Proposal of a "Checklist" for endodontic treatment

Objectives: On the basis of the 'Surgical Checklist' proposed by the WHO, we propose a new Checklist model adapted to the procedures of endodontic treatment. Study Design: The proposed document contains 21 items which are broken down into two groups: those which must be verified before beginning the treatment, and those which must be verified after completing it, but before the patient leaves the dentist's office. Results: The Checklist is an easy-to-use tool that requires little time but provides, order, logic and systematization by taking into account certain basic concepts to increase patient safety. Discussion: We believe that the result is a Checklist that is easy to complete and which ensure the fulfillment of the key points on patient safety in the field of endodontics

Antibiotic Use by Members of the Spanish Endodontic Societ

The purpose of this study was to determine the prescribing habits of active members of the Spanish Endodontic Society (AEDE) with regard to antibiotics. A one-page questionnaire was sent to the active members of the AEDE. Of the 508 surveys mailed, 158 surveys were returned, and 140 were found to be usable. The overall response rate was 31.1%. The data were analyzed using descriptive statistics and chi-square tests of independence. The average duration of antibiotic therapy was 6.8 1.8 days. In patients with no medical allergies most of responders (86.1%) selected amoxicillin as first-choice antibiotic, alone (44.3%) or associated to clavulanate (41.8%); metronidazole spiramycin and clindamycin were prescribed by 7.6% and 3.7% of the respondents. The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mgr (63.2%), followed by metronidazole-spiramycin (23.7%). For cases of irreversible pulpitis, 40.0 % of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 52.9% prescribed antibiotics. Almost 21.5% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract. We conclude that, for the most part, the majority of the members of the AEDE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance

In vitro randomized-trial on the sealing ability of carrier-based systems in curved root canals

Objetivo: comparar el porcentaje de área de gutapercha, cemento y huecos en conductos curvos obturados con sistemas con vástago y evaluar la influencia de la activación del cemento durante su colocación. Metodología: 120 conductos curvos de molares mandibulares fueron preparados a un diámetro apical ProFile 30, 0.04. Se obturaron con los sistemas GuttaCore, GuttaFusion o condensación lateral y AHplus (n = 40). Se subdividieron los grupos (n = 20) y se colocó el cemento con activación sónica o no. El cemento se mezcló con Rodamina B para permitir el análisis mediante microscopía confocal. Se calculó el área de gutapercha, cemento y huecos a 3, 6 y 9 mm del ápice. Se realizó el análisis estadístico utilizando ANOVA de dos vías. Para la comparación por pares se realizó el test de Sidak. Resultados: cuando se comparan los sistemas de gutapercha a 3 mm, GF mostró un mejor comportamiento. CL obtuvo los peores resultados. No se encontró influencia entre los sistemas de obturación y la activación del cemento. Cuando se comparó el porcentaje de huecos entre todos los grupos, los perores resultados fueron para CL a 6 y 9 mm. Conclusiones: bajo las condiciones de este estudio, el área de gutepercha, cemento y huecos depende del sistema de obturación utilizado. El uso de activación del cemento no influye en la calidad de la obturación

Effectiveness of Nd:YAG Laser on the elimination of debris and Smear Layer : a comparative study with two different irrigation solution: Edta and qmix® in addition to naocl

The aim of this study was to evaluate the effectiveness in dentin debris and smear layer removal from root canal walls using EDTA and QMix® alone and also activated with Nd:YAG laser. 50 single-rooted teeth were instrumented and divided in 5 groups according to irrigation protocol: 17% EDTA, QMix®, Nd:YAG laser alone, and combination of 17% EDTA - Nd:YAG laser and QMix® - Nd:YAG laser. Samples were evaluated using SEM. Statistical analysis was done using Chi-Square Fisher exact test and McNemar test. Dentinal debris analysis showed statistically significant differences when comparing 17% EDTA vs Laser and Laser vs QMix® in combination with Laser at the apical third. The Smear Layer analysis also showed statistically significant differences at the apical third when comparing 17% EDTA vs Laser, QMix® vs QMix® in combination with Laser and Laser vs QMix® in combination with Laser. 17% EDTA was the most efficient irrigant showing the best results. Laser alone was not effective removing either dentinal debris or smear layer

Relationship of patient complaints and signs to histopathologic diagnosis of pulpal condition

