Cone beam computed tomography aided diagnosis and treatment of endodontic cases: Critical analysis.

Although intraoral radiographs still remain the imaging method of choice for the evaluation of endodontic patients, in recent years, the utilization of cone beam computed tomography (CBCT) in endodontics showed a significant jump. This case series presentation shows the importance of CBCT aided diagnosis and treatment of complex endodontic cases such as; root resorption, missed extra canal, fusion, oblique root fracture, non-diagnosed periapical pathology and horizontal root fracture. CBCT may be a useful diagnostic method in several endodontic cases where intraoral radiography and clinical examination alone are unable to provide sufficient information.

Antimicrobial effect, in vitro, of gutta-percha points containing root canal medications against yeasts and Enterococcus faecalis.

OBJECTIVE: The objective of this study was to determine the in vitro susceptibility of Enterococcus faecalis and the most prevalent Candida species as therapy-resistant microorganisms to gutta-percha points containing root canal medications. STUDY DESIGN: Gutta-percha points containing calcium hydroxide (Calcium Hydroxide Plus Points), chlorhexidine diacetate (Activ Points), or calcium hydroxide-chlorhexidine combinations (CHX/Ca Combi Points) were tested for their ability to inhibit growth of pure cultures of Candida albicans, Candida glabrata, Candida parapsilosis, Candida krusei, Candida tropicalis, Saccharomyces cerevisiae, and Enterococcus faecalis. Approximately 2 x 10(7) microorganisms per assay were suspended in diluted human serum and co-incubated with the gutta-percha points placed in Eppendorf tubes in an incubator for up to 2 weeks. A tube was removed at 1, 2, 3, 4, 7, and 14 days, and then opened and microorganism suspensions were serially diluted in a sterile 0.9% NaCl solution. Aliquots of the dilution steps were streaked onto solid medium. After incubating the plates in an incubator at 37 +/- 1 degrees C for 48 hours, CFU numbers per milliliter of suspension were calculated. RESULTS: Calcium Hydroxide Plus Points or Activ Points did not exhibit sufficient antimicrobial or anticandidal activity for Enterococcus faecalis, Candida albicans, C. glabrata, C. parapsilosis, C. krusei, or C. tropicalis within 14 days. Only Saccharomyces cerevisiae was susceptible to the calcium hydroxide or chlorhexidine diacetate containing gutta percha points. CHX/Ca Combi Points killed C. albicans, C. glabrata, C. krusei, C. tropicalis, and S. cerevisiae completely. However, E. faecalis and C. parapsilosis were resistant to CHX/Ca Combi points within 14 days. CONCLUSION: The results show the gutta percha points containing a mixture of calcium hydroxide and chlorhexidine diacetate have efficacies superior to calcium hydroxide or chlorhexidine diacetate alone against some microorganisms except E. faecalis and C. parapsilosis.

Intracanal placement of calcium hydroxide: a comparison of two different mixtures and carriers.

Objective. The purpose of this study was to compare the placement techniques of Ca(OH)(2). Study Design. Forty simulated curved canals (42 degrees) in transparent resin blocks were used and separated into 4 experimental groups, 10 canals each. A paste of Ca(OH)(2) was mixed with either water or glycerin and placed into canals with Lentulo spiral or Pastinject. Radiographs were taken of each sample. The canal fillings were evaluated by 3 endodontists and scored as to length of placement and completeness of fill. Cohen's kappa test was used to measure agreement between raters, and Kruskal-Wallis analysis of variance test was used to determine statistical differences between the 4 groups. Results. As to length of placement, statistically significant differences were found between Ca(OH)(2) + water pastes filled with Lentulo spiral (group 1) and Ca(OH)(2) + glycerin pastes filled with either Pastinject or Lentulo spiral. The findings of group 1 showed that the paste was short of the apex by more than 2 mm, whereas the other 3 groups were either at the apex or only 1 to 2 mm short. As to middle and coronal completeness of fill, differences were found to be statistically significant between Ca(OH)(2) + water paste filled with Lentulo spiral group and the other groups. Most of the canals in group 1 had greater than one-half void space at apical third, whereas the canals had less than one-fourth void space when Ca(OH)(2) + glycerin pastes were filled with Pastinject. Conclusions. Ca(OH)(2) when mixed with glycerin and placed into the canals, either with a Lentulo spiral or Pastinject, provided satisfactory results. Pastinject showed better fillings with Ca(OH)(2) + water pastes than Lentulo spiral.