naocl 6%, 20-40 minutes excellent and efficient ...naocl 6%, 20-40 minutes edta 3 minutes...

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John S. Olmsted, DDS MSFAGD, FICD, FACD, FPFA

Diplomate, American Board of EndodonticsPast President, American Association of Endodontists

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Hinman Dental MeetingAtlanta, Georgia

Friday, March 23, 2018 2:00-5:00PM

Biochemical Irrigation

NaOCl 6%, 20-40 minutes EDTA 3 minutes Chlorahexidine 2%; Q-mix Subsonics / Ultrasonics Slotted Needle / Endo Vac

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Abstract Full Text PDF Images References

Journal of EndodonticsVolume 38, Issue 1 , Pages 37-40, January 2012

Irrigation Trends among American Association of EndodontistsMembers: A Web-based Survey

Joseph Dutner, DMD , Pete Mines, DDS, Alfred Anderson, DDS

Rohde Dental Clinic, US Army Fort Bragg DENTAC, Fort Bragg, North Carolina

published online 22 September 2011.

Abstract IntroductionThe purpose of this study was to determine current trends in irrigation selection among endodontists.

MethodsAn invitation to participate in a web-based survey (QuestionPro) was e-mailed to 3844 members of the American Association ofEndodontists. Survey participants were asked between 10 and 14 questions based on their individual responses. Among otherquestions, participants were asked about their irrigant selection, irrigant concentration, smear layer removal, and use ofadjuncts to irrigation.

ResultsA total of 3707 survey invitations were successfully delivered by e-mail after accounting for several undeliverable e-mailinvitations. There were 1102 participants, with an overall completion rate of 28.5% (n = 1054). Our data indicate that >90% ofrespondents primarily use sodium hypochlorite, with 57% of them using it at a concentration >5.0%. Seventy-seven percent ofrespondents aim to remove the smear layer during endodontic treatment. At least 45% of respondents reported using anadjunct to irrigation.

ConclusionsMost of the respondents are using full-strength sodium hypochlorite and are routinely removing the smear layer duringendodontic treatment. In addition, almost half of the respondents are using an adjunct, such as ultrasonic activation, to aid intheir irrigation technique.

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Conclusions:Most of the respondents are using full-strength sodium hypochlorite and are routinely removing the smear layer during endodontic treatment. In addition, almost half of the respondents are using an adjunct, such as ultrasonic activation, to aid in their irrigation technique.

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Effect of Long-term Exposure to Endodontic DisinfectingSolutions on Young and Old Enterococcus faecalis Biofilms inDentin Canals

, , , , ,

Published Online: January 06, 2014

DOI: http://dx.doi.org/10.1016/j.joen.2013.11.026

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Abstract

IntroductionThe purpose of this study was to evaluate the antimicrobial activity on Enterococcus faecalis biofilms in dentin canals ofshort-term and long-term exposure to different endodontic disinfecting solutions by using a dentin infection model andconfocal laser scanning microscopy.

MethodsDentinal tubules in semi-cylindrical dentin blocks were filled with E. faecalis by centrifugation and incubated to form 1-day-old and 3-week-old biofilms. The young and mature biofilms in dentin were subjected to sterile water, 2%chlorhexidine, 2% sodium hypochlorite (NaOCl), and 6% NaOCl for 3, 10, and 30 minutes. After treatments, theproportion of bacteria killed by the disinfectants was analyzed by confocal laser scanning microscopy by usingLIVE/DEAD bacterial viability stain.

ResultsThe proportion of killed bacteria was lower after 3 minutes than after 10 and 30 minutes of exposure to the disinfectingagents (P < .05). The killing of bacteria in the E. faecalis biofilms was fastest during the first 3 minutes and slowed downgreatly after 10 minutes. Six percent NaOCl was the most effective antibacterial solution against both the 1-day-old and3-week-old biofilms (P < .05). No significant difference in bacterial killing was detected between 2% chlorhexidine and2% NaOCl (P > .05). Significantly more cells were killed in young biofilms than in old biofilms in all groups (P < .05).

ConclusionsThe killing of bacteria in infected dentin by disinfecting solutions is time-dependent. However, little additional killing isobtained after the first 10 minutes of exposure.

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Journal of EndodonticsVolume 40, Issue 4, Pages 509–514, April 2014

< Previous Article Next Article >

Tianfeng Du, DDS Zhejun Wang, DDS, PhD Ya Shen, DDS, PhD Jingzhi Ma, DDS, PhD Yingguang Cao, DDS, PhD MarkusHaapasalo, DDS, PhD

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Conclusions The killing of bacteria in infected dentin by disinfecting solutions is time-dependent. However, little additional killing is obtained after the first 10 minutes of exposure.

Sodium Hypochlorite

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The Effect of 8.25% Sodium Hypochlorite on Dental PulpDissolution and Dentin Flexural Strength and Modulus

, , ,Wilford Hall Department of Endodontics, Joint Base San Antonio-Lackland, Texas and Keesler Medical Center Department ofEndodontics, Keesler Air Force Base, Biloxi, MississippiPublished Online: March 17, 2015

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Highlights• We evaluate the effect of sodium hypochlorite on pulp dissolution.• We test the effect of sodium hypochlorite on dentin flexural strength and modulus.• Dilution of sodium hypochlorite decreases its pulp dissolution capacity.• Sodium hypochlorite had no significant effect on dentin flexural strength or modulus.

Abstract

IntroductionThe purpose of this study was to evaluate the effect of various concentrations of sodium hypochlorite (NaOCl), including8.25%, on dental pulp dissolution and dentin flexural strength and modulus.

MethodsSixty dental pulp samples and 55 plane parallel dentin bars were retrieved from extracted human teeth. Five test groups(n = 10) were formed consisting of a pulp sample and dentin bar immersed in various NaOCl solutions. The negativecontrol group (n = 5) consisted of pulp samples and dentin bars immersed in saline. The positive control group (n = 5)consisted of pulp samples immersed in 8.25% NaOCl without a dentin bar. Every 6 minutes for 1 hour, the solutionswere refreshed. The dentin bars were tested for flexural strength and modulus with a 3-point bend test. The time untiltotal pulp dissolution and any changes in dentin bar flexural strength and modulus for the different NaOCl solutionswere statistically analyzed.

ResultsAn increase in NaOCl concentration showed a highly significant decrease in pulp dissolution time. The pulp dissolutionproperty of 8.25% NaOCl was significantly faster than any other tested concentration of NaOCl. The presence of dentindid not have a significant effect on the dissolution capacity of NaOCl if the solutions were refreshed. NaOCl

concentration did not have a statistically significant effect on dentin flexural strength or modulus.

ConclusionsDilution of NaOCl decreases its pulp dissolution capacity. Refreshing the solution is essential to counteract the effectsof dentin. In this study, NaOCl did not have a significant effect on dentin flexural strength or modulus.

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June 2015Volume 41, Issue 6, Pages 920–924< Previous Article Next Article >

James K.T. Cullen, DMD James A. Wealleans, DMD Timothy C. Kirkpatrick, DDS John M. Yaccino, DDS


Clinical Outcomes for TeethTreated with ElectrospunPoly(ε-caprolactone) FiberMeshes/Mineral TrioxideAggregate Direct PulpCappingJournal of Endodontics, Vol. 41,Issue 5

Outcome of Direct PulpCapping with MineralTrioxide Aggregate: AProspective StudyPublication stage: In PressCorrected ProofJournal of Endodontics

Tomographic Evaluation ofReparative DentinFormation after Direct PulpCapping with Ca(OH) ,MTA, Biodentine, andDentin Bonding System inHuman TeethPublication stage: In PressCorrected Proof

Journal of Endodontics

2

A First Step in De NovoSynthesis of a Living PulpTissue Replacement UsingDental Pulp MSCs andTissue Growth Factors,Encapsulated within aBioinspired


Conclusions

Dilution of NaOCl decreases its pulp dissolution capacity. Refreshing the solution is essential to counteract the effects of dentin. In this study, NaOCl did not have a significant effect on dentin flexural strength or modulus.

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Influence of Final Rinse Technique on Ability ofEthylenediaminetetraacetic Acid of Removing SmearLayer

Isabel Mello, DDS, MSc, PhD∗ , Brigitte Alvarado Kammerer, DDS†,Daiana Yoshimoto, DDS†, Mary Caroline Skelton Macedo, DDS, MSc,PhD‡, João Humberto Antoniazzi, DDS, PhD§

published online 25 January 2010.

Abstract

Introduction

There is ongoing debate regarding the ideal sequence, volume, andconcentration of irrigants, length of time for irrigation, and irrigationtechnique to achieve debridement of the root canal system. The aim ofthis study was to verify the impact of the final rinse technique onsmear layer removal ability of 17% ethylenediaminetetraacetic acid(EDTA).

Methods

Sixteen single-rooted human teeth were instrumented and divided into2 groups at the final rinse step according to the following final rinsetechniques used: continuous rinse group, continuous rinse with EDTAduring 3 minutes, and rinse and soaking group, rinse with 1 mL ofEDTA, soaking of the canal for 2 minutes and 30 seconds, and rinsecompletion with the remaining 4 mL for 30 seconds. The specimenswere split lengthwise and observed under scanning electronmicroscope.

Results

Data were analyzed with Kruskal-Wallis and Dunn tests. Thecontinuous rinse group presented more debris-free surfaces whencompared with the rinse and soaking group (P < .01). When the rootcanal areas were compared within the groups, no statistical differenceswere found (P > .05).

Conclusions

Results: Data were analyzed with Kruskal-Wallis and Dunn tests. The continuous rinse group presented more debris-free surfaces when compared with the rinse and soaking group (P< .01). When the root canal areas were compared within the groups, no statistical differences were found (P> .05).Conclusions: It can be concluded that a continuous rinse with 5 ml of EDTA for 3 minutes can more efficiently remove the smear layer from root canal walls.

EDTA

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Effect of Smear Layer against Disinfection Protocolson Enterococcus faecalis–infected Dentin

, ,

Published Online: September 03, 2013



Abstract

IntroductionThis study examined the effect of the smear layer on the antibacterial effect of different disinfecting solutions in infecteddentinal tubules.

MethodsCells of Enterococcus faecalis were forced into dentinal tubules according to a previously established protocol. After a3-week incubation period of infected dentin blocks, a uniform smear layer was produced. Forty infected dentinspecimens were prepared and subjected to 3 and 10 minutes of exposure to disinfecting solutions including sterilewater, 2% and 6% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 17% EDTA, and QMiX (Dentsply TulsaDental, Tulsa, OK). The following combinations were also included: 2% NaOCl + 2% CHX, 2% NaOCl + QMiX, 6%NaOCl + QMiX, and 6% NaOCl + 17% EDTA + 2% CHX. Four other dentin specimens similarly infected but with nosmear layer were subjected to 3 minutes of exposure to 2% CHX and 6% NaOCl for comparison. Confocal laserscanning microscopy and viability staining were used to analyze the proportions of dead and live bacteria inside thedentin.

