Clinical and radiographic evaluation of pulpotomies performed under intrapulpal injection of anaesthetic solution

AIM: The purpose of this study was to evaluate clinically and radiographically pulpotomies carried out under intrapulpal injection of anaesthetic solution. METHODOLOGY: Forty-one permanent mandibular molar teeth presenting with deep carious lesions and/or exposed pulps, with or without periapical changes on radiographic examination, were treated with pulpotomy and dressed with calcium hydroxide. The teeth were divided into three groups. Group A consisted of 15 teeth, where intrapulpal anaesthesia was administered by a slow injection of lidocaine hydrochloride 2%. Group B, with 14 teeth, where intrapulpal anaesthesia was obtained with lidocaine hydrochloride 2% with adrenaline 1:100,000. Group C consisted of 12 teeth in which anaesthesia was performed with a mandibular block using prilocaine hydrochloride 3% with felypressin 1: 100,000. Healing was evaluated using clinical and radiographic criteria: dentine barrier formation, absence of clinical symptoms and resolution of periapical involvement. RESULTS: After an observation time of 6-8 weeks (postoperative control) and 24-32 weeks (intermediate control), healing occurred in 13 teeth from group A (87%), in 11 teeth from group B (79%) and in 10 teeth from group C (83%). No statistical difference was demonstrated between the three groups (Fisher's exact test). CONCLUSIONS: Based on the methodology adopted, intrapulpal injection of anaesthetic solution did not impair healing in pulpotomized teeth.     

Preventive aspects in children's caries treatments preceding dental care under general anaesthesia

BACKGROUND: In Helsinki Public Dental Service (PDS) the Special Oral Health Care Unit (SOHCU) provides comprehensive dental treatments under general anaesthesia (GA). For the present study, all dental treatment given under GA for generally healthy children (n = 102) below 16 years of age (range 2.3-15.8) during a 1-year period and dental treatment and visits of these children in the preceding 2 years in Helsinki PDS was recorded in detail. These children were referred to the SOHCU because of serious difficulties in dental care due to large treatment needs or failures in psychological and chemical management, including sedation. AIM: To describe treatments given to generally healthy children under GA and to evaluate preventive aspects of their dental care in the preceding 2 years. DESIGN: The study was cross-sectional and retrospective. Data came from the patients' individual records. RESULTS: Treatments under GA included an average of 6.0 restorations (SD = 2.7, range 0-12) and 1.7 extractions (SD = 2.1, range 0-10). In the 2 preceding years, these children had visited dentist an average of 5.1 times (SD = 2.7, range 1-14) with an average of 2.4 restorations (SD = 1.9, range 0-12) and 0.5 extractions (SD = 1.4, range 0-10). Of the restorations made, 36% were temporary. Of all visits, those with an operative approach accounted for 35%, preventive for 37%, operative and preventive for 5%, and visits with total uncooperation for 23%. Of the children, 90% had at least one preventive visit. Children treated under conscious sedation in the preceding 2 years received less prevention (P = 0.02). Remaining without preventive measures was most likely for those children exhibiting visits with total uncooperation (odds ratio = 4.6; P = 0.004) and for those receiving numerous temporary fillings (odds ratio = 4.1; P = 0.0005). CONCLUSIONS: The uncooperative high-caries children pose a demanding challenge to PDS. The early identification of high-caries risk and efforts of intensive preventive care are in key position to reduce the number of children receiving treatment under GA due to high levels of dentinal decay.     

Quality evaluation of process of root canal treatments performed on young adults in Finnish public oral health service

OBJECTIVES: To evaluate the quality of root canal treatments performed in every-day practice on young adults. METHODS: A quality index related to the treatment process was developed based on the guidelines of the European Society of Endodontology. A random computerised selection of 134 young adults (born 1966-1971) produced 125 (93%) eligible oral health documents, including information on 148 teeth that were root canal treated by 47 dentists. The process of root canal treatment was evaluated according to the original oral health documents. The technical quality of root canal fillings was assessed on postoperative periapical radiographs. RESULTS: The overall Kappa statistics for the inter-examiner reliability of assessments was 0.63; the proportional agreement being 87%. The mean quality index was 6.2, s.d. 2.0, with none of the treatments scoring the maximum 13. On the 56 available postoperative radiographs, 52% of the fillings were optimal, showing a length within 0-3mm from the radiological apex, no voids in the apical part nor lumen apical to the filling. Of the completed 144 root canal treatments, only 11 included some recorded follow-up information within 15months from the termination of the treatment. CONCLUSIONS: The technical quality of the root fillings was similar to that found in previous studies. However, the quality index, paucity of pre- and post-operative radiographs, and the lack of follow-up all indicated a discrepancy between consensus guidelines and every-day practice.     

Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

Background

Dental general anaesthesia (DGA) is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients’ overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS) and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care.

Methods

The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age (<6, 6–12, 13–17, 18–68), gender, immigration, previous conscious sedation and previous DGA; medical background; reasons for DGA and treatments provided. Chi-square tests, Fisher’s exact test, and logistic regression modelling were employed in the statistical analyses.

Results

The DGA patients (n=349) were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p<0.001) and medically compromised patients among the adults (p<0.001) relative to the other age groups. The main reason for DGA was extreme non-cooperation (65%) followed by dental fear (37%) and an excessive need for treatment (26%). In total, 3435 treatments were performed under DGA, 57% of which were restorations, 24% tooth extractions, 5% preventive measures, 5% radiography, 4% endodontics and the remaining 5% periodontics, surgical procedures and miscellaneous. The reasons for DGA and the treatments provided varied according to age, immigration, previous sedation and DGA and medical background. The logistic regression model showed that previous sedation (OR 2.3; 95%CI 1.3-4.1; p=0.005) and extreme non-cooperation (OR 1.7; 95%CI 0.9-3.2; p=0.103) were most indicative of preventive measures given.

Conclusions

Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.

     

An audit of root canal treatment performed by undergraduate students

AIM: The objective of this study was to audit the quality of root canal treatment performed by undergraduate students on adult patients. METHODOLOGY: All root canal treatment completed by first and second clinical year undergraduates over a 12-month period were included in the study. The availability and readability of pretreatment, diagnostic length, try-in point and postoperative radiographs were noted for each case. All readable postoperative radiographs of primary treatments were examined for quality of the root filling, categorized as complete, incomplete apical, incomplete apical and lateral or not assessable. The distance from the radiographic apex of the root to the apical extent of each root filling was measured to 0.1 mm precision. RESULTS: Undergraduates performed primary treatment on 157 teeth. A postoperative radiograph was available in 97% of cases. A try-in point radiograph was unavailable in one-fifth of cases. Twenty-seven teeth (13%) were categorized as satisfactory in terms of both radiographic quality and distance of the root filling from the radiographic apex. CONCLUSIONS: Overall, the technical quality of root canal treatment completed by undergraduate students was poor.     

Hand and nickel-titanium root canal instrumentation performed by dental students: a micro-computed tomographic study

The aim of this study was to evaluate root canals instrumented by dental students using the modified double-flared technique, nickel-titanium (NiTi) rotary System GT files and NiTi rotary ProTaper files by micro-computed tomography (MCT). A total of 36 root canals from 18 mesial roots of mandibular molar teeth were prepared; 12 canals were prepared with the modified double-flared technique, using K-flexofiles and Gates-Glidden burs; 12 canals were prepared using System GT and 12 using ProTaper rotary files. Each root was scanned using MCT preoperatively and postoperatively. At the coronal and mid-root sections, System GT and ProTaper files produced significantly less enlarged canal cross-sectional area, volume and perimeter than the modified double-flared technique (P < 0.05). In the mid-root sections there was significantly less thinning of the root structure towards the furcation with System GT and ProTaper (P < 0.05). The rotary techniques were both three times faster than the modified double-flared technique (P < 0.05). Qualitative evaluation of the preparations showed that both ProTaper and System GT were able to prepare root canals with little or no procedural error compared with the modified double-flared technique. Under the conditions of this study, inexperienced dental students were able to prepare curved root canals with rotary files with greater preservation of tooth structure, low risk of procedural errors and much quicker than with hand instruments.     

