Use Of Hand Instruments Research Articles

Investigation of the efficacy of different Ni-Ti systems on acrylic blocks for correcting ledge formation

BackgroundThe aim of this study was to compare the efficacy of K-type stainless steel hand instruments (Mani Inc. ), Fanta AF™ Ledge Correction (LC) (Fanta Dental), and Hyflex EDM (Coltene-Whaledent) for ledge correction, canal transport, centric ability, and shaping (preparation) time after an artificial ledge has been bypassed manually in highly curved canals using acrylic blocks.MethodsForty-two resin blocks, each with a radius of 5 mm (Endo Trainer Block, VDW) and an apical inclination of 55°, were used. Under stereomicroscope magnification, standard artificial ledges were created on acrylic blocks, and attempts were then made to eliminate them using hand instruments, FantaAF™ LC, and Hyflex EDM. Before and after images were obtained using a stereomicroscope and compared using Photoshop.ResultsFanta AF™ LC and Hyflex EDM were found to be more effective for correcting ledges than hand instruments. The use of hand instruments resulted in the greatest transportation away from the canal curvature in the apical area. The canal shaping was completed in the shortest amount of time using Fanta AF™ LC, followed by HyFlex EDM and then the hand instruments.ConclusionIn terms of centric ability, the order from best to worst is as follows: Fanta AF™ LC, Hyflex EDM, and hand instruments. After the ledge was manually bypassed with hand instruments in the root canals, Hyflex EDM and Fanta AF™ LC were found to be more effective than hand instruments in reshaping the previously unreachable region between the ledge and the foramen apical.

C-Shaped configuration of the canal in mandibular molars: A case report

The primary concern of this case report is to discuss and review the different etiological features of c shaped canals, with its incidence, along with anatomical features, diagnosis and management of the c shaped configuration of the canal in the molars of the mandibular arch. Literature revealed that c shaped canal configuration is slightly a different variation that has a predilection towards the racial and most of the times or most commonly is seen in mandibular molars that too most commonly in second molar of the mandibular arch. This morphology when present in the canal may posses difficulty in shaping of the canal, cleaning of the canal as well as debridement of the canal along with obturation of the canal. The one of the most common way in the management of this c shaped canal morphology is done by with the help of usage of rotary instruments and can also with the use of hand instruments that too assisted with sonics as well as ultrasonics.

Severe Hallux Valgus Angle Attended With High Incidence of Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Follow-Up Study

The incidence of nonunion after first metatarsophalangeal joint (MTP-1) arthrodesis was found to be high in our clinic. By raising awareness for the problem, making a uniform surgical treatment protocol, banning the commonly used convex-concave reamers, and promoting solely the use of hand instruments to prepare the joint for arthrodesis, we tried to decrease the numbers of nonunion. This prospective cohort study included all patients who underwent MTP-1 fusion between January 2018 and March 2019. Patients were treated according to a standardized protocol, using hand instruments to prepare the joint for fusion. Anthropometric and therapy-related data were collected and compared with an earlier 2015–2016 cohort that was retrospectively assessed. Furthermore, the frequency of nonunion between convex-concave reamers and hand instruments was compared. A total of 53 patients underwent MTP-1 fusion surgery. The incidence of nonunion was 3.8%, significantly lower than the 24.1% in 2015 to 2016 (p = .002). Multivariate regression analysis showed a 7.11 times higher risk of nonunion in 2015 to 2016 compared with 2018 to 2019 (95% confidence interval [CI] 1.55 to 32.55) (p = .012). Furthermore, an increase of 10° in HVA showed a 1.52 risk of occurrence of nonunion (95% CI 1.07 to 2.17) (p = .021). The use of convex/concave reamers was univariately associated with a 3.61 times higher risk of nonunion (95% CI 1.14 to 11.43) (p = .029); however, after correction for preoperative HVA, the preparation method was no longer associated with the occurrence of nonunion (p = .108). Patients suffering from severe hallux valgus had nonunion in 32.1% of cases. Incidence of nonunion after MTP-1 arthrodesis was significantly reduced by raising awareness and by standardizing the treatment protocol. There was no significant difference in nonunion frequency between the methods of joint surface preparation. Severe hallux valgus is prone to nonunion, and more research into this indication for MTP-1 fusion and outcome is needed.

