Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial.

AIM: To evaluate three emergency procedures for their ability to alleviate clinical symptoms associated with symptomatic teeth having signs of (at least) partial irreversible pulpitis. METHODOLOGY: Sixty-six maxillary and mandibular molars were randomly assigned to a total pulpectomy group (TP; n = 22), partial pulpectomy group (PP; n = 22) or pulpotomy group (P; n = 22). Procedure durations were recorded. Patients answered a questionnaire on daily analgesic requirements and about clinical symptoms (pain intensity, chewing sensitivity and thermal sensitivity) after the anaesthetic effect had disappeared (Day 0) and on Days 1, 3 and 7 post-treatment. RESULTS: The total pulpectomy group was associated with the longest procedures (median, 24 min), followed by the partial pulpectomy and pulpotomy groups (P < 0.001 for all). In all three groups, pain intensity, thermal sensitivity and chewing sensitivity decreased significantly from the preoperative time-point to Day 7 (P < 0.001 for all). The total pulpectomy group reported greater reductions in pain intensity than the pulpotomy group between Days 0 and 7, Days 1 and 3, and Days 1 and 7 (P < 0.001 for all). No other intergroup differences were noted regarding reductions in pain intensity, and none were observed with respect to changes in prevalence of thermal sensitivity and chewing sensitivity. There were also no significant intergroup differences regarding the analgesic requirements throughout the 7 days. CONCLUSION: As emergency treatments for teeth having signs of irreversible pulpitis, pulpotomy, partial pulpectomy and total pulpectomy were comparable with respect to relieving clinical symptoms. Pulpotomy may be preferred because it requires significantly less time and is a simple technique that relieves symptoms quickly and effectively.

Intentional re-plantation of a vertically fractured tooth repaired with an adhesive resin.

AIM: To present the successful treatment of a vertically fractured tooth by intentional re-plantation after root canal treatment and repair with an adhesive resin. SUMMARY: Vertical root fracture is a challenging problem in respect of diagnosis and management options. In this case, a vertically fractured maxillary premolar was treated by intentional re-plantation after repairing it with 4-Methacryloxyethyl trimellitate anhyride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. At the 36-month follow-up, the tooth was asymptomatic, radiographically sound with reduced deep periodontal pockets and vertical bone loss. KEY LEARNING POINTS: • Intentional replantation after repairing fractured fragments with an adhesive resin extraorally is a treatment option. • Long-term follow-up is necessary to evaluate the outcome of this technique.

Effect of adhesive system type and root region on the push-out bond strength of glass-fibre posts to radicular dentine.

AIM: To compare interfacial strength in different thirds of the root canal amongst glass-fibre posts luted with four different adhesive luting agents. METHODOLOGY: A total of 44 extracted human single-rooted teeth were randomly divided in four groups and restored using glass-fibre posts and the following luting agents: All Bond SE/Duo-Link (ABSE), All Bond 3/Duo-Link (AB3), BisCem (BC), Clearfil ED primer II/Clearfil Esthetic Cement (CLF). One week after luting, the samples were thermocycled in water, and then embedded in acrylic resin. Three sections (cervical, middle and apical) of 2 mm thickness were prepared from each specimen, and the post in each section was subjected to a push-out test. One additional specimen for each group was prepared for scanning electron microscopy analysis and the bonding effectiveness to dentine was assessed. The data were analysed using the Kolmogorov-Smirnov test, two-way anova, one-way anova, and the Scheffe test (P < 0.05). RESULTS: The push-out bond strength values for BC and ABSE were not significantly different (P > 0.05), but both were significantly higher than the means for AB3 and CLF (P < 0.05) in the cervical and middle regions. The same trend was observed in the apical region, except for the AB3 and ABSE which were not significantly different (P > 0.05) from each other. There were significant differences in bond strength amongst root thirds, with a reduction in values from the cervical to apical third (P < 0.05). CONCLUSIONS: The use of BisCem and All Bond SE/Duo-Link combination with their simplified application procedures may be considered an alternative to the currently used systems for luting glass-fibre posts in root canal.

Push-out bond strengths: the Epiphany-Resilon endodontic obturation system compared with different pairings of Epiphany, Resilon, AH Plus and gutta-percha.

AIM: To assess the bond strength of the new resin-based Epiphany-Resilon root canal filling system, and to compare this with bond strengths of different pairings of AH Plus, gutta-percha, Epiphany and Resilon. METHODOLOGY: A total of 65 extracted human single-rooted teeth were used. All teeth were instrumented using a set of ProTaper rotary instruments. Irrigation was performed with 15 mL of 1.25% NaOCl between each instrument and the smear layer was removed during and after instrumentation with 5 mL of 17% EDTA. The canal spaces were filled with different combinations of core and sealer using lateral condensation, as follows: group 1, AH Plus + gutta-percha; group 2, AH Plus + Resilon; group 3, Epiphany + Resilon; group 4, Epiphany + gutta-percha; group 5 (control), gutta-percha only. Cylinders of root dentine 1.13 (0.06)-mm long were prepared from the coronal sections of the 65 teeth. The test specimens were subjected to the push-out test method. After adhesion testing, the remaining sections were examined under a stereomicroscope at x 25 magnification to determine the nature of bond failure. The values of bond strength were analyzed by one-way analysis of variance (ANOVA) and the post hoc Tukey's test, with significance set at P < 0.05. RESULTS: The respective mean push-out test values for groups 1-5 were: 2.000 +/- 0.369, 1.380 +/- 0.154, 1.706 +/- 0.340, 2.857 +/- 0.523 and 0.078 +/- 0.027 MPa. Significant difference (P < 0.001) occurred between the groups. Multiple paired comparisons (Tukey's test) revealed that group 4 (Epiphany + gutta-percha) had significantly (P < 0.001) greater bonding strength than all the other groups; group 1 (AH Plus + gutta-percha) had significantly (P < 0.05) greater bonding strength than group 2 (AH Plus + Resilon); and group 5 (control) had significantly (P < 0.05) lower bonding strength than all the other groups. Inspection of the surfaces revealed the bond failure to be mainly adhesive to dentine for all groups. CONCLUSIONS: The Epiphany-Resilon combination (group 3) was not superior to that of the AH Plus-gutta percha combination (group 1).