Treatment of infected root canals and apical periodontitis with penicillin

Treatment of infected root canals and apical periodontitis with penicillin

I.72 QUARTERLY REVIEW OF 1,ITERATI:RE If one stands back for a moment and surve,yw the scene of modern medicine and dontistq-, one sees how very, ...

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I.72

QUARTERLY

REVIEW

OF 1,ITERATI:RE

If one stands back for a moment and surve,yw the scene of modern medicine and dontistq-, one sees how very, very commou rcmiovat therapy liar become-tonsillectomy, alqientlectomy, and necrodontectomy add up to a majorit.~ of all operatiour; performed. mtd I venture to say that. most of these operations are unnecessary, based on faith nu~t So ORC would takt: except.ion to removing :L impressions, not on reason and evidence. tonsil, an appendix, or a dead tooth because of persistiog local pain or discomfort, but to remove them in the hope of curing :L srstemir disease is something else again rind is merely These operations are the more populsr liecsuse the operative morclutching at a straw. tality is uot high, although the risk should not. bv (tisrcgarded. One form of removal therapy-the removal of the large colon-was attended 11~ consideralite mortality, and r,:ilie, criuld not save colec~tomy from RVC~ the reputation of its author, Sir Arl~uthnot Sir Arbuthnot I.anc? :tdvocated colectomy for much the same reitso11 that doctors oblivion. and dentists advorate nerrotlo~~ttteto~~1~-to prevent ttlv at)sorl)tion of hvpothet ic*al toxins.

ENDODONTIA Behandling af iniicerede rodkanaler og apikale paradentiter med penicillin. (Treatment of Infected Root Canals and Apical Periodontitis With Penicillin.) Else Rasmussen. Denmark Dental School. Tantllaegel~lud~~t 52: 24’b”V . _( -, Ortober ,* 104X* A total of twenty-nine teeth with uecrotic root. canals and periapical infection were treated with penicillin by me&n* of irrigation (~O,OOO-100,000 units/c.e.) and insertion of Penicitliu was found to maintain its penicillin-soaked paper points (2,500.5,000 uuitw). effectiveness in the root canals for three to four days, when sealed with wax, but its action with zinc-oxide eugenol. appeared somewhat diminished when in rontact The micro. organisms of eighteen out of the twenty-nine! treated teeth were resistant to the penicillin Only in five cases was it possible to obtain sterilization of the root wnats Ii> treatment. means of the penic.illin treatment. I<. E’. 8.

Der prim&e

Erfolg der Wurselkanalbehandlung.

H. Langer.

Ztnchr.

f. Htomatol.

(Primary 46: 339, l!MX.

Success in Root Canal Therapy.)

A great variety of disinfecting methods and filling materials have Ijeeu advoc!ate~l heretofore, but one of the major factors of .cu~cess iu root canal therapy st.ilt in the conplete removal of all pulpal material and obturatiou to the apex. The Vienna school looks back on 71) per cent success in root canal treatment. with roots lilled to the apex, while in the major number of failures incomplete root filling is found. The animal experiments of Gottlieb, Kchwarz, and Stein, consisting of implantation of root t.ips (apical third) into connective tissue confirm the previous statemeut, since success of the operation mainI\ depended on the fact that the root canal was cleaned of all organic material and was fillet1 well, while partially filled or unfilled roots proved t.o he failures. Isut there is another aspect of the question. .k’aitures in root WIlitl ther;tpy ilrt! Illowl Tht! I’t’ilROIl is frequent in molars, p articularly the upper first molar (X1.4 per cent). obviously the insufficient removal of pulp and incomplete iilling. The percentage of failures in premolars and front teeth clearly points out t,he decreasing ditliautt~y in ot)taining Bent canals, ac*cessor~ canals, insufticient view of suficientlp cleaned and filled canals. uuder sterile conditions the pulpal cavity and canal openings, and dittic?ultg iu proceeding are more frequent when treating molars. It. in striking, however, that suwess iu molar treatment is slightly higher for gangrenous ones. I’rol~root. r than it is for devitalized ably a more careful evaluation of the indiwtiou for t watment~ and increased care in t.hr technique of cleansing and disinfecting are thtl reasons. Again, inoomptet.c lilling was l+rthar caunw were: breaking seen to be responsible for most failures. of instruments, false route, au11 leaking apical obturations. Stein has shown that, depending ou the different types of teet.h, X6 to 100 per cent of them havtt roots t,hat wn be reamed to tl1e apex.