Most dentists have their standard burs that are used for access preparation. Surgical length burs can be useful as the head of institut soin visage annecy handpiece can be further away from the occlusal surface so as not to obstruct the view into the tooth.
Munce Discovery Burs Figure 7 can be very useful in trying to locate calcified canals as their extra length 34mm and thin shaft facilitates improved vision. Ultrasonic instruments Figure 8 are also invaluable in allowing for improved vision and for cleaning up debris in the pulp chamber, removal of pulp stones and smoothing off the walls of the access preparation. The use of smaller mirrors, particularly in posterior areas or where access is restricted due to limited mouth opening, provides better visibility of the working field, i.
In anterior teeth, cingulum-placed access cavities Figure 10 create file restrictions, which lead to more procedural errors and file breakages and are more likely to lead to labial perforations.
The access preparation should be placed as incisally as possible Figure 11 to give straight-line access to the canal. This minimises constriction of the files and allows for increased tactile awareness of the tip of the file.
This increased tactile awareness allows for better negotiation of the canal with reduction in ledging and blockages, and minimises the risk of broken instruments.
When designing the access preparation care should be taken not to remove excessive dentin in the cervical area. Orienting the bur towards the centre of the tooth is recommended Figure 12i. This will hopefully reduce the possibility of a subgingival perforation mesially and reduce excessive dentin removal in the cervical area.
Once the pulp chamber is penetrated the use of the Endo-Z bur Figure 13 is recommended to un-roof the pulp chamber and refine the access preparation coronally. This is a tungsten carbide multi-fluted bur with a non-cutting tip so it smooths the walls of the access preparation while reducing the possibility of perforation. The size of the access is to a large extent dictated by the size of the pulp chamber and the position of the canal orifices. Exploration of the pulp chamber can be carried out with a sharp DG16 endodontic probe or the use of a Maillefer Micro-Opener Figure We have to recognise that the more tooth structure we remove the weaker the tooth; however, we need sufficient access to allow for proper preparation and disinfection of the canals and also to allow us to locate all the canals present.
Minimally invasive, so-called ninja access cavities, restrict our vision and. The use of magnification and enhanced illumination significantly improve our ability to locate all the canal orifices while reducing the amount of tooth removal necessary for access.
The more you can see the more you can treat. There are two general types of bends that can be placed in files. One is a gradual curve in the body of the file Figure 15, A and the other is an acute bend more apically placed Figure 15, B. The gradual curve is more useful initially. This facilitates placement of the file in restricted areas. The apical curve is more useful when attempting to probe and negotiate a canal to the apical foramen.
Negotiation of the canal is carried out in the presence of a viscous ethylenediaminetetraacetic acid EDTA gel such as Glyde Figure 16 or Premier RC-Prep Figure 17which acts as a lubricant and an emulsifier. Passive penetration of the canal is carried out with gentle reciprocating motions with outward cutting strokes and no great apical force. In some cases the file can be advanced to the apical third of the canal. In many narrow canals the taper of the canal is less than the taper of the file and if resistance is felt then the file is withdrawn and then small filing motions are carried out short of this length until the file feels loose Figure Once there is increased space in the coronal third of the canal, the file will often have the freedom to advance more apically.
Enlargement of the coronal two-thirds of the canal greatly facilitates access to the apical third. The canal orifice can be enlarged or modified to remove areas of restriction coronally. The size 10 file is then replaced and the canal again negotiated until resistance is felt.
Filing motions are carried out until the file is loose and a smooth path exists to this area of resistance. A measurement is taken of the distance to this point. We can now enlarge the canal coronal to this with the use of larger files or we can take advantage of NiTi glide path instruments such as the Proglider from Dentsply Sirona Figure The use of glide path instruments has been shown to be a safe and efficient means of enlarging the canal with a reduction in canal curvature modification and canal aberration as compared to stainless steel hand files.
Once the Proglider has enlarged the glide path we are now ready to use whatever NiTi system is preferred, such as the WaveOne Gold Figure 21to shape the canal.
Copious irrigation with NaOCl is carried out during this. Once the canal is prepared to the area of restriction Figure 22the NaOCl is replaced by the gel EDTA so that the apical third of the canal can be explored.
