Endodontics

5. Specialists and GDPs compared

The purpose of this study was to determine whether differences exist in disinfection protocols between endodontic specialists and general dentists. An invitation to participate in a web-based survey was sent to 950 dentists (50% GDPs: 50% endodontists) affiliated with the Spanish Board of Dentistry. Nine questions included irrigation protocols and disinfection during root canal therapy. There were no statistically significant differences in respondents’ first choice of an irrigant solution (sodium hypochlorite), but the concentration differed, and there were differences in the type of irrigant used to remove the smear layer, the use of adjuncts to irrigation, the enlargement of the apical preparation when shaping a necrotic tooth and the maintenance of apical patency throughout the debridement and shaping procedure. General dentists and endodontists embraced different disinfection protocols. The results demonstrated that endodontists keep up to date with protocols published in the literature, whereas general dentists use protocols learned during their dental training. Clinicians should be aware of the importance of disinfection techniques and their relationship to treatment outcomes.

Gregorio C et al. Differences in disinfection protocols for root canal treatments between general dentists and endodontists: A web-based survey. JADA 2015 146: 536-543.

Q Although endodontists and GDPs differed in their disinfection protocols, which of the following showed no statistically significant differences?

A The enlargement of the apical preparation

B Selection of sodium hypochlorite as first choice of irrigant

C Method of keeping updated

D Use of the same concentration of sodium hypochlorite

6. Root canal relief

How is oral health-related quality of life affected by pulpal pathology? This research studied the question and evaluated root canal treatment (RCT) in terms of pain during, and at 7 days after treatment. A consecutive sample of 250 adult patients requiring RCT for a permanent tooth (incisors, canines, premolars, and molars) participated with a baseline impact regarding oral pain and well-being recorded. After the RCT had been performed, the pain and the comfort experienced during and 7 days after treatment were recorded on a 0-10 visual analog scale. Initially, 41% reported a lot of pain, with the severity and functional limitation being significantly greater among men. During the procedure, 62% of patients did not feel any pain, and 95% were relatively comfortable. After 7 days, 60% reported some post-treatment pain although on average this was very slight. Intrasubject comparisons revealed that the pain decreased progressively from the preoperative phase up to the postoperative phase, the pain being more acute in patients with vital teeth than those with necrotic pulps.

Montero J et al. Patient-centered outcomes of root canal treatment: a cohort follow-up study. J Endodontics 2015 41: 1456-1461.

Q Which percentages of patients reported; some post-operative pain, a lot of pain initially and no pain during the procedure?

A 60: 41: 38%

B 41: 95: 62%

C 38: 62: 41%

D 60: 41: 62%

7. Upping the dosage Achieving anaesthesia in mandibular molar teeth with irreversible pulpitis is very difficult. The aim of this randomised, double-blind clinical trial was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block (IANB) when treating molars with symptomatic irreversible pulpitis. Patients with first mandibular molar teeth (n=82) so affected randomly received conventional IANB injection either with 1 (1.8 mL) or 2 cartridges (3.6 mL) of 4% articaine with 1:100,000 epinephrine. The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation on a visual analog scale. No, or mild, pain was considered as successful. Results showed that 3.6 mL articaine provided a significantly higher success rate (77.5%) than 1.8 mL (27.5%) although neither group had 100% successful anaesthesia. Increasing the volume of articaine provided a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible pulpitis, but it did not result in 100% anaesthetic success.

Abazarpoor R et al. A comparison of different volumes of articaine for inferior alveolar nerve block for molar teeth with symptomatic irreversible pulpitis. J Endodontics 2015 41: 1408-1411.

Q In this study, which anaesthetic regimen provided the most significant success rate in mandibular molar teeth with irreversible pulpitis?

A 3.8 mL of 4% articaine with 1:100,000 epinephrine

B 3.6 mL of 4% articaine with 1:100,000 epinephrine

C 1.8 mL of 4% articaine with 1:100,000 epinephrine

D 1.8 mL of 2% articaine with 1:500,000 epinephrine

8. MTA or CH? – You choose This review of the literature had the purpose of analysing studies and comparing the effectiveness of mineral trioxide aggregate (MTA) and calcium hydroxide (CH) as pulp capping materials in humans. The PubMed, Cochrane Library, Embase, and Web of Knowledge databases were used in the literature search from their establishment date until December 7, 2014. The success rate, inflammatory response, and dentine bridge formation were evaluated. Thirteen studies met the inclusion criteria although as there was no significant heterogeneity between studies a fixed-effects model was used to analyse them. The MTA treatment groups showed a significantly higher success rate compared with CH-capped groups. MTA was also superior to CH in terms of the absence of an inflammatory response as well as dentine bridge formation. The review therefore concluded that MTA has a higher success rate and results in less pulpal inflammatory response and more predictable hard dentine bridge formation than CH. MTA appears to be a suitable replacement of CH used for direct pulp capping.

Li Z et al. Direct pulp capping with calcium hydroxide or mineral trioxide aggregate: a meta-analysis. J Endodontics 2015 41: 1412-1417.

Q Calcium hydroxide is superior to mineral trioxide aggregate in:

A Treatment success rate

B Controlling inflammatory response

C Dentine bridge formation

D None of the above