Effect of Post Placement on the Restoration of Endodontically Treated Teeth: A Systematic Review.

PubMed

Zhu, Zufeng; Dong, Xiao-Yu; He, Shuai; Pan, Xiangqing; Tang, Lifang

2015-01-01

The aim of this study was to assess the effect of root canal post placement on the restoration of endodontically treated teeth. PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and two Chinese databases (China National Knowledge Internet and the Wan-fang database) were searched to identify randomized or quasi-randomized clinical trials related to post-and-core systems for the restoration of endodontically treated teeth. Studies published prior to August 2013, performed on humans, and written in English or Chinese were considered for inclusion. Two of the authors independently extracted data and assessed the quality of the selected studies. Three studies involving 317 participants were included in the review. Meta-analysis revealed that the risk of overall failure was greater with nonpost (104/271) than with post (78/377) restorations, irrespective of the number of remaining coronal walls (risk ratio [RR] = 0.41; 95% confidence interval [CI], 0.23 to 0.74). The risk of catastrophic failure was greater with nonpost (24/227) than with post (4/329) restorations, irrespective of the remaining coronal walls in restored teeth (RR = 0.11; 95% CI, 0.04 to 0.31). When three or four coronal walls remained, no catastrophic failure occurred in either the post group or the nonpost group. The difference in noncatastrophic failure between the two groups had no statistical significance no matter how many coronal walls remained (P > .05). Post placement appears to have a significant influence on reducing the catastrophic failure rate of endodontically treated teeth. When three or four coronal walls remain, post placement seems to have no influence on the restoration of endodontically treated teeth.

Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up.

PubMed

Natera, Marianella; Mukherjee, Padma M

2018-06-01

Dens evaginatus is a developmental tooth anomaly in which an extra cusp or tubercle protrudes on the occlusal surface of the tooth along with some pulpal tissue. Because of the fragile nature of the protrusion, these teeth are often at risk of pulpal exposure. When this occurs in an immature tooth, regenerative endodontic treatment may be a good treatment approach to promote root formation. There is limited literature that documents the occurrence of orthodontic treatment in teeth that have undergone regenerative endodontic therapy using triple antibiotic paste. Here we present a case of an immature premolar tooth with dens evaginatus that was diagnosed with pulp necrosis and chronic apical abscess. The tooth was treated with regenerative endodontic treatment; after which, the patient received orthodontic treatment with fixed appliances for 2 years. The tooth responded favorably to the regenerative endodontic treatment and orthodontic tooth movement. Clinically and radiographically, all the follow-up examinations revealed an asymptomatic tooth with evidence of periapical healing with stunted root development. The tooth remained asymptomatic even after 4 years. The regenerative endodontic procedure (REP) was successful in treating an immature permanent premolar with pulp necrosis and apical periodontitis with dens evaginatus. In this case, the tooth treated with an REP responded to orthodontic treatment similar to the nonendodontically treated teeth. Further studies are recommended to clarify the precise effects of orthodontic treatment on teeth treated with an REP. Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The reinforcement effect of polyethylene fibre and composite impregnated glass fibre on fracture resistance of endodontically treated teeth: An in vitro study

PubMed Central

Luthria, Archana; Srirekha, A; Hegde, Jayshree; Karale, Rupali; Tyagi, Sanjana; Bhaskaran, Sajeev

2012-01-01

Aim: The aim of this study was to evaluate the fracture resistance of endodontically treated maxillary premolars with wide mesio-occluso-distal (MOD) cavities restored with either composite resin, or composite resin reinforced with different types of fibres. Materials and Methods: Fifty human maxillary premolars were selected. Five intact teeth served as positive controls. Endodontic therapy was carried out in the remaining forty-five teeth. Standardized MOD cavities were prepared in all the teeth. The teeth were restored with a nanocomposite using an incremental technique. These forty five teeth were randomly divided into three experimental groups (Group A, B and C) (n = 15). The teeth in Group A did not undergo any further procedures. The teeth in Group B and C were reinforced with composite impregnated glass fibre and polyethylene fibre, respectively. Fracture resistance was measured in Newtons (N). Results: The positive controls showed the highest mean fracture resistance (811.90 N), followed by Group B (600.49N), Group A (516.96N) and Group C (514.64N), respectively. One Way analysis of variance (ANOVA) test revealed a statistically significant difference between all the groups (P = 0.001). Post-hoc Tukey test revealed a moderately significant difference (P = 0.034) between Control and Group B, and a strongly significant difference between Control and Group A (P = 0.002), and Control and Group C (P = 0.001). Conclusions: Endodontic therapy and MOD cavity preparation significantly reduced the fracture resistance of endodontically treated maxillary premolars (P = 0.001). No statistically significant difference was found between the experimental groups (Group A, B and C) (P > 0.1). However, the fracture resistance of the composite impregnated glass fibre reinforced group was much higher than the others. PMID:23112487

Fracture resistance of endodontically treated teeth restored with Zirconia filler containing composite core material and fiber posts.

PubMed

Jeaidi, Zaid Al

2016-01-01

To assess the fracture resistance of endodontically treated teeth with a novel Zirconia (Zr) nano-particle filler containing bulk fill resin composite. Forty-five freshly extracted maxillary central incisors were endodontically treated using conventional step back preparation and warm lateral condensation filling. Post space preparation was performed using drills compatible for fiber posts (Rely X Fiber Post) on all teeth (n=45), and posts were cemented using self etch resin cement (Rely X Unicem). Samples were equally divided into three groups (n=15) based on the type of core materials, ZirconCore (ZC) MulticCore Flow (MC) and Luxacore Dual (LC). All specimens were mounted in acrylic resin and loads were applied (Universal testing machine) at 130° to the long axis of teeth, at a crosshead speed of 0.5 mm/min until failure. The loads and the site at which the failures occurred were recorded. Data obtained was tabulated and analyzed using a statistical program. The means and standard deviations were compared using ANOVA and Multiple comparisons test. The lowest and highest failure loads were shown by groups LC (18.741±3.02) and MC (25.16±3.30) respectively. Group LC (18.741±3.02) showed significantly lower failure loads compared to groups ZC (23.02±4.21) and MC (25.16±3.30) (p<0.01). However groups ZC (23.02±4.21) and MC (25.16±3.30) showed comparable failure loads (p=0.23). Fracture resistance of endodontically treated teeth restored with Zr filler containing bulk fill composite cores was comparable to teeth restored with conventional Zr free bulk fill composites. Zr filled bulk fill composites are recommended for restoration of endodontically treated teeth as they show comparable fracture resistance to conventional composite materials with less catastrophic failures.

Endodontic Procedural Errors: Frequency, Type of Error, and the Most Frequently Treated Tooth.

PubMed

Yousuf, Waqas; Khan, Moiz; Mehdi, Hasan

2015-01-01

Introduction. The aim of this study is to determine the most common endodontically treated tooth and the most common error produced during treatment and to note the association of particular errors with particular teeth. Material and Methods. Periapical radiographs were taken of all the included teeth and were stored and assessed using DIGORA Optime. Teeth in each group were evaluated for presence or absence of procedural errors (i.e., overfill, underfill, ledge formation, perforations, apical transportation, and/or instrument separation) and the most frequent tooth to undergo endodontic treatment was also noted. Results. A total of 1748 root canal treated teeth were assessed, out of which 574 (32.8%) contained a procedural error. Out of these 397 (22.7%) were overfilled, 155 (8.9%) were underfilled, 16 (0.9%) had instrument separation, and 7 (0.4%) had apical transportation. The most frequently treated tooth was right permanent mandibular first molar (11.3%). The least commonly treated teeth were the permanent mandibular third molars (0.1%). Conclusion. Practitioners should show greater care to maintain accuracy of the working length throughout the procedure, as errors in length accounted for the vast majority of errors and special care should be taken when working on molars.

Regenerative endodontics: A way forward.

PubMed

Diogenes, Anibal; Ruparel, Nikita B; Shiloah, Yoav; Hargreaves, Kenneth M

2016-05-01

Immature teeth are susceptible to infections due to trauma, anatomic anomalies, and caries. Traditional endodontic therapies for immature teeth, such as apexification procedures, promote resolution of the disease and prevent future infections. However, these procedures fail to promote continued root development, leaving teeth susceptible to fractures. Regenerative endodontic procedures (REPs) have evolved in the past decade, being incorporated into endodontic practice and becoming a viable treatment alternative for immature teeth. The authors have summarized the status of regenerative endodontics on the basis of the available published studies and provide insight into the different levels of clinical outcomes expected from these procedures. Substantial advances in regenerative endodontics are allowing a better understanding of a multitude of factors that govern stem cell-mediated regeneration and repair of the damaged pulp-dentin complex. REPs promote healing of apical periodontitis, continued radiographic root development, and, in certain cases, vitality responses. Despite the clinical success of these procedures, they appear to promote a guided endodontic repair process rather than a true regeneration of physiological-like tissue. Immature teeth with pulpal necrosis with otherwise poor prognosis can be treated with REPs. These procedures do not preclude the possibility of apexification procedures if attempts are unsuccessful. Therefore, REPs may be considered first treatment options for immature teeth with pulpal necrosis. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

Fracture resistance of endodontically treated molars restored with horizontal fiberglass posts or indirect techniques.

PubMed

Bromberg, Carolina Ritter; Alves, Caroline Beatriz; Stona, Deborah; Spohr, Ana Maria; Rodrigues-Junior, Sinval Adalberto; Melara, Rafael; Burnett, Luiz Henrique

2016-12-01

Because of the many possibilities for endodontically restoring the posterior teeth and the high prevalence of restoration failures, this topic continues to be of major concern. A composite resin (CR) restoration reinforced by a horizontal fiberglass post may improve the fracture resistance of endodontically treated teeth. The authors investigated this possibility by comparing the fracture resistance of molars restored with direct techniques with that of molars restored with indirect techniques. The authors divided 50 extracted sound third molars into 5 groups: sound teeth, onlay (ON), inlay (IN), direct CR, and transfixed fiberglass post (TFP) plus direct CR. The authors performed standardized mesio-occlusodistal cavity preparations and endodontic treatments. The authors cemented indirect restorations of Lava Ultimate (3M ESPE) adhesively in the ON and IN groups. The authors restored CR group teeth directly with Filtek Z230 XT (3M ESPE). In the TFP group, the authors transfixed 2 fiberglass posts horizontally and restored the teeth directly with CR. Thereafter, the authors submitted the teeth to cyclic fatigue loading with 500,000 cycles at 200 newtons. The authors tested fracture resistance in newtons in a universal testing machine. The authors analyzed data with 1-way analysis of variance and a Tukey test (P < .05). Sound teeth had the highest fracture resistance. ON had the highest recovery of resistance, followed by TFP. CR had the lowest recovery, which was similar to that of IN. Endodontically treated molars restored with TFP plus CR had fracture resistance similar to those restored with ON, which was higher than that for IN or CR only. Horizontal TFPs placed inside a composite restoration had the same performance as did ON restorations. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

The effect of the duration of intravenous zolendronate medication on the success of non-surgical endodontic therapy: a retrospective study.

PubMed

Dereci, Ömür; Orhan, Ekim Onur; Irmak, Özgür; Ay, Sinan

2016-02-01

Aim of this study is to compare the clinical and radiographic success of non-surgical endodontic therapy in patients receiving intravenous zolendronate less than 1 year and more than 1 year. The clinical and radiographic follow-up data of 24 patients who were receiving IV zolendronate with 37 teeth were retrieved from the archives to evaluate clinical and radiographic healing at the end of 12 months after non-surgical endodontic therapy. The clinical and radiographic scores of teeth treated with non-surgical endodontic therapy were analyzed. The amount of non-healed and incomplete healed teeth in patients receiving zolendronate more than 1 year were more than the amount of teeth of non-healed and incomplete healed in patients receiving bisphosphonates less than 1 year (p <0.05). There was a strong relationship between the duration of the bisphosphonate medication and endodontic success.

Assessment of the Effect of Orthodontic Treatment on the Periodontal Health of Endodontically Restored Tooth.

PubMed

Jalaluddin, Md; Goyal, Vinod; Naqvi, Zuber A; Gupta, Bhaskar; Asnani, Mohil M; Sonigra, Hitesh M

2017-07-01

Intorduction: Patients usually undergo orthodontic treatment for achieving ideal interocclusal relationship between the dental tissue and bony tissue along with improving the speech, mastication, and facial esthetic appearance. Literature quotes paucity in the studies evaluating the effect of orthodontic treatment on the periodontal health of endodontically treated teeth. Hence, we planned the present study to assess the effect of orthodontic treatment on the periodontal health of endodonti-cally restored tooth. The present study included assessment of 80 patients who underwent orthodontic treatment. All the patients were divided broadly into two study groups: groups I and II. Group I included patients with the absence of endodontically treated teeth, while group II included patients which maxillary central incisors were resorted endodontically. Examination of the periodontal health of the patients was done using the community periodontal index of treatment need (CPITN) around the selected teeth. All the values were recorded during the preorthodontic time, postorthodontic time, and after the first 6 months of starting of the orthodontic treatment. All the results were recorded separately and analyzed. In the groups I and II, 28 and 25 patients respectively, had score of 1, while 10 patients in group I and 12 patients in group II had score of 2. Nonsignificant results were obtained while comparing the CPITN score in between the two study groups when measured at the pre-, intra-, and postortho time. In patients undergoing orthodontic treatment, having endodontically resorted teeth, no difference exists in relation to the periodontal health. Orthodontic treatment can be safely carried in patients with endodontically restored teeth.

Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically treated teeth.

PubMed

Venskutonis, Tadas; Daugela, Povilas; Strazdas, Marijus; Juodzbalys, Gintaras

2014-04-01

The aim of the present study was to compare the accuracy of intraoral digital periapical radiography and cone beam computed tomography in the detection of periapical radiolucencies in endodontically treated teeth. Radiographic images (cone beam computed tomography [CBCT] scans and digital periapical radiography [PR] images) from 60 patients, achieved from September 2008 to July 2013, were retrieved from databases of the Department of Oral Diseases, Lithuanian University of Health Sciences. Twenty patients met inclusion criteria and were selected for further evaluation. In 20 patients (42.4 [SD 12.1] years, 65% men and 35% women) a total of 35 endodontically treated teeth (1.75 [SD 0.91]; 27 in maxilla and 8 in mandible) were evaluated. Overall, it was observed a statistical significant difference between the number of periapical lesions observed in the CBCT (n = 42) and radiographic (n = 24) examinations (P < 0.05). In molar teeth, CBCT identify a significantly higher amount of periapical lesions than with the radiographic method (P < 0.05). There were significant differences between CBCT and PR in the mean number of lesions identified per tooth (1.2 vs 0.66, P = 0.03), number of teeth with lesions (0.71 vs 0.46, P = 0.03) and number of lesions identified per canal (0.57 vs 0.33, P = 0.005). Considering CBCT as "gold standard" in lesion detection with the sensitivity, specificity and accuracy considering as score 1, then the same parameters of PR were 0.57, 1 and 0.76 respectively. Within the limitations of the present study, it can be concluded that cone beam computed tomography scans were more accurate compared to digital periapical radiographs for detecting periapical radiolucencies in endodontically treated teeth. The difference was more pronounced in molar teeth.

Influence of ferrule preparation with or without glass fiber post on fracture resistance of endodontically treated teeth

PubMed Central

de LIMA, Alexandra Furtado; SPAZZIN, Aloísio Oro; GALAFASSI, Daniel; CORRER-SOBRINHO, Lourenço; CARLINI-JÚNIOR, Bruno

2010-01-01

Objective This study evaluated the effect of ferrule preparation (Fp) on the fracture resistance of endodontically treated teeth, restored with composite resin cores with or without glass fiber posts. Material and Methods Forty-four bovine teeth were sectioned 19 or 17 mm (2 mm ferrule) from the apex, endodontically treated and assigned to four groups (n = 11): Group 1: Fp and post; Group 2: Fp and without post; Group 3: without Fp and with post; Group 4: without Fp and without post. All specimens were restored with composite resin core and metal crown. Specimens were subjected to fracture resistance testing in a universal testing machine at a crosshead speed of 0.5 mm/min. The data were analyzed by two-way ANOVA and Tukey’s tests (α=0.05). Results The mean fracture resistance values were as follows: Group 1: 573.3 N; Group 2: 552.5 N; Group 3: 275.3 N; Group 4: 258.6 N. Significantly higher fracture resistance was found for the groups with Fp (p<0.001). Conclusion There was no statistically significant interaction between the "Fp" and "post" factors (p = 0.954). The ferrule preparation increased the fracture resistance of endodontically treated teeth. However, the use of glass fiber post showed no significant influence on the fracture resistance. PMID:20835570

A review of the regenerative endodontic treatment procedure

PubMed Central

Lee, Bin-Na; Moon, Jong-Wook; Chang, Hoon-Sang; Hwang, In-Nam; Oh, Won-Mann

2015-01-01

Traditionally, apexification has been used to treat immature permanent teeth that have lost pulp vitality. This technique promotes the formation of an apical barrier to close the open apex so that the filling materials can be confined to the root canal. Because tissue regeneration cannot be achieved with apexification, a new technique called regenerative endodontic treatment was presented recently to treat immature permanent teeth. Regenerative endodontic treatment is a treatment procedure designed to replace damaged pulp tissue with viable tissue which restores the normal function of the pulp-dentin structure. After regenerative endodontic treatment, continued root development and hard tissue deposition on the dentinal wall can occur under ideal circumstances. However, it is difficult to predict the result of regenerative endodontic treatment. Therefore, the purpose of this study was to summarize multiple factors effects on the result of regenerative endodontic treatment in order to achieve more predictable results. In this study, we investigated the features of regenerative endodontic treatment in comparison with those of other pulp treatment procedures and analyzed the factors that have an effect on regenerative endodontic treatment. PMID:26295020

Single-visit endodontic treatment of mature teeth with chronic apical abscesses using mineral trioxide aggregate cement: a randomized clinical trial.

PubMed

Alsulaimani, Reem Siraj

2016-08-23

Mature teeth with chronic apical abscesses characterized by intermittent discharge of pus through an associated sinus tract. This communication between oral mucosa and periapical inflammation is challenging for the sealing ability of root canal obturation material. Therefore, the study aim was to compare the outcomes of endodontic treatment using mineral trioxide aggregate (MTA) cement to the conventional gutta-percha cone and root canal sealer as an obturation material in mature teeth with chronic apical abscesses. Mature teeth with chronic apical abscesses referred to our clinic for root canal treatment between 2010 and 2012 were treated in a single visit and distributed among treatment (T) and control (C) groups using a predetermined randomization block (TCTC). After chemo-mechanical preparation, teeth in group T received MTA cement mixed in a 0.26 water to powder ratio, and teeth group C received gutta-percha and root canal sealer using the warm vertical technique. The treatment outcomes were defined as obturation length, periapical healing, resorption of extruded material, and survival rate at least 2.5 years after treatment. Three endodontists blinded to the type of obturation material documented treatment outcomes. Statistical analysis at P < 0.05 was conducted to measure difference between the groups. Thirty-six teeth were treated between 2010 and 2012, and 32 teeth were evaluated in 2015. Complete periapical healing was observed in 87.5 % of MTA-treated teeth and 75.0 % of gutta-percha-treated teeth. Adequate obturation length was reported in 50.0 % of MTA-treated and 37.5 % of gutta-percha-treated teeth. Complete resorption of extruded material was evident in 83.3 % MTA-treated teeth and 100.0 % gutta-percha-treated teeth. The survival rate of MTA-treated teeth was 100 % at 3, and 5 years, while the survival rate of gutta-percha-treated teeth was 83.3 % at 3, and 5 years. There was no significant difference between the groups in term of periapical healing, survival rate, obturation length, or resorption of extruded material. The outcomes of single-visit endodontic treatment of mature teeth with chronic apical abscesses using MTA cement were better, but not statistically significant, compared to conventional treatment. ISRCTN15285974 . Registered retrospectively 23 June 2015.

