Science topic

Endodontics - Science topic

A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal).
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I am trying to study the microbial populations in endodontic infections and would like to isolate the major ones. I am looking for the best transport and culture media to use as well as incubation conditions.
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Best culture media will be thioglycolate broth and agar media, best storage media will be anaerobic jar..you can check my article based on novel antibacterial dental composite based on nano ceria in which I have used antibacterial analysis
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Mono- species biofilm such as E.faecalis
Dual - species biofilm such as E.faecalis & S.mutans
What is better for intracanal medicamments antibacterial experiment?
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Mono might give accuracy but it will be to an irrelevant endpoint. The author apparently is pursuing medication - a treatment option effective in application of biofilm composed of multiple species. @
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some studies said its start to develope after 48 hrs and others said its better to investigated when its mature after 21 days.
for the research purpose which is better time for more strong and trustful study protocol?
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Hello Nawras!
Over ten years ago I studied biofilm formation in Staphylococci and Streptococci, and we incubated the bacterial cultures for a week. According to these two papers: and 2 or 3 weeks are recommended for biofilm maturation.
Good luck!
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Whenever we study anything with regard to Ex vivo studies for teeth, it is mentioned that they are freshly extracted. For how long can we store and use them and if not , is there a time duration for use?
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Thank you so much for this answer.
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Hello Everyone,
I just want to know if there is a certain protocol to prevent clogging of the salivary aspirator? I’m working in a clinic where on the same unit we do surgery(blood), endodontics (sodium hypochlorite) and odontology (provisional filling debris).
Does anyone have a good reference on the matter?
Thanks in advance.
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I recommend to pour house bleaching after 2-3 cups of water wash everyday after last patient .
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About four years after trauma (intrusion) the upper central incisors (teeth 11,21) are in an infra-position of about 5 to 7 millimeters, the lateral incisors of about 3 to 4 millimeters, resulting in an open bite in the front region. the central incisors has been intentionally replanted, an extra oral endo had been done by inserting titanium posts into the root canal from a retrograde direction. both teeth are free of infection. Starting from the apical region the root substances have been resorbed. Cervically, root substances of regular width and a height of two and four millimeters, respectively, are still existent according to intra-oral radiographs.
The lateral incisors and all more dorsal teeth don't show pathology.
lip line is low, the gingiva can't be seen even when laughing.
1. removal of teeth, vertical augmentation, implantation: extremely difficult, most demanding. foreign material. waiting for the end of facial growth, may be still a considerable number of years .
2. decoronation: bone width is maintained while vertical growth stop is compensated by bone overgrowing the root cervically. bone augmentation comparably smaller. unclear: does it still work at this age?
3. orthodontic space closure: removal of teeth necessary, risk: moving the teeth out of the bone. unclear: probability of successful treatment.
4. premolar transplantation:removal of teeth necessary. risk: 30 to 40 percent of ankylosis, no improvement compared to actual situation, loss of premolars. chance: functional healing, permanent retention.
Are there any experiences, ideas, tips and tricks for the best treatment?
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If there is alveolar bone discrepancy, then extraction and implants following growth is one option. Some case reports have been published of dentoalveolar distraction in posterior teeth
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A 16 year old female presented with a fractured and discolored maxillary central incisor and Class II div 1 malocclusion.
There is history of trauma, 5 years back.
Periapical radiograph shows widely open apex, and root length 3 mm shorter than adjacent central incisor.
What should be the sequence of treatment?
Apexification, restoration (Crown) and then orthodontic movement OR
Provisional restoration, Orthodontic movement and then apexification and crown.
Regards,
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Apexification and any other endodontic, periodontal, and restorative work need to completed before orthodontic treatment.
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What do you think about orthodontic forces on root filled tooth? Have you ever noticed any differences between this case and controlateral vital tooth? In literature, the most part of studies is based on bidimensional radiographic exams.
I am evaluating it on CBCT and I would like to share ideas. Thanks for the attention.
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Root resorption is a multifactorial process. That is why some studies have shown increased root resorption in non-vital teeth whereas some others found no difference. This is because of the multiple confounding factors which may be difficult if not impossible to control. The best management is to be aware of the potential root resorption and efficient orthodontic mechanics to complete the treatment in the shortest time possible. Our group published a meta analysis on root resorption with clear aligners and fixed orthodontic therapy. Please see below.
Gandhi V, Mehta S, Gauthier M, et al. Comparison of external apical root resorption with clear aligners and pre-adjusted edgewise appliances in non-extraction cases: a systematic review and meta-analysis. Eur J Orthod. 2021;43(1):15-24. doi:10.1093/ejo/cjaa013
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 Pulpotomy, Pulpectomy, Bulls teeth, Perforation, Crown:Root ratio, Size of pulp chamber
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According to my experience it's challenging to find, shape and clean the root canals in taurodontism. The anatomy also differs as compared to the routine cases. Ideally microscope and knowledge on anatomy would give satisfactory outcomes.
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Endodontic dental materials such as calcium hydroxide, MTA are alkaline in nature.
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Most of the times Endodontic infections are due to bacterial inhabitation. Bacteria tend to release various endotoxins, which will cause the acidic environment and bone degradation due to increased osteoclastic activity. Especially, where the pulpal infections affect the periradicular tissues the activity is more severe. So, highly alkaline materials are adivsed to be used to decrease the osteoclastic activation, inactivate@@ the bacteria and its contents and also promote the favourable environment for remineralisation. So, most Endodontic materials are formulated to be alkaline.
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This product was presented as a decalcifying agent. And, it is used in combination with Sodium hypochlorite. This combination was described as an all-in-one endodontic irrigant.
