Ida Vol 4 · Dental Probe Journal Vol 17 (4) 2017 Executive Committee 2017 INDIAN DENTAL...
Transcript of Ida Vol 4 · Dental Probe Journal Vol 17 (4) 2017 Executive Committee 2017 INDIAN DENTAL...
Hon. EditorDr. Anand N. WankhedeISSN0976-9277
DENTAL PROBEJOURNAL
DENTAL PROBEJOURNAL
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Dental Probe Journal Vol 17 (4) 2017
Executive Committee 2017
INDIAN DENTAL ASSOCIATION, NAGPUR BRANCH
PresidentDr. Manoj Chandak
44 Jeevan-Chhaya Building, New Ramdaspeth, Behind Hotel
Centre Pont, Nagpur- 10
Hon. SecretaryDr. Vaibhave Karemore66/11, Vastavya, VIP Road,Dharampeth, Nagpur - 10
Emil: [email protected]
Hon. EditorDr. Anand N. WankhedeOpp. Lok Vidhyalaya School,
Bachlor Road, Wardha - 442001Email : [email protected]
Editorial Committee
Editorial Committee
Editorial
President’s Message
Secretary’s Message
Technology : A Review Article
Knowledge, Attitude & Practice Of Dentist towards Repeat Root Canal Treatment :A Cross sectional study
To evaluate the effect of microwave disinfection on the hardness of self cure and heat cure acrylic resin.
Platelet Rich Fibrin Advancement in PRF
Dental Prob Journal Vol 17 (4) 2017
DR . MANOJ CHANDAK President
DR . VAIBHAV KAREMOREHon. Secretary
DR . KETAN GARG Treasurer
DR . TUSHAR SHRIRAOPresident Elect.
DR . SANDIP N. FULADI Imm Past President
DR . GIRISH BHUTADA1st Vice President
DR . KRISHNAKUMAR LAHOTI 2nd Vice President
DR. YOGESH S. INGOLEJoint Secretary
DR . SHRADDHA AGRAWALAsst. Secretary
DR. ANSHUL MAHAJANAsst. Treasurer
DR. POONAM HUDIYA Rep. to CDE
DR. VIVEK THOMBRERep to CDH
DR. ANAND WANKHEDE Hon. Editor (Dental Probe)
DR. MANGESH PHADNAIKEditor News Letter
DR. DEEPAK H. KAMDARRep. to IDA MSB
DR. ANIL Y. CHAUDHARI Rep. to IDA MSB
DR. ABHAY KOLTERep. to IDA MSB
DR. ZUBAIR QUAZI Rep. to IDA MSB
DR. JAYSHREE JOSHIRep. to IDA MSB
DR. ANKUR DHOOTRep. to IDA MSB
DR. SHARD KABRA Librarian
DR. MITUL MISHRA
EC Member
DR. GANESH BAJAJEC Member
DR. ANAND RATHI
EC Member
DR. ANURAG SHENDREEC Member
DR. PRAFUL SHUDDHALWAR
EC Member
DR. DEOKI KHATIEC Member
DR. ROHIT MUDEEC Member
Dr. Usha Radake
Dr. Ashok Pakhan
Dr. Manoj Chandak
Dr. Girish Bhutada
Dr. Abhay Kolte
Dr. Mangesh Padanaik
Dr. Sunita Kulkarni
Dr. Rakhi Chandak
Dr. Devendra Palve
Dr. Meenal Choudhary
Dr. Shweta Chandak
Dr. Pushpa Hazarey
Dr. Sindhu Ganvir
Dr. Vandana Gade
Dr. Abhay Datarkar
Dr. Chandrashekhar Bande
This views/ opinions express by the authors are entirely their own. The journal bears no responsibility, whatsoever about them. The readers are welcome to comment on the issues or subjects raised in the journal. No article/ write up in full or in part may be reproduced without the permission of the Hon. Editor. Any Legal issue/ matter subject to Nagpur Jurisdiction.
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Dental Probe Journal Vol 17 (4) 2017
Dental probe journal is committed to continuously reporting
developments in the field of dental sciences that would help dentists to
recognize & address the patients problem in an efficient and comfortable
manner.
Hon. Secretary’s Message
Your’s In IDA
Dr. Vaibhav Karemore
Hon. Secretary, IDA - Nagpur Branch
EDITORIALSharing of information & knowledge, exchange of experience
and expertises are very important for successful dental practice.Dental probe brings a new research work and advances in
dentistry which is mandatory for the growth and success of day to day dental practice. We have been making sincere efforts to bring to you articles with new knowledge & information.
Your’s In IDA
Dr. Anand N. Wankhede
Hon. Editor, IDA - Nagpur Branch
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President’s Message
I am happy to know that Dental Probe Journal is
committed to continuously reporting new research finding & exploring
new idea, concepts, methods & technology. We are confident that our
journal will devote to bring the new update and advances in dentistry from
clinical aspect and academic point of view. Your’s In IDA
Dr. Manoj Chandak
President, IDA - Nagpur Branch
We, the undersigned, give an undertaking to our article entitled
“______________________________________________________________________________________
____________________________________________________________________”
submitted for publication in the DENTAL PROBE JOURNAL 1. The article mentioned above has not been published or submitted to or accepted for publication in anyform, in any other journal. 2. I/We declare that I/We contributed significantly towards the research study i.e., (a) conception, designand/or analysis and interpretation of data and to (b) drafting the article or revising it critically for important intellectual content and on (c) final approval of the version to be published.