ResultsIn the presence of a smear layer, 10 minutes of exposure to QMiX, 2% NaOCl + QMiX, 6% NaOCl + QMiX, and 6%NaOCl + 17% EDTA + 2% CHX resulted in significantly more dead bacteria than 3 minutes of exposure to these samedisinfecting solutions (P < .05). No statistically significant difference between 3 and 10 minutes was found in othergroups (P > .05); 6% NaOCl + QMiX and 6% NaOCl + 17% EDTA + 2% CHX showed the strongest antibacterial effect.In the absence of a smear layer, 2% CHX and 6% NaOCl killed significantly more bacteria than they did in the presenceof a smear layer (P < .05).

ConclusionsThe smear layer reduces the effectiveness of disinfecting agents against E. faecalis in infected dentin. Solutionscontaining 6% NaOCl and/or QMiX showed the highest antibacterial activity.

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Journal of EndodonticsVolume 39, Issue 11, Pages 1395–1400, November 2013


Zhejun Wang, DDS, PhD Ya Shen, DDS, PhD Markus Haapasalo, DDS, PhD



Conclusions The smear layer reduces the effectiveness of disinfecting agents against E. faecalis in infected dentin. Solutions containing 6% NaOCl and/or QMiX showed the highest antibacterial activity.

RESEARCH Open Access

Smear layer and debris removal fromdentinal tubules using different irrigationprotocols: scanning electron microscopicevaluation, an in vitro studyHsin-Hui Wang1,2, Daniel Sanabria-Liviac3, Philippe Sleiman4, Samuel O. Dorn1 and David E. Jaramillo1*

Abstract

Background: This study investigated the ability of different irrigation protocols to keep dentinal tubules (DT) openand avoid their blockage by the smear layer (SL) during the cleaning and shaping procedure (CSP).

Methods: Twenty-five extracted teeth were divided into five groups (n = 5): group 1, NaOCl was kept in the canalduring instrumentation and then washed out with distilled water, and the canal was irrigated with NaOCl withEndoVac in between files; group 2, the same procedure as group 1, but NaOCl was replaced by EDTA; group 3, EDTAwas kept in the canal during instrumentation and then washed out with distilled water, and the canal was irrigatedwith NaOCl with EndoVac in between files; group 4, the same as group 3, but NaOCl and EDTA were alternated; andgroup 5 (control), the procedure was the same with group 1, but NaOCl was replaced by distilled water. A scanningelectron microscope was used to evaluate the cleanliness of DT at three different levels of the canals.

Results: Groups 3 and 4 showed better ability to keep DT open during CSP than the other groups. Group 4 onlyshowed statistically significant better results than group 3 at middle third (P < 0.0001).

Conclusions: Alternating the use of NaOCl and EDTA with water in between can keep DT open better and avoid theirblockage by SL during CSP compared with the use of NaOCl or EDTA alone.

Keywords: Smear layer, Dentinal tubules, Root canal irrigation

BackgroundThe present procedures to disinfect the root canal systemare primarily by means of chemo-mechanical preparation.However, only 60 to 80% or less of canal outlines can beprepared circumferentially by instrumentation (Peters2004). Thus, the disinfection of the remaining untouchedarea has to rely on chemical irrigation or intracanal medica-tions. More importantly, mechanical preparation leads tothe formation of the smear layer (SL) (McComb and Smith1975; Moodnik et al. 1976; Mader et al. 1984; Torabinejadet al. 2002; Zehnder 2006), which can only be efficientlyremoved by alternating the use of EDTA and NaOCl(Goldman et al. 1982; Baumgartner and Mader 1987).

It has been shown that irrigation with 17% EDTA has aneffect on cleaning canal walls (McComb and Smith 1975;Goldman et al. 1982; Baumgartner and Mader 1987).Moreover, both the cleaning and antimicrobial actions aremore appreciable when EDTA and NaOCl are used incombination rather than being used alone (Baumgartnerand Mader 1987; Byström and Sundqvist 1985). It is mostlyrecommended that 17% EDTA should be applied aftercleaning and shaping procedure (CSP) in order to removethe SL before root canal obturation (Baumgartner andMader 1987). Nevertheless, no definitive irrigation regimenhas been built so far.Alternating the use of EDTA and NaOCl from the begin-

ning of the CSP has been suggested (De-Deus et al. 2011).Smear layer will become infected and it should be removed.Accordingly, the early use of EDTA may be a prerequisiteto establish a protocol for irrigation. In addition, the use of

* Correspondence: [email protected] of Endodontics, The University of Texas at Houston School ofDentistry, 7500 Cambridge St., Suite 6417, Houston, TX 77054, USAFull list of author information is available at the end of the article

Evidence-Based Endodontics

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made.

Wang et al. Evidence-Based Endodontics (2017) 2:5 DOI 10.1186/s41121-017-0011-4

Conclusions: Alternating the use of NaOCl and EDTA with water in between can keep DT open better and avoid their blockage by SL during CSP compared with the use of NaOCl or EDTA alone.

10/10/13 9:10 PMInteractions between Irrigants Commonly Used in Endodontic Practice: A Chemical Analysis

Page 1 of 4http://www.jendodon.com/article/S0099-2399(12)01127-2/abstract

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Journal of EndodonticsVolume 39, Issue 4 , Pages 505-510, April 2013

Interactions between Irrigants Commonly Used in EndodonticPractice: A Chemical AnalysisMaíra Prado, DDS, MSc, Helvécio M. Santos Júnior, DSc, MSc, PhD, Claudia M. Rezende, DSc, MSc, PhD, Angelo C. Pinto, DSc, MSc, PhD,Roberto B. Faria, DSc, MSc, PhD, Renata A. Simão, DSc, MSc, PhD, Brenda P.F.A. Gomes, DDS, MSc, PhD


Abstract IntroductionThe aim of this work was to characterize the by-products formed in the associations between the most commonly used irrigantsin endodontic practice through electrospray ionization quadrupole time-of-flight mass spectrometry analyses.

MethodsSodium hypochlorite (NaOCl) (0.16%, 1%, 2.5%, and 5.25%) was associated with 2% chlorhexidine (CHX) solution and gel,17% EDTA, 10% citric acid, 37% phosphoric acid, saline solution, ethanol, and distilled water. CHX solution and gel were alsoassociated with all above mentioned irrigants. The solutions were mixed in a 1:1 ratio, and electrospray ionization quadrupoletime-of-flight mass spectrometry was used to characterize the precipitates when formed.

ResultsCHX produced an orange-brown precipitate when associated with NaOCl from 1%–5.25% and an orange-white precipitatewhen associated with 0.16% NaOCl. When associated with EDTA, CHX produced a white milky precipitate, and whenassociated with saline solution and ethanol, a salt precipitation was produced. No precipitation was observed when CHX wasassociated with citric acid, phosphoric acid, or distilled water. In the NaOCl associations, precipitation occurred only when CHXwas present.

ConclusionThe orange-brown precipitate observed in the association between CHX and NaOCl occurs because of the presence of NaOCl,an oxidizing agent causing chlorination of the guanidino nitrogens of the CHX. The precipitates formed in the reaction of CHXwith EDTA, saline solution, and ethanol were associated with acid-base reactions, salting-out process, and lower solubility,respectively. NaOCl associated with EDTA, citric acid, and phosphoric acid leads mainly to chlorine gas formation. Intermediate

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Welcome, Dr. John Olmsted Claim

Results: CHX produced an orange-brown precipitate when associated with NaOCl from 1%–5.25% and an orange-white precipitate when associated with 0.16% NaOCl. When associated with EDTA, CHX produced a white milky precipitate, and when associated with saline solution and ethanol, a salt precipitation was produced. No precipitation was observed when CHX was associated with citric acid, phosphoric acid, or distilled water. In the NaOCl associations, precipitation occurred only when CHX was present. Conclusion: The orange-brown precipitate observed in the association between CHX and NaOCl occurs because of the presence of NaOCl, an oxidizing agent causing chlorination of the guanidino nitrogens of the CHX. The precipitates formed in the reaction of CHX with EDTA, saline solution, and ethanol were associated with acid-base reactions, salting-out process, and lower solubility, respectively. NaOCl associated with EDTA, citric acid, and phosphoric acid leads mainly to chlorine gas formation. Intermediate flushes with distilled water seem to be appropriate to prevent or at least reduce formation of by-products.

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Apical Extrusion of Sodium Hypochlorite Using DifferentRoot Canal Irrigation Systems

, ,

Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon

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AbstractIntroductionRoot canal irrigation carries a risk of extrusion of irrigant into the periapical tissues. The objective of this studywas to compare different irrigation systems in matched pairs of teeth prepared to an apical size of 35.06 and50.06 by measuring the frequency and extent of apical extrusion of sodium hypochlorite (NaOCl) into asimulated periapical environment. The null hypothesis was tested that there is no difference between systems.

MethodsBilaterally matched pairs (n = 10) of single-canal extracted human anterior teeth were instrumented to an apicalsize of either 35.06 or 50.06. Teeth were embedded in a gel containing the pH-sensitive dye M-cresol purplethat changes from yellow at pH 7.4 to purple at pH 9. Root canals were irrigated with 6% NaOCl (pH 11)by using EndoActivator (EA), EndoVac (EV), Rispi-Sonic/MicroMega 1500 (MM), passive ultrasonic irrigation(PUI), and syringe irrigation with a slot-tipped needle (SN), so that each tooth underwent all irrigationprocedures in a randomized crossover design. Apical extrusion was evaluated by image analyses.

ResultsThe frequency of extrusion was less in teeth with apical preparation size 35.06 (36%) compared with 50.06(60%) (P = .014) and was dependent on the irrigation system in 35.06 (P = .039) but not 50.06 groups. In the35.06 group the frequency of extrusion was less for EV than for MM and SN (both P = .029). The extent ofextrusion was less for MM compared with PUI (P = .024) and SN (P = .046) in the 35.06 group and greater forSN compared with all other systems in the 50.06 group (P < .05). The null hypothesis was rejected.

ConclusionsThe frequency of apical extrusion of NaOCl was dependent on the type of root canal irrigation system andapical preparation size. The extent of extrusion depended on the irrigation system, with syringe and slotted-needle irrigation resulting in the greatest extent of extrusion.