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This is an interesting product that repurposes the bisphosphonate etidronate (HEDP) combined with NaOCl disinfectant. The idea was to combine an oxidation-resistant chelator directly with NaOCl disinfection solution to expedite and simplify root canal irrigation. HEDP exhibits short-term compatibility with NaOCl solutions at clinical strengths, thus retaining the desired antimicrobial and proteolytic effects of NaOCl while
adding an element of decalcification to the mixture. Here is some of the early literature on it fyi:
- Ballal NV, Das S, Rao BSS, Zehnder M, Mohn D. Chemical, cytotoxic and genotoxic
analysis of etidronate in sodium hypochlorite solution. Int Endod J. 2019;52:1228-34.
- Zehnder M, Schmidlin P, Sener B, Waltimo T. Chelation in root canal therapy
reconsidered. J Endod. 2005;31:817-20.
- Tartari T, Guimaraes BM, Amoras LS, Duarte MA, Silva e Souza PA, Bramante CM.
Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve
organic matter. Int Endod J. 2005;48:399-404.
And a newer study:
Kfir A, Goldenberg C, & Metzger Z, Hülsmann M, Baxter S. Cleanliness and erosion of root canal walls after irrigation with a new HEDP-based solution vs. traditional sodium hypochlorite followed by EDTA. A scanning electron microscope study. Clinical Oral Investigations (2020) 24:3699–3706.
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Dear All,
Can you kindly suggest applicable electronic strategies/methods that are effective to provide a preclinical and clinical training in endodontics alternative to traditional methods?
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I agree with previous strategies and encouraging students to use artificial teeth designed for endodontic training during this period.
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I am searching for someone who can do 3D reconstruction using Micro-CT data.
I have the scans but I cannot reconstruct them 3-dimentionally!
In my study, we aim to compare voids volume in 4 different obturation methods of endodontics.
The time is also very limited!
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I use ITK SNAP
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As the crown structure of tooth has crumbled mostly due to the carious process, it is a case, which has gone into the stage of Acute and Chronic irreversible pulpitis but is there any documentation as to how long can an asymptomatic tooth piece be given a diagnosis of chronic irreversible pulpitis and how can it be labelled as a case of pulpal necrosis clinically (as per the clinical classification of pulpal diseases by Cohen)?
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None till now... still waiting for some concrete evidence from cons ppl
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I am writing a synopsis for my dissertation on a topic in which I'm comparing 2 endodontic sealers clinically (RCT). there are no clinical studies for their comparison in literature till now. I am having difficulty in calculating sample size. I need guidance.
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I have the primary outcome to measure on reliable scale with intra & inter observer reliability. But unable to find suitable sample size to defend my dissertation.
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Hi!!! My name is Maria Perez Morales. I am a Dentist and Specialist in Endodontics working and living in Dubai since 11 years ago. I have had the possibility to work with patients that are coming from every where worldwide, and the perception of the pain and the acceptance of the treatment is very different from one culture to another one. I am very interested in your study, because for me the results will have a relevant application at the moment do deal with the day to day of the practitioner in Buccal Surgery and Endodontics
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I can relate to your question being a pediatric dentist who practiced on many patients in different countries (Jordan, Australi, Morocco, KSA)... yes definitely, there is a difference between cultures in perceiving pain and attitudes/ behaviors by children. The VAS is an excellent tool I’ve used myself in research to measure pain. I assume you’ll find lots of interesting factors relevant to SES, upbringing styles, education... etc A multi- center study would be excellent in this aspect. Good luck!
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Which steps should I follow to dehydration and drying before SEM evaluation. The device i’ve use for this study is a new-generation product of Hitachi btw.
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The easiest way is to observe smeared/etched surface from the top, to see if smear plugs in tubules are dissolved. You do not need any fixation, just dehydration in graded solutions of alcohol (for example, 33%, 66%, 85%, 95%, 2*100%). About 1 hour in each of solutions and overnight in the last 100% solution. Then air dry for about 24 hours.
There is another approach - to observe collagen network in an etched layer, but for this you need additional steps - fixation and specimen fracture after dehydration.
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Estimation of strength of remaining dentin is important to understand the restoration of teeth whether to proceed further or not
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The only way I know how to determine if a tooth has enough remaining structural integrity is to mesure the width and height clinically and/or on x-ray with imaging software tools. But of course, that evaluation has to be done prior to endodontic treatment, as the proposed treatment plan and consent depend on that information, ie knowing if the tooth is restorable post-endo beforehand and if so, what type of restoration is needed.
I understand that post-endo evaluation is necessary to confirm treatment plan, but pre-endo evaluation is a must and not doing so would be malpractice.
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Polarization material appears to be useful as endodontics treatment sealer that can be optically visualised in root canals with out radiographic examination
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Bioceramic sealers is the true solution for sealing problems .true mta sealer not containing resin
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Need some advises.
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many causes can be considered , central sensitisation, periodontal involvement, vicinity of teeth with maxillary sinus involvement , post injury.
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  • Are the same repetitive kinematic parameters generated by endodontic motors sufficient for the concept of single-file endodontics?
  • Do the simplified single-file systems need more complicated kinematics generated by more talented endodontic motors?
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Thanks Satish Narula Do the simplified single-file systems need more complicated kinematics generated by more talented endodontic motors?
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in an advertisement film from FKG for new files (XP-endo finisher), it is shown that the nickel-titanium file bent when it heated ( in body temperature). It is Ok and we all know that shape memory effect active with warming but in that clip (min 4) the bent file becomes straight by cooling!!!
how it happens??
the film link is in 1st comment.
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Ni Ti dental instruments must to autoclaving between application in different patients. This thermal cycles reduce bending fatigue resistance of them. functional fatigue related with this thermal fatigue ? I mean dose mechanical performance of Ni Ti changes during its standard useful life?
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  • Are the same repetitive kinematic parameters generated by endodontic motors sufficient for the concept of single-file endodontics?
