The Effect of General Anesthesia on the Outcome of Root Canal Treatment in Pediatric Patients-A Retrospective Cohort Study.

This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8-15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration.

Systemic antibiotics in endodontics-International questionnaire study: Choice of types, dosage, loading and duration.

The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.

International questionnaire study on systemic antibiotics in endodontics. Part 1. Prescribing practices for endodontic diagnoses and clinical scenarios.

OBJECTIVES: Part 1 of this two-part study aims to investigate systemic antibiotics (SA) prescribing practices for various endodontic diagnoses and clinical scenarios by general practitioners, post-graduate students and endodontists in Israel and the former Soviet Union (FSU) states. MATERIALS AND METHODS: A total of 7500 dentists from Israel and FSU states were invited to fill in an online questionnaire. The questionnaire consisted the SA prescribing for endodontic diagnoses and clinical scenarios (post operative pain, post apical surgery and post avulsion). The international guidelines of the European Society of Endodontology and the American Association of Endodontists were used as the standard of correct practice. RESULTS: A total of 1310 dentists (response rate of 17.46%, 498 Israeli and 812 FSU dentists) completed the survey. The rates of prescription SA among the Israeli and the FSU respondents for non-recommended diagnoses and clinical scenarios were 24.75% and 11.42% (P>0.05), 16.57% and 16.17% (P>0.05) respectively. The rates of prescription SA among the Israeli and the FSU respondents for recommended diagnoses and clinical scenarios were 63.39% and 62.9% (P>0.05), 27.2% and 13.9% (P>0.05) respectively. CONCLUSIONS: There are gaps between the recommended protocols for prescribing SA for patients with various endodontic diagnoses and clinical scenarios and the actual practices among Israeli and FSU dentists. Continuing education of dentists must be encouraged in order to improve SA prescription practice according to international guidelines. CLINICAL RELEVANCE: When not indicated, prescription of systemic antibiotics might lead to antimicrobial resistance, while non-prescription, when required, might have negative repercussions on the patient's health. Knowledge of the prescription habits of dentists in the endodontic practice will help prevent harmful situations.

The effect of dentin on the pulp tissue dissolution capacity of sodium hypochlorite and calcium hydroxide.

INTRODUCTION: Sodium hypochlorite (NaOCl) and calcium hydroxide (Ca[OH]2) have tissue dissolution capacity. The aim of this study was to evaluate the potential effect of dentin on their tissue dissolution capacity in a novel dentin model. METHODS: Dentin models were prepared from 25 freshly extracted human molar teeth; the crowns were separated from the roots, and a rectangular inner shape was prepared. Pulp tissue samples adjusted to similar weights of 6.5 ± 0.2 mg were randomly divided into 6 groups: NaOCl groups in test tubes or dentin models for 1 hour, Ca(OH)2 groups in test tubes or dentin models for 1 week, and control groups saline in test tubes or dentin models for 1 week. The final weights after the experimental period were checked and compared with the initial weights. The differences were statistically analyzed. RESULTS: The tissue dissolution capacity of Ca(OH)2 was affected by the presence of dentin. Similarly, NaOCl lost its effect on the pulp tissue after incubation in dentin. Comparison between all test groups showed highly significant differences (P < .001). CONCLUSIONS: Dentin has a detrimental effect on the ability of NaOCl and Ca(OH)2 to dissolve pulp tissue. The dentin model appears to be an efficient tool for the study of interactions between local endodontic medicaments, dentin, and pulp tissue.

The effect of commonly used sutures on inflammation inducing pathogens - an in vitro study.

