DTUK1910

July 19-25, 201022 Endo Tribune United Kingdom Edition cals such as sodium hypochlo- rite (bleach), EDTA and iodine to clean the intricate canal systems. Bleach is usually the medica- ment of choice due to its efficacy against pathogenic organisms and pulp digestion, and its con- centration for use varies from 0.5 per cent to 5.25 per cent. At low concentrations it is bactericidal whereas at higher concentra- tions tissue dissolution is im- proved. However, some forms of bac- teria such as enterococcus fae- calis are resistant to bleach. This microorganism is commonly de- tected in teeth with asymptomatic, persistent endodontic infections and its prevalence in such infec- tions ranges from 24 per cent to 77 per cent. Enterococci faecalis are hardy bacteria able to compete with other microorganisms, in- vade dentinal tubules, and resist nutritional deprivation. Cur- rently the most effective meth- ods used to combat these bac- teria within the root canal systems of teeth include the use of good aseptic technique, and soaking the tooth in iodine for ten minutes during treatment. After the root has been suc- cessfully treated and bacteria eliminated, the next challenge that must be overcome is how to keep bacteria out. Although the endodontist often will place a temporary seal after treatment, the duty of fitting a permanent restoration with a good coronal seal usually falls to the GDP. This will prevent coronal leak- age, which will inevitably com- promise the long-term prognosis of a root canal treated tooth. This should be done as soon as possible to protect the tooth and reduce the chance of frac- ture. Similarly, if the tooth lacks sufficient structure to hold the restoration and a post has to be placed, the post hole should be left empty for the minimum time possible and ideally dressed with calcium hydroxide. Indeed, no matter how well the root is treated, if the coro- nal seal is poor, the root treated canal may well fail and the pa- tient will have to return for fur- ther treatment. Can it be cleaned? In short, the clinician needs to ask themselves two fundamen- tal questions when considering Endodontic treatment: Can the root be cleaned and can we keep it that way? If the answer to both questions is yes, then endodon- tic treatment is a very effective option to reduce infection and relieve oral discomfort. With the help of a well-trained and efficient nurse who also appre- ciates the fundamental impor- tance of cleanliness in Endodon- tics, the patient can enjoy a very high success rate and make use of their natural teeth for many more years to come. DT page 21DTß About the author Dr Michael Sultan BDS MSc DFO is a specialist in En- dodontics and the clinical director of EndoCare. Michael qualified at Bris- tol University in 1986. He worked as a general dental practitioner for five years before com- mencing specialist studies at Guy’s hospital, London. He completed his MSc and in Endodon- tics in 1993 and worked as an in-house endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been in- volved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008, he became clinical director of Endocare a group of specialist practices. To talk to a member of the Endocare team call 020 7224 0999 or email reception@en- docare.co.uk or for more information please visit www.endocare.co.uk. Once you are rid of the bacteria - you have to keep them out! UKP00246 Increments up to 4mm without layering Flowable for excellent cavity adaptation Compatible with your current adhesive* For a free sample** please call or email us on: The revolutionary way to save time *Chemicallycompatiblewithmethacrylatebasedadhesivesandcomposites.**Limitedsamplesavailable +44 (0)1932 837303 (quoting free SDR sample)