The Athens University, School of Dentistry, accepted the challenge to organize the Dental Health ... more The Athens University, School of Dentistry, accepted the challenge to organize the Dental Health Services in the Athens 2004 Olympic and Paralympic Games in order to provide the best quality of oral health services to the athletes, coaches, escort members and Olympic Village personnel. Data from the whole activity protocol of the Athens 2004 Games Dental Health Services - the reception, admission and treatment protocols, the facilities and the infrastructure, the number of cases treated per specialty and the experience gained - were recorded. During the Olympic Games, there were more than 1400 dental cases in more than 650 patients, elite athletes, escort members, coaches and staff of the Olympic Village. Among them 313 fillings, 100 root canal therapies, 57 mouthguards and 9 dental trauma cases were treated. During the Paralympic Games, there were more than 240 dental cases in more than 220 patients. Among them 73 fillings, 12 root canal therapies, 21 extractions and 3 dental trauma cases were treated. In such events, highly trained dentists are needed and if possible, specialized in operative dentistry or endodontics. The role of team dentist seems to be of great importance.
Background: Diode-assisted endodontics is nowadays utilized for pulp space disinfection, but litt... more Background: Diode-assisted endodontics is nowadays utilized for pulp space disinfection, but little is known on the bonding potential of this lased root dentin when the tooth is restored with an intracanal polymer post. Objectives: to investigate the influence of diode laser irradiation settings, in laser-assisted endodontics, on the intraradicular bonding of composite materials. Methods: Sixteen two-rooted, maxillary first premolars were collected, prepared up to F4 (Protaper Universal. Dentsply-Maillefer, Ballaigues, Switzerland), and randomly assigned in two groups: group A (chopped mode or short pulse), diode irradiated according to protocol, pulse 25 ms, power 2.5 W, and group B (microchopped mode or ultrashort pulse), pulse 25 μs, peak power 12 W (both groups GentleRay. KaVo Dental, Biberach an der Riss, Germany). Buccal canals were irradiated, palatal ones served as controls. Canals were then obturated, post space was created in all canals, and quartz-fiber posts (ICE light D...
International Journal of Environmental Research and Public Health
Chemical air pollution in dental clinics consists of the emission of gases and particulate matter... more Chemical air pollution in dental clinics consists of the emission of gases and particulate matter (PM), both generated by dental equipment and tooth tissues. One basic application of Erbium Laser devices is cavity preparation on human teeth due to its strong affinity to water and hydroxyapatite. The objective of this study was the evaluation of indoor air quality during the application of an Er:YAG laser, as a dentin removal instrument, in a Dental Clinic. Particulate Matter (PM) was measured using the standard method of EN legislation. In order to measure total Volatile Organic compounds (VOCs), a portable monitor was used. In the first experiment, PM10 and PM2.5 concentrations were increased by approximately 10 and 15 times, respectively. From the second experiment it can be concluded that neither of the measured particle concentrations exceeded the recommended indoor limit values while windows were open, although laser influence was still detectable. Within the limitations applie...
The aim was to validate an artificial resin ‘root canal wall groove model’ (RCWGM) mimicking the ... more The aim was to validate an artificial resin ‘root canal wall groove model’ (RCWGM) mimicking the situation of natural roots with a groove of identical dimensions on debris removal out of these grooves, and to evaluate Erbium ‘laser-activated irrigation’ (LAI) with two conical tips at PIPS (photon-induced photoacoustic streaming) settings, with different activation times and different root canal positions on debris removal out of the grooves. A split RCWGM was used (resin blocks and roots of maxillary canines) with a canal size 40/0.06. The grooves in the apical third were filled with stained dentinal debris. Seventeen irrigation protocols ( n = 20) were used: syringe-needle irrigation (3× 20 s), manual dynamic activation (1× 60 s), ultrasonically activated irrigation (UAI) with 25/25 Irrisafe (3× 20 s) and LAI (2940 nm Er:YAG) with X-Pulse or PIPS tips at PIPS settings (20 mJ, 50 μs, 20 Hz) and with the fibre (IN) or (OUT) the canal: IN during 1× 20 s, and OUT during 1× 20 s, 2× 20 s, 3× 20 s, 30 s, 2× 30 s and 1× 60 s. The quantity of remaining dentine debris in the groove was evaluated on a numerical scale. Statistical analysis was performed by means of proportional odds logistic regression, equivalence testing and Wald tests. The level of significance was set at 0.05. Resin models and the RCWGM with natural teeth can be called equivalent (log odds ratio 0.185). There were mostly no statistically significant differences for debris removal between UAI and LAI ( p > 0.05) and between LAI with PIPS and X-Pulse ( p > 0.05). Although not statistically different, the numbers of completely cleaned grooves were higher with LAI than with UAI for a 1-min activation, confirming findings from other studies. There is no difference in cleaning efficacy between X-Pulse and PIPS tips at PIPS settings.
