ida vol 4 · dental probe journal vol 17 (4) 2017 executive committee 2017 indian dental...

Hon. EditorDr. Anand N. WankhedeISSN0976-9277

DENTAL PROBEJOURNAL

DENTAL PROBEJOURNAL

...................... ............................................

Dental Probe Journal Vol 17 (4) 2017

Executive Committee 2017

INDIAN DENTAL ASSOCIATION, NAGPUR BRANCH

PresidentDr. Manoj Chandak

44 Jeevan-Chhaya Building, New Ramdaspeth, Behind Hotel

Centre Pont, Nagpur- 10

Hon. SecretaryDr. Vaibhave Karemore66/11, Vastavya, VIP Road,Dharampeth, Nagpur - 10

Emil: [email protected]

Hon. EditorDr. Anand N. WankhedeOpp. Lok Vidhyalaya School,

Bachlor Road, Wardha - 442001Email : [email protected]

Editorial Committee

Editorial Committee

Editorial

President’s Message

Secretary’s Message

Technology : A Review Article

Knowledge, Attitude & Practice Of Dentist towards Repeat Root Canal Treatment :A Cross sectional study

To evaluate the effect of microwave disinfection on the hardness of self cure and heat cure acrylic resin.

Platelet Rich Fibrin Advancement in PRF

Dental Prob Journal Vol 17 (4) 2017

DR . MANOJ CHANDAK President

DR . VAIBHAV KAREMOREHon. Secretary

DR . KETAN GARG Treasurer

DR . TUSHAR SHRIRAOPresident Elect.

DR . SANDIP N. FULADI Imm Past President

DR . GIRISH BHUTADA1st Vice President

DR . KRISHNAKUMAR LAHOTI 2nd Vice President

DR. YOGESH S. INGOLEJoint Secretary

DR . SHRADDHA AGRAWALAsst. Secretary

DR. ANSHUL MAHAJANAsst. Treasurer

DR. POONAM HUDIYA Rep. to CDE

DR. VIVEK THOMBRERep to CDH

DR. ANAND WANKHEDE Hon. Editor (Dental Probe)

DR. MANGESH PHADNAIKEditor News Letter

DR. DEEPAK H. KAMDARRep. to IDA MSB

DR. ANIL Y. CHAUDHARI Rep. to IDA MSB

DR. ABHAY KOLTERep. to IDA MSB

DR. ZUBAIR QUAZI Rep. to IDA MSB

DR. JAYSHREE JOSHIRep. to IDA MSB

DR. ANKUR DHOOTRep. to IDA MSB

DR. SHARD KABRA Librarian

DR. MITUL MISHRA

EC Member

DR. GANESH BAJAJEC Member

DR. ANAND RATHI

EC Member

DR. ANURAG SHENDREEC Member

DR. PRAFUL SHUDDHALWAR

EC Member

DR. DEOKI KHATIEC Member

DR. ROHIT MUDEEC Member

Dr. Usha Radake

Dr. Ashok Pakhan

Dr. Manoj Chandak

Dr. Girish Bhutada

Dr. Abhay Kolte

Dr. Mangesh Padanaik

Dr. Sunita Kulkarni

Dr. Rakhi Chandak

Dr. Devendra Palve

Dr. Meenal Choudhary

Dr. Shweta Chandak

Dr. Pushpa Hazarey

Dr. Sindhu Ganvir

Dr. Vandana Gade

Dr. Abhay Datarkar

Dr. Chandrashekhar Bande

This views/ opinions express by the authors are entirely their own. The journal bears no responsibility, whatsoever about them. The readers are welcome to comment on the issues or subjects raised in the journal. No article/ write up in full or in part may be reproduced without the permission of the Hon. Editor. Any Legal issue/ matter subject to Nagpur Jurisdiction.

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Dental probe journal is committed to continuously reporting

developments in the field of dental sciences that would help dentists to

recognize & address the patients problem in an efficient and comfortable

manner.

Hon. Secretary’s Message

Your’s In IDA

Dr. Vaibhav Karemore

Hon. Secretary, IDA - Nagpur Branch

EDITORIALSharing of information & knowledge, exchange of experience

and expertises are very important for successful dental practice.Dental probe brings a new research work and advances in

dentistry which is mandatory for the growth and success of day to day dental practice. We have been making sincere efforts to bring to you articles with new knowledge & information.

Your’s In IDA

Dr. Anand N. Wankhede

Hon. Editor, IDA - Nagpur Branch

2

President’s Message

I am happy to know that Dental Probe Journal is

committed to continuously reporting new research finding & exploring

new idea, concepts, methods & technology. We are confident that our

journal will devote to bring the new update and advances in dentistry from

clinical aspect and academic point of view. Your’s In IDA

Dr. Manoj Chandak

President, IDA - Nagpur Branch

We, the undersigned, give an undertaking to our article entitled

“______________________________________________________________________________________

____________________________________________________________________”

submitted for publication in the DENTAL PROBE JOURNAL 1. The article mentioned above has not been published or submitted to or accepted for publication in anyform, in any other journal. 2. I/We declare that I/We contributed significantly towards the research study i.e., (a) conception, designand/or analysis and interpretation of data and to (b) drafting the article or revising it critically for important intellectual content and on (c) final approval of the version to be published.

