Publications by authors named "Paul V Abbott"

67 Publications

An evaluation of the repeatability of electric pulp sensibility tests.

Aust Endod J 2021 Aug 1. Epub 2021 Aug 1.

UWA Dental School, The University of Western Australia, Crawley, Western Australia, Australia.

The accuracy, reliability and reproducibility of electric pulp tests (EPT) have been investigated but there is conflicting information about their repeatability. The aim of this study was to investigate whether EPT are repeatable over time. EPT results from 180 healthy teeth in 39 patients with 2-10 readings per tooth (total 692 readings) were analysed. Single measures intraclass correlation coefficients (ICC) ranged from 0.776 to 0.845 in teeth with 2-7 repeated measures (P < 0.001), indicating good repeatability. With eight or more measures per tooth, the ICC was low, indicating poor repeatability over longer follow-up times, but only seven teeth in two subjects were included in this analysis. The Pearson correlation showed no statistically significant correlation for 2-7 readings but when all readings were included, there was a statistically significant negative correlation. Hence, EPT has good repeatability.
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http://dx.doi.org/10.1111/aej.12552DOI Listing
August 2021

Revised guidelines for the endodontic education of dentistry students in Australia and New Zealand (FEBRUARY 2021).

Aust Endod J 2021 Aug 23;47(2):327-331. Epub 2021 Mar 23.

UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia.

These revised guidelines for contemporary endodontic education in Australia and New Zealand (version 2021) propose the minimum criteria for the training of dentistry students. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes a general outline for education programmes in endodontics as part of general dental practice.
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http://dx.doi.org/10.1111/aej.12501DOI Listing
August 2021

Retromolar canal infiltration as a supplement to the inferior alveolar nerve block injection: an uncontrolled clinical trial.

Clin Oral Investig 2021 Sep 8;25(9):5473-5478. Epub 2021 Mar 8.

Clinical Dentistry, UWA Dental School, University of Western Australia, Perth, Australia.

Objectives: This study aimed to determine the success rate of retromolar canal (RMC) infiltration following the failure of inferior alveolar nerve block (IANB) injections for the anesthesia of mandibular first molars with acute irreversible pulpitis.

Materials And Methods: An IANB injection was administered for 50 patients with acute irreversible pulpitis. Lip numbness was set as the sign of anesthesia and further evaluated and confirmed with pulp sensibility tests after 10-15 min. Access cavity preparation was commenced unless the patient felt any pain; in this case, an RMC infiltration injection was given. The success rate was determined through the patients' recording of the presence, absence, or reduction of pain severity during access cavity preparation using the Heft-Parker visual analog scale.

Results: Seven patients (14%) did not experience any pain by pulp sensibility tests and during access cavity preparation after IANB injection. Twenty-five (58.1%) of the remaining 43 patients who had the RMC infiltration injection had reduced pain, and four patients (9.3%) experienced no pain after the RMC infiltration. Fourteen patients (32.5%) experienced no change in pain. Chi-squared test results revealed that the percentage of patients with reduced pain was higher than that of other patients (P < 0.001).

Conclusions: RMC infiltration, along with IANB, significantly reduced the pain felt by patients and increased the success of the anesthetic technique for root canal treatment of mandibular first molars with acute irreversible pulpitis.

Clinical Relevance: The administration of RMC infiltration can enhance the success of the IANB technique for anesthetizing mandibular first molars exhibiting acute irreversible pulpitis.
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http://dx.doi.org/10.1007/s00784-021-03855-2DOI Listing
September 2021

Dental Traumatology.

Authors:
Paul V Abbott

Dent Traumatol 2021 02;37(1)

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http://dx.doi.org/10.1111/edt.12656DOI Listing
February 2021

The scope of practice of the modern Endodontist in Western Australia.

Aust Endod J 2020 Dec 14;46(3):330-337. Epub 2020 Oct 14.

UWA Dental School, University of Western Australia, Nedlands, WA, Australia.

There are limited data regarding the scope of practice of Endodontists in Australia. The aim of this study was to investigate the scope of practice of Endodontists and Endodontic Registrars in Western Australia. The study comprised a three-part survey relating to demographics, clinical factors and materials and equipment. The response rate was 70.6%. Compared to the public sector, clinicians in the private sector treated on average twice as many patients per day, twice as many trauma cases per year and, as a proportion of all cases, four and a half times as many apical surgical procedures. These aspects were all statistically significantly different. Other aspects were similar to previous studies within Australia and from other countries.
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http://dx.doi.org/10.1111/aej.12450DOI Listing
December 2020

Revised guidelines for educational requirements for specialisation in endodontics in Australia and New Zealand (July 2020).

