Prophylactic penicillin versus penicillin taken at the first sign of swelling in cases of asymptomatic pulpal-periapical lesions: a comparative analysis.

In order to ascertain whether the time of administration of an antibiotic affects the occurrence of flare-ups and non-flare-up-associated swelling and pain, an analysis of components of two prospective endodontic studies on patients having asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL) was done. In the first study, prophylactic penicillin was used. In the second study, penicillin (or erythromycin for patients allergic to penicillin) was taken by the patient at the first sign of swelling (patient controlled). For the patient-controlled group, as compared to the prophylactic penicillin group, there was statistically significantly more (1) incidence of flare-ups (p less than 0.05); (2) non-flare-up-associated swelling (p less than 0.001); (3) non-flare-up-associated pain (p less than 0.05); (4) combined moderate and severe pain (p less than 0.05); (5) combined incidence of flare-ups and swelling (p less than 0.001); (6) combined incidence of flare-ups and pain (p less than 0.01); and (7) combined incidence of flare-ups and both swelling and pain (p less than 0.001). There were statistically significantly fewer instances of (1) no patient post-treatment problems (p less than 0.001) and (2) combined mild pain and no patient post-treatment problems (p less than 0.001). Hence, for asymptomatic teeth with PN/PL, it appears that prophylactic antibiotics are preferable to antibiotics taken by the patient at the first sign of swelling.

A prospective randomized trial comparing periapical instrumentation to intracanal instrumentation in cases of asymptomatic pulpal-periapical lesions.

To clarify the divergent viewpoints with respect to method of instrumentation in asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL), this prospective study was undertaken. The subjects were 106 patients with quiescent cases of PN/PL. Alternately, 53 had periapical instrumentation and 53 had intracanal instrumentation. Prophylactic antibiotics were not administered but the patients were told to take an antibiotic at the first sign of swelling. Flare-ups, non-flare-up-associated swelling and pain, and cases in which there were no postoperative problems were evaluated at 1-day, at 1 week, and at 2 months. A 6.6% incidence of flare-up was found with no statistically significant difference between periapical instrumentation (7.5%) and intracanal instrumentation (5.7%). A 27.4% incidence of swelling was found with no statistically significant difference between periapical instrumentation (24.5%) and intracanal instrumentation (30.2%). A 43.4% incidence of pain was found, with no statistically significant difference between periapical instrumentation (15.1%) and intracanal instrumentation (47.2%). When moderate pain and severe pain were combined, the incidence was 21.7%, with no statistically significant difference between periapical instrumentation (15.1%) and intracanal instrumentation (28.3%). An incidence of patients having no postoperative problems of 41.5% was found, with no statistically significant difference between periapical instrumentation (47.2%) and intracanal instrumentation (35.8%). When flare-ups were combined with swelling, the incidence was 34.0%, with no statistically significant difference between periapical instrumentation (32.1%) and intracanal instrumentation (35.8%). When flare-ups were combined with pain, the incidence was 50.0%, with no statistically significant difference between periapical instrumentation (47.2%) and intracanal instrumentation (52.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

Infectious flare-ups and serious sequelae following endodontic treatment: a prospective randomized trial on efficacy of antibiotic prophylaxis in cases of asymptomatic pulpal-periapical lesions.

Without peritreatment antibiotics, infectious flare-ups (about 15% incidence) and serious sequelae follow endodontic treatment of asymptomatic teeth with necrotic pulps and associated periapical lesions. Antibiotics administered after endodontic treatment (4-day regimen) reduce the flare-up incidence to about 2%, but hypersensitivity responses, sensitization, resistant microbes, and drug-taking compliance are potential problems. To ascertain whether a specific prophylactic antibiotic (high-dose, 1-day regimen) would preferentially maintain this low flare-up incidence while overcoming antibiotic-related problems, 315 patients with quiescent pulpal necrosis and an associated periapical lesion were randomly given either penicillin V or erythromycin (base or stearate). Evaluations of flare-up after endodontic treatment were done at 1 day, 1 week, and 2 months. A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred. Gastrointestinal side effects were found primarily with the erythromycins (12.4%). A comparative analysis of the data from our first study (no peritreatment antibiotics) and the pooled data from our last two investigations (including the current trial) showed that peritreatment antibiotic coverage significantly reduced flare-ups and serious sequelae after endodontic treatment (p less than 0.001).

A transitional anterior fixed prosthesis using composite resin.

A method has been described to temporarily restore an anterior edentulous space in a single appointment. The technique uses a composite resin to retain a resin denture tooth (pontic) supported by edgewise orthodontic wire. This approach is suggested as a transitional treatment for patients who are not amenable to either a definitive fixed or removable prosthesis.