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Trauma involving the dentoalveolar region is a frequent occurrence which can result in the fracturing and displacement of teeth, crushing and/or fracturing of bone and soft tissue injuries including contusions, abrasions and lacerations. This review describes the assessment of patients with these injuries, not in a didactic sense by repeating excellent already published classifications and treatment options, but by addressing questions that arise during assessment. It covers trauma first aid, examination of the patient, factors that affect treatment planning decisions, and the importance of communicating treatment options and prognosis to traumatized patients. [ABSTRACT FROM AUTHOR]

Aim To evaluate the penetration of irrigants up to working length using two different activation systems in curved canals instrumented with 0.04 and 0.08 taper instruments. Methodology Sixty-eight mesiobuccal canals from mandibular first molars with curvatures between 30° and 40° were used. The samples were divided into group 1, canals instrumented to size 30, 0.04 taper, and group 2, instrumented to size 30, 0.08 taper. Both groups were irrigated with a contrast solution and divided in 2 subgroups of 15 samples each: Groups 1A and 2A were activated with passive ultrasonic irrigation ( PUI), whilst groups 1B and 2B were activated with sonic irrigation ( SI). Radiographs were taken to evaluate the penetration of the contrast solution up to working length. This evaluation was performed using Adobe Photoshop CS5. Results were analysed with the chi-square test and a logistic regression model. Results Only groups with 0.04 taper demonstrated significant differences where the activation with PUI was superior at reaching working length than SI ( P = 0.010). The logistic regression model showed that the only correlation in reaching working length was the activation system used ( P = 0.005). Conclusion The results suggest that variation of canal taper does not affect the ability of PUI to reach the working length in curved canals whilst SI obtained inferior results with 0.04 taper canal preparations. [ABSTRACT FROM AUTHOR]

Mortenson D, Sadilek M, Flake NM, Paranjpe A, Heling I, Johnson JD, Cohenca N. The effect of using an alternative irrigant between sodium hypochlorite and chlorhexidine to prevent the formation of para-chloroaniline within the root canal system. International Endodontic Journal, 45, 878-882, 2012. Abstract Aim To determine if the formation of para-chloroaniline (PCA) can be avoided by using an alternative irrigant following sodium hypochlorite but before chlorhexidine. Methodology Fifty-five single-rooted teeth were decoronated, instrumented to size 40, .06 taper whilst being irrigated with 14% ethylene-diamine-tetra-acetic acid (EDTA) and 6% NaOCl. Samples were then randomly divided into three experimental and two control groups. Group 1 was irrigated with saline followed by 2% chlorhexidine gluconate (CHX). Group 2 was irrigated with 50% citric acid (CA) followed by 2% CHX. Group 3 was irrigated with 14% EDTA followed by 2% CHX. The chemical identity and quantification of the PCA in the formed precipitate was determined using gas chromatography/mass spectrometry (GC/MS). Results All experimental groups contained PCA. The mean level of PCA for group 1 (sterile saline) was 229 ng mL−1, group 2 (citric acid) 72 ng mL−1 and group 3 (EDTA) 400 ng mL−1, respectively. A significant difference was found between the saline and EDTA groups and the negative control ( P < 0.05). Although no statistical significance was found between the negative control and citric acid group, PCA was still present in this experimental group. Conclusions Citric acid used as the intermittent irrigant had the least amount of PCA formation in the canal system. Until the threshold required to cause biological damage in humans is determined, the combination of NaOCl and CHX in root canal treatment should be avoided. [ABSTRACT FROM AUTHOR]

de Gregorio C, Paranjpe A, Garcia A, Navarrete N, Estevez R, Esplugues EO, Cohenca N. Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated uninstrumented areas in oval shaped root canals. International Endodontic Journal, 45, 475-481, 2012. Abstract Aim To assess the ability of sodium hypochlorite (NaOCl) to penetrate simulated lateral canals and to reach working length (WL) when using the self-adjusting file (SAF). Methodology Seventy single-rooted teeth with oval-shaped canals were used. Upon access, presence of a single canal was confirmed by direct visualization under a dental-operating microscope. Canal length and patency were obtained using a size 10 K-file and root length standardized to 18 mm. Pre-enlargement was restricted to the coronal one-third. The apical size of each canal was gauged at WL and samples larger than size 30 were excluded. Canals were instrumented for 5 min using the SAF system while delivering a total of 20 mL of 5.25% NaOCl and 5 mL of 17% EDTA. Then, the apical diameters were standardized to size 35 using hand files. Four hundred and twenty simulated lateral canals were then created during the clearing process and roots coated with wax to create a closed system. All samples were then cleared and randomly assigned to four experimental groups: 1 ( n = 15) positive pressure; 2 ( n = 15) SAF without pecking motion; 3 ( n = 15) SAF with pecking motion; 4 ( n = 15) apical negative pressure (ANP) irrigation and ( n = 10) control groups. Samples were scored on the basis of the ability of the contrast solution to reach WL and permeate into the simulated lateral canals to at least 50% of the total length. The Kruskal-Wallis test was used to analyse irrigant penetration and the Tukey test to determine statistical differences between groups ( P < 0.05). Results All samples irrigated with ANP were associated with irrigant penetration to WL (Table 1). The differences between group 4 (ANP) and all other groups were significant in penetration to WL ( P < 0.05). The pecking motion allowed for further penetration of the irrigant when using the SAF system but failed to irrigate at WL. None of the experimental groups demonstrated predictable irrigation of simulated lateral canals. [ABSTRACT FROM AUTHOR]

