TREATMENT OUTCOME OF MANUAL VERSUS ROTARY TECHNIQUES IN SINGLE-VISIT ENDODONTICS FOR PATIENTS IN A NIGERIAN TEACHING HOSPITAL: A RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Adequate canal preparation is essential in achieving successful outcome sequel to root canal treatment. Nickel-Titanium (NiTi) rotary instruments has steadily gained grounds in endodontics for root canals preparation, however, it is yet to be widely practiced among dental practitioners in Nigeria. AIM AND OBJECTIVES: To compare the treatment outcomes of single visit root canal treatment when either rotary or manual step-back preparation technique is used in shaping the canal, employing clinical and radiographic criteria. DESIGN OF THE STUDY: A randomized controlled trial. SETTING: Conservation Unit of Restorative Dentistry Clinics, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. MATERIALS AND METHODS: 120 consecutive consenting subjects were included in the study. The inclusion criteria were: medically fit individuals with restorable anterior, premolar or first molar tooth diagnosed with irreversible pulpitis, pulp necrosis or apical periodontitis; they had no to moderate pain, with periodontally sound and not excessively curved tooth. Randomization was performed by balloting using sealed envelopes and subjects were assigned in equal numbers to one of two groups, rotary and manual. Subjects were monitored following treatment for clinical and radiographic parameters at 1 day, 1 week, 1 month, 3 months and 6 months. Data analysis was done using SPSS-version 20.0, and differences were considered significant if p < 0.05. RESULTS: Twenty-seven (45%) and 23(38.3%) teeth in manual and rotary group respectively had pain at 1-day review. Significant difference in occurrence of pain in relation to both gender (p=0.001) and tooth-type (p=0.026) was noted between the groups at 1-day review. By the final review, there was no reported post-operative pain. There was no significant difference between the two groups in relation to the other clinical parameters at the different review periods. Twenty-four (40%) and 16 (26.7%) teeth had pre-existing periapical radiolucency in manual and rotary groups respectively; by final review, periapical radiolucency had reduced to 16.9% and 3.4% respectively, with the rotary group having significantly less radiolucency. Favourable outcome at 6-month review was significantly higher in the rotary group (96.6%), compared to the manual group (83.1%) in (p=0.033); the difference in outcome was due to significantly better outcomes with the molar tooth category in the rotary group. CONCLUSION: There was a significantly more favourable treatment outcome in the rotary compared to the step-back technique in canal preparation, employing clinical and radiographic criteria.

Frequency and distribution of teeth treated by single- and multiple- visit root canal treatment in a Nigerian population by differently skilled operators.

BACKGROUND: Single visit root canal treatment (RCT) is being advocated around the world. This study profiles RCT in a Nigerian population and compares pattern of single versus multiple visit RCT to tooth type and skill level of the doctors. METHOD: A retrospective study was carried out on RCT performed in one year by fresh graduates and postgraduate dentists. Records retrieved included patients' sex and age, tooth type, location in the jaw and whether single- or multiple-visit RCT was done. RESULTS: Records of 705 teeth were reviewed, 54.6% belonged to females. Age range was 18-87 years, mean of 31.76 (± 12.31) years. Majority (70.1%) belonged to 20-39 years' age group. Most teeth were located in the maxilla (60.8%) and in posterior regions (73.6%). The most frequently root filled tooth was the mandibular first molar (20.7%) followed by maxillary central incisor (18.4%) then maxillary premolar (12.8%). However, all molars accounted for 47.3%, premolars 26.3% and incisors 25.0%. Canines (1.45%) were least frequently root-filled. Incisors (54.8%) were the teeth most frequently treated in single-visit followed by premolars (28.8%). Most frequently treated by multiple-visit were molars (51.0%). All doctors performed multiple-visit RCT in an approximately equal proportion but a significant percentage of single-visit RCT was carried out by senior doctors (71.2%). CONCLUSION: The most frequently root filled teeth were mandibular first molars. Teeth most likely to be treated by single-visit RCT were incisors. Appropriate operator skill and experience is important in the decision to perform single-visit RCT. Single-visit RCT is advocated in the developing environment.

Single visit root canal treatment: a prospective study.