Graduate and Undergraduate Teaching of Primary Tooth Pulpectomy: A Comparison among Brazilian Dental Schools

Objective: To compare the teaching of the pulpectomy in primary teeth among graduate and undergraduate Brazilian dental schools. Material and Methods: From August 2015 to July 2016, an 11-question survey was sent to 44 graduate and 207 undergraduate dental schools. Data obtained were summarized using descriptive statistics. Results: The response rate was higher from graduate (56.8%) than undergraduate (41.1%) courses. Pulpectomy was taught by all participating schools. More than 90% of the undergraduate and graduate courses recommend the use of hand instruments for canals debridement, but the widening of root canals was advised in 69.4% of undergraduate and in 84% of graduate schools. Regarding the irrigatings, 1% sodium hypochlorite as a single irrigating solution was the most taught for both biopulpectomy and necropulpectomy. The iodoform-based Guedes-Pinto paste as the single indication was the preferred root canal filling material in undergraduate schools (30.6%), while the zinc oxide-thickened calcium hydroxide paste as the single option was the most recommended in graduate courses (36%). Endodontic hand file associated with lentulo drill for filling root canals was recommended by most courses. Overall, biopulpectomy was performed in one session, while necropulpectomy led two sessions. Periapical radiograph for diagnosis and final obturation was the most adopted conduct by undergraduate (68.2%) and graduate (72%) schools. Gutta-percha and glass ionomer cement were preferred materials to seal the entrance of the pulp chamber. Conclusion: There was variability in the techniques and materials taught to perform pulpectomy in primary teeth among Brazilian graduate and undergraduate dental schools. Calcium hydroxide paste has been used in similar proportion to iodoform-based paste.

Reduction of dental fear and anxiety: the outlook of atraumatic restorative treatment

AIM: This study aimed to report a case in which the technique used was the atraumatic Restorative Treatment (ART) in patients with fear of conventional treatment. MATERIAL AND METHODS: This procedure consisted in the treatment of carious lesions in the patient associated with the program of educational and preventive measures which the patient has undergone. The technique described here was performed on tooth 85, which presented atypical carious lesion cavity, through the removal of softened carious tissue with the use of hand instruments, without anesthesia and use of direct restorative material with fluoride release (glass ionomer cement). RESULTS: As a result of this technique, there was greater patient cooperation and decrease of anxiety initially revealed. CONCLUSION: Thus, it might be concluded that the Atraumatic Restorative Treatment is a technique already established that showed clinical effectiveness in controlling the evolution of the carious process and that being well indicated, was able to induce more cooperation from the patient, leading to the success of therapy restorer. The conventional glass ionomer cement showed excessive surface wear and therefore should not be used to restore atypical cavities.

Removal of simulated biofilm: a preclinical ergonomic comparison of instruments and operators.

Periodontal scaling might cause musculoskeletal disorders, and scaling instruments might not only have different effectiveness and efficiency but also differ in their ergonomic properties. The present study assessed ergonomic working patterns of experienced (EO) and less experienced operators (LO) when using hand and powered devices for periodontal scaling and root planning. In an experimental study using periodontally affected manikins, sonic (AIR), ultrasonic (TIG) and hand instruments (GRA) were used by 11 operators (7 EO/4 LO) during simulated supportive periodontal therapy. Using an electronic motion monitoring system, we objectively assessed the working frequency and positioning of hand, neck and head. Operators' subjective evaluation of the instruments was recorded using a questionnaire. Hand instruments were used with the lowest frequency (2.57 ± 1.08s(-1)) but greatest wrist deviation (59.57 ± 53.94°). EO used instruments more specifically than LO, and generally worked more ergonomically, with less inclination of head and neck in both the frontal and sagittal planes, especially when using hand instruments. All groups found hand instruments more tiring and difficult to use than powered instruments. Regardless of operators' experience, powered instruments were used more ergonomically and were subjectively preferred compared to hand instruments. The use of hand instruments has potential ergonomic disadvantages. However, with increasing experience, operators are able to recognise and mitigate possible risks.