The correlation between the histopathologic examination of pulp biopsy specimens and patients' complaints and signs was investigated. The sensitivity, specificity and reliability of each complaint and sign, and the characteristics of pain that are associated with treatable and untreatable pulp states is proposed. Pulp specimens were obtained from teeth that required endodontic treatment. Clinical data were recorded to identify each patient's complaints. The pulp specimens were processed and the histopathologic diagnoses were categorised and correlated with the patients' complaints. Of the 240 cases, I00 (4 I .7%) were diagnosed as atrophic pulp or pulposis; 4 (I .7%) as acute pulpitis; 64 (26.7%) as transitional stage; 56 (23.3%) as chronic pulpitis. and I6 (6.7%) as acute pulpitis superimposed on a chronic pulpitis. Results showed that previous pain (p < 0.05). spontaneous pain (p < O.OI), and prolonged pain on cold stimuli (p < 0.05). were significantly more frequent in the patients with chronic pulpitis compared to those with pulposis or transitional stage. We concluded that clinicians must consider the sensitivity and specificity of patient complaints and signs in order to perform a diagnosis based upon clinical evidence.Sin financiación0.267 SJR (2005) Q3, 46/81 Dentistry (miscellaneous)UE

An in vitro evaluation of the accuracy of two electronic apex locators

Objetivo: El propósito de este estudio fue evaluar la precisión en las mediciones de dos localizadores electrónicos de ápices (LEAs): Root ZX y ProPex. Material y Métodos: De las 104 raíces unirradiculares con las que comenzó la investigación, finalmente 63 fueron utilizadas. Se desarrolló un nuevo sistema de medición in vitro, en el que la lima utilizada para las mediciones permanece unida a un calibre electrónico; por lo tanto, los datos se obtienen con un precisión de centésimas de milímetro. Se realizaron tres mediciones de las 63 muestras con cada localizador y se calculó la media. Resultados: Tras analizar los datos obtenidos con el test estadístico de la t de student, no se observó diferencia estadística significativa entre las mediciones de ambos localizadores. La precisión del ROOT ZX y del ProPex fue del 63,5% ± 1mm y del 65% ± 1mm respectivamente. Conclusiones: Los dos localizadores electrónicos suponen una ayuda muy fiable para situar la lima dentro del conducto radicular. No obstante, Su precisión no es exacta, por lo que deberían acompañarse de otras técnicas para confirmar la longitud de trabajo.No data (2008)UE

Effect of EDTA, sonic, and ultrasonic activation on the penetration of sodium hypochlorite into simulated lateral canals: An in vitro study

The purpose of this study was to evaluate the penetration of 5.25% sodium hypochlorite alone or in combination with 17% EDTA in simulated lateral canals using sonic and ultrasonic activation. Four hundred and eighty simulated lateral canals were created in 80 single rooted cleared teeth by inserting 06 K-files at 2, 4.5 and 6 mm of working length. Samples were mounted on clear silicon to simulate the presence of surrounding periodontal tissues and its effects on fluid dynamics and then randomly assigned to four experimental groups: 1 (n = 20) 5.25% NaOCl + sonic activation; 2 (n = 20) 5.25% NaOCl + ultrasonic activation; 3 (n = 20) 5.25% NaOCl + 17% EDTA + sonic activation and 4 (n = 20) 5.25% NaOCl + 17% EDTA + ultrasonic activation. Sonic activation was delivered using the Endoactivator® inserted 2 mm short of working length and activated for 1 minute. Ultrasonic activation was performed with a stainless steel ultrasonic file inserted 2 mm short of working length and passively activated for 3 cycles of 20 seconds each. Samples were evaluated by direct observation of the images recorded under the operating microscope and by radiographic evaluation after irrigation with a contrast solution. Sonic and ultrasonic activation resulted in a better irrigation of the lateral canals at 4.5 and 2 mm from working length compared to traditional needle irrigation alone. Traditional needle irrigation alone demonstrated significantly less penetration of irrigant into the lateral canals and was limited to the level of penetration of the needle. In conclusion, the addition of EDTA did not result in better penetration of irrigants into the lateral canals.Sin financiación2.953 JCR (2009) Q1, 5/64 Dentistry, oral surgery & medicineUE

Efficacy of different irrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and up to working length: An in vitro study

The removal of vital and necrotic pulp tissue, microorganisms, and their toxins is essential for endodontic success. However, the complex anatomy of the root canal system has limited our ability to debride it completely. Hence the purpose of this study was to evaluate the effect of currently used irrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and to working length in a closed system. One hundred single-rooted teeth were used in this study. A total of 600 simulated lateral canals were created, 6 in each tooth, with 2 lateral canals at 2, 4.5, and 6 mm of working length. To resemble the clinical situation, a closed system was created by coating each root with soft modeling wax. Roots were then randomly assigned to 4 experimental groups: group 1 (n = 20), Endoactivator (sonic activation); group 2 (n = 20), passive ultrasonic (PUI) activation; group 3 (n = 20), F file; group 4 (n = 20), apical negative pressure (ANP) irrigation; and control group 5 (n = 20), positive pressure irrigation. The samples were evaluated by direct observation of the images recorded under the dental operating microscope. The results demonstrated that the ANP irrigation group was superior at reaching working length, and PUI was the most effective at lateral canal penetration. The ANP irrigation system demonstrated limited activation of the irrigant into lateral canals but reached the working length significantly more than the other groups tested. In contrast, PUI group demonstrated significantly more penetration of irrigant into lateral canals but not up to the working length.Sin financiación2.904 JCR (2010) Q1, 3/77 Dentistry, oral surgery & medicineUE