Radiologic assessment of quality of root canal fillings and periapical status in an Austrian subpopulation – An observational study

PubMed Central

Frank, Wilhelm; Madaus, Theresa

2017-01-01

Background/Objective Progress in endodontic techniques and methodological advances have altered root canal therapy over the last decades. These techniques and methods need periodical documentation. This observational study determined the current prevalence of endodontic treatments, and investigated the relationship of various factors with the periapical status in a Lower Austrian subpopulation. Methodology One thousand orthopantomograms of first-time university adult patients radiographed at an outpatient clinic were evaluated. For each tooth, the presence of periradicular pathosis and/or endodontic treatment was recorded, as was the quality of (post-)endodontic treatment (homogeneity and length of root canal fillings; preparation failures; posts/screws; apicoectomies; coronal restorations). Two evaluators, blinded to each other, scored all teeth. In cases of disagreement, they joined for a consensus score. Results In all, 22,586 teeth were counted. Of these, 2,907 teeth (12.9%) had periapical pathosis, while 2,504 teeth had undergone root canal treatment. Of the endodontically treated teeth, 52% showed no radiographic signs of apical periodontitis, while 44.9% had overt apical lesions, and 3,1% revealed widened periodontal ligament space. The majority of the root canal fillings was inhomogeneous (70.4%); 75.4% were rated too short, and 3.8% too long. The presence of apical pathosis was significantly correlated (odds ratio (OR) 2.556 [confidence interval (CI) 2.076–3.146]; P<0.0001) with poor root canal fillings (length and homogeneity). Posts or screws positively affected periapical status (OR 1.853 [CI 1.219–2.819]; P = 0.004), but endodontically treated posterior teeth were infrequently restored (posts, 7.5%; screws, 2.7%). Best results were found for teeth with both appropriate endodontic treatment and adequate coronal restoration. Conclusion A high prevalence of periradicular radiolucencies was observed with root canal filled teeth, along with high numbers of unmet treatment needs. Periapical health was associated with adequate root canal obturation and high-grade postendodontic restorations, and quality regarding these latter aspects is considered mandatory to promote periapical health. PMID:28464019

A new technique to make transparent teeth without decalcifying: description of the methodology and micro-hardness assessment.

PubMed

Malentacca, Augusto; Lajolo, Carlo

2015-01-01

Diaphanisation and other in vitro endodontic models (i.e., plastic blocks, micro-CT reconstruction, computerised models) do not recreate real root canal working conditions: a more realistic endodontic model is essential for testing endodontic devices and teaching purposes. The aim of this study was to describe a new technique to construct transparent teeth without decalcifying and evaluate the micro-hardness of so treated teeth. Thirty freshly extracted teeth were randomly divided into three groups as follows: 10 non-treated teeth (4 molars, 3 premolars, 3 incisors; control group - G1), 10 teeth were diaphanised (4 molars, 4 premolars, 2 incisors - G2) and 10 teeth were treated with the new proposed technique (2 molars, 6 premolars, 2 incisors - G3). Vickers hardness tester (MHT-4 and AxioVision microscope, Carl Zeiss, 37030 Gottingen, Germany - load=50 g, dwell time=20s, slope=5, 50× magnification) was used to determine microhardness (Vickers Hardness Number - VHN). Statistical analysis was performed using the Intercooled Stata 8.0 software (Stata Corporation, College Station, TX, USA). Only groups 1 and 3 could be tested for hardness because diaphanised teeth were too tender and elastic. Differences in enamel VHN were observed between G1 (mean 304.29; DS=10.44; range 283-321) and G3 (mean 318.51; DS=14.36; range 295.5-339.2) - (p<0.05); differences in dentine VHN were observed between G1 (mean 74.73; DS=6.62; range 63.9-88.1) and G3 (mean 64.54; DS=5.55; range 51.2-72.3) - (p<0.05). G3 teeth presented a slightly lower VHN compared to G1, probably due to some little structural differences among groups, and were dramatically harder than the diaphanised teeth. The described technique, thus, can be considered ideal for testing endodontic instruments and for teaching purposes. Copyright © 2014 Elsevier GmbH. All rights reserved.

Micro-surgical endodontics.

PubMed

Eliyas, S; Vere, J; Ali, Z; Harris, I

2014-02-01

Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

Influence of the remaining coronal structure on the resistance of teeth with intraradicular retainer.

PubMed

Pereira, Jefferson Ricardo; Neto, Tatiany de Mendonça; Porto, Vinícius de Carvalho; Pegoraro, Luiz Fernando; do Valle, Accácio Lins

2005-01-01

The aim of this study was to compare the resistance of endodontically treated teeth with intraradicular retainer different amounts of remaining coronal structure. Fifty freshly extracted maxillary canines were endodontically treated and randomly assigned to five groups (n=10), as follows: group 1 (control) = teeth with custom cast post and core; group 2 = teeth without remaining coronal structure; group 3, 4 and 5 = teeth with 1 mm, 2 mm and 3 mm of remaining coronal structure, respectively. All specimens in groups 2 to 5 were restored with prefabricated post and resin core. The teeth were embedded in acrylic resin and the fracture strength was measured on a universal testing machine at 45 degrees to the long axis of the tooth until failure. Data were analyzed statistically by one-way analysis of variance and Tukey's test. There was no significant differences (p>0.05) between the control group and group 2, and between groups 3, 4 and 5 (p>0.05). Control group and group 2 had significantly higher resistance strength than groups 3, 4 and 5 (p<0.00001). The findings of this study showed that teeth without remaining coronal structure had significantly higher fracture strength than those with remaining coronal structure (1 mm, 2 mm and 3 mm). When the dental crown was not completely removed, the amount of remaining coronal dentin did not significantly affect the fracture strength of endodontically treated teeth with intraradicular retainer.

Fusobacterium nucleatum in endodontic flare-ups.

PubMed

Chávez de Paz Villanueva, Luis Eduardo

2002-02-01

The extent to which Fusobacterium nucleatum is recovered from root canals of teeth that present with an interappointment flare-up following endodontic instrumentation was investigated. Included in the study were 28 patients that sought emergency treatment after initiation of root canal therapy. Only non-painful teeth that had been treated because of a necrotic pulp and periapical inflammatory lesion were studied. Root canal samples for bacterial analysis were taken, transported to a bacteriological laboratory, and processed for a semiquantitative assessment of bacterial isolates. Bacterial findings were correlated with self-assessed pain intensity as recorded by means of a Visual Analogue Scale. Clinical presentation of swelling and presence of exudate in the treated root canals were also linked. Bacteria were recovered from all teeth examined. Gram-negative anaerobic coccoid rods (Prevotella species and Porphyromonas species) were frequent isolates. All teeth in patients who were reported to be in severe pain (Visual Analogue Scale > or = 6) displayed F nucleatum. Nine out of 10 of these teeth also had swelling and exudate in the root canals. Samples from the remaining patients that had teeth with less pain score showed a variable bacterial recovery. None of these teeth displayed F nucleatum. F nucleatum appears to be associated with the development of the most severe forms of interappointment endodontic flare-ups.

Cermet reinforcement of a weakened endodontically treated root: a case report.

PubMed

Lui, J L

1992-08-01

Many clinical applications have been recommended for glass-cermet cement because of its improved properties compared to the original glass-ionomer cements. It has also been accepted as a dentinal substitute that can strengthen teeth. In this paper, an additional clinical application for glass-cermet cement, the reinforcement of weakened endodontically treated roots, is suggested. This technique is in keeping with the trends of tooth conservation and the use of an adhesive restorative material in the restoration of severely damaged teeth by a conservative approach.

[Advantages and disadvantages of endocrown restorations of endodontically treated teeth with large coronal destruction].

PubMed

Bao, X D

2018-04-09

The strength of endodontically treated teeth were reduced apparently because of structural damage, therefore further reduction of healthy tissue should be avoided as much as possible in restoration. Endocrown made by chair-side CAD/CAM is some kind of minimal invasive restoration, and the retention of restoration is achieved by reliable bonding and macromechanial retention forces. Without post preparation, the root structure could be resevered. Following the indications and use of biomechanical dentin-like CAD/CAM materials could reduce the adverse effect of tensile stress on cervical part.

Autotransplantation of endodontically treated third molars.

PubMed

Sobhi, Muhammad Bakhsh; Rana, Muzammil Jamil Ahmed; Manzoor, Manzoor Ahmed; Ibrahim, Mohammad; Tasleem-ul-Hudda

2003-07-01

To determine the success rate in autotransplantation of endodontically treated third molars. A descriptive study. This study was carried out at Armed Forces Institute of Dentistry (AFID), Rawalpindi (Pakistan) from January 2002 to December 2002. A total of 50 patients meeting the inclusion criteria were selected who had their first or second molars in unrestorable condition with intact third molars. The donor teeth were extracted after the preparation of recipient site. After endodontically treated in vitro the donor teeth were carried to the recipient site and immobilized. Postoperative variables were recorded and analyzed on SPSS version 10. The overall success rate after six months of the transplantation of third molars was 88% with complete root formation after endodontic treatment. All the patients(12%) who had complaints were more than 35 years of age. Third molars are good substitute for the unrestorable first or second molars and would be as effective as endosseous implants. The procedure is likely to have complications in the advanced age group.

Periapical status and quality of root fillings in a selected adult Riga population.

PubMed

Jersa, Ilana; Kundzina, Rita

2013-01-01

The aim of the study was to assess the prevalence of apical periodontitis and quality of root canal fillings in an adult Riga subpopulation. Panoramic radiographs of Latvian adults 35-44 year old attending a private dental clinic for the first time during the period of 2004-2008 were included in the study. Totally, 312 out of 1248 panoramic radiographs were randomly selected and examined for periapical conditions and endodontic treatment quality. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. The periapical status was assessed using the PAI index. The data were analyzed using SPSS 14 computer software program. Statistical significance was assessed by the chi-squared (Pearson's) test. Out of the 312 individuals examined 224 (72%) had one or more teeth with apical periodontitis (PAI 3-5) and 272 individuals (87%) had one or more endodontically treated teeth. Amongst 7065 teeth evaluated 1255 (18%) were endodontically treated. Only 285 teeth (23%) of the root canal treated teeth were with complete root canal fillings. There was a statistically significant relationship between quality of root canal fillings and apical periodontitis (p<0.0001). In teeth with complete fillings only 15% were with apical periodontitis, but apical periodontitis were detected in 342 teeth (35%) with incomplete root fillings. The results from this study indicates a high prevalence of apical periodontitis and low quality of root fillings in a selected adult Riga population.

Regenerative Endodontics: A Road Less Travelled

PubMed Central

Bansal, Ramta; Mittal, Sunandan; Kumar, Tarun; Kaur, Dilpreet

2014-01-01

Although traditional approaches like root canal therapy and apexification procedures have been successful in treating diseased or infected root canals, but these modalities fail to re-establish healthy pulp tissue in treated teeth. Regeneration-based approaches aims to offer high levels of success by replacing diseased or necrotic pulp tissues with healthy pulp tissue to revitalize teeth. The applications of regenerative approaches in dental clinics have potential to dramatically improve patients’ quality of life. This review article offers a detailed overview of present regenerative endodontic approaches aiming to revitalize teeth and also outlines the problems to be dealt before this emerging field contributes to clinical treatment protocols. It conjointly covers the basic trilogy elements of tissue engineering. PMID:25478476

IPS Empress onlays luted with two dual-cured resin cements for endodontically treated teeth: a 3-year clinical evaluation.

PubMed

Atali, Pinar Yilmaz; Cakmakcioglu, Ozcan; Topbasi, Bulent; Turkmen, Cafer; Suslen, Ozlem

2011-01-01

The aim of this study was to evaluate the performance of IPS Empress ceramic onlays luted with two dual-cured adhesive resin cements for endodontically treated teeth. Twenty molar teeth were restored with all-ceramic restorations luted randomly with Maxcem or Clearfil Esthetic Cement and DC Bond Kit luting systems (n = 10 each) in 20 patients. The restorations were assessed using modified US Public Health Service criteria at baseline, 6 months, and 1, 2, and 3 years. A statistically significant deterioration was found for the criteria marginal integrity, anatomical form, and surface roughness. For luting of ceramic onlays, no difference between the two luting systems was detected.

Cuspal reinforcement in endodontically treated molars.

PubMed

Uyehara, M Y; Davis, R D; Overton, J D

1999-01-01

This in vitro study compared the ability of horizontal pins and a dental adhesive to reinforce the facial cusps of endodontically treated mandibular molars. Seventy-two mandibular molars were divided into six groups and mounted in acrylic blocks (n = 12). In Groups 1-5 standardized endodontic access and instrumentation in the coronal one-third of each root canal were completed. In Groups 1-4 the lingual cusps were reduced, leaving the buccal cusps intact. The facial cusps of the teeth in each group received one of the following modes of reinforcement: Group 1--no reinforcement; Group 2--dentin adhesive (Amalgambond Plus); Group 3--two horizontal TMS Minim pins; Group 4--two horizontal TMS Minim pins and Amalgambond Plus. Teeth in Group 5 were prepared for and restored with a complete cuspal coverage amalgam restoration using four vertical TMS Minim pins. Group 6 consisted of intact natural teeth. Using an Instron Universal Testing Machine, the lingual slope of the facial cusp of each specimen was loaded to failure using a compressive force applied at an angle 60 degrees to the long axis of the tooth. The mean fracture strengths for all groups were analyzed using a one-way ANOVA and Student-Newman-Keuls multiple range test (alpha = 0.05). Fracture patterns and modes of failure were also evaluated. The intact teeth (Group 6) were significantly more fracture resistant than all other groups, with the exception of Group 4 (combination of pins and adhesive). Group 1 (non-reinforced teeth) was significantly weaker than all other groups. Groups 2-4 (specimens with reinforced cusps) were not significantly different from each other. The use of horizontal pins or a combination of horizontal pins plus dentin adhesive for cuspal reinforcement resulted in significantly more teeth demonstrating favorable fracture patterns than did the use of adhesives alone. The buccal cusps of endodontically treated mandibular molars reinforced with a combination of horizontal pins and dentin adhesive were not significantly weaker than intact teeth. Of the restored teeth, those which had buccal cusps reinforced with horizontal pins and those treated with complete cuspal coverage amalgam restorations exhibited the most favorable restorative prognosis following cusp fracture.

Fracture resistance of endodontically treated teeth restored with a bulkfill flowable material and a resin composite

PubMed Central

Isufi, Almira; Plotino, Gianluca; Grande, Nicola Maria; Ioppolo, Pietro; Testarelli, Luca; Bedini, Rossella; Al-Sudani, Dina; Gambarini, Gianluca

2016-01-01

Summary Aim To determine and compare the fracture resistance of endodontically treated teeth restored with a bulk fill flowable material (SDR) and a traditional resin composite. Methods Thirty maxillary and 30 mandibular first molars were selected based on similar dimensions. After cleaning, shaping and filling of the root canals and adhesive procedures, specimens were assigned to 3 subgroups for each tooth type (n=10): Group A: control group, including intact teeth; Group B: access cavities were restored with a traditional resin composite (EsthetX; Dentsply-Italy, Rome, Italy); Group C: access cavities were restored with a bulk fill flowable composite (SDR; Dentsply-Italy), except 1.5 mm layer of the occlusal surface that was restored with the same resin composite as Group B. The specimens were subjected to compressive force in a material static-testing machine until fracture occurred, the maximum fracture load of the specimens was measured (N) and the type of fracture was recorded as favorable or unfavorable. Data were statistically analyzed with one-way analysis of variance (ANOVA) and Bonferroni tests (P<0.05). Results No statistically significant differences were found among groups (P<0.05). Fracture resistance of endodontically treated teeth restored with a traditional resin composite and with a bulk fill flowable composite (SDR) was similar in both maxillary and mandibular molars and showed no significant decrease in fracture resistance compared to intact specimens. Conclusions No significant difference was observed in the mechanical fracture resistance of endodontically treated molars restored with traditional resin composite restorations compared to bulk fill flowable composite restorations. PMID:27486505

Fracture resistance of endodontically treated teeth restored with a bulkfill flowable material and a resin composite.

PubMed

Isufi, Almira; Plotino, Gianluca; Grande, Nicola Maria; Ioppolo, Pietro; Testarelli, Luca; Bedini, Rossella; Al-Sudani, Dina; Gambarini, Gianluca

2016-01-01

To determine and compare the fracture resistance of endodontically treated teeth restored with a bulk fill flowable material (SDR) and a traditional resin composite. Thirty maxillary and 30 mandibular first molars were selected based on similar dimensions. After cleaning, shaping and filling of the root canals and adhesive procedures, specimens were assigned to 3 subgroups for each tooth type (n=10): Group A: control group, including intact teeth; Group B: access cavities were restored with a traditional resin composite (EsthetX; Dentsply-Italy, Rome, Italy); Group C: access cavities were restored with a bulk fill flowable composite (SDR; Dentsply-Italy), except 1.5 mm layer of the occlusal surface that was restored with the same resin composite as Group B. The specimens were subjected to compressive force in a material static-testing machine until fracture occurred, the maximum fracture load of the specimens was measured (N) and the type of fracture was recorded as favorable or unfavorable. Data were statistically analyzed with one-way analysis of variance (ANOVA) and Bonferroni tests (P<0.05). No statistically significant differences were found among groups (P<0.05). Fracture resistance of endodontically treated teeth restored with a traditional resin composite and with a bulk fill flowable composite (SDR) was similar in both maxillary and mandibular molars and showed no significant decrease in fracture resistance compared to intact specimens. No significant difference was observed in the mechanical fracture resistance of endodontically treated molars restored with traditional resin composite restorations compared to bulk fill flowable composite restorations.

FE analysis of conceptual hybrid composite endodontic post designs in anterior teeth.

PubMed

Gloria, Antonio; Maietta, Saverio; Martorelli, Massimo; Lanzotti, Antonio; Watts, David C; Ausiello, Pietro

2018-04-24

To assess conceptual designs of dental posts consisting of polyetherimide (PEI) reinforced with carbon (C) and glass (G) glass fibers in endodontically treated anterior teeth. 3D tessellated CAD and geometric models of endodontically treated anterior teeth were generated from Micro-CT scan images. Model C-G/PEI composite posts with different Young's moduli were analyzed by Finite Element (FE) methods post A (57.7GPa), post B (31.6GPa), post C (from 57.7 to 9.0GPa in the coronal-apical direction). A load of 50N was applied at 45° to the longitudinal axis of the tooth, acting on the palatal surface of the crown. The maximum principal stress distribution was determined along the post and at the interface between the post and the surrounding structure. Post C, with Young's modulus decreasing from 57.7 to 9.0GPa in the coronal-apical direction, reduced the maximum principal stress distribution in the restored tooth. Post C gave reduced stress and the most uniform stress distribution with no stress concentration, compared to the other C-G/PEI composite posts. The FE analysis confirmed the ability of the functionally graded post to dissipate stress from the coronal to the apical end. Hence actual (physical) C-G/PEI posts could permit optimization of stress distributions in endodontically treated anterior teeth. Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

Vertical root fractures and their management

PubMed Central

Khasnis, Sandhya Anand; Kidiyoor, Krishnamurthy Haridas; Patil, Anand Basavaraj; Kenganal, Smita Basavaraj

2014-01-01

Vertical root fractures associated with endodontically treated teeth and less commonly in vital teeth represent one of the most difficult clinical problems to diagnose and treat. In as much as there are no specific symptoms, diagnosis can be difficult. Clinical detection of this condition by endodontists is becoming more frequent, where as it is rather underestimated by the general practitioners. Since, vertical root fractures almost exclusively involve endodontically treated teeth; it often becomes difficult to differentiate a tooth with this condition from an endodontically failed one or one with concomitant periodontal involvement. Also, a tooth diagnosed for vertical root fracture is usually extracted, though attempts to reunite fractured root have been done in various studies with varying success rates. Early detection of a fractured root and extraction of the tooth maintain the integrity of alveolar bone for placement of an implant. Cone beam computed tomography has been shown to be very accurate in this regard. This article focuses on the diagnostic and treatment strategies, and discusses about predisposing factors which can be useful in the prevention of vertical root fractures. PMID:24778502

Dental students' perceptions about the endodontic treatments performed using NiTi rotary instruments and hand stainless steel files.

PubMed

Martins, Renata Castro; Seijo, Marília Oliveira Saraiva; Ferreira, Efigênia Ferreira; Paiva, Saul Martins; Ribeiro Sobrinho, Antônio Paulino

2012-01-01

This study evaluated the perceptions of Brazilian undergraduate dental students about the endodontic treatments performed using NiTi rotary instruments and hand stainless steel. Data were collected using a questionnaire administered to undergraduate dental students enrolled in endodontic disciplines. The students were divided into 3 groups: G1, students who had treated straight canals with SS hand instruments; G2, students who had treated curved canals with SS hand instruments; and G3, students who had treated both straight and curved canals with NiTi rotary instruments. The number of endodontic treatments performed, types of treated teeth, students' learning, time spent, encountered difficulties, quality of endodontic treatment and characteristics of the employed technique were analyzed. There was a 91.3% rate of return for the questionnaires. Mandibular molars were the most frequently treated teeth, followed by maxillary incisors. The Kruskal-Wallis test showed no differences in learning (p=0.528) or in the characteristics of the technique employed (p=0.560) among the three groups. G3 students performed a greater number of endodontic treatments (p<0.001) in a smaller time (p<0.001) than did G1 and G2 students. Difficulties were reported primarily by students in G2 and G3 compared with G1 (p=0.048). The quality of endodontic treatments differed only between G1 and G2 (p=0.045). The use of NiTi rotary instruments should be included in undergraduate dental curriculum, contributing to the increase of patients assisted and consequently to improve the clinical experience of the students.

Long-term prognosis of endodontically treated teeth: a retrospective analysis of preoperative factors in molars.