  • Do the simplified single-file systems need more complicated kinematics generated by more talented endodontic motors?
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Great editorial has been published 9 years ago :
Simplification might help GPs, not so competent in scientific and artistic aspect of endodontics, to increase quality of their endodontics.
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1. En dientes anteriores superiores e inferiores de canino a canino.
R:
2. En dientes premolares superiores e inferiores.
R:
3. En molares superiores e inferiores.
R:
4. El costo del tratamiento incluye la consulta médica?
R:
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U$ 100 para anteriores, 150 premolares y entre 80 y 200 en molares. No incluye la consulta que serían 30/40 dólares.
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I have noticed gingival and periodontal ligament fibroblasts have differing morphologies when cultured with MTA.
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Maybe MTA only caused periodontal ligaments with mild inflammation of osteofibrosis, without bony lesion formation.
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Hi to everybody in the community. I am involved in dental pulp stem cell field and i have noticed that in many papers the supplements used for dentino-osteogenic differentiation are dexamethasone (0,1μm), β-glycerophosphate (5mM) and KH2PO4 (2mM). So, basically they replace ascorbic acid with monopotassium phosphate. DO you know what could be the effect of KH2PO4? Because i know that ascorbic acid is needed to enhance the secretion of collagen type I which is essentially the matrix on which mineralization occurs..
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Is dental pulp stem cell involved in peritubular dentin formation? By the way, the potassium ion from monopotassium phosphate maybe can provide the potential difference which can help the mineralization reaction.
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Endodontically treated molars are over treated with destructive full coverage indirect crown construction, sacrificing sound tooth structure thus decreasing survival of the crowned teeth.
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To create replaceable dental pulp and minimise complications post endodontic treatment
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The current protocol for pulp regeneration shows promising results in terms of healing of periapical lesions and survival rate of treated teeth compared to traditional methods. However, there are several problems with the protocol and the outcomes are unpredictable. Therefore, every step in the treatment protocol should be revised to attain a more biocompatible strategy. More importantly, the effect of adding tissue-engineering triad components (stem cells, bioactive scaffolds and growth factors) to the current protocol needs to be studied in more relevant in situ animal models with immature teeth and concurrent pulp necrosis.
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Clinically and radiographically well treated endodontically teeth which shows failure might be due to the presence of viruses in root canal spaces
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Improper biomechanical preparation and irrigation of the root canals give space for viruses to act, so may lead to failures
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The same instrument or explorer movement is identified and disturbing to Patients .Even Manual or ultrasonic scaling is disturbing evident from facial expressions
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endodontic instrument is rotated in pulp space after removal of pulp so tooth is sense less and all instrument movement between all around dentinal wall which is rigid and sense less plus we are using reduction gear handpiece so movement of endodonitc instument is very slow and that is why it does not disturb human but if instrument is touching wall very tightly it will rub dentin wall may create heat due to friction it will disturb human while working
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During endodontic treatment of vital cases, are we able to quantify the level of biomarkers present in small samples of pulp tissue excised from the pulp chamber?
What is the appropriate/best methodology to quantify that biomarker?
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n the included studies, irreversible pulpitis was associated with different expression of various biomarkers compared to non-inflamed controls. These biomarkers were significantly expressed not only in pulp tissue, but also in gingival crevicular fluid that can be collected non-invasively and in dentin fluid that can be analyzed without extirpating the pulpal tissue. This may be used to accurately differentiate diseased from healthy pulp tissue. The main current challenges in the clinical application of biomarkers lie in the identification of biomarkers or biomarker subsets that reliably correlate with pulpal inflammation, the improvement of sample collection (substrate and protein yields), and their analysis (interference of the biomarkers with inflammation of other than pulpal origin). If these hurdles can be overcome, a more accurate pulpal diagnosis and more predictable vital pulp treatment regime may create better clinical outcomes.
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Why do the dentist and researcher use endodontic training blocks instead of extracted teeth for the comparative study of different endodontic files? Is there any similarity in endo training blocks and extracted teeth?
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I think there are two possible reasons for this:
- endodontic training blocks are all the same, i.e. it is a very standardized evaluation using such blocks.
- In many European countries (I have only experience within Europe) it is very difficult to obtain a sufficiently high number of suitable extracted teeth (less and less teeth are extracted nowadays and, in addition, the formalities, such as approval by the ethics committees, are becoming more and more complicated).
The way I see it, training blocks are the easiest (not necessarily the best) way to compare filing techniques. Even if you can't replace natural teeth with them.
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Some time sensitivity is persistent complaint after root canal treatment
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This may be related to pain referred from one tooth to another tooth or other tissue like paranasal tissue
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The apical coronal or coronal apico is known, the decision depends on the presence of necrosis or irreversible pulpitis or acute periapical abscess.
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Thank you very much for your contributions.
Recently I read a book where the author refers to what they are saying. He mentions the techniques of pulpectomy for primary teeth: with pulpal vitality (irreversible pulpitis), with pulpal necrosis without radiographic evidence of periapical lesion and necrosis with radiographic evidence of periapical lesion.
Also, the author suggests compensatory wear to facilitate cleaning and filling of the root canals.
For example, for vital teeth, it recommends the stepped technique with progressive anatomical recoil to clean the canal, give it a conical shape and facilitate sealing. The technique divides it into apical preparation and staggered preparation.
Thanks for your attention.
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Please give your customized opinion and backing scientific evidence for the best obturation method/technique ?
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Hydrulic technique with Bioceramic sealer and Bioceramic coated Guttapercha
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When performing coronal seal during regenerative endodontic procedures, which are the key points to avoid coronal discolouration afterwards?
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seal the dentin tubules of crown with sealant or dentin bonding agent before starting regenerative procedure
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For odontoblasts even a tiny amount of predentin (organic, not calcified) is essential to their survival. Please provide ref. sources. Thanks in advance
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Greetings Dr.Vassiliadis.
