Emergency assessment and treatment planning for traumatic dental injuries.

Trauma involving the dentoalveolar region is a frequent occurrence which can result in the fracturing and displacement of teeth, crushing and/or fracturing of bone and soft tissue injuries including contusions, abrasions and lacerations. This review describes the assessment of patients with these injuries, not in a didactic sense by repeating excellent already published classifications and treatment options, but by addressing questions that arise during assessment. It covers trauma first aid, examination of the patient, factors that affect treatment planning decisions, and the importance of communicating treatment options and prognosis to traumatized patients.

[Introduction to the Hebrew edition of the guidelines for the management of traumatic dental injuries by the International Association of Dental Traumatology].

The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. As a part of the IADT global effort to provide accessibility to these guidelines worldwide, we present here an Hebrew version of the official IADT guidelines.

The effect of different taper preparations on the ability of sonic and passive ultrasonic irrigation to reach the working length in curved canals.

AIM: To evaluate the penetration of irrigants up to working length using two different activation systems in curved canals instrumented with 0.04 and 0.08 taper instruments. METHODOLOGY: Sixty-eight mesiobuccal canals from mandibular first molars with curvatures between 30° and 40° were used. The samples were divided into group 1, canals instrumented to size 30, 0.04 taper, and group 2, instrumented to size 30, 0.08 taper. Both groups were irrigated with a contrast solution and divided in 2 subgroups of 15 samples each: Groups 1A and 2A were activated with passive ultrasonic irrigation (PUI), whilst groups 1B and 2B were activated with sonic irrigation (SI). Radiographs were taken to evaluate the penetration of the contrast solution up to working length. This evaluation was performed using Adobe Photoshop CS5. Results were analysed with the chi-square test and a logistic regression model. RESULTS: Only groups with 0.04 taper demonstrated significant differences where the activation with PUI was superior at reaching working length than SI (P = 0.010). The logistic regression model showed that the only correlation in reaching working length was the activation system used (P = 0.005). CONCLUSION: The results suggest that variation of canal taper does not affect the ability of PUI to reach the working length in curved canals whilst SI obtained inferior results with 0.04 taper canal preparations.

The effect of using an alternative irrigant between sodium hypochlorite and chlorhexidine to prevent the formation of para-chloroaniline within the root canal system.

AIM: To determine if the formation of para-chloroaniline (PCA) can be avoided by using an alternative irrigant following sodium hypochlorite but before chlorhexidine. METHODOLOGY: Fifty-five single-rooted teeth were decoronated, instrumented to size 40, .06 taper whilst being irrigated with 14% ethylene-diamine-tetra-acetic acid (EDTA) and 6% NaOCl. Samples were then randomly divided into three experimental and two control groups. Group 1 was irrigated with saline followed by 2% chlorhexidine gluconate (CHX). Group 2 was irrigated with 50% citric acid (CA) followed by 2% CHX. Group 3 was irrigated with 14% EDTA followed by 2% CHX. The chemical identity and quantification of the PCA in the formed precipitate was determined using gas chromatography/mass spectrometry (GC/MS). RESULTS: All experimental groups contained PCA. The mean level of PCA for group 1 (sterile saline) was 229 ng mL(-1), group 2 (citric acid) 72 ng mL(-1) and group 3 (EDTA) 400 ng mL(-1), respectively. A significant difference was found between the saline and EDTA groups and the negative control (P < 0.05). Although no statistical significance was found between the negative control and citric acid group, PCA was still present in this experimental group. CONCLUSIONS: Citric acid used as the intermittent irrigant had the least amount of PCA formation in the canal system. Until the threshold required to cause biological damage in humans is determined, the combination of NaOCl and CHX in root canal treatment should be avoided.

Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated uninstrumented areas in oval shaped root canals.

AIM: To assess the ability of sodium hypochlorite (NaOCl) to penetrate simulated lateral canals and to reach working length (WL) when using the self-adjusting file (SAF). METHODOLOGY: Seventy single-rooted teeth with oval-shaped canals were used. Upon access, presence of a single canal was confirmed by direct visualization under a dental-operating microscope. Canal length and patency were obtained using a size 10 K-file and root length standardized to 18 mm. Pre-enlargement was restricted to the coronal one-third. The apical size of each canal was gauged at WL and samples larger than size 30 were excluded. Canals were instrumented for 5 min using the SAF system while delivering a total of 20 mL of 5.25% NaOCl and 5 mL of 17% EDTA. Then, the apical diameters were standardized to size 35 using hand files. Four hundred and twenty simulated lateral canals were then created during the clearing process and roots coated with wax to create a closed system. All samples were then cleared and randomly assigned to four experimental groups: 1 (n = 15) positive pressure; 2 (n = 15) SAF without pecking motion; 3 (n = 15) SAF with pecking motion; 4 (n = 15) apical negative pressure (ANP) irrigation and (n = 10) control groups. Samples were scored on the basis of the ability of the contrast solution to reach WL and permeate into the simulated lateral canals to at least 50% of the total length. The Kruskal-Wallis test was used to analyse irrigant penetration and the Tukey test to determine statistical differences between groups (P < 0.05). RESULTS: All samples irrigated with ANP were associated with irrigant penetration to WL (Table 1). The differences between group 4 (ANP) and all other groups were significant in penetration to WL (P < 0.05). The pecking motion allowed for further penetration of the irrigant when using the SAF system but failed to irrigate at WL. None of the experimental groups demonstrated predictable irrigation of simulated lateral canals. CONCLUSIONS: In this laboratory model, ANP was the only delivery system capable of irrigating consistently to full WL. None of the systems tested produced complete irrigation in artificial lateral canals.

