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Dental Tribune Middle East & Africa Edition

7Dental Tribune Middle East & Africa Edition | January - February 2014 mcme media consistency and spun down the canal with a lentulo spi- ral instrument to a depth of 8 mm into the canal. The access cavity was closed with a ster- ile cotton pellet placed in the chamber and blue Cosmecore (Cosmedent, Chicago) (Fig. 4). The patient returned three weeks later and was asympto- matic. The access was opened and the canal again flushed with 20 ml of 5.25 percent NaOCl for 15 minutes. It was delivered in the same man- ner as in the first visit with the master delivery tip and the macro canulae of the EndoVac apical negative pressure de- livery system. The canal appeared clean and dry, with no signs of inflam- matory exudate. A #30 K-file was introduced into the canal until vital tissue was felt at a depth of 10 mm into the ca- nal space. It was used to irri- tate the tissue gently to create some bleeding into the canal. The bleeding was stopped at a level of 5 mm below the level of the CEJ and left for 30 min- utes, so that the blood would clot at that level. After 30 minutes, the presence of the blood clot to approxi- mately 5 mm apical of the CEJ was confirmed. White mineral trioxide aggregate, MTA Ange- lus was carefully placed over the blood clot and allowed to set for 20 minutes. After con- firmation was achieved of its set, a bonded composite was placed and the patient was scheduled for follow-up in three months. Unfortunately, the MTA was placed further apically then would have been preferred (Fig. 5). At the three-month follow-up appointment, the patient was totally asymptomatic, and the radiograph showed complete resolution of the radiolucency, with closure of the apex and thickening of the dentinal walls. Pulp testing was incon- clusive (Fig. 6). At the one-year follow-up ap- pointment, the radiograph revealed that treatment had been performed on this tooth by another dentist, differ- ent from her original dentist who made the initial referral. The new dentist, not familiar with revascularization treat- ment performed, had entered the root canal space, cleaned it out and obturated it with gutta-percha and sealer. For- tunately, the treatment was successful (Fig. 7). Conclusion The future of endodontics is bright as we continue to de- velop new techniques and technologies that will allow us to perform treatment pain- lessly and predictably and continue to satisfy one of the main objectives in dentistry — being to retain the natural dentition wherever possible and wherever practical. References 1. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and con- ventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965; 20; 340–349. 2. Moller AJR, Fabricius L Dahlen G, Ohman A, Heyden G. Influence of periapical tis- sues of indigenous oral bacte- rial and necrotic pulp tissue in monkeys. Scand J Dent Res 1981; 89; 475–484. 3. Torabinejad M, Pitt Ford TR. Root end filling materials: a review. Endod Dent Trauma- tol 1996; 12:161–178. 4. Ribeiro DA. Do endodontic compounds induce genetic damage? A comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:251–256. 5. Enkel B, Dupas C, Armen- gol V, et al. Bioactive materi- als in endodontics. Expert Rev Med Devices 2008; 5:475–494. that is hard tissue conductive (7). 6. Moretton TR, Brown CE Jr, Legan JJ, Kafrawy AH. Tissue reactions after subcutaneous and intraosseous implantation of mineral trioxide aggregate and ethoxybenzoic acid ce- ment, hard tissue inductive, and biocompatible. J Biomed Mater Res 2000; 52:528–533. 7. Torabinejad M, Hong OU, Pitt Ford TR. Physical proper- ties of a new root end filling material. J Endodon 1995; 21; 349–353. 8. Dentsply Tulsa Dental. Pro- RootTM MTA Root canal re- pair material; Material safety data sheet (MSDS). 9. Arnaldo Castellucci, MD, DDS. The Use of Mineral Tri- oxide Aggregate in Clinical and Surgical Endodontics. Dentistry Today, March 2003. Duarte MA, Demarchi AC, Yamashita JC, Kuga MC, Fraga Sde C. pH and cal- cium ion release of 2 root- end filling materials. 10. Duarte MA, Demarchi AC, Yamashita JC, Kuga MC, Fraga Sde C. pH and calcium ion release of 2 rootend filling materials. Oral Surg Oral Med Oral Pathol Oral Radiol En- dod. 2003 Mar; 95(3):345–347. Editorial note: References are available from the author. Fig. 4 After the triple antibiotic paste was inserted into the canal, a temporary restoration was placed Fig. 6 Three-month recall reveals excellent longitudinal apical and lateral dentin development Fig. 5 Blood clot was induced and MTA Angelus (An- gelus, Londrina, Brazil) was placed over top, and then the tooth was restored with bonded composite Fig. 7 One-year recall radiograph reveals that defini- tive endodontics had been completed by the patient’s new dentist mCME SELF INSTRUCTION PROGRAM CAPP with Dental Tribune with its mCME- Self Instruction Program gives you the opportunity to have a quick and easy way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership: Take membership for one year by subscription for the newspaper: 600 AED Take article with one newspaper subscription: 100 AED per issue. After the payment, you will receive your membership number and will be able to start the program. Completion of mCME • mCME participants are required to read a continuing medical education (CME) article in each issue. • Each article offers 2 CME Credit and followed by quiz questionnaire, which is available in http://www.cappmea.com/ mCME/questionnaires.html. •Each quiz has to be returned to events@cappmea.com or faxed to: +971436868883 in three months form the publication date • A minimum passing score of 80% must be achieved in order to claim credit • No more then two answered questions can be submitted in the same time • Validity of the article – three months • Validity of the subscription – one year • Collection of Credit hours: you will receive the summary report with Certificate maximum one mouth after expire date of your membership. For single subscription Certificate and summery report will be send one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE WRITERS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE. Gary Glassman, DDS, FRCD (C), graduated from the University of Toronto, Faculty of Dentistry in 1984; and graduated from the endo- dontology program at Temple University in 1987, where he received the Louis I. Grossman Study Club Award for academic and clinical proficiency in endodontics. The author of numerous publications, Glassman lectures globally on endodontics, is on staff at the University of Toronto, Faculty of Den- tistry, in the graduate department of endodontics, and is adjunct pro- fessor of dentistry and director of endodontic programming for the University of Technology, Jamaica. He is a fellow of the Royal College of Dentists of Canada and the endo- dontic editor for Oral Health dental journal. He maintains a private practice, Endodontic Specialists, in Toronto, Ontario, Canada. He can be reached through his website, www.rootcanals.ca. Contact Information

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