Aust Endod J 2020 Dec 7;46(3):302-306. Epub 2020 Sep 7.

UWA Dental School, University of Western Australia, Perth, Australia.

These revised guidelines developed by the Australian Society of Endodontology Inc. and the Australian and New Zealand Academy of Endodontists for educational requirements for specialisation in endodontics in Australia and New Zealand (version 2020) propose minimum criteria for training specialists in our field. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes criteria for selection of the students and describes the proposed main features and a general outline of the education programme.
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http://dx.doi.org/10.1111/aej.12431DOI Listing
December 2020

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations.

Dent Traumatol 2020 Aug 17;36(4):314-330. Epub 2020 Jul 17.

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.
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http://dx.doi.org/10.1111/edt.12578DOI Listing
August 2020

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction.

Dent Traumatol 2020 Aug 22;36(4):309-313. Epub 2020 Jun 22.

UWA Dental School, University of Western Australia, Perth, WA, Australia.

Traumatic dental injuries (TDIs) occur most frequently in children and young adults. Older adults also suffer TDIs but at significantly lower rates than individuals in the younger cohorts. Luxation injuries are the most common TDIs in the primary dentition, whereas crown fractures are more commonly reported for the permanent teeth. Proper diagnosis, treatment planning and follow up are very important to assure a favorable outcome. These updates of the International Association of Dental Traumatology's (IADT) Guidelines include a comprehensive review of the current dental literature using EMBASE, MEDLINE, PUBMED, Scopus, and Cochrane Databases for Systematic Reviews searches from 1996 to 2019 and a search of the journal Dental Traumatology from 2000 to 2019. The goal of these guidelines is to provide information for the immediate or urgent care of TDIs. It is understood that some follow-up treatment may require secondary and tertiary interventions involving dental and medical specialists with experience in dental trauma. As with previous guidelines, the current working group included experienced investigators and clinicians from various dental specialties and general practice. The current revision represents the best evidence based on the available literature and expert opinions. In cases where the published data were not conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. It is understood that guidelines are to be applied using careful evaluation of the specific clinical circumstances, the clinician's judgment, and the patient's characteristics, including the probability of compliance, finances and a clear understanding of the immediate and long-term outcomes of the various treatment options vs non-treatment. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.
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http://dx.doi.org/10.1111/edt.12574DOI Listing
August 2020

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.

Dent Traumatol 2020 Aug 13;36(4):331-342. Epub 2020 Jun 13.

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.
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http://dx.doi.org/10.1111/edt.12573DOI Listing
August 2020

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Dent Traumatol 2020 Aug;36(4):343-359

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Traumatic injuries to the primary dentition present special problems that often require far different management when compared to that used for the permanent dentition. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The primary goal of these Guidelines is to provide clinicians with an approach for the immediate or urgent care of primary teeth injuries based on the best evidence provided by the literature and expert opinions. The IADT cannot, and does not, guarantee favorable outcomes from strict adherence to the Guidelines; however, the IADT believes their application can maximize the probability of favorable outcomes.
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http://dx.doi.org/10.1111/edt.12576DOI Listing
August 2020

Pre-operative ketorolac efficacy with different anesthetics, irrigants during single visit root canal treatment of mandibular molars with acute irreversible pulpitis.

Aust Endod J 2020 Dec 3;46(3):343-350. Epub 2020 Apr 3.

Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences, Madurai, India.

Mandibular molar teeth with acute irreversible pulpitis pose challenges in single visit root canal treatment - (i) success of local anaesthesia and (ii) post-operative pain. One hundred and twenty-six patients with pain associated with carious mandibular molar teeth were enrolled. All patients were administered 10 mg of ketorolac tromethamine prior to local anaesthesia. Local anesthetics used were 2% lignocaine with 1:80 000 adrenaline and 4% articaine with 1:100 000 adrenaline. Three irrigation solutions were used - saline, 3% sodium hypochlorite and dexamethasone. Mean intra-operative pain scores for the lignocaine and articaine groups were 4.33 (±2.58) and 4.22 (±2.88), respectively. There was a statistically significant difference (P = 0.000) in post-operative pain incidence between the lignocaine and articaine groups with 16.7% (10 patients) and 49.2% (29 patients), respectively. Pre-operative ketorolac tromethamine was not effective in reducing the intra-operative pain incidence. However, it was effective in controlling post-operative pain with lignocaine anesthetic group.
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http://dx.doi.org/10.1111/aej.12407DOI Listing
December 2020

Assessment of Australian Dentists' Treatment Planning Decisions Based on Diagnosis.

