal treatment with NiTi root canal instrumentation systems renders favourable outcomes in more than 86% of the cases. Outcome is significantly affected by preoperative diagnoses but not by the specific choice of instrumentation system.


Asunto(s)
Aleaciones Dentales , Níquel , Preparación del Conducto Radicular/métodos , Tratamiento del Conducto Radicular , Titanio , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Resinas Epoxi/uso terapéutico , Diseño de Equipo , Femenino , Estudios de Seguimiento , Gutapercha/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Tejido Periapical/diagnóstico por imagen , Radiografía , Materiales de Obturación del Conducto Radicular/uso terapéutico , Preparación del Conducto Radicular/instrumentación , Tratamiento del Conducto Radicular/normas , Resultado del Tratamiento , Cicatrización de Heridas/fisiología , Cemento de Óxido de Zinc-Eugenol/uso terapéutico
7.
Int Endod J ; 36(2): 86-92, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12657151

RESUMEN

AIM: To evaluate the relative performance of ProTaper nickel-titanium (Ni-Ti) instruments shaping root canals of varying preoperative canal geometry. METHODOLOGY: Extracted human maxillary molars were scanned, before and after shaping with ProTaper, employing micro computed tomography (muCT) at a resolution of 36 mum. Canals were three-dimensionally reconstructed and evaluated for volume, surface area, 'thickness' (diameter), canal transportation and prepared surface. Based on median canal volume, canals were divided into 'wide' and 'constricted' groups. Comparisons were made between mesiobuccal (mb), distobuccal (db) and palatal (p), as well as 'wide' and 'constricted' canals, using repeated-measures anova and Scheffé posthoc tests. RESULTS: Volume and surface area increased significantly and similarly in mb, db and p canals, and gross preparation errors were found infrequently. Root canal diameters, 5-mm coronal to the apex, increased from 0.38 to 0.65 mm, 0.42 to 0.66 mm and 0.57 to 0.79 mm for mb, db and p canals, respectively. Apical canal transportation ranged from 0.02 to 0.40 mm and was independent of canal type; 'wide' canals had a significantly higher (P < 0.05) proportion of unprepared surfaces than 'constricted' canals. CONCLUSIONS: Canals in maxillary molars were prepared in vitro using ProTaper instruments without major procedural errors. These instruments may be more effective in shaping narrow canals than wider, immature ones.


Asunto(s)
Instrumentos Dentales , Cavidad Pulpar/anatomía & histología , Preparación del Conducto Radicular/instrumentación , Análisis de Varianza , Aleaciones Dentales , Cavidad Pulpar/diagnóstico por imagen , Humanos , Maxilar , Diente Molar , Níquel , Odontometría , Estadísticas no Paramétricas , Titanio , Tomografía Computarizada por Rayos X/métodos
8.
Int Endod J ; 36(2): 93-9, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12657152

RESUMEN

AIM: To investigate physical parameters for ProTaper nickel-titanium (NiTi) rotary instruments whilst preparing curved canals in maxillary molars in vitro. METHODOLOGY: A novel torque-testing platform was used to prepare root canals in 15 extracted human maxillary molars with ProTaper rotary instruments. Peak torque and force was registered along with numbers of rotations required to shape the canals. Canals were divided into 'wide' and 'constricted' groups depending on canal volumes assessed by micro computed tomography. Mean scores for each instrument type were calculated and statistically compared using anova and Scheffé posthoc tests. RESULTS: Mean torque varied between 0.8 +/- 0.5 and 2.2 +/- 1.4 N cm whilst mean force ranged from 4.6 +/- 2.6 to 6.2 +/- 2.7 N. Mean numbers of rotations totalled up to 21. All three variables registered were significantly correlated to preoperative canal volumes (P < 0.001) and differed significantly between 'wide' and 'constricted' canals (P < 0.001). CONCLUSIONS: Whilst high forces were used in some cases, no ProTaper instrument fractured when a patent glide path was present. There were significant positive correlations between canal geometry and physical parameters during shaping.