3. The undersigned author(s) hereby assigns, conveys, transfers all rights, title, interest, and copyright ownership of said work for publication. Work includes the material submitted for publication and any other related material submitted to this Journal.
4. All accepted works become the property of DENTAL PROBE JOURNAL and may not be published elsewhere without prior written permission from editor of DENTAL PROBE JOURNAL
5. The author(s) hereby represents and warrants that they are sole author(s) of the research work, that all authors have participated in and agree with the content and conclusions of the research work. Research work is original, and does not infringe upon any copyright, propriety and / or personal right of any third party and that no part of it nor any work based on substantially similar data has been submitted to another publication.
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Undertaking by the Author
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Dental Probe Journal Vol 17 (4) 2017 3
Abstract :
Wound healing is a complex biological
process with cellular events leading to repair and
regeneration of damaged tissue. Platelets isolated
from the peripheral blood acts as autologous source of
growth factors enhancing the wound healing. Platelet
rich fibrin is widely used concentrate in dentistry and
hence conventional PRF technology protocol has
been modified to extend its therapeutic applications in
various clinical situations. Modified PRF includes
Advanced PRF, Injectable PRF, Titanium PRF etc.
Advancement in PRF technology has good
future prospects for its use in dentistry in various
aspects as a healing aid.
Keywords : Platelet rich fibrin, growth factors,
wound healing, modified PRF
Introduction :
Primary objective in process of wound healing was to
develop a concentrate that could enhance body’s
healing potential. This was achieved by addition of
growth factors derived from blood. Platelet rich
plasma was introduced which contained secondary
byproducts that were known inhibitors of wound
healing and hence by removing these anti-coagulants
and modifying centrifugation protocols Platelet Rich
Fibrin was introduced in field of medicine including
dentistry. PRF consist of fibrin matrix in which
platelet cytokines, growth factors and cells are
trapped which are released over a period of time. PRF [1] was first used in 2001 by Choukroun et al
specifically in Oral and Maxillofacial surgery and
currently considered as a new generation of platelet [2]
concentrate. It acts as a biodegradable scaffold that
favours the development of microvascularization and
and is able to guide epithelial cell migration to its [3,4]
surface . Later modifications to centrifugation
speed and time have additionally improved PRF into a
concept now known as the “ LOW SPEED
CENTRIFUGATION CONCEPT.”
Protocol :
It includes centrifugation of freshly drawn blood
without any anticoagulant in glass/ glass based
collection tubes which results into formation of three
distant layers ie RBC’s at bottom, PRF at the middle
and platelet poor plasma at the top. In this protocol
blood is subjected to centrifugation at 2700-3000 rpm
for 12 minutes approximately force of 400g after [5,6]collection of patients blood sample .
Principle :
The basic principle is to allow the blood to clot
physiologically. In the centrifuge, two processes are
occurring simultaneously i.e. blood coagulation and
separation of blood elements under centrifugation
Platelet Rich Fibrin Advancement in PRF Technology : A Review Article
Address for correspondences :Dr. Sanket V. ShindeDepartment of Periodontology Government Dental College, Nagpur, Maharashtra
1) DR. SANKET V. SHINDE
2) DR. VAIBHAV A. KAREMORE
3) DR. M. B. PHADNAIK
4) DR. MEGHNA NIGAM
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Dental Probe Journal Vol 17 (4) 20174
force directed towards bottom of the test tube,
buoyant and frictional forces opposing it. Net result
RBC’s with higher mass are pulled towards the
bottom of the tube and WBC’s and platelets along
with the plasma reach the top of the test tube. This
eventually leads the formation of PRF at the middle.
Which is then carefully retrived from the test tube and
can be formed into membranes or can be use in
combination with other graft materials.
Biology :
The cell responsible for biologic activity of
PRF is the platelet. They contain alpha granules,
dense granules and glycogen granules. Alpha
granules are the most important which contribute by
virtue of various growth factors which include
platelet derived growth factor(PDGF), Vascular
endothelial growth factor(VEGF), Insulin like growth [7,8]
factor-1(IGF-1), Epidermal growth factor (EGF) .
They reach the target cells, bind to transmembrane
receptors and activate various intracytoplasmic
proteins which leads to related gene expression and
leads to cell mitosis or collagen production.
Actions of PRF
• Angiogenesis
• Mitogenesis
• Immunomodulatory effects
• Wound recolonization
• Ostegenic effects
Advanced PRF
Leukocyte and PRF (L-PRF) is produced at
Speed of 2700 rpm for 12 minutes in sterile glass [12]based Plastic tube . For formation of A-PRF Slower
Platelet Rich
Fibrin
Electron microscopic image showing platelets with various granules
Drawing of blood followed by placement of test tube in centrifuge which is then centrifuged, the middle layer i.e. PRF is retrived
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Dental Probe Journal Vol 17 (4) 2017 5
speed (1500 rpm) and more time (14 mins) is used in
sterile plain glass based vaccum tubes. Such a
protocol leads to enhanced B and T lymphocyte
entrapment, more even distribution of platelets,
neutrophilis. It also has more number of viable cells
including platelets in A-PRF. There is better
deployment of resident monocyte, macrophages and [11]
lymphocytes . It would be beneficial as it would
translate into increased amount of growth factor and
cytokine release.
Advanced PRF +
It has been suggested by Fujioka-Kobayashi
and co-workers in 2016 with centrifugation time of
1300 rpm for 8 minutes. Lesser centrifugation time
with decrease amount of forces and hence would
increase the number cells contained in PRF matrix.