OBJECTIVES: The aim was to determine the success rate of single visit root canal treatment (RCT) and thus encourage clinicians to offer this treatment option appropriately. MATERIALS AND METHODS: This was a longitudinal clinical study involving all teeth of the secondary dentition except third molars in the upper and lower jaws. Teeth having irreversible pulpitis, pulp necrosis or periapical periodontitis were included in the study. RCT and obturation was done at a single visit. The patients were monitored over 6 months. RESULTS: Forty-five teeth were treated in 21 females and 24 males, aged 18-56 years (34.4+/-12.7). Preoperatively, pain was present in 84.4%, tenderness to percussion in 53.3%, and periapical radiolucency in 24.4% teeth. Forty percent had irreversible pulpitis and 60% had apical periodontitis. Post-operatively, pain reduced to 51.1% on day 1, 15.5% at 1 week, and 0% for the rest of the period. Tenderness to percussion reduced to 15.6% at 1 week and 0% by 1 month. Periapical radiolucency reduced to 9.5% at 6 months. Favorable outcome of 33.3% was recorded on day 1 and increased to 90.5% at 6 months. Six months success rate for teeth which had irreversible pulpitis was 100% and 83.3% for apical periodontitis. The mean time needed to complete a single visit RCT ranged from 77 min for a tooth having one canal to 132 min for one having four canals. CONCLUSION: Single visit RCT is a viable treatment option for teeth having irreversible pulpitis or apical periodontitis irrespective of tooth type or number of canals. CLINICAL SIGNIFICANCE: A lot of patients are lost to follow-up visits for teeth requiring RCT once the pulp is extirpated at the first visit due to cessation of pain, subsequently leading to treatment failure. Single visit endodontics eliminates the need for follow-up visits and improves treatment prognosis.

Clinical evaluation of 16% and 35% carbamide peroxide as in-office vital tooth whitening agents.

BACKGROUND: Tooth bleaching (whitening) is a conservative and cost effective treatment of discoloured teeth. OBJECTIVES: The purpose of this study was to evaluate the clinical efficacy and safety of 16% and 35% carbamide peroxide as in-office bleaching agents. METHODS: Thirty adult subjects who desired to whiten their discoloured teeth were enrolled in the study. Carbamide bleaching agents, in concentrations of 16% and 35%, were used to whiten their teeth employing the spilt-arch technique/half-mouth design using vacuum formed half-arch matrix seated over the maxillary teeth for a one-hour session per week for two weeks. Outcome was monitored with Vita shade guide and photographs. RESULTS: Twenty females and ten males, ages 18-43 years, with mean age 27.83 years, participated in the study. Tooth whitening was obtained in all subjects. Shade tab movement of 2-4 shades and 4-6 shades was recorded at first sessions then 3-5 and 5-9 shades at second sessions for 16% and 35% concentrations of carbamide peroxide respectively. The bleaching outcome was significantly better with the 35% concentration of carbamide peroxide while transient tooth sensitivity was observed in both concentrations ofthe bleaching agents. CONCLUSION: Carbamide peroxide in 16% and 35% concentration are effective and safe for bleaching discoloured vital teeth, however, 35% concentration gave significantly more lightening effect without additional side effects compared to 16% concentration.

Fixed bridge prostheses management of epileptic patients.

BACKGROUND: Epileptic patients in the course of seizures may suffer damage to or loss of teeth and other oral tissues. Moreover, they are at great risk during their seizures from aspiration of foreign bodies such as removable dental prosthesis or fragments of prosthesis. It is therefore, necessary to provide them a tooth replacement option that would be safe and not constitute a source of danger in the course of seizures. CASE REPORTS: Two patients are presented in this report that lost teeth as a consequence of trauma sustained during seizures. They both had porcelain-fused-to-metal (ceramo-metal) fixed bridge prostheses fitted to replace the missing teeth. The fixed bridges have been in service for seven years without damage despite the fact that the patients still have seizures at the same frequency as prior to treatment that are often associated with trauma to oral tissues. CONCLUSION: Fixed bridge prostheses are a viable tooth replacement option for epileptic patients that do not pose any additional danger of being dislodged, swallowed or aspirated in the course of a seizure.