Periapical alterations or irritations resulting from root canal therapy may be caused by over-instrumentation, infection or adverse effects from substances liberated from root canal filling materials. Chemotherapeutic agents containing formaldehyde are commonly used in the treatment of dental disease. Formaldehyde is known to local irritation and skin sensitization following acute and subacute exposure. The objective of this study was to evaluate AH 26, endomethasone, N2, AH plus, diaket, forfenan and roeko seal automix. (RSA) for the presence of the formaldehyde. Sealer's powder and liquid were analyzed before and after mixing formaldehyde analysis was done using high-performance liquid chromatography with thermo-separation products spectra system and photodiode assay. Analysis showed that the AH 26, endomethasone, N2 powders and forfenan liquid contained formaldehyde and and their mixture were releasing formaldehyde. It could not decetcted any formaldehyde in AH plus, diaket and RSA samples. Because endodontic sealers can get into contact with surrounding soft and hard tissues, they should have an acceptable biocompatibility. Sealers with inferior biocompatibility, such as formaldehyde-releasing materials, should no longer be applicable in practice because safer alternatives are available.

The purpose of this study was to compare the pre-treatment and post-treatment serum antioxidants levels in acute periradicular abscess, with pain. Thirty-two patients (18 males, 14 females) with acute and painful endodontic abscesses were included in this study. Before treatment, patients had severe symptoms of inflammation, but at the end of treatment no symptoms of inflammation were observed. Glutathione reductase and catalase activities concentrations were measured in serum of patients with acute periradicular abscess, before and after treatment. There was no statistically significant effect on levels of catalase activity and glutathione reductase concentrations (p > 0.05).

Objective: The periapical abscess is a collection of pus in the pulp or around the root of teeth. Many odontogenic infections can be managed without antimicrobial therapy or bacteriologic investigation. However, when an acute bacterial infection has progressed or antimicrobial therapy might be of benefit to patients, antibiotics are prescribed. We aimed to identify microorganisms in root canals with periapical abscess and their antimicrobial susceptibility profile in order to revise antimicrobial treatment protocols when antimicrobials are used empirically. Methods: 30 patients (all of whom had pain and swelling) with odontogenic infections were included in this study. The microbiologic investigation was performed under strict aseptic conditions. A standard routine root canal therapy was instituted, and in each case a single root canal was sampled. In multirooted teeth only the largest canal was sampled to preserve the identity of a single endodontic/microbiologic ecosystem. For microbial sampling, two sequential paper points were introduced into the full length of the canal, and kept in place for 1 min. One of the paper points was used for aerobic culture and the other one for anaerobic culture. To identify isolated bacteria, whole bacterial fatty acid profiles were evaluated by using a Microbial Identification System. Antimicrobial susceptibility results were obtained by disc diffusion test for aerobics, and E-test for anaerobics. Results: In total, 156 bacterial strains were isolated. Eighty-six of them were aerobic and 70 of them were anaerobic. Eighteen (60%) cultured specimens were mixed (aerobic and anaerobic). The most prevalent bacteria were Staphylococcus spp. (aerobic), Peptostreptococcus prevotii and Streptococcus morbillorum (anaerobic). Conclusion: Beta-lactam antibiotics combined with beta-lactam inhibitor (amoxicillinclavulanic acid) had a good effect on Gram (+) and Gram (−) aerobics. When we take into consideration that beta-lactam antibiotics stimulate production of beta-lactamase, amoxicillinclavulanic acid combination appears a good first step antimicrobial therapy. Clindamycin may be a second alternative for that purpose. For anaerobics, cefoxitin and metronidazol had good effect. Although imipenem and piperasilin-tazobactam are perfect, they should not be the first step of therapy. Due to the frequency of mixed infections, a combination of amoxicillinclavulanic acid and metronidazol or a combination of clindamycin and metronidazol have a good effect on mixed infections.Keywords: MICROBIAL IDENTIFICATION SYSTEMPERIAPICAL ABSCESSANTIMICROBIAL SUSCEPTIBILITYPAIN AND SWELLING

