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Endodontics

When Should You Refer a Case for Endodontic Treatment?

Drs. Gevik Malkhassian and Craig Bellamy, Endodontists in Toronto, spoke with Dr. John O’Keefe about when general dentists should refer patients for endodontic treatment.  Highlights While mid-treatment challenges can occur in a seemingly “straight forward” endodontic treatment, a careful pre-assessment of the tooth and one’s own skill and expertise can minimize and/or prevent some of these challenges before treatment is started. In some instances, it may be determined that an endodontic referral is in the best interest of the patient and the practitioner. Some of the questions to consider include: Do I feel comfortable completing this treatment? Have I successfully treated ...

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How to Avoid Common Endodontic Pitfalls in General Practice

Dr. Viraj Vora speaks to Dr. John O’Keefe about how to avoid pitfall in endodontics. This is important to keep patient satisfaction high and practitioner stress levels low. Key messages Good diagnosis of the patient’s problem and treatment planning is essential Proper case selection is also important for success Send appropriate cases to an endodontic specialist Avoid cases that will be unsuccessful that may lead to patient retention or litigation issues in the future Know your own level of expertise and your limitations – be honest with yourself Remember that patients gather information from various sources (friends, colleagues and internet searches) ...

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What is the impact of root canal disinfection on treatment outcomes?

This summary is based on information found in Disinfection of Root Canal Systems: The Treatment of Apical Periodontitis (Wiley Publishing, 2014)   Disinfection of the root canal system and its general effect on endodontic outcomes is a complex issue, parts of which have been studied widely, but its specific effect is not well documented in clinical trials with high levels of clinical evidence. It is understood that if a canal system can be filled after a negative culture is obtained, the outcome is better (1). The steps that produce a canal system with a low level of bacteria remaining are of some dispute, and what level is critical to produce ...

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Is the anatomy of the root canal system a challenge to effective disinfection?

This summary is based on information found in Disinfection of Root Canal Systems: The Treatment of Apical Periodontitis (Wiley Publishing, 2014)   Six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment: Intraradicular infection persisting in the complex apical root canal system; Extraradicular infection, generally in the form of apical actinomycosis; Extruded root canal filling or other exogenous materials that cause a foreign body reaction; Accumulation of endogenous cholesterol crystals that irritate apical tissues; and True cystic lesions, and (vi) scar tissue (1). The internal anatomy can be notoriously complex, especially in molars, and includes extra canals, recesses, fins, isthmuses, and accessory canals that provide space for the biofilms ...

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Articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials

This summary is based on the article published in the Australian Journal of Endodontics titled: Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials (April 2016) Naichuan Su, PhD; Chunjie Li, PhD; Hang Wang, PhD; Jiefei Shen, PhD; Wenjia Liu, PhD; and Liang Kou, MD Read and Download the full-text version of the article courtesy of Wiley Publishing Context Irreversible pulpitis (IP), which is a severe damage to the pulp via bacteria in the vital dental pulp, would cause necrosis or death to pulp tissues, and thus leads to very intolerable severe spontaneous pain and forces patients to seek ...

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How does orthodontic tooth movement impact endodontic treatment and the outcome?

Teeth undergoing orthodontic tooth movement may require endodontic treatment which could be related or unrelated to orthodontic treatment. However, it is always preferable to try to foresee and treat the tooth endodontically prior to beginning orthodontics for some of the following reasons: Pulpal or periradicular pain can be masked by discomfort associated with that of tooth movement. Once fixed appliances are placed on teeth, rubber dam isolation can be difficult. Creating endodontic access preparations can be confusing as the long axis of the tooth may be difficult to determine. Working lengths or finding apical stops may be compromised by root ...

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What is the best antibiotic for orofacial infections of an endodontic nature?

Infections of an endodontic nature that are associated with orofacial pain are typically caused by obligate anaerobic bacteria. Given the spectrum of action, penicillins are the preferred antibiotic of choice. Drugs in this class act against the obligate anaerobes but, also affects the substrate interrelationships amongst various bacterial strains within the infection. As some of the strains of bacteria start to die, the others are unable to survive. The penicillins include amoxicillin as well as Augmentin (an amoxicillin and clavulanate combination). When penicillin is not effective, clindamycin may be used as it acts against anaerobic bacteria. However, clinician’s should use ...

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What kind of materials can be used to obturate root canals?

While other materials are available for obturating root canals, gutta percha is still the most widely used and accepted material. Gutta perch is biocompatible, inert material which does not irritate tissues. Composed of zinc oxide, barium sulfate and transpolyisoprene, gutta percha has the ability to adapt to root canal walls. Resilon, a thermoplastic polymer which contains bioactive glass, has become increasingly popular as a filling material recently. This technique involves the creation of a chemical bond between the sealer and filling material. Other paraformaldehyde-containing pastes have been proposed but, due to antigenic and cytotoxic effects on tissue, these have not ...

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