42 research outputs found
Critical analysis of a new system to classify root and canal morphology â A systematic review
A novel system to classify root and canal morphology was recently introduced (Ahmed et al. 2017). This systematic review aimed to answer the following research question: Does the Ahmed et al. system provide a more accurate and practical classification of root and canal anatomy compared to other classifications? A literature search was conducted in Google Scholar, Scopus and Wiley Online Library to identify the citation counts for the article entitled âA new system for classifying root and root canal morphology; doi.org/10.1111/iej.12685â. After removal of duplicates and unrelated articles, 15 studies were included and analysed. All studies compared the Ahmed et al. system with the Vertucci classification. Results revealed that both systems were able to classify simple canal configurations in singleârooted anterior and premolar teeth, distoâbuccal and palatal roots of maxillary molars. However, the Ahmed et al. system provided more accurate and comprehensive categorisations of singleârooted teeth with complex canal anatomy, multiârooted maxillary and mandibular premolars and the mesioâbuccal root of maxillary molars. Further evidence on the utility of the Ahmed et al. system is required using other diagnostic devices especially in molars
Application of a new system for classifying root and canal anatomy in clinical practice â explanation and elaboration
Adequate understanding and accurate characterization of normal and unusual root and canal morphology
are essential requirements for successful root canal treatment. A new coding system for classifying root and
canal morphology, accessory canals and anomalies has been introduced. In addition to technological advances related to experimental studies involving micro-computed tomography, the continuing clinical advances in magnification, illumination, imaging and intra-operative root canal treatment procedures have
allowed clinicians to identify an increasingly wide range of anatomical variations in roots and canals in an
attempt to achieve more predictable clinical outcomes. This review aims to provide a step-by-step explanation for the clinical application of the new coding system in dental practice, and to describe the anatomical
variations in roots and canals for teeth scheduled for root canal treatmen
Revitalizing previously treated teeth with open apices: a case report and a literature review
Revitalizing the root canals of previously treated teeth with open apices is appealing to clinicians and patients. However, there are fundamental differences in the microbiome and the microenvironment between a canal with a primary endodontic infection and a canal with a persistent endodontic infection. The aims of this report are to report a case where a previously treated tooth with an open apex and a large apical radiolucency was treated successfully using regenerative endodontic treatment (RET) and to review and critically appraise the literature on procedures and outcomes of RET that result in revitalization of canal(s) in previously treated teeth with open apices. A maxillary central incisor with poor-quality root filling, a large apical radiolucency and an open apex was retreated using RET using platelet-rich fibrin as the scaffold. After 24 months, there was complete healing of the periapical lesion and obvious radiographic signs of apical root closure. Electronic searches were performed in MEDLINE, Scopus and Embase, and the baseline, procedural and outcome data of qualified articles were collected. An assessment tool was developed to rate the quality of evidence reported in these case report/series. Nine articles, three case series and six case reports, with a total of 17 teeth of all types, were included in the reports identified. The age of patients ranged from 7 to 48 years (mean: 19.4 years). The recall period ranged from 12 to 72 months (mean: 29 months). All 17 teeth survived and were functional with healing/healed outcomes. âApical closureâ was the most common radiographic finding regarding root development. The quality of evidence using the new assessment tool was rated âExcellentâ in three case reports but only âFairâ in the other six articles. The present case report, as well as the review of the literature, suggests that revitalizing the root canal system of teeth with open apices and post-treatment disease using RET is a potentially valid treatment option. However, more clinical studies with higher levels of evidence and higher quality of evidence are required to confirm the viability of this treatment approach
The study and relevance of pulp chamber anatomy in endodontics â A comprehensive review
With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber
as an important component of the root canal system. For example, the pulp chamber is of critical relevance
during diagnostic procedures such as pulp sensibility tests, deep caries removal, vital pulp treatments, access
cavity preparation, tooth whitening, tooth restoration as well as methods for examining the floor of the pulp
chamber to aid the detection of root canal orifices or the presence of perforations and cracks. The more recent concept of minimal invasive endodontics has also created a need to understand better the anatomy of
