Calculus removal from multirooted teeth with and without surgical access

Abstract The purpose of this study was to evaluate the effect of furcation entrance width on the efficacy of calculus removal from furcation areas as well as to compare this efficacy between external and furcation surfaces after closed root planing, open root planing and use of a rotary diamond for the furcation area. 30 first and second lower molars scheduled for extraction with a calculus index 2 and a degree II or III furcation involvement were divided into 3 groups: 10 molars were scaled and root planed using a closed approach; 10 molars were scaled and root planed using an open approach; 10 molars were scaled and root planed with an open approach and rotary diamond was used for removal of deposits in the furcation area. After extraction, the width of the furcation entrance was measured buccally and lingually 2 mm apical from the bifurcation and furcations were categorized as wide (width >2.4 mm) or narrow (width <2.4 mm). The teeth were assessed in a stereomicroscope and the % of residual calculus on external and furcation surfaces was calculated. The width of the furcation entrance influenced the efficacy in root planing in the open group (p=0.0015). The use of rotary diamond was the most effective method for removing calculus both for narrow and wide furcations. The effectiveness of open root planing in the mesial root was related to the width of the furcation entrance where the % of residual calculus was significantly higher for narrow furcations (p= 0.008). Comparison between external and furcation surfaces showed that the mean values of residual calculus in the closed and open groups were lower for the external than for the furcation surfaces, but the difference was statistically significant only for the closed group (p= 0.013). When open root planing was combined with the use of rotary diamond in the furcation areas, a smaller amount of residual calculus was observed for the furcation than for the external surfaces.     

Calculus removal by scaling/root planing with and without surgical access

We assessed the presence and extent of calculus on subgingival root surfaces of teeth that received scaling and root planing (S/RP) alone, S/RP with modified Widman flap, or no treatment. After extraction, each surface was examined to determine the pocket depth (PD), area of root surface exposed to the pocket (A), and amount of pocket area showing retained calculus (C). Calculus-positive teeth (CPT) and surfaces (CPS) and percentage of pocket area occupied by calculus (C/A) were derived for each group. In general, CPT and CPS were significantly lower after S/RP with flap (37% and 14%, respectively) than after S/RP alone (62% and 24%). The advantage of S/RP with flap was greatest for facial and lingual surfaces and for anterior and premolar teeth. In both treatment groups CPS were similar over a pocket depth range of 0 to 6 mm. But in deeper pockets, CPS in teeth treated by S/RP with flap remained constant at 17% while after S/RP alone CPS increased linearly to approximately 45% at greater than 8 mm. The mean C/A was essentially equal in both treatment groups (11%) and was not related to pocket depth.     

Substance removal on teeth with and without calculus using 308 nm XeCl excimer laser radiation

It was the aim of this in vitro study to determine the potential effects of 308 nm XeCl excimer laser radiation on root surfaces when used for removing calcified deposits. The source of laser radiation was a XeCl-excimer laser (MAX 10, Fa. Medolas, Germany) emitting ultraviolet radiation at a wavelength of 308 nm with a pulse duration of 60 ns. Subjects of irradiation were 60 extracted teeth which were divided into 2 groups of 30 samples each with (group 1) and without calculus (group 2). Specimens were irradiated with 800 laser pulses at 5 different energy-densities per pulse of 1.0 J/cm2, 2.0 J/cm2, 3.0 J/cm2, 4.0 J/cm2 and 5.0 J/cm2. For each parameter 6 samples (n=6) were exposed to 308 nm excimer-laser radiation. The ablation of hard tissue on the treated root surfaces was measured 3-dimensionally with a laser scanning device (100,000 surface points per sample; accuracy: 5 microm) and evaluated with a special image analyzing software (volume, mean, median, standard deviation). In addition, a scanning electron microscopic (SEM) evaluation of the irradiated root surfaces was performed. Statistical analysis was done using ANOVA with the Scheffé-test. The lowest amount of ablation on teeth without calculus was induced with 14.01 (+/-5.86) microm using laser radiation at an energy density of 2.0 J/cm2. Maximum tissue removal in this sample group was obtained with 56.67 (+/-21.05) microm with laser treatment at an energy density of 5.0 J/cm2. While no ablation of dental cementum was detectable after irradiating root surfaces without calculus at 1.0 J/cm2, a strong removal of calculus with a mean value of 31.91 (+/-4.2) microm was observed under these conditions. The results seem to indicate that a selective removal of subgingival calculus creating a homogenous shape of the root surface with 308 nm excimer laser radiation is possible. Furthermore, no signs of the formation of a smear layer nor the induction of thermal side-effects were observed.     

