Comparison of effect of intracanal use of ketorolac tromethamine and dexamethasone with oral ibuprofen on post treatment endodontic pain.

The purpose of this study was to compare the pain-reducing efficacy of dexamethasone and ketorolac tromethamine when used as an intracanal medication, with oral ibuprofen and a placebo. An additional objective was to establish if any relationship exists between the incidence and severity of pretreatment pain and the incidence and severity of postinstrumentation pain. A total of 48 patients who presented to the University of Illinois postgraduate endodontic clinic were invited to participate. Patients were randomly assigned to 1 of 4 groups: oral ibuprofen, placebo, dexamethasone, or ketorolac tromethamine. Patients were asked to evaluate their pretreatment pain when they presented to the clinic with a Visual Analog Scale. The root canal treatment was performed in two appointments. The first appointment consisted of cleansing and shaping of the canal/s and placement of an intracanal medication. All teeth were closed with a sterile cotton pellet and IRM. Each patient was sent home with a Visual Analog Scale to fill out at 6, 12, 24 and 48 h after initiation of therapy. At the 12-h period, both dexamethasone and ketorolac provided statistically significant better pain relief than placebo. At the 24-h period, only ketorolac demonstrated better pain relief than the placebo. There were no statistically significant differences among the groups at 6 and 48 h. Although ibuprofen pain ratings were less than the placebo at all time points, the reduction was not significant. In addition, no significant differences were demonstrated between ibuprofen and either dexamethasone or ketorolac.

Diagnosis and treatment of cutaneous facial sinus tracts of dental origin.

BACKGROUND: Cutaneous draining sinus tracts of dental origin often are a diagnostic challenge. A delay in correctly diagnosing these types of lesions can result in ineffective and inappropriate treatment. CASE DESCRIPTION: The authors present five cases of facial lesions that were initially misdiagnosed as lesions of nonodontogenic origin. The correct diagnosis in each case was cutaneous sinus tract secondary to pulpal necrosis and suppurative apical periodontitis. All facial sinus tracts resolved after the patients received nonsurgical root canal therapy. CLINICAL IMPLICATIONS: As patients with cutaneous facial sinus tracts of dental origin often do not have obvious dental symptoms, possible dental etiology may be overlooked. Early correct diagnosis and treatment of these lesions can help prevent unnecessary and ineffective antibiotic therapy or surgical treatment.

An in vivo evaluation of an electronic apex locator that uses the ratio method in vital and necrotic canals.

The purpose of this study was to compare the canal length determined by an apex locator to the apical constriction in both vital and necrotic canals. Informed consent was obtained from patients waiting to have teeth extracted. The teeth were anesthetized, isolated, and accessed. The pulp was considered vital if bleeding was present in the pulp chamber. The Root ZX was used to measure the root canal length. The file was cemented into place, and the tooth was extracted. Twenty-nine teeth containing 34 cemented files were studied, and the distance from the apical constriction was measured. The Root ZX was 82.3% accurate to within 0.5 mm of the apical constriction. The mean distance from the apical constriction was 0.21 mm in vital cases versus 0.49 mm for necrotic cases. There was no statistical difference between the ability of the Root ZX to determine the apical constriction in vital canals versus necrotic canals.

Effects of long-term exposure of human periodontal ligament cells to milk and other solutions.

Periodontal ligament (PDL) cells cultured from healthy extracted human teeth were exposed to milk, Alcon Opti-Free contact lens solution, K-Mart contact lens solution, saline, and Hank's balanced salt solution. The appearance and rate of loss of the cells from the culture dishes were recorded over time at both room temperature (20 degrees C) and 4 degrees C. The results indicated that saline was superior to either of the contact lens solutions in its ability to maintain the vitality of the PDL cells. Milk at 4 degrees DC provided good short-term viability , but cells did not remain attached after 48 h. At 20 degrees C, however, milk resulted in a 24.4% retention of cells after 72 h. Hank's balanced salt solution was the best storage media, with 46.8% of sells remaining attached after 72 h of exposure. This study supports milk as a good short-term storage medium for maintaining the vitality of PDL cells in vitro.

