Singapore Dental Journal最新文献

Discovery of multiple foreign objects in the root canal is unusual and their removal is often difficult and challenging procedure. Entrapment of the foreign object in the pulp chamber or in root canal usually occur accidentally in children with the habit of chewing or placing various objects in the oral cavity. Clinically it was often encountered in tooth with wide carious lesion, exposed pulp chamber due to trauma or tooth left open for the drainage during root canal treatment. This impacted foreign body may act as a potential source of pain or infection. The attempt to retrieve such foreign object from the root canal with immature apex increases the risk of its displacement into periapical area. The present case report describes an unusual case of a patient with two metallic sewing needles inadvertently broken down in the root canal of the permanent maxillary left central incisor and it׳s successful retrieval by non-surgical endodontic treatment.

Background

This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.

Study design

An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.

Results

No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.

Conclusions

Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.

The rules governing the use of metallic mercury, a toxic and hazardous chemical, is in most jurisdictions identical to widely accepted standards and practices for handling the same chemical in industry for the protection of humans and their work environment. There cannot be exceptions solely for the practitioner dentists and their patients. Any workplace must be safe for both workers and visitors. The latter being dental patients waiting in the dentist's work environment. We reviewed the literature for toxic health effects of elemental mercury upon humans and present information about the Minimata Convention convened by the United Nations Environment Programme. A study conducted among dentists in Singapore and their personal work environment almost 30 years ago contributed to the workplace standard for elemental mercury, which was reduced, and is still currently enforced as a global standard. We recommend that dentists, with a large alternative battery of restorative materials today, make selection of a restorative material a more seriously considered choice, and not to make use of amalgam without the proper use of personal protective equipment for themselves (members of the dental operating team) and their patients, (amalgam traps and judicious monitoring of their workplace air quality). Mercury is ubiquitous in our presence due to human activities; any reduction in the dentists' workplace contributes to a global reduction.

Root coverage is achieved by many procedures like free gingival autografts, connective tissue grafts and pedicle grafts. Several studies state that root coverage using connective tissue grafts have high success rates but have disadvantages like creation of second surgical site and post-operative color harmony is less. Although Cohen and Ross reported more than 85% success in covering denuded roots, the degree of success varies among other clinicians. The double papilla pedicle graft has limited usefulness. The double papillae pedicle graft is most appropriate in those cases where esthetics demand a close tissue color match and where the papillae are large and have shallow gingival grooves.

Disinfection of root canals followed by the replacement of the infected or inflamed pulp tissues by inert materials is the foundation for treating irreversible damaged dental pulps. The management of pathological conditions of the periodontium is mainly based solely upon infection control via the reestablishment of oral hygiene, scaling and root planing to control inflammation which stops progressive bone loss. As one may see, the clinical management of endodontic and periodontal diseases has not changed drastically despite the development of new materials, techniques and medicaments. Tissue engineering is a multi-disciplinary field focused on the development of materials, techniques and strategies to improve or replace damaged or lost biological functions and tissues. As the tissue engineering field progresses, “scaffolds”, “suggest pathways” and “stem cells” abandoned their role as technical words exclusively used by scientists and slowly assume a part in the language of students, educators, clinicians and patients. However the unfamiliarity with some of the concepts can lead to misinterpretations of the current status and overexcitement about future applications of stem cells for dental-related tissue regeneration. This paper will present a panorama and the future challenges on the path to use of stem cells for endodontic and periodontal tissue regeneration.

This article quotes and discusses Jean-Anthelme Brillat-Savarin's musings on the mouth and ingestion as described in his book The Physiology of Taste. The book was first published in France in December 1825, and is still widely read as a key work in Gastronomy today. The mouth is intimately related to the acts of chewing, swallowing and eating and it would be interesting to report an early 19th century epicurean's views on the mouth.

Passages from Brillat-Savarin's book describing the functions of the teeth and tongue and the acts of tasting, chewing, and swallowing are quoted in full. Anecdotes also include one on the horrifying punishment of having one's tongue removed and another illustrating the poor oral health found among Europeans of that era.

His work offers a unique glimpse into how a 19th century gastronome viewed the oral cavity and its gastronomical functions. While some of his writings may appear archaic and antediluvian to the modern reader; others relating to, for example chewing and swallowing, are surprisingly accurate by contemporary standards. Nonetheless, the gastronomic savant seemed to know a lot right about modern stomatology!

Background

This interventional controlled clinical trial with split mouth design compares the clinical effectiveness of autologous platelet rich fibrin with open flap debridement in the management of infrabony periodontal defects.

Methods

Fifteen patients with paired contralateral infrabony defects were treated with open flap debridement and autologous platelet rich fibrin (experimental group) or open flap debridement alone (control group). The changes in probing pocket depth, clinical attachment level, and radiographic defect depth were evaluated. Patient perception regarding pain and discomfort following the procedures and early soft tissue healing responses were assessed by visual analog scales, scored 7 days after the surgical procedures. Final reevaluation was done 1 year after surgery.

Results

Baseline clinical and radiographic measurements were comparable between the groups. Reevaluation at 1 year revealed that both treatment modalities resulted in a significant decrease in probing pocket depth, gain in clinical attachment and radiographic bone fill of the defects compared to baseline. Postoperative differences observed between the two groups were 2.27±0.29 mm (P<0.001) for probing pocket depth, 3.33±0.35 mm (P<0.001) for clinical attachment level and 1.29±0.32 mm (P<0.001) for radiographic infrabony defect depth reduction, all in favor of the experimental group. Patient preference was greater and early healing response better for the experimental group as assessed by the visual analog scores.

Conclusion

Within the limitations of this study it can be concluded that use of platelet rich fibrin is more effective than open flap debridement alone in the management of infrabony periodontal defects.