Survey on the modalities of rubber dam usage for root canal treatment

Objectives: To identify the modalities for the use of rubber dam isolation during root canal treatments [RCTs] and to explore clinicians' preferences in isolating challenging cases

Methods: Ethical approval was obtained from the College of Dentistry Research Ethics Committee, Taibah University. Following two pilot studies, a final web-based questionnaire addressed the following aspects: a] respondents classification, b] usage of rubber dam c] frequencies and modalities of rubber dam usage according to teeth location, and d] management of difficult cases. The questionnaire was sent to 375 systematically selected general dental practitioners [GDPs] and 53 endodontists in the Western province of KSA. Data were analysed using the Chi-square test at p = 0.05

Results: Only 21% of GDPs used rubber dam compared to 84.8% of endodontists [p< 0.001]. 32% of GDPs who did not always using a rubber dam on anterior teeth always used one on posterior teeth. The proportion of GSPs who used rubber dam during complete RCTs increased from 15.6% in anterior teeth to 27.3% in posterior teeth [p = 0.006]. The highest proportion of GDPs [40.3%] used the split dam technique on conical or prepared teeth. In addition, 63.3% of GDPs rebuilt broken-down teeth. While 52.9% of endodontists used Ora-sealto seal a leaking rubber dam, 77.3% of GDPs used Cavil

Conclusions: Rubber dam users, especially GDPs, exercised more attention to posterior teeth compared to their anterior counterparts. Rubber dam users opted to manage difficult cases by sealing leaking rubber dam and to use the split dam technique

Retrieval of multiple separated endodontic instruments using ultrasonic vibration: Case report

This report describes the management of a complicated clinical case with three instruments fractured in one tooth. A 32-year-old patient presented with three Pro- Taper rotary files fractured in the upper right second molar [S2 and F2 in the disto-buccal canal and S1 in the mesio-buccal canal]. A staging platform was prepared in the distal canal coronal to the fragments. Under dental microscope magnification, an Endo-4 ultrasonic tip was activated to dislodge the more coronal fragment [S2] by trephining dentine around the coronal aspect of the fragment. After 11 min, the fragment became loose and was removed. Following the same protocol and using an Endo-5 ultrasonic tip, the second fragment [F2] was removed in approximately 17 min. The first attempt to remove the S1 fragment from the mesio-buccal canal was not successful. An attempt to bypass this fragment using a K-file also failed. A second attempt using the ultrasonic technique resulted in a secondary fracture of the coronal aspect of the fragment. An Endo-5 ultrasonic tip was used to dislodge the fragment, which was successfully removed in 7 min. This report concludes that once a fractured file is bypassed, the instrumentation of a root canal is best completed with hand files. Clinicians should identify their limitations and consider referring cases that are beyond their abilities. Good experience and an appropriate armamentarium enable successful management of complicated cases. Ultrasonic vibration and dental microscope magnification contribute to successful removal of fractured instruments