This randomized clinical trial compared postoperative pain in patients receiving single-visit endodontic treatment for chronic apical periodontitis and pulp necrosis using two different irrigating solutions: 5.25% sodium hypochlorite or 2% chlorhexidine gel. The study found no significant differences in postoperative pain levels between the two groups at 24, 48, 72 hours, and 7 days after treatment. Postoperative pain was generally mild and decreased over time for both groups. The trial concluded that the incidence of postoperative pain was uniformly low regardless of the irrigating solution used.
Expasyl is a hemostatic paste used for gingival retraction that provides effective retraction with minimal pressure, reducing risk of tissue damage and increasing patient comfort compared to traditional retraction cords. It is extruded directly into the sulcus rather than pressed in, retracting tissue gently. Expasyl controls bleeding and provides a clean, dry field for impressions. Studies show it is highly effective at retraction and hemostasis with minimal trauma to soft tissues.
This study compared the amount of debris extruded apically during root canal preparation using three different techniques: 1) manual step-back technique with hand instruments, 2) FlexMaster rotary system, and 3) Mtwo rotary system. The manual technique extruded significantly more debris than the two rotary techniques. The Mtwo system extruded the least amount of debris, though not significantly less than the FlexMaster system. The results suggest that rotary instrumentation techniques are associated with less apical debris extrusion than manual instrumentation.
The document describes the Self-Adjusting File (SAF), a nickel-titanium endodontic instrument used for root canal treatment. The SAF has a hollow, elastic, compressible design that allows it to conform to the unique shape of each root canal while scrubbing the canal walls. Clinical studies have shown it effectively cleans and shapes canals with less transportation compared to traditional rotary instruments.
This document summarizes the principles of cleaning root canals, including both mechanical instrumentation and antibacterial irrigation. It discusses the biological and technical objectives of chemomechanical preparation, including eliminating microorganisms and maintaining the original canal shape. Nickel-titanium rotary instruments have improved flexibility and ability to shape canals compared to stainless steel files while maintaining the original canal curvature. However, instruments still leave uncleaned areas and irrigation is important for disinfection. Safe use of rotary instruments requires understanding fracture risks related to anatomy, file size, and cyclic fatigue.
This document summarizes a study that evaluated the bond strength of two root canal filling systems (ActiV GP and gutta-percha with AH Plus sealer) when used with different irrigation protocols. Forty single-rooted teeth were divided into four groups based on the final irrigation used: EDTA, EDTA followed by chlorhexidine, MTAD, or MTAD followed by chlorhexidine. Each group was further divided based on the filling system used. Horizontal sections were taken and subjected to push-out testing to measure bond strength. The results showed that EDTA followed by chlorhexidine yielded the highest bond strength for ActiV GP. MTAD and MTAD followed by chlorhexidine adversely affected the
EVIDENCE-BASED APPROACH TO ROOT CANAL CLEANING AND SHAPING / /certified fixed...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Anatomy of apical third /certified fixed orthodontic courses by Indian dental...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Deep caries management /certified fixed orthodontic courses by Indian dental ...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Expasyl is a hemostatic paste used for gingival retraction that provides effective retraction with minimal pressure, reducing risk of tissue damage and increasing patient comfort compared to traditional retraction cords. It is extruded directly into the sulcus rather than pressed in, retracting tissue gently. Expasyl controls bleeding and provides a clean, dry field for impressions. Studies show it is highly effective at retraction and hemostasis with minimal trauma to soft tissues.
This study compared the amount of debris extruded apically during root canal preparation using three different techniques: 1) manual step-back technique with hand instruments, 2) FlexMaster rotary system, and 3) Mtwo rotary system. The manual technique extruded significantly more debris than the two rotary techniques. The Mtwo system extruded the least amount of debris, though not significantly less than the FlexMaster system. The results suggest that rotary instrumentation techniques are associated with less apical debris extrusion than manual instrumentation.
The document describes the Self-Adjusting File (SAF), a nickel-titanium endodontic instrument used for root canal treatment. The SAF has a hollow, elastic, compressible design that allows it to conform to the unique shape of each root canal while scrubbing the canal walls. Clinical studies have shown it effectively cleans and shapes canals with less transportation compared to traditional rotary instruments.
This document summarizes the principles of cleaning root canals, including both mechanical instrumentation and antibacterial irrigation. It discusses the biological and technical objectives of chemomechanical preparation, including eliminating microorganisms and maintaining the original canal shape. Nickel-titanium rotary instruments have improved flexibility and ability to shape canals compared to stainless steel files while maintaining the original canal curvature. However, instruments still leave uncleaned areas and irrigation is important for disinfection. Safe use of rotary instruments requires understanding fracture risks related to anatomy, file size, and cyclic fatigue.
This document summarizes a study that evaluated the bond strength of two root canal filling systems (ActiV GP and gutta-percha with AH Plus sealer) when used with different irrigation protocols. Forty single-rooted teeth were divided into four groups based on the final irrigation used: EDTA, EDTA followed by chlorhexidine, MTAD, or MTAD followed by chlorhexidine. Each group was further divided based on the filling system used. Horizontal sections were taken and subjected to push-out testing to measure bond strength. The results showed that EDTA followed by chlorhexidine yielded the highest bond strength for ActiV GP. MTAD and MTAD followed by chlorhexidine adversely affected the
EVIDENCE-BASED APPROACH TO ROOT CANAL CLEANING AND SHAPING / /certified fixed...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Anatomy of apical third /certified fixed orthodontic courses by Indian dental...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Deep caries management /certified fixed orthodontic courses by Indian dental ...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Management of Deep caries /certified fixed orthodontic courses by Indian dent...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Dentin forms an integral part of the tooth structure and closely resembles bone. It has a regenerative potential and provides support to enamel and protection to the pulp. Infected dentin differs from affected dentin, with infected dentin containing bacteria and having irreversibly denatured collagen versus affected dentin which can be remineralized. Caries-affected dentin produces lower bond strengths than normal dentin. Dentin permeability is related to its protective function, and sealing dentin tubules can help manage dentin hypersensitivity. The smear layer must be removed for resin bonding but can be left for amalgam. Biomimetic dentistry aims to eliminate cracks/infections and immediately seal dentin.