the pulp chamber. The purpose of this article is to discuss the research methods used to study pulp chamber
anatomy and the significance of the pulp chamber in endodontic research and clinical practice. In addition,
directions for future research are emphasised
SEM analysis of MTAD efficacy for smear layer removal from periodontally affected root surfaces
Objective: BiopureÂź MTAD (Dentsply Tulsa Dental, USA) has been developedas a final irrigant following root canal shaping to remove intracanal smear layer.Many of the unique properties of MTAD potentially transfer to the conditioningprocess of tooth roots during periodontal therapy. The aim of this ex vivo studywas to evaluate the effect of MTAD on the removal of smear layer from root surfaces.Materials and Methods: Thirty two longitudinally sectioned specimens from 16freshly extracted teeth diagnosed with advanced periodontal disease were dividedinto four groups. In group 1 and 2, the root surfaces were scaled using Gracey curettes.In group 3 and 4, 0.5 mm of the root surface was removed using a fissurebur. The specimens in group 1 and 3 were then irrigated by normal saline. Thespecimens in groups 2 and 4 were irrigated with Biopure MTAD.All specimens were prepared for SEM and scored according to the presence ofsmear layer.Results: MTAD significantly increased (P=0.001) the smear layer removal inboth groups 2 and 4 compared to the associated control groups, in which only salinewas used.Conclusion: MTAD increased the removal of the smear layer from periodontallyaffected root surfaces. Use of MTAD as a periodontal conditioner may be suggeste
A laboratory study comparing the static navigation technique using a bur with a conventional freehand technique using ultrasonic tips for the removal of fibre posts
Aim: There are currently no highâquality studies comparing the static navigation technique with conventional methods of fibre post removal. The aim of this ex vivo study was to compare the effectiveness of fibre post removal between a static navigation technique and a conventional freehand technique using ultrasonics by experienced and inexperienced operators. Methodology: Fortyâeight extracted singleârooted human premolars were rootâfilled. A fibre post was cemented in all 48 teeth, which were then divided randomly into the following groups: static navigation group using burs; static navigationâultrasonic group; and nonâguided group using ultrasonic tips. The following parameters were evaluated for both experienced operators and inexperienced operators: reaching the guttaâpercha root filling successfully, the time required to remove the entire post, the occurrence of lateral root perforations, and the amount of root dentine removed. The KolmogorovâSmirnov test was used to examine the normality of the data; the anova test was used to compare the significant differences among groups; and Tukey tests were used for all twoâbyâtwo comparisons. The significance level was set at 0.05. Results: In the static navigation group, the guttaâpercha was reached significantly more frequently than in the nonâguided group (p .05). More perforations were associated with the nonâguided group than with the other two groups. The total mean loss of dentine in the nonâguided group in all directions was 0.39 (±0.17) mm, with 0.25 (±0.09) mm for experienced, and 0.42 (±0.16) mm for inexperienced operators. Conclusion: When compared to a conventional ultrasonic technique for the removal of fibre posts, the static navigation method using burs resulted in less dentine removal, more rapid access to the guttaâpercha root filling, less overall time to remove the posts, and fewer complications. When using static navigation, there was no difference in performance between experienced and inexperienced operators
Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; pâ=â0.40). There was no significant effect of DMF on any secondary outcome
Properties and applications of calcium hydroxide in endodontics and dental traumatology
Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca2+ and OH- ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial
Pulp canal obliteration: an endodontic diagnosis and treatment challenge
Aimâ To review the literature on pulp chamber and root canal obliteration in anterior teeth and to establish a clear protocol for managing teeth with fine, tortuous canal systems.
Summaryâ Pulp canal obliteration (PCO) occurs commonly following traumatic injuries to teeth. Approximately 4â24% of traumatized teeth develop varying degrees of pulpal obliteration that is characterized by the apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. These teeth provide an endodontic treatment challenge; the critical management decision being whether to treat these teeth endodontically immediately upon detection of the pulpal obliteration or to wait until symptoms or signs of pulp and or periapical disease occur. The inevitable lack of responses to normal sensibility tests and the crown discoloration add uncertainty to the management; however, only approximately 7â27% of teeth with PCO will develop pulp necrosis with radiographic signs of periapical disease. Root canal treatment of teeth with pulpal obliteration is often challenging. This article discusses the various management approaches and highlights treatment strategies for overcoming potential complications