Treatment Of Infected Root Canals Research Articles

CHEMICAL BURN ON CHILDREN PATIENT DUE TO IATROGENIC OF CRESOPHENE DURING ROOT CANAL TREATMENT

Introduction: Chemical burns are injuries to the oral mucosa caused by the application of corrosive topical materials. Chemical trauma or chemical burns are one cause of mouth ulcers. Cutaneous and perioral skin chemical burn clinically, erythema, burning sensation, edema, desquamation, and ulcers. Case: A 6-year-old child patient complained of a burning sensation in the corner of the left lip during a treatment of root canal treatment using cresophene. Treatment: Patient was given a topical application of aloe vera extract dental gel, and was prescribed the same drug. Discussion: Cresophene is an antimicrobial agent used for infected root canal treatment. Cresophene is an agent antimicrobial class of phenol compounds, because it contains phenol, cresophene have antibacterial activity especially on group of gram positive bacteria. The clinical appearance of chemical burns depends on the severity of the tissue damage, the destructive properties, and mode of application of the causative agent. Aloe vera taken in a variety of dosage forms may be useful in accelerating the wound healing process and tend to raise the rate of success of healing and the rate of epithelialization in first and second burns.

Cauterization of Narrow Root Canals Untouched by Instruments by High-Frequency Current.

The mechanical removal of bacteria is fundamental to the treatment of infected root canals, but complete sterilization of biofilms tends not to extend to uninstrumented areas. However, during electrical conduction to a root canal filled with a conductor, the higher impedance where the root canal is narrower generates Joule heat that may result in a large temperature increase and sterilization. The effect of a high-frequency electric current on the wall of a simulated narrow root canal was investigated by scanning electron microscopy (SEM) and energy dispersive X-ray spectrometry (EDS). Simulated root canals, 0.1 mm in diameter, were prepared in dentine blocks. The root canal wall was treated with Plank-Rychlo solution for 5 min to create a decalcified layer. The simulated root canal was filled with either saline or NaClO, and 150 or 225 V at 520 kHz was applied for 0 s, 1 s, or 5 s. As the conduction time increased, and when the saline was replaced with NaClO, the proportion with a flat decalcified surface decreased, dentinal tubules and a lava-like morphology were significantly more evident on SEM (p < 0.01), and EDS showed significant decreases in carbon and oxygen and increases in calcium (p < 0.01). It was concluded that filling uninstrumented root canals with NaClO and using electrical conduction for 5 s could incinerate and eliminate the organic material of the root canal wall. The application of high-frequency electric current may lead to the cure of many cases of persistent apical periodontitis.

Microstructural analysis of accessory canals in the furcation area of the mandibular first molar using micro-computed tomography

Introduction: Accessory canals in the furcation area (ACF) can be seen to provide routes of communication joining the dental pulp and periodontal tissue and be considered a cause of endodontic-periodontal disease. However, many points remain unknown concerning the three-dimensional morphology of ACFs as well as their locations and incidences in different types of teeth. The aim of this study was to examine the three-dimensional structure of ACFs using ultra-high-resolution micro-computed tomography (micro-CT), and their incidence on the basis of the existing classification system. Materials and Methods: Ninety-six Japanese mandibular first molars were grouped according to age, with those extracted from individuals <20 years old at the time of extraction classed as “junior” and those from individuals ≥20 years old at the time of extraction as “senior.” Regions of interest were designated for vertical and horizontal observations. Collected specimens were scanned in micro-CT, and three-dimensional reconstruction and morphological analyses were carried out. The morphological classification of ACFs of Yoshida et al. was followed. After classification, the prevalence of teeth with ACFs and the total numbers and percentages of ACFs in each type were calculated. Mann–Whitney U-tests were used for the statistical analysis of numbers of ACFs, with values of P < 0.05 regarded as significant. Results: Ninety-five molars showed at least one accessory canal. Accessory canals were present in 98.0% of junior and 100% of senior individuals. Types 3 and 6 were the most commonly found in the furcation area. Junior showed significantly more accessory canals per tooth than senior (P < 0.05). Conclusions: ACFs were present in the vast majority of specimens of both junior and senior teeth. This result suggested that clinically, affecting endodontic-periodontal disease as well as the presence of ACFs may impact reinfection after infected root canal treatment.