A critical factor in your hypothesis is the distance to the closest capillary and consequently the possibility of nutrition by diffusion.
In case of a distance longer than the potential of diffusion (few μm in this case) then we have to examine the possibility of intercellular connections such as seen in the osteoblasts/osteocytes by canaliculi, which to my knowledge is limited to osteocytes. It should be possible that a fully calcified tissue can be maintained by osteocytes that practically provide the tissue with hydroxyappatite similar to odontoblasts.
In a third scenario we could use the model of muscle cells with the possibility to provide nutrition through glycogen but I am afraid that the potential to produce hydroxyapatite to withstand the process of bone remodelating is compromised.
Another idea is to introduce strategically placed undifferentiated mesenchymal cells which can both induce angiogenesis when introduced to this hypoperfused tissue and given their mineralized environment they would assume the role of further mineralization as they do in the process of intramembranous ossification.
Unfortunately without knowing the purpose of this question and its context I cannot provide any other alternative.
I hope this was helpful.
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Systematic review of endodontic pain? Tells me nothing about the project. the title is quite non descript. Do you intend evaluating endodontic pain during treatment? Thats what the title suggests. If its pain medications to relieve 'endodontic pain" would that be local analgesia during TX
OR
And this is a huge leap of faith are you intending evaluating the effectiveness of pain medication post endodontic TX? You need to make this clear in the title simply but succinctly and the rest can go in Objectives and Inclusion Criteria
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This is irrelevant the comment was about the SCOPE' of their systematic review not a scoping review prior to a systematic review
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Dear Doctor Teeuwen,
great stuff. Could not make it through all of your data yet, nevertheless, I haven't seen any comparative study which could compete with yours. Excellent work.
Nevertheless, I do have a question: did you break down your first age group (<30y) in more details? I just wonder, whether there are some children and adolescents, which would most probably be in need of an endodontic treatment due to trauma... Any differences in the results concerning (these and/or later) trauma cases?
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Dear Dr Teeuwen,
any chance to re-evaluate in order to differentiate between trauma and non-trauma cases? Could offer some help... Would be great since there are s few studies from a practice... while this is the place where the daily and real work is done. And I suppose that trauma is not only a quite numerous cause for an endo - at least in certain age groups - it should also have a big impact on success/failure.
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what changes in collagen fiber type in oral mucosa is expected when the oral mucosa is exposed to laser irradiation at 980nm wavelength?
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Nice and useful articles Nirmala..Thankyou...
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pulp revscularization in nonvital immature teeth with open apex
contradicating evidence for use of disinfectant intracanal medicament calcium hydroxide -- necrosis of cells and thing of dentin
antibiotic paste-- cytotoxicty and restriction in growth factor release from dentin wall-- galler etal ,2016
any current evidence in select this intracanal medicament for revascularization procedure would be helpful.. thank you
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Kristin Galler has an excellent review article and she is considered to be a biomolecular expert in this area...her observations are spot on and she cautions us to realize that the protocol for this approach is not set by any means. Follow her publications or listen to her presentations if you have the opportunity. I have spoken with her on this topic and am thoroughly impressed with her work and assessments. She will be a leading investigator in this area along with Stephane Simone from France. See also the attached abstracts that may shed some additional light on the question you posed. However, we have only scratched the surface in the area.
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Please suggest what you do in this situation.
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Multiple issues seem to be present in both the question and the responses. First, the use of pulp sensitivity testing as a term is most appropriate, not endodontic diagnosis, which encompasses so many other issues. Second, the issue of vitality and non-vitality is archaic as many teeth that test "vital" are in a state of degeneration and at some stage in the cyclic inflammatory response. Third, with teeth covered by full crowns, a cold test - generic, is the best to determine the responsiveness of the tissue in the tooth...and if abnormal (severe response, or lingering response, or reflects the patient's chief complaint) the C fibers are being stimulated and the pulp is most likely in some state of degeneration. If there is a response and it subsides rapidly, it is reasonable to think that the tissue is healthy (not vital) and not intervention is indicated. For those who continue to use the terms vital and non-vital I pose a question: Have you ever gone to your physician and asked him or her to check if you are vital or non-vital? You are either sick or healthy...and so it is with the tooth pulp. It seems that in this day of high technology we still have not come up with reiiable way to ascertain the true status of the dental pulp...other than maybe when it is truly necrotic. If you wish to see how far we have come with diagnosis see: J Hist Dent 2011;58(3):126-128.
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Despite the predictably higher success rates of endodontic therapy and advances in materials and techniques. Why they do not reflect the predictable outcome in the population? Is it that standard of care is not been provided. 
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Very easy explanation. Studies with 95 % success , were made under ideal controlled conditions . Epidemiological data reflect what happens in reality . Without ideal conditions or any kind of quality control.
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Are there a scientific evidences to clarify why some patients with inflamed pulp might have symptoms whereas others patients are asymptomatic ?
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Primary contributes for symptomatic pulpitis are infection, inflammation and pressure changes. And symptoms are directly proportional to matured innervation/vital nerve fibres.
1. inflammation brings about vascular changes (vasodialation, oedema) which increases local pressure, when the pressure crosses critical intrapulpal pressure (as pulp chamber is non expandable) the pressure falls back on nerves hence pain is felt. 
2. there are certain situations where this increased pressure will never crosses critical intra pulpal pressure, eg: open type of pulpitis, where the oedema fluid simply escapes through huge cavity formed due to decay. 
3. in certain conditions like chronic irreversible pulpitis, there are micro abasses forming within the infected pulp, there are instances when these microabscesses burst and coalesce. the pressure changes brought about by these events can initiate the pain.