Aims: The purpose of this study is to evaluate the efficacy of drug combination on the flare up that may occur after pulpectomy in patients treated for painful irreversible pulpitis. Material and methods: Thirty emergency patients were included in the study. All the patients who participated in the study suffered from irreversible pulpitis with spontaneous moderate-to-severe pain. The patients were randomly divided into two groups of 15 patients, all of whom were subjected to endodontic treatment. They were randomly classified as Group A, to whom medicine combination was administered, and Group B to whom medicines were not administered. The ingredients of the combination were 50 mg of diclofenac potassium, 500 mg of amoxicillin trihydrate and 250 mg ornidazol. Pain in the groups was statistically compared according to Mann–Whitney and Wilcoxon Signed Ranks test before and after the endodontic treatment. Results: The general evaluation of the pain in patients subjected to the administration of the medicine combination showed a significant difference (p < 0.05) in the relief of pain in the first 6 h and at the end of the first week as compared with those to whom nothing was administered. It can be concluded from the results that this medicine combination can be helpful in the control of pain due to endodontic treatment.

Nitric oxide (NO) affects both pain and inflammation in human tissues. Pharmacotherapy that decreases NO concentrations may have utility in treating inflammatory painful conditions. To determine the types of disorders in which such an approach should be studied, changes in NO serum levels before and after the painful inflammatory condition resolves would be helpful. This study compared the pre-treatment and post-treatment serum nitric oxide (NO) concentrations in irreversible pulpitis (inflammatory toothache). Thirty-two patients (16 males, 16 females) with irreversible pulpitis were included in this study. Before treatment, patients had severe symptoms of inflammation, but at the end of treatment no symptoms of inflammation were observed. NO concentrations were measured in serum of patients with irreversible pulpitis, before and after treatment. Differences in serum NO concentrations were not statistically significantly different before and after treatment.

Fusion and germination are developmental anomalies of the dental hard tissue. A case of a supernumerary tooth fused to the facial surface of a maxillary first premolar is reported with pain in the maxillary premolar area Clinical examination showed two separated crowns with united roots. This case was treated successfully in multiple appointments. The difference between fusion and germination is discussed.

Aims: The purpose of this study was to compare the pre-treatment and post-treatment serum antioxidants levels in acute periradicular abscess (APA), with pain. Method: Thirty-two patients (18 males, 14 females) with acute and painful endodontic abscesses were included in this study. Before treatment, patients had severe symptoms of inflammation, but at the end of treatment no symptoms of inflammation were observed. Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities, and malondialdehyde (MDA) concentrations, were measured in serum of patients with APA, before and after treatment. Results: There was no statistically significant effect on levels of SOD activity and MDA concentrations. The levels of GSH-Px activity increased significantly (p < 0.05) after endodontic treatment.

Three cases with adjacent periapical lesions are described. During root canal treatment, 0.15% benzydamine HCl for pain and 0.12% chlorhexidine gluconate for intracanal cleaning were used before the placement of the root canal sealer (Sealapex, Ca(OH)2 based). Total periapical healing was observed after six months.

Maxillary premolars have a highly variable root canal morphology, but it is rare to find three canals. This article describes the diagnosis and clinical management of a first premolar with three canals and three separate roots.

The purpose of this study was to compare the surface pH level of four different type sealers after mixing at various time intervals in vitro. After cleaning and shaping root canals in 50 recently extracted, single-rooted human teeth, they were divided into six groups. Each of four groups was obturated with Apexit, N2, Sealapex, and Grossman sealers. The remaining groups served as controls. In group 1 nothing was added to the vial of saline solution. In group 2 canals had been instrumented but not obturated with sealer. The pH level of saline solutions was determined at intervals of 1 hour, 4 hours, 1 day, 2 days, 3 days, 1 week, and 4 weeks after teeth were placed in them. The pH levels of the five solutions were compared to each other and to that of saline solution only.

A case is discussed of a 21-year-old female with a large peripheral lesion around the apices of mandibular incisors after trauma to the mandibular anterior teeth that occurred 9 years previously. During root canal treatment, 0.15% benzydamine HCl for pain and 0.12% chlorhexidine gluconate were used for the intracanal dressing and, as a base of the root canal sealer, sealapex, which is Ca(OH)2 based, was used. Total periapical healing was observed 12 months later.