This document summarizes a study that compared the sealing ability of three endodontic sealers (RoekoSeal, AH Plus, and EndoRez) in dog teeth after post-space preparation and exposure to the oral environment. 74 root canals in dog premolars were instrumented, filled with gutta-percha and one of the three sealers, and had post spaces prepared, leaving 4 mm of filling at the apex. Teeth were exposed to the oral environment for 45 days, then soaked in dye and cleared to measure leakage. EndoRez showed significantly less leakage than RoekoSeal, while AH Plus did not differ significantly from the other sealers.
The antimicrobial effectiveness of 25% propolis extractAditi Singh
This document discusses various irrigants and medicaments used in endodontic therapy. It provides information on the mechanisms of action, advantages, and disadvantages of common irrigants such as sodium hypochlorite, chlorhexidine, EDTA, MTAD, and iodine potassium iodide. It also discusses alternatives to sodium hypochlorite including laser-activated irrigation techniques. Additionally, it summarizes a study that assessed the antibacterial effects of a 25% water-soluble propolis extract as an irrigant in primary teeth root canals.
This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection.
Presented to you by Iraqi Dental Academy.
visit us on facebook:
https://www.facebook.com/Iraqi.Dental.Academy/
or Twitter:
https://twitter.com/IQDentalAcademy
Our page on Telegram:
@IraqiDental
Gingival Curettage / /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document discusses endodontic irrigation. It begins by explaining that mechanical preparation alone cannot create a healthy biological environment for healing as it cannot reach all areas of the complex root canal system. Effective irrigation is needed to supplement mechanical preparation. Sodium hypochlorite (NaOCl) is identified as the most important irrigant for its ability to dissolve and remove organic tissues, biofilms, and the smear layer. Factors like concentration, volume, temperature, activation, and contact time affect NaOCl's efficiency. Chlorhexidine may be used as an alternative but does not remove smear layer like NaOCl. Chelating agents like EDTA are used to remove the smear layer after NaOCl
Two Viewpoints: Prepared and Minimal Prep Veneerstheaacd
This document discusses and compares prepared and minimal preparation ("prep-less") veneers from the perspectives of two dental professionals, Drs. Brian LeSage and Dennis Wells. It addresses myths versus realities of each approach and provides examples of cases where each method was used. Prep-less veneers are shown to provide esthetic results with minimal risk when bonded exclusively to enamel, while also maintaining healthy gingiva. When volume increase can be tolerated, prep-less veneers offer multiple benefits to patients as a less invasive procedure. Overall, the document highlights that minimal preparation techniques for veneers align with trends in dentistry and medicine toward less invasive treatments.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats
This document summarizes pulpal reactions to various restorative materials and dental procedures. It discusses how microbial, physical, and chemical irritants can damage the pulp, including through dental caries, operative procedures, trauma, and restorative materials. It also describes the pulp's defensive reactions like formation of reactionary dentin, reparative dentin, and inflammation. Treatment options for vital pulp like indirect pulp capping, direct pulp capping, and medicaments are outlined, with calcium hydroxide and mineral trioxide aggregate highlighted as common capping materials that stimulate hard tissue formation.
1. Periodontal diseases can damage the pulp through microbial, physical, or chemical irritants. Microbial irritants like dental caries or periodontal infections allow bacteria to enter the pulp. Physical irritants include operative procedures, trauma, orthodontic movements, and deep periodontal curettage. Chemical irritants involve dental materials and antibacterial agents.
2. In response, the pulp attempts defense reactions like tubular sclerosis, tertiary dentin formation, and varying degrees of inflammation. Calcium hydroxide is commonly used in direct and indirect pulp capping procedures due to its ability to stimulate hard tissue formation and create an alkaline environment against bacteria. Successful outcomes depend on several factors.
FDI policy statement on dental bleaching materials adopted by the fdi general...Axex Dental
This document is a policy statement from the FDI World Dental Federation on dental bleaching materials. It supports the appropriate use of dentist-prescribed and supervised tooth bleaching procedures. It notes that bleaching products are safe and effective when used under dental supervision. However, over-the-counter sales of high concentration peroxide products are not supported due to risks of harm. The long-term effects of higher concentration bleaching agents on tissues are not fully understood.
This document reviews chemomechanical removal of caries as an alternative to traditional surgical removal. Chemomechanical caries removal uses chemical agents to soften infected dentin, which is then scraped away mechanically using blunt instruments. Several chemical agents have been developed for this technique, including Caridex and Carisolv. This technique aims to selectively remove only the outer, infected layer of dentin while preserving the inner, remineralizable layer. Studies show chemomechanical removal can be effective at removing caries, but may take longer than traditional drills and burs. It provides advantages of being less invasive and reducing pain compared to surgery. However, further research is still needed to optimize the technique.
24th oct Pulp Therapy In Young Permanent Teeth.pptxismasajjad1
The document discusses various pulp therapy techniques for young permanent teeth including indirect pulp capping, direct pulp capping, Cvek pulpotomy, apexogenesis, apexification, and regenerative endodontics. Important factors to consider include assessing for signs of reversible pulpitis. Indirect pulp capping involves sealing a deep lesion near the pulp with a protective material while direct pulp capping places a material directly over an exposure site after controlling bleeding. Pulpotomy removes inflamed pulp from the crown while leaving healthy tissue in the root canals. Apexogenesis treats immature teeth to allow continued root development while apexification induces a barrier in nonvital open apices. Regenerative endodontics aims
A midline diastema refers to spacing between the two front teeth. It is commonly seen in the maxillary arch during the transition from primary to permanent dentition. Causes include deciduous dentition spacing, abnormal frenal attachments, microdontia, missing teeth, and abnormal habits. Diagnosis involves a blanch test and radiographs. Treatment involves removing any underlying causes before using removable appliances, fixed orthodontic appliances like springs and elastics, or cosmetic restorations to close the space. Long term retention like fixed retainers is generally recommended.
This document discusses the procedure of pulp revascularization to treat immature permanent teeth with necrotic pulps and open apices. It involves disinfecting the root canal with calcium hydroxide or triple antibiotic paste, inducing bleeding into the canal to form a blood clot, and placing MTA over the clot to allow new tissue and blood vessel formation. This results in continued root development, thickening of dentin walls, and closure of the root apex. Advantages include natural root maturation and vital tooth structure, while disadvantages can include discoloration or resistant bacterial infection.
The document discusses skull base surgery and tumors of the nasal cavity and paranasal sinuses. It provides details on the types of tumors that can occur in these areas, including images from CT and MRI scans. It also discusses the techniques, advantages, and complications of external skull base surgery. International studies on skull base surgery for malignant tumors are summarized, showing improvements in local control and survival rates over time based on factors like histology, extent of disease, and surgical margins.
