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Setzer FC, Kratchman SI. Present Status and Future Directions - Surgical Endodontics. Int Endod J 2022; 55 Suppl 4:1020-1058. [PMID: 35670053 DOI: 10.1111/iej.13783] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
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Affiliation(s)
- F C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - S I Kratchman
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Khater AGA, Al-Hamed FS, Safwat EM, Hamouda MMA, Shehata MSA, Scarano A. EFFICACY OF HEMOSTATIC AGENTS IN ENDODONTIC SURGERY: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101540. [PMID: 34479672 DOI: 10.1016/j.jebdp.2021.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adequate hemostasis is a critical step in endodontic surgery. It facilitates the procedure and affects the success and prognosis of the operation. This systematic review and network meta-analysis (NMA) aimed to systematically assess the efficacy of hemostatic agents in endodontic surgery and to identify the most effective ones. METHODS PubMed, Scopus, Embase, Cochrane Library, Web of Science, ProQuest, and EBSCOhost databases were searched up to December 2020. We included randomized controlled trials (RCTs) evaluating the efficacy of different hemostatic measures in endodontic surgery, and their risk of bias was assessed using Cochrane's randomized trial tool (RoB 2.0). Frequentist network meta-analysis was conducted, with Odds Ratios and 95% confidence intervals (OR, 95% CI) as effect estimates using the "netmeta" package in R. The quality of evidence was assessed using the CINeMA approach. RESULTS Six RCTs involving 353 patients (mean age 48.12 y) were included. NMA revealed that aluminum chloride achieved higher hemostatic efficacy than epinephrine (OR = 2.55, 95% CI [1.41, 4.64]), while there was non-significant difference when compared with PTFE strips + epinephrine (OR = 1.00, 95% CI [0.35, 2.90]), electrocauterization (OR = 2.67, 95% CI [0.84, 8.46]), or ferric sulfate (OR = 8.65, 95% CI [0.31, 240.92]). Of all hemostatic agents, aluminum chloride ranked first in control bleeding during endodontic surgery (P-score = 0.84), followed by PTFE strips + epinephrine (P-score = 0.80), electrocauterization (P-score = 0.34), epinephrine (P-score = 0.34), ferric sulfate (P-score = 0.18). The quality of evidence was very low. CONCLUSIONS Based on the limited data, aluminum chloride provides better hemostasis than epinephrine, while there was no significant difference between the remaining hemostatic agents used in endodontic surgery, which could help clinicians choose the hemostatic agent that achieves adequate hemostasis. achieve adequate hemostasis. Given insufficient evidence, future RCTs addressing this evidence gap are required.
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Affiliation(s)
- Ahmad G A Khater
- Faculty of Oral and Dental Medicine, Ahram Canadian University, Egypt..
| | - Faez Saleh Al-Hamed
- Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Engie M Safwat
- Restorative and Dental Materials Department, National Research Centre, Egypt
| | | | | | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), University of Chieti-Pescara, Chieti, Italy; Research staff at Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD, USA
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Aminoshariae A, Donaldson M, Horan M, Kulild JC, Baur D. Perioperative Antiplatelet and Anticoagulant Management with Endodontic Microsurgical Techniques. J Endod 2021; 47:1557-1565. [PMID: 34265324 DOI: 10.1016/j.joen.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to review evidence-based recommendations for the safe perioperative management of patients undergoing endodontic microsurgery who are currently taking antiplatelet or anticoagulant medications. Using the PICO (Population, Intervention, Comparison, Outcome) format, the following scientific question was asked: In patients taking anticoagulant or antiplatelet agents, what is the available evidence in the management of endodontic microsurgery? METHODS MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov databases were searched to identify current recommendations regarding the management of antiplatelet and anticoagulant medications in the context of outpatient dental surgical procedures. Additionally, the authors hand searched the bibliographies of all relevant articles, the gray literature, and textbooks. Because of the lack of clinical studies and evidence on this subject, articles and guidelines from other organizations and association position statements were included. RESULTS Because any minor surgery can become a major surgery, the treating doctor needs to best assess the risk of bleeding, especially if the surgery is anticipated to take longer than 45 minutes. Every patient should be stratified on a case-by-case basis. Consultation with the patient's physician is highly recommended. CONCLUSIONS In order to maximize the effects of these medications (to prevent thrombosis) while minimizing the potential risks (procedural hemorrhage), clinicians should be aware of the best available evidence when considering continuation or discontinuation of antiplatelet and anticoagulant agents perioperatively for endodontic microsurgery. Ideally, a joint effort from an expert panel for microsurgery would be warranted.
