Disinfection of Root Canal Systems E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 931

Veröffentlichungsjahr: 2014

Beschreibung

Clean root canal systems are essential for successful endodontic treatment. With contributions from leading endodontists from around the world, Dr. Nestor Cohenca here presents the etiology of endodontic disease caused by the endodontic biofilm and all therapies available to predictably disinfect the root canal system, thus increasing successful endodontic outcomes. Disinfection of Root Canal Systems: The Treatment of Apical Periodontitis is an evidence-based manual that describes root canal anatomy, the endodontic biofilm, and the role of disinfection before presenting the most up-to-date methods of irrigation and disinfection. Individual chapters are devoted to each method, such as positive pressure irrigation, apical negative pressure irrigation, sonic activation, photodynamic therapy, laser technology, and ozonization and electrochemical activation. Clinical photographs throughout show proper irrigation and disinfection techniques.

Leseprobe

Table of Contents

Cover

Title Page

Copyright

Contributors

Introduction

Preface

Acknowledgments

Part 1: Background

Chapter 1: Root Canal Infection and Endodontic Apical Disease

Infection control: why now?

Terminology and apical definitions

The evolution of endodontic microbiology

The link between endodontic infection and apical disease

Conclusion

References

Chapter 2: The Anatomy of the Root Canal System as a Challenge to Effective Disinfection

Introduction

The complexity of the root canal system

The source of complexity

Detecting anatomy

The importance of understanding anatomy toward better outcomes

Clinical cases

Conclusions

References

Chapter 3: Biofilms in Root Canal Infections

Introduction

General characteristics of biofilms

Root canal biofilms

In-vitro

models to study root canal biofilms

Conclusions

References

Chapter 4: Efficacy of Root Canal Disinfection

Goals of endodontic treatment and of root canal disinfection

Detection of microbial pathogens

Sampling as a source of bias

Methods for the determination of the efficacy of root canal disinfection

Diversity of conditions requiring disinfection

References

Chapter 5: Impact of Root Canal Disinfection on Treatment Outcome

Introduction

Irrigation

References

Part 2 : Nonsurgical Intracanal Disinfection

Chapter 6: Shaping the Root Canal System to Promote Effective Disinfection

Introduction

Effect of canal preparation on intracanal bacteria

Working length and patency

Apical size and taper

Potential negative effects of shaping on disinfection

Clinical data to support specific shaping paradigms

Conclusions

Acknowledgment

References

Chapter 7: Topical Disinfectants for Root Canal Irrigation

Introduction

Irrigation solution in endodontics

Decalcifying solutions

Conclusions

References

Chapter 8: Fluid Dynamics of Irrigation within the Root Canal System

Introduction

Misconceptions

Patient safety and intracanal fluid dynamics

Debridement efficacy in inaccessible areas of the root canal system

Extracanal fluid dynamics and outcome results

Conclusions

References

Chapter 9: Positive Pressure Irrigation

Introduction

Positive pressure: the technique

Factors affecting efficacy of positive pressure irrigation

Methods used in the analysis of irrigant penetration

Computed fluid dynamics (CFD)

Irrigant extrusion

Devices combining positive pressure and activation of irrigants

Conclusions

References

Chapter 10: Apical Negative Pressure Irrigation (ANP)

Introduction

ANP overview

Efficacy

Safety: the NaOCl accident

Irrigation and postoperative pain

Revascularization

Outcome

Conclusions

References

Chapter 11: Disinfection of the Root Canal System by Sonic, Ultrasonic, and Laser Activated Irrigation