INTRODUCTION: Sutures are a vital part of nearly every surgical procedure designed to close and stabilize wound margins consequently allowing undisturbed wound healing. AIM: The aim of this study was to evaluate in vitro antimicrobial effect of 4 commonly used sutures. MATERIALS AND METHODS: The Direct Contact Test was used to evaluate the antibacterial properties of 4 types of sutures: 2 absorbable and 2 non-absorbable braided sutures, immediately or after aging for 2 or 7 days. The tested bacteria were: Staphylococcus epidermidis, Staphylococcus aureus and Pseudomonas aeruginosa. Three-way ANOVA, two-way ANOVA, one-way ANOVA and Tukey multiple comparison were used for statistical analysis. RESULTS: The absorbable Vicryl Plus exhibited a bactericidal effect against the Staphylococcus strains, which was unaffected by aging. With P. aeruginosa, there was only an initial delay in bacterial growth. All other tested sutures did not have antibacterial effects against any of the tested bacteria (p < 0.001). CONCLUSIONS: Vicryl Plus had sustained bactericidal effect against the Staphylococcus strains but not against P. aeruginosa. None of the other sutures presented any antibacterial properties.

Do dental impression materials play a role in cross contamination?

OBJECTIVE: Dentists are required to institute infectious control procedures. Dental impression materials possessing antimicrobial properties may aid in reducing the risk of cross contamination since impression materials might play a role as carriers. The purpose of this study was to evaluate the antimicrobial properties of four impression materials. METHOD AND MATERIALS: Four impression materials--Orthoprint, Impregum Penta, Aquasil Ultra Monophase, and Permlastic--were evaluated by the direct contact test. The materials were tested in contact with Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, and Candida albicans. The materials were mixed; allowed to set; and examined immediately and after aging for 24, 48, and 72 hours and 1 week. Two-way ANOVA, one-way ANOVA, and Tukey multiple comparison procedures were applied to the results. RESULTS: Impregum Penta presented the broadest antibacterial spectrum of all the materials tested. There was a complete growth inhibition of S aureus and S epidermidis, and it sustained this ability for at least 7 days. It also showed an antifungal effect by partially inhibiting the growth of C albicans, a quality that was seen only immediately after setting. Aquasil Ultra showed an antifungal effect only immediately after setting. Permlastic showed a complete growth inhibition when in contact with C albicans and sustained this ability for at least 7 days. No significant antimicrobial properties were recorded for Orthoprint. When in contact with E faecalis, no significant antibacterial properties were recorded for any of the materials. CONCLUSION: None of the tested materials exhibited a long-lasting or complete antibacterial and antifungal property. Therefore, disinfection of impressions is essential.

Antibacterial properties of pit and fissure sealants combined with daily fluoride mouth rinse.

PURPOSE: Pit and fissure sealants are widely used in the prevention of initial occlusal caries. The purpose of this study was to determine whether fluoride releasing pit and fissure sealants regain their antibacterial properties after rinsing with a fluoride solution. METHOD: Helioseal F, Ultraseal XT, Dyract Seal, and GC Fuji TRIAGE were placed on the sidewalls of the wells of a 96-microtiter plate. After polymerization and a 30 day aging process, the samples were rinsed daily with a 0.05% NaF solution for 14 days. Twenty four hours after the last fluoride rinse, freshly grown Streptococcus mutans cells (circa 1 x 106) were placed on the surface of each sample for 1 hour at 37 degrees C. Growth medium was then added to each well and bacterial growth was followed for 24 hours in a temperature-controlled spectrophotometer. Similar experiments were conducted on samples 48 hours and 72 hours after the last fluoride rinse. RESULTS: The results showed that both GC Fuji TRIAGE and Dyract Seal possessed antibacterial properties 24 hours after the last fluoride exposure. GC Fuji TRIAGE maintained potent antibacterial properties 48 hours after the last fluoride rinse. 72 hours after the last fluoride rinse none of the materials showed any antibacterial properties. CONCLUSIONS: None of the tested materials showed any antibacterial properties after a 30 day aging process An aging process of all tested sealant materials, for 30 days, resulted in a complete elimination of their antibacterial properties. After a daily 30 second rinse for two weeks with a 0.05% NaF solution, the antibacterial attributes of the glass-ionomer and the compomer based sealants were regained.

Temperature rises beneath resin composite restorations during curing.