THREE-DIMENSIONAL OBTURATION OF THE ROOT CANAL SYSTEM* by Clifford J.Ruddle,D...alvarosareis
This document provides instructions for performing a three-dimensional obturation of the root canal system using warm gutta percha. It begins by describing the complex anatomy of root canal systems, including branches, furcations, and multiple apical portals. Cleaning and shaping of the canals is described as essential to allow for complete disinfection and to create a shape that allows for filling of the entire system. The technique uses gutta percha heated to 40-45°C which is vertically compacted into the canals using specialized pluggers in an apical to coronal direction. Kerr Pulp Canal Sealer is used due to its properties. Placement involves first placing the sealer and master cone, then using pluggers
Filling Root Canals in Three Dimensionsalvarosareis
This document provides an overview of Dr. Herbert Schilder's work on root canal filling techniques. It discusses the importance of total three-dimensional filling of the root canal system. It reviews gutta percha and silver cone techniques used to achieve this, including solvent and lateral condensation methods. It emphasizes that root canal fillings must adapt to the complex shape of the root canal system and seal it off completely to ensure treatment success.
Management of Deep caries /certified fixed orthodontic courses by Indian dent...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Dentin forms an integral part of the tooth structure and closely resembles bone. It has a regenerative potential and provides support to enamel and protection to the pulp. Infected dentin differs from affected dentin, with infected dentin containing bacteria and having irreversibly denatured collagen versus affected dentin which can be remineralized. Caries-affected dentin produces lower bond strengths than normal dentin. Dentin permeability is related to its protective function, and sealing dentin tubules can help manage dentin hypersensitivity. The smear layer must be removed for resin bonding but can be left for amalgam. Biomimetic dentistry aims to eliminate cracks/infections and immediately seal dentin.
This document summarizes a study that compared the sealing ability of three endodontic sealers (RoekoSeal, AH Plus, and EndoRez) in dog teeth after post-space preparation and exposure to the oral environment. 74 root canals in dog premolars were instrumented, filled with gutta-percha and one of the three sealers, and had post spaces prepared, leaving 4 mm of filling at the apex. Teeth were exposed to the oral environment for 45 days, then soaked in dye and cleared to measure leakage. EndoRez showed significantly less leakage than RoekoSeal, while AH Plus did not differ significantly from the other sealers.
The antimicrobial effectiveness of 25% propolis extractAditi Singh
This document discusses various irrigants and medicaments used in endodontic therapy. It provides information on the mechanisms of action, advantages, and disadvantages of common irrigants such as sodium hypochlorite, chlorhexidine, EDTA, MTAD, and iodine potassium iodide. It also discusses alternatives to sodium hypochlorite including laser-activated irrigation techniques. Additionally, it summarizes a study that assessed the antibacterial effects of a 25% water-soluble propolis extract as an irrigant in primary teeth root canals.
This simplified lecture will present to you the basic concept of intracanal medicaments, their indication, classification, and their appropriate selection.
Presented to you by Iraqi Dental Academy.
visit us on facebook:
https://www.facebook.com/Iraqi.Dental.Academy/
or Twitter:
https://twitter.com/IQDentalAcademy
Our page on Telegram:
@IraqiDental
Gingival Curettage / /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document discusses endodontic irrigation. It begins by explaining that mechanical preparation alone cannot create a healthy biological environment for healing as it cannot reach all areas of the complex root canal system. Effective irrigation is needed to supplement mechanical preparation. Sodium hypochlorite (NaOCl) is identified as the most important irrigant for its ability to dissolve and remove organic tissues, biofilms, and the smear layer. Factors like concentration, volume, temperature, activation, and contact time affect NaOCl's efficiency. Chlorhexidine may be used as an alternative but does not remove smear layer like NaOCl. Chelating agents like EDTA are used to remove the smear layer after NaOCl
Two Viewpoints: Prepared and Minimal Prep Veneerstheaacd
This document discusses and compares prepared and minimal preparation ("prep-less") veneers from the perspectives of two dental professionals, Drs. Brian LeSage and Dennis Wells. It addresses myths versus realities of each approach and provides examples of cases where each method was used. Prep-less veneers are shown to provide esthetic results with minimal risk when bonded exclusively to enamel, while also maintaining healthy gingiva. When volume increase can be tolerated, prep-less veneers offer multiple benefits to patients as a less invasive procedure. Overall, the document highlights that minimal preparation techniques for veneers align with trends in dentistry and medicine toward less invasive treatments.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats
This document summarizes pulpal reactions to various restorative materials and dental procedures. It discusses how microbial, physical, and chemical irritants can damage the pulp, including through dental caries, operative procedures, trauma, and restorative materials. It also describes the pulp's defensive reactions like formation of reactionary dentin, reparative dentin, and inflammation. Treatment options for vital pulp like indirect pulp capping, direct pulp capping, and medicaments are outlined, with calcium hydroxide and mineral trioxide aggregate highlighted as common capping materials that stimulate hard tissue formation.
1. Periodontal diseases can damage the pulp through microbial, physical, or chemical irritants. Microbial irritants like dental caries or periodontal infections allow bacteria to enter the pulp. Physical irritants include operative procedures, trauma, orthodontic movements, and deep periodontal curettage. Chemical irritants involve dental materials and antibacterial agents.
2. In response, the pulp attempts defense reactions like tubular sclerosis, tertiary dentin formation, and varying degrees of inflammation. Calcium hydroxide is commonly used in direct and indirect pulp capping procedures due to its ability to stimulate hard tissue formation and create an alkaline environment against bacteria. Successful outcomes depend on several factors.
FDI policy statement on dental bleaching materials adopted by the fdi general...Axex Dental
This document is a policy statement from the FDI World Dental Federation on dental bleaching materials. It supports the appropriate use of dentist-prescribed and supervised tooth bleaching procedures. It notes that bleaching products are safe and effective when used under dental supervision. However, over-the-counter sales of high concentration peroxide products are not supported due to risks of harm. The long-term effects of higher concentration bleaching agents on tissues are not fully understood.
This document reviews chemomechanical removal of caries as an alternative to traditional surgical removal. Chemomechanical caries removal uses chemical agents to soften infected dentin, which is then scraped away mechanically using blunt instruments. Several chemical agents have been developed for this technique, including Caridex and Carisolv. This technique aims to selectively remove only the outer, infected layer of dentin while preserving the inner, remineralizable layer. Studies show chemomechanical removal can be effective at removing caries, but may take longer than traditional drills and burs. It provides advantages of being less invasive and reducing pain compared to surgery. However, further research is still needed to optimize the technique.