The study aimed to systematically appraise the evidence on the effects of low level laser therapy... more The study aimed to systematically appraise the evidence on the effects of low level laser therapy (LLLT) on bone healing following rapid maxillary expansion (RME). Electronic search was performed in MEDLINE, Scopus, and Embase databases using appropriate Medical Subject Heading terms, with no time restriction. ClinicalTrials.gov ( www.clinicaltrials.gov ) was also searched using the terms "low level laser therapy" and "maxillary expansion." Original research articles on human clinical trials that involved both RME and LLLT were included. Animal studies were also assessed on an exploratory basis. The search strategy resulted in 12 publications (4 randomized controlled trials, 8 animal studies). In human studies, bone density was assessed radiographically (either two-dimensional or three-dimensional imaging). Regardless of the discrepancies in the intervention protocols, the total of the trials revealed that LLLT had stimulatory effects on bone regeneration after R...
The aim was to evaluate ex vivo apical debris extrusion associated with WaveOne and Self-Adjustin... more The aim was to evaluate ex vivo apical debris extrusion associated with WaveOne and Self-Adjusting File instruments when used in oval canals. Twenty-four extracted human mandibular premolars with oval-shaped canals were assigned in two equal groups. Following coronal cavity preparation, a glide path was created. Group A was subjected to canal preparation using a WaveOne primary file, which was used along with syringe and needle irrigation and 10 mL of 2.4 % NaOCl solution, followed by flushing with 10 mL of 17 % EDTA solution, activation with EndoActivator for 1 min and final flushing with 10 mL of 2.4 % NaOCl solution, and activation for 30 s. Group B, the SAF system was used with continuous simultaneous irrigation, provided by the system's pump. The irrigant was supplied at 5 mL/min, alternating every minute between 2.4 % NaOCl solution and 17 % EDTA solution, over a total of 4 min followed by final flushing with 10 mL of 2.4 % NaOCl solution. Extruded apical debris from each root canal was collected into a preweighed glass vial and dried. The mean weight of the debris from each group was assessed and analyzed statistically. Both systems resulted in apical debris extrusion. The WaveOne system was associated with a statistically significant greater mean mass of apically extruded debris (2.18 ± 0.44 mg) than the SAF system (0.49 ± 0.33 mg, permutation-based Wilcoxon test, p < 0.001). Both WaveOne and the SAF systems were associated with apical debris extrusion. The amount of debris extruded by the WaveOne system was 4.4 times greater than that extruded by the SAF system. The results of the present ex vivo comparative study cannot be directly applied to the clinical situation. Difference between both groups remains completely unclear; maybe the amount of extrusion is harmless in both groups or similarly deleterious for the periradicular tissues in both groups or may be dose-related to the amount of the extruded material.
The aim of this study was to evaluate the incidence of pain of endodontic origin and its relation... more The aim of this study was to evaluate the incidence of pain of endodontic origin and its relationship with socio-economic and demographic factors among patients seeking unscheduled urgent dental care. Patients attending the Emergency Clinic of Athens Dental School, Greece, between November 2011 and June 2012, were evaluated to determine their socio-economic profile, dental problem and treatment required. The facility operated from Monday to Friday, from 8.30 am to 1.00 pm, excluding the 4 weeks encompassing the Christmas and Easter holidays. In total, 533 patients were assessed regarding gender, age, ethnicity, occupation, reason for visiting, diagnosis and treatment provided. The data obtained were recorded, reviewed, coded and analysed using Poisson regression models. Mondays and Wednesdays were the busiest days of the week. The most common occupation among the patients was 'unemployed'. Pain of endodontic origin (reversible or irreversible pulpitis, or acute apical periodontitis) was the prevailing reason for the visit. The most frequent treatments administered were pulpectomy and drainage. Prescriptions for medications were rare. Services were requested primarily by individuals who were experiencing acute pain of endodontic origin, had low or no income and were available during morning hours, probably because of the service's low cost and operational hours. Prospective studies, such as the present investigation, can provide epidemiological evidence and indicate areas in the infrastructure of emergency services which may be improved. Additionally, such studies can provide rationale for public insurance programs and can generate profiles of the patients who utilise these low-cost public services.