When both were compared L-PRF and A-PRF. A-PRF
+ demonstrated highest release of PDGF, TGF-β1,
EGF and IGF. In culture fibroblast exposed to A-
PRF+ revealed higher levels of PDGF, TGF-β and
collagen -1 at three and seven days measured in terms [13]of m-RNA expression .
Injectable PRF and Concentrated growth factors
Injectable PRF -
PRF in injectable form has been developed, [14]one of the latest technology . i-PRF is produced by
drawing blood without use of anti-coagulant in plastic
tubes without any coatings and centrifuged at 700 rpm [15]
for 3 minutes .
Concentrated growth factors -
Blood is centrifuged in non-coated test tubes
at 2400-2700 rpm for 2 minutes. The supernantant is
collected which is named as concentrated growth [16]factors .
Both of the above work on the same principle
and hence considered variants of same concentrate.
Plastic tubes have a hydrophobic surface and do not
efficiently activate the coagulation process. Hence all
the blood components that are required to form a good
concentrate reach the top of the test tube under force
in first 2-4 minutes. Separated plasma and platelets
form a yellow coloured layer which is situated at the
top of the test tube. This is then aspirated and amounts
TUBE
Glass coated
tube
Patented
Same as
A-PRF
Non-coated
MODIFICATIONS OF PRF
Sr No
1.
2.
3.
4.
PRF
Leucocyte and platelet
rich fibrin (L-PRF)[9].
Advanced platelet rich
fibrin (A-PRF)[10]
Advanced platelet rich
fibrin + (A-PRF) [10]
Injectable platelet rich
fibrin (I-PRF)[11]
PROPOSED BY
Choukroun 2004
Ghanaati 2014
Fujioka-kobayashi,
miron 2016
Mourao 2015
TIME
12
minutes
14
minutes
8
minutes
3
minutes
RPM
2700
1300
1300
700
Injectable Platelet Rich Fibrin
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Dental Probe Journal Vol 17 (4) 20176
to a partially active injectable form. Currently, it has
been used for mixing with bone grafts. This has a
potential to convert any osteoconductive graft to
osteopromotive, which will lead to better efficiency
of bone formation.
Applicatons:-
• Facelift surgeries
• Osteoarthritis
• Meniscal healing
Titanium PRF
Blood of the patient is centrifuged into two
grade IV titanium tubes, each of which has 10 ml of
blood which is then centrifuged at 2700 rpm for 12
minutes at room temperature. Titanium is supposed to
be more effective in activating platelets which results
in a more mature and aggregated form of PRF. The
fibrin carpet formed with titanium had firmer network
structure and longer resorption time in the tissue than
fibrin carpet formed with glass.
Titanium is resistant to corrosion. The inner
surface of the tube that contacts blood is made of
titanium which has a enlarged surface area through
sandblasting, laser which results in more mature and
aggregated PRF.
PRF Lysate:
It is new product of PRF . It Is Incubated at
37.c in humidified atmosphere of 5% CO2/95% air
and the exudates thus collected has been referred to as
PRF Lysate. It is a good source of growth factors. It
has been also used to reverse the damage caused by
chronic UV radiation exposure to dermal fibroblasts
by increasing the proliferation rates, migration rates
and collagen deposition equal to those of normal [17]fibroblasts .
Conclusion:
Studies have demonstrated safe and
promising results related to the use of PRF alone or in
combination with other biomaterials. Technological
advancement in field of PRF and its modifications has
paved way for its use in field of medicine and
dentistry with specific indications in different clinical
situations.
Only a perfect understanding of its
components and their significance will enable us to
comprehend the clinical results obtained and extend
its therapeutic application of this protocol.
References :
1] Choukroun J, Adda F, Schoeffler C and Vervelle A.
Une opportunite en paro- implantologie: le PRF.
Implantodontie 2000; 42:55-62.
2] Li Q, Pan S, Dangaria SJ, Gopinathan G,
Kolokythas A, Chu S, Geng Y, Zhou Y and Luan X.
Platelet rich fibrin promotes periodontal regeneration
and enhances alveolar bone augmentation. Biomed
Res Int 2013; 2013: 638043.
3] Choukroun J, Diss A, Simonpieri A, Girard MO,
Schoeffler C, Dohan AJ, Mouhyi J and Dohan SL,
Dohan AJ, Mouthyi J and Dohan DM. Platelet rich
fibrin (PRF): A second generation platelet
concentrate. Part IV : clinical effects of tissue healing. Titanium Tubes Used for T-TPF Preparation
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Dental Probe Journal Vol 17 (4) 2017 7
Oral surg Oral Med Oral Pathol Oral Radiol Endod
2006; 101:e56-60.
4] Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouthyi J and Gogly B. Platelet rich
fibrin (PRF) A second generation platelet concentrate
Part III: Leucocyte activation : a new feature for
platelet concentrate ? Oral surg Oral Med Oral Pathol
Oral Radiol Endod 2006; 101:e51-55.
5] Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouthyi J et al. Platelet rich fibrin (PRF)
A second generation platelet concentrate Part I:
technological concepts and evolution. Oral surg Oral
Med Oral Pathol Oral Radiol Endod 2006; 101:e37-
44.
6] Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouthyi J et al. Platelet rich fibrin (PRF)
A second generation platelet concentrate Part II:
platelet-related biologic features. Oral surg Oral Med
Oral Pathol Oral Radiol Endod 2006; 101:e45-50.