A size 10 file is reintroduced into the canal, this time with a small radius curve at the tip of the file. By gently rotating the file in the canal and using it as a probe, a path beyond the restriction can usually be negotiated. At this stage the electronic apex locator can be used to check the position of the file as it approaches the apical constriction or apical foramen.
If the file can be negotiated to the terminus, small amplitude movements in an up and down motion will smooth irregularities. Increasing the range of motion eventually creates a smooth pathway. Notice should be taken of the curve in the file and the orientation of the file in the canal so it can be replicated with larger files. Once this glide path is created and the 10 file is loose we can now reintroduce the Proglider, this time to the full length of the canal. The apex locator can be used to check the length and a file length radiograph can confirm correct length measurement.
If we have been able to use the Proglider to full length we can now prepare the canal to full length with our WaveOne Gold rotary files Figure If a smooth pathway cannot be created with these small files then rotary files cannot be used to full length.
Attempting to do so is likely to lead to ledging and blockages making further instrumentation more difficult. Traditionally these points were estimated to occur at 0. It has also been shown that the foramen can be as much as 2. Working long can increase the irritation to the apical tissues, is more likely to extrude infected material apically and can alter the shape of the foramen. Overextension of the gutta percha in these cases may further cause apical irritation and increase postoperative symptoms.
The use of the electronic apex locator Figure 25 has been shown to be highly 10 accurate in locating the position of the foramen or constriction. It is more accurate than radiographs and can reduce the need for additional 11 radiographs.
There are a number of different brands on the market and the modern devices are all highly accurate. It may be of interest to note that the apex locator is not a modern device. In this he described his method of using an electrical device using the difference between the conductance of the canal and that of the periodontal tissues to locate the foramen. He recognised the importance of eliminating necrotic tissues and bacteria from the apical region of the root canal for a successful outcome and the necessity to know where the foramen was to achieve this.
Although apex locators are highly accurate, there are a few areas to be mindful of that can lead to inaccurate or misleading readings: 1.
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Poor isolation and salivary contamination. The presence of sodium hypochlorite in the pulp chamber in multi-rooted teeth. Contact of the file with metallic restorations. Contact between sodium hypochlorite and metallic restorations. Instrument too small. Obturating materials limiting contact of the instrument with the canal wall. Presence of a perforation.
Instrument passing through a lateral canal. The accuracy will be improved if the pulp chamber is dry and there is definite contact of the instrument with the canal wall. One thing to note is that the. It can tell the operator when the instrument is long and when it is short of the constriction. The file must go beyond the constriction and is then withdrawn until the reading indicates that the file is short and a little skill is required to determine the point when the file goes from long to short.
It is safest to prepare the canal 0. Radiographs are necessary to confirm that the apex locator is giving an accurate reading Figure However, the correct use of the apex locator will go some way to improving the accuracy of our working length determination, while minimising the need for excessive radiographs.
Disinfection of the canal is a very important part of our preparation and failure to pay sufficient attention to this aspect of treatment is likely to increase failures even in cases where the final result, the obturation, appears good. Irrigants are used to: a flush out debris; b dissolve tissue; c kill bacteria and disrupt the biofilm; d lubricate the canal to reduce friction during instrumentation; and, e remove the smear layer.
No single solution will accomplish all of these objectives so we need combinations in the correct order to maximise their effects. We also want to avoid negative properties such as cytotoxicity, staining and weakening of tooth structure.
At present, NaOCl appears to be our best irrigant as it is a potent antimicrobial agent against both planktonic- and biofilm-containing bacteria and also has the ability to dissolve pulpal remnants. NaOCl is a toxic solution and it cannot be emphasised sufficiently that great care needs to be taken in using it.
There have been a number of reports over the years of the consequences of extrusion of NaOCl into the periapical tissues. An endodontic safe-ended needle should be used Figure It should never be wedged into the canal. Light force should be used with the syringe and a measurement taken of the position of the needle in the canal.
Extrusion of NaOCl through the apical foramen or through a perforation can cause a severe reaction with excruciating pain, swelling and haematoma formation.
