Protocols for cleaning the incisor access cavity contaminated with epoxy resin sealer

This study compared different methods for cleaning the sealer-contaminated access cavity of upper incisors. After standard endodontic access, the canals of 50 extracted maxillary incisors were chemomechanically prepared and obturated with gutta-percha and epoxy resin sealer. Teeth were randomly assigned to one of five different pulp chamber cleaning protocols (n = 10): air/water spray, ethanol-saturated cotton pellet (CP), ethanol-saturated microbrush reaching the root filling (MB), MB + air polishing (PROPHYflex; KaVo), or MB + etching with 37% phosphoric acid. Each tooth was split and the sealer-covered area of the pulp chamber was determined on images taken before and after cleaning using image analysis software. The sealer-covered area was compared across groups using one-way ANOVA. Greatest mean sealer-covered area reduction was observed for MB + etching (98.0%), MB + air polishing (95.2%), and MB alone (92.8%), yielding a significantly higher sealer-covered area reduction than after air/water spray (8.3%) and ethanol-saturated cotton pellet (53.4%). The upper incisor access cavity is best cleaned with an ethanol-saturated microbrush reaching up to the root filling, followed by air/water spraying and etching. The use of cotton pellets should be discouraged.

[Black or white--is amalgam 'out'? Part 1. Amalgam or composite: which of these 2 materials is the most deleterious?]

Dental amalgam containing mercury has been condemned because of its toxicity and hence to be damaging of harmful to the general health. It must be clear that many sensational, confusing and misleading reports have been published. Today there is evidence that dental amalgam in the oral cavity does not harm anyone's health. For those who are condemning amalgam there an abundant number of alarming reports taking into consideration the biologic effects of resin composites: methacrylate allergy for dentists and dental technicians, the three-finger-syndrome due to contact with liquid resin, allergic reactions at the level of the airways and breathing problems caused by dust particles (esp. composite particles after polishing procedures) have been described. It can be concluded that dental amalgam is not more toxic than resin composite in light of both patients' and dental care providers' health. Recent investigations demonstrated higher than expected health risks with resin composites.

[Therapeutic choices and prognosis related to teeth or implants]

Preservation of natural teeth is the ultimate goal of dentistry today. Regular screening for periodontal disease, followed by infection control whenever necessary, positively affects tooth preservation, the more when the patients complies with therapy and regular maintenance. The dentist is, however, often confronted with treatment dilemmas and has to decide whether to extract or preserve teeth, to extirpate or extract, to keep or to implant, to make removable or fixed prostheses. Decision making is depending on the prognosis of teeth and becomes more difficult when teeth are supporting prosthetic restorations because the question arises: "How long will the teeth and the restoration survive?". Systematic reviews have revealed that teeth and implants have a similar prognosis. They are prone to biological and technical complications, the latter determining long term prognosis. Implant survival rates are around 93% after 10 years but the survival of the construction ranges between 80% and 90% depending on the type and extension. Complications are reported in the order of 35%. Prosthetic restoration on natural teeth have a 10-year survival of 80-90% with 34% of complications. The present paper gives a brief overview of the prognosis of dental treatments and discusses arguments that may be of help to make treatment decision choices.

[Black or white--Which choice for the molars? Part 2. Which does one choose for the restoration of posterior teeth: amalgam or composite?]

The two direct dental restorative materials most commonly used today are silver-mercury amalgam and resin-based composite. The survival of dental amalgam restorations is twice as high than for composite fillings: polymerisation shrinkage, deficient marginal adaptation, higher wear rates, defective contact points leading to food impaction, insufficiently converted composite at the bottom of the cavity are problems that cannot be underestimated when using resin-composite. This does not imply that there is no weakness for amalgam: the need for retentive cavities at the cost of healthy tooth substance, weakening of the tooth's strength by cutting through the tooth crown's ridges, the risk of fracture of remaining tooth substance (mostly buccal and lingual surfaces) as the result of the cavity design, and the lack of adhesion between amalgam and tooth substance. Retaining a tooth's strength by the replacement of amalgam by resin-composites is not always the correct solution. In this respect, it can be questioned whether it is not appropriate to repair failing (extensive) amalgam restorations as to replace them with resin-composites. Research in this respect has demonstrated that dentists still are not convinced of this treatment option. Restoring a tooth in its original build-up or structure and function within the oral cavity is the basis of the biomimetic principle: the use of composite appears to be more obvious than restoring with amalgam. In the present survey pro's and con's of amalgams and resin-composites for the restoration of posterior teeth are weighted. The conclusion demonstrates that there is still a place for dental amalgam in modern restorative dentistry when plastic filling materials are used for the direct tooth repair or restoration.