Introduction

Mechanical properties of biofilms in relation to fluid dynamics

Sonic, ultrasonic, and laser activated irrigation systems

Flow characterization during sonic, ultrasonic, and laser activated irrigation

Chemical effects enhanced by sonic, ultrasonic, and laser activated irrigation

Suggestions for clinical procedures

Effect of the activation systems on the disinfection procedure

References

Chapter 12: Ozonization and Electrochemical Root Canal Disinfection

Ozone therapy

In dentistry

In endodontics

References

Chapter 13: Intracanal Medication in Root Canal Disinfection

Introduction

Intracanal medication—definition

Basic requisites for an interappointment intracanal medication

Materials used as interappointment intracanal medication

Root canal disinfection—future perspectives

References

Chapter 14: Emerging Technologies in Root Canal Disinfection

Introduction

Antibacterial nanoparticles

Antimicrobial photodynamic therapy

Lasers assisted root canal disinfection

Ozone

Conclusion

References

Part 3 : Apical Response and Surgery

Chapter 15: Healing of Apical Lesions: How Do They Heal, Why Does the Healing Take So Long, and Why Do Some Lesions Fail to Heal?

Introduction

What is the apical lesion?

How does an apical lesion heal?

How long does it take the lesion to heal?

Why does healing often take so long?

Why do some lesions fail to heal?

Apical debridement with no open surgery

Conclusions

References

Chapter 16: Surgical Endodontics: The Complimentary Approach

Introduction

Extraradicular endodontic plaque

Bacteria and apical actinomycosis

Virus

Fungi

Cholesterol

Foreign bodies

Anatomical complexities

Apical microsurgery

Does apical microsurgery really make a difference?

References

Index

End User License Agreement

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Guide

Cover

Table of Contents

Preface

Introduction

Part 1: Background

Chapter 1: Root Canal Infection and Endodontic Apical Disease

List of Illustrations

Figure 1.1

Figure 1.2

Figure 1.3

Figure 1.4

Figure 1.5

Figure 2.1

Figure 2.2

Figure 2.3

Figure 2.4

Figure 2.5

Figure 2.6

Figure 2.7

Figure 2.8

Figure 2.9

Figure 2.10

Figure 2.11

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Figure 2.16

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Figure 3.1

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Figure 4.1

Figure 4.2

Figure 6.1

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List of Tables

Table 1.1

Table 4.1

Table 4.2

Table 5.1

Table 5.2

Table 6.1

Table 7.1

Table 7.2

Table 7.3

Table 7.4

Table 7.5

Table 7.6

Table 11.1

Table 12.1

Table 12.2

Table 14.1

Table 14.2

Table 14.3

Table 14.4

Disinfection of Root Canal Systems

Nestor Cohenca

This edition first published 2014 © 2014 by John Wiley & Sons, Inc.

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Library of Congress Cataloging-in-Publication Data

Disinfection of root canal systems : the treatment of apical periodontitis / edited by Nestor Cohenca.

p. ; cm.

Treatment of apical periodontitis

Includes bibliographical references and index.

ISBN 978-1-118-36768-1 (cloth)

I. Cohenca, Nestor, 1968- editor of compilation. II. Title: Treatment of apical periodontitis.

[DNLM: 1. Periapical Periodontitis–therapy. 2. Root Canal Therapy. 3. Disinfection–methods. 4. Root Canal Irrigants.

5. Therapeutic Irrigation. WU 230]

RK351

617.6′342059–dc23

2014004701

Contributors

Alireza Aminlari

Private Practice, Farmington Hills, MI, USA

Department of Cariology, University of Michigan, Ann Arbor, MI, USA

Bettina Basrani

Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada

Rogério de Castilho Jacinto

Department of Semiology and Clinics, Federal University of Pelotas, Pelotas, RS, Brazil

Nestor Cohenca

Department of Endodontics and Pediatric Dentistry, University of Washington, Seattle, WA, USA

Natasha M. Flake

Department of Endodontics, University of Washington, Seattle, WA, USA

Ashraf F. Fouad

Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland, Baltimore, MD, USA

Shimon Friedman

Faculty of Dentistry, University of Toronto, Toronto, ON, Canada

Ana Maria González Amaro

Department of Microbiology, University Autonomous of San Luis Potosí, San Luis Potosí, Mexico