3. The undersigned author(s) hereby assigns, conveys, transfers all rights, title, interest, and copyright ownership of said work for publication. Work includes the material submitted for publication and any other related material submitted to this Journal.

4. All accepted works become the property of DENTAL PROBE JOURNAL and may not be published elsewhere without prior written permission from editor of DENTAL PROBE JOURNAL

5. The author(s) hereby represents and warrants that they are sole author(s) of the research work, that all authors have participated in and agree with the content and conclusions of the research work. Research work is original, and does not infringe upon any copyright, propriety and / or personal right of any third party and that no part of it nor any work based on substantially similar data has been submitted to another publication.

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Undertaking by the Author

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Dental Probe Journal Vol 17 (4) 2017 3

Abstract :

Wound healing is a complex biological

process with cellular events leading to repair and

regeneration of damaged tissue. Platelets isolated

from the peripheral blood acts as autologous source of

growth factors enhancing the wound healing. Platelet

rich fibrin is widely used concentrate in dentistry and

hence conventional PRF technology protocol has

been modified to extend its therapeutic applications in

various clinical situations. Modified PRF includes

Advanced PRF, Injectable PRF, Titanium PRF etc.

Advancement in PRF technology has good

future prospects for its use in dentistry in various

aspects as a healing aid.

Keywords : Platelet rich fibrin, growth factors,

wound healing, modified PRF

Introduction :

Primary objective in process of wound healing was to

develop a concentrate that could enhance body’s

healing potential. This was achieved by addition of

growth factors derived from blood. Platelet rich

plasma was introduced which contained secondary

byproducts that were known inhibitors of wound

healing and hence by removing these anti-coagulants

and modifying centrifugation protocols Platelet Rich

Fibrin was introduced in field of medicine including

dentistry. PRF consist of fibrin matrix in which

platelet cytokines, growth factors and cells are

trapped which are released over a period of time. PRF [1] was first used in 2001 by Choukroun et al

specifically in Oral and Maxillofacial surgery and

currently considered as a new generation of platelet [2]

concentrate. It acts as a biodegradable scaffold that

favours the development of microvascularization and

and is able to guide epithelial cell migration to its [3,4]

surface . Later modifications to centrifugation

speed and time have additionally improved PRF into a

concept now known as the “ LOW SPEED

CENTRIFUGATION CONCEPT.”

Protocol :

It includes centrifugation of freshly drawn blood

without any anticoagulant in glass/ glass based

collection tubes which results into formation of three

distant layers ie RBC’s at bottom, PRF at the middle

and platelet poor plasma at the top. In this protocol

blood is subjected to centrifugation at 2700-3000 rpm

for 12 minutes approximately force of 400g after [5,6]collection of patients blood sample .

Principle :

The basic principle is to allow the blood to clot

physiologically. In the centrifuge, two processes are

occurring simultaneously i.e. blood coagulation and

separation of blood elements under centrifugation

Platelet Rich Fibrin Advancement in PRF Technology : A Review Article

Address for correspondences :Dr. Sanket V. ShindeDepartment of Periodontology Government Dental College, Nagpur, Maharashtra

1) DR. SANKET V. SHINDE

2) DR. VAIBHAV A. KAREMORE

3) DR. M. B. PHADNAIK

4) DR. MEGHNA NIGAM

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force directed towards bottom of the test tube,

buoyant and frictional forces opposing it. Net result

RBC’s with higher mass are pulled towards the

bottom of the tube and WBC’s and platelets along

with the plasma reach the top of the test tube. This

eventually leads the formation of PRF at the middle.

Which is then carefully retrived from the test tube and

can be formed into membranes or can be use in

combination with other graft materials.

Biology :

The cell responsible for biologic activity of

PRF is the platelet. They contain alpha granules,

dense granules and glycogen granules. Alpha

granules are the most important which contribute by

virtue of various growth factors which include

platelet derived growth factor(PDGF), Vascular

endothelial growth factor(VEGF), Insulin like growth [7,8]

factor-1(IGF-1), Epidermal growth factor (EGF) .

They reach the target cells, bind to transmembrane

receptors and activate various intracytoplasmic

proteins which leads to related gene expression and

leads to cell mitosis or collagen production.

Actions of PRF

• Angiogenesis

• Mitogenesis

• Immunomodulatory effects

• Wound recolonization

• Ostegenic effects

Advanced PRF

Leukocyte and PRF (L-PRF) is produced at

Speed of 2700 rpm for 12 minutes in sterile glass [12]based Plastic tube . For formation of A-PRF Slower

Platelet Rich

Fibrin

Electron microscopic image showing platelets with various granules

Drawing of blood followed by placement of test tube in centrifuge which is then centrifuged, the middle layer i.e. PRF is retrived

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speed (1500 rpm) and more time (14 mins) is used in

sterile plain glass based vaccum tubes. Such a

protocol leads to enhanced B and T lymphocyte

entrapment, more even distribution of platelets,

neutrophilis. It also has more number of viable cells

including platelets in A-PRF. There is better

deployment of resident monocyte, macrophages and [11]

lymphocytes . It would be beneficial as it would

translate into increased amount of growth factor and

cytokine release.

Advanced PRF +

It has been suggested by Fujioka-Kobayashi

and co-workers in 2016 with centrifugation time of

1300 rpm for 8 minutes. Lesser centrifugation time

with decrease amount of forces and hence would

increase the number cells contained in PRF matrix.

