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Endodontics

How would you manage this case: crown fracture with complicated chisel-type fracture?

This case was presented in the Dental Traumatology journal (December 2013). We are asking for your feedback on how you would treat this case. The full-text article will be added to the case on November 22nd, 2013. The Clinical Case A 24-year-old male patient came to The Department of Restorative Dentistry and Endodontics at the Dental Clinic in Vojvodina with dental injury of the maxillary left central incisor. The patient reported a sport injury that had occurred the night before during a football match. Clinical and radiographic examination revealed a complicated oblique crown fracture that extended subgingivally on the mesiopalatal ...

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How effective are antimicrobial solutions?

This summary is based on the article published in Australian Endodontic Journal: Evaluation of the antimicrobial activities of chlorhexidine gluconate, sodium hypochlorite and octenidine hydrochloride in vitro (April 2013) Purpose of the study Compare the antimicrobial activity of sodium hypochlorite (NaOCl), chlorhexidine gluconate (CHX) and octenidine hydrochloride (OCT) in different concentrations against endodontic pathogens in vitro.  Method Agar diffusion procedure was used to determine the antimicrobial activity of the tested materials. Enterococcus faecalis, Candida albicans and the mixture of these were used for this study. In the agar diffusion test, 5.25% NaOCl exhibited better antimicrobial effect than the other concentrations of NaOCl for all strains. Results All concentrations of ...

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Acute apical periodontitis and vertical root fracture of the same tooth: a case report

This summary is based on the article published in the Journal of Oral Science: Acute apical periodontitis and vertical root fracture of the same tooth: a case report Full-text article (PDF) Case Report The patient was a 75-year-old man who presented for consultation in December 2006. He was referred by his practitioner because of difficulty in chewing and an associated radiolucency in the mesial root of the right mandibular first molar. The patient was in good health, had no known allergies, and was a nonsmoker. The patient’s cardiologist prescribed 50 mg of aspirin per day as a preventive measure, due to suspicion of myocardial infarction. The patient brought his ...

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Is there evidence favouring one irrigant over another irrigant in root canal treatments?

This Systematic Review Summary is adapted from the British Evidence-Based Dentistry Journal Full Text (html) Full Text (PDF) Clinical Question What are the effects of irrigants used in the non-surgical root canal treatment of mature permanent teeth? Main Results Eleven trials (851 participants, 879 teeth) were included. Six trials were assessed at high risk of bias, three unclear and two low. Four compared sodium hypochlorite versus chlorhexidine, the other trials compared different interventions and only two of these trials included useable data on the primary outcomes of swelling and pain. Meta-analysis of sodium hypochlorite versus chlorhexidine indicated no strong evidence ...

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Does endodontic microsurgery (EMS) have better outcomes than contemporary root-end surgery (CRS)?

This Systematic Review Summary is adapted from the British Evidence-Based Dentistry Journal Full Text (html) Full Text (PDF) Clinical Question Does endodontic microsurgery (EMS) have better outcomes than contemporary root-end surgery (CRS)? Main Results Fourteen studies met the inclusion criteria. Weighted pooled success rates calculated from extracted raw data showed an 88% positive outcome for CRS (95% confidence interval [CI], 0.8455-0.9164) and 94% for EMS (95% CI, 0.8889-0.9816). This difference was statistically significant (P < .0005). Relative risk ratio analysis showed that the probability of success for EMS was 1.07 times that for CRS. Seven studies provided information on the ...

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How do I manage a necrotic tooth with unstoppable drainage?

This Urgent Care Scenario (USC) is presented by the JCDA Oasis Team in collaboration with Dr. Brian Jafine. The USC is also available through the Oasis Help system   Suggested Resources Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J. 1995;28(5):261-5. Morse DR, Koren LZ, Esposito JV, Goldberg JM, Belott RM, Sinai IH, et al. Asymptomatic teeth with necrotic pulps and associated periapical radiolucencies: relationship of flare-ups to endodontic instrumentation, antibiotic usage and stress in three separate practices at three different time periods. Int J Psychosom. 1986;33(1):5-87. Walton R, Fouad A. Endodontic interappointment flare-ups: a prospective study of incidence and related factors. ...

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Is there a truly great online resource for the management of dental trauma cases?

Can there be many more stressful occasions during a busy day at your office than when an emergency dental trauma case shows up unexpectedly requiring immediate treatment? You are already running behind and the patient (and often the parent) is crying and upset. You don’t deal with this type of case every day, and you are concerned about putting a foot wrong “under the spotlight.” What do you do next? Having consulted with some eminent experts in the field of pediatric dentistry, I have no hesitation in recommending the Dental Trauma Guide website to you as an excellent “at the fingertips” resource ...

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How do I manage vital, irreversibly inflamed teeth with unstoppable bleeding?

This urgent care scenario is presented by the JCDAOasis Team in consultation with Dr. Brian Jafine. Peer-reviewed content that appeared in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca  Presentation Population Patients with recent dental restorations (amalgams, resins, crowns) or trauma Medically-compromised patients Signs Large/deep restorations and crowns (broken down, leaking, open margins) Continuous bleeding after several attempts to dry, close, or fill the root canal spaces Symptoms Pain severity: the patient may experience some pain Investigation Thoroughly assess the patient’s medical history: inquire about diabetes mellitus, bleeding disorders, hypertension, history of radiation therapy, etc. Perform an oral examination: ...

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