Cesar de Gregorio

Department of Endodontics, University of Washington, Seattle, WA, USA

Markus Haapasalo

Department of Oral Biological and Medical Sciences, Vancouver, BC, Canada

Carlos Heilborn

Private Practice, Asunción, Paraguay

Eric Herbranson

Private practice, San Leandro, California, USA

James D. Johnson

Department of Endodontics, University of Washington, Seattle, WA, USA

Anda Kfir

Department of Endodontology, Tel Aviv University, Tel Aviv, Israel

Anil Kishen

University of Toronto, Toronto, ON, Canada

Ricardo Macedo

The Academic Centre for Dentistry in Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands

Zvi Metzger

Department of Endodontology, Tel Aviv University, Tel Aviv, Israel

Paulo Nelson-Filho

Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto. University of Sao Paulo, Riberao Preto, Brazil

Frank Paqué

Department of Preventive Dentistry, Periodontology, and Cariology, University of Zurich, Zürich, Switzerland

Avina Paranjpe

Department of Endodontics, University of Washington, Seattle, WA, USA

Ove A. Peters

Department of Endodontics, University of the Pacific, San Francisco, CA, USA

Roberta Pileggi

Department of Endodontics, University of Florida, Gainesville, FL, USA

Richard Rubinstein

Private Practice, Farmington Hills, MI, USA

Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan, Ann Arbor, MI, USA

Christine M. Sedgley

Department of Endodontology, Oregon Health and Science University, Portland, OR, USA

Annie Shrestha

University of Toronto, Toronto, ON, Canada

Lea Assed Bezerra da Silva

Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto. University of Sao Paulo, Riberao Preto, Brazil

Raquel Assed Bezerra da Silva

Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto. University of Sao Paulo, Riberao Preto, Brazil

Luc van der Sluis

Department of Conservative Dentistry and Endodontics, University of Toulouse, Toulouse, France

Franklin R. Tay

Department of Endodontics, Georgia Regents University, Augusta, GA, USA

Bram Verhaagen

Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands

Michel Versluis

Research Institute for Nanotechnology, Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands

Introduction

During my first endodontic residency, my program director, Professor Ilana Heling, always reminded me that “bacteria” is the reason for all endodontic failures. Back then (24 years ago), I knew all the literature supporting the link between bacteria and apical pathosis but was naive enough to think that biomechanical instrumentation of the root canal will take care of the microbiological status inside the canal, and the immune system (the host) will do the rest at the apical area.

A few years later, the endodontic world underwent a complete reshape of concept and armamentarium. Among them being new techniques, Ni-Ti alloys, rotary systems, using nickel, and the operating microscopes. For all those endodontists trained in the early 1990s or earlier, it meant to learn endodontics almost all over again, and so we did. However, the amazing technological advancement in endodontics had a cost to the consumer, in this case, the endodontists and ultimately the patient.

If we place the financial aspect aside, these advancements were supposed to produce better endodontic therapy, which is measured by a higher outcome and more teeth being saved from extractions. However, despite the “art and science” of current endodontic therapy, current outcome studies have failed to demonstrate an increase in endodontic success. How come? Should we not expect at least a slight improvement? After all, we shape better, we see better, definitely we spend much more, and yet studies demonstrate the same outcome of apical healing. Something is wrong! In business, we would have used the expression that perhaps we invested our time and money on the wrong market.

After reading most of the outcome studies published between 2005 and 2008, I realized that we will never get any better in healing apical periodontitis until we realize and accept who our real enemy is, what our biological aim is, and what should be our strategy to target the biological reasons of the disease.