Discoloration of a single tooth is a demanding clinical issue especially if present in the aesthe... more Discoloration of a single tooth is a demanding clinical issue especially if present in the aesthetic zone. It can be due to either calcification of the pulp chamber, pulp necrosis and/or iatrogenic mishaps during various stages of the endodontic treatment. In this paper, a literature review is performed, investigating the aetiology of the discoloration of endodontically treated teeth, the bleaching agents suggested and the techniques performed in order to avoid possible side effects while guarantee an overall esthetic result. Possible side effects such as cervical resorption, crown fractures, color relapse etc. and their avoidance are emphasized. The quality of the endodontic treatment as well as the presence of an acceptable coronal restoration is considered to be the basic and necessary prerequisites for the application of any bleaching method.
Introduction: Vertical root fractures (VRFs) of endodontically treated teeth are serious complica... more Introduction: Vertical root fractures (VRFs) of endodontically treated teeth are serious complications that are associated with a poor survival prognosis. The diagnosis of VRFs is difficult, because the clinical signs and symptoms are often obscure and periapical radiographs (PAs) provide limited diagnostic information. Recently, Cone Beam Computed Tomography (CBCT) has been used to address complicated cases of VRFs with an inconclusive diagnosis. Aim: To determine the clinical diagnostic accuracy of CBCT in detecting VRFs in complex failing cases of endodontically treated teeth, as an adjunct to PAs. Materials and Methods: Evaluating the diagnostic accuracy of CBCT in a series of clinical cases of suspected VRFs, presented via clinical photographs, PAs, and CBCT images. Results: CBCT imaging significantly aided the differential diagnosis in most cases. Conclusions: CBCT imaging provides a 3D image and information in many cases of VRF that 2-dimensional PAs fail to generate. The slice thickness and interslice interval of the CBCT image influence the perception of the normal anatomy and pathoses.
Objectives: This article investigates the internal and external morphological variability of mand... more Objectives: This article investigates the internal and external morphological variability of mandibular premolars along with clinical and radiographical signs that leads to early identification of these cases. Materials and Methods: The authors identified articles by searching the PubMed, Medline and Scopus databases. Inclusion criteria were case reports of mandibular premolars with aberrant internal and external anatomy, articles that describe the origin of anatomy of mandibular premolars, the traits that may influence their external and internal variability through species revolution and articles of new technologies like cone beam computed tomography that help the diagnosis of difficult cases. Results: In the majority of the cases, mandibular premolars are reported to have one root canal running a single root. On the other hand, anatomic irregularities in this group of teeth, such as the existence of more than one root or more than one root canals or even a more complicated root canal system cannot be considered infrequent as it appears in 10-25% of the cases. Conclusion: Successful endodontic treatment of mandibular premolars is a challenge for the clinician as they often present morphological and anatomical abnormalities.
The diverse morphology of the root canal system of the mandibular premolar is a challenge for the... more The diverse morphology of the root canal system of the mandibular premolar is a challenge for the clinician to clean, shape and obturate. A case report of a mandibular second premolar with four fused roots which separated at different levels along the apical third of its root and underwent endodontic treatment is presented, along with a review of the literature.
To examine the permanent deformation of self-adjusting files (SAF) when used by endodontists with... more To examine the permanent deformation of self-adjusting files (SAF) when used by endodontists with no previous experience with this system. The canals of extracted human molars were initially prepared with glide path up to size 20 K-file. The operators were first instructed on the use of the SAF in simulated canals in plastic blocks then applied the SAF in natural root canals of extracted teeth. Every 4 min, each file was withdrawn from the canal and inspected for integrity. If intact, it was used in another canal for an additional 4 min and checked again. This was repeated until all 19 SAF files were deformed. The files were collected for inspection at ×50 magnification. All teeth were then examined radiographically for the presence of any metal fragments in the root canals. Permanent deformation was categorized according to the type and location occured. Three types were defined as follows: (i) detachment of one component of the file at one end while the component is retained (ii) detachment of a component at both ends and the component missing and (iii) permanent twisting of the component. Recordings were made and statistically analysed using McNemar's test. Mechanical failures on the 5-arch-side of SAF (odd side) were significantly more frequent in comparison with the even side (P = 0.039). Similarly, mechanical failures in arches on the odd side were also significantly more frequent compared with the even ones (P = 0.012) Longitudinal beams fractured significantly less often compared with arcs or struts (P < 0.001). In no case did complete file fracture occur, nor were metal fragments retained in the root canal. Deformation of SAF files occurred mainly as detachment of one of the arches or struts at connection points on the odd side of the file. In no case did its mechanical failure result in metal fragment retention in the root canal.