PubMed

Setzer, Frank C; Boyer, Keith R; Jeppson, Joshua R; Karabucak, Bekir; Kim, Syngcuk

2011-01-01

Long-term predictability of restored endodontically treated teeth is important for the decision of tooth retention versus extraction and implant placement. The purpose of this study was to validate the hypothesis that preoperative factors can predict the long-term prognosis of molars requiring endodontic and restorative treatment for future prognostic investigations. A clinical database was searched for molar endodontic treatments with crown placement and a minimum of 4-year follow-up. Charts of 42 patients with 50 individual treatments were randomly selected. Information concerning crown lengthening; periodontal diagnosis; attachment loss; furcation involvement; mobility; and internal, external, or periradicular resorption was recorded. Radiographs from treatment initiation and follow-up were digitalized. The presence of apical periodontitis was evaluated. Available ferrule was calculated from bitewing radiographs using CAD software (AutoCAD; Autodesk, Cupertino, CA). The resulting data, age, sex, and times of restoration and follow-up were analyzed for correlation with the presence of apical radiolucency at follow-up and the following four possible outcome scenarios: "no event," "nonsurgical retreatment," "surgical retreatment," or "extraction" using Spearman rank order correlation analysis. Patients' ages ranged from 19 to 87 years, 22 were male and 20 female, and 48 teeth (96.0%) were retained at follow-up. Of those, 44 (88.0%) were without intervention ("no event"), and four (8.0%) underwent surgical or nonsurgical retreatment. Two teeth (4.0%) had been extracted. Significant positive correlations existed between "untoward events" (any form of retreatment or extraction) and "prognostic value according to periodontal status" (p = 0.047) and "attachment loss" (p = 0.042). The only preoperative factors significant for the prognosis of restored endodontically treated molars were related to periodontal prognostic value and attachment loss. It can be concluded that it may be difficult to predict the prognosis of molars in need for endodontic treatment and restoration from prognostic factors not related to periodontal disease. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Interleukin 1 receptor antagonist (IL1RN) genetic variations condition post-orthodontic external root resorption in endodontically-treated teeth.

PubMed

Iglesias-Linares, Alejandro; Yañez-Vico, Rosa Ma; Ballesta-Mudarra, Sofía; Ortiz-Ariza, Estefanía; Mendoza-Mendoza, Asunción; Perea-Pérez, Evelio; Moreno-Fernández, Ana Ma; Solano-Reina, Enrique

2013-06-01

External apical root resorption (EARR) is a frequent iatrogenic problem following orthodontic treatment in endodontically-treated teeth, about which the literature reports substantial variability in post-orthodontic treatment EARR responses. The main focus of the present study is to clarify whether variants in the interleukin-1 receptor antagonist gene coding for the IL-1ra protein have a positive/negative influence on EARR of endodontically-treated teeth. Ninety-three orthodontic patients were genetically screened for a single nucleotide polymorphism (SNP:rs419598) in the IL1 cluster. The sample was classified into 2 groups: group 1 (affected-group) showed radiographic EARR of more than 2mm; group 2 (control-group), had no EARR or EARR ≤ to 2mm following orthodontic treatment on root-filled teeth. Logistic regression analysis was performed to obtain an adjusted estimate between the SNPs studied and EARR. Genotype distributions, allelic frequencies, adjusted odds ratios (OR) and 95% confidence intervals were also calculated. We found that subjects homozygous [1/1(TT)] for the IL1RN gene [OR:10.85; p=0.001;CI:95%] were at risk of EARR in root-filled teeth. Genetic variants in the antagonist axis balance of the IL1RN (rs419598) have a direct repercussion on the predisposition to post-orthodontic EARR in root-filled teeth. Variants in allele 1 of the interleukin-1 receptor antagonist gene(rs419598) are associated(p=0.001**) with an increased risk of suffering post-orthodontic EARR in root-filled teeth.

Teaching an engine-driven preparation technique to undergraduates: initial observations.

PubMed

Hänni, S; Schönenberger, K; Peters, O A; Barbakow, F

2003-07-01

This paper describes the initial experiences following the introduction of a rotary engine-driven preparation technique into the undergraduate endodontic programme at the Zurich University Dental Centre. Forty third-year students practised the ProFile.04 (PF.04) technique between January and July 2001 in a preclinical course. Between November 2001 and February 2002, 20 of these students (Group A) root-treated 51 teeth in their clinical course using either PF.04, the balanced force technique (BFT) or a combination of both. The second group of 20 students (Group B) similarly treated another 36 randomly selected teeth between April and July 2002. Types of teeth treated by the students and the canal preparation techniques were recorded. The students also completed a short questionnaire, evaluating their opinions of the new course. Of the 87 teeth endodontically treated during the clinical course, 34, 14 and 39 were shaped using PF.04 alone, a combination of PF.04 and BFT and BFT alone, respectively. No rotary instruments were fractured during the 1-year clinical course, although some instruments were fractured during the preclinical laboratory course. Overall, the students rated the rotary technique as positive. A rotary technique was successfully introduced into an undergraduate endodontic programme (this will be continued in the foreseeable future). However, the continuity between the preclinical and the clinical courses was poor as a result of the constraints of the general teaching programme.

Vertical Root Fracture Detection Using Limited-FOV Cone-Beam Computed Tomography

DTIC Science & Technology

2012-06-01

A thesis submitted to the Faculty of the Endodontics Graduate Program Naval Postgraduate Dental School Uniformed Services...Dental Program Navy Medicine Professional Development Center Terry D. Webb, DDS, MS CAPT, DC, USN Chairman, Endodontics Dept. Glen M. Imamura, S...Computed Tomography Geoffrey McMurray, DDS, MS ABSTRACT Introduction: Vertical root fractures (VRF) often occur in endodontically treated teeth

Comparison of Single Visit Post Endodontic Pain Using Mtwo Rotary and Hand K-File Instruments: A Randomized Clinical Trial.

PubMed

Kashefinejad, Mohamad; Harandi, Azade; Eram, Saeed; Bijani, Ali

2016-01-01

Pain is an unpleasant outcome of endodontic treatment that can be unbearable to patients. Instrumentation techniques may affect the frequency and intensity of post-endodontic pain. This study aimed to compare single visit post endodontic pain using Mtwo (NiTi) rotary and hand K-file instruments. In this randomized controlled trial, 60 teeth with symptomatic irreversible pulpitis in 53 patients were selected and randomly assigned into two groups of 30 teeth. In group A, the root canals were prepared with Mtwo (NiTi) rotary instruments. In group B, the root canals were prepared with hand K-file instruments. Pain assessment was implemented using visual analog scale (VAS) at four, eight, 12 and 24 hours after treatment. The acquired data were analyzed using chi-square, Mann-Whitney U and Student's t-test (P<0.05). Patients treated with rotary instruments experienced significantly less post-endodontic pain than those treated with hand instruments (P<0.001). The use of Mtwo (NiTi) rotary instruments in root canal preparation contributed to lower incidence of postoperative pain than hand K-files.

An assessment of fracture resistance of three composite resin core build-up materials on three prefabricated non-metallic posts, cemented in endodontically treated teeth: an in vitro study

PubMed Central

Pal, Bhupinder; Pujari, Prashant

2015-01-01

Endodontically treated teeth with excessive loss of tooth structure would require to be restored with post and core to enhance the strength and durability of the tooth and to achieve retention for the restoration. The non-metallic posts have a superior aesthetic quality. Various core build-up materials can be used to build-up cores on the posts placed in endodontically treated teeth. These materials would show variation in their bonding with the non-metallic posts thus affecting the strength and resistance to fracture of the remaining tooth structure. Aims. The aim of the study was to assess the fracture resistance of three composite resin core build-up materials on three prefabricated non-metallic posts, cemented in extracted endodontically treated teeth. Material and Methods. Forty-five freshly extracted maxillary central incisors of approximately of the same size and shape were selected for the study. They were divided randomly into 3 groups of 15 each, depending on the types of non-metallic posts used. Each group was further divided into 3 groups (A, B and C) of 5 samples each depending on three core build-up material used. Student’s unpaired ‘t’ test was also used to analyse and compare each group with the other groups individually, and decide whether their comparisons were statistically significant. Results. Luxacore showed the highest fracture resistance among the three core build-up materials with all the three posts systems. Ti-core had intermediate values of fracture resistance and Lumiglass had the least values of fracture resistance. PMID:25755926

Whitening non vital teeth – a case report

PubMed Central

Moraru, Iren; Ţuculină, Mihaela; Bătăiosu, Marilena; Gheorghiţă, Lelia; Diaconu, Oana

2012-01-01

Commonly used in cosmetic dentistry teeth whitening can be used combined with other restorative techniques during dental treatment. Non-vital teeth whitening is necessary whenever we need an improvement of their aspect, as it’s a known fact that these teeth can have a grey or pink-grey coloration when they are not correctly endodontical treated. PMID:24778849

Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage.

PubMed

Signore, Antonio; Benedicenti, Stefano; Kaitsas, Vassilios; Barone, Michele; Angiero, Francesca; Ravera, Giambattista

2009-02-01

This retrospective study investigated the clinical effectiveness over up to 8 years of parallel-sided and of tapered glass-fiber posts, in combination with either hybrid composite or dual-cure composite resin core material, in endodontically treated, maxillary anterior teeth covered with full-ceramic crowns. The study population comprised 192 patients and 526 endodontically treated teeth, with various degrees of hard-tissue loss, restored by the post-and-core technique. Four groups were defined based on post shape and core build-up materials, and within each group post-and-core restorations were assigned randomly with respect to root morphology. Inclusion criteria were symptom-free endodontic therapy, root-canal treatment with a minimum apical seal of 4mm, application of rubber dam, need for post-and-core complex because of coronal tooth loss, and tooth with at least one residual coronal wall. Survival rate of the post-and-core restorations was determined using Kaplan-Meier statistical analysis. The restorations were examined clinically and radiologically; mean observation period was 5.3 years. The overall survival rate of glass-fiber post-and-core restorations was 98.5%. The survival rate for parallel-sided posts was 98.6% and for tapered posts was 96.8%. Survival rates for core build-up materials were 100% for dual-cure composite and 96.8% for hybrid light-cure composite. For both glass-fiber post designs and for both core build-up materials, clinical performance was satisfactory. Survival was higher for teeth retaining four and three coronal walls.

Cone-beam computed tomography in the assessment of periapical lesions in endodontically treated teeth

PubMed Central

Gambarini, Gianluca; Piasecki, Lucila; Miccoli, Gabriele; Gaimari, Gianfranco; Nardo, Dario Di; Testarelli, Luca

2018-01-01

Objective: This study aimed to evaluate the relationship between the quality of the coronal restoration and the root canal filling on the periapical status of endodontically treated teeth using CBCT. Materials and Methods: CBCT data were obtained from the records of patients who deny any dental treatment in the 2 years prior to the CBCT examination. CBCT images (90 kVp and 7 mA, exposure time of 23 s, and a voxel size of 0.2 mm, with a field of view of 13 cm × 13 cm) of 1011 endodontically treated teeth were observed. A score was given to the quality of the root filling and the quality of the coronal restoration. Statistical Analysis Used: Data were statistically analyzed to correlate the periapical status with gender, dental group. and quality of endodontic treatment and restoration (Chi-square test with a significance level of P < 0.001). Results: Absence of periapical periodontitis was found in 54.9% of the cases. The periapical outcome was not related to gender or dental group (P > 0.05). A statistically significant factor (Chi-square test, P < 0.0001) resulted when different qualities of sealing were compared. Conclusions: CBCT showed that high-quality root canal treatments followed by an adequate coronal sealing restoration avoid the presence of periapical periodontitis in time. PMID:29657539

Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material-An in vitro study.

PubMed

Garlapati, Tejesh Gupta; Krithikadatta, Jogikalmat; Natanasabapathy, Velmurugan

2017-10-01

This in-vitro study tested the fracture resistance of endodontically treated molars with Mesial-Occluso-Distal (MOD) cavities restored with fibre reinforced composite material everX posterior in comparision with hybrid composite and ribbond fiber composite. Fifty intact freshly extracted human mandibular first molars were collected and were randomly divided into five groups (n=10). Group 1: positive control (PC) intact teeth without any endodontic preparation. In groups 2 through 6 after endodontic procedure standard MOD cavities were prepared and restored with their respective core materials as follows: group 2, negative control (NC) left unrestored or temporary flling was applied. Group 3, Hybrid composite (HC) as a core material (Te-Econom Plus Ivoclar Vivadent Asia) group 4, Ribbond (Ribbond; Seattle, WA, USA)+conventional composite resin (RCR) group 5, everX posterior (everX Posterior GC EUROPE)+conventional composite resin (EXP) after thermocycling fracture resistance for the samples were tested using universal testing machine. The results were analysed using ANOVA and Tukey's HSD post hoc tests. Mean fracture resistance (in Newton, N) was group 1: 1568.4±221.71N, group 2: 891.0±50.107N, group 3: 1418.3±168.71N, group 4:1716.7±199.51N and group 5: 1994.8±254.195N. Among the materials tested, endodontically treated teeth restored with everX posterior fiber reinforced composite showed superior fracture resistance. Copyright © 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Effect of a crown ferrule on the fracture strength of endodontically treated canines restored with fiber posts and metal-ceramic or all-ceramic crowns.

PubMed

Evangelinaki, Evangelia; Tortopidis, Dimitrios; Kontonasaki, Eleana; Fragou, Theodora; Gogos, Christos; Koidis, Petros

2013-01-01

The aim of this study was to comparatively evaluate the fracture strength of endodontically treated canines restored with glass-fiber posts (GFPs) and either metal-ceramic (MC) or all-ceramic (AC) crowns in the presence or absence of 2 mm of ferrule height. Fifty human maxillary canines were endodontically treated and randomly divided into five groups of 10 specimens each. The first group remained intact (control), while the remainder were restored with GFPs and composite cores with either MC or AC crowns. Each of the AC and MC groups was equally divided between teeth with or without ferrule. Teeth were embedded in acrylic resin and loaded at a 135-degree angle to their long axis until fracture. Fracture strength was not significantly different between ferrule and no ferrule groups (P = .571), but was significantly larger for the MC groups compared with the control and AC groups (P = .009 and P = .024, respectively). A significant effect of the type of restoration was found as teeth restored with MC crowns presented significantly higher fracture strength, independently of ferrule.

Outcome of Endodontic Treatments Made by Postgraduate Students in the Dental Clinic of Bretonneau Hospital

PubMed Central

Touboul, Virginie; Germa, Alice; Lasfargues, Jean-Jacques; Bonte, Eric

2014-01-01

Objective. The objective of this retrospective study is double: (1) to assess the 1–4 years of outcome of endodontic treatment performed by postgraduate students in endodontics in the Dental Clinic of Bretonneau Hospital and (2) to examine outcome predictors. Method. 363 teeth in 296 patients were treated between 2007 and 2011. 183 patients (224 teeth) were lost during the followup. 113 patients were included in the study (recall: 38%), corresponding to 139 teeth of which 8 were extracted. 131 remaining teeth (36%) were examined clinically and radiographically. Apical periodontitis (AP) was absent (PAI = 1) or present (PAI ≥ 2). Outcome was classified as “healed,” “healing,” or “diseased”. Results. The success rate was 92%. No failure was observed among the 23 initial endodontic treatments. Among the 108 retreated teeth, 80% were “healed” and 11% were “healing.” An association was found between success rate and preoperative signs or symptoms (absent 95% versus present 83%), preoperative root filling density (inadequate 93% versus adequate 57%), but not between preoperative AP status and success. Conclusion. Outcomes in this retrospective study were similar to those previously reported. However, a larger sample size is needed to assess outcome predictors more precisely. PMID:24778652

Flare-up rate of single-visit endodontics.

PubMed

Trope, M

1991-01-01

The purpose of the study was to compare the flare-up rate for single-visit endodontics among teeth without radiographic or clinical signs of apical periodontitis, those with radiographic or clinical signs of apical periodontitis not previously root-treated, and those with apical periodontitis where retreatment was performed. All teeth were instrumented to a predetermined minimum size with a 0.5 per cent solution of sodium hypochlorite being used as the irrigant. The root canal was obturated without regard to the presence or absence of symptoms or diagnosis of the apical condition. The patients were given written post-operative instructions and a prescription for 600 mg ibuprofen to be taken if mild to moderate pain developed. If severe pain and/or swelling developed, the patient was instructed to telephone immediately and was considered to have had a flare-up. Teeth without signs of apical periodontitis did not have any flare-ups. One flare-up occurred in 69 teeth with signs of apical periodontitis not previously root-treated. The majority of the flare-ups (3 of 22 teeth) occurred in teeth with signs of apical periodontitis requiring retreatment.

Student Endodontic Performance with and without Numerical Requirements.

ERIC Educational Resources Information Center

Lee, Charles Q.; And Others

1994-01-01

A study compared dental student performance in clinical endodontics under two instructional approaches, one in which number of procedures completed by students (n=79) was measured and one (n=84 students) emphasizing total patient care and stricter accounting of clinical treatment time. Results indicated the latter group treated fewer teeth but…

Periapical and endodontic status of type 2 diabetic patients in Catalonia, Spain: a cross-sectional study.

PubMed

López-López, José; Jané-Salas, Enric; Estrugo-Devesa, Albert; Velasco-Ortega, Eugenio; Martín-González, Jenifer; Segura-Egea, Juan José

2011-05-01

The aim of this study was to investigate radiographically the prevalence of apical periodontitis (AP) and endodontic treatment in a sample of adult type II diabetic patients and control subjects. In a cross-sectional study, the radiographic records of 50 adult patients reporting a history of well-controlled type 2 diabetes mellitus (DM) (study group) and 50 age- and sex-matched subjects who reported no history of DM (control group) were examined. Periapical status of all teeth was assessed using the periapical index score. The average number of teeth per patient in the diabetic and control groups was 21.9 and 24.6 teeth, respectively (P = .012). AP in one or more teeth was found in 37 diabetic patients (74%) and in 21 control subjects (42%) (odds ratio = 3.9, P = .002). One or more root-filled teeth were found in 35 (70%) and 25 (50%) of diabetic and control subjects, respectively (odds ratio = 2.3, P = .043). Among diabetic patients with root-filled teeth, 16 (46%) had AP affecting at least one treated tooth. Among controls with root-filled teeth, 6 (24%) had AP affecting at least one treated tooth (P > .05). Adjusting for teeth number, multivariate logistic regression analysis showed that periapical status (odds ratio = 3.3, P = .0071) and the number of root-filled teeth (odds ratio = 1.7; P = .0035) were significantly associated with diabetic status. The results showed that in adult patients, type 2 DM is significantly associated with an increased prevalence of AP and endodontic treatment. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparison of Single Visit Post Endodontic Pain Using Mtwo Rotary and Hand K-File Instruments: A Randomized Clinical Trial

PubMed Central

Kashefinejad, Mohamad; Harandi, Azade; Bijani, Ali

2016-01-01

Objectives: Pain is an unpleasant outcome of endodontic treatment that can be unbearable to patients. Instrumentation techniques may affect the frequency and intensity of post-endodontic pain. This study aimed to compare single visit post endodontic pain using Mtwo (NiTi) rotary and hand K-file instruments. Materials and Methods: In this randomized controlled trial, 60 teeth with symptomatic irreversible pulpitis in 53 patients were selected and randomly assigned into two groups of 30 teeth. In group A, the root canals were prepared with Mtwo (NiTi) rotary instruments. In group B, the root canals were prepared with hand K-file instruments. Pain assessment was implemented using visual analog scale (VAS) at four, eight, 12 and 24 hours after treatment. The acquired data were analyzed using chi-square, Mann-Whitney U and Student’s t-test (P<0.05). Results: Patients treated with rotary instruments experienced significantly less post-endodontic pain than those treated with hand instruments (P<0.001). Conclusions: The use of Mtwo (NiTi) rotary instruments in root canal preparation contributed to lower incidence of postoperative pain than hand K-files. PMID:27536323

The evaluation of endodontic flare-ups and their relationship to various risk factors.

PubMed

Onay, Emel Olga; Ungor, Mete; Yazici, A Canan

2015-11-14

To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.

