Enhanced access and isolation by simple modifications of dental armamentarium

A good armamentarium facilitates the efficient working of the dentist which in turn improves the quality of treatment rendered to the patient. The present invention of the unit consisting of the flexible mirror attached to the suction and the dual suction tip aims at improving the clinical efficiency of dental treatments provided. This compact unit is designed to improve the visualization and isolation of the operating field. It is also easy to fabricate and alleviates the very relevant shortcomings of clinical work.

Factores asociados a las actitudes de odontólogos peruanos hacia el aislamiento absoluto en tiempos de la COVID-19

RESUMEN Introducción: El aislamiento absoluto es una técnica odontológica que aumenta la probabilidad de éxito del tratamiento, más en esta pandemia. Objetivo: Caracterizar las actitudes de odontólogos peruanos hacia el aislamiento absoluto en tiempo de pandemia por la COVID-19 e identificar factores asociados. Métodos: Estudio observacional y transversal con empleo de técnicas analíticas, realizado a través de una encuesta virtual a odontólogos del Perú. Se usó la escala Act-AA-Cov19, al puntaje se le dividió en tercil superior (los de acuerdo) versus los otros puntajes (categoría de comparación); se obtuvieron estadísticos de asociación. Resultados: En los 279 odontólogos, la importancia del aislamiento absoluto y el uso de equipos de protección personal fue lo más aceptado (96 % de acuerdo siempre y 4 % casi siempre). La necesidad de actualizar los conocimientos sobre aislamiento absoluto se asoció con una mejor actitud hacia el proceder (RPc: 1,52; IC 95 %: 1,18-1,95; valor p= 0,001); mientras que el resultado fue opuesto en los graduados en universidades privadas (RPc: 0,79; IC 95 %: 0,66-0,95; valor p= 0,011). Conclusión: La premisa más aceptada es sobre la importancia del aislamiento absoluto y uso de equipos de protección personal, seguido por el hecho de que un campo de trabajo libre de saliva/ sangre facilita el procedimiento.

ABSTRACT Introduction: Rubber dam isolation is a dental technique that increases the probability of successful treatment, especially in this pandemic. Aim: To characterize the attitudes of Peruvian dentists towards rubber dam insolation in times of COVID-19 pandemic and to identify factors associated with them. Methods: Observational and cross-sectional study using analytical techniques, carried out through a virtual survey of dentists in Peru. The Act-AA-Cov19 scale was used, the score was divided into the upper tertile (those in agreement) versus the other scores (comparison category); association statistics were obtained. Results: Of the 279 dentists, the importance of rubber dam isolation and use of personal protective equipment was the most accepted (96 % always agreed and 4 % almost always). The need to update knowledge about rubber dam isolation was associated with a better attitude towards the procedure (PRc: 1,52; 95 % CI: 1,18-1.95; p value = 0,001); while the result was the opposite in graduates from private universities (PRc: 0,79; 95 % CI: 0,66-0,95; p value = 0,011). Conclusion: The most widely accepted premise is about the importance of rubber dam isolation and use of personal protective equipment, followed by the fact that a saliva / blood-free work area facilitates the procedure.

Aislación relativa comparada con absoluta en restauraciones de resina compuesta en pacientes con dentición permanente / Relative isolation versus rubber dam isolation for composite resin restorations in patients with permanent dentition

RESUMEN: Introducción: La técnica de restauración con resina compuesta requiere un adecuado control de la humedad durante el procedimiento. Para ello, puede realizarse aislación relativa (con tórulas de algodón y eyector de saliva) o aislación absoluta con goma dique de la o las piezas dentarias. Sin embargo, no está claro cuál de estos protocolos sería más efectivo. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que realizar aislación relativa comparado con aislación absoluta podría aumentar el riesgo de falla de restauración a los 6 meses, pero la certeza de la evidencia es baja. No es posible establecer con claridad si la aislación relativa disminuye el riesgo de falla de la restauración a 10 años, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja. No se encontraron estudios que evaluaran los desenlaces caries secundaria, sensibilidad postoperatoria y tinción.