Changes in quality of life after surgical removal of impacted mandibular third molar teeth

Background  

The decision to get impacted teeth removed is not straightforward because of the concerns about its possible outcome. Assessment of quality of life is now regarded as an essential component for assessing outcomes of dental health care. The purpose of this paper is to assess the effect of impacted third molar teeth surgery on a number of health related outcomes.     

Carisolv化学机械去龋技术治疗乳牙龋病的临床评价

目的：评价Carisolv化学机械去龋技术用于乳牙龋病治疗的临床疗效。方法：选取169个龋损乳牙，实验组104个采用Carisolv化学机械去龋，对照组73个采用牙钻去龋。去龋后每组再随机分成A、B两组，分别使用玻璃离子和复合体充填。比较临床治疗效果。结果：与对照组相比，Cafisolv化学机械去龋痛苦小（P〈0．01），在去龋时间、继发龋形成及充填体脱落方面两组无明显差异，而对牙髓的不良影响对照组高于实验组（P〈0．01）。使用不同充填材料的两组在术后并发症方面无明显差异。结论：在乳牙龋病的治疗中，使用Carisolv化学机械去龋较牙钻去龋更具优势。     

Inability to work after surgical removal of mandibular third molars

Inability to work after mandibular third-molar surgery was studied in 201 patients operated on in a specialist clinic. Mean indicated inability to work was 1.07 days; 95% confidence intend, 0.91-1.23 days; range, 0-6 days. Eighty-six (43%) patients did not indicate any reduction in working ability. Duration of operation more than 14 min, heavy smoking (> 19 cigarettes/day), and female sex were associated with prolonged inability to work Self-administered analgesic consumption and pain scores over the first postoperative week showed positive correlations with inability to work r = 0.44 and 0.41, respectively. Other indicators of the normal postoperative reaction were to a lesser extent associated with reduced ability to work Total sick-leave cost in Norway associated with surgical third-molar removals, adjusted for age-related income, employment rate, treatment rate, and provider of treatment, was 46.4 million NOK per year.     

Carisolv化学机械去龋技术治疗乳牙龋病效果的系统评价

目的:评价Carisolv化学机械去龋技术治疗乳牙龋病的临床疗效。方法:计算机检索Co-chrane图书馆(2009年第2期)、PubMed(1966~2009)、MEDLINE(1966~2009)、Embase(1966~2009)、CBM(1978~2009)、CNKI(1989~2009)、VIP(1989~2009),同时采用手工检索相关资料,纳入Carisolv化学机械去龋技术与传统机械去龋比较治疗乳牙龋病的临床随机对照试验。按Cochrane系统评价方法评价纳入研究的质量,对同质研究采用RevMan 5.0软件进行Meta分析。结果:共纳入5个随机对照试验,合计162例病人,272个乳牙。结果显示:与传统手用去龋器械比较,Carisolv化学机械去龋技术去龋时疼痛程度较轻,对龋损去除效果、去龋时间、病人接受程度及术后并发症发生率的影响,两种方法差异无统计学意义。与传统机用器械的比较,Carisolv与高速涡轮机联合去龋法对龋损去除效果的差异无统计学意义;但Carisolv的去龋时间较长[WDM=3.09,95%CI(2.38,3.80)];而疼痛程度[RR=0.62,95%CI(0.42,0.90)]及病人接受度,Carisolv优于高速涡轮机联合去龋法。与慢速涡轮机联合去龋法的比较,Carisolv15 min内的龋损去净效率低[RR=0.61,95%CI(0.47,0.78)];去龋时间较长[WDM=6.69,95%CI(5.77,7.61)];但是,对于去龋的疼痛程度和病人的接受程度,两种方法差异无统计学意义。机用器械组中仅有1个研究进行了术后半年的随访,结果显示两种去龋方法术后并发症的发生率差异没有统计学意义。结论:Carisolv化学机械去龋技术治疗乳牙龋病能够有效去除龋损组织,但其去龋时间较长且去龋效率低于传统机用器械。Carisolv去龋引起的疼痛程度及病人的接受程度优于传统高速机用去龋器械,但无异于手用或慢速机用器械。由于本系统评价纳入研究的数量和质量有限,上述结论尚需开展更多大样本、设计良好、指标全面的临床随机对照试验来进一步验证。     

