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PubMed2004

Endodontic diagnosis. Mystery or mastery?

UNLABELLED: Review of 6 clinical distinctions: (1) Symptom: "anything under the sun." DIAGNOSIS: pulp exposure. Duplicate: clinical or radiographic pulp exposure evidence. TREATMENT: endodontics or pulp cap under strict protocol conditions. (2) Symptom: "cold." DIAGNOSIS: hyperemia. Duplicate: ice. TREATMENT: pulp protection or endodontics. (3) Symptom: "heat." DIAGNOSIS: pulpitis. Duplicate: heat. TREATMENT: pulpotomy for multirooted teeth or pulpectomy for single-rooted teeth. Schedule endodontic completion. (4) Symptom: "I recently had a toothache and now it is gone." DIAGNOSIS: necrosis. Duplicate: Electric Pulp Test and ice are negative. TREATMENT: endodontics. (5) Symptom: "I had a toothache awhile back and now it is gone." DIAGNOSIS: LEO. Duplicate: Electric Pulp Test, ice, and test cavity are negative. TREATMENT: endodontics. (6) Symptom: "It really hurts to touch my tooth." DIAGNOSIS: percussion. Duplicate: may or may not have a LEO and may or may not have cellulitis. TREATMENT: reduce occlusion, access cavity, water chew, and schedule to finish endodontics. If these tests are carefully performed, then they are objective and the doctor does not have to be in a subjective situation. A newfound sense of endodontic diagnostic mastery is experienced. Perhaps the best way to summarize the simplicity of this clinical diagnostic scheme is to quote Sherlock Holmes: "Nothing is more deceptive than the obvious."

Dental Pulp Diseases↗
PubMed2004

[Initial clinic research on curved canal preparation by reverse flaring technique].

OBJECTIVE: Curved canal preparation is much difficult in root canal therapy(RCT). Step back technique and routine technique are still regular methods in curved canal preparation. The purpose of this study was to introduce a new method reverse flaring technique, and to investigate its preparation efficiency in intermediate-curvature canals. METHODS: 48 cases of lower first molars RCT were collected, which were first treated because of pulpitis or apical periodontitis in West China College of Stomatology, Sichuan University from Nov. 2001 to Aug. 2003, mesial canal curvature was intermediate (30 degrees-60 degrees), determined by Schineider method. Cases were divided into two groups, in reverse flaring technique group, canal preparation in 27 cases were finished by reverse flaring technique, 21 cases by step back technique as control. In working length determination and fitting master cone stages, cases in two groups which fit full working length were recorded, determined by radiograph, and analyzed by chi 2 test. RESULTS: In working length determination stage, cases which fit full working length in reverse flaring technique group were significantly more than that of step back technique group (P < 0.05), in fitting master cone stage, cases which fit full working length in reverse flaring technique group were also significantly more than that of step back technique group(P < 0.05). CONCLUSION: In working length determination stage, cases which fit full working length in reverse flaring technique group were significantly more than that of step back technique group (P < 0.05), in fitting master cone stage, cases which fit full working length in reverse flaring technique group were also significantly more than that of step back technique group(P < 0.05).

Adult↗
PubMed2004

[The effect of coronal preflaring on the working length measurement of root canals in molars].

PURPOSE: To study the influence of coronal preflaring of root canal on the working length measurement in molars. METHODS: 48 molars from 47 adult patients with pulpitis were divided into two groups randomly. 74 root canals of 24 molars were examined in Group 1. After preparing an access cavity, the root canal orifices were located. A 15# K-type file was inserted into root canal to detect resistance at the apical region. 75 root canals of 24 molars were examined in Group 2. Before testing the apical resistance,a size 25# and 20# ProFile.06 taper NiTi rotary instrument was used to enlarge the canal orifice and flare the coronal portion of the root canal. After placing 15# K-type files, a radiograph was taken with the bisecting-angle technique. The distance between the tip of the file and the radiographic apex was measured on the radiographs. Statistical analysis of univariate and multiple logistic regression were carried out for analysis. RESULTS: There was a significant difference between the two groups (P<0.05), there were more accurate measurements in Group 2 than in Group 1. No statistical correlation was found between X-ray measurements and age, sex and the position of molars,while there was significant correlation between maxillary molars and mandibular molars (P<0.05). CONCLUSION: Preflaring the coronal portion of the root canals could significantly increase the accurate measurements of the working length of root canals in molars.