Survey on Restoration of Endodontically Treated Anterior Teeth: A Questionnaire Based Study

PubMed Central

Ratnakar, P; Bhosgi, Rashmi; Metta, Kiran Kumar; Aggarwal, Kanika; Vinuta, S; Singh, Navneet

2014-01-01

Background: The aim of endodontic and restorative dentistry is the conservation of natural tooth structure. Endodontically treated tooth (ETT) undergoes loss of tooth structure and changes in physical characteristics. Therefore, proper selection of restoration for ETT is mandatory. The clinical approach of restoring ETT needs taking into considerations several issues. However, the best way to restore teeth after root canal treatment has long been and still a controversial subject to debate. Therefore, this study was carried out to detect the frequency of preferred methods of restoring ETT under different conditions. Materials and Methods: A questionnaire was framed and distributed among prosthodontists, endodontist and general practitioners of north India region to find out the frequency of best suitable material and method regarding restoration of ETT. 220 questionnaires were sent by electronic mail out of which 110 were received back. The questionnaire contained different methods of restoration of endodontically treated anterior teeth at different conditions (percentages) of remaining sound tooth structure. Respondents were asked to indicate their preferred method of restoration of those teeth. Results: Results showed that majority of respondents (51.82%) preferred to restore the tooth only with a tooth-color restorative material in condition A. In condition B, majority of respondents preferred to use tooth colored crown (44.55%) and prefabricated post and tooth colored restoration (24.5%). Whereas in condition C, most of the respondents preferred to use a cast post and core/crown (80.91%). Conclusion: From the findings of the present study, it can be concluded that the unrestored ETT is susceptible to fracture, which could lead to loss of tooth and that the maximum preservation of healthy tooth structure and use of restorative materials with mechanical properties similar to dental structure favor greater longevity of tooth restoration complex. PMID:25628482

Endodontic retreatment vs dental implants of teeth with an uncertain endodontic prognosis: 1-year results from a randomised controlled trial.

PubMed

Esposito, Marco; Tallarico, Marco; Trullenque-Eriksson, Anna; Gianserra, Rodolfo

To ascertain whether in the presence of a previously endodontically treated tooth with a periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single implant-supported crown. Forty patients requiring the treatment of a previously endodontically treated tooth, with a periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigators, were randomly allocated to endodontic retreatment (endo group; 20 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 20 patients) according to a parallel group design at two different centres. Patients were followed to 1 year after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink esthetic score (PES) for the soft tissues and the white esthetic score (WES) for the tooth/crown recorded by independent assessors. No patient dropped out and no complications occurred during the entire follow-up; however, one endodontically retreated tooth (5%) and one implant (5%) fractured, the difference for treatment failures being not statistically significant (difference in proportions = 0; 95% CI -0.14 to 0.14; P Fisher's exact test) = 1.000). The mean marginal bone levels at endo retreatment/implant insertion were 2.34 ± 0.88 mm for the endo and 0.23 ± 0.35 mm for the implant group, which was statistically significantly different (mean difference = 2.11 mm; 95% CI: 1.68 to 2.55; P (t-test) < 0.001). One year after completion of the treatment, teeth lost on average 0.32 ± 0.53 mm and implants 0.48 ± 0.72, the difference not being statistically significant (mean difference = -0.16 mm; 95% CI: -0.58 to 0.27; P (t-test) = 0.457). One year after completion of the endodontic retreatment, of the 13 teeth that originally had a periapical radiolucency, one was lost, six showed complete healing; four a radiographic improvement; and two showed no changes/worsening. Two of the teeth originally without a lesion developed a lesion. There were no statistically significant differences for the number of patients' visits (endo = 5.2 ± 1.8; implant = 5.5 ± 1.1; mean difference = -0.03 95% CI: -1.24 to 0.64; P (t-test) = 0.522). It took significantly more days to complete the implant rehabilitation (endo = 48.9 ± 19.5; implant = 158.5 ± 67.2; mean difference = -109.60; 95% CI: -141.26 to -77.94; P (t-test) < 0.001), but less patients' chair time (endo = 405.5 ± 230.3 min; implant = 260.0 ± 154.6 min; mean difference = 45.50; 95% CI: 19.35 to 271.65; P (t-test) = 0.025). Implant treatment was significantly more expensive (endo = 1195 ± 503.7 €; implant = 1907.5 ± 232.4 €; mean difference = -712.50; 95% CI: -963.59 to -461.41; P (t-test) < 0.001). One year after treatment completion, the mean PES was 10.92 ± 1.93 and 7.07 ± 2.87 and the mean WES was 7.67 ± 1.83 and 7.60 ± 2.32 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference 3.85; 95% CI 1.94 to 5.76; P (t-test) < 0.001) whereas no significant differences were observed for tooth aesthetics (WES) (mean difference 0.07; 95% CI -1.62 to 1.76; P (t-test) = 0.936) between treatments. The preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Aesthetics of the soft tissues and time needed to complete treatment were in favour of endodontic retreatment, whereas implant rehabilitation required half of the chair time than endodontic retreatment, but was significantly more expensive. Although much larger patient populations and longer follow-ups are needed to fully answer this question, in this scenario the less invasive endodontic retreatment could be the first therapeutic option to be considered.

Endodontics and the ageing patient.

PubMed

Johnstone, M; Parashos, P

2015-03-01

Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. © 2015 Australian Dental Association.

Orthograde endodontic retreatment of teeth with individual cast posts: report of two cases.

PubMed

Ramić, Bojana; Stojanac, Igor; Premović, Milica; Drobac, Milan; Petrović, Ljubomir

2012-01-01

The failure of primary endodontic treatment is manifested by various clinical symptoms following endodontic therapy or, more frequently, by the development of chronic inflammatory process in the apex region without any subjective symptoms. In case of unfavorable outcome of the primary endodontic treatment, orthograde endodontic retreatment is the method of choice for a prolonged therapy. Two female patients, 47 and 44 years old, were presented at the Dental Clinic of Vojvodina for endodontic retreatment of teeth 22, 23 and 13, within the repeated prosthetic restoration. Intraradicular individual cast posts were removed using ultrasonic instruments. Remains of gutta-percha were removed by engine driven rotary re-treatment files, root canals were shaped and cleaned using the crown-down technique, and obturated with gutta-percha and epoxy-resin-based sealer using the lateral compaction technique. When there are metal posts or broken instruments in the root canal, the use of ultrasonic instruments is considered a safe method characterized by negligible tooth substance loss and minimal root damage causing fractures and perforations, and the entire procedure is effective and predictable. Non-surgical orthograde endodontic retreatment, when properly performed in accessible and penetrable root canals, achieves a high cure rate, good and lasting results and eliminates the need for radical procedures, such as apical surgery or tooth extraction. When nonsurgical endodontic retreatment is done, treated teeth must be restored by full coronal coverage as soon as possible, to prevent coronal leakage or fracture.

Outcomes of endodontic therapy in general practice

PubMed Central

Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

2014-01-01

Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis. PMID:22547719

Outcomes of endodontic therapy in general practice: a study by the Practitioners Engaged in Applied Research and Learning Network.

PubMed

Bernstein, Susan D; Horowitz, Allan J; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A; Collie, Damon; Matthews, Abigail G; Curro, Frederick A; Thompson, Van P; Craig, Ronald G

2012-05-01

The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis.

Comparative Evaluation of Fracture Strength of Different Types of Composite Core Build-up Materials: An in vitro Study.

PubMed

Gowda, Srinivasa; Quadras, Dilip D; Sesappa, Shetty R; Maiya, G R Ramakrishna; Kumar, Lalit; Kulkarni, Dinraj; Mishra, Nitu

2018-05-01

The aim of the study was to evaluate the fracture strength of three types of composite core build-up materials. The objectives were to study and evaluate the fracture strength and type of fracture in composite core build-up in restoration of endodonti-cally treated teeth with or without a prefabricated metallic post. A total of 60 freshly extracted mandibular premolars free of caries, cracks, or fractures were end-odontically treated and restored with composite core build-up with prefabricated metallic posts cemented with resin luting cement (group I) and without a post (group II). This was followed by a core build-up of 10 teeth each with three different types of composite materials: Hybrid composite, nanocomposite, and ormocer respectively. The samples were mounted on polyvinyl chloride block and then loaded in the universal load frame at 90° to the long axis of tooth. The fracture strength of the samples was directly obtained from the load indicator attached to the universal load frame. Analysis of variance (ANOVA) test revealed that teeth restored with post exhibited highest fracture strength (1552.32 N) and teeth restored without post exhibited lowest fracture strength (232.20 N). Bonferroni's test revealed that values for hybrid composite (Z-100, 3M ESPE) with post, nanocomposite (Z-350, 3M ESPE) with post, ormocer composite (Admira-VOCO) with post, and nanocomposite (Z-350, 3M ESPE) without post were not significantly different from each other. Teeth restored with post and core using hybrid composite yielded the highest values for fracture strength. Teeth restored with ormocer core without post exhibited the lowest values. Teeth restored with nanocomposite core without post exhibited strength that was comparable with hybrid composite core but higher than that of ormocer. Mutilated endodontically treated teeth can be prosthetically rehabilitated successfully by using adhesive composite core build-up along with post to meet anatomical, functional, and esthetic demands.

Factors affecting the periapical healing process of endodontically treated teeth.

PubMed

Holland, Roberto; Gomes, João Eduardo; Cintra, Luciano Tavares Angelo; Queiroz, Índia Olinta de Azevedo; Estrela, Carlos

2017-01-01

Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

Factors affecting the periapical healing process of endodontically treated teeth

PubMed Central

Holland, Roberto; Gomes, João Eduardo; Cintra, Luciano Tavares Angelo; Queiroz, Índia Olinta de Azevedo; Estrela, Carlos

2017-01-01

Abstract Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction. PMID:29069143

Aesthetic treatment of discoloration of nonvital teeth.

PubMed

Miara, P

1995-09-01

Attempts to treat discoloration in nonvital teeth were first reported a century ago. This article discusses two potential causes of nonvital tooth discoloration-trauma and endodontic treatment-along with a step-by-step clinical procedure for treatment of the discoloration. In trauma, hemoglobin is released into the tissues; iron oxides, formed by oxygen and iron in hemoglobin, cause discoloration and swelling that infringes on pulp space, forcing the pulp to recede with a potential loss of tooth vitality. After endodontic treatment, either hemorrhaging, materials used, or incomplete removal and breakdown of necrotic tissue may cause staining. The learning objective of this article is to review the causes and the prevention/treatment of discoloration in nonvital teeth.

Regenerative Endodontic Therapy in a Single Visit Using Platelet-rich Plasma and Biodentine in Necrotic and Asymptomatic Immature Molar Teeth: A Report of 3 Cases.

PubMed

Topçuoğlu, Gamze; Topçuoğlu, Hüseyin Sinan

2016-09-01

This report describes 3 successful single-visit regenerative endodontic therapy cases using platelet-rich plasma (PRP) and Biodentine (Septodont, Saint Maurdes Fossés, France) for 3 immature mandibular molar teeth, all with necrotic pulp, in 2 children aged 8 years and 1 aged 9 years. Three teeth were separately diagnosed as having a necrotic pulp. After preparation of the access cavity under rubber dam isolation, the necrotic pulp was removed, and each canal was irrigated with 2.5% sodium hypochlorite, sterile saline, and 17% EDTA solutions. Freshly prepared PRP was injected into each canal up to the cementoenamel junction, and Biodentine was placed directly over the PRP clot. Each access cavity was then restored with composite resin. Follow-up clinical examinations revealed negative responses to cold and electric pulp tests. None of the treated teeth were sensitive to percussion or palpation. Radiographic examination showed continued thickening of root canal walls and apical closure of the root apex of each tooth. Single-visit regenerative endodontic therapy can be considered in necrotic and asymptomatic immature permanent teeth. PRP and Biodentine may serve as scaffold and barrier materials in regenerative endodontic procedures. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Endodontic Management of a Mandibular First Molar with Radix Entomolaris and Conservative Post-endodontic Restoration with CAD/CAM Onlay: A Novel Clinical Technique

PubMed Central

De Ataide, Ida De Noronha; Fernandes, Marina; Lambor, Rajan; Alreja, Dalip

2016-01-01

This case report describes a novel technique of restoring endodontically treated teeth. Hidden caries causing irreversible pulpitis in a mandibular molar with Radix Entomolaris (RE) was evident. The intact occlusal surface anatomy was duplicated before preparing an access cavity to replicate the original occlusal surface in the post endodontic restoration using (Computer-Aided Design and Computer-Aided Manufacturing) CAD/CAM technique. This report highlights uniquely designed onlay utilizing the benefits of contemporary materials and advanced technology. PMID:28050515

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide.

PubMed

Kulkarni, Vinaya Kumar; Ragavendra, T Raju; Deshmukh, Jeevanand; Vanka, Amit; Duddu, Mahesh Kumar; Patil, Anand Kumar G

2012-04-01

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation.

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide

PubMed Central

Kulkarni, Vinaya Kumar; Ragavendra, T. Raju; Deshmukh, Jeevanand; Vanka, Amit; Duddu, Mahesh Kumar; Patil, Anand Kumar G.

2012-01-01

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation. PMID:22629077

Incidence of Postoperative Pain after Single- and Multi-Visit Endodontic Treatment in Teeth with Vital and Non-Vital Pulp

PubMed Central

Ince, Bayram; Ercan, Ertugrul; Dalli, Mehmet; Dulgergil, Coruh Turksel; Zorba, Yahya Orcun; Colak, Hakan

2009-01-01

Objectives To assess the incidence of postoperative pain after single- and multi-visit endodontic treatment of teeth with vital and non-vital pulp. Methods In total, 306 patients with teeth requiring endodontic treatment were identified and were included in this study. Two experienced clinicians treated the patients, who were randomly assigned to two groups. While the teeth of patients in group 1 were obturated, group 2 were temporarily sealed and obturated after one week. Three days after the root canal instrumentation of each tooth, the patients were asked whether they experienced any postoperative pain and to rate the level of discomfort as no, mild, moderate, or severe pain. Data were analyzed statistically using the chi-square test. Results No significant difference in postoperative pain was found between vital and non-vital teeth (P>.01). Mild, moderate, and severe pain occurred in 31.4, 13.7, and 4.6% of vital teeth, respectively. Postoperative pain occurred in 107 (69.9%) and 106 (69.3%) teeth in the single- and multi-visit treatment groups, respectively. There was no significant difference in postoperative pain between the two groups (P>.01). Conclusions The prevalence of postoperative pain did not differ between vital and non-vital teeth. The majority of patients in either groups reported no or only mild pain. PMID:19826598

Regenerative Endodontic Treatment versus Apical Plug in Immature Teeth: Three-Year Follow-Up.

PubMed

Asgary, Saeed; Fazlyab, Mahta; Nosrat, Ali

This report compares and evaluates the treatment outcomes of regenerative endodontic treatment and apical plug as two accepted treatment protocols in a pair of necrotic immature maxillary central incisors of a 12-year old female. The patient was referred complaining of a dull pain and swelling in her upper lip area. She had a history of trauma to the anterior maxilla two years earlier. Both teeth were clinically diagnosed with pulp necrosis and periapical radiographs revealed that separate periapical radiolucent lesions surrounded the immature apices of both teeth. The left and right incisors were treated with apical plug and regenerative endodontic treatment, respectively, using calcium-enriched mixture (CEM) cement. The patient was followed-up for three years. During this period, both teeth were clinically asymptomatic and showed complete radiographic healing of the periapical lesions. The right central incisor showed root development. No tooth discoloration was evident. Apexification by apical plug placement and pulp regeneration are both reliable treatments for immature non-vital teeth. In order to choose the right treatment the advantages of either technique should be weighed against its drawbacks. CEM cement can be successfully applied for both purposes. This biomaterial causes less discoloration of the tooth.

Incidence and factors associated with flare-ups in a post graduate programme in the indian population.

PubMed

Pamboo, Jaya; Hans, Manoj-Kumar; Kumaraswamy, Bangalore-Niranjan; Chander, Subhash; Bhaskaran, Sajeev

2014-12-01

The study had twin objectives: to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment in the Department of Conservative Dentistry and Endodontics in Vyas Dental college and hospital, Jodhpur during a period of one year, and also to examine the correlation with pre-operative and operative variables. Data was collected from 1023 teeth from 916 patients who had received endodontic treatment over a 12- month period. Information was obtained for each patient treated, including pulp and peri-radicular diagnosis for the tooth, presence of pre-operatory pain, type of medication being used, type of instrumentation technique used and number of appointments needed to complete the root canal treatment. The results showed an incidence of 2.35% for flare-ups from 1023 endodontically treated teeth. Statistical analysis was done using the chi-square test. Flare-ups were found to be affected significantly by gender of patient, presence of radiolucent lesions, patients taking pre-operative analgesic or anti-inflammatory drugs and on type of instrumentation technique. In contrast, there was no correlation between flare-ups and age, different arch/tooth groups and single or multiple visit endodontics. Key words:Anti-inflammatory, flare-ups, instrumentation, prospective.

Incidence and factors associated with flare-ups in a post graduate programme in the indian population

PubMed Central

Pamboo, Jaya; Kumaraswamy, Bangalore-Niranjan; Chander, Subhash; Bhaskaran, Sajeev

2014-01-01

Objectives: The study had twin objectives: to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment in the Department of Conservative Dentistry and Endodontics in Vyas Dental college and hospital, Jodhpur during a period of one year, and also to examine the correlation with pre-operative and operative variables. Material and Methods: Data was collected from 1023 teeth from 916 patients who had received endodontic treatment over a 12- month period. Information was obtained for each patient treated, including pulp and peri-radicular diagnosis for the tooth, presence of pre-operatory pain, type of medication being used, type of instrumentation technique used and number of appointments needed to complete the root canal treatment. Results: The results showed an incidence of 2.35% for flare-ups from 1023 endodontically treated teeth. Statistical analysis was done using the chi-square test. Conclusions: Flare-ups were found to be affected significantly by gender of patient, presence of radiolucent lesions, patients taking pre-operative analgesic or anti-inflammatory drugs and on type of instrumentation technique. In contrast, there was no correlation between flare-ups and age, different arch/tooth groups and single or multiple visit endodontics. Key words:Anti-inflammatory, flare-ups, instrumentation, prospective. PMID:25674318

External apical root resorption in maxillary root-filled incisors after orthodontic treatment: A split-mouth design study

PubMed Central

Amarilla, Almudena; Espinar-Escalona, Eduardo; Castellanos-Cosano, Lizett; Martín-González, Jenifer; Sánchez-Domínguez, Benito; López-Frías, Francisco J.

2012-01-01

Introduction: The purpose of this study was to compare, in a split mouth design, the external apical root resorption (EARR) associated with orthodontic treatment in root-filled maxillary incisors and their contralateral teeth with vital pulps. Methodology: The study sample consisted of 38 patients (14 males and 24 females), who had one root-filled incisor before completion of multiband/bracket orthodontic therapy for at least 1 year. For each patient, digital panoramic radiographs taken before and after orthodontic treatment were used to determine the root resortion and the proportion of external root resorption (PRR), defined as the ratio between the root resorption in the endodontically treated incisor and that in its contralateral incisor with a vital pulp. The student’s t-test, chi-square test and logistic regression analysis were used to determine statistical significance. Results: There was no statistically significant difference (p > 0.05) between EARR in vital teeth (1.1 ± 1.0 mm) and endodontically treated incisors (1.1 ± 0.8 mm). Twenty-six patients (68.4%) showed greater resorption of the endodontically treated incisor than its homolog vital tooth (p > 0.05). The mean and standard deviation of PPR were 1.0 ± 0.2. Multivariate logistic regression suggested that PRR does not correlate with any of the variables analyzed. Conclusions: There was no significant difference in the amount or severity of external root resorption during orthodontic movement between root-filled incisors and their contralateral teeth with vital pulps. Key words:Endodontics, orthodontics, root canal treatment, root resorption. PMID:22143731

Endodontic treatment enhances the regenerative potential of teeth with advanced periodontal disease with secondary endodontic involvement

PubMed Central

Kwon, Eun-Young; Cho, Yunjung; Lee, Ju-Youn; Kim, Sung-Jo

2013-01-01

Purpose The aim of this study was to identify a role for endodontic intervention in enhancing the regenerative potential of the periodontal ligament when combined with periodontal treatment in seriously involved teeth with a secondary endodontic component. Methods Patients who exhibited radiolucency extending to the periapical region, abnormal electric pulp testing values, and deep probing depth derived from primary periodontal disease with secondary endodontic involvement were included. Intentional root canal treatment was applied to those teeth in which the apical lesions were presumed to communicate with those of the periodontal lesion of the teeth that remained vital. In all three selected cases, regenerative periodontal therapy incorporating either bone graft or guided tissue regeneration was instituted 3 months after the endodontic intervention. Results Remarkable enhancement in radiographic density was noticeable around the affected teeth as evidenced by changes in radiopacity. There was a significant reduction in the probing pocket depth and gain in the clinical attachment level. Chewing discomfort gradually disappeared from the commencement of the combined treatment. Conclusions An intentional endodontic intervention may be a worthwhile approach for the sophisticated management of teeth suffering from serious attachment loss and alveolar bone destruction with concomitant secondary endodontic involvement. PMID:23837128

The sodium hypochlorite accident: experience of diplomates of the American Board of Endodontics.

