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Leveque M, Bekhouche M, Farges JC, Richert R, Ducret M. Investigation of the early apical release from endodontic hydrogels: A 3D printed model. Int Endod J 2024; 57:943-950. [PMID: 38376094 DOI: 10.1111/iej.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
AIM Regenerative Endodontic Procedures (REPs) using new materials such as hydrogels aim to replace current endodontic treatments, but numerous limitations are to overcome. Apical release was little explored in previous studies, especially regarding hydrogels that incorporate molecules, such as growth factors and antibiotics. Apical release is a key mechanism in achieving regeneration, as it could regulate disinfection or cell colonization. Few models exist for apical release, limiting the transfer of these devices from bench to bedside. This study aims to design a simple and standardized model to identify parameters that influence the early apical release kinetic of molecules from endodontic hydrogels. METHODOLOGY Endodontic Release Inserts (ERI) were designed to mimic the situation of an immature incisor using three different diameters (Ø 0.5 to 2 mm) and to allow the study of the early release from a hydrogel in a 96-well plate. ERI was produced with a 3D printing machine. The kinetic release was investigated using 2 fluorescent, hydrophobic (BDP-500) and hydrophilic (Fluorescein) molecules, in different hydrogels (fibrin and agarose) and in various media (PBS or serum). The release kinetics were estimated by measuring the fluorescence at different time points (1 to 24 h). RESULTS ERI use made it possible to report that apical diameters increase from 500 to 1000 μm was associated with an increase in release from 4.02 ± 1.63% to 11.53 ± 2.38% over 24 h. It also allowed us to report that bottom solution composition change from PBS to human serum was associated with an increase in the release of fatty acid molecules, whilst a decrease in the hydrogel concentration was associated with a variation in release kinetics. Moreover, nano-encapsulation of a molecule was associated with a decreased release over the first 24 h from 5.25 to 0%. CONCLUSION ERI use enables investigation of the parameters influencing release kinetics from endodontic hydrogels. Further investigations are necessary to evaluate the interaction of these parameters with each other, in animal models and clinic.
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Affiliation(s)
- Marianne Leveque
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, UMS 3444 BioSciences Gerland-Lyon Sud, Lyon, France
| | - Mourad Bekhouche
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, UMS 3444 BioSciences Gerland-Lyon Sud, Lyon, France
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, UMS 3444 BioSciences Gerland-Lyon Sud, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Raphaël Richert
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
- UMR 5259 CNRS/INSA/Univ, Lyon, France
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, UMS 3444 BioSciences Gerland-Lyon Sud, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
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Edwards D, Rasaiah S, Kirkevang LL, Vaeth M, Stone SJ, Obara I, Durham J, Whitworth J. The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study. Int Endod J 2024; 57:416-430. [PMID: 38214015 DOI: 10.1111/iej.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
AIM To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. METHODOLOGY All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. RESULTS Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). CONCLUSIONS This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.
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Affiliation(s)
- David Edwards
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sabrina Rasaiah
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Michael Vaeth
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Simon J Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ilona Obara
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - John Whitworth
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Leveque M, Bekhouche M, Farges JC, Aussel A, Sy K, Richert R, Ducret M. Bioactive Endodontic Hydrogels: From Parameters to Personalized Medicine. Int J Mol Sci 2023; 24:14056. [PMID: 37762359 PMCID: PMC10531297 DOI: 10.3390/ijms241814056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Regenerative endodontic procedures (REPs) aim at recreating dental pulp tissue using biomaterials such as hydrogels. Their bioactivity is mostly related to the nature of biomolecules or chemical compounds that compose the endodontic hydrogel. However, many other parameters, such as hydrogel concentration, bioactive molecules solubility, and apex size, were reported to influence the reciprocal host-biomaterial relationship and hydrogel behavior. The lack of knowledge regarding these various parameters, which should be considered, leads to the inability to predict the clinical outcome and suggests that the biological activity of endodontic hydrogel is impossible to anticipate and could hinder the bench-to-bedside transition. We describe, in this review, that most of these parameters could be identified, described, and studied. A second part of the review lists some challenges and perspectives, including development of future mathematical models that are able to explain, and eventually predict, the bioactivity of endodontic hydrogel used in a clinical setting.
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Affiliation(s)
- Marianne Leveque
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/UCBL, 69007 Lyon, France; (M.L.); (M.B.); (J.-C.F.)
| | - Mourad Bekhouche
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/UCBL, 69007 Lyon, France; (M.L.); (M.B.); (J.-C.F.)
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/UCBL, 69007 Lyon, France; (M.L.); (M.B.); (J.-C.F.)
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (K.S.); (R.R.)
- Service d’Odontologie, Hospices Civils de Lyon, 69007 Lyon, France
| | - Audrey Aussel
- BIOTIS—Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, 33076 Bordeaux, France;
- UFR d’Odontologie, Université de Bordeaux, 33600 Bordeaux, France
- CHU de Bordeaux, Pôle de Médecine et Chirurgie Bucco-Dentaire, 33076 Bordeaux, France
| | - Kadiatou Sy
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (K.S.); (R.R.)
- Service d’Odontologie, Hospices Civils de Lyon, 69007 Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Raphaël Richert
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (K.S.); (R.R.)
- Service d’Odontologie, Hospices Civils de Lyon, 69007 Lyon, France
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/UCBL, 69007 Lyon, France; (M.L.); (M.B.); (J.-C.F.)
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; (K.S.); (R.R.)
- Service d’Odontologie, Hospices Civils de Lyon, 69007 Lyon, France
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Cai M, Abbott P, Castro Salgado J. pH changes in radicular dentine associated with calcium hydroxide and corticosteroid/antibiotic pastes. AUST ENDOD J 2023; 49 Suppl 1:273-279. [PMID: 29756400 DOI: 10.1111/aej.12280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 11/27/2022]
Abstract
The aim was to compare hydroxyl ion diffusion through dentine following placement of calcium hydroxide and Ledermix paste. Thirty-six teeth were divided into one control (n = 6) and three experimental (n = 10) groups - (i) Pulpdent paste; (ii) Pulpdent/Ledermix pastes; (iii) Ledermix paste and (iv) Saline. pH was measured in inner and outer dentine cavities over 12 months. Inner dentine time to maximum pH (Tmax ) was 1 week for Pulpdent and 2 weeks for Pulpdent/Ledermix. Pulpdent's outer dentine Tmax was 4 weeks and Pulpdent/Ledermix was 10 weeks. After day 1, Pulpdent pH was higher and this continued for 12 months. Pulpdent's outer dentine pH was higher than Ledermix and controls, but not significantly different from Pulpdent/Ledermix. Pulpdent/Ledermix had significantly higher pH than controls and Ledermix from day 5 until 10 months when Pulpdent/Ledermix outer dentine pH decreased and became similar. In all groups, pH reduced after 3 months.
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Affiliation(s)
- Michael Cai
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Paul Abbott
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
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Abbott PV. Indications for root canal treatment following traumatic dental injuries to permanent teeth. Aust Dent J 2023; 68 Suppl 1:S123-S140. [PMID: 37908151 DOI: 10.1111/adj.12989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.