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Affiliation(s)
- Anita Aminoshariae
- Departments of Endodontics, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio.
| | - Mark Donaldson
- School of Pharmacy, University of Montana, Missoula, Montana; School of Dentistry, Oregon Health and Sciences University, Portland, Oregon
| | - Michael Horan
- Oral and Maxillofacial Surgery, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
| | - James C Kulild
- UKMC Dental School, University of Missouri-Kansas City, Kansas City, Missouri
| | - Dale Baur
- Oral and Maxillofacial Surgery, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
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Lin S, Hoffman R, Nabriski O, Moreinos D, Dummer PMH. Management of patients receiving novel antithrombotic treatment in endodontic practice: Review and clinical recommendations. Int Endod J 2021; 54:1754-1768. [PMID: 33894015 DOI: 10.1111/iej.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
Cardiovascular diseases are a major component of non-communicable diseases and death, with thrombosis constituting the most common underlying pathosis of the three major cardiovascular disorders: ischaemic heart disease (acute coronary syndrome), stroke and venous thromboembolism (VTE). The introduction of direct oral anticoagulants (DOACs) in recent years has necessitated a more complex approach to periprocedural and perioperative anticoagulation management and the need for revised management strategies and protocols. Currently, patients taking classic oral anticoagulants are advised to stop taking the drugs and have their INR values checked 72 h prior to dental surgery (e.g., apical surgery, tooth extraction, and periodontal surgery) and checked again 24 h prior to the procedure to ensure it is within the therapeutic range. However, the current incorporation of these novel DOACs in routine medical practice requires changes in the way patients are managed preoperatively in dentistry, and specifically in endodontic surgery. The methodology applied in this review included searching for relevant articles in the PubMed database using keywords listed in the Entree Terms databases. Articles published on human blood clotting mechanism, antithrombotic drugs, as well as treatment guidelines and recommendations for dentistry were retrieved. In addition, textbooks and guidelines that may not have surfaced in the online search were searched manually. The aim of this paper was to review the mechanisms of action of classic and novel antithrombotic medications and their impact on endodontic treatment and the management of local haemostasis in endodontics.
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Affiliation(s)
- Shaul Lin
- Department of Endodontic, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Israeli National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel
| | - Ron Hoffman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Omri Nabriski
- Department of Endodontic, Rambam Health Care Campus, Haifa, Israel
| | - Daniel Moreinos
- Department of Endodontic, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical Sciences and Life Sciences, Cardiff University, Cardiff, UK
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Peñarrocha-Oltra D, Soto-Peñaloza D, Peñarrocha-Diago M, Cervera-Ballester J, Cabanes-Gumbau G, Peñarrocha-Diago M. Hemostatic agents in endodontic surgery of maxillary molars: A randomized controlled pilot study of polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze versus aluminum chloride. Med Oral Patol Oral Cir Bucal 2020; 25:e634-e643. [PMID: 32683388 PMCID: PMC7473427 DOI: 10.4317/medoral.23652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background Hemostasis is of critical importance in endodontic surgery. Studies on bleeding control in maxillary molars are scarce. The present study compares the efficacy of two hemostatic techniques in controlling bleeding in endodontic surgery.