The aim of this article was to investigate the temperature increase of the external root surface ... more The aim of this article was to investigate the temperature increase of the external root surface during laser-assisted endodontic treatment using a diode laser (980 nm) in a microchopped mode. Ten freshly extracted, human maxillary incisors with mature apices were collected, prepared to size F4 at working length (ProTaper; Dentsply Maillefer, Ballaigues, Switzerland), mounted to a holder, and irradiated (using spiral movements in coronal direction) with a diode laser (GENTLEray 980 Classic Plus; KaVo, Biberach, Germany) with a 200 μm fiber in four different treatment groups: Group 1 (control group) was irradiated in six cycles of 5-sec irradiation/20-sec pause with 2.5 W in the pulse mode. Groups 2 to 4 were irradiated at six cycles of 5-sec irradiation/20-sec pause in the microchopped mode (Group 2-1.6 W; Group 3-2.0 W; Group 4-2.5 W). The applied mode was 25 ms on/25 ms off. Within the on period, the laser delivered an intermittent sequence of energy complexes and the maximum output was equal to the nominated output of the device (12 W). Canals were kept moist by sterile saline irrigation in between irradiations, and temperature changes were continuously measured using a thermal imaging camera. Recordings were analyzed by a mixed model (analysis of variance [ANOVA] for repeated measurements). The highest mean of temperature rise, 1.94°C ± 1.07°C, was measured in Group 4, followed by Group 3 (1.74°C ± 1.22°C) and Group 2 (1.58°C ± 1.18°C). The lowest increase occurred in Group 1 (1.06°C ± 1.20°C). There was a significant difference (p = 0.041) between the groups. Significant differences were found between Groups 1 and 4 (p = 0.007) and 1 and 2 (p = 0.035). In addition, a marginally significant difference between Groups 1 and 2 (p = 0.052) was noted. There was no significant difference between Groups 2, 3, and 4. Despite the low mean values reported, the highest temperature increase (+5.7°C) was measured in one of the specimens of treatment Group 2 at the middle third. Under the conditions used and within the limitations of the study, the microchopped diode laser irradiation is a safe possible treatment option in laser-assisted endodontic treatment, concerning the temperature elevation on the external root surface.
The purpose of this study was to investigate the influence of bioglass, Nd:YAG laser irradiation ... more The purpose of this study was to investigate the influence of bioglass, Nd:YAG laser irradiation and their combination on dentinal tubuli occlusion as a potential dentinal hypersensitivity treatment for cervical dentinal hypersensitivity (CDH). CDH affects 8-30% of adults and nearly 85% of perio-treated patients. Various treatment schemes have been applied for treating CDH, among them being fluoride application, laser irradiation, and, recently, bioglass (NovaMin(®)). In this in vitro study, we evaluated the efficacy of NovaMin(®) paste (NM) (Denshield, Sultan, USA), Nd:YAG laser irradiation (L) at various power settings, and their combination, on dentinal orifice occlusion (DOO) as potential treatments for CDH. Forty-nine human dentin surfaces were organized into seven equal groups: groups A and B received NM followed by L (0.5 and 1 W, respectively); groups C and D received L (0.5 and 1 W, respectively) followed by NM; group E received NM; and groups F and G received L (0.5 and 1 W, respectively). Specimens were evaluated with regard to DOO under environmental scanning electron microscope. Treatment modality significantly affected DOO (p=0.012). Groups B and G scored higher DOO than the rest. By ordinal logistic regression (with boostrap standard errors), the combination of NM followed by 1 W Nd:YAG laser irradiation (group B) significantly (p<0.001) contributed to DOO, compared with groups A, C, D, E, and F. Under the limitations of this study, Nd:YAG laser irradiation at 1 W, alone or combined with NM, is a superior method for producing DOO, and may lead to an effective treatment modality for CDH.
Journal of clinical and diagnostic research : JCDR, 2014
Sinus tracts (or fistulas) are a common manifestation of pulpal necrosis that requires convention... more Sinus tracts (or fistulas) are a common manifestation of pulpal necrosis that requires conventional -or rarely surgical- endodontic treatment in order to heal. They are mainly identified intraorally and in rare cases they manifestate extraorally, depending on the causative tooth, root location, bone thickness and muscle inserts. Such conditions may be misdiagnosed and confused with other non-pulpal pathologies. A case of extra-oral submental sinus tract that was initially misdiagnosed by a physician as a non-odontogenic lesion is presented. Facial fistulas of endodontic origin, despite sparse, should be considered as an option in the differential diagnosis procedure. It is important that interaction occurs between physicians and dentists to avoid exposing patients to insufficient treatment schemes.