ABSTRACT: Introduction: Resin composite restorations technique requires effective control of moisture during the procedure. Isolation and moisture control can be performed by relative isolation (use of cotton rolls combined with aspiration by saliva ejector) or rubber dam isolation. However, there is uncertainty regarding which one of these protocols would be most beneficial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including two studies overall, of which all were randomized trials. We conclude that relative isolation may increase the risk of failure of the restorations at 6 months. We are uncertain whether relative reduces the risk of failure of the restorations at 10 years as the certainty of the evidence has been assessed as very low. No studies were found that looked at secondary caries, post-operative sensitivity or stained margins.

Emprego do isolamento absoluto em Endodontia: uma análise da percepção do paciente e do cirurgião-dentista do noroeste do Paraná / Use of absolute isolation in Endodontics: an analysis of the perception of the patient and the dentist of northwestern Paraná/Brazil

O isolamento absoluto é um procedimento indispensável no tratamento odontológico, principalmente em Endodontia. Contudo, certos profissionais ainda relutam em usá-lo. Objetivo: O presente estudo teve como objetivo entrevistar profissionais, acadêmicos de Odontologia e pacientes, visando avaliar a percepção de cada grupo com relação à eficácia e segurança do lençol de borracha, por meio do percentual de respostas dadas às perguntas. Métodos: Foram elaborados questionários a serem respondidos por 50 acadêmicos do último ano do curso de Odontologia da UNIPAR, 50 cirurgiões-dentistas e 100 pacientes de clínicas particulares e da clínica odondológica da UNIPAR da cidade de Umuarama, no Paraná. Após a coleta de todos os questionários distribuídos, as respostas apresentadas foram tabuladas e analisadas. Resultados: 66% dos odontólogos e 74% dos estudantes de Odontologia entrevistados relataram que sempre fazem o uso do isolamento absoluto, citando como pontos negativos da sua utilização o tempo para aplicação, a intolerância a ele por parte do paciente, e a falta de treinamento. Ainda, 52% dos pacientes de clínicas particulares e 54% dos pacientes da clínica odontológica da UNI- PAR consideraram o isolamento absoluto desconfortável; porém, apenas 6% e 10%, respectivamente, assinalaram que não gostariam que o isolamento absoluto fosse utilizado na próxima consulta. Conclusões: O isolamento absoluto tem uma grande aprovação pelos profissionais, acadêmicos e pacientes. Uma maioria significativa de cirurgiões-dentistas e acadêmicos de Odontologia tem em- pregado o isolamento absoluto rotineiramente na prática endodôntica. Os pacientes consideram o isolamento absoluto desconfortável; apesar disso, preferem que se faça uso dele durante o tratamento odontológico (AU).

Introduction: Rubber dam isolation is a mandatory procedure in dental treatment, especially in Endodontics. However, some professionals still refuse to employ it. Aim: This study interviewed dental professionals, dental students and patients, evaluating the perception of each group concerning the efficacy and safety of rubber dam by the percentage of responses to the questions. Methods: The questionnaires were responded by 50 students of the last year of Dentistry course at Unipar, 50 dental professionals and 100 patients from private clinics and the dental clinic of Unipar, at the city of Umuarama in Paraná. After collection of all submitted questionnaires, the responses were tabulated and analyzed. Results: 66% of dental professionals and 74% of dental students interviewed reported that they always use rubber dam isolation, mentioning as negative aspects for not using it the time required for placement, patient refusal and lack of training. Among the patients, 52% from private clinics and 54% from the dental clinic of Unipar considered the rubber dam uncomfortable, yet only 6% and 10%, respectively, indicated they would not like to use the rubber dam on the following session. Conclusions: Rubber dam isolation has great acceptance by professionals, students and patients. A significant part of dental professionals and students have been using the rubber dam routinely in the endodontic practice. The patients consider the rubber dam uncomfortable, notwithstanding they prefer to use it during dental treatment (AU).

Accidental ingestion of an endodontic file: A case report and clinical review

Foreign body ingestion or aspiration during dental procedure is a rare but serious mishap. Ingestion of blunt foreign objects is less hazardous, and the object is generally egested through the gastrointestinal tract uneventfully, but sharp objects like endodontic files may sometimes cause intestinal perforation. Safety during dental treatment of children cannot be overemphasized. The present paper reports a case of accidental ingestion of a file during pulpectomy and the retrieval by endoscopy. This article also discusses the management of such an untoward event.