Material and Methods A randomized two-arm pilot study involving 30 patients with peri-radicular lesions in maxillary molars (first and second molars) was carried out including the following hemostatic agents: polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze (test group; n = 15) and aluminum chloride (Expasyl™) (control; n = 15). Bleeding control was independently assessed by the surgeon and by two blinded observers before and after application of the hemostatic agent, and was classified as either adequate (complete bleeding control) or inadequate (incomplete bleeding control).
Results Bleeding control was similar in both groups. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosal band (≥ 2 mm) suggested a decreased risk of inadequate bleeding control of up to 89% (OR=0.11; p=0.06).
Conclusions No difference in the efficacy of bleeding control was observed between PTFE strips as an adjunct to epinephrine impregnated gauze and aluminum chloride in maxillary molars. Key words:PTFE-strips, aluminum chloride, endodontic surgery, epinephrine, hemostasis, hemostatic agent, molars.
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Menéndez-Nieto I, Peñarrocha-Diago M, Cervera-Ballester J, Peñarrocha-Diago M, Peñarrocha-Oltra D. Efficacy of infiltrative local anesthesia and inferior alveolar nerve block in periapical surgery of lower premolars and molars: A preliminary report. J Clin Exp Dent 2020; 12:e581-e587. [PMID: 32665818 PMCID: PMC7335601 DOI: 10.4317/jced.56278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/08/2020] [Indexed: 11/08/2022] Open
Abstract
Background The aims of this study were: 1) compare the amount of anesthesia used with the anesthetic technique; 2) relate the quantity of anesthesia needed with the level of anxiety of the patient; 3) study the relationship between the anesthetic technique and the level of hemostasis; 4) correlate the amount of anesthesia with patient and tooth dependent variables.
Material and Methods A randomized controlled trial was designed with two parallel groups according to the anesthetic technique: infiltrative local anesthesia (infiltrative group) and inferior alveolar nerve block (block group). The following variables were collected: sex, age, smoking habits, plaque index, symptoms, signs, position of the tooth and amount of anesthesia. Before surgery, all patients were asked to assess their anxiety on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The analysis of the hemorrhage control of aluminum chloride was judged by the surgeon and two examiners independently and recorded it as: 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control).
Results Twenty patients were included in this preliminary report. The amount of anesthesia used was lower in block group and in less anxious patients, although these results did not reach statistical significance. A relationship was found between the quantity of anesthesia used and a good hemostasis of the bony crypt before the application of the hemostatic agent (p<.05); and between elderly patients and a lower amount of anesthetic reinforcement (p<.05).
Conclusions Based on these preliminary results, we can conclude that no statistical significance difference was found between the amount of anesthesia used and the anesthetic technique or the anxiety. A relationship was found between hemostasis of the bony crypt and the quantity of anesthesia used; and between younger patients and a greater amount of anesthetic reinforcement. Key words:Anesthesia, anxiety, endodontic surgery, hemostasis, hemostatic agents,periradicular surgery.