PubMed

Kleier, Donald J; Averbach, Robert E; Mehdipour, Omid

2008-11-01

To better understand the etiology associated with sodium hypochlorite accidents, we surveyed diplomates of the American Board of Endodontics. Of the 314 diplomates who responded, 132 reported experiencing a sodium hypochlorite accident. Questions were asked about the age and sex of the patient as well as the tooth being treated, preoperative signs, symptoms, diagnosis, and radiographic appearance. Data were analyzed by chi-square tests. Significantly more women experienced sodium hypochlorite accidents compared with men (p < 0.0001). More maxillary teeth than mandibular teeth (p < 0.0001) and more posterior than anterior teeth (p < 0.0001) were involved. A diagnosis of pulp necrosis with radiographic findings of periradicular radiolucency were positively associated with such accidents (p < 0.0001). Most respondents reported that patient signs and symptoms completely resolved within a month. The occurrence of an accident, by itself, did not adversely affect the endodontic prognosis of the involved tooth. Anatomic variations may contribute significantly to the occurrence of a sodium hypochlorite accident.

Clinical evaluation of fiber-reinforced epoxy resin posts and cast post and cores.

PubMed

Ferrari, M; Vichi, A; García-Godoy, F

2000-05-01

This retrospective study evaluated treatment outcome of cast post and core and Composipost systems after 4 yrs of clinical service. 200 patients were included in the study. They were divided in two groups of 100 endodontically treated teeth restored with a post. Group 1: Composipost systems were luted into root canal following the manufacturer's instructions. Group 2: Cast post and cores were cemented into root canal preparations with a traditional technique. The patients were recalled after 6 months, 1, 2 and 4 yrs and clinical and radiographic examinations were completed. Endodontic and prosthodontic results were recorded. Group 1: 95% of the teeth restored with Composiposts showed clinical success; 3% of these samples were excluded for noncompliance and 2% showed endodontic failure. Group 2: Clinical success was found with 84% of teeth restored with cast post and core. 2% of these samples were excluded for noncompliance, 9% showed root fracture, 2% dislodgment of crown and 3% endodontic failure. Statistical evaluation showed significant differences between Groups 1 and 2 (P < 0.001). The results of this retrospective study indicated that the Composipost system was superior to the conventional cast post and core system after 4 yrs of clinical service.

Restoration and reinforcement of endodontically treated teeth with a polyethylene ribbon and prefabricated fiberglass post.

PubMed

Kimmel, S S

2000-01-01

In the past it was considered appropriate to place a cast post and core in every pulpless tooth without regard to the remaining supportive tooth structure present. Recent research and the advent of adhesive bonding techniques have caused clinicians to reevaluate their restorative protocol. This article reviews the current literature with regard to restoration of the endodontically treated tooth and presents a method for restoration and reinforcement utilizing a combination of polyethylene ribbon and a prefabricated fiberglass post.

Rigid versus flexible dentine-like endodontic posts--clinical testing of a biomechanical concept: seven-year results of a randomized controlled clinical pilot trial on endodontically treated abutment teeth with severe hard tissue loss.

PubMed

Sterzenbach, Guido; Franke, Alexandra; Naumann, Michael

2012-12-01

This is the first clinical long-term pilot study that tested the biomimetic concept of using more flexible, dentine-like (low Young modulus) glass fiber-reinforced epoxy resin posts (GFREPs) compared with rather rigid, stiff (higher Young modulus) titanium posts (TPs) in order to improve the survival rate of severely damaged endodontically treated teeth. Ninety-one subjects in need of postendodontic restorations in teeth with 2 or less remaining cavity walls were randomly assigned to receive either a tapered TP (n = 46) or a tapered GFREP (n = 45). The posts were adhesively luted using self-adhesive resin cement. The composite core build-ups were prepared ensuring a circumferential 2-mm ferrule. The primary endpoint was a loss of restoration for any reason. To study group differences, the log-rank test was calculated (P < .05). Hazard plots were constructed. After 84 months of observation (mean = 71.2 months), 7 restorations failed (ie, 4 GFREPs and 3 TPs). The failure modes were as follows: GFREP:root fracture (n = 3), core fracture (n = 1) and TP:endodontic failure (n = 3). No statistical difference was found between the survival rates (GFREPs = 90.2%, TPs = 93.5%, P = .642). The probability of no failure was comparable for both post materials (risk ratio; 95% confidence interval, 0.965-0.851/1.095). When using self-adhesive luted prefabricated posts in severely destroyed abutment teeth with 2 or less cavity walls and a 2-mm ferrule, postendodontic restorations achieved high long-term survival rates irrespective of the post material used (ie, glass fiber vs titanium). Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Saving Single-rooted Teeth with Combined Endodontic-periodontal Lesions.

PubMed

Pico-Blanco, Alexandre; Castelo-Baz, Pablo; Caneiro-Queija, Leticia; Liñares-González, Antonio; Martin-Lancharro, Pablo; Blanco-Carrión, Juan

2016-12-01

Teeth affected by combined endodontic-periodontal lesions are usually considered by all prognosis classifications as hopeless teeth. The development of new biomaterials combined with modern endodontic and periodontal regeneration techniques may improve dental prognosis and maintain the affected teeth. Moreover, 1 of the replacement options for those teeth, dental implants, has shown an increasing number of biological and technical complications. Five patients were included in this case series study. Full periodontal and radiographic examination revealed generalized chronic periodontitis. Moreover, endodontic-periodontal lesions affecting single-rooted teeth were detected in those patients with tissue destruction beyond the apex. After splinting those teeth, conventional endodontic and nonsurgical periodontal treatment was performed. Three months later, periodontal regeneration was applied at those teeth in order to reconstruct supporting tissues and to improve dental prognosis. After a follow-up period ranging from 14 months to 17 years, it was observed that all teeth remain asymptomatic and in normal function. No signs of apical pathosis were observed, and the periodontium was stable. All patients were included in a strict maintenance program to check the periodontal and apical status. This case series shows that it is possible to change the prognosis of teeth affected by combined endodontic-periodontal lesions, even if the periodontal support is destroyed beyond the apex. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Management of Teeth with Persistent Apical Periodontitis after Root Canal Treatment Using Regenerative Endodontic Therapy.

PubMed

Saoud, Tarek Mohamed A; Huang, George T-J; Gibbs, Jennifer L; Sigurdsson, Asgeir; Lin, Louis M

2015-10-01

Regenerative endodontic therapy (RET) is currently used to treat immature teeth with necrotic pulp and/or apical periodontitis. However, recently RET has been used to treat mature teeth with necrotic pulp and/or apical periodontitis and resulted in regression of clinical signs and/or symptoms and resolution of apical periodontitis. The purpose of this case report was to describe the potential of using RET to treat 2 mature teeth with persistent apical periodontitis after root canal therapy using RET. Two male patients, one 26-year old and another 12-year old, presented for retreatment of persistent apical periodontitis after root canal treatment of 2 mature teeth (#9 and #19). The gutta-percha fillings in the canals of teeth #9 and #19 were removed with Carvene gutta-percha solvent (Prevest DenPro, Jammu, India) and ProTaper Universal rotary retreatment files (Dentsply Maillefer, Ballaigues, Switzerland). The canals of both teeth were further chemomechanically debrided with rotary retreatment files and copious amounts of sodium hypochlorite irrigation and dressed with Metapaste (Meta Biomed, Chungbuk, Korea). RET was performed on teeth #9 and #19. Periapical bleeding was provoked into the disinfected root canals. The blood clots were covered with mineral trioxide aggregate plugs, and the access cavities were restored with intermediate restorative material. Teeth #9 and #19 showed regression of clinical signs and/or symptoms and healing of apical periodontitis after 13-month and 14-month follow-ups, respectively. Tooth #9 revealed narrowing of the canal space and apical closure by deposition of hard tissue. RET has the potential to be used to retreat teeth with persistent apical periodontitis after root canal therapy. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Undergraduate endodontic education: what are the challenges?

PubMed

Qualtrough, A J E

2014-03-01

To deliver the knowledge and skills required to equip undergraduate students for practice is a significant responsibility; graduates must be familiar with the diagnosis and treatment of pulpal and periradicular diseases and the preservation and restoration of pulpally compromised teeth. A greater understanding of the microbiological processes involved in endodontics and developments in instruments and materials have transformed our approaches to root canal treatment. Information technology has revolutionised certain aspects of education and has had an effect on endodontic teaching. Dental graduates will be expected to treat an increasingly elderly population and will enter a climate in which remuneration for root canal treatment could have a significant effect on the number of cases treated and the pattern of referral. Teachers of endodontics at the majority of dental schools are taxed by competing demands for time in packed curricula, a lack of availability of natural teeth for classroom exercise and a lack of suitable patients. The debate as to whether endodontics should be a specialist subject in its own right has rumbled on for three decades. Compared with the situation in the 1970s, there are now well defined curricula guidelines to which those involved in teaching can refer and map teaching in their schools against agreed norms. These create the potential for students to graduate with the knowledge and skills at a sound level of competence to carry out endodontic procedures and with a deeply engrained understanding of the need for continuing professional development.

Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy.

PubMed

Lin, Louis M; Kim, Sahng G; Martin, Gabriela; Kahler, Bill

2018-01-16

Three immature permanent teeth with pulp necrosis and apical periodontitis were treated with regenerative endodontic therapy (RET), which included root canal disinfection with sodium hypochlorite irrigation, intra-canal medication with calcium hydroxide paste, 17% EDTA rinse, induction of periapical bleeding into the canal, collagen matrix and MTA coronal seal, and composite resin restoration of access cavities. After different periods of follow-up, it was observed that continued root maturation, especially apical closure occurred despite persistent apical periodontitis of immature permanent teeth after failed RET. This finding is of interest as the secondary goal of further root maturation occurred despite failure of the primary goal of elimination of clinical symptom/sign and periapical inflammation. The possible biological mechanisms that could allow for further root maturation to occur in spite of persistent root canal infection of immature permanent teeth are discussed. Based on these observations, the biology of wound healing of immature permanent teeth after injury is not fully understood and should be further investigated. This case report demonstrates that whilst further root maturation is considered a successful outcome for teeth treated with RET, the primary objective must be the resolution of the signs and symptoms of apical periodontitis. © 2018 Australian Society of Endodontology Inc.

A prospective clinical study of regenerative endodontic treatment of traumatized immature teeth with necrotic pulps using bi-antibiotic paste.

PubMed

Nazzal, H; Kenny, K; Altimimi, A; Kang, J; Duggal, M S

2018-04-01

To evaluate the treatment outcomes of a revitalization endodontic technique (RET) for the management of traumatized immature teeth with necrotic pulps in children. Fifteen healthy children (age range = 7-10 years) with traumatized immature maxillary incisors with necrotic pulps treated with bi-antibiotic revitalization endodontic technique were prospectively assessed over approximately two years (mean = 22 months). One operator undertook all treatments, clinical reviews and standardized radiographic exposures with radiographic analysis being carried out by two calibrated experienced clinicians. Crown colour change was assessed using an objective published methodology. Wilcoxon signed-rank test was used to compare root lengths, root dentinal widths and apical foramen widths over time. Interoperator measurement reliability was consistently strong for all measurements. There was no significant difference in root lengths or root dentinal wall widths following RET. A significant difference in apical foramen widths was observed after 2 years (P = 0.013) with resolution of clinical signs of infection in all cases. Despite omitting minocycline and using Portland cement (nonbismuth containing cement), a noticeable crown colour change (yellower, redder and lighter), as measured by an objective colour measurement system with ΔE = 7.39, was recorded. Most patients, however, were satisfied with the aesthetic outcome. Traumatized immature teeth with necrotic pulps treated with revitalization endodontic technique did not demonstrate continuation of root development or dentine formation when assessed by periapical radiographs. However, apical closure and periodontal healing were observed. A measurable change in crown colour (yellower, redder and lighter), with mostly no aesthetic concern to the patients/parents, was also observed. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Endotoxin content in endodontically involved teeth. 1975.

PubMed

Schein, Benjamin; Schilder, Herbert

2006-04-01

Fluid was aspirated from the root canals of 40 endodontically involved teeth. This fluid was assayed for endotoxin with the limulus lysate test. Pulpless teeth contained greater concentrations of endotoxin than those with vital pulps. Symptomatic teeth also contained more endotoxin than asymptomatic teeth.

[Theory and practice of minimally invasive endodontics].

PubMed

Jiang, H W

2016-08-01

The primary goal of modern endodontic therapy is to achieve the long-term retention of a functional tooth by preventing or treating pulpitis or apical periodontitis is. The long-term retention of endodontically treated tooth is correlated with the remaining amount of tooth tissue and the quality of the restoration after root canal filling. In recent years, there has been rapid progress and development in the basic research of endodontic biology, instrument and applied materials, making treatment procedures safer, more accurate, and more efficient. Thus, minimally invasive endodontics(MIE)has received increasing attention at present. MIE aims to preserve the maximum of tooth structure during root canal therapy, and the concept covers the whole process of diagnosis and treatment of teeth. This review article focuses on describing the minimally invasive concepts and operating essentials in endodontics, from diagnosis and treatment planning to the access opening, pulp cavity finishing, root canal cleaning and shaping, 3-dimensional root canal filling and restoration after root canal treatment.

Periapical Status and Quality of Root Canal Fillings in a Moroccan Subpopulation

PubMed Central

El Merini, Hafsa; Lamzawaq, Amine; Hamza, Mouna

2017-01-01

Aim The aim of the study was to assess the prevalence of apical periodontitis (AP) and quality of root canal fillings in an adult Moroccan subpopulation. Methods In the study 508 patients were included, attending the Conservative Dentistry Clinic at the Faculty of Dentistry of Casablanca. 508 panoramic and 709 periapical radiographs were observed. The periapical status of all teeth (with the exception of third molars) was examined according to Ørstavik's periapical index. The statistical analysis was performed with the software Epi Info Version 6.04dfr, April 2001. Results A total of 12719 teeth were examined. 45.3% of patients had apical periodontitis. 4.2% of teeth were treated endodontically and 70.4% of these treatments were inadequate. 91,5% with inadequate endodontic treatment presented apical periodontitis, while only 8,2% with adequate endodontic treatment had apical periodontitis. The lower molars and the upper premolars were the most affected teeth. The presence of apical periodontitis was correlated significantly with insufficient root canal fillings (p < 0.05). Conclusions The present study found a high prevalence of apical periodontitis in this Moroccan population. Inadequate root canal fillings were associated with an increased prevalence of apical periodontitis. PMID:28713425

Effects of the Ratio between Pigment and Bleaching Gel on the Fracture Resistance and Dentin Microhardness of endodontically treated Teeth.

PubMed

Galloza, Marina Og; Jordão-Basso, Keren Cf; Bandeca, Matheus C; Costa, Samuel O; Borges, Alvaro H; Tonetto, Mateus R; Tirintan, Fabio C; Keine, Kátia C; Kuga, Milton C

2017-11-01

The aim of this study was to evaluate the effects of bleaching gel using 35% hydrogen peroxide (HP), associated with red carmine pigment (RC), in the 3:1 or 1:1 ratio, on fracture resistance and dentin microhardness of endodontically treated teeth. A total of 40 lower incisors were endodontically treated and divided into four groups (n = 10), according to the bleaching protocol: G1 (HP3), 35% HP + RC (3:1); G2 (HP1), 35% HP + RC (1:1); G3 (positive), 38% HP; and G4 (negative), unbleached. Four dental bleaching sessions were performed. The dental crowns were restored after the last session and submitted to the fracture resistance test. Totally, 60 specimens from the endodontically treated lower incisor crowns were prepared to evaluate the effects on dentin microhardness. The analysis was measured (in Knoop) prior to and after the last dental bleaching session using similar bleaching protocols. G2 presented the lowest fracture resistance (p < 0.05). The other groups were similar to each other (p > 0.05). No difference was observed in the reduction of dentin microhardness among the groups (p > 0.05). A 1:1 ratio (bleaching gel:pigment) caused a significant fracture resistance reduction in relation to the other protocols. No effect on the dentin microhardness reduction was observed. The pigment addition to the bleaching agent accelerates the bleaching chemical reaction. However, no studies have evaluated the ideal proportion to optimize tooth bleaching.

Effect of fiber post length and abutment height on fracture resistance of endodontically treated premolars prepared for zirconia crowns.

PubMed

Lin, Jie; Matinlinna, Jukka Pekka; Shinya, Akikazu; Botelho, Michael George; Zheng, Zhiqiang

2018-04-01

The purpose of this study was to compare the fracture resistance, mode of fracture, and stress distribution of endodontically treated teeth prepared with three different fiber post lengths and two different abutment heights, using both experimental and finite element (FE) approaches. Forty-eight human maxillary premolars with two roots were selected and endodontically treated. The teeth were randomly distributed into six equally sized groups (n = 8) with different combinations of post lengths (7.5, 11, and 15 mm) and abutment heights (3 and 5 mm). All the teeth restored with glass fiber post (Rely X Fiber Post, 3M ESPE, USA) and a full zirconia crown. All the specimens were thermocycled and then loaded to failure at an oblique angle of 135°. Statistical analysis was performed for the effects of post length and abutment height on failure loads using ANOVA and Tukey's honestly significant difference test. In addition, corresponding FE models of a premolar restored with a glass fiber post were developed to examine mechanical responses. The factor of post length (P < 0.01) had a significant effect on failure load. The abutment height (P > 0.05) did not have a significant effect on failure load. The highest mean fracture resistance was recorded for the 15 mm post length and 5 mm abutment height test group, which was significantly more resistant to fracture than the 7.5 mm post and 5 mm abutment height group (P < 0.05). The FE analysis showed the peak compression and tension stress values of 7.5 mm post length were higher than that of 11 and 15 mm post length. The stress value of remaining tooth decreased as the post length was increased. Within the limitations of this experimental and FE analysis study, increasing the post length inside the root of endodontically treated premolar teeth restored with glass-fiber posts increase the fracture resistance to non-axial forces. Failure mode is more favorable with reduced abutment heights.

Estimation of Ultimate Tensile Strength of dentin Using Finite Element Analysis from Endodontically Treated Tooth

NASA Astrophysics Data System (ADS)

Sinthaworn, S.; Puengpaiboon, U.; Warasetrattana, N.; Wanapaisarn, S.

2018-01-01

Endodontically treated teeth were simulated by finite element analysis in order to estimate ultimate tensile strength of dentin. Structures of the endodontically treated tooth cases are flared root canal, restored with different number of fiber posts {i.e. resin composite core without fiber post (group 1), fiber post No.3 with resin composite core (group 2) and fiber post No.3 accessory 2 fiber posts No.0 with resin composite core (group 3)}. Elastic modulus and Poisson’s ratio of materials were selected from literatures. The models were loaded by the average fracture resistances load of each groups (group 1: 361.80 N, group 2: 559.46 N, group 3: 468.48 N) at 135 degree angulation in respect to the longitudinal axis of the teeth. The stress analysis and experimental confirm that fracture zone is at dentin area. To estimate ultimate tensile strength of dentin, trial and error of ultimate tensile strength were tested to obtain factor of safety (FOS) equal to 1.00. The result reveals that ultimate tensile strength of dentin of group 1, 2, 3 are 38.89, 30.96, 37.19 MPa, respectively.

Fracture strength of endodontically treated molars transfixed horizontally by a fiber glass post.

PubMed

Beltrão, Maria Cecilia Gomes; Spohr, Ana Maria; Oshima, Hugo Mitsuo Silva; Mota, Eduardo Gonçalves; Burnett, Luiz Henrique

2009-02-01

To assess the effect of a horizontally transfixed fiber glass post placed between buccal and palatal surfaces, on the fracture strength of endodontically treated molar teeth with MOD cavities, either restored with resin-based composite, or not. 75 sound maxillary human third molars were extracted, embedded in acrylic resin blocks and randomly assigned to five groups (n=15). Group A (sound teeth), (control) and Groups B, C, D and E, which were subjected to the following procedures after endodontic treatment: GB--(MOD+Endo), GC--(MOD+Endo+Post), GD--MOD and composite restoration (MOD+Endo+CR), GE--(MOD+Endo+Post+CR). The specimens were stored in distilled water at 37 degrees C for 24 hours. Later, a compressive force was applied by means of a universal testing machine at 1 mm/minute speed, parallel to the long axis of the teeth until fracture occurred. The means of the results (N) followed by the same letter represent no statistical difference by ANOVA and Tukey (P<0.05): GA = 4289.8 (+/- 1128.9)a, GB = 549.6 (+/- 120.7)b, GC = 1474.8 (+/- 338.1)c, GD = 1224.7 (+/- 236.0)c, GE = 2645.4 (+/- 675.1)d. In the analysis of qualitative variables, there was a tendency to cusp fracture in all groups except for Group C. The fiber glass post transfixed horizontally in a MOD cavity significantly increased the fracture resistance of the teeth restored with resin composite.

External apical root resorption in maxillary root-filled incisors after orthodontic treatment: a split-mouth design study.