English

ABASTRACT: Atraumatic Restorative Treatment (ART) was originally developed in field settings in African subcontinent (Tanzania) by University of Dar el Salaam in 1980s; subsequently World Health Organization (WHO) promotes the use of ART especially with children. As the name indicates Atraumatic Restorative Treatment (ART) is basically a minimally invasive procedure that involves removing of softened carious dentine using hand instruments and then restoring the cavity with an adhesive material usually the Glass Ionomer Cement [1]. ART is based on the maximum preservation of sound tooth tissue and the minimum feeling of discomfort and pain, since there is use of hand instruments it perhaps also reduces pain due to reduced vibrations as occurs while use of rotary dental instruments. This technique is gaining popularity and acceptability especially in children, elderly and with those individuals who have fear and anxiety about dental treatment [2, 3]. ART requires use of very minimal portable dental equipment and was designed to use in field/community settings. It was developed for use in less developed countries of the world, where art was seen as an affordable option for patents who can’t afford to pay for more sophisticated treatments, but with improved technique and use of improved restorative materials its use has considerable expanded to developed countries as well [4-6]. This article gives a brief overview of ART and its uses in the present scenario.

The correct use of the ART approach

Confusion exists amongst dentists and scientists about the correct use of the caries management approach termed atraumatic restorative treatment (ART). Inconsistent use of the original definition of ART and suggested modifications (mART) have led to misunderstanding, misconception and miscommunication in the dental literature over the last decade. The aim of this paper is to contribute to a uniform understanding and use of the term ART. Adherence to its original description is suggested and two major aspects were addressed: the use of hand instruments only and the use of adhesive materials and systems.

Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial

To compare the effectiveness of scaling and root planing (SRP) with the use of hand instruments to that of non-surgical treatment with the use of an ultrasonic device, using clinical and microbiological criteria. Thirty-three patients with chronic periodontitis participated in this randomized-controlled clinical trial divided into two groups. Patients in the control group received SRP with hand instruments, whereas patients in the test group received ultrasonic debridement (UD). Clinical recordings concerning probing pocket depth, clinical attachment level, plaque index and gingival bleeding index were performed at baseline, 3 and 6 months after baseline. Subgingival samples were analysed using the "checkerboard" DNA-DNA hybridization technique for Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Treponema denticola. Both treatments resulted in a significant improvement in all clinical recordings. Three months after treatment, a numerical decrease was observed for P. gingivalis, T. forsythia and T. denticola in both groups, which was statistically significant only for P. gingivalis (p<0.05). Inter-group differences were observed at 6 months for T. forsythia and T. denticola (p<0.05), favouring SRP. Both treatment modalities provided comparable clinical results in the treatment of chronic periodontitis.

Atraumatic restorative treatment (ART): the Tanzanian experience

Atraumatic Restorative Treatment (ART), which involves the use of hand instruments, is a relatively inexpensive, non-sophisticated, tooth conservative technique that offers the opportunity for restorative work in remote areas without electricity. The objectives of this survey were to evaluate the experience of dental practitioners with ART and the impact of the technique on oral health care in Tanzania, where ART was pioneered. Dental officers (DOs), assistant dental officers (ADOs) and dental therapists (DTs) from different parts of the Tanzania mainland participated in a cross-sectional study that gathered information using a self-administered structured questionnaire. Only 41 (35%) of the 117 respondents were practising ART with only 6.5% of them doing so either "most of the time" or "always". Practising ART was significantly associated with the cadre of the dental practitioner, being higher among ADOs (50%) than DOs (37%) and DTs (20%), and with ART training, but was not related to either working experience or material availability. To date, ART has made little impact on oral health care delivery in Tanzania, where dental extractions still account for over 90% of all forms of dental treatment, and restorative work for less than 5%. Several problems in providing ART were noted, such as limited practical training and practice in ART, scarce resources, and lack of advocacy. An increased involvement and support for ART from the Ministry of Health and professional organisations, and public education of ART is called for.