Adult↗
PubMed2004

Zinc oxide-eugenol and calcium hydroxide pulpectomies in baboon primary molars: histological responses.

AIM: To compare histological responses to zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pulpectomies in primary molar teeth with inflamed pulps. STUDY DESIGN: This was an experimental study in 17 juvenile baboons (Papio ursinus). METHODS: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 78 primary molars; after 14 days a pulpectomy was performed on the same primary molars with the two root fillings randomly allocated. The root canal openings were then covered with IRM and the cavity filled with amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment. RESULTS: Reaction frequencies in the ZOE-treated versus CH-treated teeth were: no recognisable pulp 89% and 82%, internal root resorption 0% and 1%, external root resorption 11% and 24%, presence of bacteria 5% and 18%, periapical abscesses 24% and 52%. STATISTICS: Fisher's exact probability test showed a statistically significant higher prevalence of periapical abscesses in the CH-treated group (P=0.03, relative risk 2.2). CONCLUSIONS: ZOE pulpectomy is preferred to CH for the treatment of infected pulps in primary molars.

Animals↗
PubMed2005

[Pain during and after root canal treatment].

Toothache can be prevented or remedied with a root canal treatment. Unfortunately a root canal treatment can also be the cause of pain. During a root canal treatment pain can be suppressed by local anesthesia, the use of the airotor, the attitude of the dentist and his communication with the patient. Afterpain has three causes: damage and iatrogenic apical periodontitis, pulpitis and continuing apical periodontitis. In this article the possible treatment of pain by a root canal treatment are extensively discussed.

Analgesics↗
PubMed2006

[A study on the accuracy of electronic root canal length measurement and its influential factors].

PURPOSE: To study the accuracy of JUSTY-II electronic apex locator and the influential factors on the accuracy of root canal working length measurement. METHODS: 148 teeth, including 71 teeth with pulpitis, 46 with necrotic pulp and 31 with apical periodontitis, were divided into two groups in random. The accuracy of electronic root canal working length measurement group was compared with that of the manual measurement group by Chi(2) test. The influence of clinical types, root canal in dry or moisture conditions and root canal preparation on the accuracy of root canal working length measurement was analyzed. RESULTS: The accuracy of electronic apex locator was 87.84%, while it was 43.24% in manual measurement, the difference was significant (P<0.01). The accuracy in the group of apical periodontitis was significantly lower than that of the other groups (P<0.05). Root canal in dry or moisture conditions had no effect on the accuracy of root canal length measurement, but root canal preparation could decrease the accuracy of measurement (P<0.05). CONCLUSION: Electronic apex locator is an accurate and convenient device in measurement of root canal working length. Apical periodontitis and root canal preparation can decrease the accuracy of measurement.

Bicuspid↗
PubMed2006

[Comparison of the painless effect of four anesthetic methods during pulpal treatment].

OBJECTIVE: To compare the painless effect of four anesthetic methods during opening pulp cavity and undergoing pulpectomy for acute or chronic pulpitis. METHODS: 80 teeth of 80 patients were randomly allocated into four groups. Each group had 20 teeth. Anesthetic methods applied four different groups included block anesthesia of nerve, supraperiosteal infiltration, periodontal membrane injection and intrapulpal injection. Anesthesia doses were recorded and the pierced points, the zones of pain, the time of anesthesia action, the time of anesthesia persistence and the degrees of anesthesia were evaluated with four levels synthetic evaluation standard of anesthesia. RESULTS: Compared with periodontal membrane injection and intrapulpal injection, block anesthesia of nerve and supraperiosteal infiltration had the later time of anesthesia action and the longer time of anesthesia persistence (P<0.05). In four anesthetic methods, block anesthesia of nerve had the best painless effect (P<0.05). CONCLUSION: Four anesthetic methods have their own superiorities, and we should select proper anesthetic methods in clinical work.

Adult↗
PubMed2006

The use of general anaesthesia for the extraction of children's teeth. Results from two UK dental hospitals.