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Affiliation(s)
- P V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
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Effect of Different Intracanal Medicaments on the Viability and Survival of Dental Pulp Stem Cells. J Pers Med 2022; 12:jpm12040575. [PMID: 35455691 PMCID: PMC9032254 DOI: 10.3390/jpm12040575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Stem cells play an important role in the success of regenerative endodontic procedures. They are affected by the presence of medicaments that are used before the induction of bleeding or the creation of a scaffold for endodontic regeneration. This study examines the effects of different intracanal medicaments on the viability and survival of dental pulp stem cells at different doses and over different exposure times. Methods: Dental pulp stem cells were cultured from healthy third molar teeth using the long-term explant culture method and characterized using flow cytometry and exposed to different concentrations of calcium hydroxide, doxycycline, potassium iodide, triamcinolone, and glutaraldehyde, each ranging from 0 (control) to 1000 µg/mL. Exposure times were 6, 24, and 48 h. Cell viability was measured using the MTT assay, and apoptosis was measured using the Annexin V-binding assay. Results: All medicaments significantly reduced cell viability at different concentrations over different exposure times. Calcium hydroxide and triamcinolone favored cell viability at higher concentrations during all exposure times compared to other medicaments. The apoptosis assay showed a significant increase in cell death on exposure to doxycycline, potassium iodide, and glutaraldehyde. Conclusion: The intracanal medicaments examined in our study affected the viability of dental pulp stem cells in a time and dose-dependent manner. They also adversely affected the survival of dental pulp stem cells. Further studies are needed to better understand the effect of prolonged exposure to medicaments according to clinical protocols and their effect on the stemness of dental pulp stem cells.
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George R, Wong M, White A, Jarrett J, Walsh L. Evaluation of the diffusion of triamcinolone and demeclocycline through the dentinal tubules and apical foramen: A mass spectrometry study. J Conserv Dent 2022; 25:420-425. [PMID: 36187869 PMCID: PMC9520650 DOI: 10.4103/jcd.jcd_206_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of this study was to investigate the diffusion of triamcinolone and demeclocycline from an endodontic paste when used unmodified, versus when combined in equal parts with a calcium hydroxide paste, in terms of diffusion through the dentinal tubules versus through the apical foramen. Methodology: Medicaments were placed in endodontically prepared roots that were kept in vials of Milli-Q water. The five experimental groups in the study were (1) control – no medicament, (2) medicament containing triamcinolone and demeclocycline (T&D) and occluded apex, (3) T&D paste and patent apex, (4) T&D + calcium hydroxide (Ca(OH)2) occluded apex, and (5) T&D + Ca(OH)2 and patent apex. The triamcinolone and demeclocycline concentrations were measured with solid-phase extraction and ultra-high performance liquid chromatography–mass spectrometry, after 1, 3, 8, and 24 h, and after 1 week. Results: Most of the triamcinolone and demeclocycline diffused through the apical foramen, with sparse diffusion through the dentinal tubules. The T&D paste mixed with Ca(OH)2 in equal amounts showed greater than the expected 50% reduction in the diffusion of triamcinolone and demeclocycline from mass dilution alone (89% and 80%, respectively). Conclusions: These results stress the importance of maintaining apical patency, for allowing diffusion of active components of the drugs to target tissues in the periapical environment.
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Vatankhah M, Khosravi K, Zargar N, Shirvani A, Nekoofar MH, Dianat O. Antibacterial efficacy of antibiotic pastes versus calcium hydroxide intracanal dressing: A systematic review and meta-analysis of ex vivo studies. J Conserv Dent 2022; 25:463-480. [PMID: 36506621 PMCID: PMC9733540 DOI: 10.4103/jcd.jcd_183_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Conflicting findings on the potency of antibiotic pastes versus calcium hydroxide (CH) have been evident in the literature. Aims To compare the antibacterial efficacy of single antibiotic paste (SAP), double antibiotic paste (DAP), triple antibiotic paste (TAP), and modified TAP (mTAP) with CH on bacterial biofilms. Methods PubMed, Scopus, and Embase were comprehensively searched until August 23, 2021. The study protocol was registered in the PROSPERO. Ex vivo studies performed on Enterococcus faecalis or polymicrobial biofilms incubated on human/bovine dentin were selected. The quality of the studies was assessed using a customized quality assessment tool. Standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated for the meta-analysis. Meta-regression models were used to identify the sources of heterogeneity and to compare the efficacy of pastes. Results The qualitative and quantitative synthesis included 40 and 23 papers, respectively, out of 1421 search results. TAP (SMD = -3.82; CI, -5.44 to -2.21; P < 0.001) and SAPs (SMD = -2.38; CI, -2.81 to - 1.94; P < 0.001) had significantly higher antibacterial efficacy compared to the CH on E. faecalis biofilm. However, no significant difference was found between the efficacy of DAP (SMD = -2.74; CI, -5.56-0.07; P = 0.06) or mTAP (SMD = -0.28; CI, -0.82-0.26; P = 0.31) and CH. Meta-regression model on E. faecalis showed that SAPs have similar efficacy compared to TAP and significantly better efficacy than DAP. On dual-species (SMD = 0.15; CI, -1.00-1.29; P = 0.80) or multi-species (SMD = 0.23; CI, -0.08-0.55; P = 0.15) biofilms, DAP and CH had similar efficacy. Conclusions Ex vivo evidence showed that antibiotic pastes were either superior or equal to CH. The studied SAPs had considerably higher or similar antibacterial effectiveness compared to DAP, CH, and TAP. Hence, combined antibiotic therapy was not necessarily required for root canal disinfection ex vivo.
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Affiliation(s)
- Mohammadreza Vatankhah
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Khosravi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Dianat
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA,Address for correspondence: Dr. Omid Dianat, Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, 650 West Baltimore Street, 4th Floor, Baltimore, MD 21201, USA. E-mail:
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Abbott PV. Present status and future directions - managing endodontic emergencies. Int Endod J 2021; 55 Suppl 3:778-803. [PMID: 34958512 DOI: 10.1111/iej.13678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's - Diagnosis, Definitive dental treatment and Drugs - and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment is done can also vary, according to the diagnosis. The final "D" is Drugs - the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Australia
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10
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Edwards D, Bailey O, Stone SJ, Duncan H. How is carious pulp exposure and symptomatic irreversible pulpitis managed in UK primary dental care? Int Endod J 2021; 54:2256-2275. [PMID: 34487553 DOI: 10.1111/iej.13628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022]
Abstract
AIM To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious exposure and with additional signs and symptoms indicative of irreversible pulpitis. METHODOLOGY An electronic questionnaire was openly distributed via publicly funded (NHS) local dental committees, corporate dental service-providers, professional societies and social media. Principally NHS practitioners and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ2 tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p ≤ .2 were selected for backwards likelihood ratio logistic modelling. RESULTS In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs and symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioners as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non-UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate postoperative evaluation and use rubber dam. CONCLUSIONS Practitioners deviated from evidence-based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non-UK graduates and dentists with postgraduate qualifications adhered more to evidence-based VPT guidelines.