In some pride shipping lines bangladesh nerve damage can occur, particularly in the mandibular premolar or molar regions, leading to paraesthesia and chronic facial pain Figure It is important to confirm the length and integrity of the root canal prior to irrigating with NaOCl solutions. The use of negative pressure irrigation with devices such as the EndoVac minimises the risks involved as it reduces the apical pressure during irrigation.
Alternatively, filling the pulp chamber with NaOCl and aspirating the solution down the canal with the tip of the needle close to the working length can be employed to draw the solution into the canal. The use of devices such as the EndoActivator Figure 29 agitates the irrigants in the canal creating turbulence that increases the penetration of the solutions into the irregularities of the canal systems and increases their effectiveness.
The EndoActivator tips are designed for single use and are disposable. The IrriSafe is an ultrasonic file designed for passive ultrasonic irrigation. Unlike the plastic EndoActivator tip the IrriSafe is metallic. It is advantageous in that there may be a flushing effect during its use; however, it may also alter the shape of the prepared canal.
The IrriSafe can be used in multiple teeth; however, it will eventually fracture. Another method of agitating the irrigant in the canal is the manual dynamic activation technique. This involves the use of a well-fitting master cone of gutta percha, moving it in small mm strokes up and down in the canal in the presence of an irrigant.
This produces an effective hydrodynamic effect and improves the displacement and exchange of the irrigant. Approximately strokes are carried out to maximise the effect.
Any filing or shaping procedure produces a layer of organic and inorganic material called the smear layer and our instruments do not reach all areas of the root canal systems. The smear layer may contain infected material and may also block dentinal tubules, lateral canals, fins and apical deltas containing bacteria.
Removal of the smear opens up these areas to allow our disinfectants to have better access and therefore more effectiveness. NaOCl will dissolve the organic parts of the smear layer but we need something additional, such as EDTA or citric acid, to remove the inorganic components.
The method of choice for removal of the organic and inorganic components of the smear layer appears to be the alternate flushing of the canals with EDTA and NaOCl. However, further dilution of the NaOCl and acidifying it to reduce its pH can lead to a more effective disinfectant. NaOCl and 1ml of distilled vinegar to ml of distilled water. Another irrigant to be considered is chlorhexidine digluconate CHX. This is a good antimicrobial irrigant; however, it does not possess any tissue-dissolving capability and will not disrupt the biofilm.
It will form an orange-brownish precipitate if used directly following NaOCl, which will cause staining, so the solutions should not be mixed. Sterile water and local anaesthetic solutions have been used as irrigants but apart from flushing debris out of the canal they have no antimicrobial properties and have a very limited use.
Summary The use of the rubber dam, creation of good access, negotiation of canals to the apical constriction or dentinocemental junction particularly in cases of necrosis with apical periodontitisshaping the canals to allow our disinfectant solutions to reach all areas of the root canal system, use of combinations of disinfectant solutions to eliminate bacteria and necrotic tissue, obturation of the canals, and adequate restoration of teeth together should allow us to maximise the opportunity for a successful outcome Figure References 1.
Haapasalo, M. Persistent, recurrent, and acquired infection of the root canal system post-treatment. Endodontic Topics ; 6: Fishelberg, G. Patient safety during endodontic therapy using current technology: a case report. Journal of Endodontics ; 29 10 : Whitten, B. Current trends in endodontic treatment: report of a national survey. J Am Dent Assoc ; Glickman, G. Preparation for treatment. In: Cohen, S. Pathways of the Pulp 7th Ed. CV Mosby, St. Louis; Deutsch, A. Morphological measurements of anatomic landmarks in human maxillary and mandibular molar pulp chambers.
Journal of Endodontics ; 30 6 : Berutti, E. Use of nickel-titanium rotary pathfile to create the glide path: comparison with manual preflaring in simulated root canals. Journal of Endodontics ; 35 3 : Grove, C. Why canals should be filled to the dentinocemental junction. J Am Dent Assoc ; 17 2 : Kuttler, Y.
