A. Molander

Microbiological Evaluation of One- and Two-Visit Endodontic Treatment of Teeth with Apical Periodontitis: A Randomized, Clinical Trial

The antimicrobial efficacy of endodontic procedures performed in one-visit (including a 10-min intraappointment dressing with 5% iodine-potassium-iodide) was compared with a two-visit procedure (including an interappointment dressing with calcium-hydroxide paste). Teeth with apical periodontitis (n = 96) were randomly assigned to either group. Root canal sampling and culturing were performed before and immediately after instrumentation, and after medication. Initial sampling demonstrated the presence of microorganisms in 98% of the teeth. Postinstrumentation sampling showed reduction of cultivable microbiota. Antibacterial dressing further reduced the number of teeth with surviving microbes. In the postmedication samples, residual microorganisms were recovered in 29% of the one-visit teeth and in 36% of the two-visit treated teeth. No statistically significant differences between the groups were discerned. It was concluded that from a microbiological point of view, treatment of teeth with apical periodontitis performed in two appointments was not more effective than the investigated one-visit procedure.

Evaluation of the antibacterial potential of tetracycline or erythromycin mixed with calcium hydroxide as intracanal dressing against Enterococcus faecalis in vivo.

OBJECTIVE We evaluated the intracanal antibacterial potential of tetracycline or erythromycin mixed with calcium hydroxide (CH) against enterococci in vivo. STUDY DESIGN Fifty-five teeth in which enterococci were present were dressed for 1 month with either tetracycline (28 teeth) or erythromycin (27 teeth) mixed with CH. RESULTS The tetracycline mixture was effective against enterococci in 22 teeth (79%). In 7 teeth, other microorganisms were recovered, resulting in a total antimicrobial effect of 54%. The corresponding results for erythromycin were 96% and 56%. CONCLUSIONS The antimicrobial treatment of CH in combination with either erythromycin or tetracycline had a significant effect on enterococci, but the overall antimicrobial effect was relatively weak. Erythromycin mixed with CH seems to be a valuable option in the battle against monoinfections of enterococci.

Introducing nickel-titanium rotary instrumentation in a public dental service: The long-term effect on root filling quality

OBJECTIVE The aim of this study was to study the long-term effect on root filling quality after the introduction of nickel titanium rotary instrumentation (NTRI) within a public dental health organization. STUDY DESIGN After an education package, including hands-on training and/or lectures, the root filling quality was evaluated at the organizational level. All general dental practitioners (GDPs) employed at primary evaluation (n = 120) and after 4 years (n = 174) were included. RESULTS The improved root filling quality had been maintained 4 years later. The frequency of excellent root fillings was slightly higher at the long-term follow-up (52%) compared with the short-term follow-up (45%; P = .038). A nonsignificant decrease in very poor-quality root fillings was registered. CONCLUSIONS A technology shift among GDPs to NTRI will increase the rate of good-quality root fillings. However, the shift per se will not eliminate the problem of substandard clinical performance.

The impact of a continuing education programme on the adoption of nickel–titanium rotary instrumentation and root‐filling quality amongst a group of Swedish general dental practitioners

INTRODUCTION The aim of the study was to test the hypothesis that a further education programme relating to nickel-titanium rotary instrumentation (NTRI), with the concurrent activation of social/professional networks amongst all general dental practitioners (GDPs) in a public dental service in Sweden, would increase the adoption rate and improve root-filling quality. MATERIAL AND METHOD To activate the networks, the GDPs at the 25 clinics elected training coaches from amongst themselves. The coaches were educated by a specialist and were then free to organise and conduct the training of the local GDPs. However, collective hands-on training and discussions were mandatory. Lectures were held by an endodontist. The rate of adoption and root-filling quality was evaluated just before and 6 months after the education. Statistical tests were performed with chi-square using a 95% confidence interval. RESULTS Nickel-titanium rotary instrumentation was adopted by 88%. Excellent root fillings (score 1) increased from 45% to 59% (P = 0.003). The rate of poor-quality root fillings (score 4 and score 5) was not affected. The quality ratio (score 1/score 5) increased from 5.36 (118/22) to 9.5 (133/14). Eleven dentists (17%) at nine different clinics produced 49% of the poor-quality root fillings (score 4 and score 5). Seventy-three per cent of these dentists stated that they had adopted NTRI. CONCLUSIONS The introduction of NTRI will increase the adoption rate and the frequency of good-quality root fillings. However, it will not overcome the problems associated with dentists producing a low-quality level, even if a local professional network is activated.

Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis

OBJECTIVES The aims of this study were to evaluate whether the use of CT facilitates agreement among endodontists in selecting treatments for root-filled maxillary molars with apical periodontitis and to assess the efficacy of CT in choosing a treatment for such teeth. METHODS 39 root-filled maxillary molars from 34 patients with suspected apical periodontitis were independently evaluated by 4 endodontists and 1 postgraduate student (decision-makers). Treatment decisions were made based on intra-oral radiographs and a fictive clinical history. After 1-3 months, the same decision-makers repeated the examination of the same teeth but with additional information from a CT examination. Agreement between decision-makers with or without the availability of the CT results was measured with Cohens kappa coefficient. Differences in selected treatments with or without accessibility to the CT results were plotted for the same endodontists using descriptive statistics. RESULTS The agreement in assessments among endodontists was slight or fair before the CT results were available (range: 0.081-0.535). No increase was observed after reviewing the CT results (range: 0.116-0.379). After the use of CT, the treatment plan was changed 38-76% of the time by all decision-makers, and the changes affected 57.8% of the cases in the study. CONCLUSIONS The endodontists in this study exhibited a low degree of agreement when choosing a treatment for root-filled maxillary molars with apical periodontitis. A CT examination of the investigated teeth did not result in a significantly higher degree of agreement, and CT frequently contributed to a shift in the selected therapy.