PURPOSE: To compare the thermal conductivity of two different composite materials, with five light-cure units, in a series of different material thicknesses and light source distances. METHODS: Two commonly used resin composite restorative materials and three light emitting diodes (LED), one halogen, and one plasma arc lights were selected. The thermal conductivity of the composite materials with different light curing units (LCU) was measured and compared. A K-type thermocouple and digital thermometer were used to assess the thermal conductivity. Materials depths of 1 mm, 2 mm and 4 mm and curing distances of 0 mm, 3 mm and 6 mm were compared. Four-way ANOVA was used to analyze the Ln transformation of the maximal temperature and a Tukey test for multiple comparisons. RESULTS: Significant differences in temperature rise were observed between the two restorative materials. The thermal emission of the LED lights was higher than the other LCU's measured. An inverse ratio was found between material thickness and the measured thermal conductivity and the distance of the light tip from the restorative material.

In vitro antibacterial evaluation of flowable restorative materials.

OBJECTIVES: The microgap at the tooth-restoration interface is inevitable and may allow bacterial penetration that could lead to failure. The purpose of this in vitro study was to assess the antibacterial potential of 4 flowable composite restorative materials. METHOD AND MATERIALS: The antibacterial potential of Aeliteflo (Bisco), Filtek Flow (3M ESPE), Tetric Flow (Ivoclar Vivadent), and Dyract Flow (Dentsply) was tested against Streptococcus mutans. Agar diffusion test (ADT) and direct contact test (DCT) were the methods used. For ADT, wells were punched in S mutans-inoculated plates. The materials were placed in the wells and polymerized. Inhibition zones were measured after 48 hours' incubation at 37 degrees C. In the DCT, 8 samples of each tested material were placed on the side walls of wells in a 96-microtiter plate and polymerized. A suspension of S mutans was placed on the surface of each sample. Bacterial growth was monitored by optical density changes at 650 nm every 30 minutes for 16 hours. The experiment was repeated after the samples were aged in phosphate-buffered saline for 1 and 7 days. RESULTS: In both tests, only Dyract Flow showed inhibition of S mutans growth. Except for Dyract Flow samples, aged samples did not statistically differ in S mutans inhibition when compared to their 1-hour control counterparts. Dyract Flow samples lost their S mutans inhibitory potential after 24 hours. CONCLUSION: The flowable composites tested do not possess effective long-term antibacterial ability.

Odontogenic sinus tracts: a cohort study.

OBJECTIVE: To determine the prevalence,location, and distribution of sinus tracts in patients referred for endodontic consultation. METHOD AND MATERIALS: This cohort study included 1,119 subjects referred for endodontic consultation, 108 of whom presented with sinus tracts. Following clinical and radiographic examination, the diameter of the rarifying osteitis lesion on the radiograph was measured and the path and origin of the sinus tracts determined. Signs and symptoms, tooth site,buccal/lingual location, and diameter were recorded. Data were statistically analyzed using Pearson chi-square test. RESULTS: Sinus tracts originated mainly from maxillary teeth (63.1%); only 38.9% originated from mandibular teeth. Chronic periapical abscess was the most prevalent diagnosed origin (71.0%). Broken restorations were highly associated with the presence of sinus tracts (53.0%). The most frequent site of orifices was buccal(82.4%), followed by lingual or palatal (12.0%). Orifices on the lingual aspect of the gingiva were observed in mandibularmolars. There was an 86.8% correlation between the occurrence of an apically located sinus tract and apical rarifying osteitis(P<.01). CONCLUSION: Sinus tract in the lingual or palatal aspect of the gingiva is relatively common. Practitioners should look for signs of sinus tract during routine examination

Restoration of endodontically treated teeth review and treatment recommendations.