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December 2011 Volume 37, Issue 12, Pages 1677–1681< Previous Article Next Article >

Ross P. Mitchell, BS, DMD J. Craig Baumgartner, DDS, PhD Christine M. Sedgley, MDS, MDSc, PhD


Assessment of Apical Extrusionduring Root Canal Irrigation with theNovel GentleWave Systemin a Simulated Apical EnvironmentJournal of Endodontics, Vol. 42, Issue 1

Evaluation of 4 Different IrrigatingSystems for Apical Extrusion ofSodium HypochloriteJournal of Endodontics, Vol. 41, Issue 9

A Comparison of Apical BacterialExtrusion in Manual, ProTaper Rotary,and One Shape RotaryInstrumentation TechniquesJournal of Endodontics, Vol. 41, Issue 12

The Prognosis of Altered Sensationafter Extrusion of Root Canal FillingMaterials: A Systematic Review of theLiteratureJournal of Endodontics, Vol. 42, Issue 6

Apical Extrusion of Debris in Flat-ovalRoot Canals after Using DifferentInstrumentation SystemsJournal of Endodontics, Vol. 41, Issue 2

Conclusions The frequency of apical extrusion of NaOCl was dependent on the type of root canal irrigation system and apical preparation size. The extent of extrusion depended on the irrigation system, with syringe and slotted-needle irrigation resulting in the greatest extent of extrusion.

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In Vivo Efficacy of Three Different Endodontic Irrigation Systemsfor Irrigant Delivery to Working Length of Mesial Canals ofMandibular Molars

Hugo Roberto Munoz, DDS, MA , Karla Camacho-Cuadra, DDS

Postgraduate Endodontic Department, School of Dentistry, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala


Abstract IntroductionMany in vitro studies have debated over the ability of different irrigant delivery and/or agitation systems to reach the apical thirdof curved root canals; however, little is known about irrigant penetration in vivo. Therefore, the purpose of this study was tocompare the efficacy of the conventional endodontic irrigation needle, passive ultrasonic irrigation (PUI), and a negativepressure system for irrigant delivery to working length (WL) of mesial canals of mandibular molars.

MethodsThirty mesial canals of 30 vital mandibular first or second molars were randomly assigned into 3 groups (n = 10): (1) Monojectsyringe with 27-gauge needle; (2) PUI with IrriSafe tip; and (3) EndoVac system. All canals were treated following the samepreparation protocol to size 35/0.04 by using 5.25% NaOCl as irrigant during preparation procedure. Before obturation, canalswere irrigated with 1 mL of a radiopaque solution by using the assigned irrigation system, and a digital radiograph was taken byusing a parallel technique. With the aid of image editing software the distance between WL and maximum irrigant penetrationwas measured.

ResultsMean distances for Monoject, PUI, and EndoVac groups were 1.51 mm, 0.21 mm, and 0.42 mm, respectively. Analysis ofvariance test showed statistically significant differences between groups (P < .001). Tukey honestly significant difference testshowed statistically significant differences between the Monoject group and the other 2 groups (P < .001) but no significantdifferences between PUI and EndoVac groups (P = .06).

ConclusionsPUI and EndoVac are more effective than the conventional endodontic needle in delivering irrigant to WL of root canals.


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Conclusions:PUI and EndoVac are more effective than the conventional endodontic needle in delivering irrigant to WL of root canals.

Ultrasonics

10/10/13 12:43 PMEffects of Piezoelectric Units on Pacemaker Function: An In Vitro Study


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Journal of EndodonticsVolume 39, Issue 10 , Pages 1296-1299, October 2013

Effects of Piezoelectric Units on Pacemaker Function: An In VitroStudyGonzalo Gomez, DDS, MSc, Fernando Jara, PhD, Baltasar Sánchez, PhD, Miguel Roig, DDS, PhD, Fernando Duran-Sindreu, DDS, PhD

Abstract IntroductionThe use of piezoelectric units on patients with pacemakers is generally discouraged, although there is no empirical evidence ofthe effects of current piezoelectric units on pacemaker activity in vitro.

MethodsFour piezoelectric units (Piezosurgery3, Piezotome, Piezotome2, and Variosurg) and 2 magnetostriction units (Piezotome andPiezotome2) were tested for electromagnetic interference (EMI) with the SENSIA SESR01 pacemaker from Medtronic. Thepacemaker, with a single electrode, was immersed in a saline-solution bath and adjusted between 400 and 800 ohms tosimulate the electrical resistance of the human body and to register and to produce electrographic recordings. The pacemakerwas tested with each ultrasonic device to analyze the presence of EMI at different distances, with the ultrasound switched on,switched off, and during operation. If any of the devices produced interference, the characteristics of the interference werecategorized.

ResultsIn the positive control (direct contact between either the electrode or the generator and the ultrasound device when this wasswitched on), the pacemaker detected electrical activity as false heart activity. When all the scenarios and distances had beencovered, no EMI was produced by the ultrasound units.

ConclusionsNo EMI was detected during the testing of the piezoelectric or magnetostriction units in this in vitro model of pacemaker use.

Key Words: Electromagnetic interference, implanted cardiac pacemakers, piezoelectric unit, ultrasound unit


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Results: In the positive control (direct contact between either the electrode or the generator and the ultrasound device when this was switched on), the pacemaker detected electrical activity as false heart activity. When all the scenarios and distances had been covered, no EMI was produced by the ultrasound units. Conclusions: No EMI was detected during the testing of the piezoelectric or magnetostriction units in this in vitro model of pacemaker use.

10/10/13 2:41 PMPotential Correlation between Statins and Pulp Chamber Calcification


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Journal of EndodonticsVolume 39, Issue 9 , Pages 1119-1123, September 2013

Potential Correlation between Statins and Pulp ChamberCalcificationMary T. Pettiette, DDS , Sheng Zhong, DDS, MS, Antonio J. Moretti, DDS, MS, Asma A. Khan, DDS, PhD

Abstract Introduction3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are the first-line pharmaceuticals for the prevention andtreatment of dyslipidemia. A recent investigation has shown that statins induced odontoblastic differentiation of dental pulp stemcells. Statins enhance the differentiation of human dental pulp cells by up-regulating mineralization nodules and odontogenicmarkers. This study tested the hypothesis that the systemic administration of statins results in increased dental pulpcalcification.

MethodsThis retrospective case-control study used digital bitewing radiographs of mandibular molars. Subjects (N = 90) aged ≥60 yearswere assigned to either test (n = 45) or control (n = 45) groups based on the systemic use of statins. The dimensions of the pulpchambers were measured using a standardized method for height and mesiodistal distances. The chi-square test was used toanalyze the data. Multiple linear regression model analysis was performed to explore the association between statin intake andpulp calcification.

ResultsThree of the 45 mandibular molars in the test group exhibited almost complete pulp chamber obliteration. There was asignificant reduction in pulp chamber height ratio shown in the statin group compared with the control group (P < .0001). Whenthe mesiodistal width was compared between the 2 groups, there was no significant difference (P = .3730).

ConclusionsThe significant increase of calcification and loss of vertical height of the pulp chamber observed in mandibular molars inpatients on statin medication indicated a possible increased odontoblastic activity. Therefore, systemic statins could be acontributing factor for pulp chamber calcification.


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Results: Three of the 45 mandibular molars in the test group exhibited almost complete pulp chamber obliteration. There was a significant reduction in pulp chamber height ratio shown in the statin group compared with the control group (P < .0001). When the mesiodistal width was compared between the 2 groups, there was no significant difference (P = .3730). Conclusions: The significant increase of calcification and loss of vertical height of the pulp chamber observed in mandibular molars in patients on statin medication indicated a possible increased odontoblastic activity. Therefore, systemic statins could be a contributing factor for pulp chamber calcification.

10/10/13 3:11 PMA Comparison of the Dentin Cutting Efficiency of 4 Pointed Ultrasonic Tips


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Journal of EndodonticsVolume 39, Issue 7 , Pages 897-900, July 2013

A Comparison of the Dentin Cutting Efficiency of 4 PointedUltrasonic TipsMatthew P. Godfrey, DDS , James C. Kulild, DDS, MS, Mary P. Walker, DDS, PhD

University of Missouri-Kansas City, School of Dentistry, Kansas City, Missouri

published online 16 May 2013.

Abstract IntroductionPointed ultrasonic tips can be used for several applications including troughing around intracanal obstructions. With the varietyof pointed ultrasonic tips available, the purpose of this in vitro investigation was to compare the dentin cutting efficiency of 4commonly used pointed ultrasonic tips.

MethodsThe ultrasonic tips (n = 5 tips/group) included in the study were the following: CPR-3D (Obtura Spartan, Algonquin, IL), BL 6A(B&L Biotech, Bala Cynwyd, PA), PUENDO2 (Dentsply Tulsa Dental Specialties, Tulsa, OK), and WH1 (eie2, San Diego, CA).The tips were attached to a testing apparatus that produced linear movement and a 15-g axial force during instrumentation of ahuman dentin specimen. For all tips, instrumentation was completed at the same power setting, which fell within the powersetting range recommended by each manufacturer. Dentin specimens were weighed at baseline and after 6 minutes ofinstrumentation to measure dentin loss to the nearest 0.01 mg. A qualitative analysis of the shape and surface topography ofnew and used ultrasonic tips was performed via scanning electron microscopy.

ResultsA 1-factor analysis of variance and Tukey post hoc analysis of dentin removal revealed a statistically significant differencebetween the 4 ultrasonic tips (P < .05). The CPR-3D removed more dentin than the other 3 tips, whereas the BL 6A removedmore dentin than the WH1. Scanning electron microscopic analysis revealed the CPR-3D as having the least change to tipshape and topography as compared with the other tips.

ConclusionsWithin the limits of this study, CPR-3D showed the greatest dentin removal, which may be linked to the stability of the CPR-3Dtip shape and topography.


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Text

Results: A 1-factor analysis of variance and Tukey post hoc analysis of dentin removal revealed a statistically significant difference between the 4 ultrasonic tips (P < .05). The CPR-3D removed more dentin than the other 3 tips, whereas the BL 6A removed more dentin than the WH1. Scanning electron microscopic analysis revealed the CPR-3D as having the least change to tip shape and topography as compared with the other tips. Conclusions:

Within the limits of this study, CPR-3D showed the greatest dentin removal, which may be linked to the stability of the CPR-3D tip shape and topography.