When both were compared L-PRF and A-PRF. A-PRF

+ demonstrated highest release of PDGF, TGF-β1,

EGF and IGF. In culture fibroblast exposed to A-

PRF+ revealed higher levels of PDGF, TGF-β and

collagen -1 at three and seven days measured in terms [13]of m-RNA expression .

Injectable PRF and Concentrated growth factors

Injectable PRF -

PRF in injectable form has been developed, [14]one of the latest technology . i-PRF is produced by

drawing blood without use of anti-coagulant in plastic

tubes without any coatings and centrifuged at 700 rpm [15]

for 3 minutes .

Concentrated growth factors -

Blood is centrifuged in non-coated test tubes

at 2400-2700 rpm for 2 minutes. The supernantant is

collected which is named as concentrated growth [16]factors .

Both of the above work on the same principle

and hence considered variants of same concentrate.

Plastic tubes have a hydrophobic surface and do not

efficiently activate the coagulation process. Hence all

the blood components that are required to form a good

concentrate reach the top of the test tube under force

in first 2-4 minutes. Separated plasma and platelets

form a yellow coloured layer which is situated at the

top of the test tube. This is then aspirated and amounts

TUBE

Glass coated

tube

Patented

Same as

A-PRF

Non-coated

MODIFICATIONS OF PRF

Sr No

1.

2.

3.

4.

PRF

Leucocyte and platelet

rich fibrin (L-PRF)[9].

Advanced platelet rich

fibrin (A-PRF)[10]

Advanced platelet rich

fibrin + (A-PRF) [10]

Injectable platelet rich

fibrin (I-PRF)[11]

PROPOSED BY

Choukroun 2004

Ghanaati 2014

Fujioka-kobayashi,

miron 2016

Mourao 2015

TIME

12

minutes

14

minutes

8

minutes

3

minutes

RPM

2700

1300

1300

700

Injectable Platelet Rich Fibrin

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to a partially active injectable form. Currently, it has

been used for mixing with bone grafts. This has a

potential to convert any osteoconductive graft to

osteopromotive, which will lead to better efficiency

of bone formation.

Applicatons:-

• Facelift surgeries

• Osteoarthritis

• Meniscal healing

Titanium PRF

Blood of the patient is centrifuged into two

grade IV titanium tubes, each of which has 10 ml of

blood which is then centrifuged at 2700 rpm for 12

minutes at room temperature. Titanium is supposed to

be more effective in activating platelets which results

in a more mature and aggregated form of PRF. The

fibrin carpet formed with titanium had firmer network

structure and longer resorption time in the tissue than

fibrin carpet formed with glass.

Titanium is resistant to corrosion. The inner

surface of the tube that contacts blood is made of

titanium which has a enlarged surface area through

sandblasting, laser which results in more mature and

aggregated PRF.

PRF Lysate:

It is new product of PRF . It Is Incubated at

37.c in humidified atmosphere of 5% CO2/95% air

and the exudates thus collected has been referred to as

PRF Lysate. It is a good source of growth factors. It

has been also used to reverse the damage caused by

chronic UV radiation exposure to dermal fibroblasts

by increasing the proliferation rates, migration rates

and collagen deposition equal to those of normal [17]fibroblasts .

Conclusion:

Studies have demonstrated safe and

promising results related to the use of PRF alone or in

combination with other biomaterials. Technological

advancement in field of PRF and its modifications has

paved way for its use in field of medicine and

dentistry with specific indications in different clinical

situations.

Only a perfect understanding of its

components and their significance will enable us to

comprehend the clinical results obtained and extend

its therapeutic application of this protocol.

References :

1] Choukroun J, Adda F, Schoeffler C and Vervelle A.

Une opportunite en paro- implantologie: le PRF.

Implantodontie 2000; 42:55-62.

2] Li Q, Pan S, Dangaria SJ, Gopinathan G,

Kolokythas A, Chu S, Geng Y, Zhou Y and Luan X.

Platelet rich fibrin promotes periodontal regeneration

and enhances alveolar bone augmentation. Biomed

Res Int 2013; 2013: 638043.

3] Choukroun J, Diss A, Simonpieri A, Girard MO,

Schoeffler C, Dohan AJ, Mouhyi J and Dohan SL,

Dohan AJ, Mouthyi J and Dohan DM. Platelet rich

fibrin (PRF): A second generation platelet

concentrate. Part IV : clinical effects of tissue healing. Titanium Tubes Used for T-TPF Preparation

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Oral surg Oral Med Oral Pathol Oral Radiol Endod

2006; 101:e56-60.

4] Dohan DM, Choukroun J, Diss A, Dohan SL,

Dohan AJ, Mouthyi J and Gogly B. Platelet rich

fibrin (PRF) A second generation platelet concentrate

Part III: Leucocyte activation : a new feature for

platelet concentrate ? Oral surg Oral Med Oral Pathol

Oral Radiol Endod 2006; 101:e51-55.


Dohan AJ, Mouthyi J et al. Platelet rich fibrin (PRF)

A second generation platelet concentrate Part I:

technological concepts and evolution. Oral surg Oral

Med Oral Pathol Oral Radiol Endod 2006; 101:e37-

44.



A second generation platelet concentrate Part II:

platelet-related biologic features. Oral surg Oral Med

Oral Pathol Oral Radiol Endod 2006; 101:e45-50.