Comparison Of An Experimental Root Canal Irrigant (Sapindus Mukorossi) And Ethylenediaminetetraacetic Acid On Microhardness Of Human Dentin.

The treatment of infected root canals is one of the most essential areas in dentistry. The endodontic therapy comprises of a sequence of steps that includes the purging of disease and infectious tissues from the root canal system. The objective of the study is to compare the effect of an experimental herbal root canal irrigant (Sapindus mukorossi) and Ethylenediaminetetraacetic acid, on the micro hardness of human dentin. Ninety single rooted teeth were collected displayed intact external morphology the selected teeth were than divided randomly into 3 groups (n=30); 1 control and 2 experimental groups: Group A consisted of specimen treated with Ethanolic extract of Sapindus mukorossi. Group B consisted of specimen treated with 17% Ethylenediaminetetraacetic acid and Group C (control group) consisted of specimen of roots were sectioned immersed in distilled water. After the removal of crowns, the roots were sectioned embedded in the polymer resin leaving the root dentine exposed, the micro hardness was determined. Then, the samples from each group were treated with respective irrigant solution for 15 minutes and then observation regarding the micro hardness were noted again by using Vickers micro hardness tester. Analysis of data were obtained by application of Wilcoxon signed rank test. The study revealed that there was no significant difference noted in dentin microhardness of group "A" sample after dipping in experimental irrigant solution (Sapindus mukorossi). However, the study found significant difference in context of decrease in dentin microhardness after dipping a sample in a group "B" irrigant solution (17% Ethylenediaminetetraacetic acid). In order to preserve the strength of dentin that will ultimately be beneficial for increase in survival of teeth in function, probably the herbal extract of Sapindus mukorossi would be better candidate for future endeavour and presented as an economic and effective alternative amongst root canal irrigants.

Role of nanotechnology in endodontics

Nanotechnology is the advance science exploiting phenomena and direct manipulation of materials on the nanoscale. It can bring tremendous changes in the fields of medicine and dentistry. In dentistry, there is widespread recognition of microbial as the contributory factor for dental infection. Treatment of infected root canals presents with a significant challenge of bacterial persistence after treatment. Antibacterial Nanoparticles based treatment can improve the antibiofilm efficacy. A day may soon come when Nano dentistry will succeed in maintaining near-perfect oral health through the aid of nanorobotics and nanomaterials.

Digital Planning on Guided Endodontics Technology.

The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism's control represent risk factors for failure after the infected root canal's treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software's, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

INVESTIGATION OF ANTIBACTERIAL ACTIVITY OF ND: YAG - LASER AND STANDARD ENDODONTIC TREATMENT

Introduction: The microbial infection is one of the main causes of the dental pulp and periodontal diseases. Previously used methods for its elimination are not fully effective, and often some microorganisms in root canals (RC) remain unaffected after treatment. Another modern method for disinfection of root canal system is laser disinfection. Different types of lasers are used - Nd: YAG, Er: YAG, Diode laser. Purpose: The purpose of our study is to compare the antibacterial activity of ND: YAG laser and conventional endodontic therapy in the treatment of infected root canals. Materials and methods The study involved 36 teeth of patients diagnosed with pulp gangrene or chronic periapical periodontitis, requiring endodontic treatment. They were divided into two groups of 18 teeth each one. The teeth in both groups are prepared by Protaper Universal rotary instruments (Maillefer Instruments SA, Ballaigues, Switzerland). In group 1the root canals disinfection is performed with a Nd: YAG laser (source of Nd: YAG laser (1064 nm) is the AT Fidelis - Fotona d.d., Ljubljana laser system). In group 2 was used the following protocol of root canal disinfection: 2.5% sodium hypochlorite solution and 17% EDTA divided by irrigation with distilled water. Then a sterile paper point is placed in the root canals, and a microbiological sample is taken again. Results: In all compared pairs, there was no significantly different effect regarding the number of microorganisms. Conclusions: The disinfection rinsing method with NaOCl has the strongest antimicrobial effect in clinical studies (90% against all microbial isolates). The use of Nd: YAG laser independently is not always sufficient for root canal disinfection - the effect is about 66%.