Pain associated with root canal treatment

Our purpose was to determine the pain experienced by patients during root canal treatment and to correlate with age and gender, pulpal diagnosis, previous periapical status, dental characteristics and length of treatment. One hundred and seventy-six patients (68 men and 108 women), with ages ranged from 6 to 83 years, were randomly recruited. Patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain experienced during root canal treatment. The mean pain level during root canal treatment was 1.2 ± 0.8 in a VAS between 0 and 10. Fifty-four per cent of patients did not experience pain. There were no significant differences in relation to gender or age groups. Mandibular teeth had a significantly (P < 0.05) higher percentage incidence of pain in comparison with maxillary teeth. Pain was absent in 63% of anterior teeth compared with 44% in posterior ones (P < 0.01). Interventions shorter than 45 min resulted in a significantly higher percentage of pain absence (P < 0.05). Root canal treatment was significantly (P < 0.05) more painful in teeth with irreversible pulpitis and acute apical periodontitis compared to the group with necrotic pulps and chronic apical periodontitis (P = 0.049). In conclusion, root canal treatment in teeth with irreversible pulpitis and acute apical periodontitis was more painful. Age, tooth type and length of the treatment were factors associated with increased risk for pain experienced during the procedure. Knowledge of pain levels endured by patients will allow dentists to decide when to use supplemental local anaesthesia.Sin financiación2.223 JCR (2009) Q1, 13/64 Dentistry, oral surgery & medicineUE

Calcium silicate-based sealers: cytotoxicity and inflammatory evaluation

La biocompatibilidad de los cementos selladores es una característica que debe tenerse en cuenta, ya que podría influir en el resultado del tratamiento de conductos. El objetivo de este estudio fue analizar la citotoxicidad de los cementos selladores a base de silicatos BioRoot® RCS y Nano-ceramic Sealer®, y el sellador a base de resina epóxica AH Plus Jet®, así como su respuesta inflamatoria asociada en fibroblastos humanos. Se seleccionaron 36 dientes unirradiculares, se instrumentaron y obturaron con los selladores seleccionados. A continuación, se pusieron en contacto con el medio de cultivo para obtener los medios acondicionados a las 24, 48 y 72 horas. Los medios acondicionados obtenidos fueron cultivados con la línea celular de fibroblastos L-132. La viabilidad de las células se evaluó mediante el ensayo del bromuro de 3-(4,5-dimetiltiazol-2-il)-2,5 difenil tetrazolio (MTT). La respuesta inflamatoria se analizó mediante la medición de los niveles de IL-6 determinados a través del ensayo ELISA (ensayo por inmunoabsorción ligado a enzimas) y mediante los niveles de nitrito (ensayo de fluorescencia). Todos los selladores mostraron un cierto grado de citotoxicidad durante el tiempo de evaluación, mientras que sólo el BioRoot® RCS desencadenó una respuesta pro-inflamatoria. Es necesario seguir investigando para evaluar otros aspectos de la biocompatibilidad de los cementos selladores a base de silicato.Biocompatibility of sealers is a feature to be taken into account as it might influence the outcome of the treatment. The aim of this study was to analyze the cytotoxicity of the silicate-based root canal sealers BioRoot™ RCS and Nanoceramic Sealer™and the epoxy-resin based sealer AH Plus Jet™, as well as their associated inflammatory response in human fibroblast. Thirty-six human teeth were selected, prepared, filled with the selected sealers and put in contact with culture medium to obtain extracts at 24, 48 and 72 hours. Then, the extracts were cultured with the L-132 fibroblast cell line. Cell viability was evaluated using the 3-(4,5-dimethylthiazol-2- yl)-2,5 diphenyl tetrazolium bromide (MTT) assay. Inflammatory response was analyzed by measuring IL-6 levels determined by ELISA and nitrite levels (fluorescence assay). All sealers showed a certain degree of cytotoxicity during the evaluation time, while only the BioRoot™ RCS triggered a pro-inflammatory response. Further research is needed to assess other aspects of biocompatibility of silicate-based root canal sealers.Sin financiaciónNo data 2020UE