J Endod 2020 Apr 17;46(4):483-489. Epub 2020 Feb 17.

University of Western Australia Dental School, The University of Western Australia, Nedlands, Western Australia, Australia. Electronic address:

Introduction: An accurate diagnosis is required for the appropriate management of endodontic conditions. It is unknown whether the specific descriptive terminology used in diagnosis influences treatment decision making. The aim of this study was to determine whether treatment choices made by dentists are influenced by the diagnostic terminology used.

Methods: One hundred ninety-four dentists in Australia were recruited through the Australian Dental Association to complete an online survey regarding 14 endodontic cases. Respondents selected treatment options based on a given diagnosis and radiograph. Data were analyzed using SPSS software (Version 26; IBM Corp, Armonk, NY) and the exact McNemar test to determine if there was a difference between treatment choices for matched diagnoses with different terminology.

Results: More dentists chose to manage irreversible pulpitis operatively when the descriptive term chronic was used compared with asymptomatic (93.3% vs 59.8%, χ = 57.69, P < .005). This trend was repeated when using chronic or asymptomatic to describe apical periodontitis (96.9% vs 89.7%, exact P = .004) and apical abscesses (99.0% vs 83.5%, χ = 104.125, P < .005). The differences between acute and symptomatic were less dramatic but still presented significant differences in treatment choices for an apical abscess described as "primary acute" or "secondary acute" compared with "symptomatic" (82.0% and 96.4% vs 93.3%, P < .05).

Conclusions: Descriptive terminology, specifically the terms acute and chronic as opposed to symptomatic and asymptomatic, used in the diagnosis of endodontic conditions did influence whether clinicians chose operative management or nonoperative management. Further research is warranted to determine the extent of this influence among dentists.
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http://dx.doi.org/10.1016/j.joen.2020.01.004DOI Listing
April 2020

Comparative Study of Four Endodontic File Systems to Assess Changes in Working Length during Root Canal Instrumentation and the Effect of Canal Curvature on Working Length Change.

J Endod 2020 Jan 15;46(1):110-115. Epub 2019 Nov 15.

UWA Dental School, University of Western Australia, Nedlands, Western Australia, Australia. Electronic address:

Introduction: The aim of this study was to compare a reduction in working length and area of canal enlargement resulting from instrumentation with Hedström (Kerr Dental, Orange, CA), K (Kerr Dental), ProTaper Next (Dentsply Sirona, York, PA), and TF Adaptive (Kerr Dental) files. The effect of the canal curvature on the working length and area of canal enlargement was also assessed.

Methods: A total of 80 plastic canal models were used, 40 with a canal curvature of 10° and another 40 with a canal curvature of 30°. Instrumentation of 10 models with a 10° canal curvature and 10 models with a 30° canal curvature was performed using each of the file systems up to size 25. Working length measurements were taken before and after instrumentation with each file type and size. Twenty composite images were made from superimposition of pre- and postpreparation photographs, and the difference in area was calculated using ImageJ software (National Institutes of Health, Bethesda, MD).

Results: ProTaper Next rotary files and TF Adaptive files produced the smallest reduction in the working length and the least canal enlargement followed by Hedström files and K files, respectively. The degree of canal curvature increased the working length reduction by a significant amount when K files and ProTaper Next rotary files were used, and the degree of curvature increased canal enlargement by a significant amount when K files were used.

Conclusions: Nickel-titanium rotary files produced more favorable results than stainless steel hand files in terms of maintaining a consistent working length and producing minimal canal enlargement. Hedström files performed significantly better than K files in terms of working length reduction and canal enlargement.
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http://dx.doi.org/10.1016/j.joen.2019.10.004DOI Listing
January 2020

Diagnosis and Management of Transverse Root Fractures.