Thus, the purpose of this book is to provide the reader with a unique perspective on how to heal apical periodontitis. Successful endodontic therapy depends on the removal of microorganisms and their endotoxins from the root canal system. Toxic metabolites and by-products released from organized biofilms within the canal diffuse into apical tissues and elicit inflammatory responses and bone resorption. Therefore, as endodontists, our main goal should be to focus on the predictable elimination of microorganisms from the root canal system. However, the inherent anatomy and morphology of the root canal system imposes additional inherent challenges making this loyal task of disinfection even tougher. Isthmuses, intercanal and intracanal communications, accessory and lateral canals, curvatures and oval-shaped canals are all part of the anatomical challenges we need to overcome. Yet, the goal remains the same: control of the infection. Bacterial reduction to the extent of a negative culture should be considered the desired “clinical outcome” of endodontic treatment.

In 2004, Bergenholtz and Spangberg claimed that studies must address the fundamental principles of endodontics, rather than the adoption of cutting-edge technology that contributes to the advancement of root canal therapy. To make this statement even stronger, in 2007, Ng et al. published an excellent systematic review on the outcome of primary root canal treatment and reported that the success rates had not improved over the past 40 years. The aforementioned is in complete agreement with the finding by Kakehashi, Stanley, and Fitzgerald. We simply detoured and lost perspective for a few decades, but I believe that it is never too late to make it right.

That is how and why I became interested in the field of root canal disinfection and toward higher healing of apical periodontitis. Another of my mentors, Professor Shimon Friedman – considered one of the best in the field of endodontic outcome – once challenged me on this difficult or impossible task. Although we are not done yet, the results of years of intense research conducted by the authors of this book have produced a significant amount of new data that will provide the reader with a good and current understanding of the etiology of apical periodontitis and the techniques available to obtain a more efficient and predictable disinfection toward better healing and greater outcome. The book discusses the etiology of endodontic disease, especially the endodontic biofilm, and all therapies available to predictably disinfect the root canal system thus increasing endodontic treatment outcome.

I would like to thank the Commissioner of Wiley, Mr. Rick Blanchette, for his vision, trust, and, most of all, his persistence. Last, my gratitude to all authors and co-authors that without much hesitation collaborated with their knowledge, experience, and valuable time. I am extremely proud and blessed for the opportunity I had to work with leaders from around the world who contributed to this book. Not only because of expertise, but because we share the same concerns and passion for endodontics. Together, we joined forces to contribute to our specialty, our peers, and our patients.

Nestor Cohenca

School of Dentistry,

University of Washington,

Seattle, WA, USA

Preface

The passage of time has brought about considerable evolution of the understanding of endodontic disease and its primary cause and the modalities applied to tackle that cause as well as the limitations of those modalities. Driven by an ever-increasing volume of research, this process has seen several shifts in focus that, in turn, have generated technological advances that benefitted almost every aspect of how endodontic therapy is delivered. The rapid pace of those advances challenged the traditional endodontic textbooks to keep up both with the changing focus and the technologies developed to benefit endodontic therapy.

The current focus is the disinfection of the root canal system, widely recognized as a formidable challenge. Confronting this challenge requires specific knowledge, unique technologies developed that apply this knowledge, and updating the clinicians on how to apply those developments in practice. The textbook Disinfection of Root Canal Systems: The Treatment of Apical Periodontitis by Dr. Nestor Cohenca is designed specifically to provide the knowledge base, the detailed information on current and emerging technological advances, and guidelines on how to clinically apply those technologies. In this regard, it is a most timely addition to the endodontic texts available to clinicians, students, and researchers.

Compared to a decade ago, the understanding of canal disinfection has evolved in ways that impact changes in devices, procedures, protocols, and even concepts. For one, the limitation of endodontic instruments in disinfecting the root canals has been well appreciated, shifting the focus to the anatomical intricacies of the root canal systems as well as the microbial resilience as the ultimate challenges in the clinical practice of endodontic therapy. As a result of this shift, in a relatively short period of time, we have seen development of (the list is not all-inclusive): innovative instrument designs to better address root canal anatomy; new devices for delivery of antimicrobial agents into root canal systems; new antimicrobial agents with dual and triple activity; harnessing of physical effects to distribute and activate antimicrobial agents; optimization of the light energy applied to better address the microbial challenges within the root canal systems; and the use of nanotechnologies to challenge microbial biofilms in ways never tried before in endodontics. Faced with such rapid evolution, compiling a textbook that aims to capture the most recent innovations and concepts is a challenge. On the one hand, the historic context is required to foster a comprehensive understanding of biology and therapeutic concepts. On the other hand, the innovative content needs to remain contemporary for the next few years to come.