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Affiliation(s)
- David Edwards
- Restorative Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Oliver Bailey
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon J Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hal Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
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Eggmann F, Rihs J, Lenherr P, Weiger R, Krastl G, Zaugg LK. Spectrophotometric insights: calcium hydroxide influences tooth discolorations induced by short-term application of antibiotic/corticosteroid pastes. Clin Oral Investig 2020; 25:1141-1149. [PMID: 32712847 DOI: 10.1007/s00784-020-03414-1] [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: 01/28/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This in vitro study aimed to assess the influence of a calcium hydroxide dressing regarding the relative color change (ΔE) of enamel-dentin specimens previously exposed to antibiotic/corticosteroid pastes. MATERIALS AND METHODS Eighty bovine enamel-dentin specimens with a cylindrical central cavity were randomly allocated to four groups: NEG (empty), POS (blood), LED (Ledermix), and ODO (Odontopaste) (n = 20 each). The materials were applied and sealed with self-adhesive resin luting material. After 3 weeks, the materials were removed and a calcium hydroxide (Ca(OH)2) dressing was placed in all cavities. After a further 3-week storage period, the cavities were restored with resin-based composite. Spectrophotometric color measurements were taken over 6 months, and ΔE values were calculated. A Tukey's multiple comparison test was performed to assess significant differences within the treatment groups (p < 0.05). RESULTS Tooth discolorations were present after 3 weeks in LED (ΔE 29.14 ± 6.55) and POS (ΔE 18.05 ± 7.03); NEG and ODO remained color stable (ΔE 3.2 ± 1.36 and ΔE 2.3 ± 1.16). The 3-week Ca(OH)2 dressing decreased discolorations of POS (ΔE 15.93 ± 6.63; p = 0.37), whereas LED showed a further significant increase (ΔE 39.55; p < 0.0001). Between the end of the Ca(OH)2 dressing and the final restoration no significant color changes were observed in any group (p > 0.9). CONCLUSIONS Discolorations induced by LED progressed during the Ca(OH)2 dressing despite careful removal of all residues. CLINICAL RELEVANCE Calcium hydroxide might negatively affect the discoloring potential of Ledermix. This highlights the need for direct intracanal application methods of Ledermix ensuring a material-free access cavity or alternative antibiotic/corticosteroid pastes such as Odontopaste should be used.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Jeremy Rihs
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Patrik Lenherr
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Gabriel Krastl
- Department of Operative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - Lucia K Zaugg
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland.
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Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, O'Connell A, Flores MT, Day PF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020; 36:331-342. [DOI: 10.1111/edt.12573] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Ashraf F. Fouad
- Adams School of Dentistry University of North Carolina Chapel Hill NC USA
| | - Paul V. Abbott
- UWA Dental School University of Western Australia Crawley WA Australia
| | - Georgios Tsilingaridis
- Division of Orthodontics and Pediatric Dentistry Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Center for Pediatric Oral Health Research Stockholm Sweden
| | - Nestor Cohenca
- Department of Pediatric Dentistry University of Washington and Seattle Children’s Hospital Seattle WA Australia
| | - Eva Lauridsen
- Resource Center for Rare Oral Diseases Copenhagen University Hospital Copenhagen Denmark
| | | | - Anne O'Connell
- Paediatric Dentistry Dublin Dental University Hospital Trinity College Dublin The University of Dublin Dublin Ireland
| | - Marie Therese Flores
- Department of Pediatric Dentistry Faculty of Dentistry Universidad de Valparaíso Valparaíso Chile
| | - Peter F. Day
- School of Dentistry Community Dental Service Bradford District Care NHS Trust University of Leeds Leeds UK
| | - Lamar Hicks
- Division of Endodontics University of Maryland School of DentistryUMB Baltimore MD USA
| | - Jens Ove Andreasen
- Department of Oral and Maxillofacial Surgery Resource Centre for Rare Oral Diseases University Hospital in Copenhagen (Rigshospitalet) Copenhagen Denmark
| | - Zafer C. Cehreli
- Department of Pediatric Dentistry Faculty of Dentistry Hacettepe University Ankara Turkey
| | - Stephen Harlamb
- Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
| | - Bill Kahler
- School of Dentistry The University of Queensland St Lucia QLD Australia
| | - Adeleke Oginni
- Faculty of Dentistry College of Health Sciences Obafemi Awolowo University Ile‐Ife Nigeria
| | | | - Liran Levin
- Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
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Mirza M, Alhedyan F, Alqahtani A. Antibiotics in endodontics. JOURNAL OF DENTAL RESEARCH AND REVIEW 2019. [DOI: 10.4103/jdrr.jdrr_52_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cai M, Abbott P, Castro Salgado J. Hydroxyl Ion Diffusion through Radicular Dentine When Calcium Hydroxide Is Used under Different Conditions. MATERIALS 2018; 11:ma11010152. [PMID: 29342093 PMCID: PMC5793650 DOI: 10.3390/ma11010152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/25/2022]
Abstract
Calcium hydroxide’s anti-bacterial action relies on high pH. The aim here was to investigate hydroxyl ion diffusion through dentine under different conditions. Teeth were divided into control (n = 4) and four experimental groups (n = 10): Group 1—no medicament; Group 2—Calmix; Group 3—Calmix/Ledermix; Group 4—Calasept Plus/Ledermix; Group 5—Pulpdent/smear layer. Deep (inner dentine) and shallow (outer dentine) cavities were cut into each root. pH was measured in these cavities for 12 weeks. The inner and outer dentine pH in Group 2 was significantly higher than all groups. Inner dentine pH in Group 3 was slightly higher than that in Group 4 initially but subsequently comparable. After Day 2, Group 5 had significantly lower pH than Groups 3 and 4. The outer dentine pH in Group 3 started higher than that in Groups 4 and 5, but by Day 28 the difference was insignificant. The time for the inner dentine to reach maximum pH was one week for Group 2 and four weeks for Groups 3 and 4. The time for the outer dentine to reach maximum pH was eight weeks for all experimental groups. Mixing different Ca(OH)2 formulations with Ledermix gave similar hydroxyl ion release but pH and total diffusion was lower than Ca(OH)2 alone. The smear layer inhibited diffusion.
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Affiliation(s)
- Michael Cai
- UWA Dental School, The University of Western Australia, Crawley, WA 6009, Australia.
| | - Paul Abbott
- UWA Dental School, The University of Western Australia, Crawley, WA 6009, Australia.
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15
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Iranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review. IRANIAN ENDODONTIC JOURNAL 2017; 12:123-130. [PMID: 28496516 PMCID: PMC5421265 DOI: 10.22037/iej.2017.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment. METHODS AND MATERIALS Scopus, MEDLINE and CENTRAL databases were searched up to 30th January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers. RESULTS Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis. CONCLUSION Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed.
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Affiliation(s)
- Foad Iranmanesh
- Department ofEndodontics, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Masoud Parirokh
- Endodontology Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran;
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran;
| | - Paul V. Abbott
- Dental School, University of Western Australia, Perth, Australia
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Abbott PV. Prevention and management of external inflammatory resorption following trauma to teeth. Aust Dent J 2016; 61 Suppl 1:82-94. [DOI: 10.1111/adj.12400] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- PV Abbott
- School of Dentistry; The University of Western Australia; Western Australia Australia
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Mohammadi Z, C Cehreli Z, Shalavi S, Giardino L, Palazzi F, Asgary S. Management of Root Resorption Using Chemical Agents: A Review. IRANIAN ENDODONTIC JOURNAL 2016; 11:1-7. [PMID: 26843869 PMCID: PMC4731525 DOI: 10.7508/iej.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/28/2015] [Accepted: 10/24/2015] [Indexed: 11/30/2022]
Abstract
Root resorption (RR) is defined as the loss of dental hard tissues because of clastic activity inside or outside of tooth the root. In the permanent dentition, RR is a pathologic event; if untreated, it might result in the premature loss of the affected tooth. Several hypotheses have been suggested as the mechanisms of root resorption such as absence of the remnants of Hertwig's epithelial root sheath (HERS) and the absence of some intrinsic factors in cementum and predentin such as amelogenin or osteoprotegerin (OPG). It seems that a barrier is formed by the less-calcified intermediate cementum or the cementodentin junction that prevents external RR. There are several chemical strategies to manage root resorption. The purpose of this paper was to review several chemical agents to manage RR such as tetracycline, sodium hypochlorite, acids (citric acid, phosphoric acid, ascorbic acid and hydrochloric acid), acetazolamide, calcitonin, alendronate, fluoride, Ledermix and Emdogain.