7] Michelson AD. Platelets . 3rd ed. Amsterdam:

Academic press, 2013. Ch 17

8] Blair P, Flaumenhaft R. platelet α- granules: Basic

biology and clinical correlates. Blood reviews.

2009;23:177-89.

9]Choukroun J, Adda F, Schoeffler C, Vervelle A. Une

opportunite en paro-implantologie: Le PRF.

Implantodontie 2001;42:55-62.



A second generation platelet concentrate Part III:

leucocyte activation: a new feature for platelet

concentrates? Oral surg Oral Med Oral Pathol Oral

Radiol Endod 2006; 101:e51-55.

11] Ghanaati S, Booms P, Orlowska A, Kubesch A,

Lorenz J, Rutowski J,et al. Advanced platelet rich

fibrin : a new concept for cell based tissue engineering

by means of inflammatory cells. J Oral Implantol

2014; 40:679-89.

12] Ehrenfest DM, Kang B, Corso MD, Nally M,

Quiryen M, Wang HL et al. impact of centrifuge

characteristics and centrifugation protocols on the

cells, growth factors and fibrin architecture of a

leukocyte and L-PRF clot and membrane Part 1:

evalution of the vibration shocks of 4 models of table

centrifuges for L-PRF, Proseido 2014;2:129-39.

13] Fujioka-Kobayashi M, Miron RJ, Hernandez M,

Kandalam U, Zhang Y, Choukroun J. optimized

platelet rich fibrin with the low speed concept: growth

factor release, biocompatibility, and cellular

response. J Periodontal 2017Jan;88(1):112-121.

14] Mourao C, Valiense H, Melo E, Mourao N AND

Maia M. Obtention of Injectable platelet rich fibrin (i-

PRF) and its polymerization with bone Graft:

technical note. Revista do Colegio Brasileiro de

Cirurgioes 2015; 42:421-23.

15] Miron RJ, Fujioka-Kobayashi M, Hernandz M,

Kandalam U, Zhang Y, Ghanaati S, Choukroun J.

Injectable platelet rich fibrin (i-PRF): opportunities in

regenerative dentistry? Clin Oral Investig.2017 Feb

2. Doi:10.1007/s00784-017-2063-9.

16] Sohn DS, Huang B, Kim J, Park WE, Park CC.

Utilization of autologous concentrated growth factors

(CGF) enriched bone graft matrix (sticky bone) and

CGF enriched fibrin membrane in implant dentistry. J

Implant Advanced Clin Dent 2015;7:11-8.

17] He L, Lin Y, Hu X, Zhang Y, Wu H. A

Comparative Study of Palatelet Rich Fibrin (PRF)

and platelet rich plasma (PRP) on the effect of

proliferation and differentiation of rat osteoblast in

vitro. Oral surg Oral Med Oral Pathol Oral Radiol

Endod 2009; 108:707-713.

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Abstract -

Root canal treatment Failure is a common

problem in dentistry. The success of Repeat Root

canal treatment depends on many factors .These

includes presence of periradicular infection, broken

instrument, overfilling, underfilled canals ,missed

canals etc. Various clinical signs and radiographic

findings are indicative of Repeat root canal treatment.

The Knowledge, Attitude and Practice of Dentist

holds significant key in success of Repeat Root canal

treatment.

Aim- To evaluate the Knowledge, Attitude

and Practice of Dentist towards Repeat Root canal

treatment.

Materials and Methods- In present cross

sectional study self administered validated

questionnaire were used to analyze the Knowledge ,

Attitude and Practice of General Dentist towards

Repeat Root canal treatment.

Result- The results were obtained as

percentages after analyzing the collected information.

Average 1-5 cases of ReRCT reported to the clinic of

Dentists per month. According to the tooth type

majority of the RCT failure were noted in Mandibular

Molars (41.3%) followed by Maxillary Molars

(35.3%). Common reason for RCT failure was pain

(33.6%) and Underfilled canals (31.2%). Nonsurgical

Repeat Root Canal Treatment was preferred for more

than 50% Cases by Dentists(70.4%). H-File was used

by majority of Dentist (35.3%) for removal of Gutta

percha. Crown Down technique is used by majority of

dentists (48.9%) for cleaning and shaping of canal.

(82.3%) dentists prefer bypassing the fractured

instrument. Single cone technique used by majority of

dentists (37.7%) for obturation in ReRCT cases.

Conclusion - The study concluded that the

knowledge of Dentist towards Repeat Root canal

treatment is Fair, attitude is positive but practitoners

are still using conventional techniques like H-File,

singe cone technique and needs to incorporate new

techniques in practice.

Introduction-

Dr. Herbert Schilder stated that -

"Spec ia l ized Endodont ic Starts From

Retreatment’’

With the appropriate care , the teeth that had

endodontic treatment will last as long as other natural

teeth, however the teeth that had endodontic

treatment may fail to heal or pain may occur months

or years after treatment causing persistent infection.

The literature shows that many factors are considered

responsible for root canal treatment failure1. These

include incomplete debridement of infected or

necrotic pulp tissue, incomplete sealing of root canal

space, root fracture perforations, broken instrument,

1)

2) Dr. Jyoti Wankhade

3) Dr. Manjusha Warhadpande

Miss Vaishnavi S. Shewatkar

Address for correspondences :Miss Vaishnavi S. Shewatkar

and Hospital Nagpur Government Dental College

Knowledge, Attitude & Practice Of

Dentist towards Repeat Root Canal Treatment :A Cross sectional study

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1overfilling, missed or unfilled canal .

