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Calcium hydroxide, a material widely used for the treatment of permanent teeth has not been used frequently for pulpectomy in primary teeth. A comparative evaluation of calcium hydroxide and zinc oxide eugenol used as root canal filling materials in primary molars is presented.
HIV infected children frequently suffer from buccal-dental lesions needing dental treatment. This treatment should improve their systemic affection, localised pathology, psychological and affective state and their general quality of life. Hardly any of these children are ever treated; sometimes because of lack of family motivation (the most frequent cause) and others because of the lack of a Paediatric Dental Unit in the hospitals they attend. For this reason we present here two cases of HIV infected children, with HIV infected mothers, who, thanks to the relationship between the Paediatric and Dental Units of the hospital, have had access to dental treatment for multiple caries and candidiasis. An anatopathological diagnosis of gingival inflammation, which was also infected by candida, was also carried out. The treatment included extraction of teeth, pulpotomy, pulpectomy and the fitting of prostheses. It should be made clear that a good inter-professional relationship is needed and it must also be taken into account the great difficulty that is encountered when trying to make this group of patients understand the need for, and benefits of, dental treatment.
AIM: The object of this study was the evaluation of the success rate of endodontic treatment of primary teeth with necrotic pulps performed through a partial pulpectomy and a chemical shaping. MATERIALS AND METHODS: The study was conducted on 50 necrotic primary molars, with an oral fistula and a clinical and radiographical positive diagnosis. On each tooth the endodontic treatment was performed through mechanical strumentation for only 2-3 mm beyond the orifices of the canals and copious alternate irrigation with 10vol H(2)O(2) and 3% NaOCl (chemical shaping). After the pharmacological shaping the canals were filled with a slurry mix of powdered macrolide antibiotic (josamicina) and glycerine (or anaesthetic solution). At the second visit the same procedure was either repeated, if an oral fistula was still present, or the canals were sealed with a small amount of josamicina and glycerine paste and zinc oxide eugenol to a working length. RESULTS: The overall success rate, considering the first two teeth that were extracted as inappropriate case selection, was 45 out of the original 48 or 93%. While considering all the teeth treated the success rate was 45 out of 50, or 90%.
OBJECTIVE: To perform a systematic literature review and meta-analysis on the effectiveness of interventions used in the management of acute apical abscess in the permanent dentition. METHODS: Electronic databases were searched from their inception to March 2002. These searches, combined with manual searching, yielded 85 citations, of which 35 were relevant. Independent application of inclusion criteria by 3 reviewers yielded 8 eligible randomized controlled studies. Data on population, interventions, outcomes (reduction of pain or swelling or both, as reported by patients or clinicians) and methodological quality were determined by independent triplicate review. Disagreements were resolved by consensus. RESULTS: All papers included in the meta-analysis compared an antibiotic with an active control, a placebo or no pharmacotherapy as an adjunct for patients who had received concomitant therapy (i.e., incision and drainage, endodontic therapy or extraction). The 8 trials were randomized; in 3 of these, the method of randomization was described and appropriate. Five studies were double-blinded, and 2 of these described the method of blinding. Four trials described withdrawals, but none included an intention-to-treat analysis. Six studies compared 2 antibiotics. For the outcomes "absence of infection"and "absence of pain" the pooled odds ratios (ORs) were not statistically significant; for the outcome "absence of pain and infection," 3 studies showed an equivalent treatment effect in both treatment and control groups. One open-label study (with a quality score of 2) showed a result favouring azithromycin over co-amoxiclav (OR 0.58, 95% confidence interval 0.35-0.96). Two studies compared adjunctive antibiotic therapy with placebo; no benefit to patients was demonstrated with this intervention. CONCLUSIONS: In the management of localized acute apical abscess in the permanent dentition, the abscess should be drained through a pulpectomy or incision and drainage. This analysis indicated that antibiotics are of no additional benefit. In the event of systemic complications (e.g., fever, lymphadenopathy or cellulitis), or for an immunocompromised patient, antibiotics may be prescribed in addition to drainage of the tooth.
PURPOSE: To explore the application and the anaesthetic effect of primacaine in anaesthetizing the pulp. METHODS: 162 teeth of pulpitis underwent submucous infiltration anaesthesia via the labial or buccal side (single side anaesthesia). There were 94 teeth of acute pulpitis and 68 teeth of chronic pulpitis among them. Anaesthesia effect were observed.Maxillary, mandibular molars and mandibular premolar were respectively divided into two groups, one underwent submucous infiltration anaesthesia via the labial or buccal and lingual sides (double sides anaesthesia), the other underwent single side anaesthesia. The data was analysed with X(2) test. RESULTS: The effective rate of single side anaesthesia was 72.8%, There was no significant difference between acute and chronic pulpitis(P>0.05). For mandibular molar,the effect of double side anaesthesia was better than the single side anaesthesia (P<0.05). CONCLUSIONS: Primacaine had a good anaesthesia effect when the teeth of pulpitis underwent pulpectomy. In order to get perfect anaesthetic effect, the double side anaesthesia for the mandibular molar was suggested.