Authors:
Paul V Abbott

J Endod 2019 Dec 14;45(12S):S13-S27. Epub 2019 Oct 14.

UWA School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia. Electronic address:

Background: Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential.

Review: The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations.

Conclusion: Overall, root fractures should be managed conservatively unless they are located supracrestally.
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http://dx.doi.org/10.1016/j.joen.2019.05.009DOI Listing
December 2019

Influence of different irrigants on substance P and IL-8 expression for single visit root canal treatment in acute irreversible pulpitis.

Aust Endod J 2020 Apr 3;46(1):17-25. Epub 2019 Jul 3.

Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India.

The aim of this study was to assess the influence of ketorolac tromethamine and dexamethasone on substance P and IL-8 expression when used as a root canal irrigant for single visit root canal treatment for acute irreversible pulpitis. A total of 42 patients with pain due to acute irreversible pulpitis in carious premolar and molar teeth were included in this study. The four irrigation groups were as follows: saline (n = 11), 3% sodium hypochlorite (n = 11), ketorolac tromethamine (n = 10) and dexamethasone (n = 10). Blood samples S1 and S2 were collected upon access opening and after canal preparation, respectively. Quantification of substance P and IL-8 were done using ELISA test. Post-operative pain was assessed by questioning the patients. The difference between S1 and S2 sample values for the four different irrigant groups was not significant. The sodium hypochlorite group had a higher mean expression of substance P and IL-8 values. Dexamethasone irrigation was more effective in controlling post-operative pain.
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http://dx.doi.org/10.1111/aej.12340DOI Listing
April 2020

Influence of anti-inflammatory irrigant on substance P expression for single-visit root canal treatment of teeth with irreversible pulpitis.

Aust Endod J 2020 Apr 3;46(1):73-81. Epub 2019 Jul 3.

Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University, Madurai, India.

One of the main objectives of root canal treatment is to alleviate the pain associated with irreversibly inflamed pulps. However, some patients may have moderate to severe pain following treatment. The aim of this study was to compare and assess the effect of ketorolac tromethamine on substance P expression in the pulp and periapical tissues when used as a root canal irrigant for single-visit root canal treatment in teeth with irreversible pulpitis. Thirty-six patients were randomly allotted to three irrigant groups - saline (n = 14), 3% sodium hypochlorite (n = 11) and ketorolac tromethamine (n = 11). Pulp blood samples (S1) were collected on gaining access to the pulp, and periapical blood samples (S2) were collected after root canal preparation. Quantification of substance P was done by ELISA test. The ketorolac tromethamine group had greater reduction in substance P expression (S2). Post-operative pain levels were not significantly influenced by the different root canal irrigants.
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http://dx.doi.org/10.1111/aej.12353DOI Listing
April 2020

Diagnosis and management of transverse root fractures.

Authors:
Paul V Abbott

Dent Traumatol 2019 Dec 16;35(6):333-347. Epub 2019 Oct 16.

UWA School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia.

Background: Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential.

Review: The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations.

Conclusion: Overall, root fractures should be managed conservatively unless they are located supracrestally.
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http://dx.doi.org/10.1111/edt.12482DOI Listing
December 2019

Changes in pulp blood flow and pulp sensibility resulting from surgically assisted rapid maxillary expansion: A clinical study.

Am J Orthod Dentofacial Orthop 2019 May;155(5):632-641

University of Western Australia, Crawley, Australia.

Introduction: The aim of this work was to assess and compare changes in pulp blood flow (PBF) and pulp sensibility (PS) after surgically assisted rapid maxillary expansion (SARME) and rapid orthopedic maxillary expansion (OME).

Methods: Ten patients requiring SARME and 10 requiring OME had the pulp status of their maxillary incisors and canines assessed with the use of laser Doppler flowmetry, electric pulp testing (EPT), and CO snow. The SARME group was assessed at T1-S (before surgery), T2-S (after surgery, before expansion), T3-S (after surgery, at completion of expansion), and T4-S (3 months after surgery). The OME group was assessed at T1-O (before expansion), T2-O (after rapid expansion), and T3-O (3 months after expansion commencement). Relationships between PBF/PS and the procedures, assessment times, and tooth types were evaluated.