To meet those challenges, Dr. Cohenca teamed up with a large panel of experts, allowing the reader to benefit from contributions by 30 educators, researchers, and clinicians from four continents. The result of this collective effort is a unique textbook that highlights like no other the most current concepts of endodontic therapy of the infected teeth. With access to this collective international expertise, the reader gains an in-depth and wide-ranging insight into the current state of disinfection of root canal systems. Under this one cover, the reader will find current research-based information on endodontic infection and resulting disease, microbial challenges facing the host and the clinician, methods and limitations of assessing the efficacy of root canal disinfection, ambivalent relationship between disinfection and healing outcomes of endodontic therapy, anatomic complexities of root canal systems, value of the shaping of root canals, applicable irrigating agents, challenges inherent to flow dynamics in root canals, contrasting approaches to delivery and activation of irrigation agents within root canals, recent and emerging adjuncts to canal disinfection, intracanal medication, kinetics of the healing processes of infection-related endodontic disease, and the complimentary surgical treatment procedure. The specific areas several of its chapters focus on and detailed reviews of research findings that the chapters provide are not commonly found in endodontic textbooks.

This new textbook is organized in a logical sequence. Rather than assigning precedence to treatment techniques, the book first reviews the foundations of biology, anatomy, research methods, and healing assessment, to highlight the challenges facing the clinician and researcher in addressing the disinfection of root canal systems. This is then followed by a comprehensive coverage of the principal disinfection procedures, modalities that have yet to enter the mainstream, and emerging concepts. The lingering challenges of slow healing kinetics and surgical management when disinfection is ineffective are then reviewed to provide an essential perspective.

In compiling this textbook, its editor engaged many talented and knowledgeable individuals within the endodontic community to contribute chapters in their respective areas of undisputed expertise. With collective depth and breadth of experience and knowledge in both endodontic science and art, they possess wide-ranging insight into endodontic research, education, and clinical practice. As a longtime educator, researcher, and clinician, I find it gratifying to see the talent harnessed to collaborate on this textbook.

This textbook has all the potential to become an indispensable resource for dentists and endodontic specialists, endodontic specialty-program students, and for those engaged in endodontic research. They will find its content critical to fostering a sound understanding of the challenges underlining the disinfection of root canal systems, and also as a useful guide to the most current devices, materials, and techniques developed to meet those challenges. It will assist them in achieving sophistication in their selected endeavors.

Shimon Friedman

Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

Acknowledgments

I must confess that I was blessed with one of the best endodontic education any professional can dream of. I was lucky enough to be at the right place and at the right time. Having mentors like Adam Stabholz, Shimon Friedman, Ilana Heling, Anna Fuks, James Simon, James Johnson, Martha Somerman, and Joel Berg impacted my career. Each and every single one of them taught me something different and shaped not only my professional knowledge but also my personality. I want to take this opportunity to thank every one of them and express my gratitude and love. I hope to be able to follow their path and legacy.

Finally, I would like to acknowledge my gratitude and love to my family. First, thanks to my parents who during the first 20 years of my life have motivated me to study hard and excel. Second, I would like to thank my wife Ruti and my children Yair, Natalie, and Daniel who during the past 25 years had to understand and support the hours and days I missed from their lives. I hope that my love and dedication made it up and will serve them as a positive example that in life you need to love what you do and then give your all with passion! From my part, I know that without their love and support I would have never become who I am and this book would have never been written.

Part 1

Background