ENDO, 03/2009

Aim: To review the latest developments in the field of pulp biology, particularly those elements of specific interest to clinical dentists, whilst highlighting the importance of maintaining pulp vitality for conservative dentistry. Pulp biology is crucial to everyday practice in dentistry and the knowledge acquired, especially in the last five years on the pulp healing process, has highlighted simple but effective applications. However, difficulties in communication between biologists and clinicians, mostly due to the complexity of biology as a discipline, are a significant obstacle to therapeutic developments and their application on a larger scale. Methods: A literature review was undertaken on the current understanding of the biology of the dentine- pulp complex, especially in the context of conservative dentistry. Results: Novel biotechnological insights have recently been discovered, including the presence of stem cell-like cells within the tooth and their potential roles in reparative and regenerative processes. A greater understanding is also developing regarding the structure of the dentine-pulp complex, both macroscopically and microscopically, which may have important consequences for therapeutic choices. Conclusions: The emergence of new adhesive systems, together with disinfecting molecules, represent a first step towards the application of new biological approaches to the treatment of pulpal disease. Improved understanding of the many pathophysiological processes of the dentine-pulp complex and the development of new materials, which are being adapted to clinical conditions, has led to significant advances for the therapeutic principles underpinning conservative dentistry. Keywords: pulp biology, pulp regeneration, growth factors, reactionary dentinogenesis, TGFß1

Some recent root canal filling materials are claimed to provide a hermetic seal of the root canal system due to their ability to adhesively bond to the root canal dentine. However, it is very difficult to achieve effective bonding in the environment of the root canal system. The purpose of the present review is to discuss the limitations and effects of different materials that might adversely affect the bonding of adhesives to root canal dentine. Keywords: bonding, endodontic treatment, irrigants, limitations, radicular dentine, smear layer

The use of a dental microscope is a scientifically researched and recognised method of optimising root canal treatment. Its use results in improved diagnostic and therapeutic accuracy and considerably expands treatment options. Many therapeutic problems can be successfully managed or avoided entirely. Well-established endodontic treatment methods can be checked more effectively and improved by the use of magnification. New therapeutic methods, such as ultrasonic-abrasive micropreparation to manage and correct iatrogenically created ledges, can improve the prognosis of orthograde endodontic retreatment. Keywords: dental microscope, ledges, retreatment, ultrasonic-abrasive micropreparation

Single-visit endodontic therapy is an old concept in clinical practice. However, the controversy still exists as to which root canal treatment option is best between single- and multiple-visit endodontic therapies. Initially considered as a radical and substandard procedure, single-visit endodontic therapy is now being considered as a good alternative to multiple-visit endodontic treatment. This is due to the introduction of new and improved technologies and materials in endodontics, including surgical microscopes, NiTi rotary instrument systems, newer more reliable apex locaters, ultrasonics and newer obturation systems. This review article highlights the indications, contraindications, advantages, disadvantages, guidelines and criteria for evaluation of single-visit endodontic therapy. The review also emphasises the evidence-based practice for single-visit endodontic therapy in clinics, based on the available current literature on this issue. Keywords: post-operative pain, retreatment, single-visit endodontic therapy, success

Introduction: The aim of the present study was to compare two obturation techniques, i.e. Thermafil® and cold lateral condensation, in order to determine which one was most easily and rapidly learnt and applied by dental students. Methods: Fifty single-rooted teeth were instrumented by the crown-down technique. Five students were requested to obturate five teeth using the Thermafil technique and five using lateral condensation. A microleakage study was performed using a 2% aqueous methylene blue dye solution. The apical portion of teeth was sectioned into six sections and evaluated under a stereomicroscope. The presence of dye microleakage was considered when assessing every section. Results: Results were processed statistically by frequence of distribution and the Mann-Whitney test. A highly significant difference (P < 0.0001) was observed between Thermafil and cold lateral condensation techniques, the former resulting in lower leakage. Conclusion: The present study, though limited and only referring to a small group, suggested that characteristics of operators and the early repeated use of a technique may influence performance. Keywords: education, filling techniques, lateral condensation, Thermafil