10/10/13 12:45 PMComparison of the Time Required to Create Secondary Fr…ng Ultrasonic Vibration under Various Canal Conditions


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Journal of EndodonticsVolume 39, Issue 10 , Pages 1300-1305, October 2013

Comparison of the Time Required to Create Secondary Fractureof Separated File Fragments by Using Ultrasonic Vibration underVarious Canal ConditionsYoshitsugu Terauchi, DDS, PhD , Le O'Leary, DDS, Takatomo Yoshioka, DDS, PhD, Hideaki Suda, DDS, PhD

Abstract IntroductionNickel-titanium files often separate because of mechanical fatigue. The purpose of this study was to determine safe preparationtechniques for separated file removal by using ultrasonics.

MethodsFifty nickel-titanium file fragments were divided into 5 groups. An ultrasonic tip was activated on a file fragment positionedbetween dentin blocks simulating several canal conditions: Group 1 consisted of the fragment protruding from a pair of straightdentin blocks. For group 2, the fragment was also positioned between 2 straight dentin blocks except one block was positioned1 mm more apically than the other block, simulating a troughed area that is often created during file removal attempts. Forgroups 3–5, the fragment was positioned similarly as group 2 but between blocks with 30°, 45°, and 60° curvatures,respectively. The time it took for secondary fracture to occur was recorded, and the data were statistically analyzed.

ResultsFragments with dentin wall supporting on the opposite side of ultrasonic activation site resisted fracture significantly longer thanthose without it. Fragments in 30° and 45° curved blocks took significantly longer to fracture than the other groups (Fisherprotected least significant difference, P < .05).

ConclusionsSecondary fracture of separated files appeared to be reduced when the ultrasonic tip was applied to the inner curvature of the


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Positive Pressure Irrigation Apical Negative Pressure Irrigation

Irrigant is delivered into access chamber here

Irrigant is recovered from the apical canal here by HVE suction line

Irrigant flows rapidly and forcefully down canal walls

Endovac Pure Apex Cartridge

Irrigation Activation Systems

Ultrasonic Sonic

Other Irrigation Activation Systems

Multisonic Laser

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DOI: http://dx.doi.org/10.1016/j.joen.2017.01.013 |

The Antibacterial Effect of Nd:YAG Laser Treatment ofTeeth with Apical Periodontitis: A Randomized ControlledTrial

, ,

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AbstractIntroductionThe aim of this blind, in vivo, randomized controlled trial was to evaluate the antibacterial effect of Nd:YAG laserirradiation in endodontic treatment of single-rooted teeth with apical periodontitis. The hypothesis was thatmechanical enlargement of the root canal and Nd:YAG laser irradiation would yield more negative bacterialsamples than conventional treatment.

MethodsForty-one patients (45 teeth) were allocated to the laser (n = 22) or control (n = 23) group. The teeth in the lasergroup were instrumented, irrigated with saline, and irradiated with Nd:YAG laser according to a standardprotocol. The teeth in the control group were similarly instrumented but irrigated with 1% unbuffered sodiumhypochlorite and 15% EDTA solution. Bacterial samples were taken before and after treatment, blinded, andimmediately sent for culturing and analysis.

ResultsThe initial bacterial samples were positive in 20 of 22 teeth in the laser group and 18 of 23 (P = .414) in thecontrol group. After the initial treatment, negative bacterial samples were found in 11 teeth in the laser groupand 13 (P = .768) in the control group. After 2 to 4 days with no antibacterial dressing in the root canals, 5 teethin the laser group and 9 (P = .337) in the control group yielded negative bacterial samples.

ConclusionsAfter intervention, neither the test group nor the control group yielded predictable negative bacterial samples.Thus, the results failed to verify the hypothesis that Nd:YAG laser irradiation would yield significantly morenegative bacterial samples than conventional irrigation with 1% unbuffered sodium hypochlorite solution.

Key Words:Endodontics, root canal therapy, sodium hypochlorite, solid-state lasers, treatment outcome

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Next Article >June 2017 Volume 43, Issue 6, Pages 857–863

Maria Granevik Lindström, DDS, MSc Eva Wolf, DDS, PhD Helena Fransson, DDS, PhD

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Antibacterial Activity ofEndodontic Sealers againstPlanktonic Bacteria and Bacteriain BiofilmsPublication stage: In Press Corrected ProofJournal of Endodontics

Antibacterial Nanoparticles inEndodontics: A ReviewJournal of Endodontics, Vol. 42, Issue 10

Antibacterial Effects ofAntimicrobials Used inRegenerative Endodonticsagainst Biofilm Bacteria Obtainedfrom Mature and Immature Teethwith Necrotic PulpsJournal of Endodontics, Vol. 43, Issue 4

Antibacterial Properties ofChitosan Nanoparticles andPropolis Associated with CalciumHydroxide against Single- andMultispecies Biofilms: An In Vitroand In Situ StudyJournal of Endodontics, Vol. 43, Issue 8

Antibacterial Efficacy of

Conclusions After intervention, neither the test group nor the control group yielded predictable negative bacterial samples. Thus, the results failed to verify the hypothesis that Nd:YAG laser irradiation would yield significantly more negative bacterial samples than conventional irrigation with 1% unbuffered sodium hypochlorite solution.

Endodontics 5th Edition, Page 502

10/10/13 9:18 PMPeriapical Pressures Developed by Nonbinding Irrigation Needles at Various Irrigation Delivery Rates


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Abstract Full Text PDF Images References Supplemental Materials


Periapical Pressures Developed by Nonbinding Irrigation Needlesat Various Irrigation Delivery RatesSara Khan, DMD, Li-na Niu, DDS, MS, Ashraf A. Eid, BDS, MSc, Stephen W. Looney, PhD, Anthony Didato, DMD, Steven Roberts, DMD,David H. Pashley, DMD, PhD, Franklin R. Tay, BDSc (Hons), PhD

published online 11 February 2013.

Abstract IntroductionInjection of sodium hypochlorite (NaOCl) from the root canal into periapical tissues may result in a NaOCl incident. The purposeof this study was to examine the fluid pressure generated by canal cleansing devices at the apical interface, when the tip of theirrigation device was not binding to the canal walls.

MethodsApical pressure was monitored in a closed-system root canal model, with NaOCl delivered by a syringe pump at 0.5–8 mL/min.Devices tested were VPro EndoSafe, Max-i-Probe, NaviTip, VPro StreamClean, and EndoVac Microcannula. Apical fluidpressure was recorded with a digital manometer (N = 20). The relationships between apical fluid pressure and fluid flow ratewere modeled with polynomial regression and analyzed by using the Wald test.

ResultsEndoVac Microcannula was the only device that was capable of delivering negative apical fluid pressures, in the range of −35mm Hg, at all fluid flow rates. All other devices generated positive apical pressures that increased nonlinearly with increasingfluid flow rates. These 4 positive pressure delivery devices were capable of generating pressures that exceeded the humancentral venous pressure (5.88 mm Hg). VPro EndoSafe differed from the other positive pressure delivery devices in that itgenerated significantly higher positive pressures at all flow rates (P < .0083).

ConclusionsPositive apical irrigation pressures in excess of the central venous pressure may be generated by some canal cleansingdevices when irrigants are delivered at flow rates higher than 1 mL/min, even when the irrigation needle is not wedged into thecanal walls.

Key Words: Apical fluid pressure, fluid flow rate, sodium hypochlorite, venous pressure


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Results: EndoVac Microcannula was the only device that was capable of delivering negative apical fluid pressures, in the range of −35 mm Hg, at all fluid flow rates. All other devices generated positive apical pressures that increased nonlinearly with increasing fluid flow rates. These 4 positive pressure delivery devices were capable of generating pressures that exceeded the human central venous pressure (5.88 mm Hg). VPro EndoSafe differed from the other positive pressure delivery devices in that it generated significantly higher positive pressures at all flow rates (P < .0083). Conclusions: Positive apical irrigation pressures in excess of the central venous pressure may be generated by some canal cleansing devices when irrigants are delivered at flow rates higher than 1 mL/min, even when the irrigation needle is not wedged into the canal walls.

10/8/13 11:23 AMComparison of the Debridement Efficacy of the EndoVac Irrig…stem and Conventional Needle Root Canal Irrigation In Vivo


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Journal of EndodonticsVolume 36, Issue 11 , Pages 1782-1785, November 2010

Comparison of the Debridement Efficacy of the EndoVacIrrigation System and Conventional Needle Root Canal IrrigationIn VivoChris Siu, DDS, BSc , J. Craig Baumgartner, DDS, PhD

Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon


Abstract IntroductionThe purpose of this study was to compare the debridement efficacy of EndoVac irrigation versus conventional needle irrigationin vivo.

MethodsSeven adult patients with a total of 22 matched pairs of single-canaled vital teeth with fully formed apices were recruited.Canals were instrumented to a master apical file size #40/.04 taper. One tooth from each matched pair was irrigated by usingthe EndoVac system. The other tooth was irrigated by conventional needle irrigation. Five additional teeth were used as positivecontrols. A #10 K-file was inserted into the control canals to determine working length (WL), with no other instrumentation orirrigation performed to confirm the presence of debris. The teeth were extracted, fixed, and decalcified. Six histologic slideseach 6 μm thick were made from sections at 1 and 3 mm from WL and stained. The slide with the most debris wasphotographed at each level for each tooth. A Wilcoxon signed rank test was used to compare the percentage of debrisremaining in the canals between the 2 irrigation techniques.

ResultsThe median amount of debris remaining at 1 mm was 0.05% for the EndoVac group and 0.12% for the conventional irrigationgroup (P < .05). The median amount of debris remaining at 3 mm was 0.09% for the EndoVac group and 0.07% for theconventional needle irrigation group (P > .05).

Conclusions


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Results:The median amount of debris remaining at 1 mm was 0.05% for the EndoVac group and 0.12% for the conventional irrigation group (P < .05). The median amount of debris remaining at 3 mm was 0.09% for the EndoVac group and 0.07% for the conventional needle irrigation group (P > .05).Conclusions:EndoVac irrigation resulted in significantly less debris at 1 mm from WL compared with conventional needle irrigation. There was no significant difference at the 3-mm level.

Positive Negative

SidePort EndoVac

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Comparison of Sealer Penetration Using the EndoVac IrrigationSystem and Conventional Needle Root Canal Irrigation

,

Published Online: January 09, 2014



Abstract

IntroductionThe aim of this study was to compare the effect of the EndoVac irrigation system (SybronEndo, Orange, CA) andconventional endodontic needle irrigation on sealer penetration into dentinal tubules.

MethodsForty single-rooted, recently extracted human maxillary central incisors were randomly divided into 2 groups accordingto the irrigation technique used: conventional endodontic needle irrigation and EndoVac irrigation. All teeth wereinstrumented using the ProFile rotary system (Dentsply Maillefer, Ballaigues, Switzerland) and obturated with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) labeled with fluorescent dye. Transverse sections at1, 3, and 5 mm from the root apex were examined using confocal laser scanning microscopy. The total percentage andmaximum depth of sealer penetration were then measured.