UNLABELLED: Review of 6 clinical distinctions: (1) Symptom: "anything under the sun." DIAGNOSIS: pulp exposure. Duplicate: clinical or radiographic pulp exposure evidence. TREATMENT: endodontics or pulp cap under strict protocol conditions. (2) Symptom: "cold." DIAGNOSIS: hyperemia. Duplicate: ice. TREATMENT: pulp protection or endodontics. (3) Symptom: "heat." DIAGNOSIS: pulpitis. Duplicate: heat. TREATMENT: pulpotomy for multirooted teeth or pulpectomy for single-rooted teeth. Schedule endodontic completion. (4) Symptom: "I recently had a toothache and now it is gone." DIAGNOSIS: necrosis. Duplicate: Electric Pulp Test and ice are negative. TREATMENT: endodontics. (5) Symptom: "I had a toothache awhile back and now it is gone." DIAGNOSIS: LEO. Duplicate: Electric Pulp Test, ice, and test cavity are negative. TREATMENT: endodontics. (6) Symptom: "It really hurts to touch my tooth." DIAGNOSIS: percussion. Duplicate: may or may not have a LEO and may or may not have cellulitis. TREATMENT: reduce occlusion, access cavity, water chew, and schedule to finish endodontics. If these tests are carefully performed, then they are objective and the doctor does not have to be in a subjective situation. A newfound sense of endodontic diagnostic mastery is experienced. Perhaps the best way to summarize the simplicity of this clinical diagnostic scheme is to quote Sherlock Holmes: "Nothing is more deceptive than the obvious."
The objective of this equivalency study was to see if a colony of Streptococcus mutans placed into cavities in primary molar teeth produced pulpitis similar to an established pulpitis induction method using carious dentine. In two juvenile baboons (Papio ursinus), occlusal cavities were cut in all 16 primary molar teeth, followed by making a small pulpal exposure after which the cavity was swabbed with 37 per cent phosphoric acid. In one half of the teeth, fresh soft human carious dentine was placed over the pulpal exposure; in the remaining teeth the exposure was covered with a colony of Streptococcus mutans in agar. All the cavities were restored with unlined light-cured composite resin. After 14 days specimens were harvested and examined under the light microscope with the examiner blind to the induction method. In both groups of teeth there was recognisable pulp, hyperaemia, micro-abscesses in the pulp and peri-apical abscesses. Reactions to soft caries were more severe than to Streptococcus mutans. The results show that Streptococcus mutans placed in a cavity with an exposure produces comparable pulpitis to fresh soft human carious dentine in the same type of cavity and that both methods produce pulpitis suitable for testing pulpotomy or pulpectomy treatments.
The purpose of this in vitro study was to compare the incidence of incomplete root fractures occurring in teeth with and without dentin-retained posts. Eighty extracted human mandibular canines were treated as follows: 20 teeth (controls) received pulpectomies using broaches and sodium hypochlorite; 60 teeth received endodontic therapy with laterally condensed gutta percha. Of those 60 teeth, 20 teeth received Flexi-posts, 20 received Vlock dentin-retained posts, and 20 teeth had no posts placed. All teeth were stained with 5% Oil-Red-O stain for 5 days and sectioned at four levels. The sections were then examined under a stereomicroscope at x20 power. No complete fractures were found. Incomplete fractures were found in two teeth from the endodontic treatment only group, two teeth from the Flexi-post group, and two teeth from the Vlock group. None of the teeth in the control group were fractured. Based upon these results, it was concluded that: 1) Flexi-post and Vlock post placement is no more likely to cause root fracture than is conventional endodontic therapy alone; and 2) incomplete root fractures are more likely to be found in teeth with conventional endodontic therapy than in teeth not treated endodontically.