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Affiliation(s)
- Isabel Menéndez-Nieto
- Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Miguel Peñarrocha-Diago
- Chairman of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Juan Cervera-Ballester
- Collaborating Professor of the Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - María Peñarrocha-Diago
- Full Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - David Peñarrocha-Oltra
- Assistant Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
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Hemostatic Agents in Endodontic Surgery: A Randomized Controlled Pilot Study of Polytetrafluoroethylene Strips as an Adjunct to Epinephrine Impregnated Gauze Versus Aluminum Chloride. J Endod 2019; 45:970-976. [DOI: 10.1016/j.joen.2019.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022]
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8
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Peñarrocha-Oltra D, Menéndez-Nieto I, Cervera-Ballester J, Maestre-Ferrín L, Peñarrocha-Diago M, Peñarrocha-Diago M. Aluminum Chloride versus Electrocauterization in Periapical Surgery: A Randomized Controlled Trial. J Endod 2019; 45:89-93. [DOI: 10.1016/j.joen.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/19/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Torabinejad M, Kang HJS, Maskiewicz R, Grandhi A. The haemostatic efficacy and foreign body reaction of epinephrine-Impregnated polyurethane foam in osseous defects. AUST ENDOD J 2017; 44:204-207. [PMID: 28940453 DOI: 10.1111/aej.12234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare the haemostatic efficacy and foreign body reaction of epinephrine-impregnated cotton pellets with those of epinephrine-impregnated polyurethane (PU) foam cubes in osseous defects created in guinea pigs. Initially, these substances were randomly applied to the osseous defects in guinea pigs for 2 min and blood loss was measured. The animals were then sacrificed 7 weeks later and the degree of foreign body reaction was scored. The data were analysed by the independent-samples Kruskal-Wallis test. Epinephrine-impregnated PU foam cubes showed significantly better haemostatic effect compared to epinephrine-impregnated cotton pellets. The PU foam containing epinephrine specimens elicited significantly less foreign body reaction compared to epinephrine cotton pellets (P < 0.05). Based on the results of this study, it is concluded that epinephrine-impregnated PU foam cubes are a good alternative to epinephrine-impregnated cotton pellets as a local haemostatic agent in endodontic surgery.
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Affiliation(s)
| | - Hyun J S Kang
- Endodontics, Loma Linda University, Loma Linda, California, USA
| | | | - Anupama Grandhi
- Endodontics, Loma Linda University, Loma Linda, California, USA
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Hemostatic Agents in Periapical Surgery: A Randomized Study of Gauze Impregnated in Epinephrine versus Aluminum Chloride. J Endod 2016; 42:1583-1587. [DOI: 10.1016/j.joen.2016.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/19/2016] [Accepted: 08/07/2016] [Indexed: 11/20/2022]
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Abstract
A better understanding of endodontic disease and the causes of treatment failure has refined the role of surgery in endodontics. The advent of newer materials, advances in surgical armamentarium and techniques have also led to an improved endodontic surgical outcome. The aim of this article is to provide a contemporary and up-to-date overview of endodontic surgery. It will focus primarily on the procedures most commonly performed in endodontic surgery.
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Affiliation(s)
- B S Chong
- Professor/Honorary Consultant in Restorative Dentistry, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - J S Rhodes
- Specialist in Endodontics, Poole, Dorset
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Nabavizadeh MR, Zargaran A, Moazami F, Askari F, Sahebi S, Farhadpoor A, Faridi P. Comparison of the Hemostatic Activity of Quercus persica Jaub. & Spach. (Oak) With Ferric Sulfate in Bony Crypts. J Evid Based Complementary Altern Med 2015; 21:34-8. [PMID: 26130010 DOI: 10.1177/2156587215593378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022] Open
Abstract
Effective tissue hemostasis in periapical surgical site is important in the procedures. Plants with large amount of tannins may act as a local hemostatic agent. We aimed to compare the hemostatic effect of the extract of Quercus persica with one of the common hemostatic material used in periapical surgery. Six standardized bone holes were prepared in the calvaria of 5 Burgundy rabbits. Two hemostatic medicaments were tested for their hemostatic effect and were compared with control defects: Group 1, cotton pellet soaked in 15.5% ferric sulfate solution; Group 2, cotton pellet soaked in pure ethanolic extract of Q. persica. Bleeding score between the groups was compared. The ferric sulfate group exhibited significantly less bleeding than the other 2 groups. Q. persica was found to cause more hemostasis than the control group at 4 and 5 minutes but there were no significant differences between normal saline and Q. persica extract in bleeding control.