ResultsMann-Whitney test results showed that EndoVac irrigation resulted in a significantly higher percentage of sealerpenetration than conventional irrigation at both the 1- and 3-mm levels (P < .05). However, no difference was found atthe 5-mm level. The 5-mm sections in each group showed a significantly higher percentage and maximum depth ofsealer penetration than did the 1- and 3-mm sections (P < .05).

ConclusionsThe EndoVac irrigation system significantly improved the sealer penetration at the 1- to 3-mm level over that ofconventional endodontic needle irrigation.

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Journal of EndodonticsVolume 40, Issue 5, Pages 613–617, May 2014


Aysun Kara Tuncer, DDS, PhD Bayram Ünal, DDS, PhD



Conclusions: The EndoVac irrigation system significantly improved the sealer penetration at the 1- to 3-mm level over that of conventional endodontic needle irrigation.

Continuous Wave Obturation

Obturation

Gutta Percha

Elements Obturation Unit (EOU)

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Carrier

66% zinc oxide (filler)

20% gutta-percha (matrix)

11% heavy metal sulfates (radiopacifier)

3% waxes and/or resins (plasticizer)

Gutta Percha Standard

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Effect of Post Space Preparation on Apical ObturationQuality of Teeth Obturated with Different Techniques: AMicro–computed Tomographic Study

, , Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey

Article Info


Highlights• The warm vertical compaction (WVC) group presented the best obturation quality before and after post space

preparation.• The post space preparation negatively influenced the apical integrity of the filling materials in the cold lateral

compaction and single-cone groups, whereas it had no significant effect on the WVC group.

AbstractIntroductionThe purpose of this study was to evaluate the obturation quality of root canals filled with different techniquesand to determine whether post space preparation had an effect on the quality of apical obturation using micro–computed tomographic (micro-CT) imaging.

MethodsThe root canals of 30 human mandibular premolar teeth were instrumented, and the specimens were dividedinto 3 groups according to the obturation technique used: cold lateral compaction (CLC), warm verticalcompaction (WVC), or single-cone (SC) techniques. The specimens were stored at 37°C and 100% humidity for1 week. Then, the coronal root filling material was removed in order to create a post space. Micro-CT scanswere performed before and after post space preparation for the volumetric analysis of voids and fillingmaterials. Data were analyzed using repeated-measures analysis of variance and Bonferroni tests.

ResultsThe CLC and SC groups showed a significantly greater percentage volume of voids than the WVC group(P < .05), whereas no significant difference was found between the CLC and SC groups before and after postspace preparation (P > .05). The post space preparation caused a significant increase in the percentage volume

of voids in the CLC and SC groups (P < .05). No significant difference was detected in the percentage volumeof voids in the WVC group after post space preparation (P > .05).

ConclusionsNo root fillings were void free. The WVC group presented the best obturation quality. The post spacepreparation negatively influenced the apical integrity of the filling materials in the CLC and SC groups, whereasit had no significant effect in the WVC group.

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< Previous Article Next Article >July 2017 Volume 43, Issue 7, Pages 1152–1156

Selen Küçükkaya Eren, DDS, PhD Sevinc Askerbeyli Örs, DDS Zeliha Yılmaz, DDS, PhD

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Intentional ReplantationTechniques: A Critical ReviewPublication stage: In Press Corrected ProofJournal of Endodontics

Detecting Dentinal MicrocracksUsing Different PreparationTechniques: An In Situ Studywith Cadaver MandiblesPublication stage: In Press Corrected ProofJournal of Endodontics

A New Method to Develop HumanDental Pulp Cells and Platelet-rich Fibrin ComplexJournal of Endodontics, Vol. 42, Issue 11

Effect of InstrumentationTechniques and PreparationTaper on Apical Extrusion ofBacteriaJournal of Endodontics, Vol. 43, Issue 6

Clinical and Patient-centeredOutcomes of Nonsurgical RootCanal Retreatment in First MolarsUsing Contemporary TechniquesJournal of Endodontics, Vol. 43, Issue 2

Conclusions No root fillings were void free. The WVC group presented the best obturation quality. The post space preparation negatively influenced the apical integrity of the filling materials in the CLC and SC groups, whereas it had no significant effect in the WVC group.

Sealers Equipment Needed for the Continuous Wave Technique

Continuous Wave Downpack Units

Internal Use Only

Elements Downpac

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AlphaBrasseler EndoPro

Obtura MaxPack

Dentsply Calamus

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Dentazon Friendo & Dia-Pen

Nikinc Rootbudd

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Meta BioMed

Pen

Meta BioMed EQ Plus

Warranty 2 years 1 year 1 year 1 year 1 year 1 year 1 year 1 year 1 year

Cordless Yes Yes Yes Yes No Yes Yes Yes No

On/Off 360 ring button button button 360 ring button button360 ring 360 ring

Temp Settings

Variable 140-400 4 4 4

Variable 100-400C 3

Variable 50-350C 2

Variable 100-350

C

Vibration No No No No No No Yes No No

Continuous Wave Backfill Units

Elements Backfill B&L Beta Obtura Max

Dentsply Calamus

Fill

Dentazon Easy Gun &

Dia-Gun

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Warranty 2 years 1 year 1 year 1 year 1 year 1 year 2 year

Cordless Yes Yes No No Yes Yes No

Motorized Yes No No Yes No No No

Temp SettingsVariable 150-230 4 Variable Variable 3 Variable Variable

Needle Sizes 23 & 25 20, 23 & 25 20, 23 & 25 23 & 25 23 & 25 23 & 25 23 & 25

Cartridge Yes No No Yes No No No

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Dimple-down / Buildup

Post-space / Fiberpost

Reduce Occlusion

Emphasize Need For Coronal Coverage

SonicFill

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Fracture Strength of Endodontically Treated Teeth withDifferent Access Cavity Designs

, , , , , , ,

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Highlights• The effects of 3 access cavities on the fracture strength of teeth were evaluated.• Teeth with traditional endodontic cavity showed lower strength than other groups.• No difference was observed between conservative and “ninja” access cavity designs.• All prepared teeth showed more unrestorable fracture patterns than intact ones.

AbstractIntroductionThe purpose of this study was to compare in vitro the fracture strength of root-filled and restored teeth withtraditional endodontic cavity (TEC), conservative endodontic cavity (CEC), or ultraconservative “ninja”endodontic cavity (NEC) access.

MethodsExtracted human intact maxillary and mandibular premolars and molars were selected and assigned to control(intact teeth), TEC, CEC, or NEC groups (n = 10/group/type). Teeth in the TEC group were prepared followingthe principles of traditional endodontic cavities. Minimal CECs and NECs were plotted on cone-beamcomputed tomographic images. Then, teeth were endodontically treated and restored. The 160 specimenswere then loaded to fracture in a mechanical material testing machine (LR30 K; Lloyd Instruments Ltd,Fareham, UK). The maximum load at fracture and fracture pattern (restorable or unrestorable) were recorded.Fracture loads were compared statistically, and the data were examined with analysis of variance and theStudent-Newman-Keuls test for multiple comparisons.

ResultsThe mean load at fracture for TEC was significantly lower than the one for the CEC, NEC, and control groupsfor all types of teeth (P < .05), whereas no difference was observed among CEC, NEC, and intact teeth(P > .05). Unrestorable fractures were significantly more frequent in the TEC, CEC, and NEC groups than in thecontrol group in each tooth type (P < .05).

ConclusionsTeeth with TEC access showed lower fracture strength than the ones prepared with CEC or NEC.Ultraconservative “ninja” endodontic cavity access did not increase the fracture strength of teeth comparedwith the ones prepared with CEC. Intact teeth showed more restorable fractures than all the prepared ones.

Key Words:

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< Previous Article Next Article >June 2017 Volume 43, Issue 6, Pages 995–1000

Gianluca Plotino, DDS, PhD Nicola Maria Grande, DDS, PhD Almira Isufi, DDS, PhD, MSc Pietro Ioppolo,DpHS Eugenio Pedullà, DDS, PhD Rossella Bedini, DSc, PhD Gianluca Gambarini, MD, DDS LucaTestarelli, DDS, PhD

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Detection of FracturedEndodontic Instruments in RootCanals: Comparison betweenDifferent Digital RadiographySystems and Cone-beamComputed TomographyJournal of Endodontics, Vol. 43, Issue 4

Fracture Resistance ofEndodontically Treated TeethRestored with 2 Different Fiber-reinforced Composite and 2Conventional Composite ResinCore Buildup Materials: AnIn Vitro StudyJournal of Endodontics, Vol. 43, Issue 9

Regenerative EndodonticProcedures for Traumatized Teethafter Horizontal Root Fracture,Avulsion, and Perforating RootResorptionJournal of Endodontics, Vol. 42, Issue 10

Fracture Incidence of WaveOneand Reciproc Files during RootCanal Preparation of up to 3Posterior Teeth: A Prospective

Clinical StudyJournal of Endodontics, Vol. 43, Issue 5

Dynamic Torsional and CyclicFracture Behavior of ProFileRotary Instruments at Continuousor Reciprocating Rotation asVisualized with High-speedDigital Video Imaging

Conclusions Teeth with TEC access showed lower fracture strength than the ones prepared with CEC or NEC. Ultraconservative “ninja” endodontic cavity access did not increase the fracture strength of teeth compared with the ones prepared with CEC. Intact teeth showed more restorable fractures than all the prepared ones.

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Ferrule Effect: A Literature Review

Jelena Juloski, DDS , Ivana Radovic, DDS, MSc, PhD, Cecilia Goracci, DDS, MSc, PhD, Zoran R. Vulicevic, DDS, MSc, PhD,Marco Ferrari, MD, DDS, PhD

published online 15 November 2011.

Abstract IntroductionPreserving intact coronal and radicular tooth structure, especially maintaining cervical tissue to create a ferrule effect, isconsidered to be crucial for the optimal biomechanical behavior of restored teeth. The ferrule effect has been extensivelystudied and still remains controversial from many perspectives. The purpose of this study was to summarize the results ofresearch conducted on different issues related to the ferrule effect and published in peer-reviewed journals listed in PubMed.

MethodsThe search was conducted using the following key words: “ferrule” and “ferrule effect” alone or in combination with “literaturereview,” “fracture resistance,” “fatigue,” “finite element analysis,” and “clinical trials.”

