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Dental Tribune United Kindom Edition

13Endo TribuneJuly 30 - August 5, 2012United Kingdom EditionUnited Kingdom Edition Make compliance with the CQC as simple as possible call us now on 020 7400 8989 or email info@smile-on.com • Web-based CQC solution with easy to use templates • Online Core CPD for the whole team • Latest Best Practice eLearning programmes including Oral Cancer and Vulnerable Patients “The most complete training and compliance system available.” Smile-on Best Practice Kit for CQC The UK’s first all-inclusive online compliance management kit C CBest Practice Kit cqcm ad 2.indd 1 11/07/2012 15:15:49 ple, has been shown to be a common isolate in 27 to 77 per cent of teeth with post-treat- ment disease.12 A contami- nated canal space may result from incomplete cleansing initially or subsequent leak- age into root-canal spaces following root-canal treat- ment. Once present inside the canals, E. faecalis has a variety of characteristics that allow it to evade our best ef- forts to eradicate it from the root-canal system, including the ability to invade dentinal tubules and adhere to col- lagen.13 It is also resistant to calcium hydroxide applica- tion inside the canal system, which is an inter-appointment treatment technique used to help remove micro-organisms and their by-products, such as lipopolysaccharides, from the canal space.14, 15 E. faecalis’s resistance of calcium hydrox- ide action arises from its abil- ity to pump hydrogen ions from a proton pump. The hy- drogen combines with the hydroxyl ions of calcium hy- droxide and neutralises the high pH value.16 E. faecalis is also able to resist calcium hydroxide by being part of a biofilm. The protection of bacteria within a biofilm matrix prevents the contact of the bacteria with irrigants and medicaments, and allows communication between bacteria to aid in survival capabilities.17, 18 The presence of E. faecalis is well documented; however, its role in post-treatment disease has yet to be proven definitively.19 Its survival mechanisms, how- ever, shine a light on the per- sistent capabilities of these bacteria, and our clinical techniques must be focused on the challenge of eliminat- ing them. Iatrogenic issues encoun- tered during the initial root- canal treatment may be the cause of intra-canal bacterial infection. These issues may include perforation, incom- plete cleansing and shaping, Fig. 4b: Post-op radiograph showing treatment of the second mesiobuccal canal and appropriate lengths on retreatment of the distobuccal and palatal canals. (Courtesy of Dr Brett E. Gilbert) Fig. 5: Photograph displays excellent visibility and magnification of the pulp chamber with the use of an ultrasonic tip. (Courtesy of Dr Scott Bentkover, USA) page 14DTà ‘The bacteria pre- sent in the initial infection of a root canal differ mark- edly from the bacteria infecting a previously treated tooth’