The Athens University, School of Dentistry, accepted the challenge to organize the Dental Health ... more The Athens University, School of Dentistry, accepted the challenge to organize the Dental Health Services in the Athens 2004 Olympic and Paralympic Games in order to provide the best quality of oral health services to the athletes, coaches, escort members and Olympic Village personnel. Data from the whole activity protocol of the Athens 2004 Games Dental Health Services - the reception, admission and treatment protocols, the facilities and the infrastructure, the number of cases treated per specialty and the experience gained - were recorded. During the Olympic Games, there were more than 1400 dental cases in more than 650 patients, elite athletes, escort members, coaches and staff of the Olympic Village. Among them 313 fillings, 100 root canal therapies, 57 mouthguards and 9 dental trauma cases were treated. During the Paralympic Games, there were more than 240 dental cases in more than 220 patients. Among them 73 fillings, 12 root canal therapies, 21 extractions and 3 dental trauma cases were treated. In such events, highly trained dentists are needed and if possible, specialized in operative dentistry or endodontics. The role of team dentist seems to be of great importance.
Background: Diode-assisted endodontics is nowadays utilized for pulp space disinfection, but litt... more Background: Diode-assisted endodontics is nowadays utilized for pulp space disinfection, but little is known on the bonding potential of this lased root dentin when the tooth is restored with an intracanal polymer post. Objectives: to investigate the influence of diode laser irradiation settings, in laser-assisted endodontics, on the intraradicular bonding of composite materials. Methods: Sixteen two-rooted, maxillary first premolars were collected, prepared up to F4 (Protaper Universal. Dentsply-Maillefer, Ballaigues, Switzerland), and randomly assigned in two groups: group A (chopped mode or short pulse), diode irradiated according to protocol, pulse 25 ms, power 2.5 W, and group B (microchopped mode or ultrashort pulse), pulse 25 μs, peak power 12 W (both groups GentleRay. KaVo Dental, Biberach an der Riss, Germany). Buccal canals were irradiated, palatal ones served as controls. Canals were then obturated, post space was created in all canals, and quartz-fiber posts (ICE light D...
International Journal of Environmental Research and Public Health
Chemical air pollution in dental clinics consists of the emission of gases and particulate matter... more Chemical air pollution in dental clinics consists of the emission of gases and particulate matter (PM), both generated by dental equipment and tooth tissues. One basic application of Erbium Laser devices is cavity preparation on human teeth due to its strong affinity to water and hydroxyapatite. The objective of this study was the evaluation of indoor air quality during the application of an Er:YAG laser, as a dentin removal instrument, in a Dental Clinic. Particulate Matter (PM) was measured using the standard method of EN legislation. In order to measure total Volatile Organic compounds (VOCs), a portable monitor was used. In the first experiment, PM10 and PM2.5 concentrations were increased by approximately 10 and 15 times, respectively. From the second experiment it can be concluded that neither of the measured particle concentrations exceeded the recommended indoor limit values while windows were open, although laser influence was still detectable. Within the limitations applie...
The aim was to validate an artificial resin ‘root canal wall groove model’ (RCWGM) mimicking the ... more The aim was to validate an artificial resin ‘root canal wall groove model’ (RCWGM) mimicking the situation of natural roots with a groove of identical dimensions on debris removal out of these grooves, and to evaluate Erbium ‘laser-activated irrigation’ (LAI) with two conical tips at PIPS (photon-induced photoacoustic streaming) settings, with different activation times and different root canal positions on debris removal out of the grooves. A split RCWGM was used (resin blocks and roots of maxillary canines) with a canal size 40/0.06. The grooves in the apical third were filled with stained dentinal debris. Seventeen irrigation protocols ( n = 20) were used: syringe-needle irrigation (3× 20 s), manual dynamic activation (1× 60 s), ultrasonically activated irrigation (UAI) with 25/25 Irrisafe (3× 20 s) and LAI (2940 nm Er:YAG) with X-Pulse or PIPS tips at PIPS settings (20 mJ, 50 μs, 20 Hz) and with the fibre (IN) or (OUT) the canal: IN during 1× 20 s, and OUT during 1× 20 s, 2× 20 s, 3× 20 s, 30 s, 2× 30 s and 1× 60 s. The quantity of remaining dentine debris in the groove was evaluated on a numerical scale. Statistical analysis was performed by means of proportional odds logistic regression, equivalence testing and Wald tests. The level of significance was set at 0.05. Resin models and the RCWGM with natural teeth can be called equivalent (log odds ratio 0.185). There were mostly no statistically significant differences for debris removal between UAI and LAI ( p > 0.05) and between LAI with PIPS and X-Pulse ( p > 0.05). Although not statistically different, the numbers of completely cleaned grooves were higher with LAI than with UAI for a 1-min activation, confirming findings from other studies. There is no difference in cleaning efficacy between X-Pulse and PIPS tips at PIPS settings.