Aim To present a case report in which the pulp of two bilateral mandibular premolars with dens evaginatus were revascularized using a modified novel technique to avoid undesired crown discolouration. Recently, regeneration of necrotic pulps has become an alternative conservative treatment option for young permanent teeth with immature roots and is a subject of great interest in the field of endodontics. This novel procedure exploits the full potential of the pulp for dentine deposition and produces a stronger mature root that is better able to withstand the forces than can result in fracture. However, the current protocol has potential clinical and biological complications. Amongst them, crown discolouration, development of resistant bacterial strains and allergic reaction to the intracanal medication. In the case presented, a modified technique to avoid undesired crown discolouration was applied sealing the dentinal tubules of the chamber, thus avoiding any contact between the tri-antibiotic paste and the dentinal walls. Key learning points • Sealing the dentinal tubules of the chamber prevents the undesirable crown discolouration produced by tri-antibiotic medication whilst maintaining the revascularization potential of the pulp. • Further research is warranted to seek an alternative infection control protocol capable of preventing possible allergic reactions and development of resistant strains of bacteria, as well as a biological material capable of inducing angiogenesis and allow a more predictable scaffold and tissue regeneration. [ABSTRACT FROM AUTHOR]

Aim To provide a treatment option to endodontists performing surgery that will enhance ridge preservation when tooth extraction is required. A 47-year-old woman was referred to an endodontic practice for apical root-end resection of tooth 22 because of refractory periradicular disease. Radiographic examination revealed a large periradicular lesion, 5 mm in diameter and a root-end filling at the root apex. The treatment plan included exploratory surgery and apical root-end resection. A vertical root fracture was diagnosed and the decision was made to extract the tooth. The socket was grafted with a cancellous bovine bone and covered with a resorbable collagen membrane. Follow-up examination revealed favourable bone healing with formation of a new cortical plate and the preservation of soft tissue width and height in the aesthetic area. Key learning points •The principles of guided bone regeneration. •Preserving or reconstructing the extraction socket. •Enhances the ability to restore function and provide aesthetically pleasing restorations to patients without violating the predictability and function of the prostheses. [ABSTRACT FROM AUTHOR]

The effect of 10% carbamide peroxide or 10% hydrogen peroxide on the surface morphology and zinc oxide levels of IRM filling was tested. Ninety IRM samples were treated with either 10% carbamide peroxide, 10% hydrogen peroxide or phosphate buffer which served as control. Treatment consisted of placing the samples in a dry incubator at 37&degree;C for 1,3 or 7 days. At each time point, the samples were removed from the test solution, dried and prepared for surface scanning electron microscopy and energy dispersive spectrometric analysis. After 3 days, 10% carbamide peroxide significantly reduced the zinc oxide level as compared to the 10% hydrogen peroxide group (p<0.01) and the controls (p<0.01), 10% hydrogen peroxide reduced the zinc oxide levels similarly to the control. No significant changes in the zinc oxide levels were found between 3 and 7 days in any of the groups tested. Microscopic examination of the carbamide peroxide group revealed granular surface with well defined crystalline areas. In the hydrogen peroxide group , numerous cracks with multiple sun burst-like areas were found. At the macroscopic level , the samples of this grouped appeared cracked and more swollen, as compared to controls and samples treated with carbamide peroxide. In conclusion, both 10% carbamide peroxide and 10% hydrogen peroxide altered the surface morphology and the zinc oxide levels of IRM fillings, but their modes of action differed. [ABSTRACT FROM AUTHOR]

Variations in tooth morphology present a clinical challenge when endodontic treatment is required. A case of conservative endodontic therapy for a fused mandibular second and third molar is presented. [ABSTRACT FROM AUTHOR]

Apical periodontitis is a common development associated with teeth with necrotic pulp. Although rare, some cases may present further complications, such as neuropathies in areas adjacent to the affected tooth. A case is described in which mental nerve paresthesia was associated with a non-vital mandibular premolar. Endodontic therapy resolved the paresthesia completely without further clinical complications. [ABSTRACT FROM AUTHOR]