ResultsThe findings from reviewed articles were categorized into three main categories: laboratory studies, computer simulation, andclinical trials. Laboratory studies were further classified into subchapters based on the main aspect investigated in relation tothe ferrule effect.

ConclusionsThe presence of a 1.5- to 2-mm ferrule has a positive effect on fracture resistance of endodontically treated teeth. If the clinicalsituation does not permit a circumferential ferrule, an incomplete ferrule is considered a better option than a complete lack offerrule. Including a ferrule in preparation design could lead to more favorable fracture patters. Providing an adequate ferrulelowers the impact of the post and core system, luting agents, and the final restoration on tooth performance. In teeth with nocoronal structure, in order to provide a ferrule, orthodontic extrusion should be considered rather than surgical crownlengthening. If neither of the alternative methods for providing a ferrule can be performed, available evidence suggests that apoor clinical outcome is very likely.

Key Words: Endodontically treated teeth, ferrule effect, post and core, review


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Conclusions The presence of a 1.5- to 2-mm ferrule has a positive effect on fracture resistance of endodontically treated teeth. If the clinical situation does not permit a circumferential ferrule, an incomplete ferrule is considered a better option than a complete lack of ferrule. Including a ferrule in preparation design could lead to more favorable fracture patters. Providing an adequate ferrule lowers the impact of the post and core system, luting agents, and the final restoration on tooth performance. In teeth with no coronal structure, in order to provide a ferrule, orthodontic extrusion should be considered rather than surgical crown lengthening. If neither of the alternative methods for providing a ferrule can be performed, available evidence suggests that a poor clinical outcome is very likely.

4/5/17, 12:06 PMPerformance of Post-retained Single Crowns: A Systematic Review of Related Risk Factors - Journal of Endodontics

Page 1 of 2http://www.jendodon.com/article/S0099-2399(16)30752-X/fulltext?el…sca2=email&elsca3=0099-2399_201702_43_2_&elsca4=Dentistry

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Performance of Post-retained Single Crowns: A SystematicReview of Related Risk Factors

, , , ,

Abstract Full Text Images References Supplemental Materials

Highlights• Restoration of endodontically treated teeth should focus on the maintenance of coronal structure.• In general, posts with high values of elastic modulus present better performance.• Considering teeth with remaining coronal walls, both posts may be indicated.

AbstractIntroductionNumerous factors may influence the survival/success of post-retained restorations of endodontically treatedteeth (ETT). The aim of this review was to assess the influence of the number of remaining coronal walls, theuse or disuse of posts, and their type on the clinical performance of these restorations.

MethodsRandomized controlled trials and controlled clinical trials for ETT restored with a combination of post/crown orno post/crown were searched for in MEDLINE, Embase, and the Cochrane Library. Two authors independentlyreviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the includedstudies, and reports of randomized trials were assessed for bias using the Cochrane risk of bias tool.

ResultsNine articles were identified as meeting the inclusion criteria. Teeth without ferrule presented the highest valuesof variation of success/survival (0%–97%), whereas teeth with remaining coronal walls (1, 2, 3, or 4 walls withferrule) presented lower variation. The use of posts with a high elastic modulus success/survival rangedbetween 71.8% and 100%, whereas posts with a low elastic modulus ranged between 28.5% and 100%. Thesurvival of crowns without posts varied between 0% and 100%. The poor performance of posts with a low

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Next Article >February 2017 Volume 43, Issue 2, Pages 175–183

Rafael Sarkis-Onofre, PhD Dean Fergusson, PhD Maximiliano Sérgio Cenci, PhD David Moher, PhDTatiana Pereira-Cenci, PhD


Root Canal Treatment versus Single-ToothImplant: A Systematic Review of InternetContentJournal of Endodontics, Vol. 42, Issue 6

The Prognosis of Altered Sensation afterExtrusion of Root Canal Filling Materials:A Systematic Review of the LiteratureJournal of Endodontics, Vol. 42, Issue 6

The Effect of Sodium Hypochlorite andChlorhexidine as Irrigant Solutions forRoot Canal Disinfection: A SystematicReview of Clinical TrialsJournal of Endodontics, Vol. 42, Issue 4

Are Premixed Calcium Silicate–basedEndodontic Sealers Comparable toConventional Materials? A SystematicReview of In Vitro StudiesJournal of Endodontics, Vol. 43, Issue 4

Results

Nine articles were identified as meeting the inclusion criteria. Teeth without ferrule presented the highest values of variation of success/survival (0%–97%), whereas teeth with remaining coronal walls (1, 2, 3, or 4 walls with ferrule) presented lower variation. The use of posts with a high elastic modulus success/survival ranged between 71.8% and 100%, whereas posts with a low elastic modulus ranged between 28.5% and 100%. The survival of crowns without posts varied between 0% and 100%. The poor performance of posts with a low elastic modulus and without posts was associated with the absence of ferrule and the preservation of only 1 coronal wall.

Conclusions

The restoration of ETT should focus on the maintenance of the coronal structure. Until more studies with longer follow-up periods are available, posts with a high elastic modulus appear to present with better performance when restoring ETT with no ferrule.

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Long-term Clinical Outcomes of Endodontically TreatedTeeth Restored with or without Fiber Post–retainedSingle-unit Restorations

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Long-term Clinical Outcomes of Endodontically Treated Teeth Restored with or without Fiber Post–retained Single-unit Restorations

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AbstractIntroductionThe aim of the present study was to evaluate both survival and failure rates of endodontically treated teethrestored with or without fiber post–retained restorations after a mean observation period of at least 5 years.

MethodsA total of 144 single-rooted and multirooted teeth in 100 subjects were endodontically treated following apredetermined aseptic protocol and restored with either a fiber post and a composite core or a composite fillingwithout intraradicular retention. A fiber post was cemented when the teeth presented with only 1 wall and/orless than one third of the remaining height of the clinical crown. After a comprehensive treatment plan, the teethwere restored with either a direct composite restoration or a single-unit crown. Endodontically treated teethsupporting fixed and removable dental prostheses and telescopic crowns were excluded from the analysis.Success was defined as tooth survival without any treatment of biological and/or technical complications.

ResultsThe overall tooth survival rate was 89.6% after a mean observation time of 8.8 ± 2.3 years. The survival rate ofteeth with a fiber post amounted to 94.3%, and for teeth without a post, it was 76.3% (P < .001). The mainreason for tooth loss was root fracture (9.7%). No loss of post retention was observed. Successfully treatedteeth without any biological and/or technical complications and requiring no additional treatment during theentire observation period amounted to 79.9%.

ConclusionsEndodontically treated teeth restored with fiber posts and either a direct composite restoration or a single-unitcrown yielded higher survival and success rates compared with teeth restored without fiber posts. Verticalfractures of roots not containing a post represented a frequently encountered and serious problem.

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< Previous Article Next Article >February 2017 Volume 43, Issue 2, Pages 188–193

Kevin A. Guldener, med dent Carla L. Lanzrein, med dent Beatrice E. Siegrist Guldener, Dr med. dent.,MS Niklaus P. Lang, Prof Dr med dent, MS Christoph A. Ramseier, PD, Dr med dent, MAS Giovanni E.Salvi, Prof Dr med dent, DMD


Conclusions Endodontically treated teeth restored with fiber posts and either a direct composite restoration or a single-unit crown yielded higher survival and success rates compared with teeth restored without fiber posts. Vertical fractures of roots not containing a post represented a frequently encountered and serious problem.

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Comparison of Fracture Resistance between Cast Posts and FiberPosts: A Meta-analysis of Literature

Lili Zhou, DDS, MD, Qing Wang, DDS, MD

Department of Endodontics, College of Dentistry, Shandong University, Jinan, China

published online 26 October 2012.

Abstract IntroductionThe aim of this study was to compare the fracture resistance of cast posts versus the fracture resistance of fiber posts bymeans of meta-analysis when they were used in the restoration of endodontically treated teeth.

MethodsMEDLINE, Cochrane Controlled Trials Register, China National Knowledge Infrastructure, and China Biology Medicine discwere used in the literature search. Two independent reviewers assessed the titles and abstracts of all articles that were foundaccording to the predefined inclusion criteria. Relevant articles were acquired in full-text form. Data in these studies wereindependently extracted. Standardized mean differences of included studies were combined and analyzed by using meta-analysis.

ResultsThirteen studies met the inclusion criteria. There was considerable heterogeneity among these studies. The standardized meandifference of the combined data was 0.64 (95% confidence interval, 0.08–1.20; P < .001), indicating that the cast post groupdisplayed significantly higher fracture resistance than the fiber post group.

ConclusionsOn the basis of the current best available evidence, we concluded that cast posts had higher fracture resistance than fiberposts.

Key Words: Cast post, endodontically treated teeth, fiber post, fracture resistance, meta-analysis, post and core technique

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Conclusions On the basis of the current best available evidence, we concluded that cast posts had higher fracture resistance than fiber posts.

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Influence of Ferrule, Post System, and Length on BiomechanicalBehavior of Endodontically Treated Anterior Teeth

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Published Online: October 29, 2013



Abstract

IntroductionThe aim of this study was to evaluate the influence of post system, length, and ferrule on biomechanical behavior ofendodontically treated anterior teeth.

MethodsThe investigation was conducted by using laboratory tests and 3-dimensional finite element analysis. Eighty bovineincisors were selected and divided into 8 treatment groups (n = 10) with absence of ferrule and 2.0 mm of ferrule,restored with glass fiber post or cast post and core, and 12.0 and 7.0 mm of post length. The specimens were loaded at135° angle, and the strain was measured by using strain gauge method. Specimens were subsequently loaded untilfracture. Strain and fracture resistance results were analyzed by 3-way analysis of variance and Tukey honestlysignificant difference tests (α = 0.05). Three-dimensional models of a maxillary central incisor were generated with thesame treatment variations used in laboratory tests. Each model was subjected to 100 N oblique loads. Results wereevaluated by von Mises criterion.

ResultsFerrule was a determining factor in the strain, fracture resistance, and fracture pattern. In the absence of ferrule, the useof fiberglass posts represents a conservative choice from the standpoint of the fracture patterns observed. The length of7 mm for cast post and cores produced high rates of root fractures. Finite element analysis showed that glass fiber postshowed homogeneous stress distribution, whereas cast post showed stress concentration into root canal.

ConclusionsPost length influenced only the cast post strain and stress distribution. The ferrule groups always showed moresatisfactory stress distribution and fracture resistance.