The study aimed to systematically appraise the evidence on the effects of low level laser therapy... more The study aimed to systematically appraise the evidence on the effects of low level laser therapy (LLLT) on bone healing following rapid maxillary expansion (RME). Electronic search was performed in MEDLINE, Scopus, and Embase databases using appropriate Medical Subject Heading terms, with no time restriction. ClinicalTrials.gov ( www.clinicaltrials.gov ) was also searched using the terms "low level laser therapy" and "maxillary expansion." Original research articles on human clinical trials that involved both RME and LLLT were included. Animal studies were also assessed on an exploratory basis. The search strategy resulted in 12 publications (4 randomized controlled trials, 8 animal studies). In human studies, bone density was assessed radiographically (either two-dimensional or three-dimensional imaging). Regardless of the discrepancies in the intervention protocols, the total of the trials revealed that LLLT had stimulatory effects on bone regeneration after R...
The aim was to evaluate ex vivo apical debris extrusion associated with WaveOne and Self-Adjustin... more The aim was to evaluate ex vivo apical debris extrusion associated with WaveOne and Self-Adjusting File instruments when used in oval canals. Twenty-four extracted human mandibular premolars with oval-shaped canals were assigned in two equal groups. Following coronal cavity preparation, a glide path was created. Group A was subjected to canal preparation using a WaveOne primary file, which was used along with syringe and needle irrigation and 10 mL of 2.4 % NaOCl solution, followed by flushing with 10 mL of 17 % EDTA solution, activation with EndoActivator for 1 min and final flushing with 10 mL of 2.4 % NaOCl solution, and activation for 30 s. Group B, the SAF system was used with continuous simultaneous irrigation, provided by the system's pump. The irrigant was supplied at 5 mL/min, alternating every minute between 2.4 % NaOCl solution and 17 % EDTA solution, over a total of 4 min followed by final flushing with 10 mL of 2.4 % NaOCl solution. Extruded apical debris from each root canal was collected into a preweighed glass vial and dried. The mean weight of the debris from each group was assessed and analyzed statistically. Both systems resulted in apical debris extrusion. The WaveOne system was associated with a statistically significant greater mean mass of apically extruded debris (2.18 ± 0.44 mg) than the SAF system (0.49 ± 0.33 mg, permutation-based Wilcoxon test, p < 0.001). Both WaveOne and the SAF systems were associated with apical debris extrusion. The amount of debris extruded by the WaveOne system was 4.4 times greater than that extruded by the SAF system. The results of the present ex vivo comparative study cannot be directly applied to the clinical situation. Difference between both groups remains completely unclear; maybe the amount of extrusion is harmless in both groups or similarly deleterious for the periradicular tissues in both groups or may be dose-related to the amount of the extruded material.
The aim of this study was to evaluate the incidence of pain of endodontic origin and its relation... more The aim of this study was to evaluate the incidence of pain of endodontic origin and its relationship with socio-economic and demographic factors among patients seeking unscheduled urgent dental care. Patients attending the Emergency Clinic of Athens Dental School, Greece, between November 2011 and June 2012, were evaluated to determine their socio-economic profile, dental problem and treatment required. The facility operated from Monday to Friday, from 8.30 am to 1.00 pm, excluding the 4 weeks encompassing the Christmas and Easter holidays. In total, 533 patients were assessed regarding gender, age, ethnicity, occupation, reason for visiting, diagnosis and treatment provided. The data obtained were recorded, reviewed, coded and analysed using Poisson regression models. Mondays and Wednesdays were the busiest days of the week. The most common occupation among the patients was 'unemployed'. Pain of endodontic origin (reversible or irreversible pulpitis, or acute apical periodontitis) was the prevailing reason for the visit. The most frequent treatments administered were pulpectomy and drainage. Prescriptions for medications were rare. Services were requested primarily by individuals who were experiencing acute pain of endodontic origin, had low or no income and were available during morning hours, probably because of the service's low cost and operational hours. Prospective studies, such as the present investigation, can provide epidemiological evidence and indicate areas in the infrastructure of emergency services which may be improved. Additionally, such studies can provide rationale for public insurance programs and can generate profiles of the patients who utilise these low-cost public services.