Coronal restorations and posts can positively influence the long-term prognosis of teeth following root canal therapy. Final sealing the canal by placing an appropriate post and core will minimize leakage of oral fluids and bacteria into the periradicular area and is recommended as soon as possible after completion of root canal filling. Glass ionomer or MTA placed over the residual root canal filling after post space preparation may be effective to prevent bacterial leakage. A ferrule of 1-2 mm of tooth tissue coronal to the finish line of the crown significantly improves the fracture resistance of the tooth and is more important than the type of the material the core and post are made of.

Antibacterial properties of four endodontic sealers.

The purpose of this study was to evaluate the antimicrobial effects of root canal sealers. The direct contact test (DCT) was used to assess the antibacterial properties of AH plus, Apexit Plus, Epiphany SE, and RoekoSeal when in contact with Enterococcus faecalis. The materials were examined immediately after setting and 1, 2, 7, and 14 days after aging in phosphate-buffered-saline. Statistical analysis with two-way analysis of variance, one-way analysis of variance, and Tukey multiple comparison was applied to the data. Apexit Plus had a short-term antibacterial effect of 1 day on E. faecalis, whereas Epiphany SE enhanced bacterial growth for at least 7 days. AH plus and RoekoSeal were ineffective.

The influence of 2 condensation techniques on the marginal seal of packable resin composite restorations.

OBJECTIVE: To evaluate the effect of manual condensation versus a combination of manual and mechanical, or automatic, condensation on the gingival marginal seal of packable resin composite restorations. METHOD AND MATERIALS: Two packable composites, Pyramid Dentin (Bisco Dental) and Filtek P-60 (3M Espe), were tested. The study consisted of 37 extracted caries-free human molars and premolars. In each tooth, 2 standardized Class 2 cavities were prepared and restored using the incremental technique; the mesial restoration was condensed by hand instrument, and the distal by a combination of the manual and mechanical condenser (KaVo). Restored teeth were subjected to automatic thermal stresses and cycling load stresses. Teeth were immersed in 0.5% basic fuchsin at 37 degrees C for 96 hours. Samples were sectioned mesiodistally in 3 sections. Dye penetration at the gingival margin was examined. RESULTS: Automatic condensation of Filtek P-60 and Pyramid demonstrated better sealing properties, with a median dye penetration of 0 and 1, respectively (on a dye penetration scale of 0 to 3), compared to manual condensation, median of 2 (P = .043) and 3 (P = .079), respectively. Better sealing ability was shown with P-60 than with Pyramid Dentin when manual condensation was used (P = .037). No significant difference was observed between the 2 products when tested with automatic condensation (P = .066). CONCLUSION: In this in vitro study the combination of manual and automatic condensation resulted in reduced gingival margin microleakage for both packable composites.

Antibacterial properties of self-etching dental adhesive systems.

BACKGROUND: Dental adhesives with antibacterial properties may reduce recurrent or secondary caries. The authors conducted a study to examine the immediate and long-lasting antibacterial properties of four self-etching adhesive systems. METHODS: The authors used the agar diffusion test (ADT) and direct contact test (DCT) to measure the antibacterial properties of AdheSe (Ivoclar Vivadent, Schaan, Liechtenstein), Adper Prompt L-Pop (3M ESPE, Seefeld, Germany), Clearfil Protect Bond (Kuraray, Kurashiki, Okayama, Japan) and Xeno III (Dentsply, Konstanz, Germany) on Streptoccocus mutans after aging samples in phosphate-buffered saline for one, two, seven and 14 days. RESULTS: Only Clearfil Protect Bond showed an inhibition halo in the ADT. In the DCT, fresh samples of all of the tested materials exhibited potent antibacterial properties, which were maintained by AdheSe for one day and Clearfil Protect Bond for seven days. None of the adhesive systems exhibited any antibacterial properties after 14 days. CONCLUSIONS: All of the tested adhesives had an immediate bactericidal effect on S. mutans. None, however, had long-lasting antibacterial properties. CLINICAL IMPLICATIONS: The application of self-etching adhesive materials could contribute to the immediate elimination of residual bacteria. The likelihood of developing secondary caries as a consequence of bacterial microleakage may not be affected by the use of the adhesive systems tested in this study.

