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Title: The use of mineral trioxide aggregate (MTA) in teeth with necrotic pulps and open apices. Author: Giuliani V. et al Reviewed by: Pranav Vohra, D.M.D. Journal: Dent Traumatol 2002 Aug;18(4):217-21 Purpose: A clinical case report on three cases treated with the use of an MTA apical plug for apexification. Materials & Methods: The three cases discussed are maxillary centrals with history of trauma and open apices due to necrosis. -Teeth were isolated, accessed, and root canals were rinsed with 5% NaOCl; then, calcium hydroxide paste was placed in the canals for 1 week. -An apical plug of 4mm MTA was then placed in each canal and the teeth obturated with warm GP technique. -Radiographic evaluation was done at 6 months and 1 year. Results: Resolution of the periapical radiolucencies was seen in all three cases. Discussion: The successful outcome and the speed of completion of treatment make MTA a valid option for apexification cases.
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Author: Sanjay Tewari Journal: OOO
2002;93:716-9 Reviewer: Alison Morrison, D.M.D. Objective: The purpose of this investigation was to
evaluate the coronal microleakage in endodontic access cavities restored with Kalzinol (ZOE Dentsply) and a
zinc oxide eugenol (ZOE) intermediate restorative
material at different intervals. (Kalzinol is a
zinc oxide eugenol-based cement reinforced with
polystyrene polymer) Materials and Methods: Eighty recently extracted human, caries
free molars were selected and stored in saline. Endodontic access
cavities were prepared and pulp chamber contents were removed. No attempt was made to remove material from
the root canal. A dry cotton pellet
was placed in the pulp chamber, leaving 4 to 5 mm of space for the temporary
restoration. Teeth were randomly
divided into two groups of 40 and each group was filled with one of the two
materials. Material was mixed
following the manufacturers instructions and placed with finger
pressure. Teeth were dried and coated
with sticky wax leaving only the coronal access exposed. Positive controls were coated with sticky
wax but no restorative material was placed.
Negative controls were completely coated with wax over a cotton pellet
in the pulp chamber. Restored access
cavities were immersed in 2% freshly prepared methylene
blue dye, and dye penetration was evaluated at 1, 2, 4, and 7day intervals. Results: Results of this study demonstrated variable
leakage patterns in both groups at all intervals. By day 7, both ZOE and Kalzinol
exhibited complete dye penetration into the pulp chamber in all of the
samples. ZOE cement displayed
dye penetration throughout the complete depth of the restoration, reaching
the pulp chamber by the second day, whereas Kalzinol
produced leakage reaching the pulp chamber on the fourth day. Conclusion: Results indicated that none of the ZOE
formulations tested could predictably produce a fluid tight seal even up to
the fourth day. It was recommended
that early replacement of temporary ZOE restorations during and after endodontic treatment be undertaken in an effort to
produce a better prognosis.
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Week of January 8, 2003 |
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Title: Antibiotic
susceptibility of bacteria associated with endodontic
abscesses. Author: Baumgartner JC and Xia T. Reviewed by: Pranav Vohra, D.M.D. Journal: JOE 2003 Jan;29(1):44-7 Purpose: To perform antibiotic susceptibility tests on a series of bacteria isolated from endodontic infections. Materials & Methods: Clinical samples were aseptically aspirated with a needle from endodontic abscesses, cultivated, and identified. -The antibiotics tested were penicillin V, amoxicillin, amoxicillin + clavulanic acid (augmentin), clindamycin, metronidazole, and clarithromycin. - The E-test was used to measure the zones of inhibition around each antibiotic for each of the 98 isolated bacteria. Results: Anaerobes accounted for 66% of the bacteria from endodontic abscesses , while 34% were facultative anaerobes. Antibiotic susceptibility of the bacteria was as follows:
Discussion: The authors conclude that due to the high number of resistant organisms in our population today, the practitioner should use prudence when selecting anti-microbial antibiotics. - Due to the narrow spectrum of bacteria associated with endodontic abscesses and the high efficacy of Penicillin V, it remains the drug of first choice. -Though, amoxicillin and amoxicillin+ clavulanic acid have a wider spectrum of action, their efficacy is similar to Pen V and thus their role in endodontic infections should be limited to prevent selection of resistant organisms. -The use of amoxicillin and amoxicillin+ clavulanic acid should be reserved for more serious infections involving non-oral bacteria and immunocompromized patients. -Clindamycin is a valid choice for patients with Pen hypersensitivity, while clarithromycin is an alternative to erythromycin in pen sensitive patients with mild infection.
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