sodium-hypochlorite and Dental-Fistula

Use of magnifying loupe may increase the efficiency of dental care. This clinical trial compared the time in performing non-surgical endodontic therapy with or without the use of a magnifying loupe.. Patients who required primary endodontic treatment in clinical trial centres at the University of Hong Kong (HKU) in Hong Kong and Peking University (PKU) in Beijing were invited to participate in this study. Two HKU dentists and 2 PKU dentists, forming 2 pairs of dentists with similar years of clinical experience, performed endodontic treatments according to the same procedures and used the same materials, either in single or multiple visits. They had no prior experience with the use of a magnifying loupe. One dentist from each pair was trained to use a magnifying loupe (x2.5). The treatment time was recorded.. Eighty-four PKU patients with a mean age of 42.8 years and 98 HKU patients with a mean age of 46.0 years were recruited in this study. Ninety-six teeth were treated with a magnifying loupe and 86 teeth were treated without a magnifying loupe. The results showed that treatment time was not associated with age, gender, tooth vitality, or the presence of apical radiolucency or sinus tract. The results of ANCOVA revealed the treatment time was associated with the clinic (HKU or PKU), root canal system (single or multiple), presence of preoperative pain, treatment visit (single or multiple), the use of a magnifying loupe, and the experience of the operator.. In this study, the use of a magnifying loupe could significantly reduce the endodontic treatment time.. Clinical Trials ChiCTR-IOR-15005988 registered 15 February 2015.

Topics: Adult; Calcium Hydroxide; Clinical Competence; Dental Alloys; Dental Fistula; Dental Pulp Cavity; Equipment Design; Female; Humans; Lenses; Male; Middle Aged; Nickel; Periapical Diseases; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Time Factors; Titanium; Toothache; Zinc Oxide-Eugenol Cement

Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments.. Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation.. The attrition rate was 5.1%, and a total of 538 teeth were evaluated. Among these teeth, 232 (43%) were operated in HK, 275 (51%) were treated in a single visit, and 234 (43%) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95% CI = 0.21-0.57, p < 0.01) and less pre-operative pain (OR = 1.10, 95% CI = 1.03-1.18, p < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7% (68 of 275) and 33.5% (88 of 263), respectively (p = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0% (11 of 275) and 5.3% (14 of 263), respectively (p = 0.47).. There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments.. ChiCTR-IOR-15005989.

Topics: Adult; Appointments and Schedules; Calcium Hydroxide; Dental Fistula; Epoxy Resins; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Middle Aged; Pain; Pain Measurement; Periapical Abscess; Periapical Periodontitis; Periodontal Pocket; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Mobility

Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.

Topics: Alveolar Process; Anatomic Variation; Bone Diseases, Infectious; Chronic Periodontitis; Cutaneous Fistula; Dental Fistula; Diagnosis, Differential; Gutta-Percha; Humans; Iatrogenic Disease; Male; Medical Errors; Molar; Periapical Abscess; Radiography, Dental; Retreatment; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Tooth Root; Treatment Failure; Young Adult

The morphogenic complexities of dens invaginatus (DI) Oehlers type 3 in maxillary canines offer significant endodontic challenges.. A case report is provided of a 14-year-old female patient who presented with an anomalous-looking permanent maxillary canine associated with a sinus tract. Pulp testing revealed a normal response on the distal aspect of the tooth, whereas the mesial segment tested nonresponsive. A radiolucent lesion was seen on the mesiolateral radicular area adjacent to the severely distended pulp chamber. A gutta-percha point inserted into the sinus tract traced to this same region. The diagnosis was normal pulp coincident with DI Oehlers type 3 with pulp necrosis and chronic apical abscess.. Despite a concerted effort to limit the root canal therapy to only the necrotic canal, its proximity to the normal canal obviated this possibility, entailing endodontic treatment of the entire root canal system. The necrotic pulp space was subjected to sustained irrigation with 5.25% sodium hypochlorite and then completed with 17% ethylenediaminetetraacetic acid. A bolus of gutta-percha was used to create an apical barrier, and then the remainder of the enlarged pulp space was obturated with injectable thermoplasticized gutta-percha. At a 4.5-year recall, there was no clinical and radiographic evidence of infection.. Endodontic success was accomplished with meticulous efforts of disinfection. Thermoplasticized gutta-percha can offer utility for obturation of anatomically complicated pulp spaces. The use of the dental operating microscope is an invaluable aid for discernment of the intricacies of teeth affected with DI type 3 variant and can enhance clinical outcomes.

Topics: Adolescent; Cuspid; Dens in Dente; Dental Fistula; Dental Pulp Necrosis; Edetic Acid; Female; Follow-Up Studies; Gutta-Percha; Humans; Maxilla; Periapical Abscess; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Treatment Outcome

To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment.. This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error.. proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001).. Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.