In reviewing the various studies concerning the direct pulp capping procedure in primary teeth, using rigid criteria for case selection and procedure appears to insure a significant amount of success. It is acknowledged that vital primary pulp tissue is capable of healing without resorting to complete pulpectomy, although statistically direct pulp capping has been found to be less successful in primary teeth than indirect pulp therapy or coronal amputation (pulpotomy). To achieve success for direct pulp capping in primary teeth, the considerations involve: selecting teeth with minimal or no clinical signs of pulpal inflammation; or pretreating the carious tooth with a sedative restoration before excavating the caries; disinfecting the cavity floor; enlarging the actual exposure, and flushing out dentinal debris with mild solutions; controlling bleeding by not allowing a clot to form; placing a hard-set, CaOH material over the exposure, followed by a fast-setting, zinc oxide-eugenol cement to achieve a hermetic seal; and lastly, placing a stainless steel crown to minimize microleakage and prevent a fractured or defective restoration. These procedural steps can hardly ensure complete success in direct pulp capping of a primary tooth; but, based on the many cited investigations in this review, a significant amount of success can be expected without resorting more frequently to invasive techniques. Surely the evidence presented leading to the feasibility of direct pulp capping in primary teeth merits further investigations, before dogmatically rejecting this procedure of pulp therapy.
(1) The standard treatment for metastatic prostate cancer is hormone therapy, based on medical castration (with an LH-RH agonist) or surgical castration (pulpectomy), possibly combined with an androgen antagonist. For patients with hormone-resistant disease the only cytotoxic agents approved in France, estramustine and mitoxantrone, have no proven impact on survival. (2) Docetaxel is now approved in Europe for the treatment of hormone-resistant metastatic prostate cancer, in combination with a steroid. (3) In an open-label comparative trial involving 1006 patients, docetaxel infusion at a dose of 75 mg/m2 every 3 weeks, in combination with prednisone (or prednisolone), significantly extended the median survival time by about 2.5 months as compared with a mitoxantrone-prednisone combination (18.9 versus 16.5 months). In another open-label comparative trial involving 674 patients, a combination of docetaxel + estramustine was significantly more effective than a mitoxantrone + prednisone combination in extending median survival time (17.5 versus 15.6 months). (4) The adverse effects of docetaxel + prednisone were the same as those seen with other indications (hair loss, nausea and vomiting, diarrhea, neutropenia, nail disorders, neuropathies), and were severe in 25% of patients. (5) In France the cost of docetaxel therapy for hormone-resistant metastatic prostate cancer is more than 1000 euros every three weeks. (6) In practice, docetaxel is the first cytotoxic agent shown to prolong survival in men with hormone-resistant metastatic prostate cancer. The benefit is limited, however, especially given the potentially severe adverse effects of docetaxel, which must be disclosed to patients.
OBJECTIVE: Microleakage continues to be a main reason for failure of root canal therapy, where the challenge has been to achieve an adequate seal between the internal tooth structure and the main obturation material, gutta-percha. The Resilon/Epiphany (R/E) system uses a new obturation material that bonds chemically with the internal tooth structure, thereby decreasing the possibility of microleakage. The purpose of this study was to compare dye leakage in root canals filled with R/E and those in which gutta percha was used. METHODS AND MATERIALS: Pulpectomies were performed on 105 extracted human singlecanal mandibular incisors. The teeth were then randomly divided into 2 groups: 1 was obturated with gutta-percha and the other with R/E. Obturation was performed using the lateral condensation technique. The teeth were then incubated for 10 days, 1 month or 3 months in a heated water bath solution with dye to simulate conditions in the human oral cavity. Teeth were sectioned and examined under dissecting and scanning electron microscopes to assess dye penetration, seal and bonding. RESULTS: Resilon as the main obturation material consistently resulted in less microleakage than gutta-percha at all 3 time intervals. CONCLUSION: The R/E system provides a new material for root canal treatment. R/E creates a chemical bond with the internal tooth structure over the entire root area that is maintained over time, thus representing a better option than gutta-percha. Further studies on R/E will help validate its use and determine its long-term success rates in vivo.
In two groups, each of 50 patients undergoing pulpectomy or multiple extractions, effects of combining xylocaine nerve block with halothane general anesthesia were studied. Local blockade of surgical stimuli reduced markedly the incidence of dysrhythmias occurring during halothane anesthesia. Recovery was faster and postoperative analgesia was enhanced.
The purpose of this investigation was to evaluate direct pulp capping in primary teeth with calcium hydroxide agents. All utilized datas were selected from all the charts of the 3,675 patients at Pediatric Dentistry clinic of the School of Dentistry, Hiroshima University. The results obtained were as follows: 1) The number of all primary teeth where direct pulp capping, pulpotomy and pulpectomy were performed, was 2,511, and direct pulp capping was performed on 124 primary teeth (4.9%). Out of the 124 primary teeth, 100 were clinically evaluated. 2) At the time of the final follow up examination for each treated tooth, the ratio of teeth judged as being clinically successful were 94 (94.0%) and 6 (6.0%) as being unsuccessful. In the first year after treatment, the majority of unsuccessful cases were found. 3) We had many unsuccessful cases of anterior teeth on which composite resin and glassinomer cement had been filled after direct pulp capping. 4) Of 6 teeth judged as being clinically unsuccessful, 2 showed spontaneous pain, 1 discoloration of the tooth, 1 gingival swelling and 2 abscess formation. 5) Out of 100 primary teeth in the clinical examination, 66 became available for radiographic evaluation, and the ratio of teeth judged as being successful were 58 (87.9%) and 8 (12.1%) as being unsuccessful. During the two years following the treatment, we found most of unsuccessful cases.