Microscopic investigation of root apexes. J Am Dent Assoc ; 50 5 : FIGURE Negotiating canals to the apical constriction, adequate shaping to allow disinfectant solutions access to all areas and good three-dimensional obturation maximises the opportunity for successful outcomes.
Alothmani, O. The anatomy of the root apex: a review and clinical considerations in endodontics. Saudi Endo Journal ; 3 1 : Violich, D. International Endodontic Journal ; A retrospective investigation of the oral health records of a cohort of preschool children who received extractions under general anaesthesia including cost analysis of treatment Précis: Over a two-year period, a considerable number of preschool children required dental extractions under general anaesthesia, with economically-disadvantaged children at a greater risk of requiring treatment.
Children who underwent extractions under general anaesthesia at an early age demonstrated poor oral health into adolescence as confirmed by a year follow-up. A nationallystructured prevention programme targeting preschool children is necessary in order to lower caries levels and reduce costs. Children with a disadvantage were more likely to require extractions under. Negative experiences of dentistry can result in difficulty with dental care and oral health that have lifelong implications.
Dental general anaesthesia DGA facilitates treatment of caries within this vulnerable group, contributing to oral rehabilitation, while alleviating pain and infection, and takes into account their age, developmental status and psychosocial well-being. Access to DGA in Ireland is limited; the provision of DGA requires substantial investment and should operate with the support of a preventive programme targeting preschool-aged children.
Most authors agree that the primary indication for the provision of DGA is the treatment of dental caries and its sequelae. Whelton et al. Resource limitations often result in a focus on restorative treatment in the permanent dentition and preschool-aged children receive little or no preventive care.
Treatment in this age group may only be sought when pain or infection are present. This group of patients are at the extreme, not only of clinical care but also of financial expenditure. The costs of DGA are dependent on the country and treatment need. A five-year longitudinal study found that children who had a preventive visit by one year of age had lower total dental costs at age five years than children who had their first preventive visit between the ages of two and five years.
It is not a question of general anaesthesia or preventive care; there will be a need for both. However, with constrained resources in healthcare, further examination is needed of the benefit of funding preventive regimes, particularly in high-risk populations.
A purposive sample was selected in order to obtain subjects who were representative of the preschool service user Table 1. The ethos of strict confidentiality was upheld throughout the data collection process. Children were selected by virtue of having attended a HSE dental clinic requiring referral for DGA prior to their fifth birthday. At this point all records were anonymised through the use of an individual identification number that could not be limited back to the database.
No personal identifying data will be included in this, nor in any publications arising from the study. Entry to this area was by authorised personnel only.
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No data were removed from this location. The data were analysed using an encrypted PC, which was password protected and securely stored. A data extraction form was.
In considering subsequent treatment need, a hierarchy of treatment severity was used for data collection. Oral hygiene instruction, dietary analysis and referral to a dental hygienist formed one group, followed by those who required fissure sealants only. A superior level in the hierarchy was represented by those requiring a restoration due to caries, with extraction under local anaesthetic LA or referral for DGA signifying the most severe treatment need.
It was anticipated that in addition to those children requiring fissure sealants only, within the groups requiring restorations and extractions fissure sealants were also applied as part of the treatment plan. The Delivering Equality of Opportunity in Schools DEIS status is used as a proxy for economic disadvantage at the school level, as an individual measure of disadvantage, such as medical card status, was unavailable.
DEIS was introduced as an Irish Government action plan with a focus on targeting additional resources towards particular schools. Schools are identified for inclusion based on a range of indicators, including prevalence of. Medians were used as a measure of central tendency where continuous variables were not normally distributed. Non-parametric tests were used with respect to proportions. Costs were divided into direct and indirect expenditure. Such costs included total annual allocated theatre costs including personnel salaries, theatre cleaning costs and waste management costs.
Indirect costs were estimated mean values representing loss of income, mileage and childcare expenses Table 2. The median age at first visit was four years, with a range of one to five years. The total population of zero to five year olds in the Cork and Kerry region in was 39, Table 4: Treatment provided to children who had undergone DGA at preschool age in first, third and sixth class. Type of treatment.
