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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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What is the Differential Diagnosis and How Would you manage this Case?

This case is presented by Dr. Robert Bouclin Watch the Case Presentation   We welcome your feedback about this case. You have the option to remain anonymous in leaving your feedback. Please note that all your comments are moderated by the CDA Oasis Team and no comments go live immediately. Your feedback is sent to us in the form of an email which is accessed by the CDA Oasis Team and is not shared by a third party. You can safely leave your name and email allowing us to contact you, if needed, and that information will remain confidential at all ...

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Which bacteria are most commonly associated with failed endodontic cases?

Three species of bacteria are most commonly implicated in the failure of endodontic treatment. The microorganisms colonize dentinal walls and any debris that is pushed through the apex as well as dentine tubules of pulpless necrotic teeth. Enterococcus faecalis Associated with 30-40% of failed root canal treatments May be resistant to calcium hydroxide as well as chemomechanical endodontic processes Increased tendency to be resistant to antibiotics Actinomyces Can survive for long periods of time without causing host responses and is therefore, considered to have low pathogenicity Causes chronic infections Lives in necrotic pulpal and infected periapical tissues Streptococcus anginosus, Streptococcus ...

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What can cause root canal treatments to fail?

Root canal treatment failures can be attributed to two main causes: microbial or non-microbial. MICROBIAL causes can either be intra- or extra-radicular in nature Intraradicular Microorganisms found in root-canal-treated teeth with persisting periapical disease are different from those found in untreated teeth. The majority of bacteria found in treated teeth are Gram positive facultative anaerobes which reside in accessory canals, along the root-filling material in the main canal and in the dentinal tubules. There is no evidence to suggest that certain bacterial species are resistant to treatment. However, the existence of bacteria in treated teeth could mean that they have ...

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