- Email: [email protected]
Primary root filling materials
the severity of disease and to ascertain if adequate asthma control is being maintained. The patient and/or parents and medical care provider should be asked about frequency of exacerbations, date of last attack, frequency of symptoms, exercise limitations, peak expiratory flow or forced expiratory volume in 1 second, hospitalizations, medication history, common triggers, and whether steroid cover is needed for prolonged or stressful treatment.
necessary. If the patient cannot use the inhaler appropriately, the drug should be administered using a spacer device. Oxygen is administered if indicated. If no improvement is seen or the attack is severe, an ambulance should be summoned. If the patient loses consciousness, cardiopulmonary resuscitation is appropriate.
During the procedure, the dentist should take all necessary measures to avoid triggering an exacerbation. This includes controlling aerosols from ultrasonic hand pieces, tooth enamel dust, and dental material residue, all of which have triggered attacks. Prolonged supine positioning should be avoided. A rubber dam may reduce the likelihood of an attack and ensure the airway is protected.
Clinical Significance.—Patients with asthma are at increased risk for developing dental problems often because of their medications. In addition, the dental environment houses multiple common triggers for asthma attacks. Thus dental practitioners must take precautions and plan for avoiding any asthma exacerbations as well as for intervening should any adverse events develop.
If the patient experiences an exacerbation of the asthma, he or she may be unable to breathe, may wheeze, and can be unable to speak. Respiration is diminished, heart rate is increased, and, in a severe attack, the patient may become cyanotic, demonstrate reduced respiratory effort and heart rate, show confusion or other neurological signs, or become unconscious. The dentist should (1) assess airway, breathing, circulation, disability, and exposure; (2) sit the conscious patient upright and administer two short puffs of a short-acting beta agonist; and (3) repeat if
Harrington H, Prado N, Barry S: Dental treatment in children with asthma—a review. Br Dent J 220:299-302, 2016 Reprints available from N Harrington, Oral and Maxillofacial Surgery, Countess of Chester Health Park, Liverpool Rd, Chester, CH2 1UL; e-mail: [email protected]
Primary root filling materials Background.—Pulpal treatment is delivered with the aim of preserving the integrity and health of oral tissues. Pulpectomy helps in retaining primary teeth that have irreversible pulp pathosis without symptoms and has a high success rate. However, it is also associated with complications related to the primary dentition’s complex root canal morphology, inherent physiologic root resorption, close proximity to permanent successors, difficulty visualizing tooth apices radiographically, complicated diagnosis related to the immaturity of the patient, requirement for behavioral management of the patient, and selection of technique and materials to be used for filling. The root filling materials chosen most often for primary teeth are zinc oxide eugenol (ZOE), iodoform-based pastes, and calcium hydroxide. Ideal filling material for primary teeth should be easily placed and removed, resorb at a rate similar to that of the primary root, not set to a hardness that could interfere with permanent tooth eruption, be radiopaque, not discolor the tooth, adhere to the walls, have minimal to no shrinkage, possess antiseptic properties, and cause no harm to periapical tissues or the
permanent tooth germ. Currently none of the materials available can fulfill all of these criteria. A prospective, double-blind, randomized controlled trial was conducted to assess the success rates of the current root filling materials used for pulpectomy in primary teeth. Methods.—The clinical and radiographic success rates of RC Fill, Vitapex, and Pulpdent root canal sealer were investigated in a population of 4- to 9-year-old children whose primary mandibular molars had necrotic pulps or irreversible pulpitis. The 90 children (129 teeth) were randomly assigned to receive RC Fill (ZOE plus iodoform), Vitapex (calcium hydroxide), or Pulpdent root canal sealer (ZOE). Outcomes defined by modified American Association of Endodontists (AAE) criteria were evaluated clinically and radiographically at 6, 12, and 30 months. Pearson’s chisquare analysis was done for intention-to-treat (ITT) and per-protocol populations. Results.—Twelve percent attrition left 90 teeth to assess at 30 months, but at the 6-, 12-, and 30-month evaluations, all
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Issue 2
2017
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three materials were associated with 100% clinical success. None of the teeth developed new lesions. Teeth demonstrated regeneration and reduction in the size of the furcation and periapical radiolucencies. However, thickening of the lamina dura and widening of the periodontal ligament space were observed in some cases, which were considered failures. As a result, the overall radiographic success rates were 94% at 6 months, 90% at 12 months, and 97% at 30 months for RC Fill, Vitapex, and Pulpdent, respectively. The differences between the various materials were not statistically significant. The ITT analysis yielded results similar to the per-protocol results when all clinical and radiographic parameters were considered. Discussion.—The three materials provided equally effective root filling performances for up to 30 months in these primary teeth with necrotic pulps or irreversible pulpitis.
