From: Dr.Mohammed Al Shehri
Date: Fri, 19 Mar 2010 11:25:37 +0300
Subject: AEEDC 2010 presentation

Hi Mohammed,

Congratulations on very nice presentation.
I would only add that after EDTA I always use a final flash with 2.5 % hypochlorite and 3 % hydrogen peroxide
( or sometimes saline followed by metronidazole saline solution ).

I would kindly suggest that you try a single cone with "capillary condensation" technique of  Dr.Deyan Kosev
and use of bioceramic sealer in a same way as you have used AH Plus - i.e. Lentulo and also sealer over a single cone.
Only take care, so that the tip of the cone be located 1 mm less than WL. This way last mm will be filled with
bioceramic only. Yes, I am biased :-) , but bc sealer is a good tool against E. faecalis and maintains pH 12 for
at least 78 hours after filling of the canal.It also does not shrink at all and bonds to dentin of the canal's walls.

It is nice to see these conofocal laser electron microscopies, too ( were these given to you by Gustavo or they were
made at your University ? ). -  Valeri Stefanov

To Valeri Stefanov:

I would only add that after EDTA I always use a final flash with 2.5 %
hypochlorite and 3 % hydrogen peroxide ( or sometimes saline followed by
metronidazole saline solution )

On what occasions do you use metronidazole saline solution? Why is it more
benefitial? What would be the concentration of the mix? - >Anne-Ly

Hi Anne, I am using Metronidazole in all non-vital cases. It has good antibacterial activity against anaerobic
bacteria causing dental infections. ( it is also a part of 3x paste ). The solution I am using is called EFLORANE
( Krka - Slovenia ). One 100 ml bottle contains 500 mg metronidazole, so 1ml contains 5 mg of metronidazole.
That is the solution normally used for IV applications of the drug.

Its use combined with excellent activity of iRootSP bioceramic sealer against Ent. faecalis allow me to have good
final results. - Valeri

Hello! Thank you for the clarification.
In what method are you using EFLORANE (plain syringe irrigation, manual
dynamic agitation, US or something else?) Can you post your full
irrigation protocol in non-vital teeth? (Perhaps you have already done
that in earlier times, I have been reading ROOTS only for 5 months:) - Anne-Ly

Anne-Ly, I am using Metronidazole with plain syringe irrigation.

I am starting vital cases with RC Prep and non-vital cases with EDTA 17 % solution with  #06 K file, #08 K file
and  #10 D finder MANI - Japan file.

Starting with # 15 K file I am using 2.5 %  hypo inside chamber, while I am instrumenting the canal and I am
irrigating with 2 ml hypo before use of next size file. I create glide path with hand files up to # 25 and then
I use currently HERO Shaper Difficult sequence set machine files ( Micro-Mega France good price for high quality ).
At the end I am enlarging / instrumenting  the apical third depending on the case with
different size .02 hand K files  - # 35, 40 and up. After the canal is fully instrumented the final irrigation
consists of 2 ml  2.5 % hypo, 2ml EDTA 17% solution, again 2 ml 2.5 % hypo followed by 2ml 3% hydrogen peroxide
or saline. Finally in re-treatment and non-vital cases, incl. those with pa lesion - 2 - 4 ml metronidazole solution
Drying with PP followed by  "capillary condensation" with bioceramic sealer and single-cone gutta (in certain cases
additional smaller size  .02 cones are added ).

Aim is that canal walls to be in contact with bioceramic only and most apical 1 mm to be filled by bioceramic only.
- Valeri

From: Valeri Stefanov
To: ROOTS
Sent: Wednesday, March 24, 2010 6:48 AM
Subject: Re:[roots] AEEDC 2010 presentation

See attached instructions for use of HERO Shaper Difficult Sequence files set ( Yellow ) - Valeri




Hello, I want to ask you what is the difference  if we use Clorhexidin 2% at the end? - Dunia

Dunia, If you mean clinical results there will be no difference.

Metronidazole  is 5 times cheaper :-) here and carries no risk if some of it, by incident,
is spilled out inside the mouth. - Valeri

Heji Valeri, Do you mean Chlorhexidin and Metronidazole antagonize -about- the same range of bacteria species?
How long would you leave both of them them into the canal? I leave chorhexidine 1 minute into the canal.
- Cheers, August

Heji August, I can't remember saying the antibacterial activity of CHX and Metro are the same :-) !
Anyway, I doubt you will find any statistically significant difference in final outcome after using one or another
as a final rinsing. If you mix CaOH with 1 % CHX and leave it in the canal for a week or more results may be different
of course. Here we are talking just final rinsing of the canal.

Remember I am using bioceramic sealer with excellent activity against Ent. faecalis :-)) for 78 hours after filling !
It is different from AH Plus which after hardening does not show any antibacterial activity at all.  -  Valeri