7] Michelson AD. Platelets . 3rd ed. Amsterdam:
Academic press, 2013. Ch 17
8] Blair P, Flaumenhaft R. platelet α- granules: Basic
biology and clinical correlates. Blood reviews.
2009;23:177-89.
9]Choukroun J, Adda F, Schoeffler C, Vervelle A. Une
opportunite en paro-implantologie: Le PRF.
Implantodontie 2001;42:55-62.
10] Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouthyi J et al. Platelet rich fibrin (PRF)
A second generation platelet concentrate Part III:
leucocyte activation: a new feature for platelet
concentrates? Oral surg Oral Med Oral Pathol Oral
Radiol Endod 2006; 101:e51-55.
11] Ghanaati S, Booms P, Orlowska A, Kubesch A,
Lorenz J, Rutowski J,et al. Advanced platelet rich
fibrin : a new concept for cell based tissue engineering
by means of inflammatory cells. J Oral Implantol
2014; 40:679-89.
12] Ehrenfest DM, Kang B, Corso MD, Nally M,
Quiryen M, Wang HL et al. impact of centrifuge
characteristics and centrifugation protocols on the
cells, growth factors and fibrin architecture of a
leukocyte and L-PRF clot and membrane Part 1:
evalution of the vibration shocks of 4 models of table
centrifuges for L-PRF, Proseido 2014;2:129-39.
13] Fujioka-Kobayashi M, Miron RJ, Hernandez M,
Kandalam U, Zhang Y, Choukroun J. optimized
platelet rich fibrin with the low speed concept: growth
factor release, biocompatibility, and cellular
response. J Periodontal 2017Jan;88(1):112-121.
14] Mourao C, Valiense H, Melo E, Mourao N AND
Maia M. Obtention of Injectable platelet rich fibrin (i-
PRF) and its polymerization with bone Graft:
technical note. Revista do Colegio Brasileiro de
Cirurgioes 2015; 42:421-23.
15] Miron RJ, Fujioka-Kobayashi M, Hernandz M,
Kandalam U, Zhang Y, Ghanaati S, Choukroun J.
Injectable platelet rich fibrin (i-PRF): opportunities in
regenerative dentistry? Clin Oral Investig.2017 Feb
2. Doi:10.1007/s00784-017-2063-9.
16] Sohn DS, Huang B, Kim J, Park WE, Park CC.
Utilization of autologous concentrated growth factors
(CGF) enriched bone graft matrix (sticky bone) and
CGF enriched fibrin membrane in implant dentistry. J
Implant Advanced Clin Dent 2015;7:11-8.
17] He L, Lin Y, Hu X, Zhang Y, Wu H. A
Comparative Study of Palatelet Rich Fibrin (PRF)
and platelet rich plasma (PRP) on the effect of
proliferation and differentiation of rat osteoblast in
vitro. Oral surg Oral Med Oral Pathol Oral Radiol
Endod 2009; 108:707-713.
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Dental Probe Journal Vol 17 (4) 20178
Abstract -
Root canal treatment Failure is a common
problem in dentistry. The success of Repeat Root
canal treatment depends on many factors .These
includes presence of periradicular infection, broken
instrument, overfilling, underfilled canals ,missed
canals etc. Various clinical signs and radiographic
findings are indicative of Repeat root canal treatment.
The Knowledge, Attitude and Practice of Dentist
holds significant key in success of Repeat Root canal
treatment.
Aim- To evaluate the Knowledge, Attitude
and Practice of Dentist towards Repeat Root canal
treatment.
Materials and Methods- In present cross
sectional study self administered validated
questionnaire were used to analyze the Knowledge ,
Attitude and Practice of General Dentist towards
Repeat Root canal treatment.
Result- The results were obtained as
percentages after analyzing the collected information.
Average 1-5 cases of ReRCT reported to the clinic of
Dentists per month. According to the tooth type
majority of the RCT failure were noted in Mandibular
Molars (41.3%) followed by Maxillary Molars
(35.3%). Common reason for RCT failure was pain
(33.6%) and Underfilled canals (31.2%). Nonsurgical
Repeat Root Canal Treatment was preferred for more
than 50% Cases by Dentists(70.4%). H-File was used
by majority of Dentist (35.3%) for removal of Gutta
percha. Crown Down technique is used by majority of
dentists (48.9%) for cleaning and shaping of canal.
(82.3%) dentists prefer bypassing the fractured
instrument. Single cone technique used by majority of
dentists (37.7%) for obturation in ReRCT cases.
Conclusion - The study concluded that the
knowledge of Dentist towards Repeat Root canal
treatment is Fair, attitude is positive but practitoners
are still using conventional techniques like H-File,
singe cone technique and needs to incorporate new
techniques in practice.
Introduction-
Dr. Herbert Schilder stated that -
"Spec ia l ized Endodont ic Starts From
Retreatment’’
With the appropriate care , the teeth that had
endodontic treatment will last as long as other natural
teeth, however the teeth that had endodontic
treatment may fail to heal or pain may occur months
or years after treatment causing persistent infection.
The literature shows that many factors are considered
responsible for root canal treatment failure1. These
include incomplete debridement of infected or
necrotic pulp tissue, incomplete sealing of root canal
space, root fracture perforations, broken instrument,
1)
2) Dr. Jyoti Wankhade
3) Dr. Manjusha Warhadpande
Miss Vaishnavi S. Shewatkar
Address for correspondences :Miss Vaishnavi S. Shewatkar
and Hospital Nagpur Government Dental College
Knowledge, Attitude & Practice Of
Dentist towards Repeat Root Canal Treatment :A Cross sectional study
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Dental Probe Journal Vol 17 (4) 2017 9
1overfilling, missed or unfilled canal .
