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May 17-23, 201020 Implant Tribune United Kingdom Edition opathogenic effect; additionally, it may destroy surrounding tissue resulting in the five classic signs and symptoms of inflammation; calor, dolor, rubor, tumor and pe- nuria. Patient evaluation and the appropriate diagnosis/treatment of the source of an infection are of utmost importance. Patients demonstrating signs and symptoms associated with severe endodontic infection (Ta- ble I) should have the root canal system filled with calcium hy- droxide and the access sealed. In the event of copious drainage, the access can be left open for no longer than 24 hours, the tooth then isolated with rubber dam, the canals irrigated and dried and calcium hydroxide inserted into the root canal space and the access sealed (10) . The anti- biotic of choice for periradicular abscess remains Penicillin VK; however, recent studies have re- ported that amoxicillin in com- bination with clavulinate (1gm loading dose with 500mg q8h for seven days) was a more effective therapeutic regimen (11) . Systemic antibiotic adminis- tration should be considered if there is a spreading infection that signals failure of local host re- sponses in abating the dispersion of bacterial irritants, or if the pa- tient’s medical history indicates conditions or diseases known to reduce the host defense mecha- nisms or expose the patient to higher systemic risks. Antibiotic treatment is generally not recom- mended for healthy patients with irreversible pulpitis or localised endodontic infections (Table II). Numerous studies with well- defined diagnosis and inclusion criteria failed to demonstrate en- hanced pain resolution beyond the placebo effect (12, 13) . The sophistication of endo- dontic equipment, materials and techniques has been steadily it- erated and innovated since the second survey. The microscope first introduced to otolaryngology around 1950, then to neurosur- gery in the 1960s, is now stand- ard of care for the voyage into the microcosmic world of the root canal system. Recursions in the micro-processing technologies of electronic foramenal locators be- gat unprecedented accuracy lev- Figs 5a, 5b – Flat field sensors provide a sense of the extent of osseous pathology; however, the periapical radiographic image corresponds to a two-dimensional aspect of a three dimensional structure. Periapi- cal lesions confined within the cancellous bone are usually not detected. Thus a lesion of a certain size can be detected in a region covered by a thin cortex, whereas the same size lesion cannot be detected in a region covered by thicker cortex. Fig 6 – All cone beam tomography units provide correlated axial, coronal and sagittal multiplanar volume reformations. Basic enhancements include zoom or magnification and visual adjustments to narrow the range of grey-scale, in addition to the capability to add annotation and cursor-driven measurement. Fig 7 – Strategic extension of the access perimeter is too of- ten undervalued in terms of successful endodontic treatment outcomes. The shape of the chamber must be regressed to its native state to ensure that axial interference is negated as an instrument traverses the length of the root canal space. page 19DTà Untitled-14 1 3/12/09 10:23:32