Antibacterial properties of temporary filling materials.

The purpose of this study was to investigate the antibacterial properties of temporary fillings. The direct contact test (DCT) was used to evaluate the antibacterial properties of Revoltek LC, Tempit, Systemp inlay, and IRM. These were tested in contact with Streptococcus mutans and Enterococcus faecalis. The materials were examined immediately after setting, 1, 7, 14, and 30 days after aging in phosphate buffered saline (PBS). Statistical analysis included two-way ANOVA, one-way ANOVA, and Tukey multiple comparison. Systemp inlay, Tempit, and IRM exhibited antibacterial properties when in contact with S. mutans for at least 7 days, Tempit and IRM sustained this ability for at least 14 days. When in contact with E. faecalis Tempit and IRM were antibacterial immediately after setting, IRM sustained this ability for at least 1 day. Our study suggests that the difference in temporary filling materials may influence which microorganism will be able to invade the root canal system.

Antibacterial properties of 4 orthodontic cements.

BACKGROUND: White spot lesions are observed in nearly 50% of patients undergoing orthodontic treatment. Long-lasting antibacterial properties of orthodontic cements can reduce this phenomenon. METHODS: The antibacterial properties of 4 orthodontic cements were evaluated by direct contact test (DCT) and agar diffusion test (ADT). With the DCT technique, octet specimens of glass ionomer (CX-Plus; Shofu, Kyoto, Japan), reinforced glass ionomer (GC Fuji ORTHO LC; GC Corporation, Tokyo, Japan), and 2 composite (Transbond XT and Transbond Plus; 3M Unitek, Monrovia, Calif) orthodontic cements were placed on the sidewalls of wells of a 96-microtiter plate. Streptococcus mutans cells (ca. 1 x 10(6) ) were placed on the surface of each specimen for 1 hour at 37 degrees C. Then, fresh media was added to each well, and bacterial growth was monitored for 16 hours with a temperature-controlled spectrophotometer. This was repeated on specimens aged in phosphate-buffered saline for 1 day, 1 week, and 1 month. The ADT was performed by placing specimens in wells punched in agar plates. RESULTS: Measurement of the halo in bacterial lawn after 48 hours showed that only the glass ionomer cement (CX-Plus) produced an inhibition zone (1.2 mm around the sample). Results at the DCT showed that only the reinforced glass ionomer cement (GC Fuji ORTHO LC) exhibited potent antibacterial activity, which lasted 1 week and diminished over the next 3 weeks. CONCLUSIONS: The reinforced glass ionomer cement possessed the most potent and long-lasting antibacterial activity.

Surface antibacterial properties of packable resin composites: part I.

OBJECTIVE: Restorative materials that possess antibacterial properties are considered advantageous. The aim of this study was to test the antibacterial properties of packable resin composite materials using a direct contact test (DCT) and an agar diffusion test (ADT). METHODS AND MATERIALS: Quadruple samples of SureFil, Alert, P-60, Synergy Compact, Pyramid, and Solitair were placed on the sidewalls of wells in a 96-microtiter plate, and polymerized. A suspension of 10-microL growth medium containing ca. 1 x 10(6) viable mutans streptococci cells were placed on the surface of each sample for 1 hour at 37 degrees C. Fresh medium was then added to each well, and the microtiter plates were placed in a temperature-controlled spectrophotometer which also served as an incubator. Bacterial growth was followed by recording the changes in optical density every 30 minutes for 16 hours. The ADT was performed by placing samples in punched wells of inoculated agar plates, and measurement of the inhibition zone was performed after 72 hours. RESULTS: In both tests, none of the materials inhibited growth of S. mutans. In the DCT, three materials enhanced bacterial growth. Composite samples, aged in phosphate buffered saline for 7 and 30 days, showed no differences when on tested material and controls. CONCLUSIONS: Packable composite materials revealed no antibacterial properties. Furthermore, freshly polymerized composites supported bacterial growth.