24th oct Pulp Therapy In Young Permanent Teeth.pptxismasajjad1
The document discusses various pulp therapy techniques for young permanent teeth including indirect pulp capping, direct pulp capping, Cvek pulpotomy, apexogenesis, apexification, and regenerative endodontics. Important factors to consider include assessing for signs of reversible pulpitis. Indirect pulp capping involves sealing a deep lesion near the pulp with a protective material while direct pulp capping places a material directly over an exposure site after controlling bleeding. Pulpotomy removes inflamed pulp from the crown while leaving healthy tissue in the root canals. Apexogenesis treats immature teeth to allow continued root development while apexification induces a barrier in nonvital open apices. Regenerative endodontics aims
A midline diastema refers to spacing between the two front teeth. It is commonly seen in the maxillary arch during the transition from primary to permanent dentition. Causes include deciduous dentition spacing, abnormal frenal attachments, microdontia, missing teeth, and abnormal habits. Diagnosis involves a blanch test and radiographs. Treatment involves removing any underlying causes before using removable appliances, fixed orthodontic appliances like springs and elastics, or cosmetic restorations to close the space. Long term retention like fixed retainers is generally recommended.
This document discusses the procedure of pulp revascularization to treat immature permanent teeth with necrotic pulps and open apices. It involves disinfecting the root canal with calcium hydroxide or triple antibiotic paste, inducing bleeding into the canal to form a blood clot, and placing MTA over the clot to allow new tissue and blood vessel formation. This results in continued root development, thickening of dentin walls, and closure of the root apex. Advantages include natural root maturation and vital tooth structure, while disadvantages can include discoloration or resistant bacterial infection.
The document discusses skull base surgery and tumors of the nasal cavity and paranasal sinuses. It provides details on the types of tumors that can occur in these areas, including images from CT and MRI scans. It also discusses the techniques, advantages, and complications of external skull base surgery. International studies on skull base surgery for malignant tumors are summarized, showing improvements in local control and survival rates over time based on factors like histology, extent of disease, and surgical margins.
THREE-DIMENSIONAL OBTURATION OF THE ROOT CANAL SYSTEM* by Clifford J.Ruddle,D...alvarosareis
This document provides instructions for performing a three-dimensional obturation of the root canal system using warm gutta percha. It begins by describing the complex anatomy of root canal systems, including branches, furcations, and multiple apical portals. Cleaning and shaping of the canals is described as essential to allow for complete disinfection and to create a shape that allows for filling of the entire system. The technique uses gutta percha heated to 40-45°C which is vertically compacted into the canals using specialized pluggers in an apical to coronal direction. Kerr Pulp Canal Sealer is used due to its properties. Placement involves first placing the sealer and master cone, then using pluggers
Filling Root Canals in Three Dimensionsalvarosareis
This document provides an overview of Dr. Herbert Schilder's work on root canal filling techniques. It discusses the importance of total three-dimensional filling of the root canal system. It reviews gutta percha and silver cone techniques used to achieve this, including solvent and lateral condensation methods. It emphasizes that root canal fillings must adapt to the complex shape of the root canal system and seal it off completely to ensure treatment success.
This randomized clinical trial compared postoperative pain in patients receiving single-visit endodontic treatment for chronic apical periodontitis and pulp necrosis using either 5.25% sodium hypochlorite or 2% chlorhexidine gel as the irrigating solution. The study found no significant differences in postoperative pain levels between the two groups at 24, 48 and 72 hours and 7 days after treatment. Pain levels decreased over time with very few patients reporting any pain after 24 hours. The trial concluded that the incidence of postoperative pain was uniformly low regardless of the irrigating solution used.
Tratamento endodôntico de incisivo central superior com dois canais radicular...alvarosareis
Este artigo relata um caso clínico de um incisivo central superior com duas variações anatômicas raras: dois canais radiculares e lesão periapical. A tomografia computadorizada confirmou a anatomia atípica e mostrou o sucesso do tratamento endodôntico.
Tratamento endodôntico de incisivo central superior com dois canais radicular...alvarosareis
Este artigo descreve um caso clínico de tratamento endodôntico de um incisivo central superior com duas raízes e dois canais radiculares. A anatomia interna deste dente apresentou uma variação anatômica rara. A importância do conhecimento da anatomia dentária e do uso da tomografia computadorizada para diagnóstico são enfatizados.
Artigo gustavo apcdTratamento endodôntico de incisivo central superior com do...alvarosareis
Este artigo descreve um caso clínico de tratamento endodôntico de um incisivo central superior com duas raízes e dois canais radiculares. A anatomia interna atípica foi diagnosticada por meio de radiografias e confirmada por tomografia computadorizada. O tratamento foi realizado com sucesso e demonstrou a importância do conhecimento anatômico e de exames complementares para o diagnóstico correto.
Este artigo descreve um caso clínico de tratamento endodôntico de um incisivo central superior com duas raízes e dois canais radiculares. A anatomia interna deste dente apresentou uma variação anatômica rara. A importância do conhecimento da anatomia dentária e do uso da tomografia computadorizada para diagnóstico são enfatizados.
Unlocking Productivity: Leveraging the Potential of Copilot in Microsoft 365, a presentation by Christoforos Vlachos, Senior Solutions Manager – Modern Workplace, Uni Systems
In his public lecture, Christian Timmerer provides insights into the fascinating history of video streaming, starting from its humble beginnings before YouTube to the groundbreaking technologies that now dominate platforms like Netflix and ORF ON. Timmerer also presents provocative contributions of his own that have significantly influenced the industry. He concludes by looking at future challenges and invites the audience to join in a discussion.
Threats to mobile devices are more prevalent and increasing in scope and complexity. Users of mobile devices desire to take full advantage of the features
available on those devices, but many of the features provide convenience and capability but sacrifice security. This best practices guide outlines steps the users can take to better protect personal devices and information.
TrustArc Webinar - 2024 Global Privacy SurveyTrustArc
How does your privacy program stack up against your peers? What challenges are privacy teams tackling and prioritizing in 2024?
In the fifth annual Global Privacy Benchmarks Survey, we asked over 1,800 global privacy professionals and business executives to share their perspectives on the current state of privacy inside and outside of their organizations. This year’s report focused on emerging areas of importance for privacy and compliance professionals, including considerations and implications of Artificial Intelligence (AI) technologies, building brand trust, and different approaches for achieving higher privacy competence scores.
