Dental India Newsletter dated 3rd September 2006

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Dental List of "objectives"

Dear Grasshopper,
Unless we have a Unless we have a
crystal ball, we can never be sure of a clinical outcome.  However, we can create favorable conditions for repair and "assume" that we will achive a 90% success healing:

  1. correct diagnosis
  2. proper access
  3. finding all the orifices to the canal systems
  4. obtaining and maintaining proper WL to the apical foramina
  5. debridement with the understanding that canals are not round like plastic blocks and that we need to instrument the out of round areas the best we can
  6. continuous and deep irrigation with appropriate solutions
  7. proper apical enlargement to proper sizes based upon mophology of the root canal, not the philosophy of 'gurus'  ;-)
  8. the placement of a proper antimicrobial disinfectant to assist in dissoloving tissues and neutralizing toxins (LPS, TNF, etc.) as well as microorganisms that are left behind
  9. a proper coronal seal
  10. at the second appointment; re-establish the correct WL
  11. thorough irrigation, re-establishment of apical patency with a size #10 or #15 hand file
  12. apically gauge and apically clear the last few mm's of canal space
  13. final rinses with appropriate solutions in the proper order
  14. use ultrasonics with NaOCl
  15. remove the smear layer
  16. use CHX and cone-fit in CHX
  17. dry the canal and look for exudation etc
  18. obturate the canal system
  19. place a proper coronal; seal
  20. follow-up the case
  21. impress your program director    - Courtesy Fred Barnett, ROOTS
 
Is there life after Buckley's formocresol? Part II - Development of a protocol for the management of extensive caries in the primary molar.

Patchett CL, Srinivasan V, Waterhouse PJ.

Department of Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK. c.l.patchett@ncl.ac.uk

OBJECTIVE: To produce a working clinical protocol for pulp therapy techniques in the extensively carious primary molar. INTRODUCTION: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. As such, a medicament that can be used to replace formocresol in clinical practice should be identified. METHODS: Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence-based protocol, for the management of the extensively carious primary molar. CONCLUSION: A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.

Abstract: Influence of rubber dam isolation on human pulp responses after capping with calcium hydroxide and an adhesive system.

de Lourdes Rodrigues Accorinte M, Reis A, Dourado Loguercio A, Cavalcanti de Araujo V , Muench A.

Department of Dental Materials, School of Dentistry, University of Sao Paulo, SP, Brazil.

OBJECTIVE: The objective was to evaluate the influence of rubber dam isolation on the response of human pulps capped with calcium hydroxide and an adhesive system. METHODS AND MATERIALS: Direct pulp capping was performed in 40 caries-free human premolars scheduled for extraction as part of orthodontic treatment. The teeth were randomly divided into 8 groups (n = 5) according to the combination of treatment factors: capping agent (adhesive resin or calcium hydroxide), isolation (rubber dam or cotton pellets only), and period of evaluation (30 or 60 days). Class 2 cavities were prepared, and pulp exposures were created on the occlusal floor. After capping, all teeth were restored with Z-100 placed incrementally. After 30 or 60 days, patients were asked about their symptoms, teeth were extracted, and serial sections were evaluated. The data were subjected to a nonparametric test. RESULTS: Overall, the histologic features showed that the pulp response was worse for groups capped with adhesive. For adhesive-capped groups, the pulp response varied from pulp necrosis to acute inflammatory cell infiltrate, and most of the pulps capped without rubber dam isolation showed severe inflammatory cell infiltrate involving the coronal pulp with chronic abscesses. For the calcium hydroxide groups, all specimens showed dentin bridge formation, regardless of the type of isolation used. CONCLUSION: Calcium hydroxide should be used as the material of choice for pulp capping with or without rubber dam isolation. The use of adhesive systems in vital pulp capping is contraindicated, especially if rubber dam isolation is not implemented.

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