Assessment of Apical Extrusion of Debris during Endodontic Retreatment with 3 Rotary Nickel-Titanium Retreatment Systems and Hand Files

Aim: to evaluate the amount of debris extruded apically as well as the time needed for removal of root canal filling material using ProTaper, MTwo, REndo NiTi rotary retreatment systems and hand files

Subcutaneous emphysema in patients undergoing root canal treatment:a systematic review of the factors affecting its development and management

Background: Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications. Aim: To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management. Data sources: An electronic search was conducted in EMBASE (1947–2018), LILACS (1982–2018), PubMed (1950–2018), SciELO (1997–2018), Scopus (1970–2018), Web of Science (1900–2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand-searched. Study eligibility criteria, participants, interventions: The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients. Study appraisal and synthesis methods: Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis. Results: The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air-water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1-17 days. Limitations: Case reports and case series are a low level of evidence. Conclusions and implications of key findings: Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air-water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions

Removal Efficacy of Various Calcium Hydroxide/Clorexidine Medicaments from the Root Canal, Int

Abstract Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. International Endodontic Journal, 39, 55-61, 2006. Aim To compare the efficiency of removing calcium hydroxide [Ca(OH) 2 ]/chlorhexidine (CHX) (gel), Ca(OH) 2 /CHX (solution) and Ca(OH) 2 /saline pastes with the use of instrumentation and irrigation with sodium hypochlorite and ethylene diamine tetraacetic acid (EDTA) solutions. Moreover the role of the patency file in the cleanliness of the apical third of the root canal was evaluated. Methodology Sixty-four human single-rooted teeth with straight canals were used. Root canal preparation was performed with a stepback technique using Hedström (H) files. Teeth were randomly assigned to three groups and subsequently filled with one of the pastes: Ca(OH) 2 /CHX (gel), Ca(OH) 2 /CHX (solution) and Ca(OH) 2 /saline paste. The medicaments were removed 10 days later using instrumentation and irrigation with 1% sodium hypochlorite and 17% EDTA, with or without obtaining patency of the apical foramen with a size 10 H-file. The crowns were removed at the cemento-enamel junction and the roots were grooved longitudinally and split into halves. Images of all halves were acquired with the use of a flatbed scanner. A scoring system of 1 to 4 was used to assess the amount of residue on the cervical, middle and apical third of the canal. Data were subjected to statistical analysis using Kruskal-Wallis and MannWhitney tests, with Bonferroni correction, at 95% confidence level (P < 0.05). Results Remnants of medicament were found in all experimental teeth regardless of the experimental material used and the use of the patency file. When examining the root canal as a whole, Ca(OH) 2 /CHX (gel) paste was associated with significantly larger amount of residue, whereas the Ca(OH) 2 /CHX (solution) paste was associated with less amount (P < 0.05) than the other two medicaments with or without the use of a patency file. Conclusions None of the techniques used in this study removed the inter-appointment root canal medicaments effectively; the use of the patency file facilitated removal of more of the medicament in the apical third of those straight canals