Uso de aislamiento absoluto con dique de goma en tratamientos restaurativos por rehabilitadores orales en el departamento de Antioquia / Use of absolute isolation with rubber dam in restorative treatments by oral rehabilitators in the department of Antioquia / Uso de isolamento absoluto com represa de borracha em tratamentos reativos por reabilitadores oral no departamento de Antioquia

Resumen Introducción y Objetivo: El aislamiento absoluto del campo operatorio con dique de goma (DG), es esencial para el resultado exitoso del tratamiento endodóntico y restaurador. A la fecha, no existe evidencia científica que soporte su uso entre rehabilitadores orales. Los propósitos de este estudio fueron: determinar la frecuencia del uso de DG como método de aislamiento absoluto, identificar que variables sociodemográficas influenciaron su uso y conocer las principales razones de su uso o no por rehabilitadores orales del departamento de Antioquia durante los procedimientos restaurativos. Materiales y métodos: Una encuesta autodiligenciable con 17 preguntas fue hecha a 77 rehabilitadores orales. Un análisis estadístico descriptivo univariado y bivariado utilizando la prueba de chi cuadrado de Pearson fue utilizado para determinar la asociación entre los factores demográficos y el uso o no del DG (P <0.05). Resultados: En general, la prevalencia del uso del DG fue de 89,6% intervalo de confianza (IC) 95% (82,8%- 96,4%), siendo mayor en el sector posterior 61,1%, seguido por 55,9% en el sector anterior, 19,5% cementación de postes y 14,3% en la elaboración de postes. Mientras la falta de tiempo con 44,2% y no ver la necesidad 28,6%, fueron las razones más prevalentes para omitir el uso del DG; el control de la humedad con 81,8% y mejorar la adhesión 71,4%, justificaron su uso. La experiencia clínica fue la única variable que influenció el uso del DG (P = 0.03). Conclusión: El uso de DG fue más frecuente para el sector posterior que el anterior, y frecuentemente omitido para la elaboración y cementación de postes.

Abstract Introduction and Objective: The absolute isolation of the operative field with rubber dam (DG), is essential for the successful outcome of the endodontic and restorative treatment. To date, there is no scientific evidence to support its use among oral rehabilitators. The purposes of this study were: to determine the frequency of the use of DG as a method of absolute isolation, to identify which socio-demographic variables influenced its use, and to know the main reasons for its use or not by oral rehabilitators of the department of Antioquia during the restorative procedures. Materials and methods: A self-diligent survey with 17 questions was done to 77 oral rehabilitators. A descriptive uni-variate and bivariate statistical analysis using Pearson's chi-square test was used to determine the association between demographic factors and the use or not of the DG (P <0.05). Results: In general, the prevalence of the use of the DG was 89.6% confidence interval, 95% (82.8% - 96.4%), being higher in the posterior sector 61.1%, followed by 55.9% in the previous sector, 19.5% post cementation and 14, 3% in the development of posts. Meanwhile, the lack of time with 44.2% and not seeing the need 28.6%, were the most prevalent reasons for omitting the use of the DG; the humidity control with 81.8% and improve the adhesion 71.4%, justified its use. Clinical experience was the only variable that influenced the use of DG (P = 0.03). Conclusion: The use of DG was more frequent for the posterior sector than the previous one, and frequently omitted for the elaboration and cementation of posts.