AIM: To study the reasons forgiving children a general anaesthetic (GA) for the extraction of teeth, in two different paediatric dentistry centres and to compare them with draft guidelines disseminated for discussion by the British Society of Paediatric Dentistry (BSPD). METHODS: Data were collected on children who required GA extractions over a two month period (1st may to 30th June 2004) at the Paediatric Dental Units of Liverpool University Dental Hospital (LUDH) and the University Dental Hospital of Manchester (UDHM). The information collected included date of birth, gender, date of referral, date of assessment and date of GA. The reason for the GA was noted in terms of the proposed BSPD guidelines for short GA. RESULTS: A total of 264 and 268 children required extractions under GA at LUDH and UDHM respectively. At LUDH the main reason in 189 (72%) children was severe pulpitis requiring immediate relief of pain where a child does not have the intellectual maturity to cope with treatment under local analgesia (LA). This was followed by failed extractions under LA in 53 (20%) children. This reason is not listed under the proposed BSPD guidelines. At UDHM the main reason for GA in 114 (42%) children was symptomatic teeth causing pain in more than two quadrants (or in two quadrants necessitating the use of bilateral inferior dental blocks). CONCLUSIONS: There were differences in the clinical rationale for GA between children attending the two centres. Further information is needed to refine the proposed guidelines on the use of GA for dental extractions in paediatric dentistry. The guidelines need to be flexible and updated to reflect changes in practice and service provision.

Anesthesia, Dental↗
PubMed2006

[Evaluation of antibacterial activity of apex-phoresis].

Effects of apex-phoresis on dental root canal microflora were studied and optimal dosage parameters were determined. Microbiological study in vitro has established that optimal antibacterial effect was achieved with the apex-phoresis dosage in the range between 2.5-5 mA/min. Study of the effects of apex-phoresis on dental root canal microflora in vivo disclosed its high antibacterial activity both in cases of pulpitis and destructive forms of chronic periodontitis. For the first time the data are confirmed by molecular-genetic method of detection of hard to cultivate virulent anaerobic bacteria. The results of the study allow to recommend apex-phoresis for wide use in clinical practice as an effective way to sterilize difficult to traverse dental root canals.

Adolescent↗
PubMed1990

Local anesthesia failure in endodontic therapy: the acute inflammation factor.

The attainment of clinically acceptable local anesthesia is often problematic in the treatment of symptomatic pulpitis and symptomatic apical periodontitis. This article reviews the literature to identify the extent of this problem and to understand the organic components involved with this condition. Inflammation, infection, pH changes, alteration in nerve cell membranes, and anatomic variations are all possible causes for failure of local anesthesia during emergency endodontic therapy.

Anesthesia, Dental↗
PubMed1989

[Three dimensional study of the pulpal vascular changes during inflammation].

In this study, the changes of canine pulpal vascular architecture, at various stage of growth when subjected so acute and chronic inflammation were examined through a scanning electron microscope using vascular corrosive resin casts. The following results were obtained. 1. The sites of leakage of MMA resin out of the blood vessels coincided with the site where microleakage occurred, thus suggesting that resin cast method is a useful technique to study the area where vascular permeability was increased. 2. In an acute inflammation, leakage of resin out of blood vessels was mainly observed at the sites of venular network (VN) and venous capillaries, and these could be discriminated by use of the casts method. This is in accordance with the result by Tsuchiya, Magino and Palade, where they showed that vascular permeability was preferentially observed in venule and venous capillaries. 3. In pulp with a lesser number of venules during the stage of late maturation, leakage of resin was observed from those surviving venules to the bundle of main blood vessels. 4. Leakage of resin was not observed in the terminal capillary network (TCN), but in the capillary network (CN) and VN, especially just beneath the dentin, where cavity preparation with a water spray was performed. Accordingly, the generation of heat during cavity preparation was thought to be the main reason for disturbance of the pulp. 5. Severe case of suppurative and chronic ulcerative pulpitis were generated within one week after cavity preparation. The vascular architecture was characterized by a dense granular capillary network facing the ulcerative surface. 6. One week after pulpal exposure, at the stage of early maturation of pulp, the granulated blood vessels located within the exposed pulp had a tendency to shift to a pulp polyp. And the granulated blood vessels after two months showed a pulp polyp. 7. At the late maturation stage of pulp, development the pulp chamber and dentin tubules were saturated by resin cast method, suggesting the possibility of leakage out of blood vessels and the death of some odontoblasts. The pulp at this stage shifted to a gangrous pulp. 8. In conclusion, the pulpal vascularity constantly undergoes morphologic changes incidential to various condition such as growth, maturation and inflammation. Basically, vascularity of dental pulp consists of three major layers, that is TCN, CN and VN. When it comes to the maturation stage, owing to the apposition of secondary dentin, the pulp cavity will become narrow and the vasculation within it will undergo a histologic change. As a result, most of the VN disappears.(ABSTRACT TRUNCATED AT 400 WORDS)