A 1-year follow-up study on leakage of four root canal sealers at different thicknesses

Determination of leakage using a fluid transport model allows measurement of leakage in a longitudinal manner. Leakage of four sealers at three different thick- nesses in 225 bovine root sections, after storage in water for 1 year, was measured again using the same method- ology. The change in seal over time for each sealer was observed. The results after the second measurement showed that every sealer produced the best seal when the sealer layer was the thinnest. AH26, Ketac-Endo and Tubli-Seal showed a reduction in leakage over time and gave significantly less leakage than Sealapex (P<0.005). Sealapex showed sigdicantly more leakage after storing in water for 1 year (P<0.005). Therefore, the long-lasting seal of sealer may, among other influencing factors, depend on the layer thickness and the solubility of the material.     

3种根管治疗器械根管再治疗的临床效果比较

目的：比较3组器械在根管再治疗中的临床应用效果,探讨其中2种镍钛器械的应用特点。方法选择173例因根充不实或欠填需根管再治疗的177颗第一恒磨牙作为研究对象,84颗患牙均有叩痛,经首次根管治疗后出现自觉症状,随机分为3组（TF1组、Protaper D1组和不锈钢锉1组）,每组各28颗;93颗无叩痛患牙,也随机分为3组（TF2组、Protaper D2组和不锈钢锉2组）,每组各31颗。预备时间组间比较采用方差分析;预备后无痛率或缓解率和器械损伤情况组间比较采用卡方检验。结果预备时间TF组明显少于Protaper D组和不锈钢锉组（P=0.00）;TF组的无痛率和缓解率明显高于不锈钢锉组（P<0.01）;60支TF锉发生螺纹损伤;1支ProtaperD发生折断。结论在临床根管再治疗中使用TF机用镍钛锉比不锈钢锉更能减少术中疼痛,节省用时,更适合弯曲根管的使用,但其易发生螺纹损伤,值得注意。     

A Five-year study of Hudron root canal fillings

A prospective clinical and radiographic study was conducted in order to compare Hydron and laterally condensed gutta-percha/AH-26 root canal fillings. Paralleling technique periapical radiographs were taken preoperatively, postoperatively and at recall appointments at post-treatment intervals of 6 months, 1 year, 2 years, 3 years and 5 years. Clinical examination at the recall appointments revealed no adverse signs or symptoms amongst all the patients who attended (mean attendance 44.5% at each interval). Radiographs were scored according to the periapical status of the treated root, and comparable bone healing rates were observed between the two root-filling materials. Among the patients attending recall appointments, there were no radiographic signs of failure of any of the 39 gutta-percha/AH-26 root canal fillings. However, three of the 35 canals filled with Hydron were classified as failures, and four required further assessment after the 5-year recall appointment. This study indicated that Hydron and gutta-percha/AH-26 root canal fillings were well accepted but, on the basis of radiographic assessment, success with gutta-percha/AH-26 was more predictable.     

3种不同根管治疗器械对根管充填物清除效果的比较研究

目的比较G钻+手动K锉、Protaper再治疗镍钛锉、Reciproc单只锉在根管再治疗中对牙胶的清除效果及推出根尖孔碎屑量。方法选择60颗离体单根管牙进行根管预备、充填、玻璃离子封闭30 d,随机分成3组,每组20颗,分别用G钻+不锈钢手动K锉(A组)、Protaper再治疗锉(B组)及Reciproc单只锉(C组)去除根管充填物,采用根尖X线片和扫描电镜的方法评估根管内的充填物去除的情况,比较3组样本牙根管充填物的清除效果;记录去除充填物所用的操作时间;用称量的方法计算每组推出根尖孔的牙胶碎屑的量。结果 3组样本牙根管壁均有残留的充填物,B,C两组根管壁残留的充填物明显低于A组(P<0.05),C组清除效果优于B组(P<0.05)。和A组相比,B,C组均可以减少再治疗时间(P<0.05)。推出根尖孔的碎屑量A组最多,其次是B组,C组最低(P<0.05)。结论镍钛器械无论是在清除效果、操作时间、推出根尖孔碎屑量上都优于手动器械;Reciproc单只锉优于Protaper再治疗锉。     

Radiographic prevalence of root canal ramifications in a sample of root canal treatments in a Brazilian Dental School