Table 5: Direct and indirect costs for DGA. Costs 1. Annual total allocated theatre costs 2. Annual third-party cleaning costs 3. Annual theatre consumables. The median number of appointments prior to DGA was three in a range from one to eight. The median number of days spent waiting from initial referral was 30, in a range from one to days. The median number of teeth extracted was four, with a minimum of one and a maximum of The median number of DGAs was one, with a maximum of four.
The Kruskal—Wallis test was used to determine if there was a relation between the number of appointments prior to DGA and the indicator for treatment. Cost analysis DGA cost was considered at a microeconomic level with both direct and indirect costs being collected. In addition, the average cost of DGA per child was calculated.
The median age of the children was four years. There was a greater proportion of boys requiring treatment and the majority of patients were from the north Cork area. Most authors agree that caries levels have not decreased in the preschool category and as a result more children are undergoing treatment under DGA at an earlier age. In addition, there was a regional DGA service previously available, which may have contributed to increased referrals for DGA and increased expectation among parents.
The total population of zero to five year olds in the Cork and Kerry region in was 39,;19 thus, our study sample is a small representation of this cohort. The majority of children referred for DGA were healthy children without a significant medical history.
These results indicate neither fluoride nor adverse medical history having an effect. This underlines national health promotion strategies and guidelines indicating that water fluoridation is not sufficient alone and should be supplemented by oral health promotion initiatives and targeted caries prevention measures. This highlights the opinion of the literature that DGA is a facility for which there is demand from all social groups.
Disadvantaged children have a higher risk of requiring a DGA in their lifetime; however, this is not occurring in isolation, with their equivalents in the higher group also placing a strain on the system.
Dental services in Ireland are organised in a manner that assumes attendance at private practitioners outside of designated school assessment or emergency appointments. These findings would suggest that this is not the case in either social group. These results also emphasise the multifactorial aetiology of dentinal caries and that the role of parental counselling, oral hygiene education and high-sugar diets must be examined.
These findings would suggest that proportionate universalism must be considered. Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently.
To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is greater in those who are disadvantaged. These results are consistent with reports from the literature where most authors agree that the primary indication for the provision of DGA is the treatment of dental caries and its sequelae. On occasion, the maximum number of DGAs could be attributed to the presence of a complicated medical history along with anxiety.
However, in most cases there were no predisposing factors that would indicate an increased likelihood of requiring treatment under DGA. We must consider the negative implications on quality of life and the lasting psychological impact on attitude toward dental treatment that may arise from such service organisation.
This was noted as a marker on the electronic patient chart. It was beyond the remit of this study to examine individual referral forms, which would have provided further insight into the referral patterns; however, this may be an area where further research is needed. Charts where there were missing referrals related to dentists who treated the child under DGA themselves or where the DGA was completed as an emergency treatment, usually within hours.
This included children who required a subsequent DGA, but also those who were referred and while on a waiting list developed further symptoms warranting a second referral. The median waiting time was 30 days and ranged from one to days. This echoes evidence from literature regarding waiting time for treatment where North et al.
An aim of this research was to investigate the dental experience, as derived from dental records, of the cohort subsequent to DGA in order to identify any discernible patterns of treatment. By virtue of undergoing DGA at a young age, these children are all at a high risk for future dental caries. Evidence has shown that past caries experience is an indicator of future caries development,35 that children who undergo extensive treatment under general anaesthetic at a young age are at an increased risk of requiring a repeat procedure,22 and that attendance patterns postoperatively play a substantial role in the risk of repeat DGA.
A finding to emphasise is poor attendance rates that exist within this group. This is the last appointment within the public dental service and is concerning as from evidence we know there is no culture of attendance in the private dental sector. The Irish Oral Health Services Guideline Initiative examined the evidence-based guidance on the use of topical fluorides for caries prevention in children in Ireland including the cost-effectiveness of the programme.
This programme focuses on caries reduction in the permanent dentition and further research is needed in determining if the same results could be achieved for the primary dentition within the preschool cohort.
However, the question must be asked: should some of the tremendous resources allocated to DGA be redistributed to provide an equally effective preventive and oral health promotion regime?
