Essay Example on Bioactive endodontic types of cement are Limited









The potential disadvantages are discoloration systemic effects and retreatability Publications using Bioactive endodontic cements are limited Torabinejad et al 2017 Studies support the use of MTA as an apical plug for teeth with necrotic pulps and open apices but evidence for other bioactive endodontic cements is limited to case reports and case series There was lack of detailed information on practitioner experience small sample size short term follow up lack of calibration between dentists Variations in preoperative conditions low recall rates were all problems with the studies available Evaluation with a longer period showed higher success rates in teeth with preoperative periapical lesions following placement of MTA as an apical plug Mente et al 2009 Endodontic revitalization procedures often have tooth discoloration Recent reviews have reported both revitalisation and apical MTA placement had a high survival rate and successful outcome with no significant difference between procedures Torabinejad et al 2017 Whilst tooth discoloration is a problem for aesthetics in the anterior region more research is needed to find the cause its treatments and consider the use of their bioactive endodontic materials in its place Studies on Biodentinetm and Endosequence putty are recent 2016 but few in number Perforation repairs in maxillary teeth had more success than mandibular and when MTA was used the success rate was 80 9 The studies did have small sample sizes and short follow up periods 

Time between perforation and its repair is a factor as delay increases infection at the site and decreases prognosis Bioceramic materials in deep cavities and asymptomatic exposures may reduce the need for endodontic intervention in the future and reduce the need for posts and cores Baba and Goodacre 2014 The cost of these materials may currently be the hindering factor in making them more commonplace in general practice Indeed in cases where prognosis is poor e g resorption non resolving lesions a bit of MTA seems to arrest the process but whether these are short term solutions to the inevitable loss of the tooth remains to be seen and this area needs more long term studies and follow ups Setzer and Kim 2014 John et al 2007 stated that there were limited long term follow up studies in literature in apical surgery don't show the use of contemporary techniques that were available such as microscopes flap designs ultrasonic retro preparation and superior root end filling materials Setzer el al 2010 found a success rate for traditional techniques at 59 and 94 for modern techniques using MTA microscopes and microsurgical techniques The rates of healing in the few studies were high and between 88 91 Zuolo Chong et al Gagliani et al Tsesis et al 2013 stated the need for long term studies using modern surgical endodontic techniques A lot of studies did not distinguish data from traditional techniques or those using modern techniques 

The use of an endodontic microscope and cone beam computed tomography CBCT can have a higher success rate as would experience of the surgeon CBCT was found to be more accurate in detecting minor lesions DePaula Silva et al 2009 CBCT could give lower healing rates and require longer durations of follow up to demonstrate complete healing The use of CBCT for routine follow up is not recommended due to the radiation dose but CBCT can be useful for pre treatment planning in a compromised tooth prior to surgery Demonstrating healing in surgical endodontic cases requires long term follow up which is often lacking Tulus and Hulsmann 2016 The widespread use of endodontic microscope nickel titanium rotary files ultrasonic instrumentation and apex locators are some of the advances in the recent decades Silvestrin 2014 Endodontists are well positioned to discuss restorability and prognostic longevity of teeth and are at the crossroads between endodontic and implant related treatment Silvestrin 2014 Silvestrin 2014 states that endodontists are experts at working to 0 5 mm increments or less and the nature to be precise can work to place position and angulated implants with precision Dentists trained in both fields could help decision making without a bias and retain compromised teeth for longer As more practitioners use these bioceramics MTA with microscopes gain experience and competence it could result in endodontics and regenerative procedures maintaining teeth for longer In considering all the evidence there is always a need to retain an anterior tooth even if it is compromised The justification is that if it remains functional even for only a few years it helps the patient have a functional tooth till the transition can be made to other treatment options 

A lot of studies have provided only short term data and longer studies over 20 years may indicate a higher success for endodontic treatment and lower for implants Looking at the future of implant studies there may be even less strict criteria adopted to define or underdiagnosed problems like peri implantitis in the future Lee et al 2017 For a patient having their own tooth allows the option to progress to an implant if that fails It gives a patient the opportunity to progress over their lifetime with the various treatment options modern dentistry can offer Teeth which would have been extracted in the past may now be considered using modern endodontics even if the long term data is lacking as the options also lack similar data

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