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Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shaheed Beheshti University of Medical Sciences, and Iranian National Elite Foundation, Tehran, Iran
| | - Zafer C Cehreli
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | | | - Luciano Giardino
- Department of Periodontology, Endodontology, Pharmacology and Microbiology, Dental School, University of Brescia, Italy
| | - Flavio Palazzi
- Department of Odontostomatological and Maxillofacial Sciences, Federico II University of Naples, Italy
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Attachment Ability of Human Apical Papilla Cells to Root Dentin Surfaces Treated with Either 3Mix or Calcium Hydroxide. J Endod 2015; 42:89-94. [PMID: 26454719 DOI: 10.1016/j.joen.2015.08.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/07/2015] [Accepted: 08/27/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Tissue regeneration and root continuation are the ultimate goals in regenerative endodontics. Apical papilla cells (APCs) have been hypothesized to play roles in those processes. Therefore, preservation of cell vitality and promoting initial cell attachment seem to be crucial steps. The purposes of this study were to investigate the attachment ability and morphology of viable human APCs by using fibronectin immunofluoresence, alamarBlue assay, and scanning electron microscopy, when APCs were grown on human root dentin surfaces treated with 3Mix or calcium hydroxide (Ca(OH)2) at different concentrations. METHODS Human root dentin slices were divided into 6 groups: (1) control, (2) 3Mix 0.39 μg/mL, (3) 3Mix 100 μg/mL, (4) 3Mix paste, (5) Ca(OH)2 1 mg/mL, and (6) Ca(OH)2 1000 mg/mL. All samples were separately treated for 7 days and final rinsed with 17% EDTA. Then primary human APCs were seeded. Fibronectin immunofluorescence was used to evaluate the attachment ability of APCs on treated dentin. A vitality assay by using alamarBlue was monitored at specific time intervals. The morphology of the cells on the dentin was observed under scanning electron microscopy. RESULTS The lowest number of fibronectin-positive cells was observed on root dentin treated with 3Mix paste (P < .05). The 3Mix at 0.39 and 100 μg/mL did not affect the amount of APC attachment, whereas the viability of APCs on the dentin surface was significantly lower in the 100-μg/mL 3Mix-treated group than in the negative control group (P < .05). Both concentrations of Ca(OH)2 induced APC attachment (P < .05). Moreover, only cells grown on the surfaces treated with Ca(OH)2 exhibited cytoplasmic processes. CONCLUSIONS Human root dentin treated with 3Mix paste had significantly lower APC attachment. The 3Mix at 0.39 μg/mL and 100 μg/mL had no significant negative effect on APC attachment on dentin. Higher numbers of cells attaching on dentin were observed in calcium hydroxide-treated groups.
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Effects of a triple antibiotic solution on pulpal dynamics after intentionally delayed tooth replantation in mice. J Endod 2014; 40:1566-72. [PMID: 25260727 DOI: 10.1016/j.joen.2014.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/05/2014] [Accepted: 05/09/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study analyzed the detailed biological events underlying pulpal dynamics evoked by 3Mix (the mixture of ciprofloxacin, metronidazole, and minocycline) solution after intentionally delayed tooth replantation because 3Mix improves pulpal healing after tooth injuries. METHODS The maxillary first molars of 3-week-old mice were extracted and immersed in 3Mix solution for 30 minutes in comparison with phosphate buffered saline (PBS) alone. Cell proliferation, apoptosis, and differentiation were assessed in extracted/replanted teeth during days 0-14 using immunohistochemistry, apoptosis assay, and reverse-transcriptase polymerase chain reaction. RESULTS 3Mix solution accelerated odontoblast differentiation in the coronal pulp on day 7 and tertiary dentin formation on day 14, whereas the regenerative process was delayed in the PBS group. Cell proliferation and apoptosis occurred in the pulp of the 3Mix group during days 5-7 and subsequently decreased from days 7-14. On day 5, dentin sialophosphoprotein and nestin were first recovered in the 3Mix group, whereas expression levels for alkaline phosphatase, osteopontin, and osteocalcin increased in the PBS group. The expression levels for octamer-binding factor 3/4A and 3/4B reached the maximum level on day 1 and were sharply decreased on day 3 in both groups. High expression levels of Cd11c were first observed in the 3Mix group on day 1 and later at days 5 and 7. CONCLUSIONS The results suggest that the application of 3Mix may suppress osteoblast differentiation by the migration of dendritic cells to the injury site and via the activation of stem/progenitor cells, resulting in the acceleration of odontoblastlike cell differentiation.
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Kaufman AY, Solomonov M, Galieva D, Abbott PV. Allergic reaction to the tetracycline component of Ledermix paste: a case report. Int Endod J 2014; 47:1090-7. [DOI: 10.1111/iej.12252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Y. Kaufman
- Endodontics and Dental Traumatology Department; Graduate School of Dentistry; Rambam Health Care Campus; Haifa Israel
| | - M. Solomonov
- Department of Endodontics; Sheba Hospital; Tel Hashomer Israel
| | - D. Galieva
- Department of Therapeutic Stomatology; Moscow State University of Medicine and Dentistry; Moscow Russia
| | - P. V. Abbott
- School of Dentistry; The University of Western Australia; Perth WA Australia
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Discoloration of roots caused by residual endodontic intracanal medicaments. ScientificWorldJournal 2014; 2014:404676. [PMID: 24688386 PMCID: PMC3934450 DOI: 10.1155/2014/404676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/26/2013] [Indexed: 11/18/2022] Open
Abstract
AIMS This study examined the extent to which intervisit corticosteroid-based antibiotic pastes (CAP) medicaments contribute to staining of tooth structure after attempted removal by irrigation techniques. METHODS A total of 140 roots were prepared and the canals were filled with Ledermix paste (demeclocycline), Odontopaste (clindamycin), and Doxypaste (doxycycline). The pastes were removed after 2 or 4 weeks of storage in the dark using EDTA and NaOCl with either a 27-gauge-slotted needle or an EndoActivator (Dentsply). The roots were then exposed to an intense light source for 30 minutes each week and photographed after a further 1, 3, or 6 months. Digital images were standardized and data for changes in luminosity were analysed using repeated measures ANOVA and a post hoc test. RESULTS Removal of the medicament did not prevent later discolouration. There was no significant difference between the paste removal methods. Ledermix paste caused the greatest darkening compared to the untreated controls, for both application periods and both methods of removal. Doxypaste and Odontopaste caused less darkening than Ledermix. CONCLUSION Medicaments that stain teeth may continue to discolour teeth despite best attempts to remove them. This study stresses the importance of material selection and minimising contact of Ledermix within the coronal aspects of teeth.