氟斑牙冷光美白应用祛氟剂及微打磨技术的效果评价

目的:评价氟斑牙冷光美白应用祛氟剂及微打磨技术的效果.方法:将四川省第四人民医院口腔科2012年8月-2015年7月收治的122例中度氟斑牙患者按照随机数字表法分为研究组和对照组,每组61例.全部患者实施预处理.对照组实施Beyond冷光美白治疗联合祛氟剂涂抹治疗.研究组在冷光美白治疗之前实施微打磨治疗,后续治疗同对照组.比较2组治疗完成时、治疗后1个月及6个月的牙美白效果及美白治疗时的牙敏感度.采用SPSS19.0软件包对数据进行统计学分析.结果:2组均无无效病例,均无失访病例.研究组治疗完成时、治疗1个月后及6个月后美白效果均显著高于对照组(P＜0.05).治疗过程中无牙极敏感病例.2组不显著敏感率及显著敏感率均无显著差异(P＞O.05).结论:氟斑牙冷光美白时应用祛氟剂及微打磨技术可显著提高美白效果,且不会因显著增加牙敏感性而导致治疗中断.     

The efficacy of subgingival calculus removal with endoscopy-aided scaling and root planing: a study on multirooted teeth

BACKGROUND: The dental endoscope was developed to facilitate visualization of the subgingival environment as an aid in diagnosis and non-surgical root debridement. The purpose of this study was to determine whether endoscopy-aided scaling and root planing (SRP) resulted in a greater reduction of residual calculus compared to SRP alone in multirooted teeth. METHODS: Twenty-four patients were enrolled and contributed 35 tooth pairs (70 teeth in total). Each tooth per pair was randomly assigned to receive endoscopy-aided SRP (test) or SRP alone (control). Both teeth were extracted immediately after treatment, washed with water, and stained with methylene blue. The percentage of residual calculus was determined via stereomicroscopy and digital image software by a single masked examiner. RESULTS: Overall, there was 1.16% (P = 0.097) less residual calculus at test versus control sites. At interproximal surfaces, test roots had 2.63% less residual calculus than control roots (P = 0.003), whereas test roots had slightly more residual calculus than controls at buccal/lingual surfaces (0.36%; P = 0.652). There were no statistically significant differences in residual calculus between groups at deeper probing depths or at sites with deep furcation invasions. Only at shallower interproximal sites with probing depths < or =6 mm was significantly less residual calculus seen in roots treated with endoscopy (P = 0.020). Treatment time decreased significantly as operator experience increased; however, no significant improvement in residual calculus levels was noted with greater experience. CONCLUSION: Within the confines of this study, the use of the endoscope as an adjunct to traditional SRP provided no significant improvement in calculus removal in multirooted molar teeth.     

健康教育路径的构建对门诊阻生牙拔除手术患者的影响

目的:探讨健康教育路径的构建对门诊阻生牙拔除手术患者的影响,以提高门诊阻生牙拔除手术的护理水平。方法:将100例门诊阻生牙拔除手术患者随机分为实验组、对照组,每组各50例。实验前所有患者均用汉密顿焦虑量表评估焦虑状况,实验组对阻生牙拔除手术患者健康教育路径实施健康教育,对照组仅采用传统方式宣教,在手术后再以汉密顿焦虑量表对2组患者的焦虑状况进行评估,采用问卷方式对患者的认知情况和满意度进行评价。评估结果采用SPSS 16.0软件包进行t检验和方差分析。结果:实验前患者汉密顿焦虑量表评分无显著差异,实验后实验组患者汉密顿焦虑量表评分显著低于对照组(P<0.01),对相关知识的认知情况、满意度显著高于对照组(P<0.01)。结论:对门诊阻生牙拔除手术患者实施健康教育路径,能显著降低患者的焦虑情绪,提高患者对治疗的依从性,提高患者满意率,改善服务质量,减少并发症。     

Evaluation of selective caries removal in deciduous teeth by a fluorescence feedback-controlled Er:YAG laser in vivo

This study investigated the ability and efficacy of an Er:YAG laser with a fluorescence feedback system for caries removal in deciduous teeth. Seventy-nine carious lesions were excavated using a fluorescence-controlled Er:YAG laser. Endpoint of treatment was defined by emission of fluorescence from the dentine surface below the pre-selected threshold level of 7 units and the subsequent termination of Er:YAG laser radiation. Dentine samples were obtained from the cavity floor, and viable counts of both Streptococcus mutans and Lactobacilli, expressed as colony forming units (log CFU), were evaluated. Preparation time was recorded to assess efficacy of the treatment procedure. S. mutans and/or Lactobacilli were found in 25 out of 79 lesions. Regarding the counts for S. mutans and Lactobacilli, the median log CFU was 0 (min, 0; max, 5.5) and 0 (min, 0; max, 6), respectively, with 2.4% of all samples yielding more than 100 CFU S. mutans and 4.8% yielding more than 100 CFU Lactobacilli. In 8 out of 79 cases, laser excavated cavities were not judged being caries-free using the conventional tactile criterion for assessing caries tissue. Focussing on these teeth, the median log CFU was 0 (min, 0; max, 0.5) for S. mutans and 0 (min, 0; max, 1.6) for Lactobacilli. The mean time for treatment was 2.3 +/- 1.2 min. Of the children, 93.8% rated the laser treatment to be comfortable. The study indicates that the fluorescence feedback-controlled Er:YAG laser might be an appropriate device for caries removal in children using the suggested threshold level of 7 units.     