Resumo Introdução e Objetivo: O isolamento absoluto do campo operatório com o dique de borracha (DG) é essencial para o sucesso do tratamento endodôntico e restaurador. Até o momento, não há evidências científicas para apoiar seu uso entre reabilitadores orais do departamento de Antioquia. Os objetivos deste estudo foram: Determinar a frequência do uso de GD como método de isolamento absoluto, identificar quais variáveis sociodemográficas estão sendo utilizadas e conhecer as principais razões para seu uso ou não por reabilitadores orais da comunidade do Departamento de Antioquia, durante os procedimentos restaurativos. Materiais e métodos: Foi realizado um inquérito auto-diligente com 17 questões a 77 reabilitadores orais. Uma análise estatística descritiva univariada e bivariada, utilizando o teste qui-quadrado de Pearson, foi utilizada para determinar a associação entre fatores demográficos e o uso ou não do GD. (P<0,05). Resultados: Em geral, a prevalência do uso do GD foi de 89,6% de intervalo de confiança, 95% (82,8% - 96,4%), sendo maior no setor subsequente 61,1%, seguido por 55,9% no setor anterior, 19,5% pós-cimentação e 14, 3% no desenvolvimento de posts. Enquanto isso, a falta de tempo com 44,2% e não a necessidade de 28,6%, foram os motivos mais prevalentes para omitir o uso do GD; o controle de umidade com 81,8% e melhora a adesão de 71,4%, justificou seu uso. A experiência clínica foi a única variável que influenciou o uso de GD (P= 0,03). Conclusão: O uso de GD foi mais frequente para o setor posterior do que o anterior, e freqüentemente omitido para a elaboração e cimentação de postes.

Factors associated with patients' satisfaction of rubber dam use during root canal treatment

The use of rubber dam (RD) has been recommended in dental procedures including root canal treatment. The aim of the study was to identify factors that were associated with patients' satisfaction and acceptance of RD. Setting and Design: This was a cross-sectional study, conducted from January 2015 to December 2016 at Kuwait University School of Dentistry. Materials and Methods: A pretested questionnaire was used by a face-to-face interview of patients after taking informed consent. The study was approved by the Institutional Ethics Review Board. The providers/operators who applied RD were grouped into three categories: undergraduate final year (7th year) dental students; general dentists and postgraduate students; and specialists. Results: Mean age of the patients (n = 175) was 31.6 ± 13.0 years. About 55% had past experience, and 52% expressed a better experience during the current procedure compared with the previous one. A positive experience during the current procedure correlated significantly with the future intention of RD use (r = 0.244, P = 0.001). Time needed for RD application was short (4 min), irrespective of the operators. The duration of RD use during the procedure was significantly shorter among dental specialists compared with the other groups. Time for RD application was the only significant predictor for patient satisfaction, after controlling for other independent variables. Conclusion: Based on the positive influence of current RD use on the future intention, dentists should spend time needed to explain the importance, safety and effectiveness of RD use with their patients.

Algunas consideraciones sobre el aislamiento absoluto / Some considerations on absolute isolation

El aislamiento absoluto es un procedimiento clínico que contribuye a mejorar los procederes en la operatoria dental, rehabilitación, odontopediatría y endodoncia, pues propicia un ambiente adecuado para los materiales de restauración, así como en la seguridad del paciente. Con el fin de promover su uso en la práctica se realizó una revisión bibliográfica que incluye la historia, elementos del aislamiento absoluto, recomendaciones y evidencia científica sobre su uso.

Absolute isolation is a clinical procedure that contributes to improve procedures in the dental operative, rehabilitation, Odontopediatrics and Endodontics, because it propitiates an appropriate atmosphere for the restoration materials, as well as in the patient's security. With the purpose of promoting their use in practice a literature review was carried out that includes the history, elements of the absolute isolation, recommendations and scientific evidence on their use.

Rubber dam as a barrier membrane in the treatment of periodontal osseous defect.

Background: Barrier membrane helps in periodontal regeneration by preventing the migration of epithelial cells and cells from the gingival connective tissue onto the root surface. Different types of membranes have been used to regenerate periodontal tissues. There are very few documented reports where rubber dam has been used as a barrier membrane for regeneration of periodontal defects. Case Description: A female patient aged 20 years with localized aggressive periodontal disease participated in this clinical report. Infrabony defect in the lower anterior region was selected for surgical treatment. Rubber dam was trimmed to cover the defect. Orthodontic treatment was done for the realignment of malpositioned teeth 1 year after the surgery and patient was followed up for a period of 3 years after surgery. Results: Rubber barrier membrane did not result in any untoward side effects. Patient did not show any sign of inflammation or recurrence of probing depth at 3-year follow-up period. Clinical Implications: Rubber dam as barrier membrane yields good results.

Accidental ingestion of a barbed wire broach and its endoscopic retrieval: Prevention better than cure.