The aim of this study was to radiographically investigate the presence of root canal ramifications found after endodontic treatment, and to determine any relationship between their presence and the type of the auxiliary chemical substance used. The study evaluated 1,470 endodontic treatments performed by final year undergraduate students at the Dental School of Piracicaba, State University of Campinas (UNICAMP), SP, Brazil, during the period from 1998 to 2000. The X-rays taken during treatment were evaluated in order to establish the presence of ramifications of the root canal system. The initial X-ray did not show the presence of any canal ramifications. After filling, X-rays showed only 3 ramification types: 3.06% of lateral canals, 2.99% of apical deltas, and 0.1% of interradicular canals. The maxillary premolars showed the highest number of lateral canals (n = 13), followed by mandibular premolars (n = 10) and maxillary incisors (n = 10). Apical deltas were mostly found in mandibular molars (n = 14), followed by maxillary incisors (n = 9). Only mandibular molars had interradicular canals. The detection of ramifications increased with the use of EDTA. However, no statistically significant relationship was found between the type of auxiliary chemical substance used and the number of root canal ramifications detected after root canal filling. It was concluded that the frequency of root canal ramifications found radiographically was low in treatments performed by undergraduate students.     

Effect of root canal treatments on quartz fiber posts bonding to root dentin

The aim of this study was to evaluate the effect of irrigants and endodontic sealers on fiber post push-out strength in both fatigue cycling and no-cycling conditions. Fifty single-rooted human teeth received five endodontic treatments. The posts were cemented using a flowable composite and a three-steps adhesive. Five specimens from each group were subjected to 2 x 10(6) cycles of 37.5 N. There were 200 sections obtained for the push-out test. Fatigue cycled groups treated with an eugenol-containing sealer showed the lowest push-out strength (p < 0.001). No significant differences were found among no-cycled groups (p = 0.665). The post-cement interface was found to be weaker than the cement-dentin one. However, fatigue cycles increased the occurrence of cement-dentin failures (p = 0.001). The eugenol-containing sealer reduced the bonding of fiber posts when mechanically cycled, thus the use of a resin-based sealer is advisable.     

3种根管治疗方法的临床效果比较

目的：观察Profile机动镍钛针根管预备器械预备根管，热融胶针充填根管与传统根管治疗方法的临床效果。方法：将患者随机分为3组，A组：Profile预备根管，热融胶针充填根管。B组：Profile预备根管，碘仿糊剂牙胶尖根充。C组：手工法不锈钢扩大针预备根管，碘仿糊剂牙胶尖根充。结果：经X线片和临床对比观察．A组优于B组．B组优于C组。结论：Profile机动镍钛针预备根管，工作效率高，根管预备形态好，省时省力。热融胶针充填根管恰充率明显高于其他方法。经过Profile预备的根管，使用国产材料根充同样可以达到满意效果。手工预备根管和传统侧压法根充较费时费力，恰充率低于机动预备和热融胶针根充组：     

Monitoring the outcomes of root canal re‐treatments

This paper provides a review of clinical protocols and emphasizes the importance of follow‐up for re‐treated teeth. A clinically useful strategy is presented for review of non‐surgical and surgical re‐treatments based on best available current evidence.     

An audit of the quality of root canal treatments performed by undergraduate dental students on single-rooted teeth in Glasgow dental hospital and school

The aim of this investigation was to assess the technical quality of root canal treatments performed by undergraduate dental students on single rooted teeth at the Glasgow Dental Hospital and School. One hundred radiographs of single rooted teeth that had root canal treatment were randomly selected and examined under even illumination in a darkened room using x2 magnification. Of 100 teeth, 20 had voids, and one was perforated. The remaining 79 teeth were assessed using predetermined criteria, and 80% (n=63) were judged to be 'acceptable' 5% (n=4) were 'under-filled, and 15% (n=12) were 'over-filled'. The quality of root canal fillings performed in single rooted teeth by undergraduate dental students at the Glasgow Dental Hospital and School was found to comparable to, or better than, that reported from other international institutions.     

Comprehensive dental treatment under general anaesthesia

Objectives

Patients unable to tolerate routine dental treatment in an ordinary dental setting may undergo a wide range of dental procedures under general anaesthesia. This report describes a practical protocol for providing full dental treatment under general anaesthesia.

Matherials and Metods

The importance of adequate treatment planning and safety measures is illustrated through the presentation of clinical cases.

Results

Suggestions are provided as to the use of techniques managing difficult treatment settings that allow the implementation of high-quality dental care in long sessions.

Conclusions

Complete treatment can be achieved in a single visit, thus avoiding repeated risk of anxiety for the patient associated with the treatment as well as subsequent further sessions with related schedule adjustment.