Size of Master Apical File and Optimal Irrigation of the Apical Zone: A Systematic Review

Introduction: To determine what would be the minimal apical diameter for optimal chemomechanical preparation in the root canal system in terms of debridement and/or irrigation delivery, in patients undergoing nonsurgical root canal treatment. Methods and Materials: Randomized controlled clinical trials, cohorts, cross-over studies from peer-reviewed journals published in English from January 1950 to June 2018 which reported outcome in terms of healing, microbial reduction and/or effectiveness of irrigation delivery to the apical third of the root canal system. Two reviewers conducted a comprehensive literature search. There were no disagreements between the two reviewers. The articles that met the inclusion criteria went through a predefined review process. Results: Due to the variety of methodologies and different techniques used to measure outcome for master apical file enlargement, it was not possible to standardize the research data and to perform meta-analysis. Twelve clinical articles were identified that met the inclusion criteria. Conclusions: The overall level of evidence on this topic was moderate (fair). From this systematic review, the majority of the studies collected and referred to recommend sizes higher than #30 as the minimal size in order to adequately prepare the apical region of the root canals. Only 2 out of 12 studies suggested the size #25 as acceptable. From this systematic review it may be concluded that a larger MAF preparation above size 30 aids chemomechanical action.Keywords: Apical Size; Endodontics; Irrigation; Master Apical Size; Systematic Revie

Placement of Mineral Trioxide Aggregate Using Two Different Techniques

AbstractTHE PLACEMENT OF MINERAL TRIOXIDE AGGREGATE USING TWO DIFFERENT TECHNIQUESBy Anita Aminoshariae, D.D.S.A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth UniversityVirginia Commonwealth University, 2003Major Director: Gary R. Hartwell, D.D.S., M.S.Chairman and Professor, Department of EndodonticsThe purpose of this study was to determine if the adaptation of Mineral Trioxide Aggregate (MTA) to the walls of the samples would differ when placed into simulated root canals of varying length using two different placement and condensation methods. Hand condensation was compared to ultrasonic condensation. Eighty polyethylene tubes were divided into four groups of twenty tubes each. The tubes in the four groups were prepared to receive 3, 5, 7 and 10-mm lengths of MTA respectively. Each group of twenty tubes was then subdivided so that ten samples of each length would have MTA placed and condensed by the hand method and the other ten by the ultrasonic method. After condensation the samples were evaluated with a light microscope and radiographs for the degree of adaptation of the MTA to the tube walls and for the presence of voids within the MTA material itself. The results demonstrated an 80% agreement for findings between the light microscopy and radiographic evaluation. Hand condensation resulted in better adaptation to the tube walls and less voids than the ultrasonic method. There was no significant difference in the results for any of the four lengths of MTA placed by the hand method (p\u3e 0.9). At this time hand condensation should be considered the preferred method for placement of MTA

Is it time US dentistry ended its opioid dependence?

Background. In 2017, 11.4 million US citizens misused prescription opioids, resulting in 46 overdose-deaths daily and a $78.5 billion burden on the economy. Dentists are one of the most frequent prescribers of opioids and there is concern that dental prescribing is contributing to the opioid crisis. Methods. A recent study showed 22.3% of US dental prescriptions were for opioids compared to 0.6% in England, where nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for most analgesic prescriptions. This observation prompted a review of international analgesic prescribing habits and of the advantages and disadvantages of opioids and NSAIDs for treating dental pain. Results. US opioid prescribing far exceeded that in other countries where NSAIDs accounted for the vast majority of dental analgesic prescribing. Furthermore, recent reviews confirm NSAIDs, and NSAID-acetaminophen combinations are as or more effective than opioids for controlling dental pain and cause significantly fewer side-effects. Conclusions. In light of the potential for misuse, and evidence that NSAIDs are as effective as opioids and have fewer side effects, there is clear patient benefit in avoiding opioids for the prevention or management of dental pain. Practical Implications. A growing preponderance of evidence shows that opioids are not needed for routine dental care. This article provides an overview of the evidence and outlines possible pain management models to minimize opioid use in dentistry. The purpose is to stimulate debate on this important topic and encourage the development of definitive guidance by professional bodies, health providers, and state and federal agencies

Analgesic exposure in pregnant rats affects fetal germ cell development with inter-generational reproductive consequences

Analgesics which affect prostaglandin (PG) pathways are used by most pregnant women. As germ cells (GC) undergo developmental and epigenetic changes in fetal life and are PG targets, we investigated if exposure of pregnant rats to analgesics (indomethacin or acetaminophen) affected GC development and reproductive function in resulting offspring (F1) or in the F2 generation. Exposure to either analgesic reduced F1 fetal GC number in both sexes and altered the tempo of fetal GC development sex-dependently, with delayed meiotic entry in oogonia but accelerated GC differentiation in males. These effects persisted in adult F1 females as reduced ovarian and litter size, whereas F1 males recovered normal GC numbers and fertility by adulthood. F2 offspring deriving from an analgesic-exposed F1 parent also exhibited sex-specific changes. F2 males exhibited normal reproductive development whereas F2 females had smaller ovaries and reduced follicle numbers during puberty/adulthood; as similar changes were found for F2 offspring of analgesic-exposed F1 fathers or mothers, we interpret this as potentially indicating an analgesic-induced change to GC in F1. Assuming our results are translatable to humans, they raise concerns that analgesic use in pregnancy could potentially affect fertility of resulting daughters and grand-daughters