Clinical Significance.—The current root filling materials are comparable in their ability to perform successfully for up to 30 months. Long-term follow-up data are needed to detail their performance until permanent teeth erupt and replace these primary teeth.
Pramila R, Muthu MS, Deepa G, et al: Pulpectomies in primary mandibular molars: A comparison of outcomes using three root filling materials. Int Endod J 49:413-421, 2016 Reprints available from R Pramila, Pedo Planet (Anna Nagar), Paediatric Dental Ctrs, Flat No 2, 1st Flr, 1076-G, TVS colony, Anna Nagar West Extension, Chennai – 600101, Tamil Nadu, India; e-mail: [email protected]
Removable Prosthodontics Coating to prevent denture stomatitis Background.—Denture wearers often suffer denture stomatitis (DS), which is caused by multiple factors, including mucosal trauma, aged denture material, residual monomer allergy, and, most commonly, the combination of poor oral hygiene and Candida albicans infection. C albicans biofilm is highly resistant to antifungal agents. In addition, continued wearing of the infected denture maintains contact between the infectious agent and the mucosa. As a result, research has been focused on developing ways to prevent denture colonization with microorganisms. The use of composite surface sealants to coat denture materials has offered promise in this area, although biofilm formation will probably not be completely eliminated from denture surfaces. Surface sealants must be combined with mechanical and chemical cleansing of the dentures to be most effective. Elderly individuals are the most common denture wearers, but their often diminished motor and mental functions may not permit sufficient mechanical cleansing, increasing the importance of using chemical agents to remove denture plaque. Denture emersion in sodium hypochlorite is a well-recognized method for achieving disinfection effectively. An in vitro evaluation of the C albicans biofilm formation on coated surfaces and the effect on this biofilm achieved by immersion in 1% sodium hypochlorite for 30 and 90 cycles of disinfection was conducted. Methods.—Two commercial composite surface sealants (Biscover and Surface Coat) were compared for their ability
94
Dental Abstracts
to reduce C albicans biofilm formation on denture resin that was prepared to simulate rough or smooth denture surfaces. In addition, the surface integrity of the denture resin after disinfection with 1% sodium hypochlorite solution was tested. Four surface-treatment groups were formed: one had smooth surfaces with 0.3 mm average surface roughness (Ra), one had rough surfaces (3 mm Ra), one had rough surfaces treated with Biscover, and one had rough surfaces treated with Surface Coat. Randomly selected specimens from each group were immersed in distilled water or 1% sodium hypochlorite for either 30 or 90 cycles. A crystal violet (CV) stain was applied to quantify biofilm formation, and a scanning electron microscopic evaluation was done to visually analyze the surface integrity and biofilm formation of the samples. Results.—CV staining indicated no significant differences in absorbance values between the Biscover specimens and those with uncoated 0.3-mm Ra surfaces. No differences between the Surface Coat surfaces and the uncoated 3-mm Ra surfaces. A comparison of the two sets of groups indicated that the uncoated 0.3-mm Ra surfaces and the Biscover surfaces had significantly lower absorbance values than the uncoated 3-mm or Surface Coat surfaces. A comparison of the immersed and cycled samples with the non-immersed samples of each group revealed that the uncoated surfaces were significantly different with 90 cycles
necessary. If the patient cannot use the inhaler appropriately, the drug should be administered using a spacer device. Oxygen is administered if indicated. If no improvement is seen or the attack is severe, an ambulance should be summoned. If the patient loses consciousness, cardiopulmonary resuscitation is appropriate.
