Case complexity of root canal treatments accepted for training in a secondary care setting assessed by three complexity grading systems: A service evaluation.

AIMS: To evaluate the complexity of root canal treatments accepted for treatment by postgraduate training grades at Cardiff University Dental Hospital (CUDH) using the English Commissioning Standard for Restorative Dentistry (ECS) in comparison with the American Association of Endodontists case complexity form (AAE) and the Restorative Index of Treatment Need (RIOTN). METHODOLOGY: Two hundred case records were evaluated using the AAE, RIOTN and ECS scoring systems. Each case received a score from minimal to high complexity (1-3). Examiners were calibrated and inter-examiner reliability calculated using the percentage agreement. Frequency of scores were then compared. RESULTS: Most cases were at level 3 and assessment varied amongst the criteria used (AAE: 99.5%, RIOTN: 65.5% and ECS: 55.5%). The AAE factor 'endodontic treatment history' was largely responsible for differing scores when compared with the RIOTN (78%) and ECS (64%). The RIOTN factor regarding post treatment disease ('endodontic retreatment') was responsible for increased complexity compared with ECS in most cases (74%). The ECS factor 'quality of root filling' was the most common reason (85%) for an increase in complexity compared with RIOTN. CONCLUSIONS: Within the limitations of this service evaluation, it was possible to conclude that a high proportion of cases treated by training grades at CUDH were of a high complexity level (level 3) using the three guidelines (ECS, AAE and RIOTN). These cases were appropriate for postgraduate training under various levels of supervision and substantiated by the findings reported here. The factors responsible for a large part of difference in allocation of scores amongst the systems were 'endodontic treatment history', 'root canal retreatment' and 'quality of root filling'.

The Use of 3D Metal Printing (Direct Metal Laser Sintering) in Removable Prosthodontics.

The use of 3D printing is expanding and it is envisaged that it will have an increasing presence within dentistry. Having an appreciation and understanding of such technology is therefore paramount. It is currently used to produce a variety of dental objects/prostheses. This paper briefly looks at 3D printing in dentistry and specifically describes the use of the direct metal laser sintering 3D printing technique in the production of cobalt chromium removable prosthesis frameworks. Clinical relevance: Understanding the different technologies that can and are being used within the dental field is important, particularly as it is a rapidly changing field. Having an understanding of such technologies will allow practitioners to utilize such technologies appropriately in the management of their patients.

Failure Mechanisms of Fibre Posts: A Literature Review.

AIM: To review the available evidence for the causes of failure of fibre posts. MATERIALS AND METHOD: A search of MEDLINE was conducted to retrieve available data on fibre posts used for restoration of endodontically treated teeth since 1980. The Cochrane Library was also separately searched for systematic reviews. Additionally, references of the retrieved articles were also hand searched for further relevant papers. All the selected papers were then critically appraised subject to meeting inclusion criteria. RESULTS: Nineteen prospective clinical trials were included after critical appraisal of the papers. Causes of failure of fibre posts were identified as follows: adhesive failure, root fracture, post fracture, endodontic failure, secondary caries and periodontal complications. Risk factors for each of the failures were investigated and evidence-based recommendations for minimising these complications are discussed. CONCLUSION: Although laboratory studies showed favourable mechanical and physical properties of fibre posts, clinically, there has been a wide range of failures mechanisms are reported in the literature. Adhesive failure was reported in 16 of the 19 trials, making it the most frequent cause of failure. The available evidence does not indicate a difference in short-term survival probability between metal or fibre posts. A number of risk factors, which affect the longevity of fibre posts, were identified and discussed. Since there is considerable heterogeneity in study designs and reported survival rates of included studies, longer-term well-designed standardised clinical trails are required.

Orthodontic extrusion: an interdisciplinary approach to patient management.

UNLABELLED: Root fractures that occur at the cervical margin do not always heal predictably, even following a period of splinting. This often leaves margins either sub-gingival or sub-crestal. This provides an unsatisfactory situation for restoring the remaining root as restorations will impinge on the biological width. Provided a root is long enough to support a post crown, then orthodontic extrusion to provide sufficient supra-gingival tooth tissue is a useful treatment option to consider. A review of the literature on orthodontic extrusion is considered in conjunction with a case report of the management of a young male who fractured a canine and lateral incisor whilst playing cricket. CLINICAL RELEVANCE: Trauma to upper anterior teeth is frequently seen in practice. One treatment option in the management of sub-crestal cervical root fractures is orthodontic extrusion, rather than removal of the tooth.

Sodium hypochlorite accident--a complication of poor access cavity design.

A case is presented of soft tissue damage resulting from inadvertent injection of sodium hypochlorite through a perforation created during root canal treatment of a mandibular incisor. The importance of access cavity design to help avoid such complications is highlighted and the anatomy of the mandibular incisor is discussed. Measures to minimize the risk of a hypochlorite accident and its potentially serious complications are proposed.

'Double-veneers'--a novel approach to treating macrodontia.

UNLABELLED: Macrodontia is a relatively rare but cosmetically challenging dental anomaly with different aetiologies. Where surgical interventions are inappropriate, minimal restorative interventions may be indicated. A case is described of a teenager with macrodontic central incisors who was treated with indirect composite 'double veneers'. The aesthetic outcome was excellent without unnecessary loss of teeth. CLINICAL RELEVANCE: Knowledge of the use of indirect composite veneers provides another treatment option for aesthetic problems in the management of tooth anomalies, including macrodontia.