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Affiliation(s)
- Mohammad Reza Nabavizadeh
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arman Zargaran
- Pharmaceutical Sciences Research Center and Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariborz Moazami
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Askari
- Pharmaceutical Sciences Research Center and Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Safoora Sahebi
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Farhadpoor
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouya Faridi
- Pharmaceutical Sciences Research Center and Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Lui JN, Khin MM, Krishnaswamy G, Chen NN. Prognostic Factors Relating to the Outcome of Endodontic Microsurgery. J Endod 2014; 40:1071-6. [DOI: 10.1016/j.joen.2014.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 04/09/2014] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
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Jang Y, Kim H, Roh BD, Kim E. Biologic response of local hemostatic agents used in endodontic microsurgery. Restor Dent Endod 2014; 39:79-88. [PMID: 24790919 PMCID: PMC3978108 DOI: 10.5395/rde.2014.39.2.79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/24/2014] [Indexed: 11/11/2022] Open
Abstract
Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.
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Affiliation(s)
- Youngjune Jang
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyeon Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Byoung-Duck Roh
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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Jang Y, Kim E. Cardiovascular effect of epinephrine in endodontic microsurgery: a review. Restor Dent Endod 2013; 38:187-93. [PMID: 24303352 PMCID: PMC3843028 DOI: 10.5395/rde.2013.38.4.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/08/2013] [Accepted: 09/08/2013] [Indexed: 11/11/2022] Open
Abstract
Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.
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Affiliation(s)
- Youngjune Jang
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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Kumar KS, Reddy GVK, Naidu G, Pandiarajan R. Role of povidone iodine in periapical surgeries: Hemostyptic and anti-inflammatory? Ann Maxillofac Surg 2013; 1:107-11. [PMID: 23483078 PMCID: PMC3591019 DOI: 10.4103/2231-0746.92768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Periapical surgery needs asepsis, a bloodless field for ensuring success of the treatment. Efficacy of Povidone Iodine (PVI) in the elimination of pathogen causing periapical lesions is well established. PVI is also widely used as a disinfectant, sclerosing agent, styptic as well as an anti-odematous agent. MATERIALS AND METHODS This prospective pilot study done on 20 males between 20-40 years age group with periapical lesions in single rooted maxillary anterior tooth of 1-2 cm in diameter. The bleeding time, clotting time, bleeding time at the apex, drugs used and visual analogue scale of oedema on postoperative days were obtained. Descriptive statistics, paired t test and independent t-test were used. RESULTS AND CONCLUSION Results show a statistically significant reduction in the time required to achieve a bloodless field and a marked decrease in oedema in the first and second postoperative days resulting in lesser consumption of NSAIDs. In conclusion, the effect of PVI in periapical surgery seems to reduce the bleeding time at apex, total dose of NSAIDs used, oedema on first two postoperative days with high statistical significance. Hence the routine use of saline in periapical surgeries may be effectively substituted with PVI. The finding of this pilot study has to be evaluated using wider samples for effective clinical translations.
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Affiliation(s)
- K Senthil Kumar
- Department of Conservative Dentistry, Chettinad Dental College and Research Institute, Kelambakkam, Chennai, India
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Peñarrocha-Diago M, Maestre-Ferrín L, Peñarrocha-Oltra D, von Arx T, Peñarrocha-Diago M. Influence of hemostatic agents upon the outcome of periapical surgery: dressings with anesthetic and vasoconstrictor or aluminum chloride. Med Oral Patol Oral Cir Bucal 2013; 18:e272-8. [PMID: 23229242 PMCID: PMC3613880 DOI: 10.4317/medoral.18002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 06/10/2012] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. DESIGN A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. RESULTS A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p > 0.05). CONCLUSION The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant.