See how organizational priorities and strategic approaches to data security and privacy are evolving around the globe.
This webinar will review:
- The top 10 privacy insights from the fifth annual Global Privacy Benchmarks Survey
- The top challenges for privacy leaders, practitioners, and organizations in 2024
- Key themes to consider in developing and maintaining your privacy program
Removing Uninteresting Bytes in Software FuzzingAftab Hussain
Imagine a world where software fuzzing, the process of mutating bytes in test seeds to uncover hidden and erroneous program behaviors, becomes faster and more effective. A lot depends on the initial seeds, which can significantly dictate the trajectory of a fuzzing campaign, particularly in terms of how long it takes to uncover interesting behaviour in your code. We introduce DIAR, a technique designed to speedup fuzzing campaigns by pinpointing and eliminating those uninteresting bytes in the seeds. Picture this: instead of wasting valuable resources on meaningless mutations in large, bloated seeds, DIAR removes the unnecessary bytes, streamlining the entire process.
In this work, we equipped AFL, a popular fuzzer, with DIAR and examined two critical Linux libraries -- Libxml's xmllint, a tool for parsing xml documents, and Binutil's readelf, an essential debugging and security analysis command-line tool used to display detailed information about ELF (Executable and Linkable Format). Our preliminary results show that AFL+DIAR does not only discover new paths more quickly but also achieves higher coverage overall. This work thus showcases how starting with lean and optimized seeds can lead to faster, more comprehensive fuzzing campaigns -- and DIAR helps you find such seeds.
- These are slides of the talk given at IEEE International Conference on Software Testing Verification and Validation Workshop, ICSTW 2022.
Why You Should Replace Windows 11 with Nitrux Linux 3.5.0 for enhanced perfor...SOFTTECHHUB
The choice of an operating system plays a pivotal role in shaping our computing experience. For decades, Microsoft's Windows has dominated the market, offering a familiar and widely adopted platform for personal and professional use. However, as technological advancements continue to push the boundaries of innovation, alternative operating systems have emerged, challenging the status quo and offering users a fresh perspective on computing.
One such alternative that has garnered significant attention and acclaim is Nitrux Linux 3.5.0, a sleek, powerful, and user-friendly Linux distribution that promises to redefine the way we interact with our devices. With its focus on performance, security, and customization, Nitrux Linux presents a compelling case for those seeking to break free from the constraints of proprietary software and embrace the freedom and flexibility of open-source computing.
UiPath Test Automation using UiPath Test Suite series, part 6DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 6. In this session, we will cover Test Automation with generative AI and Open AI.
UiPath Test Automation with generative AI and Open AI webinar offers an in-depth exploration of leveraging cutting-edge technologies for test automation within the UiPath platform. Attendees will delve into the integration of generative AI, a test automation solution, with Open AI advanced natural language processing capabilities.
Throughout the session, participants will discover how this synergy empowers testers to automate repetitive tasks, enhance testing accuracy, and expedite the software testing life cycle. Topics covered include the seamless integration process, practical use cases, and the benefits of harnessing AI-driven automation for UiPath testing initiatives. By attending this webinar, testers, and automation professionals can gain valuable insights into harnessing the power of AI to optimize their test automation workflows within the UiPath ecosystem, ultimately driving efficiency and quality in software development processes.
What will you get from this session?
1. Insights into integrating generative AI.
2. Understanding how this integration enhances test automation within the UiPath platform
3. Practical demonstrations
4. Exploration of real-world use cases illustrating the benefits of AI-driven test automation for UiPath
Topics covered:
What is generative AI
Test Automation with generative AI and Open AI.
UiPath integration with generative AI
Speaker:
Deepak Rai, Automation Practice Lead, Boundaryless Group and UiPath MVP
In the rapidly evolving landscape of technologies, XML continues to play a vital role in structuring, storing, and transporting data across diverse systems. The recent advancements in artificial intelligence (AI) present new methodologies for enhancing XML development workflows, introducing efficiency, automation, and intelligent capabilities. This presentation will outline the scope and perspective of utilizing AI in XML development. The potential benefits and the possible pitfalls will be highlighted, providing a balanced view of the subject.
We will explore the capabilities of AI in understanding XML markup languages and autonomously creating structured XML content. Additionally, we will examine the capacity of AI to enrich plain text with appropriate XML markup. Practical examples and methodological guidelines will be provided to elucidate how AI can be effectively prompted to interpret and generate accurate XML markup.
Further emphasis will be placed on the role of AI in developing XSLT, or schemas such as XSD and Schematron. We will address the techniques and strategies adopted to create prompts for generating code, explaining code, or refactoring the code, and the results achieved.
The discussion will extend to how AI can be used to transform XML content. In particular, the focus will be on the use of AI XPath extension functions in XSLT, Schematron, Schematron Quick Fixes, or for XML content refactoring.
The presentation aims to deliver a comprehensive overview of AI usage in XML development, providing attendees with the necessary knowledge to make informed decisions. Whether you’re at the early stages of adopting AI or considering integrating it in advanced XML development, this presentation will cover all levels of expertise.
By highlighting the potential advantages and challenges of integrating AI with XML development tools and languages, the presentation seeks to inspire thoughtful conversation around the future of XML development. We’ll not only delve into the technical aspects of AI-powered XML development but also discuss practical implications and possible future directions.
UiPath Test Automation using UiPath Test Suite series, part 5DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 5. In this session, we will cover CI/CD with devops.
Topics covered:
CI/CD with in UiPath
End-to-end overview of CI/CD pipeline with Azure devops
Speaker:
Lyndsey Byblow, Test Suite Sales Engineer @ UiPath, Inc.
Communications Mining Series - Zero to Hero - Session 1DianaGray10
This session provides introduction to UiPath Communication Mining, importance and platform overview. You will acquire a good understand of the phases in Communication Mining as we go over the platform with you. Topics covered:
• Communication Mining Overview
• Why is it important?
• How can it help today’s business and the benefits
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Maruthi Prithivirajan, Head of ASEAN & IN Solution Architecture, Neo4j
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Mike Del Balso, CEO & Co-Founder at Tecton, presents "Full RAG," a novel approach to AI recommendation systems, aiming to push beyond the limitations of traditional models through a deep integration of contextual insights and real-time data, leveraging the Retrieval-Augmented Generation architecture. This talk will outline Full RAG's potential to significantly enhance personalization, address engineering challenges such as data management and model training, and introduce data enrichment with reranking as a key solution. Attendees will gain crucial insights into the importance of hyperpersonalization in AI, the capabilities of Full RAG for advanced personalization, and strategies for managing complex data integrations for deploying cutting-edge AI solutions.