Penetración real de la irrigación en el interior de sistemas de conductos cerrados / Royal Irrigation Penetration within the closed conduit systems

El objetivo de esta revisión bibliográfica sobre los principales artículos publicados en revistas de impacto dentro del campo de la endodoncia es analizar, a las vista de los resultados que encontramos en la literatura la penetración real de nuestros irrigantes dentro de sistemas de conductos. Muchos son los estudios in vitro que obtienen buenos resultados para la irrigación por presión positiva (jeringa) mientras que otros muchos demuestran una efectividad muy limitada. El motivo radica en simular las condiciones perirradiculares adecuadamente. La dinámica de fluidos se ve alterada por completo si los tejidos peiodontales no se simulan adecuadamente obteniendo en dichas investigaciones resultados más que cuestionables. Describiremos los métodos empleados para analizar la penetración de los irrigantes, del mismo modo que compararemos los resultados de los distintos sistemas de irrigación y activación tanto en estudios in vivo como in vitro. Al encontrarnos en sistemas de conductos cerrados la dinámica de fluidos resulta especialmente particular ya que al contrario de los que podamos pensar, el recambio de los irrigantes en la porción apical del conducto es muy limitada así como su acción de limpieza y desinfección. Estos sistemas cerrados posibilitan atrapamientos de aire, que se ven favorecidos por la formación de vapores de amonio y dióxido de carbono producidos por la descomposición de materia orgánica llevada a cabo por el Hipoclorito de Sodio (AU)

The purpose of this review of the main articles published in journals of impact within the field of endodontics is analyzed, the results thant we can find in literatura about the real penetration of irrigants in closed canal systems. Many in vitro studies that performed well for positive pressure irrigation (syringe) while many others show a very limited effectiveness. The reason is adequately simulate of periradicular tissues. The fluid dynamics is altered completely if the periodontal tissues are not adequately simulate make results obtained in these investigations more questionable. We will compare the results of different methods of activitation and deliberation systems of our irrigants, just as we will observe the methods used to analyze the penetration of irrigants both in vivo and in vitro. We are working in close canal Systems, so fluid dynamics is particularly special because unlike what we might think the replacement of the irriganst in the apical portion of the canal is very limited as is their share of Cleaning and disinfection. These closed systems allow air traps, which are favored by the formation of vapors of ammonia and carbon dioxide produced by decomposition of organic matter carried out by the sodium hypochlorite (AU)

Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report.

AIM: To present a case report in which the pulp of two bilateral mandibular premolars with dens evaginatus were revascularized using a modified novel technique to avoid undesired crown discolouration. SUMMARY: Recently, regeneration of necrotic pulps has become an alternative conservative treatment option for young permanent teeth with immature roots and is a subject of great interest in the field of endodontics. This novel procedure exploits the full potential of the pulp for dentine deposition and produces a stronger mature root that is better able to withstand the forces than can result in fracture. However, the current protocol has potential clinical and biological complications. Amongst them, crown discolouration, development of resistant bacterial strains and allergic reaction to the intracanal medication. In the case presented, a modified technique to avoid undesired crown discolouration was applied sealing the dentinal tubules of the chamber, thus avoiding any contact between the tri-antibiotic paste and the dentinal walls. KEY LEARNING POINTS: * Sealing the dentinal tubules of the chamber prevents the undesirable crown discolouration produced by tri-antibiotic medication whilst maintaining the revascularization potential of the pulp. * Further research is warranted to seek an alternative infection control protocol capable of preventing possible allergic reactions and development of resistant strains of bacteria, as well as a biological material capable of inducing angiogenesis and allow a more predictable scaffold and tissue regeneration.

Ridge preservation in cases requiring tooth extraction during endodontic surgery: a case report.

AIM: To provide a treatment option to endodontists performing surgery that will enhance ridge preservation when tooth extraction is required. SUMMARY: A 47-year-old woman was referred to an endodontic practice for apical root-end resection of tooth 22 because of refractory periradicular disease. Radiographic examination revealed a large periradicular lesion, 5 mm in diameter and a root-end filling at the root apex. The treatment plan included exploratory surgery and apical root-end resection. A vertical root fracture was diagnosed and the decision was made to extract the tooth. The socket was grafted with a cancellous bovine bone and covered with a resorbable collagen membrane. Follow-up examination revealed favourable bone healing with formation of a new cortical plate and the preservation of soft tissue width and height in the aesthetic area. KEY LEARNING POINTS: The principles of guided bone regeneration. Preserving or reconstructing the extraction socket. Enhances the ability to restore function and provide aesthetically pleasing restorations to patients without violating the predictability and function of the prostheses.