Topics: Adult; Chelating Agents; Chlorhexidine; Cohort Studies; Contraindications; Dental Fistula; Dental Pulp Cavity; Edetic Acid; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Periapical Diseases; Periapical Tissue; Post and Core Technique; Prognosis; Prospective Studies; Radiography; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Toothache; Treatment Outcome; Wound Healing; Zinc Oxide-Eugenol Cement

Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. This report describes the treatment a previously traumatized young maxillary lateral incisor, severely affected by inflammatory root resorption. An 11-year-old boy presented with pain and mobility in his maxillary incisors which experienced fall trauma 2 years earlier. Radiographic examination revealed incomplete root development of the right central incisor, associated with advanced inflammatory root resorption and a periapical lesion. Following removal of a prior long-term calcium hydroxide dressing, the root canal was submitted to a 2-week irrigation regimen involving 1.25% sodium hypochlorite and 2% chlorhexidine gluconate. Thereafter, the entire root was filled with mineral trioxide aggregate. The radiographic follow up at 6 months showed arrest of root resorption and initiation of periapical healing in the absence of clinical symptoms and mobility. This was followed by advanced osseous regeneration and re-establishment of the periodontal space at 12 and 24 months. From the present case, it can be concluded that mineral trioxide aggregate obturation can be a viable option that can improve the healing outcomes in cases of severe inflammatory root resorption in young permanent teeth.

Topics: Aluminum Compounds; Bone Regeneration; Calcium Compounds; Child; Chlorhexidine; Dental Fistula; Dental Pulp Necrosis; Drug Combinations; Follow-Up Studies; Humans; Incisor; Male; Oxides; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Resorption; Silicates; Sodium Hypochlorite; Tooth Crown; Tooth Fractures; Tooth Mobility; Treatment Outcome

Sodium hypochlorite solution is toxic to vital tissues, causing severe effects if extruded during endodontic treatment. This paper presents a report on the tissue damage related to inadvertent extrusion of concentrated sodium hypochlorite solution during root canal treatment. A 65-year-old woman was referred with moderate pain, ecchymosis, and severe swelling of the right side of the face. These symptoms appeared immediately after a root canal treatment of the maxillary right canine, which had been started 21 hours earlier. It was diagnosed as air emphysema related to sodium hypochlorite solution extravasation during the endodontic treatment. To avoid this, an initial radiograph should be taken to determine the correct canal working length and confirm root canal integrity.

Topics: Aged; Dental Fistula; Ecchymosis; Edema; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Periapical Abscess; Periapical Tissue; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Subcutaneous Emphysema

To describe a case in which a mandibular right second premolar with a necrotic pulp, sinus tract, periradicular radiolucency and an immature apex underwent revascularization via a single treatment approach.. Revascularization procedures have the potential to heal a partially necrotic pulp, which can be beneficial for the continued root development of immature teeth. However, it is not clear which revascularization protocols are the most effective. This case report details the outcome of a successful revascularization procedure on tooth 45 (FDI) in a 12-year-old patient, eliminating the associated periapical pathosis within 19 months. The tooth was treated using coronal root irrigation with 6% NaOCl and 2% chlorhexidine without instrumentation in a single visit. The successful outcome of this case report suggests that this conservative revascularization treatment approach can preserve the vitality of the dental pulp stem cells and create a suitable environment for pulp regeneration, resulting in the completion of root maturation.. The noninstrumentation procedure using 6% NaOCl and 2% chlorhexidine coronal irrigation may help preserve the remaining vital dental pulp stem cells believed to be critical for pulp revascularization. A single visit pulp revascularization protocol can be a favourable treatment option for an immature permanent tooth with a partially necrotic pulp.

Topics: Child; Chlorhexidine; Chronic Disease; Dental Fistula; Dental Pulp; Dental Pulp Cavity; Dental Pulp Necrosis; Female; Humans; Neovascularization, Physiologic; Periapical Abscess; Regeneration; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Stem Cells; Tooth Apex

This paper describes the clinical courses of three cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. All teeth involved had periradicular radiolucent areas noted on radiographic examination and extra-oral sinus tracts appearing on the chin with exudation and unpleasant aesthetic appearance. The adopted treatment protocol included treating the sinus tract surface simultaneously with the root canal therapy. After root canal shaping using 5.25% sodium hypochlorite solution, calcium hydroxide-based pastes associated with different vehicles were inserted into the root canal for 4 months, and were changed monthly. All the sinus tracts healed in 7 to 10 days. The apical lesions were completely repaired in a maximum period of 24 months. The treatment adopted provided a complete healing of the periapical lesions in a short follow-up period. Surgical repair of the cutaneous sinus tract was therefore unnecessary.

Topics: Adolescent; Adult; Calcium Hydroxide; Cutaneous Fistula; Dental Fistula; Female; Humans; Male; Periapical Abscess; Radiography; Root Canal Irrigants; Sodium Hypochlorite

To describe the role of calcium hydroxide in infection control during complex endodontic retreatment.. A case is presented in which two conventional endodontic treatments and two surgical interventions failed to bring periapical healing. Despite this history, a further conventional treatment augmented by long-term disinfection with calcium hydroxide finally delivered a successful outcome.. Periapical healing follows proper intracanal infection control. Despite repeated surgical and nonsurgical intervention, careful retreatment can often bring healing. Calcium hydroxide has long-acting antimicrobial and soft-tissue dissolving activity. It is a helpful adjunct in endodontic retreatment.

Topics: Calcium Hydroxide; Dental Fistula; Dentin, Secondary; Disinfectants; Follow-Up Studies; Humans; Male; Middle Aged; Periapical Abscess; Periapical Diseases; Retreatment; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Treatment Failure; Treatment Outcome