COMPARATIVE STUDY OF ANTIBACTERIAL ACTIVITY OF PHOTOACTIVATED DISINFECTION WITH FOTOSAN AND STANDARD ENDODONTIC TREATMENT

Introduction: The purpose of endodontic treatment is to eliminate the bacterial infection in the root canal system and allow healing of apical periodontitis. Sometimes the anatomical complexity of the root canal system makes complete removal of bacteria almost impossible even if the conventional methods of chemo-mechanical debridement are performed strictly according to the protocol. So additional methods of root canal disinfection can be applied such as photoactivated disinfection (PAD). Purpose: The aim of our study was to compare the antibacterial activity of PAD with FotoSan, and conventional endodontic therapy in the treatment of infected root canals. Materials and methods: The study involved 36 teeth of patients who are diagnosed with pulp necrosis or with the periapical chronic periodontitis and require endodontic treatment and divided into two groups of 18 teeth each. The first microbiological sample was taken by placing a sterile paper point in the root canal, after endodontic access cavity preparation. All root canals are prepared by Protaper Universal rotary instruments (Maillefer Instruments SA, Ballaigues, Switzerland). In the first group, the disinfection of the root canals was made with photoactivated disinfection with FotoSan. In the second group was performed the endodontic treatment with the standard protocol of irrigation - 2.5% sodium hypochlorite solution and 17% EDTA. After that, the root canals are dried with sterile points, and a second microbiological sample is taken. Results: In all compared pairs, there was no significantly different effect regarding the number of microorganisms. Conclusions; The disinfection with NaOCl has the strongest antimicrobial effect in this study. Second place is occupied by PAD with FotoSan. We believe that the established antimicrobial effect of PAD make the method appropriate as complementary to routine endodontic treatment.

A case of infected root canal treatment of a mandibular first molar with a perforated floor of the pulp chamber, and a middle mesial canal

A case of infected root canal treatment of a mandibular first molar with a perforated floor of the pulp chamber, and a middle mesial canal

Effect of Bioactive Glass-Based Root Canal Sealer on the Incidence of Postoperative Pain after Root Canal Obturation.

The purpose of this study is to evaluate the effect of a bioactive glass-based root canal sealer, Nishika Canal Sealer BG (CS-BG), on the incidence of postoperative pain (PP) after root canal obturation (RCO). Eleven dentists performed pulpectomy or infected root canal treatments for 555 teeth. During RCO, CS-BG was used. After RCO, the rate of PP and the factors affecting PP (pain during RCO and pain immediately after RCO) were analyzed. PP was observed in eight teeth (1.5%), and within 7 days after RCO, there were no teeth with pain. In these teeth with PP, there was a significant difference in the occurrence of pain during RCO, but not in the occurrence of pain immediately after RCO, when compared with pulpectomy and infected root canal treatment. These clinical results show that CS-BG has an excellent biocompatibility, and can suppress the distress of patients during RCO.

Effectiveness of rotary and reciprocating systems on microbial reduction: A systematic review.

Introduction:The role of microorganism and their products in the initiation, propagation, and persistence of periradicular periodontitis has been established. One of the major goals of the treatment of infected root canals of teeth with apical periodontitis is to promote maximal reduction in the intracanal bacterial populations. Engine-driven nickel-titanium instruments possess the latest generation of root canal instruments. The possible benefit of rotary instrumentation over other instrumentation techniques regarding cleaning and disinfecting effects would be irrigant warming and/or turbulence caused by the mechanical rotation of instruments. Furthermore, reciprocating instrument has been introduced for root canal preparation. It has been shown that instruments subjected to reciprocation have increased resistance to fatigue and longer usual life when combined with instruments used in continuous rotation motion. The reciprocating system uses single-file instrumentation technique which can shape and clean the canal in a shorter period and together with the lesser amount of antimicrobial agent.Objective:The objective of this study is to compare and evaluate the microbial reduction of rotary and reciprocating systems on microbial reduction.Search Strategy:A search was performed in Electronic databases (i.e., PubMed, Cochrane library, Science direct, Lilac, Sigle) using following search terms alone and in combination by means of PubMed search builder from January 1985 to December 2017.Selection Criteria:Studies were selected if they met the following criteria: In vivo studies comparing rotary and reciprocating system in asymptomatic apical periodontitis patients.Main Results:The results showed that the reciprocating system exerted an almost similar antibacterial effect when compared with the rotary system.Conclusion:The present systematic review does not provide concrete evidence to show increased antibacterial efficacy of reciprocating system as compared to the rotary system. Furthermore, clinical trials are required to evaluate the efficacy of various instrumentation systems in reducing bacteria from the root canal system.

