Comparison of heat-testing methodology.

INTRODUCTION: Patients with irreversible pulpitis occasionally present with a chief complaint of sensitivity to heat. To appropriately diagnose the offending tooth, a variety of techniques have been developed to reproduce this chief complaint. Such techniques cause temperature increases that are potentially damaging to the pulp. Newer electronic instruments control the temperature of a heat-testing tip that is placed directly against a tooth. The aim of this study was to determine which method produced the most consistent and safe temperature increase within the pulp. This consistency facilitates the clinician's ability to differentiate between a normal pulp and irreversible pulpitis. METHODS: Four operators applied the following methods to each of 4 extracted maxillary premolars (for a total of 16 trials per method): heated gutta-percha, heated ball burnisher, hot water, and a System B unit or Elements unit with a heat-testing tip. Each test was performed for 60 seconds, and the temperatures were recorded via a thermocouple in the pulp chamber. Analysis of the data was performed by using the intraclass correlation coefficient. RESULTS: The least consistent warming was found with hot water. The heat-testing tip also demonstrated greater consistency between operators compared with the other methods. Hot water and the heated ball burnisher caused temperature increases high enough to damage pulp tissue. CONCLUSIONS: The Elements unit with a heat-testing tip provides the most consistent warming of the dental pulp.

Endodontic diagnostic terminology update.

Determination of the etiology of the patient's chief complaint and a correct diagnosis are paramount prior to a recommendation of endodontic therapy. Reproduction of the patient's chief complaint is critical. If the chief complaint cannot be reproduced, consider consultation with or referral to an endodontist or orofacial pain specialist. The diagnostic terminology presented in this update provides for a more accurate description and communication of the health or pathological conditions of both pulpal and apical tissues. This information is summarized in Table I.

Mandibular first molar with six separate canals.

INTRODUCTION: Many anatomical variations can occur within the mandibular first molar. Commonly, 3-4 canals are located, but as many as 6-7 canals have been reported. METHODS: This report describes a case of a mandibular first molar with 6 separate canals (3 mesial and 3 distal) that was instrumented with conventional hand and rotary files and obturated by using a hybrid warm vertical compaction technique. RESULTS: Recall examination as far as 3 years post-treatment found no sensitivity to percussion or palpation and recall radiographs after treatment show resolution of the previous apical periodontitis. CONCLUSIONS: The existence of such teeth as these underlies the importance of looking for additional canals.

Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain.

This study compares single-dose ibuprofen pretreatment for postoperative endodontic pain. Thirty-nine emergent patients were randomly assigned to 3 groups: placebo, ibuprofen tablets, or ibuprofen liquigels. Patients recorded their pain levels before and at the end of treatment, then every 6 hours for 24 hours after administration of the medications and standard endodontic treatment. Pain evaluations by using 3 pain scales (visual analog scale [VAS], category, and Heft-Parker) were highly correlated, suggesting the rationale for only using one pain scale in pain studies. No significant differences in postoperative pain levels were found between either single-dose ibuprofen formulation or the placebo control group (P = .84). Patients treated with calcium hydroxide versus obturation did not differ in postoperative pain levels (P = .44). This study suggests that single-dose pretreatment analgesia alone in endodontic pain patients will not significantly reduce postoperative pain below the reduction in pain from endodontic treatment.

Gender differences in analgesia for endodontic pain.

The purpose of this prospective clinical trial was to investigate the analgesic efficacy of three oral medication groups on postoperative endodontic pain in male and female dental patients, with an emphasis on analgesic differences between the sexes. Forty-three patients were administered ibuprofen 600 mg, placebo, or pentazocine 50 mg/0.5 mg naloxone in a randomized, double-blinded manner. Beginning immediately after endodontic treatment, patients took the assigned medication every 6 hours for 24 hours and recorded their degree of discomfort on a 100-mm visual analog scale. Statistical analysis of the data showed that ibuprofen 600 mg provided statistically significantly greater analgesia than placebo at 6 and 12 hours (P = 0.0014 and 0.0024), and pentazocine/naloxone provided statistically significantly greater analgesia than placebo at 12 hours (P = 0.0084). Sex-dependent differences were noted within the pentazocine/naloxone group, which showed significantly greater analgesia in females compared with males (P = 0.007).

Factors affecting outcomes for single-tooth implants and endodontic restorations.

Initial root canal therapy and implant placement are both common treatment modalities, and, as such, prognostic factors that influence the treatment outcomes of these two restorations should be identified. In a retrospective chart review, 196 implant restorations and 196 matched initial nonsurgical root canal treated (NSRCT) teeth in patients were evaluated for four possible outcomes-success, survival, survival with intervention, and failure. Results showed that smokers had fewer successes and more failures in both groups (p = 0.0001), whereas NSRCT outcomes were affected by periradicular periodontitis (p = 0.001), post placement (p = 0.013), and overfilling (p = 0.003). Outcomes for both groups were not significantly affected by diabetes, age, or gender. Implant group outcomes were not affected by implant length (from 10 to 16 mm), diameter (from 3.25 to 5.5 mm), or an adjacent endodontically treated tooth, nor were NSRCT outcomes affected by the number of appointments for the procedure.

Cemental tear: a case report of a rare root fracture.

A 79-yr-old female presented to the clinic for endodontic evaluation of an unresolved periodontal defect. The patient's dental history included extraction of tooth #30 with subsequent placement of two dental implants. The patient presented with a localized periodontal defect on the distal of tooth #29. Radiographic evaluation revealed a thin radiopacity and associated radiolucency along the entire lateral aspect of tooth #29. Periodontal surgery and biopsy resulted in a diagnosis of cemental tear. Cemental tears have been rarely reported in the endodontic literature. Case reports of cemental tears have been associated with age, trauma, and traumatic occlusion. With the increasing age of the dental population and longer retention of teeth, clinicians should be aware of this rare entity.