PubMed

Llamas-Carreras, José María; Amarilla, Almudena; Espinar-Escalona, Eduardo; Castellanos-Cosano, Lizett; Martín-González, Jenifer; Sánchez-Domínguez, Benito; López-Frías, Francisco Javier

2012-05-01

The purpose of this study was to compare, in a split mouth design, the external apical root resorption (EARR) associated with orthodontic treatment in root-filled maxillary incisors and their contralateral teeth with vital pulps. The study sample consisted of 38 patients (14 males and 24 females), who had one root-filled incisor before completion of multiband/bracket orthodontic therapy for at least 1 year. For each patient, digital panoramic radiographs taken before and after orthodontic treatment were used to determine the root resortion and the proportion of external root resorption (PRR), defined as the ratio between the root resorption in the endodontically treated incisor and that in its contralateral incisor with a vital pulp. The student's t-test, chi-square test and logistic regression analysis were used to determine statistical significance. There was no statistically significant difference (p > 0.05) between EARR in vital teeth (1.1 ± 1.0 mm) and endodontically treated incisors (1.1 ± 0.8 mm). Twenty-six patients (68.4%) showed greater resorption of the endodontically treated incisor than its homolog vital tooth (p > 0.05). The mean and standard deviation of PPR were 1.0 ± 0.2. Multivariate logistic regression suggested that PRR does not correlate with any of the variables analyzed. There was no significant difference in the amount or severity of external root resorption during orthodontic movement between root-filled incisors and their contralateral teeth with vital pulps.

Evaluation of odontological assistance to soldiers going on a mission, and prognostication of their odontological problems.

PubMed

Kelbauskiene, Nijole; Kelbauskas, Eduardas; Nedzelskiene, Irena

2006-01-01

The aim of the study was to evaluate the condition of the oral cavity in soldiers going on a military mission, the level of odontological assistance to them, and to prognosticate possible odontological problems during the mission period. We studied 50 soldiers going on a military mission in Iraq. During the study we applied odontological examination and panoramic imaging. We found that soldiers' teeth were treated, and they received comprehensive odontological assistance: 18% of soldiers had their teeth restored with single crowns and bridges, and 56% of soldiers had underwent endodontic treatment of their teeth. During the radiological examination we diagnosed individual cases of dental caries on the contact surfaces of teeth, and determined the level of the filling of root canals of endodontically treated teeth and the relationship of this level with radiological changes in apical periodontium. 67.3% of teeth had incompletely filled root canals, and radiological changes in their apical periodontium were reliably more frequent (80.6%) than in the apical periodontium of teeth with completely filled root canals (19.4%) (p<0.001). Of significant concern is the fact that frequently teeth with incompletely filled root canals and apical periodontal damage are restored using radical post-core and crowns. Radiological examination showed that in teeth with signs of chronic apical periodontitis and insufficient quality of filling, the condition may become more acute and cause odontological problems. A part of odontological problems in soldiers may be caused by incorrect position of the third molars in the jaw and possible aggravated eruption of these teeth.

Apical Periodontitis and Endodontic Treatment in Patients with Type II Diabetes Mellitus: Comparative Cross-sectional Survey.

PubMed

Smadi, Leena

2017-05-01

The aims of this study were to investigate the prevalence of apical periodontitis (AP) in diabetes mellitus (DM) patients compared with nondiabetic patients and to examine the effect of glycemic control on the prevalence of AP. Radiographs of a group of DM patients were compared with those of a matched nondiabetic group to identify AP. The diabetic group was subdivided according to the level of glycemic control into two subgroups: A well-controlled DM and a poorly controlled DM. The periapical index score was used to assess the periapical status. All groups were compared in regard to the presence of AP lesions, the number of end-odontically treated teeth (ET), and the percentage of failure of endodontically treated teeth (AP/ET ratio). Statistical Package for the Social Sciences (SPSS version 20.0, Chicago, Illinois, USA) was used for all the analyses; p ≤ 0.05 was considered as statistically significant. The prevalence of AP was higher in diabetic group than in the nondiabetic group (13.5 vs 11.9% respectively). Diabetic group had more teeth with endodontic treatment ET compared with nondiabetic group (4.18 vs 1.82% respectively); this difference was statistically significant (p = 0.001) along with higher AP/ET ratio (27.7 vs 19.3 respectively). The poorly controlled DM group had a higher prevalence of AP lesions compared with the well-controlled DM group (18.29 vs 9.21 respectively). This difference was statistically significant (p = 0.001); they also had a higher percentage of ET (5.55 vs 3.13% respectively) and AP/ ET ratio (32.0 vs 21.8% respectively). This survey demonstrates a higher prevalence of AP in DM patients compared with nondiabetic group, with an increased prevalence of persistent chronic AP. Compared with a well-controlled diabetic group, a poor glycemic control may be associated with a higher prevalence of AP and increased rate of endodontic failures. Counseling diabetic patients, particularly those with poor glycemic control, about the risk of failure of endodontic treatment can be part of planning management, which could include refereeing diabetic patients who need endodontic treatment for consultant care.

Treatment Recommendations for Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network

PubMed Central

McCracken, Michael S.; Louis, David R.; Litaker, Mark S.; Minyé, Helena M.; Mungia, Rahma; Gordan, Valeria V.; Marshall, Don G.; Gilbert, Gregg H.

2016-01-01

Background Objectives were to: (1) quantify practitioner variation in likelihood to recommend a crown; and (2) test whether certain dentist, practice, and clinical factors are significantly associated with this likelihood. Methods Dentists in the National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In four clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. These responses were used to calculate a dentist-specific “Crown Factor” (CF; range 0–12). A higher score implies a higher likelihood to recommend a crown. Certain characteristics were tested for statistically significant associations with the CF. Results 1,777 of 2,132 eligible dentists responded (83%). Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, endodontically-treated, or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, Southwest practitioners, and practitioners with a balanced work load were more likely to recommend crowns, as were practitioners who use optical scanners for digital impressions. Conclusions There is substantial variation in the likelihood of recommending a crown. While consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied by type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Practical Implications Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture -- whether from endodontic treatment, fractured teeth, or large restorations -- prompted many clinicians to recommend crowns. PMID:27492046

Influence of Endodontic Treatment and Retreatment on the Fatigue Failure Load, Numbers of Cycles for Failure, and Survival Rates of Human Canine Teeth.

PubMed

Missau, Taiane; De Carlo Bello, Mariana; Michelon, Carina; Mastella Lang, Pauline; Kalil Pereira, Gabriel; Baldissara, Paolo; Valandro, Luiz Felipe; Souza Bier, Carlos Alexandre; Pivetta Rippe, Marília

2017-12-01

This study evaluated the effects of endodontic treatment and retreatment on the fatigue failure load, numbers of cycles for failure, and survival rates of canine teeth. Sixty extracted canine teeth, each with a single root canal, were selected and randomly divided into 4 groups (n = 15): untreated, teeth without endodontic intervention; prepared, teeth subjected only to rotary instrumentation; filled, teeth receiving complete endodontic treatment; and retreated, teeth retreated endodontically. After the different endodontic interventions, the specimens were subjected to fatigue testing by the stepwise method: 200 N (× 5000 load pulses), 300 N, 400 N, 500 N, 600 N, 800 N, and 900 N at a maximum of 30,000 load pulses each or the occurrence of fracture. Data from load to failure and numbers of cycles for fracture were recorded and subjected to Kaplan-Meier and Log Rank tests (P < .05), in addition to Weibull analysis. The fractures of the specimens were classified as repairable or catastrophic. The retreated, filled, and untreated groups presented statistically significantly higher fatigue failure loads and numbers of cycles for failure than did the prepared group. Weibull analysis showed no statistically significant difference among the treatments for characteristic load to failure and characteristic number of cycles for failure, although, for number of cycles, a higher Weibull modulus was observed in filled and retreated conditions. The predominant mode of failure was catastrophic. Teeth subjected to complete endodontic treatment and retreatment behaved similarly in terms of fatigue failure load and number of cycles to failure when compared with untreated teeth. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

SEM and microCT validation for en face OCT imagistic evaluation of endodontically treated human teeth

NASA Astrophysics Data System (ADS)

Negrutiu, Meda L.; Nica, Luminita; Sinescu, Cosmin; Topala, Florin; Ionita, Ciprian; Bradu, Adrian; Petrescu, Emanuela L.; Pop, Daniela M.; Rominu, Mihai; Podoleanu, Adrian Gh.

2011-03-01

Successful root canal treatment is based on diagnosis, treatment planning, knowledge of tooth anatomy, endodontic access cavity design, controlling the infection by thorough cleaning and shaping, methods and materials used in root canal obturation. An endodontic obturation must be a complete, three-dimensional filling of the root canal system, as close as possible to cemento-dentinal junction, without massive overfilling or underfilling. There are several known methods which are used to assess the quality of the endodontic sealing, but most are invasive. These lead to the destruction of the samples and often no conclusion could be drawn in respect to the existence of any microleakage in the investigated areas of interest. Using an time domain en-face OCT system, we have recently demonstrated real time thorough evaluation of quality of root canal fillings. The purpose of this in vitro study was to validate the en face OCT imagistic evaluation of endodontically treated human teeth by using scanning electron microscopy (SEM) and microcomputer tomography (μCT). SEM investigations evidenced the nonlinear aspect of the interface between the endodontic filling material and the root canal walls and materials defects in some samples. The results obtained by μCT revealed also some defects inside the root-canal filling and at the interfaces between the material and the root canal walls. The advantages of the OCT method consist in non-invasiveness and high resolution. In addition, en face OCT investigations permit visualization of the more complex stratified structure at the interface between the filling material and the dental hard tissue.

Regenerative endodontics: a state of the art.

PubMed

Bansal, Rashmi; Bansal, Rajesh

2011-01-01

Scientific advances in the creation of restorative biomaterials, in vitro cell culture technology, tissue grafting, tissue engineering, molecular biology and the human genome project provide the basis for the introduction of new technologies into dentistry. Non-vital infected teeth have long been treated with root canal therapy (for mature root apex) and apexification (for immature root apex), or doomed to extraction. Although successful, current treatments fail to re-establish healthy pulp tissue in these teeth. But, what if the non-vital tooth could be made vital once again? That is the hope offered by regenerative endodontics, an emerging field focused on replacing traumatized and diseased pulp with functional pulp tissue. Restoration of vitality of non-vital tooth is based on tissue engineering and revascularization procedures. The purpose of this article is to review these biological procedures and the hurdles that must be overcome to develop regenerative endodontic procedures.

Endodontic Treatment of an Autogenous Transplanted Tooth Using an Er,Cr:YSGG Laser and Radial Firing Tips: Case Report.

PubMed

Martins, Miguel Rodrigues; Lima, Rita C; Pina-Vaz, Irene; Carvalho, Manuel Fontes; Gutknecht, Norbert

2016-10-01

Although several surgical techniques have been reported, no study has yet reported alternative strategies for endodontic treatment of autogenous transplanted teeth. Therefore, the aim of this clinical report is to present the long-term endodontic outcome of a nonvital autogenously transplanted third molar treated with an Er,Cr:YSGG laser and radial firing tips (RFTs). Autogenous tooth transplantation can be considered an alternative to restore edentulous areas and, in donor's teeth with complete root formation, root canal treatment should be performed up to 14 days following transplantation. In the present case report, the patient returned only after 6 months, with clinical and radiological signs of apical periodontitis (AP) associated with the transplanted tooth. Instead of traditional endodontic chemical irrigants or medications, the protocol for smear-layer removal and root canal disinfection was based on intracanal irradiation with an Er,Cr:YSGG laser and RFTs. After 3-years' follow-up, the complete reestablishment of the periodontal ligament and the arrest of the resorptive process could be noticed. This protocol has shown to be effective for the endodontic treatment of a transplanted multi-rooted tooth with AP. Further randomized clinical trials should be conducted to clearly demonstrate the effectiveness of this laser-assisted endodontic protocol.

Fusion of a supernumerary tooth to right mandibular second molar: a case report and literature review.

PubMed

Zhu, Min; Liu, Chao; Ren, Shuangshuang; Lin, Zintong; Miao, Leiying; Sun, Weibin

2015-01-01

Gemination or fusion is a rare occurrence in the mandibular posterior teeth. The aim of this article is to describe the problems encountered and the strategy employed in treating such cases. A 34 years old patient came with the complaint of spontaneous and radiating pain in the right mandibular posterior region. The tooth in concern was an anomalous 'double' second mandibular molar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin. The present case emphasizes the importance of identifying anatomical anomalies during treatment of fused teeth with supernumerary tooth, and the need for the use of advanced imaging modalities like CBCT which is a critical aid in the diagnosis of such cases. Fused teeth can be managed quite efficiently by an overall combined treatment including both endodontic and periodontal therapy.

Outcome of Endodontically Treated Teeth Diagnosed With Cracked Tooth

DTIC Science & Technology

2015-06-01

However, variable symptoms complicate the diagnosis (9). In a study of 32 patients presenting with diffuse longstanding orofacial pain eventually...883-92. 22)Byrnjulsen A, Fristad I, Grevstad T, Hals-Kvinnsland I. Incompletely fractured teeth associated with diffuse longstanding orofacial pain ...cracked tooth is highly associated with discomfort. Patients often describe a momentary, sudden, sharp, lancinating pain that results in continuous tooth

Fracture resistance of structurally compromised and normal endodontically treated teeth restored with different post systems: An in vitro study

PubMed Central

Mortazavi, Vajihesadat; Fathi, Mohammadhossein; Katiraei, Najmeh; Shahnaseri, Shirin; Badrian, Hamid; Khalighinejad, Navid

2012-01-01

Background: With the aim of developing methods that could increase the fracture resistance of structurally compromised endodontically treated teeth, this study was conducted to compare the effect of three esthetic post systems on the fracture resistance and failure modes of structurally compromised and normal roots. Materials and Methods: Forty five extracted and endodontically treated maxillary central teeth were assigned to 5 experimental groups (n=9). In two groups, the post spaces were prepared with the corresponding drills of the post systems to be restored with double taper light posts (DT.Light-Post) (group DT.N) and zirconia posts (Cosmopost) (group Zr.N). In other 3 groups thin wall canals were simulated to be restored with Double taper Light posts (DT.W), double taper Light posts and Ribbond fibers (DT+R.W) and Zirconia posts (Zr.W). After access cavity restoration and thermocycling, compressive load was applied and the fracture strength values and failure modes were evaluated. Data were analyzed using two-way ANOVA, Tukey and Fisher exact tests (P<0.05). Results: The mean failure loads (N) were 678.56, 638.22, 732.44, 603.44 and 573.67 for groups DT.N, Zr.N, DT.W, DT+R.W and Zr.w respectively. Group DT+R.W exhibited significantly higher resistance to fracture compared to groups Zr.N, DT.W and Zr.w (P<0.05). A significant difference was detected between groups DT.N and Zr.W (P=0.027). Zirconia posts showed significantly higher root fracture compared to fiber posts (P=0.004). Conclusion: The structurally compromised teeth restored with double taper light posts and Ribbond fibers showed the most fracture resistance and their strengths were comparable to those of normal roots restored with double taper light posts. More desirable fracture patterns were observed in teeth restored with fiber posts. PMID:22623936

Tissue Engineering Considerations in Dental Pulp Regeneration

PubMed Central

Nosrat, Ali; Kim, Jong Ryul; Verma, Prashant; S. Chand, Priya

2014-01-01

Regenerative endodontic procedure is introduced as a biologically based treatment for immature teeth with pulp necrosis. Successful clinical and radiographic outcomes following regenerative procedures have been reported in landmark case reports. Retrospective studies have shown that this conservative treatment allows for continued root development and increases success and survival rate of the treated teeth compared to other treatment options. Although the goal of treatment is regeneration of a functional pulp tissue, histological analyses show a different outcome. Developing predictable protocols would require the use of key elements for tissue engineering: stem cells, bioactive scaffolds, and growth factors. In this study we will review the evidence based steps and outcomes of regenerative endodontics. PMID:24396373

Pro-oxidant status and matrix metalloproteinases in apical lesions and gingival crevicular fluid as potential biomarkers for asymptomatic apical periodontitis and endodontic treatment response

PubMed Central

2012-01-01

Background Oxidative stress and matrix metalloproteinases -9 and -2 are involved in periodontal breakdown, whereas gingival crevicular fluid has been reported to reflect apical status. The aim of this study was to characterize oxidant balance and activity levels of MMP -2 and -9 in apical lesions and healthy periodontal ligament; and second, to determine whether potential changes in oxidant balance were reflected in gingival crevicular fluid from asymptomatic apical periodontitis (AAP)-affected teeth at baseline and after endodontic treatment. Methods Patients with clinical diagnosis of AAP and healthy volunteers having indication of tooth extraction were recruited. Apical lesions and healthy periodontal ligaments, respectively, were homogenized or processed to obtain histological tissue sections. Matrix metalloproteinase -9 and -2 levels and/or activity were analyzed by Immunowestern blot, zymography and consecutive densitometric analysis, and their tissue localization was confirmed by immunohistochemistry. A second group of patients with AAP and indication of endodontic treatment was recruited. Gingival crevicular fluid was extracted from AAP-affected teeth at baseline, after endodontic treatment and healthy contralateral teeth. Total oxidant and antioxidant status were determined in homogenized tissue and GCF samples. Statistical analysis was performed using STATA v10 software with unpaired t test, Mann-Whitney test and Spearman's correlation. Results Activity of MMP-2 and MMP-9 along with oxidant status were higher in apical lesions (p < 0.05). Total oxidant status correlated positively with matrix metalloproteinase-2 and lesion size (p < 0.05). Gingival crevicular fluid showed significantly lower levels of total antioxidant status in diseased teeth at baseline compared to controls and endodontically-treated groups. Conclusions Apical lesions display an oxidant imbalance along with increased activity of matrix metalloproteinase-2 and -9 and might contribute to AAP progression. Oxidant imbalance can also be reflected in GCF from AAP-affected teeth and was restored to normal levels after conservative endodontic treatment. These mediators might be useful as potential biomarkers for chair-side complementary diagnostic of apical status in GCF. PMID:22436166

Pro-oxidant status and matrix metalloproteinases in apical lesions and gingival crevicular fluid as potential biomarkers for asymptomatic apical periodontitis and endodontic treatment response.

PubMed

Dezerega, Andrea; Madrid, Sonia; Mundi, Verónica; Valenzuela, María A; Garrido, Mauricio; Paredes, Rodolfo; García-Sesnich, Jocelyn; Ortega, Ana V; Gamonal, Jorge; Hernández, Marcela

2012-03-21

Oxidative stress and matrix metalloproteinases -9 and -2 are involved in periodontal breakdown, whereas gingival crevicular fluid has been reported to reflect apical status. The aim of this study was to characterize oxidant balance and activity levels of MMP -2 and -9 in apical lesions and healthy periodontal ligament; and second, to determine whether potential changes in oxidant balance were reflected in gingival crevicular fluid from asymptomatic apical periodontitis (AAP)-affected teeth at baseline and after endodontic treatment. Patients with clinical diagnosis of AAP and healthy volunteers having indication of tooth extraction were recruited. Apical lesions and healthy periodontal ligaments, respectively, were homogenized or processed to obtain histological tissue sections. Matrix metalloproteinase -9 and -2 levels and/or activity were analyzed by Immunowestern blot, zymography and consecutive densitometric analysis, and their tissue localization was confirmed by immunohistochemistry. A second group of patients with AAP and indication of endodontic treatment was recruited. Gingival crevicular fluid was extracted from AAP-affected teeth at baseline, after endodontic treatment and healthy contralateral teeth. Total oxidant and antioxidant status were determined in homogenized tissue and GCF samples. Statistical analysis was performed using STATA v10 software with unpaired t test, Mann-Whitney test and Spearman's correlation. Activity of MMP-2 and MMP-9 along with oxidant status were higher in apical lesions (p < 0.05). Total oxidant status correlated positively with matrix metalloproteinase-2 and lesion size (p < 0.05). Gingival crevicular fluid showed significantly lower levels of total antioxidant status in diseased teeth at baseline compared to controls and endodontically-treated groups. Apical lesions display an oxidant imbalance along with increased activity of matrix metalloproteinase-2 and -9 and might contribute to AAP progression. Oxidant imbalance can also be reflected in GCF from AAP-affected teeth and was restored to normal levels after conservative endodontic treatment. These mediators might be useful as potential biomarkers for chair-side complementary diagnostic of apical status in GCF.

Endodontic implications of the variability of the root canal systems of posterior teeth.

PubMed

Biggs, J T; Benenati, F W

1995-01-01

Variations in the morphology of roots and root canal systems create challenges which the dental practitioner must be able to recognize. Endodontic therapy is predictable and successful only to the extent that the root canal system can be debrided, disinfected and sealed against future contamination. In order to accomplish these goals it is necessary to become familiar with the variability of the system we seek to treat.

An audit on technical quality of root fillings performed by undergraduate students.