The endodontic Retreatment demand is
increased, because the observation of numerous cross
sectional studies showed that an increased percentage
of root filled teeth have an evidence of apical 2
periodontitis radiographically .On the basis of
various clinical sighns and symptoms Repeat root
canal treatment may be indicated1.
Root canal treatment is technically
demanding and it fails when treatment falls short of
acceptable standards. In an effort to provide patients
with most recent and predictable treatment planning,
clinicians must be well informed about outcome of
root canal treatment. It is important to acknowledge
that outcome of root canal treatment is dependent not
only on specific factors like root canal infection,
complexity of root canal morphology , but is also very
much influenced by less, more distinct causes such as
dentists knowledge and attitudes. These factors may
be even more important causes of failure of
endodontic therapy.
This study highlights the practice of Dentist
towards Repeat Root canal treatment, thus
emphasizing the fact that substantial measures must
be taken to improve the existing practice of dentistry
in terms of quality.
Materials & Methods-
The present study was a cross sectional study . After
taking approval from ethical committee study was
conducted on 180 Dentists in central India. This study
was of four months duration. Sample size was
calculated by using sample size calculation software.
Dentists who were willing to participate in study was
included and Dentists who were not willing to
participate in study was excluded from study .
After taking Consent from Dentist, Self
administered Validated questionnaire containing
eighteen close-ended questions and two-open ended
questions were distributed among 200 Postgraduate
Students, General Dental Practitioners and
Specialists and Diploma specialists. The Response
rate was 90 %.Each question was thoroughly
analyzed as percentages .
Statistical Analysis-
All the collected information from the study
subjects, regarding the Knowledge, Attitude and
Practice towards Repeat Root Canal treatment were
analyzed using computer software SPSS to get the
result as percentages.
In present study 180 postgraduates , general
dental practitioners ,specialists and diploma
specialists were included.
Operator Frequency Percentage
G.D.P. 96 53.2%
Specialists 58 32.4%
PG students 20 11.3%
Diploma Dentists 6 3%
Table 1: Participation of
practitioners according to qualification
Table 2: Percentagewise distribution of Factors
responsible for endodontic treatment failure.
Factors for endodontic failure Percetage(%)
Pain 34%
Underfilled obturation 31%
Missed canal 18%
Overfilling 12%
Fractured or Dislodged 5%
restoration.
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Dental Probe Journal Vol 17 (4) 201710
Observation and Results -
Graph 1: Percentagewise distribution of
endodontic failure according to tooth type.
Graph 2: Instrument or technique used for GP
removal.
Graph 3 : Percentagewise distribution of
technique used for cleaning and shaping in
ReRCT cases.
Graph 4: percentagewise distribution of technique
used for retrieval of fractured instrument.
Graph 5:Percentagewise distribution of type of
coronal restoration used in ReRCT cases.
Repeat Root canal treatment reported to clinic
per month to an individual Dentist was 1-5 cases
according to (70%) Dentists. Majority opinion is
Nonsurgical Repeat Root Canal Treatment (63%) in
Root Canal Treatment failure cases . More than
50%cases are treated Non surgically, 25-50% cases
by Extraction and less than 25% cases are treated
Surgically. Complete removal of Gutta Percha is the
major step in Retreatment
Various obturation techniques are used for
Repeat Root Canal treatment single cone technique
(37.7%)is used by majority of Dentists, cold lateral
compaction (32.4%) followed by warm vertical
compaction (29.9%)
The standard of Coronal Restoration has an
effect on periapical status of root filled teeth3, the
outcome of poor Root canal filling can be favourable ,
if the quality of coronal restoration is good1, various
post obturation coronal restoration techniques are
used.
Zinc oxide Eugenol (71.2%) is the most
commonly used interappointment medicament.
Discussion –
ReTreatment is required if previous Root
Canal Treatment has not been done upto acceptable 5
standards. The major factor for Repeat Root canal
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Dental Probe Journal Vol 17 (4) 2017 11
removal of endodontic obturating material ,this
enables chemicomechanical reinstrumentation and
disinfection of root canal system, thus GP removal is
the crucial step in retreatment in which majority
Dentists are using H-Files(35%) .According to the
results of this study rotatry instruments is used by less
number of Dentists (15% )which is accordance with 6
the study of D.Jain , S.Taur(2013)
According to the results of this study Calcium
hydroxide is most commonly used intracanal
medicament (63.4%) which is in accordance with the
study of Vytaute Peciuliene, Rasmute Maneliene
(2009)
General dental practitioners refer cases to the
specialist in cases such as Instrument fracture,
Perforations, Accessory canal, Apicectomy
Retrograde filling, Post & core, ReRCT with third
molars , Unmanageable reduced mouth opening.
Conclusion-
The observation from present study
concluded that the knowledge of Dentist towards
Repeat Root canal treatment is Fair, attitude is
positive but practitioners are still using conventional
techniques like H-File, single cone technique and
needs to incorporate new techniques in practice. The
substantial steps must be taken to improve the
existing practice in terms of quality of endodontic
treatment. This study highlights the factors necessary
for success of Repeat Root Canal Treatment.
Recommendations-
1. Proper case selection should be done to increase the
success of the endodontic treatments.
2. Teeth with suspected complex anatomy should be
thoroughly evaluated by high quality preoperative
radiographs.