4. These all symptoms are highly variable among individuals, individual teeth, type (primary/permanent) and age of the teeth. individual variation is primarily because of pain threshold. in primary and young permanent teeth the neural tissue is not considerably dense and it is immature. Hence the chances of asymptomatic progress of pulpitis is high in such teeth. 
5. Finally another contributing factor can be speed of progress of lesion. in cases of ECC or rampant caries the destruction is extremely rapid, which destroys nerve fibres in fraction of time, leaving very less time for symptom development.  
6. When the pulpitis progress to periradicular abscess, the same principles of "pressure changes" apply. sooner the pressure relieved (usually sinus formation) lessor the symptoms.
Pulpal pathology is one of the least explored subject in dentistry. Glad to see this question. Hope I addressed the query at least to some extent...,
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What are the recent techniques or medicaments used for management of external root resorption of an intruded permanent incisor with or with out open apices?
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Yes. Regenerative endodontics is a promising modality that works to improve the limitations of the traditional means of treatment of the open apex; namely apixification either with using calcium hydroxide or MTA which lack the potential for further development of the root.
It could solve the problem of immature teeth if started immediately when the pulp vitality is lost so as not to give chance for external root resorption to occur beside , to gain the mentioned advantages of the procedure.
The challenge is the mangement of mature teeth which developed external root resorption.
Thanks again for your valuable contribution Dr. Abu- Hussein. 
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Not a fair amount of information is given to patients while choosing between implant versus endodontic therapy. There seems some sort of disagreement between endodontists and implantologists. Not all but few are always promoting implant as solely beneficial treatment, often underscoring benefits of endodontic treatment and highlighting disadvantages of endodontic treatment. 
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Implants do not have 100% success...ten year data tends to show that success is possibly in the low 80%...why do you think we now see text books and articles published on dealing with implant failures...and how about those that are not in any report and the patient just has them taken out or the bone loss is so great they fall out. Remember, implants are evaluated as to survival not success or failure. 
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Many authors recommend the use for dentin reparation, but there are divergences when they talk about, if the Ca(OH)2 only form dentin in contact with the injured pulp or it can induce the formation of dentin too  when it is placed in deep cavities near the pulp chamber.
Thank you in advance and best regards.
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Dear alain
Calcium Hydroxide (CH) is extensively used for hard tissue formation. The hard tissue formation may be required at a place where pulp has exposed or in deep cavities where pulp has not exposed. Its mode of action to form hard tissue is described as under:
CH dissociates into its constituents ions as Ca and Hydroxyl ions when it comes in contact with aqueous fluids from vital tooth tissues. In exposed pulp situation, it causes coagulative necrosis which converts underlying undiferentiated cells to odntoblasts. The odontonblast deposit the reparative dentin. In deep cavities without pulp exposure, dissociation of Hydroxyl ion helps in strong antibacterial activity and Ca is deposited to protect the underlying pulp. 
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I know that ethanol is used to stabilize chloroform. Can I do it by myself, by putting 97% ethanol to chloroform, or I need to by already stabilized solution.
If I can do it myself, what concentration?  
I found some information that 1% of ethanol should do the effect.
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I agree with you it can be done by yourself by adding 1% absolute alcohol/ 97% ethyl alcohol to chloroform for the stability of chloroform. Better if it is done in a safety hood.
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Several referrals are done seeking intentional RCT from Prosthodontist for Fixed partial denture when they anticipate pain and/or hypersensitivity in the vital abutment. There seem to be no any criteria in the literature to support it. It is being done only on the basis of the intellectual guess. Thus, several teeth are losing pulp and vitality. In the healthy teeth following tooth preparation pain or hypersensitivity may be the transient problem, in an absence of infection and after proper coverage of cut tooth structure it may subside. So what do you think? Not all cases but the majority of cases can be prevented from losing the health of pulp. Cement the tooth with temporary cement and wait for symptoms to relieve.
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Consensus Conference Subcommittee 2
was charged with the identification and definition of
all diagnostic terms for pulpal health and disease states
by using a systematic review of the literature. Methods:
Eight databases were searched, and numerous widely
recognized endodontic texts were consulted. For each
reference the level of evidence was determined, and
the findings were summarized by members of the
subcommittee. Highest levels of evidence were always
included when available. Areas of inquiry included
quantification of pulpal pain, the designation of conditions
that can be identified in the dental pulp, diagnostic
terms that can best represent pulpal health and disease,
and metrics used to arrive at such designations. Results
and Conclusions: On the basis of the findings of this
inquiry, specific diagnostic terms for pulpal health and
disease are suggested. In addition, numerous areas for
further study were identified. (J Endod 2009;35:1645–
1657)
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I completely agree with the wettability of root canal and contact angle as mentioned by the author. Contact angle studies should be performed on a moist teeth and not on a dehydrated or completely dried teeth as done is several in vitro studies. In the clinical scenario, once the root canals are irrigated, they are dried with paper points. Hence, the root canals will never be completely dry, but they remain moist.
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I am planning to study the micro-push out bond strength of a root canal sealer to root canal dentin. I had come across many studies regarding various factors that affect the push-out bond strength. Variables studied were type of sealer, core material, obturation technique, tooth type, tooth portion, storage time, presence or absence of smear layer, slice thickness etc. But the taper of the prepared root canal was not investigated. I had observed practically during retreatment procedures the retention of guttapercha in root canals prepared with more tapered rotary systems is less. Will the taper of the rotary instrument affect the push-out bond strength?
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Thank you Dr Rashid. I have gone through these publications. Variables studied were irrigants, obturating materials, surface treatments. Please let me know if you come across studies regarding push out bond strength variations with different tapered instruments. Thank you.
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There are some authors that describe good results. What do you think about it?