Accuracy of two different apex locators in primary teeth with and without root resorption

The objective of this study was to assess the accuracy of two frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan) in primary teeth with and without root resorption in vitro. For this study, 90 sound extracted primary teeth (60 molars and 30 incisors; 93 roots with visible resorption and 51 roots without) were selected. A total of 144 root canals were included. After access preparation, root canal lengths were measured visually. The teeth were embedded in an alginate model developed specifically for testing apex locators. Electronic length was determined with two different frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan). Statistical evaluation was performed using Mann–Whitney U and Wilcoxon W tests (p < 0.05). Results revealed that both apex locator devices did not show similar values to visual length measurements with statistically significant differences in primary teeth with root resorption (p < 0.05). For the teeth without root resorption, Endex showed similar values to visual length measurements with no statistically significant differences (p > 0.05), but Root ZX values were different than visual length and the differences were statistically significant (p < 0.05). There were no significant differences between the two apex locators considering the presence of root resorption. The two frequency apex locators can be recommended for use in root canal therapy for primary teeth with and without root resorption, only if electrical determination of root canal length is supported with other diagnostic measures.     

Nonsurgical and surgical periodontal therapy in single-rooted teeth

The purpose of this study was to compare the effect of tooth related and patient related factors on the success of non-surgical and surgical periodontal therapy. In 41 patients (22 female) with untreated and/or recurrent periodontitis, no therapy, scaling and root planing (SRP), or access flap (AF) were assigned according to probing pocket depth (PPD). PPD and vertical relative attachment level (RAL-V) were obtained initially, 3 and 6 months after therapy. Baseline data were compared according to therapy, jaw, tooth type, and site. Factors influencing clinical parameters were identified using multilevel analyses. Baseline PPDs were deeper interproximally, in the maxilla and at premolars compared to buccal/oral sites, mandibular, and anterior teeth. At 6 months, PPD reduction and RAL-V gain were significantly greater at sites receiving SRP and AF as compared to untreated sites (p < 0.001). PPD reduction and RAL-V gain were significantly less (p < 0.005) in smokers as compared to nosmokers and at interproximal sites (p < 0.0001) as compared to buccal/oral sites. RAL-V gain was less in aggressive periodontitis, and PPD reduction was less in the maxilla (p < 0.001). In sites with greater bone loss and infrabony defects, a poorer response was observed regarding RAL-V gain or PPD reduction, respectively. The conclusions of the study are the following: (1) Nonsurgical and surgical periodontal therapies are effective in single-rooted teeth; (2) severe interproximal bone loss and infrabony defects deteriorate clinical results; and (3) there seem to be more defect-associated (tooth, site) factors influencing treatment outcome than patient-associated factors.     

Assessment of the referral system for surgical removal of third molars at the Dental Faculty,King Saud University

Introduction: There is compelling evidence that prophylactic extraction of third molars is a health problem that needs to be addressed. In particular, the vast amount of evidence demonstrating complications after removal of third molars, rather than supporting the necessity of removal or the negative effects of retention, raise this concern. Objective: The aim of this study was to investigate the referral system for third molar extraction at our institution by assessing patient opinions and the experience of the oral surgeons and the referring dentists. The main outcome measures of concern were the reasons for third molar extraction, patient awareness about the surgery and the comorbidities that may accompany the surgery. Methods: Pilot cross-sectional survey questionnaires were distributed at the Dental Faculty Clinic at King Saud University, from 15 March 2015 to 30 June 2016 by the staff in charge of the patient waiting area, oral surgery clinic, primary care clinic and specialist clinic. Results: Of 400 potential respondents, 226 completed the survey (response rate: 54%). Of these patients, 91% knew why they had been referred to the oral surgery department, but 73.5% did not understand the surgical extraction procedure or its complications. In total, 45.2% of the patients referred had no signs or symptoms, and 36% were referred for prophylactic reasons. In conclusion, our system needs reassessment. To combat the subjective health practice of routinely referring patients for prophylactic extraction, the role of primary care should be emphasised by implementing a system for regular patient check-ups, and public awareness should be increased.Key words: Wisdom tooth, removal, retention, surgery     