The endodontic Retreatment demand is

increased, because the observation of numerous cross

sectional studies showed that an increased percentage

of root filled teeth have an evidence of apical 2

periodontitis radiographically .On the basis of

various clinical sighns and symptoms Repeat root

canal treatment may be indicated1.

Root canal treatment is technically

demanding and it fails when treatment falls short of

acceptable standards. In an effort to provide patients

with most recent and predictable treatment planning,

clinicians must be well informed about outcome of

root canal treatment. It is important to acknowledge

that outcome of root canal treatment is dependent not

only on specific factors like root canal infection,

complexity of root canal morphology , but is also very

much influenced by less, more distinct causes such as

dentists knowledge and attitudes. These factors may

be even more important causes of failure of

endodontic therapy.

This study highlights the practice of Dentist

towards Repeat Root canal treatment, thus

emphasizing the fact that substantial measures must

be taken to improve the existing practice of dentistry

in terms of quality.

Materials & Methods-

The present study was a cross sectional study . After

taking approval from ethical committee study was

conducted on 180 Dentists in central India. This study

was of four months duration. Sample size was

calculated by using sample size calculation software.

Dentists who were willing to participate in study was

included and Dentists who were not willing to

participate in study was excluded from study .

After taking Consent from Dentist, Self

administered Validated questionnaire containing

eighteen close-ended questions and two-open ended

questions were distributed among 200 Postgraduate

Students, General Dental Practitioners and

Specialists and Diploma specialists. The Response

rate was 90 %.Each question was thoroughly

analyzed as percentages .

Statistical Analysis-

All the collected information from the study

subjects, regarding the Knowledge, Attitude and

Practice towards Repeat Root Canal treatment were

analyzed using computer software SPSS to get the

result as percentages.

In present study 180 postgraduates , general

dental practitioners ,specialists and diploma

specialists were included.

Operator Frequency Percentage

G.D.P. 96 53.2%

Specialists 58 32.4%

PG students 20 11.3%

Diploma Dentists 6 3%

Table 1: Participation of

practitioners according to qualification

Table 2: Percentagewise distribution of Factors

responsible for endodontic treatment failure.

Factors for endodontic failure Percetage(%)

Pain 34%

Underfilled obturation 31%

Missed canal 18%

Overfilling 12%

Fractured or Dislodged 5%

restoration.

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Observation and Results -

Graph 1: Percentagewise distribution of

endodontic failure according to tooth type.

Graph 2: Instrument or technique used for GP

removal.

Graph 3 : Percentagewise distribution of

technique used for cleaning and shaping in

ReRCT cases.

Graph 4: percentagewise distribution of technique

used for retrieval of fractured instrument.

Graph 5:Percentagewise distribution of type of

coronal restoration used in ReRCT cases.

Repeat Root canal treatment reported to clinic

per month to an individual Dentist was 1-5 cases

according to (70%) Dentists. Majority opinion is

Nonsurgical Repeat Root Canal Treatment (63%) in

Root Canal Treatment failure cases . More than

50%cases are treated Non surgically, 25-50% cases

by Extraction and less than 25% cases are treated

Surgically. Complete removal of Gutta Percha is the

major step in Retreatment

Various obturation techniques are used for

Repeat Root Canal treatment single cone technique

(37.7%)is used by majority of Dentists, cold lateral

compaction (32.4%) followed by warm vertical

compaction (29.9%)

The standard of Coronal Restoration has an

effect on periapical status of root filled teeth3, the

outcome of poor Root canal filling can be favourable ,

if the quality of coronal restoration is good1, various

post obturation coronal restoration techniques are

used.

Zinc oxide Eugenol (71.2%) is the most

commonly used interappointment medicament.

Discussion –

ReTreatment is required if previous Root

Canal Treatment has not been done upto acceptable 5

standards. The major factor for Repeat Root canal

...................... ............................................


removal of endodontic obturating material ,this

enables chemicomechanical reinstrumentation and

disinfection of root canal system, thus GP removal is

the crucial step in retreatment in which majority

Dentists are using H-Files(35%) .According to the

results of this study rotatry instruments is used by less

number of Dentists (15% )which is accordance with 6

the study of D.Jain , S.Taur(2013)

According to the results of this study Calcium

hydroxide is most commonly used intracanal

medicament (63.4%) which is in accordance with the

study of Vytaute Peciuliene, Rasmute Maneliene

(2009)

General dental practitioners refer cases to the

specialist in cases such as Instrument fracture,

Perforations, Accessory canal, Apicectomy

Retrograde filling, Post & core, ReRCT with third

molars , Unmanageable reduced mouth opening.

Conclusion-

The observation from present study

concluded that the knowledge of Dentist towards

Repeat Root canal treatment is Fair, attitude is

positive but practitioners are still using conventional

techniques like H-File, single cone technique and

needs to incorporate new techniques in practice. The

substantial steps must be taken to improve the

existing practice in terms of quality of endodontic

treatment. This study highlights the factors necessary

for success of Repeat Root Canal Treatment.

Recommendations-

1. Proper case selection should be done to increase the

success of the endodontic treatments.

2. Teeth with suspected complex anatomy should be

thoroughly evaluated by high quality preoperative

radiographs.