Dental Pulp↗
PubMed1989

Pulp capping with hydroxyapatite ceramic in rat molars.

Direct pulp capping with a hydroxyapatite ceramic in rat molars induced the formation of reparative dentin in the exposure sites after 2 weeks. In addition, foci of acute and chronic pulpitis were detected. After 6-8 weeks of application of the material partial or total necrosis occurred. The use of hydroxyapatite as a possible pulp capping material is discussed.

Animals↗
PubMed1989

[Caries profunda problems in past and at present].

The development of profound caries therapy in relation to soft carious dentin and carious changed dentin is summed up. Because of its pulpitis preventing meaning profound carious therapy demands the scientific disputation in presence and future.

Dental Caries↗
PubMed1989

[Question of curative anesthesia].

As a method for keeping a tooth pulp vital that has undergone inflammatory alterations, curative anesthesia is controversial. Generally accepted ideas on the mechanism of action and on therapeutic concepts are lacking. Animal experiments using Laser Doppler flowmetry and intravital microscopy are to demonstrate that, under defined conditions, local anesthesia may reduce the effects of neurogenic pulpitis. A therapeutic recommendation, however, cannot be given.

Anesthesia, Dental↗
PubMedDate not supplied

[In vivo study of the analgesic action of different methods and drugs in endodontics].

In order to treat the acute pulpal pain of the emergency patient, there are different methods and medicaments in the clinical practice. The aim of this study was to investigate the efficacy of variant treatment methods and medicaments used clinically to manage acute pulpal pain. The material of this method consisted of 100 patients who came in the clinic of endodontics of Athens university, with symptoms of acute pulpitis. The patients were divided in three groups. In the first group the carious dentin was excavated without exposuring the pulp and a cotton pellet with eugenol or comphorted p-chlorophenol was placed in the cavity. In the second group the carious dentin was also removed, a small pulp lesion was made and the same medicaments were placed in the cavity. In the third group pulpotomy was performed and the same drugs were placed in the cavity. The results indicated that the method of pulpotomy was the most effective one for pain alleviation. Furthermore eugenol was proved to be more effective as a sedative drug than comphorted p-monochlorophenol.

Chlorophenols↗
PubMed1977

[Decisive factors in the indication for pulp and peridontal treatment].

The explanation of the goal of pulp-periodontium treatment is followed by guidelines concerning the indication for the methods of pulp preservation (indirect capping, direct capping, pulpitis treatment by means of anaesthetics), of partial pulp preservation (vital amputation) and for pulpectomy (vital and non-vital techniques). The different passages of the paper terminate with conclusions for practice.

Administration, Topical↗
PubMed1977

[Pain in the maxillofacial area: diagnosis and treatment].

Based on characteristic case-reports the mostly occurring patterns of maxillo-facial pain are discussed. A description is given of pain in case of pulpitis, dento-alveolar abcess, dry socket, deep local periodonitis, temporomandibular joint arthrosis, dehiscence of the mandibular canal, maxillary sinusitis, malignant neoplasm. Trigeminal neuralgia, atypical facial neuralgia and psychogenic pains are discussed. The article concludes with a survey of the most important symptoms of these pain-syndromes in order to facilitate a correct diagnosis.

Adult↗
PubMed1978

[Bilateral synalgias].

Total pulpitis leads in most cases to unilateral synalgia. Bilateral synalgiae are considerably rarer, but theoretically possible, in which pain radiates to the non-affected half of the jaw or face. Case reports illustrate the symptomatology, cause and therapy.

Adult↗