Discoloration of a single tooth is a demanding clinical issue especially if present in the aesthe... more Discoloration of a single tooth is a demanding clinical issue especially if present in the aesthetic zone. It can be due to either calcification of the pulp chamber, pulp necrosis and/or iatrogenic mishaps during various stages of the endodontic treatment. In this paper, a literature review is performed, investigating the aetiology of the discoloration of endodontically treated teeth, the bleaching agents suggested and the techniques performed in order to avoid possible side effects while guarantee an overall esthetic result. Possible side effects such as cervical resorption, crown fractures, color relapse etc. and their avoidance are emphasized. The quality of the endodontic treatment as well as the presence of an acceptable coronal restoration is considered to be the basic and necessary prerequisites for the application of any bleaching method.
Introduction: Vertical root fractures (VRFs) of endodontically treated teeth are serious complica... more Introduction: Vertical root fractures (VRFs) of endodontically treated teeth are serious complications that are associated with a poor survival prognosis. The diagnosis of VRFs is difficult, because the clinical signs and symptoms are often obscure and periapical radiographs (PAs) provide limited diagnostic information. Recently, Cone Beam Computed Tomography (CBCT) has been used to address complicated cases of VRFs with an inconclusive diagnosis. Aim: To determine the clinical diagnostic accuracy of CBCT in detecting VRFs in complex failing cases of endodontically treated teeth, as an adjunct to PAs. Materials and Methods: Evaluating the diagnostic accuracy of CBCT in a series of clinical cases of suspected VRFs, presented via clinical photographs, PAs, and CBCT images. Results: CBCT imaging significantly aided the differential diagnosis in most cases. Conclusions: CBCT imaging provides a 3D image and information in many cases of VRF that 2-dimensional PAs fail to generate. The slice thickness and interslice interval of the CBCT image influence the perception of the normal anatomy and pathoses.
Objectives: This article investigates the internal and external morphological variability of mand... more Objectives: This article investigates the internal and external morphological variability of mandibular premolars along with clinical and radiographical signs that leads to early identification of these cases. Materials and Methods: The authors identified articles by searching the PubMed, Medline and Scopus databases. Inclusion criteria were case reports of mandibular premolars with aberrant internal and external anatomy, articles that describe the origin of anatomy of mandibular premolars, the traits that may influence their external and internal variability through species revolution and articles of new technologies like cone beam computed tomography that help the diagnosis of difficult cases. Results: In the majority of the cases, mandibular premolars are reported to have one root canal running a single root. On the other hand, anatomic irregularities in this group of teeth, such as the existence of more than one root or more than one root canals or even a more complicated root canal system cannot be considered infrequent as it appears in 10-25% of the cases. Conclusion: Successful endodontic treatment of mandibular premolars is a challenge for the clinician as they often present morphological and anatomical abnormalities.
The diverse morphology of the root canal system of the mandibular premolar is a challenge for the... more The diverse morphology of the root canal system of the mandibular premolar is a challenge for the clinician to clean, shape and obturate. A case report of a mandibular second premolar with four fused roots which separated at different levels along the apical third of its root and underwent endodontic treatment is presented, along with a review of the literature.
To examine the permanent deformation of self-adjusting files (SAF) when used by endodontists with... more To examine the permanent deformation of self-adjusting files (SAF) when used by endodontists with no previous experience with this system. The canals of extracted human molars were initially prepared with glide path up to size 20 K-file. The operators were first instructed on the use of the SAF in simulated canals in plastic blocks then applied the SAF in natural root canals of extracted teeth. Every 4 min, each file was withdrawn from the canal and inspected for integrity. If intact, it was used in another canal for an additional 4 min and checked again. This was repeated until all 19 SAF files were deformed. The files were collected for inspection at ×50 magnification. All teeth were then examined radiographically for the presence of any metal fragments in the root canals. Permanent deformation was categorized according to the type and location occured. Three types were defined as follows: (i) detachment of one component of the file at one end while the component is retained (ii) detachment of a component at both ends and the component missing and (iii) permanent twisting of the component. Recordings were made and statistically analysed using McNemar's test. Mechanical failures on the 5-arch-side of SAF (odd side) were significantly more frequent in comparison with the even side (P = 0.039). Similarly, mechanical failures in arches on the odd side were also significantly more frequent compared with the even ones (P = 0.012) Longitudinal beams fractured significantly less often compared with arcs or struts (P < 0.001). In no case did complete file fracture occur, nor were metal fragments retained in the root canal. Deformation of SAF files occurred mainly as detachment of one of the arches or struts at connection points on the odd side of the file. In no case did its mechanical failure result in metal fragment retention in the root canal.