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Eftekhar B, Moghimipour E, Pourakbar Jahandideh P, Jalali S, Mahmoudian M. Analgesic effect of odontopaste and a compound intracanal medicament between root canal therapy appointments. Jundishapur J Nat Pharm Prod 2013; 8:169-74. [PMID: 24624209 PMCID: PMC3941894 DOI: 10.17795/jjnpp-12473] [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: 05/27/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pain experience makes a serious anxiety for both patient and clinician before and after root canal treatment. Pain is a complex psychophysiologic phenomenon. OBJECTIVES The aim of this randomized control trial study was to evaluate the analgesic effect of Odontopaste® and a corticosteroid containing compound medicament between root canal therapy appointments. MATERIALS AND METHODS One hundred and twenty lower first and second mandibular molars with spontaneous pain and sensitivity to percussion were selected and divided into three groups (40 patients per each group). After root canal preparation, patients were entered one of these groups randomly. Root canals in group 1 were dressed with Odontopaste, in group 2 with a compound intracanal medicament, and in group 3 with placebo. Patients determined their pain rate and percussion sensitivity on Heft-parker VAS diagram, before the first appointment and 24 hours and 7 days after that. RESULTS Spontaneous pain and Percussion sensitivity score averages of 24 hours after the first appointment in group 1 and group 2 were less than group 3, which indicates statistically significant difference between these groups. There was no statistically significant difference between these groups after 7 days neither on spontaneous pain nor percussion sensitivity. CONCLUSIONS Odontopaste® and compound intracanal medicaments resulted in statistically significant reduction in postoperative pain and percussion sensitivity after 24 hours, but there was no statistically significant difference after 7 days with placebo.
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Affiliation(s)
- Behrooz Eftekhar
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Eskandar Moghimipour
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Pejman Pourakbar Jahandideh
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Sahar Jalali
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mahsa Mahmoudian
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, Kenny DJ, Sigurdsson A, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Tsukiboshi M. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2012; 39:412-419. [PMID: 22409417 DOI: 10.1111/j.1600-9657.2012.01125.x] [Citation(s) in RCA: 341] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. 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 task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.
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Affiliation(s)
- Lars Andersson
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
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Thomson AD, Athanassiadis B, Kahler B, Walsh L. Tooth discolouration: Staining effects of various sealers and medicaments. AUST ENDOD J 2012; 38:2-9. [DOI: 10.1111/j.1747-4477.2011.00339.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Day PF, Gregg TA, Ashley P, Welbury RR, Cole BO, High AS, Duggal MS. Periodontal healing following avulsion and replantation of teeth: a multi-centre randomized controlled trial to compare two root canal medicaments. Dent Traumatol 2011; 28:55-64. [PMID: 21988960 DOI: 10.1111/j.1600-9657.2011.01053.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-setting calcium hydroxide (Ultracal XS(®) ) is recommended by the International Association of Dental Traumatology as the initial medicament following avulsion and replantation for mature teeth. There is experimental evidence to suggest Ledermix(®) , placed as an alternative inter-visit dressing may improve periodontal healing. AIM This study investigated, using a multi-centre randomized controlled trial, the effect of two root canal medicaments, Ledermix(®) and Ultracal XS(®) , on periodontal healing of avulsed and replanted teeth. MATERIAL AND METHODS Children were recruited if they fulfilled all inclusion criteria. Treatment followed a standardized protocol. Assessment of periodontal healing or ankylosis was made clinically and radiographically by an experienced, 'blinded', clinician at 12months. RESULTS Over 200 patients were assessed for eligibility at five centres. Twenty-nine patients were eligible for inclusion. Final analysis involved 22 patients with 27 teeth. Ankylosis was detected in four of the 12 teeth in the Ledermix(®) group and nine of 15 in the Ultracal XS(®) group. No significant difference between medicaments was found in the proportion of teeth or patients showing periodontal healing. DISCUSSION There was no significant difference in periodontal healing between the two medicaments at either a tooth or patient level. The numbers recruited fell short of an estimated power calculation. For patients meeting the inclusion criteria and completing the trial, periodontal healing was seen in 52% of teeth at the 12-month assessment between both groups. The only factor found to significantly influence the periodontal outcome was dry time.
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Affiliation(s)
- Peter F Day
- Leeds Dental Institute, Leeds Belfast Children's Hospital, Belfast Eastman Dental Institute, London, UK.
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Athanassiadis B, Abbott PV, George N, Walsh LJ. In vitro study of the inactivation by dentine of some endodontic medicaments and their bases. Aust Dent J 2010; 55:298-305. [PMID: 20887518 DOI: 10.1111/j.1834-7819.2010.01238.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to investigate the antimicrobial effect of endodontic medicaments and their bases in the presence of dentine powder. METHODS The medicaments tested were Ledermix paste, Pulpdent paste, a 50:50 combination of the Pulpdent:Ledermix and their bases. The test organism was Enterococcus faecalis ATCC 29212. The presence or absence of dentine was examined as well as the effect of autoclaving dentine. Serial dilutions of samples at 1 hour, 1 day and 3 days were used for colony counting. The effects of dentine powder on pH for saturated Ca(OH)2 solution and Pulpdent paste at 1 hour and 24 hours were also measured. RESULTS Pulpdent and the 50:50 combination of Pulpdent:Ledermix completely inhibited the growth of E. faecalis from 1 hour onwards, and these results were not affected by the presence/absence of dentine powder, pre-incubation period, timing of autoclaving, or exposure time. Saturated solutions of Ca(OH)2 are prone to inactivation by dentine powder unlike Pulpdent paste. Ledermix paste took 3 days to exert a significant effect on the growth of E. faecalis. CONCLUSIONS In this laboratory study, both Pulpdent and the 50:50 mixture of Pulpdent with Ledermix were effective medicaments against E. faecalis in the presence of dentine powder.
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Affiliation(s)
- B Athanassiadis
- School of Dentistry, The University of Western Australia, Western Australia.
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Mohammadi Z, Abbott PV. Antimicrobial substantivity of root canal irrigants and medicaments: a review. AUST ENDOD J 2010; 35:131-9. [PMID: 19961451 DOI: 10.1111/j.1747-4477.2009.00164.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Disinfection of the root canal system is one of the primary aims of root canal treatment. This can be achieved through the use of various antimicrobial agents in the form of irrigants and medicaments. These agents are only used for relatively short periods of time ranging from minutes (for irrigants) up to days or several weeks (for medicaments) and therefore their long-term antimicrobial effects rely on whether or not the particular agent has any properties of substantivity. If irrigants and medicaments had effective long-term residual antimicrobial activity that could prevent re-infection of the root canal system, then the long-term outcomes of endodontic treatment might be improved. Only a small number of studies have investigated the short-term substantivity of commonly used antimicrobial agents and the results show substantivity of chlorhexidine lasts for up to 12 weeks and tetracycline for up to 4 weeks. However, it is not known whether the substantivity of these agents will last for longer periods of time as this has not been investigated.
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Affiliation(s)
- Zahed Mohammadi
- Shahid Sadoughi Dental School, Department of Endodontics, Imam Avenue, Fazaye Sabz Cross Road, Yazd, Iran.