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Journal of EndodonticsVolume 40, Issue 1, Pages 119–123, January 2014


Paulo César Freitas Santos-Filho, DDS, MS, PhD Crisnicaw Veríssimo, DDS, MS Paulo Vinícius Soares, DDS, MS, PhDRebeca Carniello Saltarelo, DDS Carlos José Soares, DDS, MS, PhD Luis Roberto Marcondes Martins, DDS, MS, PhD



Conclusions: Post length influenced only the cast post strain and stress distribution. The ferrule groups always showed more satisfactory stress distribution and fracture resistance.

« Previous Next »



Comparative Evaluation of Fracture Resistance under Static andFatigue Loading of Endodontically Treated Teeth Restored withCarbon Fiber Posts, Glass Fiber Posts, and an ExperimentalDentin Post System: An In Vitro Study

Khetarpal Ambica, BDS, MDS , Kavitha Mahendran, BDS, MDS, Sangeeta Talwar, BDS, MDS, Mahesh Verma, BDS, MDS,Govindaswamy Padmini, BDS, MDS, Ravishankar Periasamy, BDS, MDS


Abstract IntroductionThis investigation sought to compare the fracture resistance under static and fatigue loading of endodontically treated teethrestored with fiber-reinforced composite posts and experimental dentin posts milled from human root dentin by using computer-aided design/computer-aided manufacturing.

MethodsSeventy maxillary central incisors were obturated and divided into 4 groups: control group without any post (n = 10), carbonfiber post group (n = 20), glass fiber post group (n = 20), and dentin post group (n = 20). Control group teeth were prepared to aheight of 5 mm. In all other teeth, post space was prepared; a post was cemented, and a core build-up was provided. Half thesamples from each group were statistically loaded until failure, and the remaining half were subjected to cyclic loading, followedby monostatic load until fracture.

ResultsOne-way analysis of variance and Bonferroni multiple comparisons revealed a significant difference among test groups. Thecontrol group demonstrated highest fracture resistance (935.03 ± 33.53 N), followed by the dentin post group (793.12 ± 33.69N), glass fiber post group (603.44 ± 46.67 N), and carbon fiber post group (497.19 ± 19.27 N) under static loading. Thesevalues reduced to 786.69 ± 29.64 N, 646.34 ± 26.56 N, 470 ± 36.34 N, and 379.71 ± 13.95 N, respectively, after cyclic loading.

ConclusionsResults suggest that human dentin can serve as post material under static and fatigue loading. Although at an early stage inresearch, the use of dentin posts in root-filled teeth looks promising.


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Conclusions Results suggest that human dentin can serve as post material under static and fatigue loading. Although at an early stage in research, the use of dentin posts in root-filled teeth looks promising.

« Previous Next »


Journal of EndodonticsVolume 34, Issue 5 , Pages 519-529, May 2008

A Review of Factors Influencing Treatment Planning Decisions ofSingle-tooth Implants versus Preserving Natural Teeth withNonsurgical Endodontic Therapy

Mian K. Iqbal, BDS, DMD, MS , Syngcuk Kim, DDS, PhD

Department of Endodontics, The Robert Schattner Center, University of Pennsylvania, School of Dental Medicine, Philadelphia,Pennsylvania.

Abstract One of the major issues confronting the contemporary dental clinician is the treatment decision between extracting a tooth withplacement of a dental implant or preserving the natural tooth by root canal treatment. The factors that dictate the correctselection of one procedure over the other for each particular case are not yet established by randomized controlled studies. Theaim of this review is to evaluate key factors allowing the clinician to make clinical decisions on the basis of the best evidenceand in the patient's best interests. General considerations are discussed that will help the reader analyze clinical studiesfocused on this problem. Importantly, the major studies published to date indicate that there is no difference in long-termprognosis between single-tooth implants and restored root canal–treated teeth. Therefore, the decision to treat a toothendodontically or to place a single-tooth implant should be based on other criteria such as prosthetic restorability of the tooth,quality of bone, esthetic demands, cost-benefit ratio, systematic factors, potential for adverse effects, and patient preferences. Itcan be concluded that endodontic treatment of teeth represents a feasible, practical, and economical way to preserve functionin a vast array of cases and that dental implants serve as a good alternative in selected indications in which prognosis is poor.

Key Words: Prognosis of root canal treated teeth, prognosis of single tooth implants, root canal restoration, root canal treatedteeth, single tooth implants, treatment planning

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It can be concluded that endodontic treatment of teeth represents a feasible, practical, and economical way to preserve function in a vast array of cases and that dental implants serve as a good alternative in selected indications in which prognosis is poor.

Post Operative Care

Share Radiographs With Patient “This is the hardest endo I have done (today)” Non Steroidal Anti Inflammatory (NSAID) Pain Medications Antibiotics Telephone Call To Patient Next Day

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Nonsteroidal Anti-inflammatory Drugs for ManagingPostoperative Endodontic Pain in Patients Who Presentwith Preoperative Pain: A Systematic Review and Meta-analysis

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Highlights• Ibuprofen 600 mg provides greater pain relief than placebo.• Ibuprofen 600 mg/acetaminophen 1000 mg provides greater pain relief than placebo.• Naproxen 500 mg and ketoprofen 50 mg may be more effective than ibuprofen.• Insufficient evidence to recommend a single most effective nonsteroidal anti-inflammatory drug and dose.

AbstractIntroductionNonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperativepain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome,Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthogradeendodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics orplacebo in reducing postoperative pain and the incidence of adverse events.

MethodsOvid MEDLINE (1946–December 15, 2015), the Cochrane Database of Systematic Reviews (2005–December15, 2015), and the Cochrane Central Register of Controlled Trials (to December 15, 2015) were searched usingincluded drugs, indications, and study designs as search terms. Hand searches in texts were also conducted.Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the riskof bias tool. L'Abbe plots were used for qualitative review. Where applicable, meta-analysis was conducted onthe pooled effect size (ES).

ResultsTwo thousand two hundred eighty-four studies were identified through the database searches; 405 full-textarticles were assessed. Fifteen articles met the inclusion criteria; qualitative analysis revealed all studies had a

moderate to high risk of bias. Ibuprofen was the most studied NSAID. The L'Abbe plots showed that NSAIDSare effective at relieving postoperative endodontic pain overall. Meta-analysis showed that ibuprofen 600 mg ismore effective than placebo at 6 hours postoperatively (ES = 10.50, P = .037), and ibuprofen600 mg + acetaminophen 1000 mg combination is more effective than placebo (ES = 34.89, P = .000) but notsignificantly different than ibuprofen (ES = 13.94, P = .317). Five studies reported patients experiencing adverseevents such as drowsiness, dizziness, nausea, and emesis; 2 studies reported that patients experienced noadverse events.

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< Previous Article Next Article >January 2017 Volume 43, Issue 1, Pages 7–15

Elizabeth A. Smith, DDS J. Gordon Marshall, DMD Shelley S. Selph, MD, MPH Dale R. Barker, DDSChristine M. Sedgley, MDS, MDSc, PhD

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Conclusions A combination of ibuprofen 600 mg and acetaminophen 1000 mg is more effective than placebo but not significantly different than ibuprofen 600 mg at 6 hours postoperatively. Ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively; however, there are insufficient data to recommend the most effective NSAID, dose amount, or dose interval for the relief of postoperative endodontic pain of longer duration in patients with preoperative pain.

Ibuprofen-200, 400, 600, 800600 milligrams per dose or 3200 mg per day (5 maximum doses).

Non Steroidal Anti Inflammatory (NSAID) Steroids

Prednisone-5mgsDisp:21 tabs XXISig: 6, 5, 4, 3, 2, 1

Prednisone-5mgsDisp:1dose packSig: as directed

« Previous Next »


Journal of EndodonticsVolume 38, Issue 8 , Pages 1035-1039, August 2012

Effect of Bupivacaine on Postoperative Pain for Inferior AlveolarNerve Block Anesthesia after Single-visit Root Canal Treatment inTeeth with Irreversible Pulpitis

Masoud Parirokh, DDS, MSc , Mohammad Hosein Yosefi, DMD, Nouzar Nakhaee, MD, Hamed Manochehrifar, DMD, PaulV. Abbott, MDS, Farshid Reza Forghani, DMD, MS

published online 04 June 2012.

Abstract IntroductionPain control after root canal treatment is of great importance in endodontic practice. The aim of the present study was toinvestigate the effect of a long-acting anesthetic (bupivacaine) on postoperative pain and the use of analgesics after root canaltreatment.

MethodsIn a randomized double-blinded clinical trial, 60 patients (30 per group) having first or second mandibular molars withirreversible pulpitis randomly received either 0.5% bupivacaine with 1:200,000 epinephrine or 2% lidocaine with 1:80,000epinephrine as the anesthetic solutions for inferior alveolar nerve blocks. After single-visit root canal treatment, each patientrecorded their pain score on a visual analogue scale at 6, 12, 24, 36, 48, and 72 hours after treatment. Data were analyzed byMann-Whitney, χ2, Cochrane Q, and t tests as well as Pearson correlation analysis.

ResultsThe results indicate that patients who received bupivacaine had significantly lower pain scores at 6 and 12 hours after rootcanal treatment compared with the patients who received lidocaine (P < .05). The use of analgesics in the bupivacaine patientswas significantly lower than in the lidocaine group (P < .05).

ConclusionsPatients who received bupivacaine as the anesthetic agent for single-visit endodontic treatment of irreversible pulpitis inmandibular molars had significantly less early postoperative pain and used fewer analgesics than those who had lidocaine asthe anesthetic.

Key Words: Bupivacaine, IANB, lidocaine, long acting anesthesia, one visit, postoperative pain, root canal treatment, single


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Conclusions Patients who received bupivacaine as the anesthetic agent for single-visit endodontic treatment of irreversible pulpitis in mandibular molars had significantly less early postoperative pain and used fewer analgesics than those who had lidocaine as the anesthetic.

Pain Medications

Tylenol Maximum Daily Dosage Extra Strength Tylenol 500mg

tablets has gone down from 8 per day to 6 per day, i.e. from 4,000mg

per day to 3,000mg per day.

