Ronald R. Lemon

Effectiveness of Various Medications on Postoperative Pain following Complete Instrumentation

The root canals of 588 consecutive nonsurgical patients with varying levels of pain were completely instrumented in 10 endodontic practices and 4 endodontic graduate programs. The participants were sequentially assigned to one of nine medications and a placebo. The severity of pain was assessed by the visual analog scale for 72 h following instrumentation. Among all of the parameters studied, three factors (preoperative pain, apprehension, and types of medication) were found to be significant in determining postinstrumentation pain. An association was found between the intensity of pre-and postoperative pain. As the intensity of preoperative pain increased, the chances for more severe postoperative pain increased (p < 0.0001). In addition, an association between the presence of apprehension before any treatment and postoperative pain was also noted (between 0.012 < p < 0.047). Examination of the time-effect curves for various medications in patients with no mild pain showed no statistical significant difference between the effectiveness of different medications and placebo. However, a multiple comparison of the effectiveness of various medications and placebo on patients in moderate and severe preoperative pain showed that ibuprofen, ketoprofen, erythromycin base, penicillin, and methylprednisolone plus penicillin were more effective than placebo within the first 48 h following complete instrumentation.

Coronal leakage: Effects of smear layer, obturation technique, and sealer

Coronal microleakage may be a major factor in the etiology of treatment failure. This study examined the effect of obturation technique, sealer, and the presence of smear layer on coronal microleakage. Two hundred extracted human teeth were assigned to 20 treatment groups. Groups were examined with the smear layer present or smear layer removed (17% REDTA). Access cavities were exposed to artificial saliva then Pelikan Ink. Teeth were cleared and linear dye penetration measured. When all groups with the smear layer removed were compared with all groups with the smear layer present, significantly less leakage was seen when the smear layer was removed. Ultrafil displayed significantly more leakage than all other groups. Vertical compaction of lateral condensation and Thermafil obturations significantly reduced leakage. AH-26 displayed significantly less leakage than Roths 811 sealer. These results indicate that removal of the smear layer, the use of AH-26, and vertical compactin have cumulative effects in reducing coronal leakage.

Dowel space preparation and apical leakage

Leakage studies using 45 Ca were performed on gutta-percha filled teeth after pilot posthole preparation. Results showed no significant difference in apical leakage occurred when the spaces were created immediately after obturation or when they were made a week later.

Ferric sulfate hemostasis: Effect on osseous wound healing. I. Left in situ for maximum exposure*

Ferric sulfate solution is an accepted soft tissue hemostatic agent for use in dermatology and dentistry. This study was designed to test its effect on osseous healing when used during surgery to control osseous hemorrhage. Standardized osseous defects were created bilaterally in the naturally edentulous zone in rabbit mandibles. The control site was sutured immediately after clot formation in the defect. The contralateral experimental site received ferric sulfate application until complete hemostasis was achieved. The defect was filled with ferric sulfate solution to maximize any effect on healing and then closed with sutures. The experimental and control specimens were examined histologically after 18 and 46 days and scored for healing. Statistical analysis by Wilcoxon signed rank test showed significant adverse effects on osseous healing when ferric sulfate solution was left in situ.

Effect of post space preparation on apical seal using solvent techniques and Peeso reamers

Abstract The purpose of this study was to evaluate the effect on the apical seal of gutta-percha removal with Peeso reamers and softening agents, both immediately after obturation and one week after obturation. Sixty freshly extracted maxillary central incisors were obturated with gutta-percha and sealer using lateral condensation. In one group, post spaces were prepared with rotary instruments. In a second group, softening agents and files were used. Autoradiographic investigation using Ca 45 showed significant apical leakage in both groups when gutta-percha was removed immediately after obturation. Neither method caused significant apical leakage when post space preparation was delayed one week to allow sealers to harden.

Simplified esthetic root extrusion techniques

Abstract A modified technique of root extrusion is described. Emphasis is placed on chair-time efficiency, patient comfort, and esthetics during treatment. Case selection and alternative methods of therapy are discussed.

Apical seal: McSpadden vs lateral condensation

Sixty extracted maxillary central incisors were obturated either by lateral condensation with sealer, the McSpadden technique with sealer, or the McSpadden technique without sealer. Autoradiographic investigation with Ca 45 showed no statistically significant difference in millimeters of vertical leakage among the groups. However, in comparing roots with leakage vs roots without leakage, the McSpadden technique without sealer showed a statistically significant higher incidence of leakage than lateral condensation with sealer. Therefore, the McSpadden technique without sealer was more unpredictable than lateral condensation with sealer in establishing an apical seal.

Ferric Sulfate Hemostasis: Effect on Osseous Wound Healing, II, With Curettage and Irrigation

Hemorrhage control is often a problem for the clinician during osseous surgery. Ferric sulfate is an effective hemostatic agent, but with prolonged application to an osseous defect can cause persistent inflammation and delayed healing. The purpose of this investigation was to evaluate the effectiveness of ferric sulfate as a hemostatic agent and to determine its effect on healing after thorough curettage and irrigation from osseous surgical wounds. Standard size osseous defects were created bilaterally in the mandibles of rabbits. Ferric sulfate was placed in one defect until hemostasis was obtained; the contralateral defect was allowed to fill with blood and clot. After 5 min both defects were curetted and irrigated. The repair of the defects was evaluated histologically at 18 and 46 days. There were no significant differences between the ferric sulfate-treated defects and the untreated controls. When adequately curetted and irrigated from the surgical site prior to closure, ferric sulfate did not cause persistent inflammation or delay osseous repair in comparison to controls.