Teeth restored with intracoronal restorations that provide no protection of the cusps from occlusal loading may fracture completely or partially. An incomplete dentinal fracture of a vital posterior tooth may cause pain. This condition is commonly known as the "cracked tooth syndrome". Location of the dentinal crack is difficult and must be guided by a precise history, thermal pulp testing and inspection of the dentinal walls within the suspect tooth. The number, extent and direction of the fracture lines may be ascertained readily by using transillumination and magnification. This allows the clinician to distinguish between oblique and vertical cracks. Treatment of oblique incomplete fracture relies on desensitisation of the hypersensitive dentine followed by splinting of the tooth fragments. Treatment of vertical incomplete fracture requires pulpectomy and immediate splinting of the crown. Two case reports are presented.
Tuberosity anesthesia is a loco-regional anesthesia aiming at anesthetizing with a single injection the superoposterior alveolar nerves, by approaching the maxillary tuberosity through a direct anteroexternal pathway. This anesthesia involves an area located behind the pyramidal process of the maxillary bone which includes the molars, gingival buccal mucosa, sinus bone and mucosa. Well-tolerated by the patient, since it is practically a painless procedure, tuberosity anesthesia is the preferred method to perform surgery in the posterior maxillary area. Its administration may be extended without condition to treatment of the upper molars: custy + crown + bridge preparations on vital teeth, pulpectomies, thanks to the rapid onset and efficacy of the anesthesia obtained. The only contraindication involves patients with vascular or hematologic disorders, ruling out procedures where a blood vessel might be injured with a needle. In that case, intraligamentary or transcortical instillation is indicated since para-apical anesthesia is not a valid alternative due to the proximity of the external alveolar artery.
Root canal length was determined with an electronic apex locator in 253 root canals and compared to the results obtained by radiographic length determination. After electronic measurement the tip of the instrument only in 56.6% was 0-1 mm from the roentgenographic apex. The electronic device gave better results after pulpectomies than in nonvital cases. Even worse results were obtained in revision cases.
We have analysed the filling length in 495 teeth, the length of which was measured with various methods routinously used in practice today. Significantly better fillings of root canals after pulpectomy were observed in the group, in which the length of canals was measured with odontometer, in comparison with the group, in which the lengths were measured with the tactile sense method (P less than 0.01), and with the group, in which the length was measured with preoperative radiogram only (P less than 0.05). The odontometric method resulted in statistically significant reduction of overfilled teeth in comparison with the x-ray measurement and with the radiogram made with the instrument in the root canal (P less than 0.01).
Debridement of the root canal system has long been recognized as the critical phase of success in endodontic therapy. Because of the morphological complexity of most root canals, complete removal of the pulp tissue during the mechanical preparation of these root canals is often impracticable. Sodium hypochlorite is thus currently favored by most endodontists as the routine irrigant on account of its antimicrobial action and its capacity to dissolve fresh tissue together with necrotic tissues. Formocresol is another common medicament for endodontic treatment and is usually used for pulpotomy, pulpectomy and intracanal medication. Nevertheless, it was empirically believed that formocresol may interrupt the action of sodium hypochlorite in the dissolution of residual tissue. Therefore, the present study was undertaken to testify whether formocresol can substantially retard the solvent action of sodium hypochlorite by comparing the effectiveness of 5% sodium hypochlorite on fresh and formalin-fixed tissues. Connective tissue from the abdominal wall of Sprague-Dawley rats was cut into pieces weighing 0.05 g and measuring about 2 x 10 x 10 mm. A total of 20 pieces of tissue were collected and divided into two groups: 10 pieces were used immediately as the fresh-tissue group; the other 10 pieces were fixed in 10% formalin for 7 days as the fixed-tissue group. Each group was then immersed in 5 ml of 5% sodium hypochlorite for 60 seconds, and 1 ml was aspirated from each for assay. Dialysis was performed using 2 liters of double distilled water for a period of 4 hours with the water changed hourly.(ABSTRACT TRUNCATED AT 250 WORDS)