Infected immature teeth treated with surgical endodontic treatment and root-reinforcing technique with glass ionomer cement

Abstract –  The authors propose surgical endodontic treatment of immature teeth characterized by necrosis and infection, especially after failure of apexification or in the presence of older, fibrous, and extensive lesion. A glass ionomer cement, autopolymerizable and condensable, is used as retro-filling material and as a reinforcement material for the canal walls. The variety of different cases presented here show that this rapid technique is reliable and reproducible.     

Electronic determination of root canal length in primary teeth with and without root resorption

AIM: To test an electrical device for determining root canal length in primary teeth in vitro, and to compare it with the radiographic length measurement. METHODOLOGY: Two examiners determined the root canal length of 24 extracted maxillary primary incisors (12 with visible root resorption and 12 without) using an electrical root canal meter (Tri Auto ZX, Morita, Dietzenbach, Germany). The instrument was left in the root canal after the second examination and a radiograph was taken. The whole tooth was cleared by immersion in methylsalicylate and subsequently photographed. Both radiographs and photographs of cleared teeth were measured and compared with the electronic measurements. RESULTS: The evaluation of the radiographs showed a mean distance between the instrument tips and apices of 0.60 (+/- 0.41) mm; evaluation of the cleared teeth showed an equivalent distance of 0.62 (+/- 0.40) mm. The mean distance between instrument tip and acceptable working length (determined with the clearing method) was 0.26 (+/- 0.24) mm in teeth without resorption and 0.29 (+/- 0.30) mm in teeth with resorption. CONCLUSION: The presence of resorption in primary teeth did not affect the accuracy of electrical measurement of root canal length in vitro. The application of this method in primary teeth should be evaluated further.     

导板与显微镜辅助拆除纤维桩的精确度比较

目的 通过离体牙模型对导板支持与显微镜辅助2种纤维桩拆除系统的精确度进行比较,为临床医师拆除纤维桩提供新思路和理论依据。方法 将28颗人类离体前磨牙随机分为导板组与显微镜组,进行根管治疗及纤维桩修复治疗后,分别采用数字化导板与显微镜辅助超声器械进行纤维桩拆除。利用Mimics 10.0软件测量拆除后的偏差值,比较2种纤维桩拆除系统的精确度。结果 导板组的尖端垂直偏差为0.99 mm±0.52 mm,尖端水平偏差为0.75 mm±0.19 mm,角度偏差为2.32°±0.64°,体积损失为8.09 mm³±1.42 mm³;显微镜组的尖端垂直偏差为0.44 mm±0.23 mm,尖端水平偏差为0.23 mm±0.07 mm,角度偏差为0.64°±0.31°,体积损失为15.25 mm³±3.94 mm³。2组的尖端水平偏差、角度偏差和体积损失的差异有统计学意义(P<0.05),尖端垂直偏差的差异无统计学意义(P>0.05)。结论 在数字化导板的支持下拆除纤维桩有助于减少桩核修复后牙的体积损...     

800例正畸患者中先天缺失牙及其与多生牙、锥形牙相关性分析

目的：观察正畸患者中伴有恒牙先天缺失、多生牙和锥形牙或过小牙的发生率及分布,并分析其相关性。方法：随机抽取正畸患者800例,男260例,女540例,年龄12-40岁。通过石膏模型和曲面断层片统计先天缺牙、多生牙、锥形牙或过小牙的发生率及分布。通过分类变量的关联性来分析多生牙和锥形牙或过小牙与先天缺牙的相关性,假设检验采用列联表的独立性x2检验,并采用Pearson列联系数r来描述两变量关联程度。结果：800例中发生恒牙先天缺失100例,发生率为12．5％。常见的缺失牙位从多到少依次为下颌侧切牙、下颌第二前磨牙、下颌中切牙、上颌侧切牙、上颌第二前磨牙。多生牙的发生率为3．1％,锥形牙或过小牙占8．3％。通过分类变量的关联性分析得出,锥形牙或过小牙的发生与先天缺牙有相关性,Pearson列联系数r为0．173。结论：正畸患者中恒牙先天缺失的发生率为12．5％,最常见的缺失牙位是下颌侧切牙和下颌第二前磨牙;正畸患者中恒牙先天缺失和锥形牙或过小牙的发生具有相关性。