Arieh Y. Kaufman

Hypersensitivity to sodium hypochlorite

Sodium hypochlorite (NaOCl), the most commonly used irrigant in endodontics, is known to produce allergic reactions. This fact, however, is rarely mentioned in endodontic texts. Until now, only two cases of adverse reaction describing accidental injection of NaOCl have been reported. In the current study a case is presented in which hypersensitivity to household bleach was proven with skin patch tests. The clinician was warned of the possible health hazard from using NaOCl in this patient by the past medical history. Endodontic therapy was carried out with an irrigant not containing NaOCl after the allergy to NaOCl was verified. Treatment was uneventful. It is suggested that before any endodontic treatment in which sodium hypochlorite is to be used, the patient should be asked about hypersensitivity to household bleaching materials.

In vivo model for assessing the functional efficacy of endodontic filling materials and techniques.

Endodontic fillings were challenged with bacterial ingress in mandibular premolars of 4 beagle dogs. Groups 1, 2, and 3 (n = 9), had canals filled with gutta-percha and sealer, gutta-percha alone, and sealer alone, respectively. After 2 wk, pulp chambers were inoculated with plaque. Group 4 (n = 9) and group 5 (n = 5) had canals either filled as in groups 1 to 3 or unfilled, respectively, but not inoculated. Group 6 (n = 5) had canals unfilled and inoculated. Teeth were radiographed periodically for 14 wk, dogs terminated, and jaw blocks retrieved and processed for light microscopic examination. Rarefying osteitis appeared in group 6 at 3 wk and in groups 2, 3, and 5 at 11 wk. Periradicular inflammation was none, mild, or severe. Occurrence of severe inflammation in groups 1 to 6 was 0, 11%, 33%, 0, 60%, and 100%, respectively. Groups 1 to 3 combined differed significantly from group 4 (repeated-measures ANOVA, p < 0.05). This model could be used to assess the functional efficacy of endodontic fillings in vivo.

Tooth length determination : a review

Tooth length determination is a crucial step in endodontic treatment. Until the late 1970s, tooth length determination was based mainly on radiographic interpretation. The advent of apex locators, which identify the difference in the electrical resistance between the root canal and the periodontal membrane, ushered in a new era for measuring tooth length. However, the accuracy of these devices has been questioned. Pertinent literature is discussed with the aim of providing information on the development of the concept, techniques, and devices for tooth length determination.

Taurodontism: an Endodontic Challenge. Report of a Case

Taurodontism is a morphoanatomical change in the shape of a tooth, which usually occurs in multirooted teeth. An enlarged body and pulp chamber, as well as apical displacement of the pulpal floor, are characteristic features. Endodontic treatment of a taurodont tooth is challenging, because it requires special care in handling and identifying the number of root canals. A case of endodontic treatment of a maxillary first molar with taurodontism is presented.

Determination of location of root perforations by electronic apex locators

OBJECTIVES This study was conducted to evaluate the accuracy of two electronic apex locators, the Sono Explorer Mark 2 Junior (Hakusui, Osaka, Japan) and Apit 2 (Osada, Tokyo, Japan) in detecting root perforations. The adequacy of radiographs for identifying root perforations was also assessed. STUDY DESIGN Thirty-two extracted human teeth were perforated in the middle third of the root and embedded in alginate. Determination of all perforations were carried out with K-files no. 25 attached to the apex locators tested. Two radiographs were taken at two angulations after each electronic measurement. The actual location of the file tip in relation to the perforation was determined with a stereomicroscope. A total of 512 radiographs were evaluated to attempt to identify root perforations. RESULTS The mean distance of the file tip from the external outline of the root surface was short for both instruments. A statistical difference (p < 0.05) was found between the two apex locators in dry canals or if saline solution was present. There was no significant difference between the two instruments in the presence of sodium hypochlorite. Evaluators radiographically identified 45% of the root perforations when located in buccal-lingual directions. CONCLUSION Under the in vitro conditions of this study, both devices determined the location of the perforations in an acceptable clinical range short of the root surface. Radiographs were found to be less reliable in identification of perforation locations.