Ozony Tron®の歯内療法処置への応用 : オゾンの感染根管治療に対する殺菌効果について

Ozony Tron®の歯内療法処置への応用 : オゾンの感染根管治療に対する殺菌効果について

A confusing endodontic case with retrograde periodontitis.

Endodontic-periodontal lesions are often observed in clinical situations. Although endodontic-periodontal lesions are encountered, they may pose difficulties for the clinician in diagnosis and may complicate the treatment. Diagnosis is often challenging because these diseases have been primarily studied as separate entities, and each primary disease may mimic the clinical characteristics of the other disease. In this report, a simple classification of endodontic-periodontal lesions is demonstrated, and presents a case of endodontic-periodontal disease in an immature tooth with a vertical bone defect showing retrograde periodontitis in which successful results were obtained by using infected root canal treatment and apexification with Vitapex? containing calcium hydroxide.

Culture-dependent approaches to explore the prevalence of root canal pathogens from endodontic infections

Endodontic infections are considered to be caused by the presence of various microorganisms within the root canal system. Recognition of this microbiota contributes to the successful treatment of infected root canals. This study investigated the microorganisms associated with primary and secondary endodontic infections via culture methods, biochemical tests, and molecular approaches in an Iranian population. Microbial specimens were collected from 36 patients with primary endodontic infection and 14 patients with a history of root canal therapy. Advanced microbiological culture techniques were used to isolate microbiota; subsequently, biochemical tests and 16S ribosomal RNA gene sequencing were performed to identify the microorganisms. Within the total 218 cultivable isolates, Veillonella parvula (20.6%) was found to occur with the highest frequency in primary endodontic infection, followed by Porphyromonas gingivalis (14.1%), and Aggregatibacter actinomycetemcomitans (9.2%). Enterococcus faecalis (36.6%) was the most predominant microorganism in secondary endodontic infections, followed by Candida albicans, Propionibacterium acnes, and V. parvula with frequencies of 20%, 2%, and 2%, respectively. It was concluded that V. parvula and E. faecalis was most frequently found in primary and secondary endodontic infections, respectively.

CLINICAL EFFECTIVENESS OF TREATMENT THE PATIENTS WITH CHRONIC APICAL PERIODONTITIS

Background. The success of endodontic treatment is provided by a thorough instrumental and antiseptic treatment of infected root canals, and it depends on the composition of filling material, the degree of adhesion to dentin, hermetic obturation of apical foramen, solubility of sealer.Objective. The study was aimed to evaluate the effectiveness of root canal obturation with BioRootTM RCS sealer in the treatment of patients with chronic apical periodontitis.Materials and methods. Endodontic treatment of 23 teeth in 20 patients with chronic apical periodontitis by method of lateral compaction of gutta-percha was carried out. In the main group root canals were obturated with BioRootTM RCS, in the control group the canals were filled with Apexit Plus. The percentage of efficient or non-efficient cases was evaluated on the basis of radiographic comparison of treated chronic apical periodontitis immediately after obturation, in three, six months and one year. Radiographic conditions were defined as existing state, improvement and worsening.Results. In a year of dynamic evaluation the final results were: in the main group – 54.55% of the patients had complete bone healing, in 27.27% of cases the focus of bone destruction was decreased by ½ or more of the initial sizes, 18.18% – resorption lesion was decreased by less than ½; in the control group – 33.33% of improvement, 25.0% of existing state and 41.66% of worsening.Conclusions. BioRootTM RCS using for root canals obturation in the treatment of chronic apical periodontitis we proved the high effectiveness of the treatment undertaken: complete healing or improvement of radiographic conditions of periapical bone destruction with X-ray signs of bone regeneration.