Results: In the SARME group, surgery did not cause significant (P ≥0.05) reduction in PBF, maxillary expansion did cause significant (P ≤0.05) reduction in PBF, pretreatment PBF was reestablished by T4-S, and nonresponses to both EPT and CO peaked at T2-S. In the OME group, rapid expansion caused significant (P ≤0.05) reduction in PBF, pretreatment PBF was reestablished by T3-O, and all teeth responded to at least 1 of EPT or CO at each assessment time.

Conclusions And Clinical Implications: Within the study's limitations, it can be concluded that both SARME and OME induce reduction but not elimination of PBF to maxillary anterior teeth and therefore do not cause loss of pulp vitality; surgery for SARME does not significantly reduce PBF to maxillary anterior teeth, rather it is the process of maxillary expansion that significantly reduces PBF in SARME patients; and caution when using CO and EPT tests alone to assess pulp status after SARME is warranted because the capacity for CO or EPT to provide negative sensibility responses despite the presence of PBF was observed.
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http://dx.doi.org/10.1016/j.ajodo.2018.05.025DOI Listing
May 2019

Mechanisms of Staining with Demeclocycline and Doxycycline Root Canal Medicaments.

Eur Endod J 2018 19;3(2):66-72. Epub 2018 Jul 19.

School of Dentistry, University of Queensland, Herston, Australia.

Tetracyclines are a unique class of antibiotics which also have additional effects including anti-inflammatory, anti-resorptive and substantive within the root canal. There has been a long-held view that tetracycline medicaments discolour teeth and should be avoided. The evidence base around this topic was explored, including a review of the methodology used in laboratory studies. A search of PubMed, Medline and Scopus databases was conducted to identify studies of demeclocycline and doxycycline medicaments used in root canal therapy. An analysis of the methodology used in these studies was performed to determine if these replicate current clinical practice. The related literature on mechanisms of tetracycline stability and the effects of light, oxidation, moisture and chemical interactions was examined. Studies investigating the effects of Ledermix paste on segments of bovine dentine and avulsed or reimplanted teeth as well as combinations with other antibiotics were excluded from this review. Even though demeclocycline medicament pastes were introduced in 1962, the first laboratory studies of discolouration were not done until 2000. All later studies followed a similar approach, which included exposure to sodium hypochlorite for up to 30 minutes and storage in moist conditions with 100% humidity. Staining during dark storage and enhanced staining on exposure to light were reported, indicating multiple pathways of degradation of demeclocycline and its reaction products. Light, moisture and oxidation are the key factors which drive discolouration from demeclocycline. Clinical issues from tooth staining can be prevented by removal of medicament pastes from the access cavity, and placement of a sound interim restoration. Use of a doxycycline paste obviates concerns of staining. Laboratory assessments of the potential for staining should replicate in vivo conditions.
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http://dx.doi.org/10.14744/eej.2018.47966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006570PMC
July 2018

Efficacy of Pre-Medication with Ibuprofen on Post-Operative Pain after Pulpotomy in Primary Molars.

Iran Endod J 2018 ;13(2):216-220

Department of Pediatric Dentistry, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Pain management following dental procedures, particularly pulpotomies and extraction, is of great importance in pediatric dentistry. The aim of this study was to investigate the efficacy of pre-treatment with ibuprofen on post-operative pain following pulpotomy of primary molars.

Methods And Materials: In a split mouth double-blinded randomized clinical trial, 49 children aging between 6-10 years old were given either ibuprofen or a placebo 45 min prior to the treatment. After pulpotomy and placement of a stainless steel crown (SSC), the pain level was evaluated using the Wong-Baker face visual analogue scale for up to 7 days post-treatment. McNemar and Wilcoxon tests were used for data analysis.

Results: Forty-five patients were eligible to participate in this study. Pre-medication with ibuprofen significantly reduced pain during the first 24 h post-treatment (=0.032). However, there was no significant difference in the pain levels between placebo and ibuprofen groups at 48 and 72 h post-treatment (=0.154 and =0.197, respectively). The number of times patients needed analgesics in ibuprofen group was significantly lower compared to that in the placebo group (=0.008).

Conclusion: Pre-medication with ibuprofen resulted in less pain following pulpotomy and SSC placement in primary teeth.
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http://dx.doi.org/10.22037/iej.v13i2.16624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911297PMC
January 2018

Modified Revascularization in Human Teeth Using an Intracanal Formation of Treated Dentin Matrix: A Report of Two Cases.

J Int Soc Prev Community Dent 2017 Jul-Aug;7(4):218-221. Epub 2017 Jul 31.