If there was increased focus on this area, then there may be a reduction in the levels of dental caries, a corresponding reduction in the need for treatment under DGA and ultimately a reduction in cost. A framework for further research may be to consider the design of a preventive programme to operate within the preschool age group with limited resources, while maintaining a DGA service. Strategies to prevent dental caries in children and adolescents: Evidence-based guidance on identifying high caries risk children and developing preventive strategies for high caries risk children in Ireland Full guideline.
Department of Health and Human Services. Rockville, MD: U. MacCormac, C. Reasons for referral of children to a general anaesthetic service in Northern Ireland. Int J Paediatr Dent ; 8: Karim, Z. Utilization of dental general anaesthesia for children. Malays J Med Sci ; Guideline on behavior guidance for the pediatric dental patient. Pediatric dentistry ; Tipperary — a comparison of medical card holders and non-medical card holders. University College Cork, Cook, H. Berg, B. The cost of nursing caries in a Native American Head Start population.
J Clin Pediatr Dent ; Association of Dental Surgeons of British Columbia. Vancouver, BC, American Academy of Pediatric Dentistry. Pediatric dentistry ; E Lee, J. Examining the cost-effectiveness of early dental visits.
Pediatric Dentistry ; Savage, M. Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics ; ee Sohn, W. Effects of early preventive dental visits among Medicaid enrolled children. J Dent Res ; Beil, H. Effect of early preventive dental visits on subsequent dental treatment and expenditures.
Medical care ; Oral health assessment: best practice guidance for providing an oral health assessment programme for school. Conclusion A significant number of preschool children require extractions under DGA. Results indicate that such children progress to adolescence with poor oral health, as evidenced by the need for further restorations, extractions and repeat DGA.
A nationally-structured preventive programme targeting preschool-aged children is necessary in attempting to defeat the high levels of dental caries within this group. Irish Oral Health Services, Department of Children and Youth Affairs. Central Statistics Office.
Population Census Reports. Kakaounaki, E. Repeat general anaesthesia, a 6year follow up. Int J Paediatr Dent ; Amin, M. Early childhood caries: recurrence after comprehensive dental treatment under general anaesthesia. Eur Arch Paediatr Dent ; Further dental treatment needs of children receiving exodontia under general anaesthesia at a teaching hospital in the UK. International Journal of Paediatric Dentistry ; Harrison, M. Repeat general anaesthesia for paediatric dentistry.
Br Dent J ; Department of Health and Children. Dental Health Action Plan. Dublin: Hawkins House, Parnell, C. Oral health policy — time to broaden our horizons? Journal of the Irish Dental Association ; 58 3; Suppl. CSO, Department of Education and Science. Dublin: Department of Education and Science, Hosey, M. The behaviour, social status and number of teeth extracted in children under general anaesthesia: a referral centre revisited. Br Dent J ;discussion Madan, C.
Trends in demand for general anaesthetic care for paediatric caries in Western Australia: geographic and socioeconomic modelling of service utilisation. Int Dent J ; Marmot, M. University College London, Characteristics of children referred to a general anaesthetic service in Northern Ireland.
J Ir Dent Assoc ; Jamjoom, M. Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia. Olley, R. Why are children still having preventable extractions under general anaesthetic?
A service evaluation of the views of parents of a high caries risk group of children. Br Dent J ; E North, S. Almeida, A. Hughes, C. Future caries susceptibility in children with early childhood caries following treatment under general anesthesia. Berkowitz, R. Clinical outcome for nursing caries treated using general anesthesia. Batchelor P. The distribution of burden of dental caries in schoolchildren: a critique of the high-risk caries prevention strategy for populations.
BMC Oral Health ; 6: 3. Selwitz, R. Dental caries. The Lancet ; Petersen, P. Community Dentistry and Oral Epidemiology ; Prognostic value of a simplified method for periodontal risk assessment during supportive periodontal therapy. Aim: To evaluate the association between risk scores generated with a simplified method for periodontal risk assessment Perio Riskand tooth loss as well as bone loss during supportive periodontal therapy SPT.