3. Teeth with such complex anatomy should be
referred to the endodontists.
treatment is the persistent microbial infection in the 1
root canal system and periradicular tissue .
Root canal treatment failure is much 1
dependent on the location of tooth in an arch . In this 1respect most of failures occur in posterior teeth , the
analysis of the data in terms of individual tooth
showed the majority of the endodontic treatment
failures occurred in Mandibular molars(41.3%)
followed by Maxillary Molars(35.1%) which is
contradictory to the Azhar Iqbal study conducted in 1Saudi Arabia(2016)
The overall widely recognized explanation
behind endodontic failure in multirooted teeth was
untreated or unfilled canals taking after the 1
underfillings of the root canal .The cause of
periradicular tissue irritation is the remaining necrotic
and infected pulp tissues in improperly instrumented 15
and incompletely filled canals .The results in our
study showed the most common reason for
Retreatment is Pain (33.6%) followed by Underfilled
Obturation (31.2%) which is in accordance with 1
Azhar iqbal study conducted in Saudi Arabia (2016)
& contradictory to the study of Iftikhar Akbar 5(2015)
Surgical Retreatment were carried out more
frequently on Anterior teeth when compared with
Molar and Premolar which is in accordance with 13study of Lazarski et al.(2001) , Salherabi &
8Rotstein(2004) .
According to the results of this study Sodium
Hypochlorite is the most commonly used irrigating
solution (68.3%) which is in accordance with study of 7
MS Clegg (2006) sowing Sodium Hypochlorite is the
most widely used endodontic irrigating solution
because of its bactericidal activity & ability to
dissolve vital and necrotic organic tissues.
Nonsurgical endodontic retreatment requires
access to the root canal system through the complete
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Dental Probe Journal Vol 17 (4) 201712
References-
1. The Factors responsible for Endodontic
treatment failure in Permanent dentitions of the
patients reported to the college of Dentistry,university
of Aljouf, Kingdom of Saudi Arabia: Azhar -Iqbal -
IJCR(2016)
2. A prospective study of the factors affecting
outcome of Nonsurgical root canal treatment:Ng YL,
Mann V,Gulabivala K-Int. J.Endo (2001)
3. Periapical status and quality of root filling
materials and coronal restoration:Kirkevang
L,Orstavik D-Int. j.Endo. (2000)
4. Comparison of intermaxillary tooth size
discrepancies among different malocclusion group
:Nie Q, Lin J-Am J Orthod Dentofacial Orthop(1999)
5. A Radiographic study of the problem &
failures of endodontic treatment:Iftikhar Akbar-
International Journal of Health Science (2015)
6. Attitude of general dental practitioners
towards endodontic treatment procedures in India
;Deepak jain , S Taur (2013)
7. The effect of exposure to irrigating solutions
on apical dentin biofilms invitro;M.S.Clegg ,
F.G.Vertucci Int .j.Endo (2006).
8. Endodontic Treatment Outcomes in a Large
Patient Population in the USA :An Epidemiological
Study –Robert Salherabi , Ilan Rotstein :A.A.E.
Int.,J.Endo. (2004)
9. Attitudes of general dental practitioners
towards endodontic standards and adoption of new
technology:LiteratureReview-VytautePeciuliene,
Rasmute Maneliene: Stomatologija, Baltic Dental &
Maxillofacial Journal (2009)
10. Outcome of Secondary Root Canal Treatment
:a Systemic review of literature: Ng YL, Mann V,
GulabivalaK.-Int. J.Endo(2008)
11. Efficacy of Different Methods for Removing
Root Canal Filling Material in Retreatment :
SwethaKasam,AnnapoornaBallagereMariswamy-
IJCR(2016)
12. Outcomes of Root Canal Treatment in Dental
Practice-Based Research Network practices: Gregg
H. Gilbert, Ken R. Tilashalski, Mark S.Litaker,
Sandre F. McNeal, Michael j. Boykin, Allen W.
Kessler(2009)
13. Epidemological Evaluation of the Outcomes
of Nonsurgical Root Canal Treatment in a large cohort
of Insured Patients: M. P. Lazarski,Willam A Walker-
Int. J.Endo(2001)
14. Electronic apex locators: Gordon MPJ,
Chandler-Int.j.Endo (2004).
15. Factors affecting successful prognosis of
Root canal treatment : Matsumoto T ,Nagai T-Int. J.
Endo (1987)
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Dental Probe Journal Vol 17 (4) 2017 13
Abstract :
Increased prevalence of some infectious
diseases i.e. Hepatitis B, AIDS altered the public
opinion to infection control during dental service.
Impressions trays, casts and prosthesis are all of
potential sources of cross contamination to and from
patients, clinical personnals and dental technicians.
The purpose of this study was to evaluate the effect of
microwave disinfection on the hardness of heat cure
acrylic resin and self cure acrylic resin.
Materials and Methods
Samples were made of heat cure and self cure
acrylic resins. First the samples were subjected to
hardness test without the microwave disinfection and
then the same samples were subjected to microwave
disinfection which served as experimental group.
Rockwell hardness tester was used to check the
hardness of samples.
Result
The result showed that microwave
disinfection showed no significant changes in
hardness of heat cure and self cure acrylic resins.
Conclusion
Microwave disinfection can be used safely to
disinfect prosthesis made of heat cure and self cure
acrylic resin in clinical prosthodontic procedures.
To evaluate the effect of microwave disinfection on
the hardness of heat cure and self cure acrylic resin. An in-vitro study.