Department of Endodontics, Islamic Azad University, Dental Branch, Tehran, Iran.

Ethylenediaminetetraacetic acid (EDTA)-treated dentin matrix (TDM) is an enriched source of bioactive molecules. Therefore, it was hypothesized that fabrication of autogenous TDM on root dentinal walls of necrotic immature permanent teeth may allow more predictable outcome of revascularization treatments. Two young patients with permanent nonvital immature teeth were chosen for revascularization treatment. After appropriate disinfection of root canal system, TDM was fabricated on root dentinal walls using different dilutions of EDTA. Then, bleeding was induced in canals and calcium-enriched mixture (CEM) cement was placed over the blood clots. In all follow-up periods, both cases were asymptomatic and radiographic findings have shown a continued root development. Revascularization is a valuable treatment for nonvital immature teeth, allows continuation of root development. Modification of root regeneration through a TDM protocol may seem more predictable treatment and improve maturogenesis than traditional therapy.
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http://dx.doi.org/10.4103/jispcd.JISPCD_80_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558258PMC
July 2017

Clinical and histological responses of human dental pulp to MTA and combined MTA/treated dentin matrix in partial pulpotomy.

Aust Endod J 2018 Apr 18;44(1):46-53. Epub 2017 Aug 18.

Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran.

The aim of this study was to compare the responses of mineral trioxide aggregate (MTA) and combined MTA/treated dentin matrix (TDM) as direct pulp capping material. In this clinical trial study, 33 intact third molars in 11 healthy volunteers (three molars in each) were included. Partial pulpotomies were performed in a split mouth manner in two of the third molars in each patient randomly and the third tooth had used as TDM source. The coronal dentin was chopped to dentine chips and transformed to TDM using different concentrations of ethylene diamine tetraacetic acid (EDTA) solution. Pulps were directly capped by MTA alone or using a combination layering of MTA/TDM. Following 6-week clinical and radiological evaluations, each tooth was extracted and prepared for histological evaluation. There were no significant differences in the clinical and radiographic responses or in the quality of dentin bridges (P > 0.05). However, the dentin bridge was significantly thicker in MTA/TDM group than MTA group (P = 0.003). Using the combination of MTA/TDM as a pulp-dressing agent may form a thicker dentin bridge compared to MTA alone.
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http://dx.doi.org/10.1111/aej.12217DOI Listing
April 2018

Treatment of a Maxillary Second Molar with One Buccal and Two Palatal Roots Confirmed with Cone-Beam Computed Tomography.

Iran Endod J 2017 ;12(3):371-375

Endodontic Department, Dental School, Kerman University of Medical Sciences, Kerman, Iran.

Root canal configuration is an important subject in endodontic practice and dentists should be familiar with all possible types of root canal configuration. A forty-three year old male was referred for root canal treatment of his maxillary left second molar tooth with symptomatic irreversible pulpitis. Pre-operative radiographs showed a three rooted molar. However, after access cavity preparation two palatal and one buccal orifices were detected. The patient was informed of the unusual root canal anatomy and cone-beam computed tomography (CBCT) was ordered for precise evaluation of the anatomy. CBCT image confirmed the presence of one buccal and two palatal root canals; an exceptionally rare condition.
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http://dx.doi.org/10.22037/iej.v12i3.16331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527217PMC
January 2017

Supplementary techniques for pain control during root canal treatment of lower posterior teeth with irreversible pulpitis: A systematic review and meta-analysis.

Aust Endod J 2018 Apr 24;44(1):14-25. Epub 2017 Jul 24.

Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry Center of Excellence in Oral and Maxillofacial Biology, Chiang Mai University, Chiang Mai, Thailand.

The purpose of this systematic review and meta-analysis was to evaluate utilisation of supplementary techniques for pain control during root canal treatment of lower molars with irreversible pulpitis. The literature was searched using electronic databases up to year 2012. Seventeen studies with 1504 participants were included and each study compared experimental interventions with a standard treatment, i.e. the inferior alveolar nerve block. Changing the injection techniques or supplemental injection had no significant effect on pulp anaesthesia compared to the standard treatment (P = 1.00 or P = 0.14), whereas changing anaesthetic features and increasing anaesthetic volumes resulted in significantly higher rates of anaesthesia than those of the standard treatment (P = 0.03 and P = 0.007, respectively). Premedication with non-steroidal anti-inflammatory drugs (NSAIDs) also significantly increased the success rate of anaesthesia (P = 0.001). Taken together, increased anaesthetic volumes and premedication with NSAIDs provide predictable anaesthesia and more pain control during endodontic treatment of lower molars with irreversible pulpitis.
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http://dx.doi.org/10.1111/aej.12212DOI Listing
April 2018

Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review.

