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Endodontic ‘solutions’ part 2: an audit comparing current practice in belfast with uk and republic of ireland dental schools M-L Good IA El Karim DL Hussey Dental Update 2024 39:5, 707-709.
Consultant, Department of Restorative Dentistry, The Royal Hospitals, Belfast Health and Social Care Trust, Grosvenor Road, Belfast, BT12 6BP, Northern Ireland
Professor of Restorative Dentistry and Consultant, Department of Restorative Dentistry, Queen's University, Grosvenor Road, Belfast, BT12 6BP, Northern Ireland, UK
Endodontic lubricants, irrigating solutions and medicaments help reduce the microbial load within root canals. Primary and secondary cases involve different microbes. Each ‘solution’ or combinations thereof could play a significant role but no detailed guidelines exist on their use. An audit was undertaken to compare current practice in Belfast Dental School to the others across the UK and Republic of Ireland (ROI). This audit highlighted three main differences between Belfast and other dental schools. Many other institutions utilized other irrigants besides sodium hypochlorite (NaOCl), different intracanal medicaments, including calcium hydroxide, and higher concentrations of NaOCl. Having gathered this information, we ask, ‘Is there sufficient evidence to change the endodontic regime currently used at Belfast Dental School?’. Using the findings from the literature review (Part 1), we introduce new evidence-based protocols for primary and secondary cases for use in Belfast Dental School.
Clinical Relevance: In the absence of detailed clinical guidelines on the use of endodontic lubricants, irrigants and medicaments in primary and secondary cases, it is important to be aware of current practice in UK and ROI dental schools where dentists and specialists are trained.
Article
There are two types of endodontic case, those involving teeth that have never been root-treated, known as primary, and those where a previous root treatment has failed, known as secondary. All cases involve microbes which are organized into protective adhesive biofilms,1 but the species of microbes differ in primary and secondary cases. Primary infections tend to include many species, involving mostly gram negative anaerobes plus fungi.2 Secondary infections, however, involve fewer species and often include E faecalis,3–5 which can be difficult to eliminate.6
The aim of endodontic treatment or retreatment is to reduce the infection of the root canal system (RCS) sufficiently to allow the host response to favour healing of the periapical tissues.
Following the literature review in Part 1 of this paper it is clear that there are many endodontic ‘solutions’ available which are claimed to help prepare and disinfect the RCS. There are, however, only a few that have evidence to support their use clinically, although no detailed guidelines exist on this topic from the British Endodontic Society (BES), the European Society of Endodontology (ESE) and the American Endodontic Society (AES). In the absence of such guidelines, and in order to formulate protocols for primary and secondary cases for use in Belfast Dental School, an audit was undertaken on the current use of endodontic ‘solutions’ across UK and Republic of Ireland dental schools.
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