3. Teeth with such complex anatomy should be

referred to the endodontists.

treatment is the persistent microbial infection in the 1

root canal system and periradicular tissue .

Root canal treatment failure is much 1

dependent on the location of tooth in an arch . In this 1respect most of failures occur in posterior teeth , the

analysis of the data in terms of individual tooth

showed the majority of the endodontic treatment

failures occurred in Mandibular molars(41.3%)

followed by Maxillary Molars(35.1%) which is

contradictory to the Azhar Iqbal study conducted in 1Saudi Arabia(2016)

The overall widely recognized explanation

behind endodontic failure in multirooted teeth was

untreated or unfilled canals taking after the 1

underfillings of the root canal .The cause of

periradicular tissue irritation is the remaining necrotic

and infected pulp tissues in improperly instrumented 15

and incompletely filled canals .The results in our

study showed the most common reason for

Retreatment is Pain (33.6%) followed by Underfilled

Obturation (31.2%) which is in accordance with 1

Azhar iqbal study conducted in Saudi Arabia (2016)

& contradictory to the study of Iftikhar Akbar 5(2015)

Surgical Retreatment were carried out more

frequently on Anterior teeth when compared with

Molar and Premolar which is in accordance with 13study of Lazarski et al.(2001) , Salherabi &

8Rotstein(2004) .

According to the results of this study Sodium

Hypochlorite is the most commonly used irrigating

solution (68.3%) which is in accordance with study of 7

MS Clegg (2006) sowing Sodium Hypochlorite is the

most widely used endodontic irrigating solution

because of its bactericidal activity & ability to

dissolve vital and necrotic organic tissues.

Nonsurgical endodontic retreatment requires

access to the root canal system through the complete

...................... ............................................


References-

1. The Factors responsible for Endodontic

treatment failure in Permanent dentitions of the

patients reported to the college of Dentistry,university

of Aljouf, Kingdom of Saudi Arabia: Azhar -Iqbal -

IJCR(2016)

2. A prospective study of the factors affecting

outcome of Nonsurgical root canal treatment:Ng YL,

Mann V,Gulabivala K-Int. J.Endo (2001)

3. Periapical status and quality of root filling

materials and coronal restoration:Kirkevang

L,Orstavik D-Int. j.Endo. (2000)

4. Comparison of intermaxillary tooth size

discrepancies among different malocclusion group

:Nie Q, Lin J-Am J Orthod Dentofacial Orthop(1999)

5. A Radiographic study of the problem &

failures of endodontic treatment:Iftikhar Akbar-

International Journal of Health Science (2015)

6. Attitude of general dental practitioners

towards endodontic treatment procedures in India

;Deepak jain , S Taur (2013)

7. The effect of exposure to irrigating solutions

on apical dentin biofilms invitro;M.S.Clegg ,

F.G.Vertucci Int .j.Endo (2006).

8. Endodontic Treatment Outcomes in a Large

Patient Population in the USA :An Epidemiological

Study –Robert Salherabi , Ilan Rotstein :A.A.E.

Int.,J.Endo. (2004)

9. Attitudes of general dental practitioners

towards endodontic standards and adoption of new

technology:LiteratureReview-VytautePeciuliene,

Rasmute Maneliene: Stomatologija, Baltic Dental &

Maxillofacial Journal (2009)

10. Outcome of Secondary Root Canal Treatment

:a Systemic review of literature: Ng YL, Mann V,

GulabivalaK.-Int. J.Endo(2008)

11. Efficacy of Different Methods for Removing

Root Canal Filling Material in Retreatment :

SwethaKasam,AnnapoornaBallagereMariswamy-

IJCR(2016)

12. Outcomes of Root Canal Treatment in Dental

Practice-Based Research Network practices: Gregg

H. Gilbert, Ken R. Tilashalski, Mark S.Litaker,

Sandre F. McNeal, Michael j. Boykin, Allen W.

Kessler(2009)

13. Epidemological Evaluation of the Outcomes

of Nonsurgical Root Canal Treatment in a large cohort

of Insured Patients: M. P. Lazarski,Willam A Walker-

Int. J.Endo(2001)

14. Electronic apex locators: Gordon MPJ,

Chandler-Int.j.Endo (2004).

15. Factors affecting successful prognosis of

Root canal treatment : Matsumoto T ,Nagai T-Int. J.

Endo (1987)

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Abstract :

Increased prevalence of some infectious

diseases i.e. Hepatitis B, AIDS altered the public

opinion to infection control during dental service.

Impressions trays, casts and prosthesis are all of

potential sources of cross contamination to and from

patients, clinical personnals and dental technicians.

The purpose of this study was to evaluate the effect of

microwave disinfection on the hardness of heat cure

acrylic resin and self cure acrylic resin.

Materials and Methods

Samples were made of heat cure and self cure

acrylic resins. First the samples were subjected to

hardness test without the microwave disinfection and

then the same samples were subjected to microwave

disinfection which served as experimental group.

Rockwell hardness tester was used to check the

hardness of samples.

Result

The result showed that microwave

disinfection showed no significant changes in

hardness of heat cure and self cure acrylic resins.

Conclusion

Microwave disinfection can be used safely to

disinfect prosthesis made of heat cure and self cure

acrylic resin in clinical prosthodontic procedures.

To evaluate the effect of microwave disinfection on

the hardness of heat cure and self cure acrylic resin. An in-vitro study.