Best regards and thank you in advance
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This is an important topic  so I will present detailed information :
- In general, if the patient presents with severe symptoms and the diagnosis is acute apical periodontitis or abscess, obturation is contraindicated. These are emergency situations, and it is preferable to manage the immediate problem and delay definitive treatment.
- Painful irreversible pulpitis is a different situation. Because the inflamed pulp (which is the pain source) is to be removed, obturation may be completed at the same appointment.
- In necrotic Pulp without significant symptoms, obturation may be completed during the same appointment as canal preparation.  Pulp necrosis with asymptomatic periradicular pathosis (that is, chronic apical periodontitis, suppurative apical periodontitis, or condensing osteitis) alone is not necessarily a contraindication to single-appointment treatment at least as related to postobturation symptoms.
- There may be an advantage, however, to multiple appointments related to healing of apical pathosis. Some studies indicate the benefits of treating these patients in two visits. Placement of an intracanal antimicrobial dressing such as calcium hydroxide reduces bacteria and reduces inflammation somewhat.
- One situation that contraindicates single-visit care is the presence and persistence of exudation in the canal during preparation. The potential for post-treatment exacerbation is increased if the periapical lesion is productive and generates continual suppuration. If the canal is sealed, pressure and corresponding tissue destruction may proceed rapidly.  In these cases, canal preparation is completed, followed by calcium hydroxide placement. A dry cotton pellet is placed over the calcium hydroxide and the access is sealed with a temporary restoration. Generally, exudation will be diminished and controllable at a subsequent appointment; obturation may then be completed.
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Bond matters a lot with respect to sealing ability and prevention from permeability of microorganism.
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Dear Deepak
your question does not seems to be clear (may be complicated) but the statement about microleakage  is clear and widely accepted.  
In vitro tests usually are more practical to perform,   dr Kupka asked about the type of pulp  capping agents ( chemical setting or light cure setting ) that makes scene as light cured capping agent presented as one hard peace after curing but   does not strongly bonds to dentin ( etched or non ) because of  the polymerization shrinkage  stress that occurs which tends to debond the material from the tooth structure 
then the above RMGIC will add stress after curing which might lead to more stress and shrinkage resulting in additional  microleakage . after this step you want to apply your light curing composite adding more strees .
another consideration is the different protocols you have to follow regarding the smear layer treatment for each of the three materials you want to use and compare  
Best regards,   I hope that i did not add much  confusion  to the question  
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Many researchers said that CaOH can`t be used in primary teeth because go against resorption process due to permanents coming. In your experience and research can be used CaOH in temporary teeth?
Thank you in advance and best regards.
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Thank you Zafar you can share it on social networks for better results and discussion. A pleasure for me to help you. Best regards
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There are lot of sterilization techniques mentioned in the endodontic literatures, however each technique has its own pros and cons....
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Hi Dr Vineet, though single use of endodontic files is good,it may not appear practical for many practitioners. usually manufacturers recommend reuse of files for 3 to 4 canals (not teeth!). when you consider reusing the files, recommended method is autoclaving (avoid flash autoclaves) but remaining organic debris on the files may interfere with efficient steam penetration leading in to insufficient sterilization. hence it is better to clean them in an ultrasonic bath (consider using multienzyme cleaners) before autoclaving. And immidiately after use place the files in chlorhexidine until transporting files for cleaning as dried organic debris is difficult to remove.(hydrogen peroxide should be avoided as it may have corrosion effect)
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A few of text book call to an status of dental pulp "hot tooth" where the tooth afected can be treate even using anesthesic agents cause the pain remaining. Anybody hear about this?
Thank you in advance.
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Dear Bernardino,
Thank you very much for your answer.
Best regards
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Could application of LASER in root canal system has any beneficial effect on the disinfection protocol
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Photothermal lasers (diode and Nd:YAG) have shown promise in bactericidal effects.  However, these days, there is much more emphasis on the photoacoustic nature of laser energy in root canals, especially with erbium lasers, which have been shown to create shockwaves, pressure waves and cavitation within the endodontic canal system.  This powerful combination is highly effective in removing bacteria and biofilm from the canal.  See Gordon's study published in JADA which demonstrates 99.7% reduction in intracanal pathogens using only erbium laser.  I suspect effect is greater now, with conical laser fibers which direct energy laterally far more than ever before.  Walsh has shown similar cavitation effects using diode lasers, however, because of the greatly reduced peak power compared to erbium lasers, the cavitation cannot be as significant.  In the end, although disinfection is very significant, no one has shown complete eradication or sterility, which was your original question.
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Sodium hypochlorite , EDTA, Hydrogen peroxide are all used as endodontic irrigants. Newer include herbal irrigants as well as passive ultrasonic irrigation systems.
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Sodium hypoclorite (3 to 6%) is the best for dissolution of organic matherial an to kill bacterias, folowed by EDTA to remove the smear layer. Clorhexidine is a good irrigation solution, but dont dissolve the organic matherials and is not active against some bacterias. H2O2 is good after access cavity, in cases of biopulpectomy, to remove the blood.
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I tried to repair fractures lines in furcation of lower molar treated endodontically years ago.... Any advice?
Thank you in advance and regrads.
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Totally agree. The examination on details of the patient before any treatment plan is very important to obtain resolts with better perspectives to patient.
Thank you all of you for all answer. Best regards.
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Pain is produced when a stimulus strong enough to trigger a nervous response is applied to a tooth. The intensity, location and quality of pain will differ, depending on the type of stimulus, as well as the type of nerve fibers excited in the process. 
Sensory nerve fibers in the pulp consist of myelinized A-fibers, which prevail, and non-myelinized C-fibers. Of the former, these are mainly A-delta fibers, which conduct the impulses faster, while, speaking of the latter, C-fibers, which are thinner and slower conducting. A-delta fibers are responsible for strong, immediate, sharp, well localized pain, and C-fibers for dull, continuous, and irradiating pain.
