Scanning microscopic evaluation of canal dkbridement as compared to present methods
Samples on paper points wwe olktincd from root canals of thirty-one teeth at diff(wnt, treatment intervals and cw~luated for exudate, suhjectcd to l~actc~riologic auxlysis, and/or cxarninetl with the scanning electron microscope (SEM). Exudate was prcwnt on twenty-six specimens, llositive cultures verv wportcd in forty-ones spwirrw~~s, and SEA1 analysis rcvexlcd the presence of debris in fifty-eight sl~ecimnw.
T
horough shaping, tlccolltamillatioll, and dCbritlement of the root canal arc eswntial to satisfactory cwdodontic therapy. In order to estimate that these CSMW tials are attained, the therapist may apply subjective standards, such as the prcs(‘llcc’ of exudate or bacteriologic laboratory analysis. Most stutlies support the use of the culture technique in endoclontic practiw, but man;. rc~otnmentl that a better means of monitoring the microbial status of the root canal bc established1 A negative culture is not in itself a firm determinant of sterility of the root canal.‘)-- Because of its tloubtful relevancy as an iw tlicator. the culture test has been abandoned by some inr-cstigators.“~ 4 Sinw there are, as yet, no now methods for evaluating canal &britlcment, nor a comparison available bctwccn the presence of csudatc aljcl l)acteriologic w11tamination, a study was designed to investigate this area furthrr. This report will describt~ the wrrclation between the prcsencc of exudate, bacteriologic contamina’ Ikpartnwnt
of E:ndodontics,
Dental
‘“Chief, Ilepartment of Biophysics, Reed Army Medical Center. ““Dirwtor, Endodontk Residency, \I-alt(‘r Rwtl Army Medical Center.
Activities, MEI)l)AC, United States Army
Fort Henning, Ga. Institute of Ikwtal
Rescwrch,
I:nitcd
Institute
Research,
\Valtcr
States
Army
of
Ikntal
113
Oral surg. .I ul,v. 1977
Single isolate5 Streptococcu\ alpha
beta gamma enterococcl bovis epidermicuh Staphylococcuh Lactobacillus Diphtheroid Mixed isolates
Total
points
,1
Fi{/. 1. Scanning electron micrograpll (SEM) Note the wllulosc
intr:lpoint port’s,
fibers of the pnpcr point (Magnification, ~1,000.)
(PF),
of a paper point wit11no the lutirlg matwixl (I,/,
visil)lc contaminant. and the numrrous
exi~mind for cell content, mic~i~oorganisms, and other debris at various powers from x200 to x2,000. The surface material was graded for presence or absence on the micrograph at x200 magnification. RESULTS
The time for completion of root canal therapy ranged from 2 to 5 weeklyspawd visits, averaging 2.3 visits for anterior teeth and 3.5 visits for posterior twth. The types of organisms reportctl were streptococcus, staphylococcus, lactolwcdlus, and tliphthcroitl (Table I). The results of the ninety-one paper point samples rccordcd for presence of esudatc, bacteriological culture, and scanning niicwswq).v are presented in Table 11. Exudate was observed on twenty-six specilll(ws. Positive culture reports were received on forty-one spe&iens. SEX analysis revealed the presence of debris on fifty-eight specimens. Exudate-culturcl ol~servations wcrc in agrcemcnt iii fifty-tight (64 per vent) cases, csudatc and SfCM in fifty-three (58 per cent), and culture ant1 SE&I in fifty-six (62 per cent) of’ the cases. All three modes of analysis wt’rc in agreement in thirty-eight (42 per cent) of the specimens studied In thirty-five specimens, exudate was absent, yet SERl obserrations were positive. Twenty-six specimens w&h negative culture
S,‘(
tic ‘S)
1>'iq. .5. d4, SF31 of paper point completely covered with red blood cells. (Magnific x“o0. ,) B. Higher rrmpific:~tion of A (~5,000) showing red blood cells (Eh’C) and adj&?nt ((‘1 which :~pp~ar singly 3s well as in clusters on the point fiber (PF).
ation, COCCl
C101~11dCDride?)tr?tf
121
REFERENCES 13. N., ant1 Hchildw, H. : Inthmmation an11 Infection of tllcs Pulp ant1 Pt,ri:rpival ‘I’issuc: ,I Synthesis, ORAL tir7Rc;. 34: 498-501, 19%. 2. Inglv, .J. I., and Zeldow, B. J.: Eraluntion of Xechnnical lllstrumc~nt;tti~l~ au11 Kcy+ptivc (‘ulturc~ in Endodontic Therapy, J. Am. Dent. Assoc. 57: 4714i6, 1954. 3. &wlcr, I. I
Samples on paper points wwe olktincd from root canals of thirty-one teeth at diff(wnt, treatment intervals and cw~luated for exudate, suhjectcd to l~actc~riologic auxlysis, and/or cxarninetl with the scanning electron microscope (SEM). Exudate was prcwnt on twenty-six specimens, llositive cultures verv wportcd in forty-ones spwirrw~~s, and SEA1 analysis rcvexlcd the presence of debris in fifty-eight sl~ecimnw.