During the procedure, the dentist should take all necessary measures to avoid triggering an exacerbation. This includes controlling aerosols from ultrasonic hand pieces, tooth enamel dust, and dental material residue, all of which have triggered attacks. Prolonged supine positioning should be avoided. A rubber dam may reduce the likelihood of an attack and ensure the airway is protected.
Clinical Significance.—Patients with asthma are at increased risk for developing dental problems often because of their medications. In addition, the dental environment houses multiple common triggers for asthma attacks. Thus dental practitioners must take precautions and plan for avoiding any asthma exacerbations as well as for intervening should any adverse events develop.
If the patient experiences an exacerbation of the asthma, he or she may be unable to breathe, may wheeze, and can be unable to speak. Respiration is diminished, heart rate is increased, and, in a severe attack, the patient may become cyanotic, demonstrate reduced respiratory effort and heart rate, show confusion or other neurological signs, or become unconscious. The dentist should (1) assess airway, breathing, circulation, disability, and exposure; (2) sit the conscious patient upright and administer two short puffs of a short-acting beta agonist; and (3) repeat if
Harrington H, Prado N, Barry S: Dental treatment in children with asthma—a review. Br Dent J 220:299-302, 2016 Reprints available from N Harrington, Oral and Maxillofacial Surgery, Countess of Chester Health Park, Liverpool Rd, Chester, CH2 1UL; e-mail: [email protected]
Primary root filling materials Background.—Pulpal treatment is delivered with the aim of preserving the integrity and health of oral tissues. Pulpectomy helps in retaining primary teeth that have irreversible pulp pathosis without symptoms and has a high success rate. However, it is also associated with complications related to the primary dentition’s complex root canal morphology, inherent physiologic root resorption, close proximity to permanent successors, difficulty visualizing tooth apices radiographically, complicated diagnosis related to the immaturity of the patient, requirement for behavioral management of the patient, and selection of technique and materials to be used for filling. The root filling materials chosen most often for primary teeth are zinc oxide eugenol (ZOE), iodoform-based pastes, and calcium hydroxide. Ideal filling material for primary teeth should be easily placed and removed, resorb at a rate similar to that of the primary root, not set to a hardness that could interfere with permanent tooth eruption, be radiopaque, not discolor the tooth, adhere to the walls, have minimal to no shrinkage, possess antiseptic properties, and cause no harm to periapical tissues or the
permanent tooth germ. Currently none of the materials available can fulfill all of these criteria. A prospective, double-blind, randomized controlled trial was conducted to assess the success rates of the current root filling materials used for pulpectomy in primary teeth. Methods.—The clinical and radiographic success rates of RC Fill, Vitapex, and Pulpdent root canal sealer were investigated in a population of 4- to 9-year-old children whose primary mandibular molars had necrotic pulps or irreversible pulpitis. The 90 children (129 teeth) were randomly assigned to receive RC Fill (ZOE plus iodoform), Vitapex (calcium hydroxide), or Pulpdent root canal sealer (ZOE). Outcomes defined by modified American Association of Endodontists (AAE) criteria were evaluated clinically and radiographically at 6, 12, and 30 months. Pearson’s chisquare analysis was done for intention-to-treat (ITT) and per-protocol populations. Results.—Twelve percent attrition left 90 teeth to assess at 30 months, but at the 6-, 12-, and 30-month evaluations, all
Volume 62
Issue 2
2017
93
three materials were associated with 100% clinical success. None of the teeth developed new lesions. Teeth demonstrated regeneration and reduction in the size of the furcation and periapical radiolucencies. However, thickening of the lamina dura and widening of the periodontal ligament space were observed in some cases, which were considered failures. As a result, the overall radiographic success rates were 94% at 6 months, 90% at 12 months, and 97% at 30 months for RC Fill, Vitapex, and Pulpdent, respectively. The differences between the various materials were not statistically significant. The ITT analysis yielded results similar to the per-protocol results when all clinical and radiographic parameters were considered. Discussion.—The three materials provided equally effective root filling performances for up to 30 months in these primary teeth with necrotic pulps or irreversible pulpitis.