Laser heat is a natural stimulus and corresponds with common painful experiences. With continuous application of laser heat, the C fibers are affected; vasodilatation temporarily increases intra-pulpal pressure and causes intense pain so can this pain stimulation by low level laser therapy be used for endodontic diagnosis ?
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Yes. LLLT could be used for diagnosis.
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Mineral trioxide aggregate (MTA) is a biomaterial used for root-end filling, perforation repair, internal and external resorption, vital pulp therapy and apical barrier formation for teeth with necrotic pulps and open apices. Recently MTA based sealers have opened up the horizon for root canal sealers. Sealers based on MTA have been reported to be biocompatible, stimulate mineralization and encourage apatite-like crystalline deposits along the apical- and middle-thirds of canal walls.
Calcium enriched mixture (CEM) cement, Biodentin, Bioaggregate, and EndoSequence Root Repair Material (ERRM) and EndoSequence BC Sealer have been introduced to the market recently. Is there any difference in the indications, clinical applications and success rate of MTA, biodentine and CEM cement in endodontic uses?
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Dear Alain,
Thanks for your explanation. I got information from it. 
Best wishes
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-patient diagnosed with fibromyalgia
-tooth 35 was treated endodontically because of pain (altough the vitality tests were normal)
-patient still feels pain that evolved into a pain on percussion
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Dear
Sure but if the tooth was treated perfect and without any problem.
You must check the tooth with bit check for vertical fracture or additional canal.
Sincerely 
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Can anyone suggest a sufficient amount of thermomechanical load for post endodontic restorations?
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look there- we made a numbe rof tests trying to correlate in-vivo and in.vitro
Jungbauer M., Rosentritt M., Reill M., Naumann M., Handel G.: Valuation of simulation of anterior post and core restorations. CED Thessaloniki 2007. #57
You can find the poster under
year 2007
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What do you do to prevent the lost of height of the interproximal papilla?
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In esthetic zone and crowned teeth my first option is always papilla preservation technique, papilla based incision described by Velvert. If you can master it great, otherwise LBO incision if there is sufficient width of the attached gingiva ( minimum 4 mm).
Semi lunar flaps are obsolete now, not used any more particularly in modern endodontic microsurgery.
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Pulpotomy considered one of the final treatment for primary dentition while for adult cases lastly it considered according to clinical classification of pulp and periradicular diseases published by American Association of Endodontic and approved by American Board of Endodontic as (previously initiated therapy) and it's not final treatment regardless of type of pulpotomy materials, so accordingly all cases of pulpotomy should send to endodontist to complete final endodontic treatment while I will ask about experience and prognosis of cases of pulpotomy for adult and it's prognosis with best regards.
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pulpotomy using MTA could be a good alternative for RCT for managing symptomatic mature permanent teeth with carious exposure.
As concluded by the following paper..
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One of the challenges is management of calcified canals, degree of difficulty varies according to different factors like localization of calcification but mid root calcified is difficult to treat compared with orifice calcification but mid root calcification of multi rooted teeth is very difficult to opened it without procedural errors I will ask about new techniques to treat calcified canals
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Application of EDTA upto 40 seconds or bypass the calcification and these are methods normally  i  do whenever come across such cases.
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With the 6th generation apex locators coming into market, and there are many different EAL's made by some many different companies. It is really difficult for the dentist to choose amongst them.. So let us discuss (based on evidence and experience) which one is better
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Root ZX
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I want to test torsion on endodontic files, and I need a torsion meter that measures torsion in a micro scale rather than a macro scale.
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InsyAllah I will explain in detail soon.
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I consider MTA a predictable method to obtain a sealing in those situations but Revascularization has showed compromising results. Is this technique enough supported in the literature to considered to be the treatment of choice?
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Dear all,
Very interesting answers, very similar with my point of view. However, I would consider Revascularization using Apical Negative Pressure, instead of using a cocktail of antibiotics. In this way, we eliminate any possibility of producing crown discoloration and there is enough support from the recent literature demonstrating at least the same results. So, no need to use antibiotics, in my opinion.
About when to use a Revasc protocol or a MTA plug. It is quite difficult to establish a "line" between both treatments. I try to offer the possibility of a reverse treatment if I consider that the dentin thickness and the development of the root is too poor and could compromise the root strength. BUT, as I said, it is almost impossible to establish a line between both options, at this moment.
I believe that offering this possibility (revasc) does not close any door, since after a possible failure in a reverse. We would still have the option B, with an apical plug.
Best regards,
Cesar de Gregorio
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preservation of osseous capital, osseo-integration, cost, ….
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Now, the question that needs to be addressed is what do you classify as mini implants ?
Regular implants usually are 3.2 mm diameter or more. I am going on the definition that these mini dental implants are those that less than 3.2 mm. Also there are these narrow diameter implants of 1.8 mm diameter as well, which are also increasingly used.
The largest implant possible needs to be used. One benefit of implant supported denture is that the implant placement is not bound by adjacent tooth structure but by the bone support and vital structures (inferior alveolar nerve / mental nerve).
Mini implants are best used as temporary bone anchorage devices or for exceptional circumstances where the space is less for placement of regular implants either in height or in width. As for implant supported mandibular prosthesis, it should ideally be replacing a canine and / or a premolar tooth as these are the most common teeth used as tooth supported over dentures.
But 4 Mini Dental implants are being used for support dentures with success. So, why not ? This is not the ideal solution but acceptable compromise in old patients or in other patients who are not candidates for regular implants or in those who require grafts but cannot tolerate the procedure or refuse it. Even though the mini dental implants were initially used as temporary / transitional implants, increasingly we see them used long term as well.