1) Dr. Neha Ahuja (Mahajana)

2) Dr. Anshul Mahajan

This study evaluated the effect of microwave

disinfection on the hardness of heat cure and self cure

acrylic resin. 15 Samples each of self cure and heat

cure acrylic resin without microwave disinfection

were used as a control group and the same samples

were microwave disinfected and were used as a

experimental group. 6 minute exposure at 650 W for

15 days to microwave was employed as disinfection

procedure. The samples were stored in distilled water

at 37 degree Celsius for 24 hours prior to disinfection.

There were no statistically significant differences in

the hardness of heat cure and self cure acrylic resin

after disinfection with microwave.

Introduction

Cross-contamination between patients and

dental personnel can occur not only through

contaminated dentures but also through polishing

agents and instrumentation.. Williams et al

demonstrated that denture laboratory pumice

continues to be a major reservoir for bacterial

contamination in prosthetic dentistry. A study by

Kahn et al demonstrated the transfer of oral flora from

a contaminated denture to a disinfected denture

through the polishing wheel and pumice. These

microorganisms can penetrate into the interior of

porous acrylic resin. Therefore, to reduce the chances

of cross-contamination, dentures should be

completely disinfected before being sent to the [1]laboratory and before insertion .

In choosing a disinfectant for dental

Address for correspondences :Dr. Neha Ahuja (Mahajan)

Dental Square, Multispeciality Dental ClinicNagpur

Private Practitioner,

...................... ............................................


prostheses, consideration should be given to its

compatibility with the type of material to be [2]

disinfected to avoid adverse effects . Ideally, the

physical and mechanical properties of denture base

resins and artificial denture teeth should remain

unaltered after the disinfection process. It has been [3-4] [5]

demonstrated that the hardness , flexural strength , [6]and colour stability of denture base resins can be

significantly affected by disinfectant solutions such

as glutaraldehyde, chlorhexidine, phenolic-based,

alcohol-based, and hypochlorite disinfectants.

Microwave irradiation has been suggested as

a simple and effective method for denture

disinfection, different regimens have been tested.

Microwave irradiation 6 min in water at 650 W,

performed on three hard chair side relining material

proved to be completely effective against potentially

pathogenic microorganisms such as staphylococcus

aureus, pseudomonas aeruginosa, bacillius subtilis [7]and candida albicans .

Therefore, this in vitro study has undertaken

to evaluate effect of microwave disinfection on

hardness of heat cure and self cure acrylic resins.

Materials and methods

Materials:

1. Heat cure acrylic resin (DPI)

2. Self cure acrylic resin (DPI)

3. Modelling wax(Link,MDM corporation, New

Delhi)

4. Type II gypsum product(Kalabhai Karson Pvt. Ltd,

Mumbai)

5. Cold mould seal(DPI,Dental materials, Mumbai)

Equipments:

1. Varsity pattern Dental flask and clamps

(Jabbar ,India)

2. Hydraulic press(Carlo de giorgi,GD;Italy)

3. Digital acrylizer

4. Incubator

5. Domestic microwave (LG company)

6. Rockwell Hardness Tester (AI RAS company,

available at DMCOE, Sawangi, Wardha)

Method

1. Preparation of heat cure acrylic resin sample:

Two piece metal mould was prepared of size

65mm in length, 20 mm in width,3mm thickness to

prepare wax samples. The mould was then packed

with acrylic dough of heat cure and processing of

acrylic resin sample using long curing cycle at 70

degree Celsius for 9 hrs using acrylizer to obtain

samples of heat cured acrylic resin. Samples so

retrieved were finished and polished. The samples

were stored in distilled water at 37 degree Celsius for

24 hours prior to disinfection.

2. Preparation of self cure acrylic resin sample :

Two piece metal mould was prepared of size

65mm in length, 20 mm in width,3mm thickness to

prepare wax samples. The mould was then packed

with acrylic dough of self cure. After room

polymerization samples were retrieved and finished

and polished. The samples were stored in distilled

water at 37 degree Celsius for 24 hours prior to

disinfection.

...................... ............................................


3. Grouping of sample :

Total 30 sample size was used. Samples were

divided in two groups. Control group A 30 samples

(15 Heat cure + 15 self cure acrylic resin) – not

subjected to any disinfection. Experimental group B

30 samples (15 Heat cure + 15 self cure acrylic resin)

– same subjected to microwave disinfection.

4. Disinfection and testing of the samples :

All samples of were subjected to Rockwell

hardness tester for evaluating hardness using 60-gf

load and were denoted as Rockwell hardness

number(RHN). Three indentations were made on

each sample and RHN was calculated for each sample

for all groups and then mean value for heat cure and

self cure acrylic resin was be calculated as control

group. These samples as per grouping were then

subjected to microwave disinfection for 6 min at 650

W daily for 15 days. After disinfection the hardness

will then be measured using Rockwell hardness tester

on 7th and 15th day .

Results :

...................... ............................................


...................... ............................................


Result of the study was not statistically

significant, there was no difference in the hardness of

samples before and after disinfection with

microwave.

Discussion

Dental prosthesis are usually fabricated in

acrylic resin. Self cure acrylic resin are used for

temporary purposes and heat cure acrylic resin are

used for permanent purposes. In days of cross-

infection it is mandatory for every person to perform

disinfection procedure for all the stages of denture

fabrication. This investigation evaluates the effect of

microwave disinfection on the hardness of heat cure

and self cure acrylic resin. Heat cure and self cure

acrylic resin (DPI) revealed non significant decrease

in hardness after disinfection with microwave.