Clinical Significance.—The current root filling materials are comparable in their ability to perform successfully for up to 30 months. Long-term follow-up data are needed to detail their performance until permanent teeth erupt and replace these primary teeth.
Pramila R, Muthu MS, Deepa G, et al: Pulpectomies in primary mandibular molars: A comparison of outcomes using three root filling materials. Int Endod J 49:413-421, 2016 Reprints available from R Pramila, Pedo Planet (Anna Nagar), Paediatric Dental Ctrs, Flat No 2, 1st Flr, 1076-G, TVS colony, Anna Nagar West Extension, Chennai – 600101, Tamil Nadu, India; e-mail: [email protected]
Removable Prosthodontics Coating to prevent denture stomatitis Background.—Denture wearers often suffer denture stomatitis (DS), which is caused by multiple factors, including mucosal trauma, aged denture material, residual monomer allergy, and, most commonly, the combination of poor oral hygiene and Candida albicans infection. C albicans biofilm is highly resistant to antifungal agents. In addition, continued wearing of the infected denture maintains contact between the infectious agent and the mucosa. As a result, research has been focused on developing ways to prevent denture colonization with microorganisms. The use of composite surface sealants to coat denture materials has offered promise in this area, although biofilm formation will probably not be completely eliminated from denture surfaces. Surface sealants must be combined with mechanical and chemical cleansing of the dentures to be most effective. Elderly individuals are the most common denture wearers, but their often diminished motor and mental functions may not permit sufficient mechanical cleansing, increasing the importance of using chemical agents to remove denture plaque. Denture emersion in sodium hypochlorite is a well-recognized method for achieving disinfection effectively. An in vitro evaluation of the C albicans biofilm formation on coated surfaces and the effect on this biofilm achieved by immersion in 1% sodium hypochlorite for 30 and 90 cycles of disinfection was conducted. Methods.—Two commercial composite surface sealants (Biscover and Surface Coat) were compared for their ability
94
Dental Abstracts
to reduce C albicans biofilm formation on denture resin that was prepared to simulate rough or smooth denture surfaces. In addition, the surface integrity of the denture resin after disinfection with 1% sodium hypochlorite solution was tested. Four surface-treatment groups were formed: one had smooth surfaces with 0.3 mm average surface roughness (Ra), one had rough surfaces (3 mm Ra), one had rough surfaces treated with Biscover, and one had rough surfaces treated with Surface Coat. Randomly selected specimens from each group were immersed in distilled water or 1% sodium hypochlorite for either 30 or 90 cycles. A crystal violet (CV) stain was applied to quantify biofilm formation, and a scanning electron microscopic evaluation was done to visually analyze the surface integrity and biofilm formation of the samples. Results.—CV staining indicated no significant differences in absorbance values between the Biscover specimens and those with uncoated 0.3-mm Ra surfaces. No differences between the Surface Coat surfaces and the uncoated 3-mm Ra surfaces. A comparison of the two sets of groups indicated that the uncoated 0.3-mm Ra surfaces and the Biscover surfaces had significantly lower absorbance values than the uncoated 3-mm or Surface Coat surfaces. A comparison of the immersed and cycled samples with the non-immersed samples of each group revealed that the uncoated surfaces were significantly different with 90 cycles