T
horough shaping, tlccolltamillatioll, and dCbritlement of the root canal arc eswntial to satisfactory cwdodontic therapy. In order to estimate that these CSMW tials are attained, the therapist may apply subjective standards, such as the prcs(‘llcc’ of exudate or bacteriologic laboratory analysis. Most stutlies support the use of the culture technique in endoclontic practiw, but man;. rc~otnmentl that a better means of monitoring the microbial status of the root canal bc established1 A negative culture is not in itself a firm determinant of sterility of the root canal.‘)-- Because of its tloubtful relevancy as an iw tlicator. the culture test has been abandoned by some inr-cstigators.“~ 4 Sinw there are, as yet, no now methods for evaluating canal &britlcment, nor a comparison available bctwccn the presence of csudatc aljcl l)acteriologic w11tamination, a study was designed to investigate this area furthrr. This report will describt~ the wrrclation between the prcsencc of exudate, bacteriologic contamina’ Ikpartnwnt
of E:ndodontics,
Dental
‘“Chief, Ilepartment of Biophysics, Reed Army Medical Center. ““Dirwtor, Endodontk Residency, \I-alt(‘r Rwtl Army Medical Center.
Activities, MEI)l)AC, United States Army
Fort Henning, Ga. Institute of Ikwtal
Rescwrch,
I:nitcd
Institute
Research,
\Valtcr
States
Army
of
Ikntal
113
Oral surg. .I ul,v. 1977
Single isolate5 Streptococcu\ alpha
beta gamma enterococcl bovis epidermicuh Staphylococcuh Lactobacillus Diphtheroid Mixed isolates
Total
points
,1
Fi{/. 1. Scanning electron micrograpll (SEM) Note the wllulosc
intr:lpoint port’s,
fibers of the pnpcr point (Magnification, ~1,000.)
(PF),
of a paper point wit11no the lutirlg matwixl (I,/,
visil)lc contaminant. and the numrrous
exi~mind for cell content, mic~i~oorganisms, and other debris at various powers from x200 to x2,000. The surface material was graded for presence or absence on the micrograph at x200 magnification. RESULTS
The time for completion of root canal therapy ranged from 2 to 5 weeklyspawd visits, averaging 2.3 visits for anterior teeth and 3.5 visits for posterior twth. The types of organisms reportctl were streptococcus, staphylococcus, lactolwcdlus, and tliphthcroitl (Table I). The results of the ninety-one paper point samples rccordcd for presence of esudatc, bacteriological culture, and scanning niicwswq).v are presented in Table 11. Exudate was observed on twenty-six specilll(ws. Positive culture reports were received on forty-one spe&iens. SEX analysis revealed the presence of debris on fifty-eight specimens. Exudate-culturcl ol~servations wcrc in agrcemcnt iii fifty-tight (64 per vent) cases, csudatc and SfCM in fifty-three (58 per cent), and culture ant1 SE&I in fifty-six (62 per cent) of’ the cases. All three modes of analysis wt’rc in agreement in thirty-eight (42 per cent) of the specimens studied In thirty-five specimens, exudate was absent, yet SERl obserrations were positive. Twenty-six specimens w&h negative culture
S,‘(
tic ‘S)
1>'iq. .5. d4, SF31 of paper point completely covered with red blood cells. (Magnific x“o0. ,) B. Higher rrmpific:~tion of A (~5,000) showing red blood cells (Eh’C) and adj&?nt ((‘1 which :~pp~ar singly 3s well as in clusters on the point fiber (PF).
ation, COCCl
C101~11dCDride?)tr?tf
121
REFERENCES 13. N., ant1 Hchildw, H. : Inthmmation an11 Infection of tllcs Pulp ant1 Pt,ri:rpival ‘I’issuc: ,I Synthesis, ORAL tir7Rc;. 34: 498-501, 19%. 2. Inglv, .J. I., and Zeldow, B. J.: Eraluntion of Xechnnical lllstrumc~nt;tti~l~ au11 Kcy+ptivc (‘ulturc~ in Endodontic Therapy, J. Am. Dent. Assoc. 57: 4714i6, 1954. 3. &wlcr, I. I