Ingestion of instruments is a potential complication that can occur during dental procedures. We report a case of accidental ingestion of an endodontic barbed wire broach during root canal treatment and its subsequent retrieval by endoscopic methods. Although prevention is the best approach, proper management of such an event is also crucial. The objective of this report is to draw attention to the potentially serious complications that can occur if preventive techniques are not practised, and to discuss the accepted guidelines for management of such an event.

Isolamento do Campo Operatório: Panorama de Utilização em Consultórios e Clínicas Privadas de Belo Horizonte, MG, Brasil / Rubber Dam: Use in Private Clinics in Belo Horizonte, MG, Brazil

Objetivo: verificar a utilização de isolamento em consultórios e clínicas privadas em Belo Horizonte, observando-se: tipo, procedimentos executados com isolamento e o motivo da escolha; além de fatores como: tempo de formação dos cirurgiões-dentistas (CDs), classe econômica dos pacientes e presença de pessoal auxiliar (ASB). Método: a amostra elegível foi formada por CDs atuantes na região Centro-Sul da cidade. A amostra final de conveniência foi de 115 CDs que responderam a um instrumento de coleta de dados com questões descritivas e objetivas. Os dados foram analisados descritivamente e pelo teste Qui-quadrado (p≤0,05).Resultados: dos CDs que participaram da pesquisa, 55% eram do gênero feminino; 63,5% tinham entre 23 e 35 anos; 39% tinham menos de cinco anos de atividade profissional e 59% eram especialistas. Eram da região Central 69% e Sul 31%; têm ASB 66% dos CDs. Os pacientes foram classificados em classe econômica A (11%), B (30%), C (34%), D (16%) e E (9%). Relataram utilizar algum tipo de isolamento 82% dos CDs (36% relativo; 28% absoluto; e 36% ambos). O grau de aceitação dos pacientes quanto aos métodos de controle de umidade foi considerado alto para 52% dos CDs. O principal motivo para escolha doisolamento absoluto foi o controle de infecção (27%) e para o relativo foi a praticidade (24%). O isolamento absoluto é utilizado principalmente na endodontia (38%) e o relativo em restaurações (33%). Gênero (p=0,6483), tempo de atividade (p=0,2576), especialidade (p=0,0733) e presença de ASB (p=0,4127), não influenciaram significativamente na escolha do tipo de isolamento. Conclusão: a maioria dos CDs relatou utilizar algum tipo de isolamento do campo operatório e aponta como principais vantagens a biossegurança, a praticidade e melhor qualidade dos procedimentos executados

Objective: The aim of this study was to investigate the use of isolation in offices and private clinics in Belo Horizonte, it was observed: the type, procedures performed in isolation and the reason for their choices. In addition to those factors were also observed the duration of the dentistsÆ training, the patientsÆ economic class and the presence of an office assistant.Method: The eligible sample consisted of active dentist in the southcenter region of the town. The final sample of convenience was 115 professionals who answered to an instrument data collection with descriptive and objective questions. The results were analyzed descriptively and by Qui-Square test (p≤0,05).Results: Among the dentist in the survey 55% were female, 63.5% were between 23 and 35 years old, 39% had less than five years of professional activity and 59% were specialists; 69% were from the central region and 31% from the south; 66% of the dentists have assistant in office. Patients were classified according to their economic class; class A (11%), B (30%), C (34%), D (16%) and E (9%). 82% of the dentists reported the use of some type of insulation, (36% relative, 28% absolute, and 36% both). The degree of the patientsÆ acceptance to methods of moisture control was considered high, for 52% of the professionals. The main reason for choosing the absolute isolation was the control of infection (27%) and the relative was the practicality (24%). The rubber dam is mainly used in endodontics (38%) and the relative isolation is used in restorations (33%). The gender (p=0.6483), professional activity time (p=0.2576), training (p=0.0733) and presence of an office assistant (p=0.4127) havenÆt significant influence in the type of isolation choice. Conclusion: The most of dentists reported using some type of isolation of the operative field and indicated that the main advantages are the biosafety, practicality and quality of procedures performed

An experimental study of guided bone regeneration of bone defects in rabbit using rubber dam