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Dental Tribune United Kingdom Edition

23ClinicalJuly 11-17, 2011United Kingdom Edition For more information or to subscribe please call Joe Aspis on 020 7400 8969 or email What’s missing? implants Fill the gaps... implants, the international magazine of oral implantology, delivers the latest thinking in this fast-moving area of the dental profession. User-oriented case studies, scientific reports, meetings, news and reports, as well as summarised product information, make up an informative read You got the look... cosmetic dentistryYou got the look... cosmetic dentistry - beauty & science presents the most significant international developments in the world of cosmetic and restorative dentistry. With an editorial mix of speciality articles, clinical studies, case reports, industry reports, reviews, news, and lifestyle articles, cosmetic dentistry leads the way Enjoy Endodontics? rootsDown your canal... roots is the place to keep up with the latest developments in the endodontic arena. A combination of comment, studies, case reports, industry news, reviews, and news, those professionals with an interest in endodontics will find roots invaluable £30 each for a yearly subscription or as a special offer take all three titles for just £50 per year hibit initial bacterial adherence and accumulation of biofilms, giving longer term immunity to bacterial leakage. Although this time period is unknown, some research has indicated that a five minute rinse may give up to 12 weeks’ immunity. How- ever other researchers think that this period is too short and suggest one week is required for dentine adsorption. Further research has shown a synergistic effect when mixed with calcium hydroxide as an inter-appointment dressing and it is especially effective against E. Faecalis. This all may appear to sug- gest that we should swap sodi- um hypochlorite for chlorhexi- dine. However there is always a downside. Firstly not only is sodium hypochlorite very effective against most bacteria but it is also able to act as a tissue solvent, effectively disrupt- ing and dissolving pulpal tis- sue which is ideal in those places our instruments can- not reach. It can also disrupt biofilms. Unfortunately, chlo- rhexidine has neither of these actions. Secondly, just like so- dium hypochlorite, the tissue toxicity increases with higher concentrations. However, the effect of chlorhexidine can be increased by heating it in a similar fashion to sodium hy- pochlorite. There are also cost implications as sodium hy- pochlorite is very cheap and can be bought for 50p per litre, whereas although chlorhexi- dine mouthwash is cheap, the higher concentrations are very expensive and can retail at £50 for the same amount. Clearly it is impractical to swap the large volumes of bleach for chlo- rhexidine. Most endodontists, there- fore, use a combination of sodi- um hypochlorite and chlorhex- idine to have a broad a kill as possible and to take advantage of the dissolution properties of sodium hypochlorite. However, when combined, an orange/ brown precipitate of an in- soluble neutral salt is formed. This precipitate, para-chloro- alanine, is carcinogenic, can cause tooth discolouration and can occlude dentinal tubules. The precipitate can be mini- mised by thoroughly drying the canal and using saline as a rinse between irrigants. A suggested regime may be therefore to use sodium hy- pochlorite exclusively in all vital and hyperaemic canals. This takes advantage of its tissue dissolution properties. Chlorhexidine and sodium hy- pochlorite should be used in non-vital teeth and especially in re-treatment cases. Sodium hypochlorite is the key irrigant but, as a final rinse, chlorhexi- dine can be used to kill specifi- cally the micro-organisms im- mune to sodium hypochlorite and to confer longer-term im- munity. DT ‘Most endodontists, therefore, use a combination of sodium hypochlo- rite and chlorhexi- dine to have a broad a kill as pos- sible and to take advantage of the dissolution proper- ties of sodium hy- pochlorite’ About the author Dr Michael Sul- tan BDS MSc DFO FICD is a specialist in Endodontics and the Clinical Direc- tor of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for five years before com- mencing special- ist studies at Guy’s hospital, London. He completed his MSc and in Endo- dontics in 1993 and worked as an in- house endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the spe- cialist register in Endodontics in 1999 and has lectured extensively to post- graduate dental groups as well as lec- turing on Endodontic courses at East- man CPD, University of London. In 2008 he became clinical director of En- doCare - a group of specialist practices. For further information please call EndoCare on 0844 893 2020 or visit