Materials and methods: Data related to patients 42 males; mean age: Patients were stratified according to Perio Risk score on a scale from 1 — low risk to 5 — high risk as calculated at the end of active periodontal therapy. Risk groups were compared for tooth loss as well as the changes in radiographic bone levels occurred during SPT. Results: The mean number of teeth lost per patient during SPT varied from 0 to 1.
Conclusions: Periodontal risk assessment according to Perio Risk may help to identify patients at risk for tooth loss during SPT. Despite decades of titanium as the gold standard in oral implantology, the search for alternatives has been growing. High aesthetic standards and increasing incidence of titanium allergies, along with a rising demand for metalfree reconstructions, have led to the proposal of ceramics as potential surrogates.
Following numerous experimental studies, zirconium dioxide zirconia has earned its place as a potential substitute for titanium in implantology. Technical failure as a result of fracture of the material is also a major concern.
Nevertheless, various two-piece systems have been progressively emerging with promising results. Screw-retained abutments are desirable but present a major technical challenge. Innovation and technical advances will undoubtedly lead to further improvement in the reliability and strength of zirconia implants, allowing for novel designs, connections and reconstructions. However, the evidence for a final verdict is, at present, still incomplete. Rombouts, C. The pulp is a highly vascularised tissue situated in an inextensible environment surrounded by rigid dentin walls, with the apical foramina being the only access.
The pulp vascular system is not only responsible for nutrient supply and waste removal but also contributes actively to the pulp inflammatory response and subsequent regeneration. This review discusses the underlying mechanisms of pulp vascularisation during tooth development, regeneration, and therapeutic procedures, such as tissue engineering and tooth transplantation.
Whereas the pulp vascular system is established by vasculogenesis during embryonic development, sprouting angiogenesis is the predominant process during regeneration and therapeutic processes. Hypoxia can be considered a common driving force.
Dental pulp cells under hypoxic stress release proangiogenic factors, with vascular endothelial growth factor being one of the most potent. The benefit of exogenous vascular endothelial growth factor application in tissue engineering has been well demonstrated. Interestingly, dental pulp stem cells have an important role in pulp revascularisation. Indeed, recent studies show that dental pulp stem cell secretome possesses angiogenic potential that actively contributes to the angiogenic process by guiding endothelial cells and even by differentiating themselves into the endothelial lineage.
Although considerable insight has been obtained in the processes underlying pulp vascularisation, many questions remain relating to the signaling pathways, timing, and influence of various stress conditions. Journal of Dental Research ; 96 2 : Evaluation of the efficiency of denture cleaners for removing denture adhesives Harada-Hada, K. Objective: We developed a new scoring index for assessing the removability of denture adhesives and evaluated the removal efficiency of denture cleaners.
Background: Although our understanding of the importance of denture care is increasing, little is known about the effectiveness and efficiency of denture cleaners on denture adhesives. Therefore, guidelines for proper cleaning are necessary. Materials and methods: We used five denture cleaner solutions on two cream adhesives, one powder adhesive and one cushion adhesive. After immersion in the denture cleaners for a designated time, we evaluated the area of the sample plate still covered by denture adhesive.
Results: Cream adhesives were removed more completely after immersion in the majority of the denture cleaners than in water. Powder adhesive was removed more quickly than cream adhesives. Cushion adhesive was not removed by immersion in either the denture cleaners or water control. Conclusion: Some denture cleaners could liquefy cream adhesives more than water, but these differences were not observed in the case of powder and cushion adhesives. Gerodontology ; Strong local ties.
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Brosser les dents 2 à 3 minutes. La fixation du fluor contribue à la reminéralisation de l'émail et à la résistance aux attaques acides à l'origine de caries. Skip to main content. Merci d'avoir accepté les cookies La page courante va maintenant être rechargée afin d'appliquer les réglages que vous avez choisi.
J'accepte Réglage des cookies Politique de confidentialité. Asset 6. Tube de 50 ml. Comment l'utiliser Composition et résultats cliniques Produits complémentaires Où nous trouver. Étude menée par les laboratoires Pierre Fabre auprès de 45 adultes et 44 enfants, utilisation 2 fois par jour pendant 3 semaines.