Acetaminophen

Pain Medications

• Darvocet® • Endocet® • Fioricet® • Hycotab • Hydrocet® • Hydrocodone Bitartrate • Lortab®• Percocet®

• Phenaphen®• Sedapap®• Tapanol®• Ultracet®• Vicodin®• Zydone®

Some Common Prescription Drugs That Contain Acetaminophen

Pain Medications

• Actifed® • Anacin® • Benadryl® • Cepacol® • Contac® • Coricidin® • Dayquil® • Dimetapp® • Dristan® • Elixir® • Excedrin® • Feverall® • Formula 44® • Goody’s® Powders

• Liquiprin®• Midol®• Nyquil®• Panadol®• Robitussin®• Saint Joseph® Aspirin-Free• Singlet®• Sinutab®• Sudafed®• Theraflu®• Triaminic®• TYLENOL® Brand Products• Vanquish®• Vicks®• Zicam®

Some Common Over-the-Counter Drugs That Contain Acetaminophen

Pain Medications Pain MedicationsVicodin (acetaminophen/hydrocodone)Lortab (acetaminophen/hydrocodone)Norco (acetaminophen/hydrocodone)Percocet (acetaminophen/oxycodone)

OxyContin (oxycodone)Ultram (tramadol)

Nucynta (tapentadol)Demerol (meperidine) +(promethazine)

Dilaudid (hydromorphone)Opana (oxymorphone)

Antibiotics

PenVK-500mgsDisp:25 tabs XXVSig: 2 stat, 1q6h

Amoxicillin-500mgsDisp:25 tabs XXVSig: 2 stat, 1q8h

AntibioticsAugmentin-500mgs

(amoxicillin + clavulanate)Disp:25 tabs XXVSig: 2 stat, 1q8h

Keflex (cephalexin)-500mgsDisp:12 tabs XII

Sig: 1q12h

Antibiotics

Cleocin (clindamycin)-150mgsDisp:25 tabs XXVSig: 2 stat, 1q6h

Cipro (ciprofloxacin)- 250mgsDisp:12 tabs XII

Sig: 1 q12h

AntibioticsFlagyl (metronidazole)-250 mgs

Disp: 21 Tabs XXISig: 1 tab q8h

Z-Pak (azithromycin)- 250mgsDisp:1 dose pack

Sig: 2 stat, 1 daily next 4 days

Antibiotics

Minocin (tetracycline)- 100mgsDisp:25 tabs XXV

Sig: 1 q12h

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Antibiotic Use in 2016 by Members of the AmericanAssociation of Endodontists: Report of a National Survey

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Highlights• AAE members were surveyed about their antibiotic prescribing practices.• Amoxicillin prescribing has significantly increased and penicillin decreased.• Regional differences in antibiotic prescribing practices exist in the US.• Thirty-seven percent reported prescribing antibiotics that are not necessary.

AbstractIntroductionThis study surveyed the antibiotic prescribing practices of endodontists, and data were compared with previoussurveys conducted in 1994 and 1999.

MethodsA 17-question survey was sent via www.surveymonkey.com to 3000 active members of the AmericanAssociation of Endodontists for responses about antibiotic prescribing practices and demographics. The datawere analyzed using descriptive statistics, chi-square tests, and linear regression analyses.

ResultsSix hundred eighty-six participants (22.86%) completed the survey. The most frequently prescribed antibioticswere amoxicillin (60.71%) followed by penicillin V (30.43%) and clindamycin for patients with allergies (95.4%).Respondents reported prescribing antibiotics for irreversible pulpitis with mild symptoms (1.75%), irreversiblepulpitis with moderate symptoms (6.41%), necrotic pulp with symptomatic apical periodontitis (43.59%),chronic apical abscess without (10.50%) or with symptoms (29.74%), acute apical abscess (95.92%), avulsion(70.26%), endodontic surgery (41.69%), retreatment (silver point [23.76%] or gutta-percha [15.60%]),postoperative pain after instrumentation or obturation (12.39%), and perforation repair (5.98%). The type ofpractice (solo/group) and geographic region (Southeast) were significant predictors of increased antibioticprescribing; 36.89% of respondents reported prescribing antibiotics that are not necessary, most commonlybecause of patient expectations.

ConclusionsSince 1999, there has been a significant shift from prescribing penicillin V to amoxicillin as endodontists' firstchoice of antibiotic and a significant increase in the use of clindamycin for penicillin-allergic patients. Antibioticscontinue to be prescribed in clinical situations for which they are typically not indicated, most commonlybecause of patient expectations. Regional differences in antibiotic prescribing practices by endodontists existin the United States.

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< Previous Article Next Article >October 2017 Volume 43, Issue 10, Pages 1615–1622

Mark Germack, DDS Christine M. Sedgley, MDS, MDSc, PhD Wael Sabbah, BDS, DDPH, MSc, PhDBrian Whitten, DDS

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Conclusions Since 1999, there has been a significant shift from prescribing penicillin V to amoxicillin as endodontists' first choice of antibiotic and a significant increase in the use of clindamycin for penicillin-allergic patients. Antibiotics continue to be prescribed in clinical situations for which they are typically not indicated, most commonly because of patient expectations. Regional differences in antibiotic prescribing practices by endodontists exist in the United States.

AAE Guidance on the Use of Systemic Antibiotics in Endodontics | Page 1

AAE Position Statement

INTRODUCTION

The spectrum of endodontic pathosis includes many conditions for which

dentists and endodontists determine that it is appropriate to prescribe

antibiotics. Some of these conditions involve purely an inflammatory

reaction, and some involve various stages of infection. This infection may

be localized to the pulp and periapical tissues, and it may be spreading

to regional lymph nodes, or systemically. This document is intended to

present the available evidence related to prescribing antibiotics, highlight

appropriate clinical recommendations and identify gaps in knowledge for

which personal judgment is the best guide for assessing risks and benefits in

this practice.

This document is not intended to be an exhaustive systematic review on

the subject. It will also not address the systemic or topical application of

antibiotics following traumatic injuries to teeth (which are addressed in

other AAE guidelines), and the use of antibiotics as intracanal medicaments.

Finally, this document is not intended to present new knowledge in the field.

Overall risks and benefits of prescribing systemic antibioticsAntibiotics are an important class of drugs. Clearly, the benefits of correct use

of antibiotics include the resolution of infection, prevention of the spread of

disease and minimization of serious complications of disease. Up to 50% of all

antibiotics are prescribed or used incorrectly. Risks associated with the use of

antibiotics include nausea, vomiting, diarrhea and stomach cramps because of

the disturbances of the gut microflora.

A particular concern to the use of oral antibiotics is the development of

Clostridium difficile infection. C. difficile was responsible for almost half a

million infections and was associated with approximately 29,000 deaths

in 2011 (1). Among the antibiotics prescribed for endodontic infections,

clindamycin, amoxicillin, cephalosporins are commonly associated with C. difficile infection, whereas macrolides and metronidazole are less commonly

so (2). Other side effects include the development of yeast infections in the

mouth or vagina, again resulting from an imbalance in the body’s normal flora.

Antibiotics can also cause allergic reactions ranging from rash, skin reactions,

Stevens-Johnson syndrome to breathing difficulty and anaphylaxis.

About This DocumentThis paper is designed to provide scientifically based guidance to clinicians regarding the use of antibiotics in endodontic treatment. Thank you to the Special Committee on Antibiotic Use in Endodontics: Ashraf F. Fouad, Chair, B. Ellen Byrne, Anibal R. Diogenes, Christine M. Sedgley and Bruce Y. Cha.

©2017

Distribution Information

AAE members may reprint

this position statement for

distribution to patients or

referring dentists.

AAE Guidance on

the Use of Systemic

Antibiotics in

Endodontics

The guidance in this statement is not intended to substitute for a clinician’s independent judgment in light of the conditions and needs of a specific patient.

AAE Guidance On Use of Systemic Antibiotics

AAE Quick Reference Guide on Antibiotic Prophylaxis 2017 Update | Page 1

AAE Quick Reference Guide

Endocarditis Prophylaxis RecommendationsThese recommendations are taken from 2017 American Heart Association and American College of Cardiology focused update of the 2014 AHA/ADA Guideline for Management of Patients with Valvular Disease (1) and cited by the ADA (2).

Prophylaxis against infective endocarditis is reasonable before dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa in patients with the following:

In 2017, the AHA and American College of Cardiology (ACC) published a focused update (5) to their previous guidelines on the management of valvular heart disease. This reinforced their previous recommendations that AP is reasonable for the subset of patients at increased risk of developing IE and at high risk of experiencing adverse outcomes from IE (5). Their key recommendations were:

1. Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts.

2. Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.

3. Previous IE.4. Unrepaired cyanotic congenital heart disease or repaired congenital

heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device.

5. Cardiac transplant with valve regurgitation due to a structurally abnormal valve.

Distribution Information

AAE members may reprint this position statement for distribution to patients or referring dentists. Antibiotic Prophylaxis

2017 Update

The guidance in this statement is not intended to substitute for a clinician’s independent judgment in light of the conditions and needs of a specific patient.

About This DocumentThis paper is designed to provide scientifically based guidance to clinicians regarding the use of antibiotics in endodontic treatment. Thank you to the Special Committee on Antibiotic Use in Endodontics: Ashraf F. Fouad, Chair, B. Ellen Byrne, Anibal R. Diogenes, Christine M. Sedgley and Bruce Y. Cha.

©2017

Infective Endocarditis Prophylaxis

For infective endocarditis prophylaxis, current guidelines support premedication for a relatively small subset of patients. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor.

The current infective endocarditis/valvular heart disease guidelines state that use of preventive antibiotics before certain dental procedures is reasonable for patients with:

• prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts;

• prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords;

• a history of infective endocarditis; • a cardiac transplant with valve regurgitation due to a structurally

abnormal valve; • the following congenital (present from birth) heart disease: • unrepaired cyanotic congenital heart disease, including

palliative shunts and conduits • any repaired congenital heart defect with residual shunts or

valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device

Infective Endocarditis Prophylaxis Prosthetic Joint Implants

In patients with prosthetic joint implants, a January 2015 ADA clinical practice guideline, based on a 2014 systematic review states, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.”

Prosthetic Joint Implants

According to the ADA Chairside Guide, for patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription.

3/8/17, 1:19 PMAntibiotics in Endodontics: a review - Segura-Egea - 2017 - International Endodontic Journal - Wiley Online Library

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Review

Antibiotics in Endodontics: a review

First published:16 January 2017 Full publication history

DOI:10.1111/iej.12741 View/save citation

Cited by:0 articles

J. J. Segura-Egea , K. Gould, B. Hakan Şen, P. Jonasson, E. Cotti, A. Mazzoni, H. Sunay, L. Tjäderhane,

P. M. H. Dummer

Browse Early View Articles Online Version of Record published before inclusion in an issue

AbstractThe overuse of antibiotics and the emergence of antibiotic-resistant bacterial strains is a global concern.This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal withoral and dental infections. The aim of this paper was to review the current literature on the indications anduse of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenicinfections, including endodontic infections, are polymicrobial, and in most cases, the prescription ofantibiotics is empirical. This has led to the increasing use of broad-spectrum antibiotics even in caseswhere antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localizedacute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage

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AbstractThe overuse of antibiotics and the emergence of antibiotic-resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad-spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.

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