1) Dr. Neha Ahuja (Mahajana)
2) Dr. Anshul Mahajan
This study evaluated the effect of microwave
disinfection on the hardness of heat cure and self cure
acrylic resin. 15 Samples each of self cure and heat
cure acrylic resin without microwave disinfection
were used as a control group and the same samples
were microwave disinfected and were used as a
experimental group. 6 minute exposure at 650 W for
15 days to microwave was employed as disinfection
procedure. The samples were stored in distilled water
at 37 degree Celsius for 24 hours prior to disinfection.
There were no statistically significant differences in
the hardness of heat cure and self cure acrylic resin
after disinfection with microwave.
Introduction
Cross-contamination between patients and
dental personnel can occur not only through
contaminated dentures but also through polishing
agents and instrumentation.. Williams et al
demonstrated that denture laboratory pumice
continues to be a major reservoir for bacterial
contamination in prosthetic dentistry. A study by
Kahn et al demonstrated the transfer of oral flora from
a contaminated denture to a disinfected denture
through the polishing wheel and pumice. These
microorganisms can penetrate into the interior of
porous acrylic resin. Therefore, to reduce the chances
of cross-contamination, dentures should be
completely disinfected before being sent to the [1]laboratory and before insertion .
In choosing a disinfectant for dental
Address for correspondences :Dr. Neha Ahuja (Mahajan)
Dental Square, Multispeciality Dental ClinicNagpur
Private Practitioner,
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Dental Probe Journal Vol 17 (4) 201714
prostheses, consideration should be given to its
compatibility with the type of material to be [2]
disinfected to avoid adverse effects . Ideally, the
physical and mechanical properties of denture base
resins and artificial denture teeth should remain
unaltered after the disinfection process. It has been [3-4] [5]
demonstrated that the hardness , flexural strength , [6]and colour stability of denture base resins can be
significantly affected by disinfectant solutions such
as glutaraldehyde, chlorhexidine, phenolic-based,
alcohol-based, and hypochlorite disinfectants.
Microwave irradiation has been suggested as
a simple and effective method for denture
disinfection, different regimens have been tested.
Microwave irradiation 6 min in water at 650 W,
performed on three hard chair side relining material
proved to be completely effective against potentially
pathogenic microorganisms such as staphylococcus
aureus, pseudomonas aeruginosa, bacillius subtilis [7]and candida albicans .
Therefore, this in vitro study has undertaken
to evaluate effect of microwave disinfection on
hardness of heat cure and self cure acrylic resins.
Materials and methods
Materials:
1. Heat cure acrylic resin (DPI)
2. Self cure acrylic resin (DPI)
3. Modelling wax(Link,MDM corporation, New
Delhi)
4. Type II gypsum product(Kalabhai Karson Pvt. Ltd,
Mumbai)
5. Cold mould seal(DPI,Dental materials, Mumbai)
Equipments:
1. Varsity pattern Dental flask and clamps
(Jabbar ,India)
2. Hydraulic press(Carlo de giorgi,GD;Italy)
3. Digital acrylizer
4. Incubator
5. Domestic microwave (LG company)
6. Rockwell Hardness Tester (AI RAS company,
available at DMCOE, Sawangi, Wardha)
Method
1. Preparation of heat cure acrylic resin sample:
Two piece metal mould was prepared of size
65mm in length, 20 mm in width,3mm thickness to
prepare wax samples. The mould was then packed
with acrylic dough of heat cure and processing of
acrylic resin sample using long curing cycle at 70
degree Celsius for 9 hrs using acrylizer to obtain
samples of heat cured acrylic resin. Samples so
retrieved were finished and polished. The samples
were stored in distilled water at 37 degree Celsius for
24 hours prior to disinfection.
2. Preparation of self cure acrylic resin sample :
Two piece metal mould was prepared of size
65mm in length, 20 mm in width,3mm thickness to
prepare wax samples. The mould was then packed
with acrylic dough of self cure. After room
polymerization samples were retrieved and finished
and polished. The samples were stored in distilled
water at 37 degree Celsius for 24 hours prior to
disinfection.
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Dental Probe Journal Vol 17 (4) 2017 15
3. Grouping of sample :
Total 30 sample size was used. Samples were
divided in two groups. Control group A 30 samples
(15 Heat cure + 15 self cure acrylic resin) – not
subjected to any disinfection. Experimental group B
30 samples (15 Heat cure + 15 self cure acrylic resin)
– same subjected to microwave disinfection.
4. Disinfection and testing of the samples :
All samples of were subjected to Rockwell
hardness tester for evaluating hardness using 60-gf
load and were denoted as Rockwell hardness
number(RHN). Three indentations were made on
each sample and RHN was calculated for each sample
for all groups and then mean value for heat cure and
self cure acrylic resin was be calculated as control
group. These samples as per grouping were then
subjected to microwave disinfection for 6 min at 650
W daily for 15 days. After disinfection the hardness
will then be measured using Rockwell hardness tester
on 7th and 15th day .
Results :
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Dental Probe Journal Vol 17 (4) 201716
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Dental Probe Journal Vol 17 (4) 2017 17
Result of the study was not statistically
significant, there was no difference in the hardness of
samples before and after disinfection with
microwave.