Asunto(s)
Instrumentos Dentales , Análisis del Estrés Dental , Preparación del Conducto Radicular/instrumentación , Análisis de Varianza , Aleaciones Dentales , Cavidad Pulpar/anatomía & histología , Humanos , Maxilar , Diente Molar , Níquel , Análisis de Regresión , Estadísticas no Paramétricas , Estrés Mecánico , Titanio , Torque
9.
Int Endod J ; 35(1): 22-9, 2002 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-11853235

RESUMEN

AIM: The aim of this investigation was to assess the marginal adaptation of Super-EBA (EBA) and Pro Root MTA (MTA) root-end fillings and the occurrence of microcracks in resected root-ends of extracted teeth before and after occlusal loading for a five-year equivalent period in a computer-controlled masticator. METHODOLOGY: Twenty-four molar teeth were root-filled using lateral condensation and their root-ends resected. Root-end cavities were prepared and either EBA or MTA root-end fillings were placed. All surgical procedures were completed in vitro under an operating microscope. Replicas taken of the root-end fillings and resected root-ends were examined using an SEM before and after they were subjected to in vitro chewing cycles in a computer-controlled chewing simulator for the equivalent of 5 years. Marginal adaptation and integrity of the two root-end filling materials were evaluated and the presence of microcracks recorded. RESULTS: Before loading, a continuous margin was observed with 99.4 +/- 2.4% of EBA and 99.2 +/- 1.6% of MTA root-end fillings. After loading, the percentage of continuous margin decreased to 93.1 +/- 6.6% and 98.9 +/- 3.2% for EBA and MTA, respectively. After occlusal loading, 39.5% of the EBA root-end fillings were overfilled, whilst 52.6% of the MTA root-end fillings were underfilled. In total, 12.5% of the resected root-end surfaces showed microcracking before loading and 25% after occlusal loading. CONCLUSIONS: Both EBA and MTA displayed excellent marginal adaptation before masticatory loading. After loading, the amount of continuous margin for both root-end filling materials decreased slightly but was still high.


Asunto(s)
Compuestos de Aluminio/química , Fuerza de la Mordida , Compuestos de Calcio/química , Recubrimientos Dentinarios/química , Óxidos/química , Obturación Retrógrada , Materiales de Obturación del Conducto Radicular/química , Silicatos/química , Análisis de Varianza , Simulación por Computador , Adaptación Marginal Dental , Combinación de Medicamentos , Humanos , Masticación , Microscopía Electrónica de Rastreo , Modelos Biológicos , Diente Molar , Técnicas de Réplica , Obturación Retrógrada/instrumentación , Propiedades de Superficie , Terapia por Ultrasonido/instrumentación
10.
Int Endod J ; 34(2): 142-8, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11307263

RESUMEN

AIM: This study compared the appearance of root-end cavity preparations and the time required to prepare them using prototype ultrasonic diamond-coated (DC) and stainless-steel (SS) retrotips. METHODOLOGY: In 12 maxillary and 12 mandibular molar teeth 48 root-end cavities were prepared ultrasonically in the palatal, mesio-buccal, distal and mesial root-ends using DC and SS retrotips, alternately. Replicas of the resected root tips and the root-end cavities were examined under a scanning electron microscope (SEM), recording (i) incidence and extent of dentine cracks (ii) minimum remaining thickness of the dentine walls and (iii) surface quality of the resected root-ends. The time taken to complete the preparation was also recorded. Means of these parameters were compared for both types of retrotips using nonparametric tests. RESULTS: No resected root-ends had cracks before preparation. However, after preparation one root-end cavity shaped by an SS retrotip had a microcrack visible at 23x magnification. Four and seven other root-ends had crazed surfaces in the DC and SS groups, respectively (P > 0.05). Remaining minimum dentine thickness was 0.56 +/- 0.28 mm and 0.71 +/- 0.24 for the DC and SS groups, respectively, and this difference was significant (P < 0.05). A root-end cavity in one specimen in the DC group was perforated. Preparation times ranged from 25 s to 361 s and were significantly lower for DC tips (P < 0.01) than the SS tips. The time required to prepare root-end cavities also differed between roots; root-end preparation in mandibular molars was more time consuming. CONCLUSIONS: A better quality surface was produced by the prototype diamond-coated retrotips, in less time than the SS retrotips, which in turn caused fewer cracks than previously reported. DC retrotips removed more dentine than SS retrotips and should therefore be used with care to avoid overpreparation or perforation.


Asunto(s)
Apicectomía/instrumentación , Diamante , Preparación del Conducto Radicular/instrumentación , Acero Inoxidable , Ápice del Diente/ultraestructura , Raíz del Diente/ultraestructura , Terapia por Ultrasonido/instrumentación , Apicectomía/métodos , Dentina/ultraestructura , Diseño de Equipo , Humanos , Incidencia , Microscopía Electrónica de Rastreo , Diente Molar , Técnicas de Réplica , Preparación del Conducto Radicular/métodos , Estadísticas no Paramétricas , Propiedades de Superficie , Factores de Tiempo , Terapia por Ultrasonido/métodos
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