Dentinal tubules of 27 cylindrical bovine root specimens were infected with Enterococcus faecalis. In nine specimens, 5% chlorhexidine was placed in a slow-release device (Activ Point) for 7 days, in another nine irrigation with 10 ml of 0.2% chlorhexidine was used, and the remaining nine served as positive control. Powder dentin samples obtained from within the canal lumina using ISO 025 to 033 burs were examined for the presence of vital bacteria by inoculating brain-heart infusion plates and counting colony forming units. Results were analyzed using analysis of variance and covariance with repeated measures. Heavy bacterial infection was observed at the layer close to the lumen in the control specimens, decreasing rapidly from layer to layer up to the deepest layer tested (400-500 microm), which contained several hundred colony forming units. Viable bacteria in each layer of dentin were significantly reduced with chlorhexidine irrigation solution (p< 0.01) and were completely eliminated with the chlorhexidine slow-release device (p < 0.01).

There are several protocols for the successful management of dental trauma emergencies. However, these existing protocols are inconsistent regarding several issues. As the Israeli dental community and patients have specific characteristics, a modified and adaptable protocol was required. This new protocol contains simple and straightforward clinical guidelines, arranged in table format, according to the nature of the trauma. The present study shows the protocol for luxation and avulsion injuries, with new recommendations for the treatment of luxated closed-apex teeth, the preferred at-site treatment and storage medium for avulsed teeth, and the conditioning of the root surface in these cases. To emphasize and explain the modification of this new protocol, research-based information has been incorporated.

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