Discussion
Dental prosthesis are usually fabricated in
acrylic resin. Self cure acrylic resin are used for
temporary purposes and heat cure acrylic resin are
used for permanent purposes. In days of cross-
infection it is mandatory for every person to perform
disinfection procedure for all the stages of denture
fabrication. This investigation evaluates the effect of
microwave disinfection on the hardness of heat cure
and self cure acrylic resin. Heat cure and self cure
acrylic resin (DPI) revealed non significant decrease
in hardness after disinfection with microwave.
Shen et al reported that the rigidity and surface
morphology of denture base resins were affected by
glutaraldehyde-based disinfectants (alkaline, phenol [8]buffered . It may be assumed that the sodium
hypochlorite solution may have penetrated into the 8tested materials and resulted in softening. Asad et al
reported that a significant decrease in hardness was
observed when heat-polymerized resin specimens
were immersed in 0.5% chlorhexidine gluconate
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Dental Probe Journal Vol 17 (4) 201718
[3]solution for 7 days . Residual monomer content may
adversely affect the mechanical properties of denture
base resins owing to a plasticizing effect which
reduces the inter-chain forces so that deformation
occurs more easily under load during hardness tests.
Dixon et al evaluated the effect of 5 exposures to
microwave irradiation as a disinfection method for
dentures on the hardness of denture base materials.
The authors found that there were no significant
differences for the resilient lining material
(Molloplast-B; Detax, Ettlingen, Germany) (39.9
Shore A), and the denture base acrylic resin (Lucitone [9]
199) (98.4 Shore A) tested .
Rockwell Hardness Tester was used for 6 min
at 650W to check the hardness of heat cure and self
cure acrylic resin before and after disinfection with
microwave.The heat cure acrylic resin exhibited more
hardness than self cure in control group. Self cure
acrylic resin exhibited more loss of hardness as
compared to heat cure acrylic resin after disinfection
for 7 days. Microwave disinfection for 15 days, heat
cure acrylic resin exhibited marginal loss than self
cure where more loss of hardness is observed. Self
cure acrylic resin materials exhibited more reduction
in hardness as compared to heat cure acrylic resin
materials after microwave disinfection. However
this loss of hardness has negligible influence on the
functioning of the prosthesis. In spite of various
investigation there exists a need for further research to
elucidate, the efficacy of microwave disinfection of
the hardness of heat cure and self cure acrylic resins.
Conclusion
Control of cross-infection has been a subject
of interest to the dental area over the last few decades,
due to the concern about the transmission of
infectious-contagious diseases, such as AIDS,
hepatitis, tuberculosis, pneumonia, and herpes,
between the dental patients and dental personnel and
the dental office and dental prosthesis laboratory.
Dental practitioner has a legal and ethical
responsibility to prevent infections in patients and
staff members and an interest in protecting her-
himself from contracting a disease from a
patient. microwave disinfection is an effective, quick,
easy, and inexpensive versatile tool that can be
performed by dentists, assistants, technicians,
patients and/or their caregivers to inactivate
microorganisms. In addition, the use of a microwave
oven does not require special storage and does not
induce resistance for fungi or other microorganisms.
Thus this method may have an important potential use
in dental offices, dental laboratories, and institutions
and hospitals in which patients are treated, especially
those wearing removable dentures. Further studies
using different brands of acrylic resin should be
carried out to strengthen the research data.
References :
[1] Karin Hermana Neppelenbroek, DDS, MSc,a
Ana Cla´udia Pavarina, DDS, MSc, PhD,b. Carlos
Eduardo Vergani, DDS, MSc, PhD,c and Eunice
Teresinha Giampaolo, DDS, MSc, PhDd : Hardness
of heat-polymerized acrylic resins after disinfection
and long-term water immersion, Journal Of
Prosthetic Dentistry 2005;93:171-6.
[2] Smith DC. The cleansing of dentures. Dent
Pract Dent Rec 1966;17:39-43.
[3] Asad T, Watkinson AC, Huggett R. The
effects of various disinfectant solutions on the surface
hardness of an acrylic resin denture base material. Int
J Prosthodont 1993;6:9-12.
[4] Polyzois GL, Zissis AJ, Yannikakis SA. The
effect of glutaraldehyde and microwave disinfection
on some properties of acrylic denture resin. Int
JProsthodont 1995;8:150-4.
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Dental Probe Journal Vol 17 (4) 2017 19
[5] Asad T, Watkinson AC, Huggett R. The effect
of disinfection procedureson flexural properties of
denture base acryl ic res ins . J Pros thet
Dent1992;68:191-5.
[6] Ma T, Johnson GH, Gordon GE. Effects of
chemical disinfectants on thesurface characteristics
and color of denture resins. J Prosthet Dent
1997;77:197-204.
[7] Ana Lucia Machado, DDS, MSc, PhD; Larry
C. Breeding, MSc, DMD;and Aaron D. Puckett, PhD.
Effect of Microwave Disinfection Procedures on
Torsional Bond Strengths of Two Hard Chairside
Denture Reline Materials J Prosthodont 2006;15:337-
344.
[8] Shen C, Javid NS, Colaizzi FA. The effect of
glutaraldehyde base disinfectants on denture base
resins. J Prosthet Dent 1989;61:583-9.
[9] Dixon DL, Breeding LC, Faler TA:
Microwave disinfection of denture base materials
colonized with Candida albicans.J Prosthet Dent
1999;81:207-214
[10] Ana Lucia Machado, DDS, MSc, PhD,a Larry
C. Breeding, MSc, DMD,b and Aaron D. Puckett,
PhDc : Effect of microwave disinfection on the
hardness and adhesion of two resilient liners. Journal
Of Prosthetic Dentistry 2005;94:183-9.
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