Contemporary endodontics - part 2.

The aim of this paper is to present the contemporary developments in root canal treatment, restoration of the endodontically treated tooth, and advanced endodontic procedures, such as root canal retreatment and surgical endodontics.

Contemporary endodontics - part 1.

This is the first of two review papers which aim to update the general dental practitioner on contemporary endodontic practice. This first paper reviews advancements in knowledge of endodontic infections, case selection and diagnosis. An overview is given of contemporary pulp therapy and the role of antibiotics in endodontics. The second paper assesses the recent developments in root canal treatment, restoration of the endodontically treated tooth, and advanced endodontic procedures, ie root canal retreatment and surgical endodontics.

The use of limited cone beam computed tomography in the diagnosis and management of a case of perforating internal root resorption.

AIM: To describe the use of cone beam computed tomography (CBCT) in the diagnosis and management of a maxillary lateral incisor with perforating internal root resorption (IRR). SUMMARY: Root resorption is the loss of dentine or cementum as a result of osteoclastic cell action. IRR occurs exclusively as a result of pulpal inflammation. Until very recently, the diagnosis of internal and external resorptive defects has been limited to the information obtained from conventional radiographic techniques. This case report describes the use of CBCT in the diagnosis and treatment planning of a case of perforating IRR. Emphasis is given to the modifications made to the treatment procedures in view of the additional information obtained from the CBCT data. KEY LEARNING POINTS: • Internal root resorptive defects may perforate the external root surface, and this may not be detectable using conventional radiographic techniques; consideration of this should be made during diagnosis and treatment planning. • CBCT provides additional relevant information on the location and nature of root resorptive defects when compared with that provided by conventional radiographs. • CBCT findings may modify treatment planning, as well as the techniques that may be employed during both non-surgical and surgical endodontic treatment.

Why do general dental practitioners refer to a specific specialist endodontist in practice?

AIMS: To identify the factors that influence the decision of general dental practitioners (GDPs) in Northern Ireland to refer to a specific specialist endodontist. METHODOLOGY: A self-administered questionnaire was sent to 220 GDPs in Northern Ireland. The questionnaire comprised questions on demographic characteristics, pattern of practice, pattern of referral and factors influencing the decision to refer to a specific specialist endodontist in practice. The data were analysed using descriptive statistics and the chi-squared (χ(2) ) test at the 0.05 level of significance. RESULTS: The response rate was 81%. All respondents stated that they carried out root canal treatment, and the majority (83%) stated that they also carried out root canal retreatment. A minority of respondents (11%) stated that they carried out surgical endodontics. These individuals were more likely to be men, hold a postgraduate qualification, or work in a rural location. The majority of respondents (94%) referred patients with an endodontic problem. These individuals were more likely to be women, not hold a postgraduate qualification, or not carry out surgical endodontics. GDPs indicated a preference for referring to a specialist endodontist in practice over other treatment providers. Factors considered to be of importance in the decision to refer to a specialist endodontist in practice included the practice location of, reputation of, communication with and patient management by the specialist endodontist. The greatest proportion of respondents ranked short waiting time for a consultation as the top promoter when referring to a specific specialist endodontist in practice. CONCLUSION: The decision by GDPs to refer to a specific specialist endodontist in practice is multifactorial and influenced by several factors independent from the nature of endodontic disease. In Northern Ireland, the top promoter for referring to a specific specialist endodontist in practice was a relatively short waiting time for a consultation.

Matrix metalloproteinase-3 differences in oral and skin fibroblasts.

While skin wounds heal by scarring, wounds of oral mucosa show privileged healing with minimal scar formation. Our hypothesis was that phenotypic differences between oral and skin fibroblasts underlie these differences in healing. The aims of this study were to compare MMP-3 expression by oral and skin fibroblasts and investigate a role for MMP-3 in mediating collagen gel contraction. Oral fibroblasts induced significantly greater gel contraction than did paired skin cells. Inhibition of MMP activity significantly inhibited gel contraction by both cell types. Specific inhibition of MMP-3 activity reduced gel contraction by oral, but not skin, fibroblasts. Oral fibroblasts produced significantly higher levels of MMP-3 than did skin fibroblasts at all levels studied. TGF-beta1 and -beta3 isoforms stimulated MMP-3 expression at mRNA, protein, and activity levels by both fibroblast populations. Results suggest that increased MMP-3 production by oral fibroblasts may underlie the differences in wound-healing outcome seen in skin and oral mucosa.

The Charles Bonnet syndrome: symptomatic relief with atypical neuroleptics: a case series.

We describe a consecutive case series of five patients who all fulfil published criteria for Charles Bonnet syndrome. Four of the five patients showed a good response to the atypical antipsychotic sulpiride. The nature of the Charles Bonnet syndrome is briefly reviewed.