Bacteremia after Endodontic Procedures in Patients with Heart Disease: Culture and Molecular Analyses

IntroductionInfective endocarditis (IE) is still associated with high mortality, and antibiotic prophylaxis strategies are under intense debate. We evaluated the incidence of bacteremia after root canal preparation in teeth with necrotic pulps and apical periodontitis. MethodsBlood samples were taken before and 5 and 30 minutes after endodontic treatment in teeth with apical periodontitis from individuals at high (n = 21) or no risk (n = 11) for IE. The former received prophylactic antibiotic therapy. Bacteriologic samples were taken from root canals before chemomechanical preparation to confirm pulp infection. Samples were subjected to aerobic and anaerobic culture and quantitative real-time polymerase chain reaction (qPCR), the latter to determine the total bacterial and streptococcal levels. ResultsCulture revealed no bacteremia in all individuals. Analysis by qPCR showed that bacterial DNA occurred in all root canal samples. qPCR showed a similar incidence of bacteremia between patients who received or did not receive prophylactic antibiotic therapy (P > .05). In blood samples taken 5 minutes after endodontic procedures, bacteria were detected in 2 of 11 (18%) individuals not taking antibiotics and in 4 of 21 (19%) patients under prophylaxis. After 30 minutes, the incidence of bacteremia decreased to 2 of 21 (10%) in patients taking antibiotics and was undetectable in patients at no risk of IE. The incidence of bacteremia by streptococci was identical as that for total bacteria. ConclusionsNo detectable bacteremia was evident by culture after treatment of infected root canals. Molecular analysis revealed bacterial DNA and streptococci in blood from some patients without a significant difference between individuals receiving or not receiving antibiotic prophylaxis.

Antibacterial effect of chlorhexidine-cetrimide combination, Salvia officinalis plant extract and octenidine in comparison with conventional endodontic irrigants.

The aim of the present study was to compare the antimicrobial effect of sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), a CHX/cetrimide solution (CHX+CTR), octenidine hydrochloride (OCT) and Salvia officinalis plant extract against Enterococcus faecalis. Seventy decoronated single-rooted human teeth were infected and divided into 6 test (n=10) and 2 control groups (n=5) (negative, sterile samples and positive, infected samples). Following irrigants were then applied to test groups: 2.5% NaOCl, 5.25% NaOCl, CHX, CHX+CTR, S. officinalis extract and OCT. The dentin chips were obtained from inner root canal walls and analyzed by counting the number of colony forming units (CFU). The 2.5% NaOCl, 5.25% NaOCl, CHX and OCT groups presented no bacterial growth (CFU=0). S. officinalis and CHX+CTR groups reduced the number of E. faecalis cells but could not eliminate all. OCT may have potential as an endodontic irrigant in treatment of infected root canals.

Antibacterial effect of triantibiotic mixture versus calcium hydroxide in combination with active agents against Enterococcus faecalis biofilm.

The aim of the present study was to compare the antibacterial effect of calcium hydroxide (CH), triantibiotic mixture (TAM), and CH in combination with chlorhexidine (CHX), sodium hypochlorite (NaOCl) or colchicine (COL) against Enterococcus faecalis (E. faecalis) in surface and deep dentinal tubules. Seventy five fresh single-rooted human teeth were infected and divided into five experimental groups (n=15). The experimental groups were treated with CH+distilled water, CH+CHX, CH+NaOCl, CH+COL+distilled water and TAM+distilled water. Dentin chips obtained from surface and deep dentin of these root canals were prepared and analyzed by counting the number of colony forming units. There was significant difference between groups in the surface dentin (p<0.05). TAM showed higher antibacterial activity compared to CH-containing groups. There was no significant difference between TAM and CH-containing groups in the deep dentin (p>0.05). CH-containing medications and TAM can be used as effective disinfectants in treatment of infected root canals.

Reconsideration of infected root canal treatment

Reconsideration of infected root canal treatment

Infected root canal treatment with systemic administration of antibiotics based on susceptibility test : A case report

Infected root canal treatment with systemic administration of antibiotics based on susceptibility test : A case report