Iran Endod J 2017 ;12(2):123-130

Dental School, University of Western Australia, Perth, Australia.

Introduction: Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment.

Methods And Materials: Scopus, MEDLINE and CENTRAL databases were searched up to 30 January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers.

Results: Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis.

Conclusion: Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed
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http://dx.doi.org/10.22037/iej.2017.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421265PMC
January 2017

General dentists' use of diagnostic equipment and methods.

Aust Endod J 2017 Aug 18;43(2):66-72. Epub 2017 Apr 18.

School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia.

An accurate diagnosis is essential for making treatment decisions in dentistry. However, little research is available as to which tests are done routinely and how commonly they are performed. The purpose of this study was to investigate diagnostic methods and equipment used by general dentists in private practice in Perth. The study involved a retrospective audit of 30 patient records from seven individual general dentists working in private practices in the Perth Metropolitan area. De-identification of patient records was done prior to the researchers' visit. Radiographs were the most commonly used diagnostic tool. Percussion was also commonly employed, followed by cold pulp testing and mobility. The most commonly used tests were radiographs, percussion, periodontal probing and visual examination. The frequency of these tests differed depending on whether the patient presented with or without pain, with percussion and cold tests used more frequently when the patient presented with pain.
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http://dx.doi.org/10.1111/aej.12200DOI Listing
August 2017

Letter re: Radiation shielding in dentistry: an update.

Aust Dent J 2017 03;62(1):117-118

School of Dentistry, Oral Health Centre of Western Australia, The University of Western Australia, Perth, Western Australia, Australia.

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http://dx.doi.org/10.1111/adj.12488DOI Listing
March 2017

Postoperative Pain Following Treatment of Teeth with Irreversible Pulpitis: A Review.

N Y State Dent J 2017 Jan;83(1):44-53

Patients typically associate dental care with pain. Pain has both physiological and psychological components. Endodontic post-treatment pain continues to be a significant problem facing the dental profession. For patients presenting with preoperative pain, most will continue to experience pain after root canal treatment, with pain levels ranging from mild to severe. The purpose of this paper was to review the symptoms and classification of irreversible pulpitis, including acute and chronic pulpitis, incidence of postoperative pain following treating teeth with irreversible pulpitis, factors influencing postoperative pain, persistent pain after root canal treatment, preventing postoperative pain and pharmacological management of postoperative pain.
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January 2017

The Effect of Maxillary First Molar Root Length on the Success Rate of Buccal Infiltration Anesthesia.

J Endod 2016 Oct 10;42(10):1462-6. Epub 2016 Aug 10.

School of Dentistry, University of Western Australia, Perth, Australia.

Introduction: Several variables may influence anesthesia success in maxillary molars. This investigation was conducted to evaluate the effect of root length on the success rate of infiltration injections of 2% lidocaine with 1:80,000 epinephrine.

Methods: One hundred maxillary first molars with irreversible pulpitis were treated. After the administration of a buccal infiltration injection of 2% lidocaine with 1:80,000 epinephrine, the patients' pain during dentin cutting, pulp exposure, and root canal instrumentation were evaluated using the Heft-Parker visual analog scale. No or mild pain was considered as success. Data were analyzed by the point-biserial correlation test and receiver operating characteristic curve analysis.

Results: Overall, 61% of the teeth had successful anesthesia after the administration of a single buccal infiltration injection of anesthetic solution. The point-biserial correlation test showed that the teeth that had palatal and distobuccal roots with longer root lengths showed significantly higher anesthesia failure (P < .05). However, receiver operating characteristic curve analysis did not show a clinically useful cutoff point of root length corresponding with anesthesia failure.

Conclusions: Maxillary first molars having irreversible pulpitis with longer roots may have more anesthesia failures after a single buccal infiltration injection with 2% lidocaine and 1:80000 epinephrine.
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http://dx.doi.org/10.1016/j.joen.2016.07.005DOI Listing
October 2016
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