[The choice between 'conservation of a tooth using endodontic treatment and crown restoration' or 'extraction of the tooth and its replacement by an implant'. Recommendations for a single tooth]

Recent studies provide evidence that root canal treatment results in excellent clinical outcomes for our patients, which is in favour of the preservation of teeth. Therefore, endodontic treatment remains a highly predictable method to retain teeth with irreversible pulpal disease. Retention rates of root filled teeth of more than 90 percent have been shown. At present there are many alternative treatments available to preserve or replace diseased teeth and considerable progress has been made in this field. With the increasing popularity of implants and for some too complicated the root canal anatomy, more teeth than before are extracted to be replaced with implants. Unfortunately, there has not been that much of research identifying the best strategies for selecting one treatment approach over another. Consequently there is a need for recommendations regarding endodontic versus implant therapy.

[Dental and buccal complications of lip and tongue piercing]

Oral and facial piercing with different kinds of body art are being observed more frequently in medical and dental practices. Principally, piercing is not a new form of body art and is traditional in different geographical areas. In this review, the possible risks and complications are described. Postprocedural complications are oedema, haemorrhage and infection. Other adverse outcomes include mucosal or gingival trauma, chipped or fractured teeth, increased salivary flow, calculus build-up, and interference with speech, mastication and swallowing. Dentists, and oral- and maxillofacial surgeons should be in the position to advise patients with orofocial piercings or those who plan to have this type of body art performed.

[Endodontics and apical periodontitis]

The aim of this paper is to discuss the relation between root canal treatment and apical periodontitis (AP). AP is caused by micro organisms and is mainly a chronic inflammation. There is some evidence of an effect on the general health in immunocompromised patients. A higher incidence of AP on root filled teeth has been found. A number of preoperative and operative factors influence prevalence of AP on root filled teeth. Rubberdam placement and cleaning and shaping of the root canal during root canal treatment is important to create a clean canal to promote healing or prevent the development of AP. Placement of a good quality root filling and a well sealing coronal restoration are also important for the prevention of reinfection of the root canal. The quality of root fillings differs between clinical and epidemiological studies what is reflected in a lower prevalence of AP in the former.

[Dens invaginatus--a challenge in endodontics]

Dens invaginatus is a malformation of teeth probably due to infolding of the dental papilla during tooth development. A wide range of morphologic variations have been described. Both coronal and radicular invaginations have been demonstrated. Typical characteristics associated with the coronal invagination are the complex anatomy and the early pulp necrosis. The etiology, epidemiology, classification and therapeutic considerations are reviewed.

[Fraudulent use of digital radiographs: secret reality or fiction?]

Digital radiography has several advantages and has become an indispensable diagnostic tool for many dentists in daily practice. Once the digital captation appears on screen, the dental x-ray software allows image enhancement, to get a better vision and diagnosis. This image enhancement is acquired for example by adjusting the colour, density, sharpness, brightness or contrast. If the digital radiographs are exported, using various software packages created for graphic design and image manipulation, digital information can be altered, added or removed. Dental radiographs are easily duplicated, stored or spread in digital format. How can their authenticity be guaranteed, especially in insurance cases? Image enhancement features of digital radiography allow mishandling or potential abuse. Recently published studies illustrate the potential fraudulent use of digital radiography. In this article, some manipulated radiographic images are presented, to raise concerns about security, reliability and the potential for fraud.

[LASER applications in endodontics]

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of lasers with a wide range of characteristics are now being used in endodontic therapy. In the past two decades much experience and knowledge has been gained The first purpose of the present paper is to provide an understanding of the essential physical science behind laser technology and information on the effects of laser beams on tissue (tissue interaction). A second purpose is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, modification of the root canal walls, sterilization of the root canal system, cleaning--shaping--obturation of the root canal, and endodontic surgery. It will be clear that a number of endodontic procedures with conventional treatments cannot provide comparable results or are less effective.