[New treatment protocols for avulsed teeth].

Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan and prognosis. The injuries to the permanent dentition include crown and root fractures, subluxations, luxations and tooth avulsion. Common complications are pulp necrosis, periapical pathosis and root resorption. This article will describe new clinical modalities for the treatment of avulsed teeth and discuss the rational for their use.

Effect of gutta-percha solvents on surface microhardness of IRM fillings.

Eighty identical samples of IRM were prepared and embedded in acrylic resin. The samples were polished, rinsed, and divided into experimental groups and controls, 10 specimens each. Each experimental group was treated for 1 or 5 min with one of the following gutta-percha solvents: chloroform, xylene, or halothane. Sterile saline was used as a control. Treatment consisted of pipetting each solvent onto the external IRM surface. The specimens were then sealed in plastic assay tubes for the corresponding exposure periods. At each time period, surface microhardness of the samples was measured using a mini-load hardness tester with a 500 g load for 20 s. It was found that xylene and halothane caused significant reduction in surface microhardness of IRM after 5 min (p < 0.01). Chloroform caused significant reduction in surface microhardness of IRM after 1 min of treatment (p < 0.01). Chloroform caused total dissolution after 5 min of treatment. Saline caused only minor and nonsignificant changes in surface microhardness of IRM.

Effect of chloroform, xylene, and halothane on enamel and dentin microhardness of human teeth.

OBJECTIVE: The purpose of this study was to assess in vitro the effect of commonly used gutta-percha solvents on the microhardness of human enamel and dentin. STUDY DESIGN: Crowns of human teeth were cut and treated with chloroform, xylene, and halothane. Treatment consisted of exposing the specimens for 5 or 15 minutes to the test solvents. Acid-treated and saline-treated specimens served as controls. After each treatment period, the specimens were rinsed, dried, and prepared for Vicker's microhardness analysis. Vicker's microhardness values for each specimen were recorded before and after treatment, and the differences were statistically compared. RESULTS: A statistically significant decrease in enamel and dentin microhardness was found in most solvent-treated groups; the amount of the decrease was directly related to the exposure time. CONCLUSIONS: Chloroform, xylene, and halothane may cause a significant softening effect on both enamel and dentin. This softening is already apparent after 5 minutes of treatment.

Endodontic therapy for a fused mandibular molar.

Variations in tooth morphology present a clinical challenge when endodontic treatment is required. A case of conservative endodontic therapy for a fused mandibular second and third molar is presented.

Mental nerve paresthesia associated with a non-vital tooth.

Apical periodontitis is a common development associated with teeth with necrotic pulp. Although rare, some cases may present further complications, such as neuropathies in areas adjacent to the affected tooth. A case is described in which mental nerve paresthesia was associated with a non-vital mandibular premolar. Endodontic therapy resolved the paresthesia completely without further clinical complications.

Endodontic retreatment of unusually long maxillary central incisors.

Anatomical and morphological variations in teeth may affect the success and prognosis of endodontic therapy. The reported data regarding such variations in the maxillary central incisors are limited. This article presents a case of endodontic retreatment in unusually long maxillary central incisors.

Effect of carbamide peroxide and hydrogen peroxide on the surface morphology and zinc oxide levels of IRM fillings.

The effect of 10% carbamide peroxide or 10% hydrogen peroxide on the surface morphology and zinc oxide levels of IRM fillings was tested. Ninety IRM samples were treated with either 10% carbamide peroxide, 10% hydrogen peroxide or phosphate buffer which served as control. Treatment consisted of placing the samples in a dry incubator at 37 degrees C for 1, 3 or 7 days. At each time point, the samples were removed from the test solutions, dried and prepared for surface scanning electron microscopy and energy dispersive spectrometric analysis. After 3 days, 10% carbamide peroxide significantly reduced the zinc oxide levels as compared to the 10% hydrogen peroxide group (<0.01) and the controls (p<0.01). 10% hydrogen peroxide reduced the zinc oxide levels similarly to the control. No significant changes in the zinc oxide levels were found between 3 and 7 days in any of the groups tested. Microscopy examination of the carbamide peroxide group revealed granular surface with well defined crystalline areas. In the hydrogen peroxide group, numerous cracks with multiple sun burst-like areas were found. At the macroscopic level, the samples of this group appeared cracked and more swollen, as compared to controls and samples treated with carbamide peroxide. In conclusion, both 10% carbamide peroxide and 10% hydrogen peroxide altered the surface morphology and the zinc oxide levels of IRM fillings, but their modes of action differed.