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Abbott PV, Salgado JC. Strategies for the endodontic management of concurrent endodontic and periodontal diseases. Aust Dent J 2010; 54 Suppl 1:S70-85. [PMID: 19737270 DOI: 10.1111/j.1834-7819.2009.01145.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endodontic and periodontal diseases can provide many diagnostic and management challenges to clinicians, particularly when they occur concurrently. As with all diseases, a thorough history combined with comprehensive clinical and radiographic examinations are all required so an accurate diagnosis can be made. This is essential since the diagnosis will determine the type and sequence of treatment required. This paper reviews the relevant literature and proposes a new classification for concurrent endodontic and periodontal diseases. This classification is a simple one that will help clinicians to formulate management plans for when these diseases occur concurrently. The key aspects are to determine whether both types of diseases are present, rather than just having manifestations of one disease in the alternate tissue. Once it is established that both diseases are present and that they are as a result of infections of each tissue, then the clinician must determine whether the two diseases communicate via the periodontal pocket so that appropriate management can be provided using the guidelines outlined. In general, if the root canal system is infected, endodontic treatment should be commenced prior to any periodontal therapy in order to remove the intracanal infection before any cementum is removed. This avoids several complications and provides a more favourable environment for periodontal repair. The endodontic treatment can be completed before periodontal treatment is provided when there is no communication between the disease processes. However, when there is communication between the two disease processes, then the root canals should be medicated until the periodontal treatment has been completed and the overall prognosis of the tooth has been reassessed as being favourable. The use of non-toxic intracanal therapeutic medicaments is essential to destroy bacteria and to help encourage tissue repair.
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Affiliation(s)
- P V Abbott
- School of Dentistry, The University of Western Australia, Nedlands, WA 6009, Australia.
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Mohammadi Z, Abbott PV. On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology. Int Endod J 2009; 42:555-67. [PMID: 19467048 DOI: 10.1111/j.1365-2591.2009.01564.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Z Mohammadi
- Department of Endodontics, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran.
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33
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Ehrmann EH, Messer HH, Clark RM. Flare-ups in endodontics and their relationship to various medicaments. AUST ENDOD J 2008; 33:119-30. [PMID: 18076580 DOI: 10.1111/j.1747-4477.2007.00087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this research is to investigate the frequency of endodontic flare-ups using a visual analogue scale. Definitions of flare-ups vary widely as does their reported frequency. A flare-up was defined as an increase of 20 or more points on the visual analogue scale for a given tooth, within the periods of 4 h and 24 h after the initial treatment appointment. The data from a previous study were used to determine the incidence of flare-ups after using three modalities (Ledermix, calcium hydroxide and no medication) to manage patients presenting for relief of pain of endodontic origin. A statistical analysis showed that there were no significant differences in flare-up rates at both the 4-h and 24-h periods between the three modalities. Further research is required using the above definition of a flare-up and standardising treatment protocols.
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Affiliation(s)
- Ernest H Ehrmann
- School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.
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34
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El Karim I, Kennedy J, Hussey D. The antimicrobial effects of root canal irrigation and medication. ACTA ACUST UNITED AC 2007; 103:560-9. [PMID: 17223590 DOI: 10.1016/j.tripleo.2006.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 06/17/2006] [Accepted: 10/04/2006] [Indexed: 10/23/2022]
Abstract
The role of microorganisms in the development and maintenance of pulpal and periapical inflammation have been well documented. The success of root canal treatment largely depends on the elimination of microbial contamination from the root canal system. Although mechanical instrumentation of root canals can reduce bacterial population, effective elimination of bacteria cannot be achieved without the use of antimicrobial root canal irrigation and medication. This review will discuss the antimicrobial effects of the known root canal irrigants and medicaments and explore future developments in the field.
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Affiliation(s)
- Ikhlas El Karim
- Department of Restorative Dentistry, School of Clinical Dentistry, Queen's University Belfast, Belfast, Northern Ireland.
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35
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Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007; 52:S64-82. [PMID: 17546863 DOI: 10.1111/j.1834-7819.2007.tb00527.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bacteria have been implicated in the pathogenesis and progression of pulp and periapical diseases. The primary aim of endodontic treatment is to remove as many bacteria as possible from the root canal system and then to create an environment in which any remaining organisms cannot survive. This can only be achieved through the use of a combination of aseptic treatment techniques, chemomechanical preparation of the root canal, antimicrobial irrigating solutions and intracanal medicaments. The choice of which intracanal medicament to use is dependent on having an accurate diagnosis of the condition being treated, as well as a thorough knowledge of the type of organisms likely to be involved and their mechanisms of growth and survival. Since the disease is likely to have been caused by the presence of bacteria within the root canal, the use of an antimicrobial agent is essential. Many medicaments have been used in an attempt to achieve the above aims but no single preparation has been found to be completely predictable or effective. Commonly used medicaments include calcium hydroxide, antibiotics, non-phenolic biocides, phenolic biocides and iodine compounds. Each has advantages and disadvantages, and further research is required to determine which is best suited for root canal infections.
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Affiliation(s)
- B Athanassiadis
- School of Dentistry, The University of Western Australia, Nedlands
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36
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Chu FCS, Leung WK, Tsang PCS, Chow TW, Samaranayake LP. Identification of Cultivable Microorganisms from Root Canals with Apical Periodontitis Following Two-Visit Endodontic Treatment with Antibiotics/Steroid or Calcium Hydroxide Dressings. J Endod 2006; 32:17-23. [PMID: 16410062 DOI: 10.1016/j.joen.2005.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The study was aimed at comparing the efficacy of disinfection of root canals with periapical radiolucencies when treated with either antibiotics/steroid medicaments (Ledermix or Septomixine) or a calcium hydroxide paste (Calasept). Microbiological samples were taken before and after two-visit endodontic treatment from 88 canals with apical periodontitis. All of the canals but one (87 of 88) had cultivable growth before treatment. After dressing with Ledermix, Septomixine, or Calasept, the percentages of canals remained with positive growth were 48% (13 of 27), 31% (8 of 26), and 31% (11 of 35), respectively. The chi(2) tests showed there were no significant differences in the number of canals with positive growth or mean colony forming units counts after instrumentation, irrigation and dressing. In the Ledermix group, 38 strains of bacteria were recovered. The Septomixine group had 25 strains, and the Calasept group had 25 strains. Gram-positive facultative anaerobic cocci (including staphylococci and streptococci) were more prevalent than the Gram-negative obligate anaerobic rods after treatment in all three groups. Similarities in the reduced number of canals with residual growth, and the prevalence of Gram-positive facultative anaerobic cocci suggest that the use of different inter-appointment dressings produced similar microbiological outcomes. However, factors other than the antimicrobial effectiveness of intracanal medicaments may also be responsible for the results observed.
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Affiliation(s)
- Frederick C S Chu
- Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, China.
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37
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Heithersay GS, Chambers G. Inaugural Geoffrey Heithersay oration in endodontics and oral biology. AUST ENDOD J 2003; 29:81-6. [PMID: 14655821 DOI: 10.1111/j.1747-4477.2003.tb00520.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Smiles are often a reflection of dental health, and as such provide great satisfaction to a dental practitioner who has successfully managed complex dental problems such as malformed, malpositioned or traumatically damaged teeth. A biological approach to the management of the pulpal and periodontal responses to dental trauma has been made possible by cumulative research, and application of this knowledge will enhance successful treatment.