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Scarano A, Artese L, Piattelli A, Carinci F, Mancino C, Iezzi G. Hemostasis Control in Endodontic Surgery: A Comparative Study of Calcium Sulfate versus Gauzes and versus Ferric Sulfate. J Endod 2012; 38:20-3. [DOI: 10.1016/j.joen.2011.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 11/25/2022]
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Azargoon H, Williams BJ, Solomon ES, Kessler HP, He J, Spears R. Assessment of Hemostatic Efficacy and Osseous Wound Healing Using HemCon Dental Dressing. J Endod 2011; 37:807-11. [DOI: 10.1016/j.joen.2011.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 02/16/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
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von Arx T, Jensen SS, Hänni S, Schenk RK. Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions. Int Endod J 2006; 39:800-8. [PMID: 16948666 DOI: 10.1111/j.1365-2591.2006.01152.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the haemostatic efficacy and the histologic tissue responses after the application of different haemostatic agents used in periradicular surgery. METHODOLOGY The study was conducted in the calvarium of six rabbits. Standardized bone defects (diameter 4 mm) were trephined, and different haemostatic agents were applied and compared with control defects: bone wax (left for 10 min), Stasis (ferric sulphate, left for 5 s), Expasyl (aluminium chloride, left for 2 min and left permanently in situ), and a combination of Expasyl (2 min) and Stasis (5 s). The sites were photographed before the application and after the removal of the haemostatic agents. Three independent examiners judged the initial and final bleeding (on the photographs) using a bleeding score for each site and treatment. The results were compared using Wilcoxon's signed rank test. For the histologic analysis, three animals were killed after 3 weeks and three animals after 12 weeks. Transverse, nondecalcified sections were stained with combined basic fuchsin and toluidine blue for descriptive histology. RESULTS The most efficient haemorrhage control was provided by Expasyl in combination with Stasis and by Expasyl alone, whereas bone wax had the weakest bleeding reduction effect. The histologic analysis after 3 weeks demonstrated an inflammatory and foreign body tissue response towards all haemostatic agents. At 12 weeks, this tissue response was less pronounced but still present in sites treated with bone wax or Expasyl. In general, the inflammatory tissue reactions were limited to the bone defects, and never extended into the surrounding tissues. CONCLUSIONS Expasyl alone or in combination with Stasis appeared to be the most efficient of tested agents to control the bleeding within the bony defects created in a rabbit calvarium model.
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Affiliation(s)
- T von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Berne, Berne, Switzerland.
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Kim S, Kratchman S. Modern Endodontic Surgery Concepts and Practice: A Review. J Endod 2006; 32:601-23. [PMID: 16793466 DOI: 10.1016/j.joen.2005.12.010] [Citation(s) in RCA: 391] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 12/17/2005] [Indexed: 12/18/2022]
Abstract
Endodontic surgery has now evolved into endodontic microsurgery. By using state-of-the-art equipment, instruments and materials that match biological concepts with clinical practice, we believe that microsurgical approaches produce predictable outcomes in the healing of lesions of endodontic origin. In this review we attempted to provide the most current concepts, techniques, instruments and materials with the aim of demonstrating how far we have come. Our ultimate goal is to assertively teach the future generation of graduate students and also train our colleagues to incorporate these techniques and concepts into everyday practice.
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Affiliation(s)
- Syngcuk Kim
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, 19008, USA.