The aim of this article was to investigate the temperature increase of the external root surface ... more The aim of this article was to investigate the temperature increase of the external root surface during laser-assisted endodontic treatment using a diode laser (980 nm) in a microchopped mode. Ten freshly extracted, human maxillary incisors with mature apices were collected, prepared to size F4 at working length (ProTaper; Dentsply Maillefer, Ballaigues, Switzerland), mounted to a holder, and irradiated (using spiral movements in coronal direction) with a diode laser (GENTLEray 980 Classic Plus; KaVo, Biberach, Germany) with a 200 μm fiber in four different treatment groups: Group 1 (control group) was irradiated in six cycles of 5-sec irradiation/20-sec pause with 2.5 W in the pulse mode. Groups 2 to 4 were irradiated at six cycles of 5-sec irradiation/20-sec pause in the microchopped mode (Group 2-1.6 W; Group 3-2.0 W; Group 4-2.5 W). The applied mode was 25 ms on/25 ms off. Within the on period, the laser delivered an intermittent sequence of energy complexes and the maximum output was equal to the nominated output of the device (12 W). Canals were kept moist by sterile saline irrigation in between irradiations, and temperature changes were continuously measured using a thermal imaging camera. Recordings were analyzed by a mixed model (analysis of variance [ANOVA] for repeated measurements). The highest mean of temperature rise, 1.94°C ± 1.07°C, was measured in Group 4, followed by Group 3 (1.74°C ± 1.22°C) and Group 2 (1.58°C ± 1.18°C). The lowest increase occurred in Group 1 (1.06°C ± 1.20°C). There was a significant difference (p = 0.041) between the groups. Significant differences were found between Groups 1 and 4 (p = 0.007) and 1 and 2 (p = 0.035). In addition, a marginally significant difference between Groups 1 and 2 (p = 0.052) was noted. There was no significant difference between Groups 2, 3, and 4. Despite the low mean values reported, the highest temperature increase (+5.7°C) was measured in one of the specimens of treatment Group 2 at the middle third. Under the conditions used and within the limitations of the study, the microchopped diode laser irradiation is a safe possible treatment option in laser-assisted endodontic treatment, concerning the temperature elevation on the external root surface.
The purpose of this study was to investigate the influence of bioglass, Nd:YAG laser irradiation ... more The purpose of this study was to investigate the influence of bioglass, Nd:YAG laser irradiation and their combination on dentinal tubuli occlusion as a potential dentinal hypersensitivity treatment for cervical dentinal hypersensitivity (CDH). CDH affects 8-30% of adults and nearly 85% of perio-treated patients. Various treatment schemes have been applied for treating CDH, among them being fluoride application, laser irradiation, and, recently, bioglass (NovaMin(®)). In this in vitro study, we evaluated the efficacy of NovaMin(®) paste (NM) (Denshield, Sultan, USA), Nd:YAG laser irradiation (L) at various power settings, and their combination, on dentinal orifice occlusion (DOO) as potential treatments for CDH. Forty-nine human dentin surfaces were organized into seven equal groups: groups A and B received NM followed by L (0.5 and 1 W, respectively); groups C and D received L (0.5 and 1 W, respectively) followed by NM; group E received NM; and groups F and G received L (0.5 and 1 W, respectively). Specimens were evaluated with regard to DOO under environmental scanning electron microscope. Treatment modality significantly affected DOO (p=0.012). Groups B and G scored higher DOO than the rest. By ordinal logistic regression (with boostrap standard errors), the combination of NM followed by 1 W Nd:YAG laser irradiation (group B) significantly (p<0.001) contributed to DOO, compared with groups A, C, D, E, and F. Under the limitations of this study, Nd:YAG laser irradiation at 1 W, alone or combined with NM, is a superior method for producing DOO, and may lead to an effective treatment modality for CDH.
Journal of clinical and diagnostic research : JCDR, 2014
Sinus tracts (or fistulas) are a common manifestation of pulpal necrosis that requires convention... more Sinus tracts (or fistulas) are a common manifestation of pulpal necrosis that requires conventional -or rarely surgical- endodontic treatment in order to heal. They are mainly identified intraorally and in rare cases they manifestate extraorally, depending on the causative tooth, root location, bone thickness and muscle inserts. Such conditions may be misdiagnosed and confused with other non-pulpal pathologies. A case of extra-oral submental sinus tract that was initially misdiagnosed by a physician as a non-odontogenic lesion is presented. Facial fistulas of endodontic origin, despite sparse, should be considered as an option in the differential diagnosis procedure. It is important that interaction occurs between physicians and dentists to avoid exposing patients to insufficient treatment schemes.
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