Expert consensus on irrigation and intracanal medication in root canal therapy

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.

Expert consensus on regenerative endodontic procedures

Regenerative endodontic procedures(REPs)is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis.The ultimate objective of REPs is to regenerate the pulp-dentin complex,extend the tooth longevity and restore the normal function.Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports,case series,cohort studies,and randomized controlled studies.However,variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics.The heterogeneity in protocols may cause confusion among dental practitioners,thus guidelines and considerations of REPs should be explicated.This expert consensus mainly discusses the biological foundation,the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis,as well as the main complications of this treatment,aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies,suggesting REPs may become a more consistently evidence-based option in dental treatment.

Evaluation of four final irrigation protocols for cleaning root canal walls

The aim of this study was to compare the efficiency of four final irrigation protocols in smear layer removal and bacterial inhibition in root canal systems.Thirty roots inoculated with Enterococcus faecalis were prepared with ProTaper Universal files.The teeth were disinfected by conventional needle irrigation,sonic agitation using the EndoActivator device,passive ultrasonic irrigation,or an M3 Max file.Teeth with no root canal preparation served as blank controls for the establishment of the infection baseline.Teeth with preparation but no final irrigation served as a post-instrumentation baseline.After the final irrigation,the teeth were sectioned in half.One half of each tooth was examined by scanning electron microscopy(SEM)to assess smear layer removal using a five-point scale.The other half was examined by confocal laser scanning microscopy(CLSM)using the LIVE/DEAD BackLight bacterial viability kit to evaluate the depth of bacterial survival in dentinal tubules.SEM analysis revealed no significant difference in smear layer removal throughout the whole canal among the EA,PUI,and M3 Max groups(P>0.05).CLSM revealed that PUI achieved the greatest bacterial inhibition depth in the coronal((174.27±31.63)μm),middle((160.94±37.77)μm),and apical((119.53±28.49)μm)thirds of the canal(all P<0.05 vs.other groups).According to this comprehensive SEM and CLSM evaluation,PUI appears to have the best infection control ability in root canal systems.

Effect of externally applied Jidesheng anti-venom on skin and soft-tissue necrosis after Chinese cobra bite: a retrospective study

OBJECTIVE: To evaluate the effects of Jidesheng anti-venom used externally for skin and soft-tissue necrosis from Chinese cobra bite.METHODS: A retrospective review was performed according to the clinical data recorded from January 2002 to December 2012. A total of 126 patients(116 females and 10 males) with skin and soft-tissue necrosis due to Chinese cobra bite were divided into two groups. The control group was treated externally with 40% glyceride magnesium sulfate(n=52), and the treatment group was given Jidesheng anti-venom externally(n=74). The data collected included maximum local necrotic area of skin and soft tissues, de-tumescence time, healing time,and skin-grafting rate.RESULTS: There were no significant differences in gender, age, and disease condition between the control and treatment groups(P>0.05). No statistically significant difference was found in de-tumescence time between the two groups(P>0.05). The maximum local necrotic area of skin and soft tissues was(19.9 ± 7.3) cm2in the treatment group,while it was(23.3±6.4) cm2in the control group.The healing time of the treatment group was shorter than that of the control group [(32.1 ± 3.7) vs(34.4±4.5) days)] The skin-grafting rate in the treatment group was lower than that of the control group(10.81% vs 25.00%). There were statistically significant differences in maximum local necrotic area of skin and soft tissues, healing time, and skin-grafting rate between the control and treatment groups(all P<0.05).CONCLUSION: External application of Jidesheng anti-venom may help to promote wound healing and reduce the skin-grafting rate in cases of skin and soft-tissue necrosis due to Chinese cobra bite.