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38
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Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J 2003; 36:868-75. [PMID: 14641427 DOI: 10.1111/j.1365-2591.2003.00735.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain. METHODOLOGY Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study. Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis. All teeth underwent conventional root canal treatment, which involved the instrumentation to the apices of each canal at the first visit. Canals were instrumented using a stepback technique and hand-files along with irrigants using Milton's (1% sodium hypochlorite) solution followed by 15% EDTAC. The canals were dried and one of the following three medicaments was inserted into the canal in random sequence: Group 1: Ledermix paste (Lederle Pharmaceuticals, Division of Cyanamid, Wolfratshausen, Germany); Group 2: calcium hydroxide paste (Calcipulpe, Septodont, France); and Group 3: no dressing. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days. RESULTS The mean score pain for all three groups was between 42 and 48 prior to treatment being commenced. After 4 days, the pain score for Group 2 was 10, for Group 3 was 7 and for Group 1 was 4. Mean preoperative pain level was 44.4 (of a maximum 100) for all groups, and declined by 50% (to 22.1) after 24 h. Patients in Group 1 (Ledermix) experienced significantly less (P = 0.04) postoperative pain than those in the other two groups. There was no significant difference between Group 2 (calcium hydroxide) and Group 3 (no dressing). CONCLUSION Under the conditions of this study, painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all. Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis, with a rapid onset of pain reduction.
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Affiliation(s)
- E H Ehrmann
- School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 711 Elizabeth Street, Melbourne, Victoria, 3000, Australia.
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39
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Hauman CHJ, Love RM. Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 1. Intracanal drugs and substances. Int Endod J 2003; 36:75-85. [PMID: 12657150 DOI: 10.1046/j.1365-2591.2003.00631.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Irrigation solutions and intracanal medicaments are used within the root canal to clean and aid in disinfecting the dentinal walls. Although these materials are intended to be contained within the root canal, they invariably contact the periapical tissues, either through inadvertent extrusion through the apex or leaching. This paper is a review on the methodology involved in biocompatibility testing followed by a discussion on biocompatibility of contemporary intracanal drugs and substances used in endodontics.
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Affiliation(s)
- C H J Hauman
- Department of Oral Rehabilitation, School of Dentistry, University of Otago, Dunedin, New Zealand.
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40
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Bryson EC, Levin L, Banchs F, Abbott PV, Trope M. Effect of immediate intracanal placement of Ledermix Paste(R) on healing of replanted dog teeth after extended dry times. Dent Traumatol 2002; 18:316-21. [PMID: 12656865 DOI: 10.1034/j.1600-9657.2002.00142.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ledermix Paste is a paste containing triamcinolone and demeclocycline with demonstrated anti-inflammatory activity that may slow down resorptive processes after severe traumatic injuries to the dentition. A total of 29 premolar roots of six mongrel dogs were extracted and instrumented with rotary nickel titanium files. Fifteen of these roots were then filled with a calcium hydroxide (Ca(OH)2) slurry and 14 roots were filled with Ledermix Paste paste. All accesses were sealed with glass ionomer and the roots replanted after an extraoral dry time of 60 min. After 4 months, the dogs were killed and the roots prepared for histological evaluation. Five-micrometer thick cross-sections of the root and surrounding tissue taken every 90 micro m were evaluated for healing. In addition, residual root mass was also measured to determine the extent of root structure loss for each treatment method. The Ledermix Paste-treated roots had statistically significantly more healing and less resorption than the roots treated with Ca(OH)2. Root filling with Ledermix Paste also resulted in significantly less loss in root mass due to resorption compared to those roots filled with Ca(OH)2. Immediate intracanal placement of Ledermix Paste at the emergency visit after an avulsion injury appears to decrease resorption and increase favorable healing.
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Affiliation(s)
- E C Bryson
- Department of Endodontics, School of Dentistry, UNC at Chapel Hill, Chapel Hill, NC 27955, USA; Oral Health Centre of WA and School of Dentistry, The University of Western Australia, Perth, Australia
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41
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Wong KS, Sae-Lim V. The effect of intracanal Ledermix on root resorption of delayed-replanted monkey teeth. Dent Traumatol 2002; 18:309-15. [PMID: 12656864 DOI: 10.1034/j.1600-9657.2002.00137.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Progressive root resorption is one of the common sequelae in replanted teeth, which is detrimental to their long-term prognosis. Ledermix paste, with its composition of triamcinolone acetonide and demethylclortetracycline, has been shown to inhibit inflammation and the associated hard tissue resorption. This study evaluated the effect of immediate intracanal Ledermix on root resorption of delayed-replanted monkey teeth. A total of 36 roots were root canal treated. For the experimental group, intracanal Ledermix was placed prior to extraction and replantation after 1-h bench dry. The positive control group was root filled and replanted after 1 h while the negative control group was root filled and replanted immediately. The monkeys were sacrificed after 12 weeks. The H&E histological tissue specimens were prepared and evaluated using a method modified from that of Andreasen's morphometric analysis, as favorable or complete healing and unfavorable healing, comprising inflammatory root resorption and replacement resorption. The results were analyzed using Kruskal-Wallis and Mann-Whitney U-tests as well as Wilcoxon signed ranks test. The negative control group produced highly significant favorable healing and unfavorable healing as compared to the Ledermix group (P = 0.000). The Ledermix group only showed significantly higher occurrence of complete healing (35.46%) compared to the positive control group (16.58%) (P = 0.037) but there were no significant differences in the inflammatory root resorption and replacement resorption. Nevertheless, when the latter two unfavorable healing patterns were combined, there was a significantly lower overall unfavorable healing in the Ledermix group (64.54%) when compared to the positive control group (83.43%) (P = 0.037). This unfavorable healing outcome in the Ledermix group, however, was not significantly different from the favorable healing outcome with the same treatment modality (P = 0.110).
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Affiliation(s)
- Kian Seong Wong
- Endodontic Residency Training Program, Graduate School of Dental Studies, Faculty of Dentistry, National University of Singapore, Republic of Singapore
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42
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43
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Abstract
The aim of this review article is to supplement the recently published International Association of Dental Traumatology (IADT) guidelines on treatment of the avulsed tooth. A thorough discussion on the reasoning behind each guideline is presented. In addition, the author's views on alternate treatment strategies and future directions, along with recent research on the subject of the avulsed tooth, are also presented.
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Affiliation(s)
- Martin Trope
- Department of Endodontics, School of Dentistry, University of North Carolina, North Carolina, NC 27599, USA
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44
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Abstract
AIM The aims of this study were to: (i) investigate the effects of Ledermix paste as an intracanal medicament on discolouration of mature teeth, (ii) examine whether the discolouring effects were related to the method of application, and (iii) examine the effects of sunlight upon discolouration of mature teeth. METHODOLOGY The root canals of 45 mature extracted human teeth were prepared and filled with either Ledermix paste, calcium hydroxide [Ca(OH)2], or saline. In group 1, Ledermix paste was placed apical to the cemento-enamel junction (CEJ), whilst in groups 2 and 3 the paste filled the entire pulp chamber and root canals. In group 4, a Ca(OH)2 and methyl cellulose paste and, in group 5, saline (control) were allowed to fill the pulp chamber and the root canals. Group 3 teeth were kept in the dark and the other groups were exposed to indirect sunlight for 12 weeks. RESULTS After 12 weeks, sunlight exposure had caused dark grey-brown staining of the teeth in the Ledermix groups, but this did not occur when the teeth were kept in the dark. More severe staining was noted when Ledermix paste filled the pulp chamber than when the paste was restricted to below the CEJ. CONCLUSIONS It was concluded that Ledermix paste may cause discolouration of teeth. Such effects can be minimized if placement of the paste is restricted to below the gingival margin. Clinicians should ensure that Ledermix paste is not left on the walls of access cavities.