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Building Retrieval-Augmented Generation (RAG) systems with open-source and custom AI models is a complex task. This talk explores the challenges in productionizing RAG systems, including retrieval performance, response synthesis, and evaluation. We’ll discuss how to leverage open-source models like text embeddings, language models, and custom fine-tuned models to enhance RAG performance. Additionally, we’ll cover how BentoML can help orchestrate and scale these AI components efficiently, ensuring seamless deployment and management of RAG systems in the cloud.
Unlock the Future of Search with MongoDB Atlas_ Vector Search Unleashed.pdfMalak Abu Hammad
Discover how MongoDB Atlas and vector search technology can revolutionize your application's search capabilities. This comprehensive presentation covers:
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Sudheer Mechineni, Head of Application Frameworks, Standard Chartered Bank
Discover how Standard Chartered Bank harnessed the power of Neo4j to transform complex data access challenges into a dynamic, scalable graph database solution. This keynote will cover their journey from initial adoption to deploying a fully automated, enterprise-grade causal cluster, highlighting key strategies for modelling organisational changes and ensuring robust disaster recovery. Learn how these innovations have not only enhanced Standard Chartered Bank’s data infrastructure but also positioned them as pioneers in the banking sector’s adoption of graph technology.
1. jcda ca
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
Applied
Research
jadc
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Cite this article as:
Publié par
J Can Dent Assoc 2010;76:aXXX
l’Association dentaire canadienne 2012;78:c84
Influence of Irrigating Solution on Postoperative
Pain Following Single-Visit Endodontic
Treatment: Randomized Clinical Trial
Gustavo Almeida, DDS, MSc; Eduardo Marques, DDS, MSc; Alexandre Sigrist
De Martin, DDS, MSc, PhD; Carlos Eduardo da Silveira Bueno, DDS, MSc, PhD;
Anthony Nowakowski, BSc, DMD; Rodrigo Sanches Cunha, DDS, MSc, PhD
Abstract
Objective: To compare 2 irrigation solutions in terms of postoperative pain after single-visit treatment of chronic apical periodon-
titis with pulp necrosis.
Methods: A total of 126 patients requiring treatment of apical periodontitis and pulp necrosis were randomly assigned to 2
groups according to the solution used for irrigation: 5.25% sodium hypochlorite (NaOCl) or 2% chlorhexidine gel (CLX) (63
patients in each group). To assess postoperative pain, a questionnaire and pain intensity scale were administered at 24, 48 and
72 hours and 7 days after the procedure. The χ2 test was used to compare the intensity of pain with the 2 irrigation solutions.
Results: No patients reported severe pain at any stage. Moderate pain was reported by 3% of patients (2/63 in each group) after
24 hours and by no patients beyond 24 hours, regardless of the irrigant used. Mild pain was more frequent but diminished rapidly
(reported by 19% [12/63] of patients in the NaOCl group and 16% [10/63] in the CLX group at 24 hours, by 10% [6/63] in the NaOCl
group and 11% [7/63] in the CLX group at 48 hours, by 3% [2/63] in both groups at 72 hours and by 2% [1/63] in both groups at 7
days). There were no statistically significant differences in postoperative pain between the 2 groups at any time point (p > 0.05).
Conclusions: The incidence of postoperative pain after single-visit endodontic treatment of chronic apical periodontitis with pulp
necrosis was uniformly low, regardless of the irrigant used.
T
he success of endodontic treat- play an important role, making up
ment is directly associated with for the shortcomings of instrumenta-
infection control.1-5 The liter- tion and complementing endodontic
ature indicates that rotary, hand or disinfection procedures.8
hybrid instrumentation, even when Sodium hypochlorite (NaOCl)
performed correctly, is inadequate to solution is the standard irrigant for
clear all organic and inorganic debris cleansing and disinfection of the root
from the root canal system.6-8 For this canal. 3 It has antimicrobial and histo-
and other reasons, irrigating solutions lytic characteristics, among other
jcda ca | 2012 |
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2. J Can Dent Assoc 2012;78:c84 jcda
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ca
Published by
The Canadian Dental Association
properties.9 However, NaOCl may be cytotoxic to odontal pockets, persistent exudate, or incomplete
the periradicular tissues, particularly at high con-
centrations.10,11 As such, postoperative pain is a
jadc
root formation, or if there was failure to achieve
apical patency. Patients with immunosuppression
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
concern when highly concentrated NaOCl solu- or immunocompromise were also excluded.
Publié par
tions are used in single-visit treatment of non- l’Association dentaire canadienne
Randomization
vital teeth because of the risk of extravasation of
The study sample consisted of 126 patients,
the irrigant into these tissues.12 Some investiga-
each seeking treatment for a single tooth (Table 1).
tors have suggested 2% chlorhexidine gel (CLX)
Any patient seeking treatment for the target condi-
as a good choice of irrigant for necrotic teeth
tion was eligible for inclusion, regardless of which
because of its antimicrobial action, high substan-
tooth required treatment. To minimize allocation
tivity and low toxicity.13,14 In addition, CLX may be
bias, the patients were randomly assigned to 2 bal-
less caustic than NaOCl.12 However, Mohammadi
anced groups by means of a restricted adaptive
and Abbott 5 reported that despite acceptable bio-
randomization procedure. For one group, 5.25%
compatibility, CLX is also potentially cytotoxic
NaOCl (Farmácia Fórmula & Ação, São Paulo, SP,
and may induce allergic reactions, though rarely.
Brazil) was used as the irrigant during treatment,
Direct comparison of NaOCl and CLX in a ran-
and for the other group, a mixture of 2% CLX
domized clinical trial, in terms of their influence
(Farmácia Fórmula & Ação) and normal saline
on postoperative pain, was therefore warranted.
(L.B.S, São Paulo, SP, Brazil) was used.
