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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
38 roots1 2016 Using a dental dam Only half of US dentists use recommended dental dam during root canal treatment Alternative filling material Scientists test new nanodiamond biomaterials for root canal therapy New research conducted at the University of California, Los Angeles (UCLA) has demonstrated that using nanodiamonds to fortify gutta-percha, the pre- dominant material used for obturation, could significantly improve outcomes in patients. In the study, nanodiamonds showed considerable advantages comparedwithconventionalgutta-percha,suggestingthatnanodiamond-en- hanced gutta-percha could be used as an alternative filling material in future endodontic therapy. Gutta-percha is malleable, inert and biocompatible, and is the standard of careforendodontictreatmenttoday.However,ithasbeenassociatedwith a number of shortcomings, including leakage, root canal reinfection and poormechanicalproperties.Inordertoaddresstheseissues,researchers have developed and tested nanodiamond-reinforced gutta-percha as an alternative root filling material. Nanodiamonds are particles formed as byproducts of diamond refining and mining, and have been widely explored for use in dentistry, cancer therapy, imaging, regenerative medicine, and other applications. In the current study, which used extracted human teeth, the enhanced materialperformedaseffectivelyasconventionalgutta-perchaobturation material. In addition, the researchers observed that gutta-percha com- bined with nanodiamonds loaded with amoxicillin, a broad-spectrum anti- biotic used to combat infection, effectively prevented bacterial growth. During the next two years, the UCLA team plans to optimize the formula- tion of the new nanodiamond material and begin clinical trials at the uni- versity. Editorialnote:Thestudy,titled"Nanodiamond–GuttaPerchaCompositeBioma- terials for Root Canal Therapy," was published online on Oct. 9 in the ACS Nano journal ahead of print. Using a dental dam during root canal treatment is believed to enhance patient safety and optimize the chances of successful treatment. Howev- er, a new study has found that only 47 per cent of US dentists always use a dental dam. It further revealed substantial variations in dental dam use and dentists’ differing attitudes towards it. In the survey, conducted by the National Dental Practice-Based Research Network, 1,490 general dentists were asked about dental dam use using an anonymous questionnaire. It found that only 47 per cent of dentists always use a dental dam during root canal treatment, with an additional 17 per cent reported using it 90–99 per cent of the time. Although using a dental dam during all root canal treatment is considered the standard of care in dental textbooks and the American Association of Endodontists recommending it, the survey found substantial variation in attitudes toward its use. Some dentists questioned whether the scientific evidence is strong enough to prove that dental dam use is the only way to improve the odds of successful treatment, while others reported that they use other ways that they feel are safe and effective to isolate the tooth being treated. "Beliefs that dental dam use is inconvenient, time-consuming, not effec- tive, not easy to place or affected by patient factors were independently andsignificantlyassociatedwithloweruseofadentaldam,"saidDrGregg Gilbert, professor and chair of the Department of Clinical and Community Sciences at the University of Alabama (UAB) School of Dentistry. "These attitudesexplainwhythereissubstantialdiscordancebetweenpresumed standards of care and actual practice." Generally, the results of the study call into question whether there is a common standard of care in this aspect of dental care, given that most general dentists are not following that standard. However, dentists who were supporting the use of a dental dam in every casefeltverystronglyaboutit,thestudyfound.Theyencouragedpatients to become advocates of their own care by asking that a dental dam always be used during root canal treatment. TheNationalDentalPractice-BasedResearchNetwork,headquarteredat the University of Alabama in Birmingham, is a national consortium of dental care providers and dental organizations that conduct studies to better inform clinical decision-making. Founded in 2002, the network includes about 4000 clinicians and 750 practices or clinics. Editorial note: The results of the study, titled “Discordance between presumed standard of care and actual clinical practice: The example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network”, were published online on 9 December in the BMJ open journal. A 3-D image of a tooth filled with nanodiamond-enhanced gutta-percha (left), and an indi- vidual gutta-percha point.(Image:UCLA School of Dentistry) news Although using a dental dam during all root canal treatment is considered the standard of care,a new survey found substantial variation in attitudes toward its use. Photograph: Filip Obr/Shutterstock