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Affiliation(s)
- S T Kim
- School of Dental Science, University of Melbourne, Melbourne, Victoria, Australia
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45
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Chang YC, Tai KW, Chou LS, Chou MY. Effects of camphorated parachlorophenol on human periodontal ligament cells in vitro. J Endod 1999; 25:779-81. [PMID: 10726519 DOI: 10.1016/s0099-2399(99)80295-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To date, there has been very little research into the possible effects of endodontic therapy on regeneration of a lost periodontal attachment. The objective of this study was to examine the effects of the endodontic medication, camphorated parachlorophenol (CMCP), on human periodontal ligament cells in vitro. The cytotoxic effects of CMCP were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide colorimetric assay and cell proliferation using a [3H]thymidine incorporation assay. CMCP inhibited the human periodontal ligament cells viability and proliferation in a dose-dependent manner (p < 0.05). These data indicate that the use of CMCP in a root canal could cause periodontium damage. Although this study was conducted in vitro, the findings suggest that it may not be advisable to use CMCP as an interim medication when a periodontal surgical procedure, especially an attempt at regeneration or a new attachment procedure, is being considered in tissues adjacent to the endodontically involved tooth.
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Affiliation(s)
- Y C Chang
- Department of Periodontics, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan, Republic of China
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46
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Wiebkin OW, Cardaci SC, Heithersay GS, Pierce AM. Therapeutic delivery of calcitonin to inhibit external inflammatory root resorption. I. Diffusion kinetics of calcitonin through the dental root. ENDODONTICS & DENTAL TRAUMATOLOGY 1996; 12:265-71. [PMID: 9206373 DOI: 10.1111/j.1600-9657.1996.tb00525.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Insertion of calcitonin into root canals of monkey teeth has been shown to inhibit external inflammatory root resorption and suppress inflammation. Regulation of this therapeutic event depends upon the rate of arrival (diffusion) of the hormone at sites of resorptive activity. In the present study, the diffusion characteristics of calcitonin through the dental root in an extracted human-tooth model are described, and the role of cementum in the diffusion process is also addressed. Root-canals were endodontically prepared to form a reservoir for [125I]-calcitonin, and macerated to remove organic material from dentinal tubules. In teeth with intact cementum, an initial period of delay (4-5 h) prior to the detection of calcitonin at the external tooth-root surface was followed by a rapid release of the calcitonin during the first 10.5 h (rate peaks at 6 h). Slower, sustained releases of calcitonin through intact cementum were measured for the following 9 days. Removal of cementum, to expose "smear-free" dentine, resulted in an earlier efflux of calcitonin (2 h) at external tooth surfaces and increased amounts of calcitonin release over 9 days. Biphasic delivery of calcitonin by such internal diffusion mechanisms suggests that loss of cementum will enhance therapeutic availability, while prolonged delivery to intact external dental-root surfaces following early intra-canal placement may also be useful for the therapeutic prevention of external inflammatory root resorption.
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Affiliation(s)
- O W Wiebkin
- Department of Dentistry, Royal Adelaide Hospital, University of Adelaide, South Australia, Australia
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47
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Hume WR, Gerzina TM. Bioavailability of components of resin-based materials which are applied to teeth. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1996; 7:172-9. [PMID: 8875031 DOI: 10.1177/10454411960070020501] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Chemical components of many materials used in dental practice can move into the local biophase, where they can have beneficial or adverse effects. The strongest indirect evidence that components of resin-based materials used in dentistry can move into the biophase are the many reports of allergic dermatitis in dental personnel. Direct measurement of component release has shown that triethylene glycol dimethacrylate (TEGDMA), hydroxyethyl methacrylate (HEMA), and, in the case of some orthodontic cements, bis-glycidyl methacrylate and benzoyl peroxide can move into an aqueous medium from a range of resin-based materials which are applied to teeth as part of oral care. In the case of resin composite restorations, HEMA and TEGDMA are available in microgram quantities via the salivary surface in the minutes and hours after clinical placement and via dentin and pulp in the hours and days after placement. Fortunately, moderate thickness of dentin protects pulp tissue against local toxicity. There are no data which suggest that systemic toxicity is a risk with any of these materials. There are some case reports of allergic responses to the monomers in patients, but the incidence of such responses appears at present to be much lower than that in dental personnel.
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Affiliation(s)
- W R Hume
- Department of Restorative Dentistry, University of California, San Francisco 94143-0758, USA
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48
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Guignes P, Faure J, Maurette A. Relationship between endodontic preparations and human dentin permeability measured in situ. J Endod 1996; 22:60-7. [PMID: 8935019 DOI: 10.1016/s0099-2399(96)80273-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Endodontic preparations may induce changes in the permeability of radicular dentin. The aim of this study was to analyze the variation of hydraulic conductance measured in situ after three endodontic preparations (manual K+H files, ultrasonic preparation, and manual with NaOCI and EDTA). Scanning electron microscopic analysis of the canal walls was made to permit correlations between variations of permeability and the amount of surface covered with smear layer or organic debris. There was an inverse relationship between the variations in dentin permeability and the presence of smear layer. The significance of this correlation was variable according to the techniques used. Dentin thickness was as significant a factor in influencing radicular permeability as was the smear layer. The use of EDTA induced a considerable increase in radicular permeability. The use of ultrasonics produced a similar but weaker effect.
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Affiliation(s)
- P Guignes
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Surgery, Toulouse, France
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49
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Breault LG, Schuster GS, Billman MA, Hanson BS, Kudryk VL, Pashley DH, Runner RR, McPherson JC. The effects of intracanal medicaments, fillers, and sealers on the attachment of human gingival fibroblasts to an exposed dentin surface free of a smear layer. J Periodontol 1995; 66:545-51. [PMID: 7562345 DOI: 10.1902/jop.1995.66.7.545] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To date there has been very little research into the possible effects of endodontic therapy on regeneration of the lost periodontal attachment. The objective of this study was to examine the effects of endodontic medicaments on fibroblast attachment to dentin surfaces free of a smear layer. Pulp chambers of extracted third molars were filled with one of the following medicaments: gutta-percha with Roth's zinc oxide and eugenol-based sealer, warm gutta-percha with sealer, warm gutta-percha without sealer, calcium hydroxide, formocresol, cotton pellet, or left empty. A predetermined dentin surface area was then inoculated with human gingival fibroblasts at a concentration of 2 x 10(4) cells per ml. The cells were allowed to adhere to the dentin surface for either 4 or 24 hours, then cell attachment was quantified using a methyl-tetrazolium assay. The data were analyzed using a Kruskal-Wallis one-way analysis of variance and Dunn's multiple comparison test. It was determined that fibroblast attachment was significantly reduced when exposed to formocresol or warm gutta-percha without sealer at both the 4 and 24 hour interval (P < or = 0.05). This suggests that the use of formocresol or warm gutta-percha without sealer in a root canal may impede periodontal wound healing and regeneration.
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Affiliation(s)
- L G Breault
- U.S. Army Dental Activity, Ft. Gordon, GA, USA
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50
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Vanderas AP. Effects of intracanal medicaments on inflammatory resorption or occurrence of ankylosis in mature traumatized teeth: a review. Dent Traumatol 1993. [DOI: 10.1111/j.1600-9657.1993.tb00271.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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