Radiation-induced root surface caries restored with glassionomer cement placed in conventional and ART cavity preparations: Results at two years

There are no published studies comparing the clinical performances of more-viscous glass-ionomer cement (GIC) restorations when placed using conventional and atraumatic restorative treatment (ART) cavity preparation methods to restore root surface caries. One dentist used encapsulated Fuji IX GP and Ketac-Molar to restore 72 conventional and 74 ART cavity preparations for 15 patients who had received cervicofacial radiation therapy. Two assessors evaluated the restorations at six, 12, and 24 months for retention, marginal defects and surface wear, and recurrent caries. After two years, the cumulative restoration successes were 65.2 per cent for the conventional and 66.2 per cent for the ART cavity preparations, without statistical or clinical significance (P > 0.50). Restoration dislodgement accounted for 82.8 per cent and marginal defects for 17.2 per cent of all failures. There were no instances of unsatisfactory restoration wear or recurrent caries observed. Teeth with three or more restored cervical surfaces accounted for 79.3 per cent of all failures (P < 0.0001). For root surface caries restored with GIC, the use of hand instruments only with the ART method was an equally effective alternative to conventional rotary instrumentation for cavity preparation. Larger restorations had higher failures, usually from dislodgement.

No difference between ultrasonic/sonic and manual debridement for the treatment of chronic periodontitis?

Data sources Data sources were Medline, the Cochrane Controlled Trials Register, Biosis, EMBASE, Health Devices Alerts, Meditec, Russmed articles and Scisearch dated up to April 2001, and reference lists from relevant articles. Study selection Randomised controlled trials were selected if they had at least 6 months’ follow-up and compared machine-driven instruments with hand instruments for the treatment of chronic periodontitis. Data extraction and synthesis Information regarding the quality and characteristics of studies was extracted independently by two reviewers. Kappa scores determined their agreement. Prevention of tooth loss was the primary outcome, with secondary outcomes of prevention of disease progression, resolution of anatomical defects and resolution of gingival inflammation also considered. Efficiency was assessed as the mean time needed to treat one tooth. Qualitative synthesis was conducted for all outcomes except time needed to treat one tooth, where a meta-analysis was performed. Results Thirteen studies were included in the review. No study reported on the selected primary outcome variables. Using the outcome variables of clinical attachment gain, probing pocket-depth reduction or bleeding on probing-reduction, there appeared to be no differences between ultrasonic/sonic and manual debridement. No major differences in the frequency or severity of adverse effects were found. Ultrasonic/sonic debridement was found to take significantly less time, ie, 36.6% of the time for debridement using hand instruments. Conclusions Ultrasonic/sonic subgingival debridement requires less time than use of hand instruments. The data did not indicate a difference between ultrasonic/sonic and manual debridement for the treatment of chronic periodontitis for single-rooted teeth but the evidence is not very strong. High quality trials are needed to assess the efficacy of machine-driven subgingival debridement. Clinical outcome variables that have a tangible benefit to the patients should be used.

The use of hand instruments in supportive periodontal treatment.

The use of hand instruments in supportive periodontal treatment.

River Surveys in Unmapped Territory

There are presented herein methods designed to assist engineers concerned with river-utilization problems in unmapped areas and in areas where stream flow data generally are lacking. The subject is treated under two headings: (a) Short- cut methods adapted to exploratory or reconnaissance surveys which limit engineers to the use of hand instruments, the slide rule, and expedients for estimating river discharge and river gradients; (b) methods of providing reliable surveys of specific local areas and also of providing more extensive maps which include the use of aerial photogrammetric methods. Convenient tables and diagrams are submitted. The hope is expressed that additional methods of this nature may be submitted by other engineers as the fruits of their experience.