The study described here involved in vivo
assessment of the incidence of postoperative pain Endodontic Protocol
after single-visit endodontic treatment of patients After removal of caries-affected tissue, place-
with radiographically visible chronic apical peri- ment of rubber dam for isolation and establish-
odontitis and necrotic pulp, with either 5.25% ment of access to the root canal, the pulp chamber
NaOCl or 2% CLX plus normal saline (0.9% NaCl) was flushed with the designated irrigant by means
as the irrigant. of a 5-mL disposable syringe (Injex, Ourinhos,
SP, Brazil) and a 20 × 0.55 mm needle (Nipromed,
Methods Sorocaba, SP, Brazil) so that the needle would
stay loose inside the canal. Instrumentation
Patient Selection
was performed with a crown-down technique,
This prospective randomized clinical study was using ProTaper Universal rotary files (Dentsply/
approved by the São Leopoldo Mandic Center for Maillefer, Ballaigues, Switzerland) and hand files
Dental Research Ethics Committee (protocol no. (K-files and Flexofiles, Dentsply/Maillefer). Initial
2008/0346). All patients were informed of the pur- exploration was performed with a size 10 or size 15
poses of the study and provided written informed K-file, followed by S1 and SX rotary files. Coronal
consent. The study was conducted in accordance flaring was completed with size 4, 3 and 2 Gates–
with the provisions of the Declaration of Helsinki. Glidden drills (Dentsply/Maillefer) in a crown-
Patients who spontaneously sought care at the down fashion, respecting the natural anatomy of
dental practices of the 2 lead investigators (G.A. the canal, keeping a constant 5-mm distance from
and R.S.C.), both trained endodontists with over the radiographically determined apical limit and,
10 years of clinical experience, were recruited for in curved canals, going as far as the beginning of
the study. the curve. The preparation length was kept 1 mm
Patients were eligible for inclusion in the study short of the apical foramen, as defined by a Root
if they had no relevant comorbid conditions; had ZX II apex locator (J Morita, Kyoto, Japan).
received no antibiotics, anti-inflammatories or Apical patency was determined with a size 10
analgesics for at least 1 week before the study treat- or size 15 file, and irrigation with 2 mL of the
ment; had no preoperative pain; and had a diag- appropriate solution for each group was performed
nosis of chronic apical periodontitis with perira- each time instruments were switched. S1, S2, F1,
dicular bone loss and apical patency. Patients were F2 and F3 rotary files were used for shaping, fol-
excluded if they had calcified teeth, deep peri- lowed by cavity refinement with a minimum size
• 2 of 6 • | 2012 | jcda ca
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3. J Can Dent Assoc 2012;78:c84 jcda ca
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Published by
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Table 1 Distribution of teeth evaluated
No. of teeth in jadc
Tooth study sample NaOCl CLX DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Maxillary Publié par
l’Association dentaire canadienne
Central incisor 1 1 0
Lateral incisor 1 1 0
Canine 1 0 1
Premolar 23 14 9
Molar 44 20 24
Mandibular
Central incisor 0 0 0
Lateral incisor 1 1 0
Canine 3 1 2
Premolar 17 8 9
Molar 35 17 18
25, 30 or 35 Flexofile, depending on the anatomy pletion of endodontic treatment. Each participant
of the canal. Again, irrigation with 2 mL of the also returned in person for assessment. Pain was
specified solution was performed each time instru- classified on a 4-point scale, where 0 = absent, 1
ments were switched. Apical patency was main- = mild (not requiring analgesia), 2 = moderate
tained with a size 10 file. After shaping, the smear (relieved by analgesia) and 3 = severe (not relieved
layer was removed with 10 mL of 17% ethylenedi- by analgesia).
aminetetra-acetic acid (EDTA) (Farmácia Fórmula
& Ação) applied with an ultrasonic cavitation unit Statistical Analysis
(Enac, Osada, Japan) for 3 minutes, followed by a The Pearson χ2 test was used to compare pain
final washout with 5 mL of 5.25% NaOCl for the intensity between the 2 groups at 24, 48 and 72
NaOCl group or 10 mL of normal saline for the hours and 7 days after the procedure. The signifi-
CLX group. Each tooth was immediately subjected
cance level was set at p = 0.05.
to obturation with the warm vertical condensa-
tion (System B) technique, with gutta-percha and Results
Pulp Canal Sealer EWT (Sybron Endo, Orange,
CA, USA); back-filled by means of the Obtura II The 126 patients, 80 women and 46 men,
system (Obtura Spartan, Earth City, MO, USA); ranged in age from 18 to 59 years (median 38
and dressed with Cimpat, a premixed, non- years). All 126 patients completed the study and
eugenol, temporary filling material in paste form returned the questionnaires.
(Septodont, Saint-Maur-des-Fossés, France), and For all time points evaluated, there were no sig-
Z-250 resin composite (3M, Sumaré, SP, Brazil). nificant differences between the 2 groups in terms
of postoperative pain (p > 0.05) (Table 2). None of
Patient Questionnaire
Each participant received a questionnaire for the patients in either group reported severe pain.
assessment of pain (on a self-explanatory scale) Pain levels decreased with time elapsed since the
and determination of frequency of use of anal- procedure; the worst period was 24 hours after the
gesics after the root canal procedure, to be filled treatment, when 2 (3%) of the 63 patients in each
out at 24, 48 and 72 hours and 7 days after com- group experienced moderate pain.
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Cumulative Discussion
jadc
0
0
98
100
0
0
98
100
One approach to modern endodontics is com-
%
DES CONNAISSANCES
pletion of required therapy in aDENTAIRES INDISPENSABLES
single visit and
prospective, randomized clinicall’Associationhave pro-
trials dentaire canadienne
Publié par
vided evidence of the reliability of single-visit
Valid %
7 days
100
0
12
0
100
98
0
0
98
2
endodontics.1,15-20
Table 2 Self-reported pain intensity at 24, 48 and 72 hours and at 7 days after single-visit treatment for apical periodontitis with pulp necrosis
One aspect of success in endodontic therapy
is the minimization of postoperative pain; how-
Frequency
ever, the frequent occurrence of such pain has
63
0
1
0
63
62
0
0
62
1
been a concern since the late 1880s.21 Discomfort
after endodontic treatment is usually ascribed
Pain was assessed on a 4-point scale, where 0 = absent, 1 = mild (not requiring analgesia), 2 = moderate (relieved by analgesia) and 3 = severe (not relieved by analgesia).
Cumulative
to a tissue response caused by one or more fac-
tors, including failure at the cleaning and shaping
0
100
0
97
0
0
97
100
%
stages, presence of infected debris and damage to
the pulp.4 Overinstrumentation may be a mechan-
ical cause, whereas chemical factors include extru-
Valid %
72 h
100
0
3
0
100
97
0
0
97
3
sion of intracanal medications, filling materials or
irrigants.22 Sample selection for the present study
was restricted to patients with chronic apical peri-
Frequency
odontitis precisely because these patients are at
63
0
2
0
63
61
0
0
61
2
increased risk of postoperative pain 23; however,
meticulous aseptic technique was followed to min-
Cumulative
imize risk of microbial exacerbation of any pain.