Effective shelf-life of prepared sodium hypochlorite solution.

Although the tissue solvent and bactericidal properties of sodium hypochlorite are well known, the effective shelf-life of prepared sodium hypochlorite solutions is not known. The stability of sodium hypochlorite is adversely affected by exposure to high temperature, light, air, and the presence of organic and inorganic contaminants. The purpose of this study was to investigate the variables of storage conditions and time on the tissue-dissolving capacity of three different concentrations of sodium hypochlorite. Fresh frozen human umbilical cord was used as the tissue sample for this experiment. Tissue samples were dissolved at time intervals ranging from 1 day to 10 wk in 5.25%, 2.62%, and 1.0% solutions of sodium hypochlorite. The tissue-dissolving ability of 5.25% sodium hypochlorite remains stable for at least 10 wk. The tissue-dissolving ability of 2.62% and 1.0% sodium hypochlorite remains relatively stable for 1 wk after mixing, then exhibits a significant decrease in tissue-dissolving ability at 2 wk and beyond.

Instrumentation of curved root canals: a comparison study.

Flex-R, Flex-O, and K-Flex files were compared using a circumferential filing technique on 30 extracted human molars. The buccal canals of maxillary molars and mesial canals of mandibular molars were utilized. The minimal initial curvature was 18 degrees. Canal curvature was measured before and after filing, and changes were analyzed statistically. Analysis showed that, no matter which of the instruments was used, the angle of curvature was maintained with a high degree of accuracy.

Survey at urban college indicates compliance.

While the emergence of AIDS and associated barrier controls has impacted on dental practice, little inquiry has been undertaken to explore changes in clinical teaching. The purpose of this study was 1) to determine if any changes in teaching behavior have occurred, and 2) to explore attitudes of clinical faculty concerning controls. A questionnaire was sent to all clinical faculty at an urban college of dentistry. Most faculty reported being aware of and complying with control protocols. Although the majority of respondents (62 percent) reported spending the same amount of time with students and patients before and after barrier controls, a substantial number reported spending more time with students and patients implementing control techniques and less time in physical contact with patients and demonstrating dental procedures. The majority of the faculty felt the college's barrier controls were about right, although some recommended specific additions and deletions. Attitudinal responses were quite varied and often emotional, ranging from "No matter what we do, it can never be enough" to "It's ridiculous."

Inflammatory resorption: untreated, arrested, prevented.

Three human replantation cases are presented wherein the results are in accord with the literature concerning inflammatory resorption and calcium hydroxide therapy. The cases unintentionally simulate a designed experiment wherein the control case received no treatment and the other 2 were subjected to independent variables such as obturation in the hand and the timing of the calcium hydroxide therapy. The untreated case resulted in loss of the tooth, while manipulation of variables in the other two resulted in retention.

Twelve-year follow-up of a replanted incisor.

A case report with a 12-yr follow-up of a replanted maxillary incisor is presented. A maxillary incisor, #8, with incomplete root formation was replanted without splinting following a 2-h sojourn in salt water. The pulp responded positively to the electric pulp tester for 2 yr. There was no response to the electric pulp tester 5 yr postoperatively. Although there was some external root resorption, the root appeared to have reached normal length. Two parallel vertical radiolucent slits were present in a trabeculated substance in the site normally occupied by the pulp. This case illustrates an example of revascularization and pulp obliteration. Interestingly, at the 12-yr follow-up, the replanted tooth, as well as tooth 7, showed blunted apices that occurred following orthodontic tooth movement.

Mandibular first molar with three distal canals.

A mandibular molar requiring root canal therapy was found with five canals, a mesial root, and two distal roots. The distobuccal root had two separate canals, and the distolingual root had but one. The bizarre aspects of this case are somewhat lessened because of the presence of the second distal root. Practitioners should not become excessively alarmed by the increasing reports of bizarre pulpal anatomy. However, knowledge of their existence may occasionally enable them to treat a case successfully that otherwise might have ended in failure.