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REGAN JOHND, WITHERSPOON DAVIDE, FOYLE DEBORAHM. Surgical repair of root and tooth perforations. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1601-1546.2005.00183.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lin CP, Chen YJ, Lee YL, Wang JS, Chang MC, Lan WH, Chang HH, Chao WMW, Tai TF, Lee MY, Lin BR, Jeng JH. Effects of root-end filling materials and eugenol on mitochondrial dehydrogenase activity and cytotoxicity to human periodontal ligament fibroblasts. J Biomed Mater Res B Appl Biomater 2005; 71:429-40. [PMID: 15389508 DOI: 10.1002/jbm.b.30107] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Various root-end filling materials have been used to prevent the entry of root-canal pathogens into periapical regions. Five root-end filling materials were compared regarding the cytotoxicity, apoptosis, and mitochondrial dehydrogenase (MDH) activities of human periodontal ligament (PDL) fibroblasts, with the use of a novel transwell culture system. Exposure to IRM (a ZnO eugenol-based intermediate restorative material), a 2-ethoxybenzoic acid cement (Super EBA), and amalgam for 3 days inhibited the MDH activity of PDL fibroblasts as indicated by decrease in 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) reduction by 97%, 95%, and 51%, respectively. Evident suppression of MTT reduction by amalgam and glass ionomer cement (GIC) was noted after 5 days of exposure, with 73% and 46% of inhibition, respectively. Mineral trioxide aggregates (MTA) showed little effect on MDH activity. IRM and Super EBA were cytotoxic to PDL fibroblasts as indicated by a trypan blue dye exclusion technique. GIC and amalgam showed mild cytotoxicity. IRM, GIC, and amalgam further induced apoptosis of PDL cells, as revealed by the presence of sub-G0/G1 DNA content in flow cytometric histogram. Twenty-four-hour exposure to IRM and Super EBA elevated the MDH activities to 156% and 117%, correspondingly, of that of control. Eugenol, a phenolic ingredient in Super EBA and IRM, also increases MDH activity of PDL fibroblasts by 45% and 51%, at concentrations of 0.5 and 1 mM. However, at concentrations higher than 0.5 mM, eugenol decreased the number of viable PDL fibroblasts. These results suggest that MTA is a biocompatible root-end filling material, followed by self-curing Fuji II GIC and amalgam. IRM and Super EBA ingredients induced marked cytotoxicity and transiently stimulate MDH activities, which is possibly due to their content of eugenol and induction of cellular adaptive response.
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Affiliation(s)
- Chun-Pin Lin
- Department of Dentistry, National Taiwan University Hospital, College of Medicine
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Vy CH, Baumgartner JC, Marshall JG. Cardiovascular Effects and Efficacy of a Hemostatic Agent in Periradicular Surgery. J Endod 2004; 30:379-83. [PMID: 15167461 DOI: 10.1097/00004770-200406000-00001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the hemostatic efficacy and systemic cardiovascular effects of CollaCote collagen sponges saturated with 2.25% racemic epinephrine during endodontic surgery. A total of 48 patients participated in the study. Patients received CollaCote-saline or CollaCote-epinephrine placed in the bony crypt, after which hemostatic efficacy was evaluated. Blood pressure and pulse rate was recorded before and after administration of the local anesthetic, after the application of the test solutions, and before the patient's dismissal. Results showed no significant difference in blood pressure or pulse rate between the experimental and control groups. In the CollaCote-saline group, five of six cases failed to achieve hemorrhage control. In the CollaCote-epinephrine group, 1 of 42 cases had no hemorrhage control. Two patients had slight but apparent intermittent bleeding. Complete hemostasis was achieved in 39 of 42 cases. In conclusion, the results suggest that CollaCote collagen sponges saturated with 2.25% racemic epinephrine provide excellent hemostasis with no evident changes in blood pressure or pulse rate.
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Affiliation(s)
- Christina Hong Vy
- Department of Endodontology, Oregon Health & Science University, School of Dentistry, Portland, OR, USA
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Vickers FJ, Baumgartner JC, Marshall G. Hemostatic efficacy and cardiovascular effects of agents used during endodontic surgery. J Endod 2002; 28:322-3. [PMID: 12043873 DOI: 10.1097/00004770-200204000-00015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The hemostatic efficacy, as well as the cardiovascular effects, of two hemostatic agents currently used during endodontic surgery was examined. The hemostatic agents used were epinephrine pellets (Racellet pellets) or 20% ferric sulfate (Viscostat). Patients were assigned to one of two experimental groups. Blood pressure and pulse rate were recorded pre- and postoperatively and at three additional times during the surgery (root-end resection, root-end preparation, and filling). The adequacy of hemostasis was rated by the surgical operator. Results indicated that there is no significant change in cardiovascular effects when using either of these hemostatic agents. Except in one case where ferric sulfate was the agent, both agents produced surgical hemostasis that allowed for a dry field for root-end filling.
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Affiliation(s)
- Francine J Vickers
- Department of Endodontology, Oregon Health Sciences University, Portland 97201, USA
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