Likewise, because preoperative pain is one of the
0
0
89
100
0
90
100
0
%
strongest predictors of postoperative pain, the
study was restricted to patients without any pre-
operative pain.24
Valid %
48 h
100
0
0
89
11
100
0
90
10
0
Unfortunately, it is difficult to objectively
measure a patient’s level of discomfort; data
for this variable therefore depend on subjective
Frequency
information provided by patients themselves and
63
0
7
0
63
56
0
57
6
0
are subject to error. In this study, postopera-
tive pain was measured by means of a question-
naire and a 4-point pain intensity scale, similar
NaOCl = 5.25% sodium hypochlorite, CLX = 2% chlorhexidine gel.
Cumulative
to methods used in several previous studies.24-27
0
97
100
81
0
78
97
100
%
In contrast, Figini and colleagues 4 assessed pain
according to only 2 levels: “discomfort” and
absence of pain.
Valid %
24 h
100
0
16
3
81
100
0
78
19
3
Previous authors have assessed the toxicity of
irrigating solutions and the severity of inflamma-
tion caused when endodontic medications con-
Frequency
tact the periapical tissues and have shown that
63
0
2
51
10
63
12
0
49
2
these factors play a role in the occurrence of pos-
toperative pain after single-visit treatment of teeth
affected by apical periodontitis. 3,11,28-30 However,
intensitya
by group
previous studies have led to divergent opinions
NaOCl
Total
Total
Pain
about the best choice of irrigant for optimal dis-
CLX
3
2
0
1
3
0
1
2
infection of the root canal system with the least
a
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5. J Can Dent Assoc 2012;78:c84 jcda ca
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
possible damage to the periapical tissue. 3,5,9,12,14 there were no significant differences in postopera-
Therefore, a head-to-head comparison was chosen
for this study of 2 chemical compounds in terms of
tive pain in the current study, probably because
sample selection was restricted to patients with
jadc
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
pain occurring after endodontic treatment. chronic apical periodontitis undergoing single- Publié par
NaOCl is currently the irrigant of choice visit treatment. l’Association dentaire canadienne
because of its chemical properties, which make it
an effective cleanser and disinfectant of the root Conclusion
canal system and an excellent solvent for organic
Both of the irrigants tested in this study
tissue. 3 A concentration of 5.25% was chosen to
(5.25% NaOCl and 2% CLX gel with 0.9% NaCl)
ensure more effective antimicrobial action (than
were associated with low rates of postopera-
would be the case with a lower concentration) and
tive pain among patients undergoing single-visit
stability of histolytic activity,12 and because high-
endodontic treatment for chronic apical periodon-
concentration solutions may have greater potential
titis with pulp necrosis. It is likely that as long
for dissolution of debris in areas that cannot be
as the selected irrigant is kept inside the root
reached by endodontic instrumentation.9 However,
canal by means of a low-pressure irrigation tech-
high concentrations substantially increase the tox-
nique, postoperative pain and flare-ups can be
icity of this irrigant and, in cases of extravasation,
avoided. a
could lead to postoperative pain.10 Conversely,
CLX with normal saline has been suggested by
THE AUTHORS
some investigators as a good choice of irrigant for
necrotic teeth because of its antimicrobial action,
high substantivity and low toxicity.13,14 It should Dr. Almeida is course coordinator, division of
not, however, be used as the sole irrigant, as 2% endodontics CIODONTO, Ilhéus, BA, Brazil.
CLX cannot dissolve organic matter.9,12
The results of this study showed no signif-
icant difference, in terms of postoperative pain
Dr. Marques is assistant professor, division of
at any of the time points evaluated, between endodontics CIODONTO, Ilhéus, BA, Brazil.
5.25% NaOCl and 2% CLX when used for irri-
gation during single-visit endodontic therapy.
The pain decreased with time, and by day 7 only
Dr. De Martin is assistant professor, division of
2% of patients in each group reported mild pain
endodontics, Center for Dental Research, São
(not requiring analgesia). This information is Leopoldo Mandic, Campinas, SP, Brazil.
clinically important, indicating that the main
reason for postoperative pain is probably debris
(contaminated or not) that is expelled outside Dr. Bueno is course coordinator, division of
endodontics, Center for Dental Research, São
the canal toward the periradicular tissue during Leopoldo Mandic, Campinas, SP, Brazil.
debridement. 22 Despite a wealth of in vitro
comparisons of the activity and effectiveness
of NaOCl and CLX, 5,12,31 a review of the litera- Dr. Nowakowski is assistant professor, depart-
ture revealed no in vivo clinical trials comparing ment of restorative dentistry, University of
Manitoba, Winnipeg, Manitoba.
5.25% NaOCl and 2% CLX with normal saline in
terms of postoperative pain after single-visit treat-
ment. Bashetty and Hegde32 conducted a random- Dr. Cunha is assistant professor, division endo-
ized comparison of 5.25% NaOCl and 2% CLX dontics, department of restorative dentistry,
in patients undergoing multiple-visit treatment University of Manitoba, Winnipeg, Manitoba.
for a variety of dental conditions. They found a
Correspondence to: Dr. Rodrigo Sanches Cunha, Faculty
significant difference in postoperative pain at
of Dentistry, Department of Restorative Dentistry, D226C-
6 hours after the procedure but no significant dif- 780 Bannatyne Ave., University of Manitoba, Winnipeg, MB
ferences at any other point in time. In contrast, R3E 0W2, Canada. Email: Rodrigo.Cunha@ad.umanitoba.ca
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The authors have no declared financial interests in any com- of asymptomatic necrotic teeth with apical periodontitis: a ran-
jadc
pany manufacturing the types of products mentioned in this domized clinical trial. J Endod. 2007;33(10):1145-8.
article. 19. Penesis VA, Fitzgerald PI, Fayad MI, Wenckus CS, BeGole
EA, Johnson BR. Outcome of one-visit DES CONNAISSANCES endo-
and two-visit
dontic treatment of necrotic teeth with apical periodontitis: a
DENTAIRES INDISPENSABLES
This article has been peer reviewed. randomized controlled trial with one-year evaluation. J Endod.
Publié par
2008;34(3):251-7. l’Association dentaire canadienne
20. El Mubarak AH, Abu-bakr NH, Ibrahim YE. Postoperative
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