Shen et al reported that the rigidity and surface

morphology of denture base resins were affected by

glutaraldehyde-based disinfectants (alkaline, phenol [8]buffered . It may be assumed that the sodium

hypochlorite solution may have penetrated into the 8tested materials and resulted in softening. Asad et al

reported that a significant decrease in hardness was

observed when heat-polymerized resin specimens

were immersed in 0.5% chlorhexidine gluconate

...................... ............................................


[3]solution for 7 days . Residual monomer content may

adversely affect the mechanical properties of denture

base resins owing to a plasticizing effect which

reduces the inter-chain forces so that deformation

occurs more easily under load during hardness tests.

Dixon et al evaluated the effect of 5 exposures to

microwave irradiation as a disinfection method for

dentures on the hardness of denture base materials.

The authors found that there were no significant

differences for the resilient lining material

(Molloplast-B; Detax, Ettlingen, Germany) (39.9

Shore A), and the denture base acrylic resin (Lucitone [9]

199) (98.4 Shore A) tested .

Rockwell Hardness Tester was used for 6 min

at 650W to check the hardness of heat cure and self

cure acrylic resin before and after disinfection with

microwave.The heat cure acrylic resin exhibited more

hardness than self cure in control group. Self cure

acrylic resin exhibited more loss of hardness as

compared to heat cure acrylic resin after disinfection

for 7 days. Microwave disinfection for 15 days, heat

cure acrylic resin exhibited marginal loss than self

cure where more loss of hardness is observed. Self

cure acrylic resin materials exhibited more reduction

in hardness as compared to heat cure acrylic resin

materials after microwave disinfection. However

this loss of hardness has negligible influence on the

functioning of the prosthesis. In spite of various

investigation there exists a need for further research to

elucidate, the efficacy of microwave disinfection of

the hardness of heat cure and self cure acrylic resins.

Conclusion

Control of cross-infection has been a subject

of interest to the dental area over the last few decades,

due to the concern about the transmission of

infectious-contagious diseases, such as AIDS,

hepatitis, tuberculosis, pneumonia, and herpes,

between the dental patients and dental personnel and

the dental office and dental prosthesis laboratory.

Dental practitioner has a legal and ethical

responsibility to prevent infections in patients and

staff members and an interest in protecting her-

himself from contracting a disease from a

patient. microwave disinfection is an effective, quick,

easy, and inexpensive versatile tool that can be

performed by dentists, assistants, technicians,

patients and/or their caregivers to inactivate

microorganisms. In addition, the use of a microwave

oven does not require special storage and does not

induce resistance for fungi or other microorganisms.

Thus this method may have an important potential use

in dental offices, dental laboratories, and institutions

and hospitals in which patients are treated, especially

those wearing removable dentures. Further studies

using different brands of acrylic resin should be

carried out to strengthen the research data.

References :

[1] Karin Hermana Neppelenbroek, DDS, MSc,a

Ana Cla´udia Pavarina, DDS, MSc, PhD,b. Carlos

Eduardo Vergani, DDS, MSc, PhD,c and Eunice

Teresinha Giampaolo, DDS, MSc, PhDd : Hardness

of heat-polymerized acrylic resins after disinfection

and long-term water immersion, Journal Of

Prosthetic Dentistry 2005;93:171-6.

[2] Smith DC. The cleansing of dentures. Dent

Pract Dent Rec 1966;17:39-43.

[3] Asad T, Watkinson AC, Huggett R. The

effects of various disinfectant solutions on the surface

hardness of an acrylic resin denture base material. Int

J Prosthodont 1993;6:9-12.

[4] Polyzois GL, Zissis AJ, Yannikakis SA. The

effect of glutaraldehyde and microwave disinfection

on some properties of acrylic denture resin. Int

JProsthodont 1995;8:150-4.

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[5] Asad T, Watkinson AC, Huggett R. The effect

of disinfection procedureson flexural properties of

denture base acryl ic res ins . J Pros thet

Dent1992;68:191-5.

[6] Ma T, Johnson GH, Gordon GE. Effects of

chemical disinfectants on thesurface characteristics

and color of denture resins. J Prosthet Dent

1997;77:197-204.

[7] Ana Lucia Machado, DDS, MSc, PhD; Larry

C. Breeding, MSc, DMD;and Aaron D. Puckett, PhD.

Effect of Microwave Disinfection Procedures on

Torsional Bond Strengths of Two Hard Chairside

Denture Reline Materials J Prosthodont 2006;15:337-

344.

[8] Shen C, Javid NS, Colaizzi FA. The effect of

glutaraldehyde base disinfectants on denture base

resins. J Prosthet Dent 1989;61:583-9.

[9] Dixon DL, Breeding LC, Faler TA:

Microwave disinfection of denture base materials

colonized with Candida albicans.J Prosthet Dent

1999;81:207-214

[10] Ana Lucia Machado, DDS, MSc, PhD,a Larry

C. Breeding, MSc, DMD,b and Aaron D. Puckett,

PhDc : Effect of microwave disinfection on the

hardness and adhesion of two resilient liners. Journal

Of Prosthetic Dentistry 2005;94:183-9.

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