They come cheap but they come in one piece! This means that if the ball attachment of the implant gets worn out in say 5-8 years, the entire implant will need to be replaced. In regular implants, only the prosthetic attachment (ball attachment) can be replaced. This is an important consideration. Removing an osseointegrated implant from the bone is not easy and even if it is done, there is considerable bone loss. So this aspect needs to be considered while using mini implants for removable complete denture support.
Regards,
Dr. Akilesh R
Consultant Oral and Maxillofacial Surgeon
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I am looking for recent studies or RCT comparing PMC with traditional restorative materials? 
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I think you can get it from  Cochrane systematic review.
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And do these methods have negative effects on the coronal microleakage?
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I would suggest that total seal within the pulp chamber is not really relevant. It is the peripheral seal around the lesion that counts and that means total adhesion to either enamel and/or dentine. Sealing enamel with etching and composite resin is routine and sealing dentine through conditioning and glass-ionomer is likewise routine. Clean the pulp chamber as best possible and then ensure the margins of the lesion are treated as required to achieve adhesion and seal the lesion totally.
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Tooth restoration using fiber post systems became a prior treatment when tooth strenghtdening is needed. But only 90% of treatment is successful. The most common failure is POST DEBONDING.
How to increase cement and intraradicular dentine adhesion? Which cement or bonding system is highly recommended trying to avoid debonding?
Literature offers to use 10% sodium ascorbate after NaOHCl, avoid one step self-etch bondng systems, avoid extensive root canal preparation, use oval shaped posts... 
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As pointed out by Dr. Steier (and his general guidance principles are correct), using the right irrigation protocol is essential: 1) proper removal of the smear layer without causing degradation of the collagen fibers and demineralization of the dentin; 2) use of substances, such as chlorhexidine to prevent the release of the MMPs; and 3) possibly the most important would be to ensure that there are no occlusal discrepancies that can add aberrant forces to the tooth during function...as this is one of the major reasons for both post debonding and loss of coronal marginal integrity of the crown over time. This is often overlooked when trying to analyze the cause for failure of these restorative systems and the root canal procedure.
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I need to know the fatigue curve of materials commonly used in endodontic treatments: human dentin, crown, fiber endodontic posts, and so on.
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Thanks to all for your replies. The references in particular will be very useful to me!
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If yes, then what is specific advantages you feel over, conventional inferior alveolar nerve block.
Are you aware of any studies in this subject.
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Yes I have but I did not get the 99% success rate as reported in the original Gow-Gates experiment. I recommend reading the Gow-Gates technique; a pilot study for extraction procedures with clinical evaluation and review.
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Current opinion is requested/is there a necessity to seal the orifice/orifices of endodontically treated teeth with glass ionomer to prevent microleakage under composite restoration or not?
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A solid statement indeed. May I please respectfully ask:
...based on which solid scientific evidence?
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Obturation of the root canal might be hindered by calcification of apical 1/3 of the canal. What is the prognosis of this treatment?
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Calcification does not start from the apical area, rather calcification begins from the coronal aspect moving towards the apical area. Loss of working length in constricted canals due to deposition of dentin debris may be misjudged as apical calcification. When you ask about root canal being obturated upto working length, is it the radiographic apex you are taking into consideration? You can definitely rely on apex locator to verify WL upto TARGET AREA (as it is now called). In Geriatric patients there is defintiely increased dentinal sclerosis and increased cementum deposition at root apex which might reduce the WL in such cases. Also canals tend to get blocked easily for Geriatric cases, so more attention needs to be given while treating such patients.
Thanks. 
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When attempting removal of fractured endodontic instruments by ultrasonic activation, the heat generated when dealing with NiTi fragment is greater compared to that with SS fragments. Why ?
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Friction of dissimilar metals may result in heat generation. This is well addressed in the literature. Your findings are interesting to me because NiTi is softer than SS, and I guess the heat generation should be less. The softness of NiTi fragments while removal can even be observed clinically. But since you find the opposite, then it seems that there is a certain interaction in the friction of surfaces in contact.
Friction between NiTi and SS in orthodontics may give you a clue to explain your findings. (ex: http://www.ncbi.nlm.nih.gov/pubmed/2378317). Different opinions from colleagues in dental materials and orthodontcs could help you as well. I am also interested to know the explanation!.
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As stated by the manufacturers the added features which certainly seems interesting , but I couldn't find any substantial literature on the above system.
If any of the fellow clinicians have used the V-TAPERED 2H file system or have come across any literature kindly share.
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Hello Dr. Mehta,
I had come across this V taper files in our endo conference last year. The design features looks promising. I wanted to use this system, but the GP cones were little too expensive. And since it is a variable taper file, it is not possible to use other constant taper GP cones. Or else we will have to use WVC. In a country like India, we have to always assess the cost/ benefit ratio. I am also eagerly looking forward to some alternative.
Thanks and Regards
Nasil
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Since autoclave sterilization became the reliable method in almost every dental clinic, I think it's only valuable to evaluate the effect of autoclaves on NiTi files. Any opinions about that?
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I think, it is better a comparative study be performed between dry heat and autoclave regard to quality of sterilization and comparison of the probable damages to NITI files.
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I have a 12 years old patient with a traumatized upper lateral and canine, incomplete root formation, open apex in both of them in X-ray, no mobility for both, pain upon percussion related only to lateral. Access opening was done and there was a relief of pain. Could the protocol of that be in the form of Pulpotec Pulpotomy until root growth completion? And then re-entry and complete RCT can be done?
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The main purpose in these cases is the maintaining of the pulp vitality, so if in your case ,pulp is vital, partial or cervical pulpotomy must be did and placed MTA on the remainder of the pulp tissue. After setting of the MTA, permanent restoration of the crown can be performed (this technique is named maturegenesis). If the pulp is nonvital revascolarization using triple antibiotic paste is suitable choice.
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