Repair of an Iatrogenic Furcal Perforation with Mineral Trioxide Aggregate: A Case Report with 6-Month Follow-Up

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure.Successful treatment depends on the immediate sealing of the perforation and prevention of infection. Several materials usedinitially to repair the perforation were considered inadequate due to their bacterial leakage and lack of biocompatibility to theunderlying tissues. Recently, mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair,retrograde filling, pulp capping, and apexification. Successful management of an iatrogenic furcal perforation using MTA onmandibular first molar is described in this case report. The tooth was endodontically treated and coronally restored with resincomposite. After 6 months, the absence of periradicular radiolucent lesion indicated a successful outcome of sealing the furcalperforation using MTA.

Furcal-perforation repair with mineral trioxide aggregate: Two years follow-up.

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA.

Effect of chlorhexidine gel containing saccharin or aspartame in deaf children highly infected with mutans streptococci

Aim: Since deaf children are unable to comprehend or cooperate with dental treatment due to lack of communication, preventive measures may be an important way to control the high prevalence of dental caries in these patients. The aim of the this study was to evaluate the effect of an intensive treatment with chlorhexidine (CHX) gel, containing either saccharin or aspartame, in deaf children highly infected with mutans streptococci (MS). Methods: Eighteen children were randomly divided into two groups, according to the sweetener used to improve the CHX gel bitter taste: saccharin or aspartame. Before CHX treatment, saliva samples were collected to establish baseline microbial data for MS. CHX gel was applied on two consecutive days, four times the first day and three times the second day. Saliva samples were then taken after 7, 30, 60, 90 and 120 days to evaluate MS oral recolonization. Results: CHX gel containing saccharin was not effective on the reduction of MS levels, while the gel containing aspartame decreased significantly MS levels after treatment (P<.05). Conclusions: Although a new CHX application may be necessary after 60 days to control caries risk and MS levels, CHX treatment should be individually controlled because of variations in the response of subjects.

Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials

The purposes of this study were to evaluate the effectiveness of 2 percent chlorhexidine (CHX) gluconate gel, calcium hydroxide [Ca(OH)2] and their combination with iodoform and zinc oxide powder as intracanal medications against select microorganisms, and to measure the pH changes caused by these medications. Antimicrobial activity was determined by the agar diffusion method. The zones of growth inhibition were measured and the results were analyzed statistically by Kruskal-Wallis test (p<0.05). The pH of the pastes was measured right after preparation, after 24 h and 1 week later. The largest mean zones of microbial inhibition were produced by 2 percent CHX gel, followed by Ca(OH)2 + 2 percent CHX gel + iodoform, Ca(OH)2 + 2 percent CHX gel, Ca(OH)2 + 2 percent CHX gel + zinc oxide, and Ca(OH)2 + water. The mean pH of all medications stayed above 12.0 during the whole experiment, except for CHX gel (pH=7.0). The results of this study showed that all medications had antimicrobial activity, but the most effective against the tested microorganisms were 2 percent CHX gel, followed by its combination with Ca(OH)2 and iodoform.

O objetivo do estudo foi avaliar, in vitro, a efetividade antimicrobiana da clorexidina gel 2 por cento (CHX) e hidróxido de cálcio, isoladamente e associados com iodofórmio e pó de óxido de zinco como medicamentos intracanais frente a microrganismos e medidos pHs das diferentes medicações. A atividade antimicrobiana foi determinada pelo método de difusão em ágar. As áreas de inibição de crescimento foram medidas e os resultados estatisticamente analisados utilizando-se o teste de Kruskal-Wallis (p<0,05). O pH das pastas foi mensurado após a manipulação, após 24 h e após uma semana. Os resultados mostraram que a maior zona de inibição foi da CHX gel 2 por cento, seguida pelo Ca(OH)2 + 2 por cento CHX gel, Ca(OH)2 + 2 por cento CHX gel + iodofórmio, Ca(OH)2 + 2 por cento CHX gel +óxido de zinco, Ca(OH)2 + água. A média de pH de todos os medicamentos intracanais foi de 12 durante todo o experimento, exceto com CHX gel 2 por cento (pH=7,0). Estes resultados permitiram concluir que todos os medicamentos tiveram atividade antimicrobiana, no entanto, a maior foi da CHX gel 2 por cento, seguido da associação com o Ca(OH)2. e iodofórmio.

Comparative study of the antimicrobial efficacy of chlorhexidine gel, chlorhexidine solution and sodium hypochlorite as endodontic irrigants

The purpose of this study was to assess the in vitro the antimicrobial efficacy of chlorhexidine gluconate gel as an endodontic auxiliary chemical substance compared to sodium hypochlorite (NaOCl) and chlorhexidine gluconate solution. The antimicrobial efficacy of the tested substances was evaluated using the agar diffusion test. The growth inhibition zones produced by 0.2 percent, 1 percent and 2 percent chlorhexidine gel were evaluated against 5 facultative anaerobic bacteria and 4 pigmented Gram-negative anaerobes, and compared to the results obtained by NaOCl and chlorhexidine solution. The largest growth inhibition zones were produced when the test bacteria were in contact with 2 percent chlorhexidine gluconate gel (11.79 mm), being significantly different (p<0.05) from the growth inhibition zones produced by all NaOClconcentrations, including 5.25 percent (9.54 mm). However, there was no statistically significant difference (p>0.05) between the growth inhibition zones obtained with equal concentrations of chlorhexidine solution and gel. The results of this study indicate that, as far as its antimicrobial properties are concerned, chlorhexidine gel has a great potential to be used as an endodontic auxiliary chemical substance.

O objetivo deste estudo foi avaliar in vitro a atividade antimicrobiana do gluconato de clorexidina gel, como irrigante endodôntico, comparando-o ao hipoclorito de sódio (NaOCl) e ao gluconato de clorexidina líquido. A atividade antimicrobiana das substâncias testadas foi avaliada pelo teste de difusão em ágar. As zonas de inibição de crescimento bacteriano produzidas pela clorexidina gel a 0,2 por cento; 1 por cento e 2 por cento foram observados frente a 5 espécies de bactérias anaeróbias facultativas e 4 espécies de anaeróbios estritos, Gram-negativos e produtores de pigmento negro; e comparados com os resultados obtidos pelo NaOCl e pela clorexidina líquida. As maiores zonas de inibição foram produzidas quando as bactérias testadas ficaram em contato com a clorexidina a 2 por cento em gel (11,79 mm), apresentando diferença estatisticamente significante (p<0,05) quando comparados às zonas de inibição de crescimento bacteriano produzidas por todas as concentrações avaliadas de NaOCl, incluindo 5,25 por cento (9,54 mm). No entanto, não houve diferença estatisticamente significante (p>0,05) comparando as zonas produzidas por concentrações equivalentes de clorexidina líquida ou gel. Os resultados indicaram que a clorexidina em gel tem grande potencial para ser usada como substância química auxiliar quanto às suas propriedades antimicrobianas.