Endodontic needs of geriatric patients in private practice

Twenty-five (25) teeth of fifteen (15) elderly patients endodontically treated in a private clinic for the span of three (3) years were evaluated in terms of success and failure of treatment. The attitudes of the patients towards endodontics were determined. Also, medical, dental and radiographic records were reviewed. Of the fifteen (15) patients. 53.3% belonged to age group 60 to 69 years old and the other half belonged to the 70 years and above age bracket. Majority were female, married and college graduates. Premolars constituted 40% of the teeth treated. Post, core and PFM crowns were the most common restoration for both anterior and posterior teeth. Success rate of root canal treatment was a high 84%. Patients gave a more positive attitude to the endodontic treatment mentioning relief of pain, appreciation of better food and self-esteem. Calcification was the most common problem encountered during the treatment. Quality radiograph, proper instrumentation, appropriate techniques and chemical adjuncts are recommended. Likewise, proper patient management, needed rapport and patience have to be stressed.     

Endodontic complications after plastic restorations in general practice

AIM: To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining. METHODOLOGY: A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05). RESULTS: A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92). CONCLUSIONS: Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams.     

Endodontic treatment of teeth with periapical radiolucent areas in a general dental practice

Clinical details of 192 teeth with preoperative periapical radiolucent areas, treated endodontically, are described. The presenting signs and symptoms as well as some postoperative observations are listed. Periapical radiolucent areas were most frequently found related to maxillary teeth: 55 percent were adjacent to teeth with a single root canal and 30 percent related to teeth with three root canals. Radiographic follow-up 1 or more years after therapy was possible in 124 of the root-filled teeth: of those teeth, 59 percent showed disappearance of the radiolucent area and 29 percent exhibited a decrease in size of the area. The degree of success did not appear to be related to the number of root canals filled per tooth but, rather, to whether or not the root filling was short of the radiographic apex. In addition, the prognosis made at the time of root filling was accurate in most cases when compared to the estimated success rates.     

Endodontic materials

This article presents a review of materials currently used in the practice of endodontics. Current endodontic materials include those that have been thoroughly tested by scientific investigation, clinical usage, and time, as well as others that are the result of new knowledge in the field of dental materials. Article sections are devoted to obturation materials, sealers, irrigation materials, smear layer removal, root-end filling materials, and intracanal medicaments. Knowing the particular qualities of materials can aid the clinician in choosing those that are appropriate for a given situation. Properties, components, and rationale for the materials' use are presented to aid the clinician in choosing materials for a particular need.     

Endodontic microsurgery

The field of endodontics has seen vast improvements in technology and techniques over the past several years. Perhaps the one area of endodontics that has improved the most is the way in which surgery is performed. With the use of state-of-the-art instruments, new and improved materials, and a surgical operating microscope, the gap has narrowed between biological concepts and the ability to achieve consistently successful clinical results. The practice of these techniques is now referred to as endodontic microsurgery.