Antibacterial surface properties of polymerized single-bottle bonding agents: part II.

OBJECTIVE: Microorganisms are directly associated with the etiology of enamel, dentin, and pulpal pathology. Due to the growing usage of one-bottle bonding materials with resin composite restorations, as well as sealing agents with amalgam restorations, it is important that they possess antibacterial properties. In the present study, the antibacterial properties of polymerized one-bottle bonding agents were tested, using the direct contact test (DCT) and the agar diffusion test (ADT). METHOD AND MATERIALS: Quadruple samples of the following materials were tested in both assays: Bond-1, OptiBond Solo, One-Step, Gluma, Prime & Bond NT, and Synergy. In the DCT, samples were placed on the sidewalls of wells of a 96-microtiter plate and polymerized. A 10-microL suspension of Streptococcus mutans was placed on the surface of each sample for 1 hour at 37 degrees C. Fresh media was then added, and bacterial growth was followed with a temperature-controlled spectrophotometer. In the ADT, samples were placed in punched wells of inoculated agar plates, and halos in the bacterial lawn were measured after 72 hours. RESULTS: In the DCT, all the tested bonding agents exhibited potent antibacterial properties; virtually no viable bacteria were present in any of the samples. When the samples were aged in phosphate-buffered saline for 24 hours, all the tested agents, similar to the freshly polymerized samples, exhibited potent antibacterial properties. This property was lost in samples aged for 7 days. Fresh samples assayed by ADT demonstrated no inhibition halo around any of the samples. CONCLUSION: Collectively, the present data suggest that one-bottle bonding agents possess in vitro antibacterial properties for at least 24 hours. This phenomenon was demonstrated only by DCT.

Surface antibacterial properties of fissure sealants.

PURPOSE: Sealants form a physical barrier between the oral environment and deep fissures that contribute to caries prevention. It is postulated that sealants possessing antibacterial properties are advantageous. The purpose of this study was to evaluate the antibacterial properties of four pit and fissure sealants using direct contact test (DCT) and agar diffusion test (ADT). METHODS: For the DCT, 8 samples of Helioseal F (Vivadent), Ultraseal XT (Ultadent-Weldent), Conseal F (SDI), and Dyract Seal (Dentsply) were placed on the sidewalls of wells of a 96-microtiter plate. After polymerization, freshly grown Streptococcus mutans cells (circa 1 x 10(6)) were placed on the surface of each sample for 1 hour at 37 degrees C. Fresh media was then added to each well and bacterial growth was followed for 16 hours by temperature-controlled spectrophotometer. Similarly prepared samples were aged in phosphate buffered saline for 14 and 30 days and the DCT was repeated. The ADT was performed by placing samples in uniform wells punched in agar plates. RESULTS: Freshly polymerized samples in the DCT, Dyract Seal and Ultraseal XT possessed prominent antibacterial properties. Dyract Seal also demonstrated the most potent antibacterial properties, which lasted 14 days but faded within 30 days. In ADT, the halo in the bacterial lawn was measured after 48 hours, and only Dyract Seal demonstrated an inhibition zone. CONCLUSIONS: The compomer-based sealant Dyract Seal possessed the most potent and longest lasting antibacterial activity.

Endodontic failure caused by inadequate restorative procedures: review and treatment recommendations.

A review of the literature was performed to determine whether prompt placement of coronal restorations, including sealing and placement of posts and cores, can positively influence the long-term prognosis of teeth after root canal therapy. Both hand and MEDLINE searches were employed to identify peer-reviewed articles on radicular apical integrity after coronal restorations, especially where root canal space was used for post and core fabrication. A total of 41 articles published between 1969 and 1999 (the majority from the 1990s) were reviewed. The literature suggests that the prognosis of root canal-treated teeth can be improved by sealing the canal and minimizing the leakage of oral fluids and bacteria into the periradicular areas as soon as possible after the completion of root canal therapy.