PubMed

Fong, W; Heidarifar, O; Killough, S; Lappin, M J; El Karim, I A

2018-04-01

To evaluate radiographically the technical quality of root fillings performed by undergraduate dental students and to assess whether students were exposed to an appropriate endodontic case mix during their clinical training. A retrospective audit was undertaken evaluating the clinical records of patients who underwent endodontic procedures during the period from September 2015 to June 2016 in the Dental School at Queen's University Belfast, UK. Two final-year dental students were trained and calibrated to evaluate postoperative intra-oral periapical radiographs of completed root canal treatments using specific assessment criteria. Data were presented as frequencies, percentage and mean ± standard deviation (SD). Comparisons of treatment outcomes between groups (posterior and anterior teeth) were calculated using Fisher's exact test, and the level of significance was set at P < 0.05. Intra- and interexaminer reproducibility was assessed by Kappa statistics. A total of 222 teeth and 381 canals were assessed, and of those, 253 (66%) of the root fillings were found to be acceptable in all the assessment parameters, namely taper, length and lateral adaptation of the root filling. Subanalysis of individual root filling parameters revealed that 372 canals (97%) exhibited good taper, and 275 canals (72%) were considered to be of an appropriate length, with 89 canals (23%) found to be underfilled and 17 canals (5%) overfilled. Overall 346 (91%) of canals had good lateral condensation. Students treated both single and multirooted teeth, and there was no significant association between tooth type and the quality of root filling provided (P > 0.05). In the majority of the teeth treated by undergraduate students at Queen's University Belfast, the technical quality of the root filling was acceptable and students were exposed to an appropriate case mix for endodontic training. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

PubMed Central

Bilge Gülsüm, NUR; Evren, OK; ALTUNSOY, Mustafa; AĞLARCI, Osman Sami; ÇOLAK, Mehmet; GÜNGÖR, Enes

2014-01-01

Objective This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation. Material and Methods The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test. Results The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth]. Conclusions The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics. PMID:25591019

Treatment of Mature Permanent Teeth with Necrotic Pulps and Apical Periodontitis Using Regenerative Endodontic Procedures: A Case Series.

PubMed

Saoud, Tarek Mohamed; Martin, Gabriela; Chen, Yea-Huey M; Chen, Kuang-Liang; Chen, Chao-An; Songtrakul, Kamolthip; Malek, Matthew; Sigurdsson, Asgeir; Lin, Louis M

2016-01-01

Regenerative endodontic procedures (REPs) are usually used to treat human immature permanent teeth with necrotic pulps and/or apical periodontitis. Successful REPs result in the elimination of clinical signs/symptoms, the resolution of apical periodontitis, and, in some cases, thickening of the canal walls and/or continued root development with or without apical closure. REPs can restore the vitality of tissue in the canals of immature permanent teeth previously destroyed by infection or trauma. Vital tissue is inherited with immune defense mechanisms to protect itself from foreign invaders. Recently, REPs have also been used to successfully treat human mature permanent teeth with necrotic pulps and apical periodontitis. The purpose of this case series was to present the potential of using REPs for mature permanent teeth with necrotic pulps and apical periodontitis. This case series consisted of 6 patients, 4 females and 2 males. The patients' ages ranged from 8-21 years old. Seven permanent teeth, 4 anterior and 3 molar teeth, with necrotic pulps and apical periodontitis were treated using REP. Radiographically, the root development of all teeth was almost completed except the apices of 2 molars, which showed slightly open. Complete chemomechanical debridement of the canals of the teeth was performed, and the canals were dressed with Metapaste (Meta Biomed Co, Ltd, Chungbuk, Korea) during treatment visits. Periapical bleeding into the canals was induced at the last treatment visit by placing a hand #20 or #25 K-file with the tip slightly bent through the apical foramina into the periapical tissues. A 3-mm thickness of mineral trioxide aggregate was placed into the coronal canals over semicoagulated blood. The access cavities were restored with either composite resin or amalgam. Follow-ups of the 7 teeth ranged from 8 to 26 months. The periapical lesions of 2 teeth were considered healed, and 5 teeth revealed healing. Clinical signs/symptoms were absent in all teeth at follow-up visits at different time points. None of the treated teeth responded to cold and electric pulp tests. This case series shows the potential of using REPs for mature teeth with necrotic pulp and apical periodontitis. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[A clinical study of endodontic flare-ups].

PubMed

Yeh, S J; Lin, Y T; Lu, S Y

1994-06-01

The purpose of this study was to investigate the clinical variables influencing endodontic flare-ups. Three hundred and thirteen teeth receiving endodontic treatment at the Endodontic Department, Chang Gung Memorial Hospital were studied from December 1992 to February 1993. Among them, 21 teeth with significant pain and 9 with apical swelling were noted after the first appointment of treatment. Three teeth with persistent pain and one with apical swelling were also found one week after completion of endodontic therapy. The results showed significant improvement of clinical symptoms and signs one week after completion of endodontic treatment in comparison with pretreatment and after the first appointment (p < 0.025). The factors such as presence of pretreatment complaints, periapical lesions and vital pulp had significant effects on the incidence of endodontic flare-ups after the first appointment of treatment (P < 0.025). In contrast, patients' sex, the number of visits, and whether this was a retreatment case or not had no significant effect on the frequency of these endodontic flare-ups.

Comparison of the Effectiveness of Four Different Types of Needles in Irrigating Endodontically Treated Teeth.

DTIC Science & Technology

1980-02-08

3. Shih, M.; Marshall, F. J.; and Rosen, S. The bactericidal efficiency of sodium hypochlorite as an endodontic irrigant. Oral Surg 29(4): 613-619...and Rosen9 investi- gated the cleansing effect of sodium hypochlorite and normal saline on the apical one third using a standard irrigating method. They...found that sodium hypochlorite was no better than normal saline solutiun in irrigating this segment. Salzgeber and Brilliant10 investigated the

Whitening of endodontically untreated calcified anterior teeth.

PubMed

Pedorella, C A; Meyer, R D; Woollard, G W

2000-01-01

Definitive treatment for whitening endodontically untreated anterior teeth with dystrophic calcification is provided by removing the coronal sclerotic dentin and utilizing internal and external bleaching as necessary.

Influence of gel/LED-laser application on cervical microleakage of two barrier materials used for endodontically treated teeth whitening

NASA Astrophysics Data System (ADS)

Marchesan, Melissa Andréia; Barros, Felipe; Porto, Saulo; Zaitter, Suellen; Brugnera, Aldo, Jr.; Sousa-Neto, Manoel D.

2007-02-01

This study evaluated ex vivo the influence of the number of gel/LED-laser applications/activations on cervical microleakage of two different barrier materials used for protection during whitening of endodontically treated teeth. Eighty-four canines were instrumented and obturated with epoxy resin sealer. The seal was removed 2 mm beyond the cemento-enamel junction for barrier placement and the teeth were divided into two groups of 40 teeth each: G1, zinc phosphate cement; G2, glass ionomer cement. The two groups were subdivided into 4 subgroups (n=10 each): I) no gel or LED-laser application; II) one gel application and two LED-laser activations; III) two gel applications and four LED-laser activations; IV) three gel applications and six LED-laser activations. The teeth were immersed in India ink for 7 days, decalcified and cleared. Cervical microleakage was quantified with a measurement microscope. Statistical analysis showed that zinc phosphate caused significantly lower microleakage than glass ionomer cement (presented microleakage in all subgroups). However, after two (p<0.01) and three (p<0.001) applications of gel, there was statistially significant microleakage in zinc phosphate barriers. Based on the present results, it can be concluded that cervical barriers with zinc phosphate cement show less cervical microleakage and that two or more applications/activations of gel/LED-laser significantly increase microleakage.

Fracture resistance exhibited by endodontically treated and retreated teeth shaped by ProTaper NEXT versus WaveOne: An in vitro study

PubMed Central

Khalap, Neha Deepak; Hegde, Vibha; Kokate, Sharad

2015-01-01

Aim: To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment. Materials and Methods: One hundred freshly extracted human teeth were selected. 20 samples served as control (untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n = 20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were statistically analyzed. Result: When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01). Conclusion: Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth. PMID:26752838

Fracture resistance exhibited by endodontically treated and retreated teeth shaped by ProTaper NEXT versus WaveOne: An in vitro study.

PubMed

Khalap, Neha Deepak; Hegde, Vibha; Kokate, Sharad

2015-01-01

To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment. One hundred freshly extracted human teeth were selected. 20 samples served as control (untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n = 20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were statistically analyzed. When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01). Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth.

CRITICAL ANALYSIS OF ARTIFICIAL TEETH FOR ENDODONTIC TEACHING

PubMed Central

Nassri, Maria Renata Giazzi; Carlik, Jaime; da Silva, Camila Roberta Nepomuceno; Okagawa, Renata Elisa; Lin, Suzy

2008-01-01

The purpose of this study was to evaluate the use of artificial teeth for endodontic teaching. A questionnaire was prepared and submitted to 18 professors of Endodontics from different Brazilian universities to evaluate the following features of five cloudy resin artificial teeth: internal and external anatomy; coronal chambers regarding their size, shape and canal path; root canal regarding their size, shape and position; fulfillment of the pulp chamber and root canals by considering the texture, quantity, color, and ease of handling; resin hardness and visualization of the radiographic image. The results presented favorable opinions, in terms of internal and external anatomy, coronal pulp chambers and root canal and handling and radiographic imaging. The contents of the pulp space and hardness of the teeth were considered satisfactory. The average grade assigned to the artificial tooth quality was 8.4, in a 0-10 scale. In conclusion, the artificial teeth have potential to replace the natural teeth in endodontic teaching; however, improvements are still necessary to reach a better quality model. PMID:19089288

Critical analysis of artificial teeth for endodontic teaching.

PubMed

Nassri, Maria Renata Giazzi; Carlik, Jaime; da Silva, Camila Roberta Nepomuceno; Okagawa, Renata Elisa; Lin, Suzy

2008-01-01

The purpose of this study was to evaluate the use of artificial teeth for endodontic teaching. A questionnaire was prepared and submitted to 18 professors of Endodontics from different Brazilian universities to evaluate the following features of five cloudy resin artificial teeth: internal and external anatomy; coronal chambers regarding their size, shape and canal path; root canal regarding their size, shape and position; fulfillment of the pulp chamber and root canals by considering the texture, quantity, color, and ease of handling; resin hardness and visualization of the radiographic image. The results presented favorable opinions, in terms of internal and external anatomy, coronal pulp chambers and root canal and handling and radiographic imaging. The contents of the pulp space and hardness of the teeth were considered satisfactory. The average grade assigned to the artificial tooth quality was 8.4, in a 0-10 scale. In conclusion, the artificial teeth have potential to replace the natural teeth in endodontic teaching; however, improvements are still necessary to reach a better quality model.

Analysis of factors associated with cracked teeth.

PubMed

Seo, Deog-Gyu; Yi, Young-Ah; Shin, Su-Jung; Park, Jeong-Won

2012-03-01

The purpose of this study was to analyze the characteristics, distribution, and associated factors of longitudinal fractured teeth according to the well-defined criteria of the American Association of Endodontists (AAE). One hundred seven teeth with longitudinal fracture from 103 patients were diagnosed and analyzed. The patients' signs, symptoms, age, and sex were noted as well as the tooth number, dental arch, filling materials, size/classification of restoration, crack direction, pulp vitality, whether the patient had undergone endodontic treatment, bite test results, percussion test results, wear facet, and periodontal pocket depth. Eighty-seven teeth were diagnosed with a cracked tooth (81.3%), 14 were diagnosed with vertical root fracture (VRF, 13.1%), 4 had a split tooth (3.7%), and 2 had a fractured cusp (1.9%); 82.2% showed a sensitive reaction on the bite test. Longitudinal tooth fractures were observed most frequently in patient in their 40s. The upper first molar (28.0%) was most frequently cracked, followed by the lower first molar (25.2%), the lower second molar (20.6%), and the upper second molar (16.8%). Most longitudinal tooth fractures (72.0%) occurred mainly in restored teeth, whereas only 28.0% were found in intact teeth. Compared with resin (4.7%) or porcelain (0.9%), the use of nonbonded inlay restoration materials such as gold (20.5%) or amalgam (18.7%) increased the occurrence of longitudinal tooth fractures. Out of 107 of longitudinal fractured teeth, 33 (30.8%) were treated endodontically and 74 (69.2%) were not. VRF was associated with endodontic treatment. The bite test is most reliable for reproducing symptoms. The combined use of various examination methods is recommended for detecting cracks and minutely inspecting all directions of a tooth. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients.

PubMed

Ricucci, Domenico; Siqueira, José F; Bate, Anna L; Pitt Ford, Thomas R

2009-04-01

This study intended to examine histologically root canal-treated teeth evincing apical periodontitis lesions and correlate the findings with clinical observations. Specimens were obtained from 24 patients (12 asymptomatic and 12 symptomatic) by extraction or endodontic surgery and consisted of roots or root tips and the associated pathologic lesion. Specimens were processed for histologic analysis, and serial sections were evaluated. Findings were correlated with clinical observations according to the presence or absence of symptoms. The mean period elapsed from treatment to specimen retrieval in the asymptomatic group was 7.5 years, as compared with 2.2 years in the symptomatic group. All specimens exhibited periradicular inflammation. Bacteria were visualized in all cases, except for 1 specimen from the asymptomatic group in which a foreign body reaction to overfilled material was the probable reason for emergent disease in a previously vital case. Irrespective of the presence of symptoms, bacteria were always located within the root canal system, although they were also observed in the periradicular tissues in 1 asymptomatic and 4 symptomatic teeth. In general, intraradicular bacterial colonization was heavier in symptomatic failed teeth. The present findings support the role of intraradicular infections, usually in the form of biofilms, as the primary cause of endodontic treatment failure.

Bone structure regeneration after low induction magnetic field treatment in teeth chosen for extraction.

PubMed

Opalko, K; Dojs, A

2006-01-01

The aim of the work was to use and to evaluate the usefulness of the slow variable magnetic fields to aid the treatment of the teeth chosen for extraction. The marginal paradontium of periapical bone of teeth was in a state of extensive destruction. The teeth were chosen for extraction. 13 patients were chosen. 10 of them had with endo-perio changes and 3 suffered from full tooth luxation and had the teeth replanted. Those people were to have an extraction procedure or were declared as impossible to treat in other dental offices. Patients underwent non-aggressive skaling, endodontic treatment and were exposed to slow variable magnetic fields generated by Viofor JPS, accordingly to methods and parameters suggested by Department of Propaedeutics in Dentistry of Pomeranian Medical University in Szczecin. The process of healing of changes was evaluated radiologically. RTG done after 2 weeks and after 2 months were evaluated in respect of bone regeneration. They show the bone structure concentration. A RTG evaluation after half a year, two and three years show a preservation of the bone structure concentration. The use of slow variable magnetic fields contributed to bone structure regeneration and to preserve teeth with recorded endo-perio syndrome. Endodontic treatment of replanted teeth, aided with magnetostimulation has stopped the osteolisis process.

Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems

PubMed Central

Punjabi, Mansi; Dewan, Ruchika Gupta; Kochhar, Rohit

2017-01-01

Aim and Objectives: The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. Materials and Methods: One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups (n = 25) and two control groups (n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Results: Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. Conclusion: GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth. PMID:29430099

Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems.

PubMed

Punjabi, Mansi; Dewan, Ruchika Gupta; Kochhar, Rohit

2017-01-01

The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups ( n = 25) and two control groups ( n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth.

Impact of the quality of coronal restoration and root canal filling on the periapical health in adult syrian subpopulation

PubMed Central

Alafif, Hisham

2014-01-01

Background: The purpose of this study was to determine the status of periapical tissues of endodontically treated teeth according to coronal restorations and root canal fillings separately and in concomitant in adult Syrian subpopulation. Methods: 784 endodontically treated teeth from two hundred randomly selected Syrian adult patients were radiographically evaluated. According to predetermined criteria, the quality of coronal restorations and root canal filling of each tooth was scored as adequate or inadequate. The status of periapical tissues was also classified as healthy or diseased. Results were analyzed using Chi-squared test. Results: Adequate coronal restorations were determined in 58.54% of cases which was accompanied with less periapical pathosis than that in teeth with inadequate restorations (P < 0.01). 14% of teeth were restored by posts which showed no significant impact on the periapical tissues health. 18.5% of endodontic treatments were evaluated as adequate with less number of periapical radiolucencies than that of inadequate root canal fillings (P < 0.01). Absence of periapical pathosis was 96.6% in cases with both adequate coronal restorations and root canals fillings. The rate was 88.5% in cases with only adequate root canals fillings, and about 70% in cases with only adequate coronal restorations. When the treatment was inadequate in both coronal and root canals fillings, success rate was only observed in 48.8%. Conclusion: The most important factor with regard to the periradicular tissue health is the quality of root canal filling without neglecting the influence of coronal restoration (regardless of its type). There is a high prevalence rate of periapical pathosis in Syrian subpopulation due to poor dental practice. PMID:25565729

Dentin-like versus Rigid Endodontic Post: 11-year Randomized Controlled Pilot Trial on No-wall to 2-wall Defects.

PubMed

Naumann, Michael; Sterzenbach, Guido; Dietrich, Thomas; Bitter, Kerstin; Frankenberger, Roland; von Stein-Lausnitz, Manja

2017-11-01

This is the first long-term randomized controlled trial to evaluate dentin-like glass fiber posts (GFPs) compared with rather rigid titanium posts (TPs) for post-endodontic restoration of severely damaged endodontically treated teeth with 2 or fewer remaining cavity walls. Ninety-one subjects in need of post-endodontic restorations were randomly assigned to receive either a tapered GFP (n = 45) or TP (n = 46). Posts were adhesively luted by using self-adhesive resin cement, followed by composite core build-up and preparation of 2-mm ferrule design. Primary end point was loss of restoration for any reason. Kaplan-Meier curves were constructed, and log-rank test was calculated (P < .05). After a follow-up of 132 months, 17 GFP and 20 TP restorations survived, and 19 failed (12 GFP, 7 TP). Failure modes for GFP were root fracture (n = 4), core fracture (n = 1), secondary caries (n = 1), endodontic failure (n = 2), extraction because of tooth mobility grade III associated with insufficient design of removable partial denture (n = 1), tooth fracture (n = 1), and changes in treatment plan (n = 2); failure modes for TP were endodontic failure (n = 5), root fracture (n = 1), and 1 extraction for other reasons. Cumulative survival probability was 58.7% for GFP and 74.2% for TP. When using self-adhesively luted prefabricated posts, resin composite core build-up, and 2-mm ferrule to reconstruct severely damaged endodontically treated teeth, tooth survival is not influenced by post rigidity. Survival decreased rapidly after 8 years of observation in both groups. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Outcomes of different vital pulp therapy techniques on symptomatic permanent teeth: a case series.

PubMed

Asgary, Saeed; Fazlyab, Mahta; Sabbagh, Sedigheh; Eghbal, Mohammad Jafar

2014-01-01

In modern endodontics, vital pulp therapy (VPT) has been considered an ultra-conservative treatment modality. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP). The present article reviews the treatment outcomes of 94 permanent teeth with irreversible pulpitis treated with either IDPC (n=28), DPC (n=28), MP (n=29) or CP (n=9) using calcium-enriched mixture (CEM) cement. After a mean follow-up time of 12.3 months, 93 treated teeth were radiographic/clinically successful; only one radiographic failure was observed in the DPC group.

Outcomes of Different Vital Pulp Therapy Techniques on Symptomatic Permanent Teeth: A Case Series

PubMed Central

Asgary, Saeed; Fazlyab, Mahta; Sabbagh, Sedigheh; Eghbal, Mohammad Jafar

2014-01-01

In modern endodontics, vital pulp therapy (VPT) has been considered an ultra-conservative treatment modality. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP). The present article reviews the treatment outcomes of 94 permanent teeth with irreversible pulpitis treated with either IDPC (n=28), DPC (n=28), MP (n=29) or CP (n=9) using calcium-enriched mixture (CEM) cement. After a mean follow-up time of 12.3 months, 93 treated teeth were radiographic/clinically successful; only one radiographic failure was observed in the DPC group. PMID:25386213

Effect of Intracoronal Depth of Teeth Restored with Endocrowns on Fracture Resistance: In Vitro and 3-dimensional Finite Element Analysis.

PubMed

Dartora, Nereu Roque; de Conto Ferreira, Michele Bertoluzi; Moris, Izabela Cristina Maurício; Brazão, Elisabeth Helena; Spazin, Aloísio Oro; Sousa-Neto, Manoel Damião; Silva-Sousa, Yara Terezinha; Gomes, Erica Alves

2018-07-01

Endodontically treated teeth have an increased risk of biomechanical failure because of significant loss of tooth structure. The biomechanical behavior of endodontically treated teeth restored was evaluated using different extensions of endocrowns inside the pulp chamber by in vitro and 3-dimensional finite element analysis (FEA). Thirty mandibular human molars were endodontically treated. Standardized endocrown preparations were performed, and the teeth were randomly divided into 3 groups (n = 10) according to different endocrown extensions inside the pulp chamber: G-5 mm, a 5-mm extension; G-3 mm, a 3-mm extension; and G-1 mm, a 1-mm extension. After adhesive cementation, all specimens were subjected to thermocycling and dynamic loading. The survival specimens were subjected to fracture resistance testing at a crosshead speed of 1 mm/min in a universal testing machine. All fractured specimens were subjected to fractography. Data were analyzed by 1-way analysis of variance and the Tukey post hoc test (P < .05). Stress distribution patterns in each group were analyzed using FEA. Qualitative analyses were performed according to the von Mises criterion. After dynamic loading, a survival rate of 100% was observed in all groups. For static loading, statistically significant differences among the groups were observed (P < .05) (G-5 mm = 2008.61 N, G-3 mm = 1795.41 N, and G-1 mm = 1268.12 N). Fractography showed a higher frequency of compression curls for G-5 mm and G-3 mm than for G-1 mm. FEA explained the results of fracture strength testing and fractography. Greater extension of endocrowns inside the pulp chamber provided better mechanical performance. Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Considerations for Altering Preparation Designs of Porcelain Inlay/Onlay Restorations for Nonvital Teeth.