[Evaluation of pulpal blood flow by laser doppler flowmetry as a test of tooth vitality in long-term follow-up: case report]

The reliability of laser Doppler flowmetry in a 2-probe assessment of pulpal blood flow is well known. The purpose of this case report was to determine its use as an exclusive and reliable tool for tooth vitality diagnosis in a long-term follow-up. As a result of a traumatic injury to a 24-years old Caucasian female, tooth pulp vitality was studied in 6 maxillary front teeth over 30 weeks through use of 2-probe laser Doppler flowmetry and current sensitivity tests. A similar assessment was repeated after 228 weeks. Confronted with an alveolar bone fracture with a tooth in the fracture line, one intrusion and several luxated teeth, current sensitivity tests are found not to be so reliable indicators of revascularisation as significant results are given later (7 weeks) compared to laser Doppler flowmetry tests (1 week). A pathway with ischaemia (3 weeks), hyperaemia (7 weeks) and restored blood supply in the pulp measured by laser Doppler flowmetry tests was found and avoided endodontic treatment. Teeth vascularisation evolved normally (228 weeks). Despite a high indication in all sensitivity tests for endodontic treatment, the use of laser Doppler flowmetry tests was clear, more reliable than sensitivity tests and exclusive as denervation was postponed and pulp vascularisation was evident.

[Calcium hydroxide-based pastes used in endodontics]

The aim of the present study is to propose a classification of calcium hydroxide pastes on the basis of the vehicle that retains the calcium hydroxide. The vehicle determines the working characteristics of the calcium hydroxide: viscous and only vehicles prolong the action of the calcium hydroxide as compared with water-soluble substances. Physicochemical properties of the vehicle may limit the effectiveness in disinfecting the entire root canal system. As calcium hydroxide is not effective against all bacterial species found in root canal infections, associations with other medicaments have been proposed to enhance the efficacy of the intracanal medication.

[Accidental extrusion of calcium hydroxide-based pastes into periapical lesions]

Calcium hydroxide is a widely used material in endodontic treatment due to its high alkalinity and antimicrobial properties. It is thought to create a favourable environment for periradicular repair and healing, and to stimulate hard tissue formation. The aim of the present retrospective study was to evaluate the effect of accidental and voluminous overextensions of calcium hydroxide pastes into periapical lesions and tissues on the prognosis of periapical healing. It was seen that calcium hydroxide overextensions did not disfavour healing, none of the endodontic treatments failed but healing was delayed in the majority of cases and in a number of cases extrusion induced immediate flare-ups. Therefore the deliberate extrusion of calcium hydroxide into periapical tissues is not advocated.

[Coronal leakage reconsidered]

The aim of the present study was to evaluate the impact of the quality of the coronal restoration and of the root filling on periapical health. In a sample of 937 root filled teeth which had not received restorative treatment in the previous year, the technical quality of the coronal restorations and of the root fillings was radiographically scored; in addition the technical quality of the coronal restorations was clinically scored as well. The data showed that the technical standard of both coronal restoration and root filling were essential to periapical health. The study also showed the relatively limited value of epidemiologic findings. Epidemiologic research is descriptive as well as analytical in approach. According to the present data, endodontic failure cannot be fully explained by radiographic analysis only. Nevertheless, epidemiologic data remain a valuable component to the source of knowledge regarding etiologic factors and proper treatment procedures in order to improve the results of endodontic practice.

A two-probe laser Doppler flowmetry assessment as an exclusive diagnostic device in a long-term follow-up of traumatised teeth: a case report

The reliability of laser Doppler flowmetry in a two-probe assessment of pulpal blood flow is well known. The purpose of this case report was to determine its use as an exclusive and reliable tool for tooth vitality diagnosis in a long-term follow-up. As a result of a traumatic injury to a 24-year-old Caucasian female, tooth pulp vitality was studied in six maxillary front teeth over 30 weeks using two-probe laser Doppler flowmetry and current sensitivity tests. A similar assessment was repeated after 228 weeks. Confronted with an alveolar bone fracture with a tooth in the fracture line, one intrusion and several luxated teeth, current sensitivity tests are found not to be as reliable indicators of revascularisation, as significant results are obtained later (7 weeks) than using laser Doppler flowmetry tests (1 week). A pathway with ischaemia (3 weeks), hyperaemia (7 weeks) and restored blood supply in the pulp measured by laser Doppler flowmetry tests was found and avoided endodontic treatment. Teeth vascularisation evolved normally (228 weeks). Despite a strong indication in all sensitivity tests for endodontic treatment, the use of laser Doppler flowmetry tests was clear, more reliable than sensitivity tests and exclusive, as denervation was postponed and pulp vascularisation evident.