Biomedical subjects
Publications and source records attributed to R R Lemon.
The authors surveyed 360 general dentists and 291 endodontists to obtain information on routine, nonemergency endodontic treatments adapted to clinical practice. Frequent practices and recent advances in treatment modalities-including instrumentation, obturation, intracanal preparations, medications and restorations-are highlighted.
The root canals of 588 consecutive nonsurgical patients with varying levels of pain were completely instrumented in 10 endodontic practices and 4 endodontic graduate programs. The participants were sequentially assigned to one of nine medications and a placebo. The severity of pain was assessed by the visual analog scale for 72 h following instrumentation. Among all of the parameters studied, three factors (preoperative pain, apprehension, and types of medication) were found to be significant in determining postinstrumentation pain. An association was found between the intensity of pre-and postoperative pain. As the intensity of preoperative pain increased, the chances for more severe postoperative pain increased (p < 0.0001). In addition, an association between the presence of apprehension before any treatment and postoperative pain was also noted (between 0.012 < p < 0.047). Examination of the time-effect curves for various medications in patients with no mild pain showed no statistical significant difference between the effectiveness of different medications and placebo. However, a multiple comparison of the effectiveness of various medications and placebo on patients in moderate and severe preoperative pain showed that ibuprofen, ketoprofen, erythromycin base, penicillin, and methylprednisolone plus penicillin were more effective than placebo within the first 48 h following complete instrumentation.
Ferric sulfate solution is an accepted soft tissue hemostatic agent for use in dermatology and dentistry. This study was designed to test its effect on osseous healing when used during surgery to control osseous hemorrhage. Standardized osseous defects were created bilaterally in the naturally edentulous zone in rabbit mandibles. The control site was sutured immediately after clot formation in the defect. The contralateral experimental site received ferric sulfate application until complete hemostasis was achieved. The defect was filled with ferric sulfate solution to maximize any effect on healing and then closed with sutures. The experimental and control specimens were examined histologically after 18 and 46 days and scored for healing. Statistical analysis by Wilcoxon signed rank test showed significant adverse effects on osseous healing when ferric sulfate solution was left in situ.
Hemorrhage control is often a problem for the clinician during osseous surgery. Ferric sulfate is an effective hemostatic agent, but with prolonged application to an osseous defect can cause persistent inflammation and delayed healing. The purpose of this investigation was to evaluate the effectiveness of ferric sulfate as a hemostatic agent and to determine its effect on healing after thorough curettage and irrigation from osseous surgical wounds. Standard size osseous defects were created bilaterally in the mandibles of rabbits. Ferric sulfate was placed in one defect until hemostasis was obtained; the contralateral defect was allowed to fill with blood and clot. After 5 min both defects were curetted and irrigated. The repair of the defects was evaluated histologically at 18 and 46 days. There were no significant differences between the ferric sulfate-treated defects and the untreated controls. When adequately curetted and irrigated from the surgical site prior to closure, ferric sulfate did not cause persistent inflammation or delay osseous repair in comparison to controls.
The internal matrix concept of perforation repair offers distinct advantages over classic techniques. The biocompatible matrix allows control of the repair material. The technique sensitivity involved with placement of the repair material is reduced and contamination of the restorative material with hemorrhage is prevented. In accessible locations perforations can be repaired predictably and, by comparison, the prognosis is improved greatly. Fewer surgeries or surgical alterations of teeth will be necessary, thus reducing the cost of treatment. A higher percentage of existing crowns can be salvaged if surgical alteration of the tooth is prevented. Microsurgical techniques currently are being developed and researched that may allow nonsurgical repair of inaccessible perforations. The scope of endodontic therapy, therefore, will be expanded.
Internal, or "walking," bleaching has been successfully used in dentistry for many years to reverse stains associated with nonvital teeth. The procedure is predictable for color change but is not without problems. Current research has identified the cause of cervical resorption, which has been associated with internal bleaching. Second-generation esthetic bonding materials theoretically should provide an improved seal at the tooth-restorative interface, but the limited current research does not support this contention. A suggested method for internal bleaching and restoring the access cavity is presented.
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