Apical extent of rotary canal instrumentation with an apexlocating handpiece in vitro

PROBLEM The Tri Auto ZX (J. Morita Co., Kyoto, Japan) is a cordless endodontic handpiece with a built-in apex locator that is programmed to reverse the direction of rotation when the file reaches a predetermined apical level or when torque becomes excessive. OBJECTIVE The purpose of this investigation was to examine the apical extent of rotary canal instrumentation and the ability to maintain apical constriction with the Tri Auto ZX at different automated settings. STUDY DESIGN In 60 extracted teeth, canals were measured to the apical constriction, first visually and then electronically with the Tri Auto ZX; then they were instrumented with nickel titanium rotary files. For the instrumentation, the automatic apical reverse mechanism of the handpiece was set to 1, 1.5, or 2; these settings correspond to different distances from the apical foramen. Instrumentation was carried out apically until rotation was reversed by the automatic apical reverse function; the instrumented length was then measured, and the canal was filled with gutta-percha and sealer. The integrity of the apical constriction was assessed by exposing the apical 4 mm of the canal and observing the dentin-cementum junction. Paired t-tests were used to compare the visually measured length, the electronically measured length, and the instrumented length for each tooth. RESULTS On average, the electronically measured length was 0.54 mm shorter than the visually measured length (p < 0.05). When the automatic apical reverse mechanisms setting was 1, the instrumented length was 0.1 mm shorter than the electronically measured length; when the setting was 1.5, the instrumented length was 0.36 mm shorter than the electronically measured length (p < 0.01). Results were inconsistent when the setting was 2. CONCLUSION Instrumentation with the automatic apical reverse feature set at 1 consistently approximated the apical constriction; however, the constriction was frequently enlarged.

Facial emphysema caused by hydrogen peroxide irrigation: report of case

A case is described in which a facial emphysema occurred during irrigation with hydrogen peroxide in the course of endodontic treatment. The emphysema lasted for three days and was accompanied by sharp pain during the first day.

Conservative treatment of root perforations using apex locator and thermatic compactor—case study of a new method

Endodontic perforation, a serious complication in dental practice, is among the most common problems associated with endodontic procedures. Recommended methods of treatment are surgical or conservative using calcium hydroxide paste. A method in which perforations can be obturated immediately after their detection is described. The method utilizes an apex locator for measurement and detection of the perforation and a two-step treatment of thermatic compaction for filling the root canal as well as the perforation. A number of cases with a long follow-up are presented.

Uncontrolled bleeding during endodontic treatment as the first symptoms for diagnosing von Willebrand's disease

Von Willebrands disease has been established as the most common hereditary hemorrhagic disease. Endodontic treatment, when possible, rather than extraction is the treatment of choice in patients suffering from such a disease. A case is presented in which, during regular endodontic treatment, uncontrollable bleeding occurred, suggestive of a generalized bleeding disorder. A thorough hematologic examination revealed von Willebrands disease, which the patient was not aware of. The dental surgeon can play an important role in the diagnosis and treatment of such patients.

Salvizol as an intracanal antiseptic for endodontic use

T he indiscriminate use of strong antiseptics for disinfection of root canals during endodontic treatment is no longer considered to be essential for a successful outcome. The present philosophy is, rather, to use antiseptic agents on a selective basis and with great care. Thus, when indicated, the medicament of choice should have satisfactory antimicrobial activity but still not cause unnecessary tissue damage. Iodine potassium iodide (IKI) ,2 per cent, ‘* * is presently the outstanding example of an antiseptic that combines an excellent antimicrobial activity with the lowest toxic effect described. However, IKI, 2 per cent, is still not the final solution, since it possesses an undesirable high toxicity. In the process of evaluation of known antimicrobial agents, Salvizol (Nl, N”-decamethylene-N*, N*‘-decamethylene-bis-4-aminoquinaldinium-diacetate) was identified as having a broad antimicrobial spectrum3-5 and yet a low general toxicity.6 Salvizol is also surface active,’ and in a recent study8 the cleansing effect was reported to be superior to that of EDTAC. The aim of the present study was to evaluate the toxicity and tissue-irritating qualities of Salvizol under controlled conditions and to compare the medicament with IKI 2 per cent and EDTAC.