PubMed

Homsy, Foudda; Eid, Rita; El Ghoul, Wiam; Chidiac, Jose Johann

2015-08-01

The aim of this study was to compare all ceramic inlay/onlay survival rates in vital and nonvital teeth having the same cavity design. Filling the pulp chamber with ceramic materials or not was also discussed. Ceramic class II inlays/onlays were made on 11 premolars and 30 molars: 14 vital, 27 endodontically treated. The same tooth preparation design was performed on vital and nonvital teeth: In nonvital teeth the pulp chambers were covered by a glass ionomer cement until the pulpal floor depths were between 2 and 2.5 mm, more likely similar to the vital teeth preparations. In vital teeth, glass ionomer was used as a liner to achieve pulpal floor depths between 2 and 2.5 mm when needed. The restorations were assessed (at baseline, 6 months, 1 and 2 years) according to three criteria: marginal discoloration, marginal integrity, and fracture of teeth/restorations, consistent with United States Public Health Service (USPHS) criteria. Eight teeth (19%) showed minor marginal discolorations, while three molars (7%) had loss of marginal integrity. These margins were adjusted using rubber polishing cups and were then judged clinically acceptable. From these three molars, one was vital and two were endodontically treated. No fracture of teeth or restorations was observed. Chi square and exact probability tests were used. There was no statistical difference between vital and nonvital teeth (p = 0.719 chi-squared and Fisher) or between premolars and molars (p = 0.564 chi-squared; 1.000, Fisher). Within the limitations of this study there was no difference for the same inlay/onlay cavity design between vital and nonvital teeth. In nonvital teeth, it seems that filling the pulp chamber with a ceramic core material is not important. Long-term observation periods are needed to reinforce the clinical behavior outcome. © 2015 by the American College of Prosthodontists.

Healing of Horizontal Intra-alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate.

PubMed

Kim, Dohyun; Yue, Wonyoung; Yoon, Tai-Cheol; Park, Sung-Ho; Kim, Euiseong

2016-02-01

The purpose of this retrospective study was to evaluate the healing type and assess the outcome of horizontal intra-alveolar root fractures after endodontic treatment with mineral trioxide aggregate (MTA) as filling material. The clinical database of the Department of Conservative Dentistry at Yonsei University Dental Hospital, Seoul, Korea, was searched for patients with histories of intra-alveolar root fractures and endodontic treatments with MTA between October 2005 and September 2014. Radiographic healing at the fracture line was evaluated independently by 2 examiners and was classified into 4 types according to Andreasen and Hjørting-Hansen. Of the 22 root-fractured teeth that received endodontic treatment with MTA, 19 cases participated in the follow-up after a period of at least 3 months. Seventeen of the 19 teeth (89.5%) exhibited healing of the root fractures. For each healing type, 7 teeth (36.8%) showed healing with calcified tissue, 8 teeth (42.1%) showed interposition of connective tissue, 2 teeth (10.5%) showed interposition of connective tissue and bone, and 2 teeth (10.5%) showed interposition of granulation tissue without healing. Within the limitations of this study, intra-alveolar root fractures showed satisfactory healing outcomes after endodontic treatment with MTA. MTA could be considered to be suitable filling material for the endodontic treatment of horizontal intra-alveolar root fractures. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Stress distribution of endodontically treated teeth with titanium alloy post and carbon fiber post with different alveolar bone height: A three-dimensional finite element analysis.

PubMed

Singh, S Vijay; Bhat, Manohar; Gupta, Saurabh; Sharma, Deepak; Satija, Harsha; Sharma, Sumeet

2015-01-01

A three-dimensional (3D) finite element analysis (FEA) on the stress distribution of endodontically treated teeth with titanium alloy post and carbon fiber post with different alveolar bone height. The 3D model was fabricated using software to represent an endodontically treated mandibular second premolar with post and restored with a full ceramic crown restoration, which was then analyzed using FEA using FEA ANSYS Workbench V13.0 (ANSYS Inc., Canonsburg, Pennsylvania, U.S.A) software. The FEA showed the maximum stresses of 137.43 Mpa in dentin with alveolar bone height of 4 mm when the titanium post was used, 138.48 Mpa when carbon fiber post was used as compared to 105.91 Mpa in the model with alveolar bone height of 2 mm from the cement enamel junction (CEJ) when the titanium post was used and 107.37 Mpa when the carbon fiber post was used. Stress was observed more in alveolar bone height level of 4 mm from CEJ than 2 mm from CEJ. Stresses in the dentin were almost similar when the carbon fiber post was compared to titanium post. However, stresses in the post and the cement were much higher when titanium post was used as compared to carbon fiber post.

[Bio-Oss collagen bone grafting in the treatment of endodontic-periodontic lesion].

PubMed

Sun, Jiang; Liu, Qiong

2009-09-01

To study the effect of Bio-Oss collagen for bone grafting in the treatment of endodontic-periodontic lesion. Thirty patients (37 teeth) with endodontic-periodontic lesions received root canal therapy and periodontal treatment. Four weeks after the treatment, Bio-Oss collagen was grafted in these teeth. Clinical examinations were performed 1, 3, 6, 9, and 12 months after the surgery. The mobility of these teeth improved 1 month after the surgery. At 3, 6, 9, and 12 months after the surgery, the pocket depth reduced obviously good attachment and further improvement of the tooth mobility. Bio-Oss collagen for bone grafting can achieve good therapeutic effect for endodontic-periodontic lesions.

The Effect of Immediate versus Delayed Dowel Space Preparation on Endodontically Filled Teeth.

DTIC Science & Technology

1981-01-01

solution of 1% sodium hypochlorite (Chlorox Corp., Oakland, CA) to remove any tissue tags attached to the root surface. The crowns of all the teeth were...stored. Two weeks later, twenty more weo~ similarly filled. Using hot endodontic pluggers, dowel spaces were prepare d 4h-th~t eithe 3mm or 71T11 of...Preparation on Endodontically Filled Teeth Acce sion r NTIS .... D TTC TAB Distrilu Av r i 0ou- Dist 1 A! The Effect of Immediate Versus Delayed Dowel

Randomized clinical study comparing metallic and glass fiber post in restoration of endodontically treated teeth.

PubMed

Gbadebo, Olaide S; Ajayi, Deborah M; Oyekunle, Oyekunle O Dosumu; Shaba, Peter O

2014-01-01

Post-retained crowns are indicated for endodontically treated teeth (ETT) with severely damaged coronal tissue. Metallic custom and prefabricated posts have been used over the years, however, due to unacceptable color, extreme rigidity and corrosion, fiber posts, which are flexible, aesthetically pleasing and have modulus of elasticity comparable with dentin were introduced. To compare clinical performance of metallic and glass fiber posts in restoration of ETT. 40 ETT requiring post retained restorations were included. These teeth were randomly allocated into 2 groups. Twenty teeth were restored using a glass fiber-reinforced post (FRP) and 20 others received stainless steel parapost (PP), each in combination with composite core buildups. Patients were observed at 1 and 6 months after post placement and cementation of porcelain fused to metal (PFM) crown. Marginal gap consideration, post retention, post fracture, root fracture, crown fracture, crown decementation and loss of restoration were part of the data recorded. All teeth were assessed clinically and radiographically. Fisher's exact test was used for categorical values while log-rank test was used for descriptive statistical analysis. One tooth in the PP group failed, secondary to decementation of the PFM crown giving a 2.5% overall failure while none in the FRP group failed. The survival rate of FRP was thus 100% while it was 97.5% in the PP group. This however was not statistically significant (log-rank test, P = 0.32). Glass FRPs performed better than the metallic post based on short-term clinical performance.

A study of flare-ups following single-visit root canal treatment in endodontic patients.

PubMed

Kalhoro, Feroze Ali; Mirza, Assad Javed

2009-07-01

To determine the frequency of flare-ups in single-visit endodontic treatment and the associated factors. Observational. Baqai Dental College Hospital, Karachi, from November 2005 to May 2006. One hundred patients were assigned for single-visit root canal treatment. Patients that defaulted after the first appointment (incomplete treatment) were excluded from the study. For each tooth treated, the clinical factors and conditions existing before and after the completion of treatment were recorded. This data included patient's age, gender, type of tooth, pre-operative status of pulp and periapical tissues and recording pain and swelling (flare-ups) postoperatively after 1 day, 7 days and 1 month. The significance of results was obtained by applying paired-sample t-test and Pearson X2 test. Three of one hundred cases showed flare-ups after treated in single appointment. On the other hand, a marked number (n=97) of cases did not show flare-ups during the study period. None of the studied variables showed any statistically significant bearing on rate of flare-ups in single appointment root canal treatment. The single-visit root canal treatment was safe in terms of endodontic flare-ups as far as results of this study are concerned. It was safer in both vital and non-vital teeth, and even in teeth with periapical pathosis.

Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment.

PubMed

Akbar, Iftikhar; Iqbal, Azhar; Al-Omiri, Mahmoud K

2013-05-01

The objective of this study was to compare postobturation flare-ups following single and two-visit endodontic treatment of molar teeth with periapical radiolucency. A total of 100 patients with asymptomatic molar teeth with periapical radiolucency were selected. They were randomly allocated into two groups. Fifty patients received complete endodontic treatment in one-visit. Fifty patients received treatment by debridement and instrumentation at the first visit followed by obturation at the second visit. 10% of patients had flare-ups in the single visit group and 8% of patients had flare-ups in the two-visit group. Number of visits did not affect the success of endodontic treatment (p>0.05). Age, gender and tooth type had no effects on the occurrence of flare-ups regardless the number of visits (p>0.05). One-visit endodontic treatment was as successful as two-visit endodontic treatment as evaluated by rate of flareups in asymptomatic molar teeth with periapical radiolucency.

Effect of prophylactic amoxicillin on endodontic flare-up in asymptomatic, necrotic teeth.

PubMed

Pickenpaugh, L; Reader, A; Beck, M; Meyers, W J; Peterson, L J

2001-01-01

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of prophylactic amoxicillin on the occurrence of endodontic flare-up in asymptomatic, necrotic teeth. Seventy patients participated and had a clinical diagnosis of an asymptomatic, necrotic tooth with associated periapical radiolucency. One hour before endodontic treatment, patients randomly received either 3 g of amoxicillin or 3 g of a placebo control in a double-blind manner. After endodontic treatment, each patient received: ibuprofen; acetaminophen with codeine (30 mg); and a 5 1/2-day diary to record pain, swelling, percussion pain, and number and type of pain medication taken. The results demonstrated 10% of the 70 patients had a flare-up characterized by moderate-to-severe postoperative pain or swelling that began approximately 30 h after endodontic treatment and persisted for an average of 74 h. Of the seven patients who had flare-ups, 4 were in the amoxicillin group and 3 were not. Prophylactic amoxicillin did not significantly (p = 0.80) influence the endodontic flare-up. We concluded that a prophylactic dose of amoxicillin before endodontic treatment of asymptomatic, necrotic teeth had no effect on the endodontic flare-up.

Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth.

PubMed

Garcia-Godoy, Franklin; Murray, Peter E

2012-02-01

The regeneration of immature permanent teeth following trauma could be beneficial to reduce the risk of fracture and loss of millions of teeth each year. Regenerative endodontic procedures include revascularization, partial pulpotomy, and apexogenesis. Several case reports give these procedures a good prognosis as an alternative to apexification. Care is needed to deliver regenerative endodontic procedures that maintain or restore the vitality of teeth, but which also disinfect and remove necrotic tissues. Regeneration can be accomplished through the activity of the cells from the pulp, periodontium, vascular, and immune system. Most therapies use the host's own pulp or vascular cells for regeneration, but other types of dental stem cell therapies are under development. There are no standardized treatment protocols for endodontic regeneration. The purpose of this article is to review the recent literature and suggest guidelines for using regenerative endodontic procedures for the treatment of permanent immature traumatized teeth. Recommendations for the selection of regenerative and conventional procedures based on the type of tooth injury, fracture type, presence of necrosis or infection, periodontal status, presence of periapical lesions, stage of tooth development, vitality status, patient age, and patient health status will be reviewed. Because of the lack of long-term evidence to support the use of regenerative endodontic procedures in traumatized teeth with open apices, revascularization regeneration procedures should only be attempted if the tooth is not suitable for root canal obturation, and after apexogenesis, apexification, or partial pulpotomy treatments have already been attempted and have a poor prognosis. © 2011 John Wiley & Sons A/S.

The Efficacy of Calcium Hydroxide Powder mixed with 0.2% Chlorhexidine Digluconate or mixed with Normal Saline as Intracanal Medicament in the Treatment of Apical Periodontitis.

PubMed

Menakaya, Ifeoma N; Adegbulugbe, Ilemobade C; Oderinu, Olabisi H; Shaba, Olufemi P

2015-08-01

To compare the efficacy of calcium hydroxide powder mixed with 0.2% chlorhexidine digluconate or mixed with normal saline as intracanal medicament in the treatment of apical periodontitis. Subjects were 55 in number aged 17 to 60 years. Two-visit conventional root canal treatment was performed on 70 teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with 35 teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. All treated teeth were evaluated clinically and radiographically for signs and symptom of periapical infection at specified periods postoperatively. Overall efficacy of medicament was rated based on quality guidelines for endodontic treatment by the European Society of Endodontology 2006. A postoperative favorable outcome of 97.1% in the control group and 94.3% in the experimental group was observed at 6-month review. This difference was not statistically significant (p > 0.05). The use of normal saline or 0.2% chlorhexidine digluconate to mix calcium hydroxide used as intracanal medicament during endodontic treatment resulted in high postoperative favorable outcomes. Efficacy of 0.2% chlorhexidine digluconate as a vehicle for mixing calcium hydroxide as an intracanal medicament in the treatment of apical periodontitis is comparable to the efficacy of calcium hydroxide mixed with normal saline.

Cross-sectional evaluation of post-operative pain and flare-ups in endodontic treatments using a type of rotary instruments.

PubMed

Tanalp, Jale; Sunay, Hakki; Bayirli, Gündüz

2013-01-01

The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. Pulpal necrosis without periapical pathosis was determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). Teeth with pre-operative pain were more prone to developing post-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapical pathosis and post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developing pain and flare-ups compared to those with no periapical involvement (p = 0.0001). Future studies may focus on the influence of rotary instrumentation systems in more specific groups of cases. Meanwhile; microbiological as well as psychological aspects of flare-ups are topics that warrant further investigation.

[Effect of revascularization treatment of immature permanent teeth with endodontic infection].

PubMed

Huang, Yibin; Chen, Ke; Zhang, Ying; Xiong, Huacui; Liu, Caiqi

2013-05-01

To observe the effect of revascularization for treatment of immature teeth with endodontic infection mediated by calcium hydroxide. Seventeen pediatric patients with endodontic infections of the permanent teeth were treated with routine root canal and pulp cavity irrigation and disinfection followed by application of calcium hydroxide paste to the root canal orifice to induce revascularization. Another 17 patients received conventional apexification procedures to serve as the control group. The patients were followed up to observe the therapeutic effect of the treatments. In the revascularization treatment group, 4 cases showed healed periapical lesions 6 to 18 months after the surgery with thickened root canal walls and closure of the apical foramen; in 10 cases, the periapical lesions healed 12 to 18 months postoperatively with lengthened root, thickened root canal wall, and narrowed apical foramen. One patient reported pain and swelling at 2 months, and 2 patients showed the formation of gum fistula and ceased development of the roots at 7 and 8 months. In the control group, the periapical lesions healed in 1 cases at 12 months postoperatively with apical foramen closure; in 11 cases, hard tissues formed in the root apex without obviously lengthened roots 6 to 8 months after the surgery; in 5 cases, no apical barrier formed even 12 to 18 months after the surgery. The overall effective rates were similar between the two groups (P>0.05). Revascularization by calcium hydroxide sealing can promote root development of immature permanent teeth with pulpitis or periradicular periodontitis.

Identification of possible factors impacting dental students' ability to locate MB2 canals in maxillary molars.

PubMed

Park, Ellen; Chehroudi, Babak; Coil, Jeffrey M

2014-05-01

This study examined the effect of the access size and straight-line path of access on third-year dental students' ability to locate a second mesiobuccal (MB2) canal in maxillary first and second molars. One hundred and six third-year dental students at one Faculty of Dentistry performed simulated root canal treatment with the aid of 2x magnification loupes on extracted teeth. A postgraduate endodontic student subsequently made a reasonable search for an untreated MB2 canal with the aid of a dental operating microscope. The mesiobuccal roots were then sectioned horizontally for determination of the canal configuration. The dental students were able to treat an MB2 canal in 15.8 percent of the teeth, but this was not associated with satisfactory access criteria. The postgraduate endodontic student identified an MB2 canal in 54.7 percent of the remaining tooth samples excluding those where the MB2 canal was found by the dental students; this represented 94.3 percent of those teeth confirmed by horizontal sectioning of the root to have an MB2 canal. The postgraduate student troughed, on average, 2.6 mm before negotiating the MB2 canal. As satisfactory access criteria and straight-line path of access did not correlate with the dental students' ability to find a second mesiobuccal canal, this result has important implications for educational goals with respect to endodontic treatment of maxillary molar teeth.

A laboratory comparison of individual Targis/Vectris posts with standard fiberglass posts.

PubMed

Corsalini, Massimo; Genovese, Katia; Lamberti, Luciano; Pappalettere, Carmine; Carella, Mauro; Carossa, Stefano

2007-01-01

This article presents an in vitro analysis of a specific occlusal loading test on endodontically treated teeth restored with 2 different composite post materials. Individual, customized posts (IFPs) were compared to standard fiberglass posts (SFPs). The selected IFPs (standard cylindric Targis/Vectris posts) were compared to SFPs (Conic 6% Post, Ghimas). The posts were first subjected to a 3-point bending test to compare their flexural elastic properties. They were then used to restore 22 endodontically treated artificial maxillary central incisors and subjected to a specific occlusal loading simulation test. The loading test showed that IFP restorations performed better than SFP restorations. A clinical evaluation of this laboratory observation is suggested.

[Evaluation of postoperative pain comparing manual and ultrasonic endodontic instrumentation in patients with cleft lip and palate].

PubMed

Brosco, H B; Pimentel, P A; Lacerda, A G; Nishiyama, C K; de Moraes, I G

1989-01-01

Our purpose was to compare incidence of post-surgical pain associated to the endodontic therapy where the instrumentation on the root canal was performed by the method of Marshall & Pappin and the method of Marshall & Pappin complemented by the ultrasonic. Seventy patients with only one tooth needing endodontic treatment were treated by one of the methods and, posteriorly, evaluated. The endodontic treatment was performed at one time and from the seventy teeth, thirty have been instrumented by the manual method complemented by the ultrasonic and forty by the manual instrumentation. The patients were clinically controlled after the endodontic treatment was finished during periods of 24, 48 and 72 hours to evaluate their post-surgical condition. The results suggest that were no statistically significant differences (p less than 0.05) in the incidence of pain between the employed methods or according to the pulpar semiologic condition in any of the observed periods. However, we have realized that there was a tendency for a smaller percentage of a postoperative pain in those cases of necropulpectamy treated by the endosonic ultrasonic synergistic system. In those cases of biopulpectomy this has been not observed.

A Technique for Staining Extracted Teeth: A Research and Teaching Aid for Bleaching.

DTIC Science & Technology

1980-10-01

teeth, the pulps extirpated, and the root canals instrumented with #10 to #20 files. The teeth were then placed in 5.25% sodium hypochlorite solution for...patient and the dentist.4 Hence, the bleaching of these discolored non-vital teeth becomes an extremely important phase of endodontic therapy. 1-6...dentists at the Edward C. Penick Endodontic Study Club stated they never bleached a tooth as an undergraduate. Six chairmen of dental school

An animal model to study regenerative endodontics.

PubMed

Torabinejad, Mahmoud; Corr, Robert; Buhrley, Matthew; Wright, Kenneth; Shabahang, Shahrokh

2011-02-01

A growing body of evidence is demonstrating the possibility for regeneration of tissues within the pulp space and continued root development in teeth with necrotic pulps and open apices. There are areas of research related to regenerative endodontics that need to be investigated in an animal model. The purpose of this study was to investigate ferret cuspid teeth as a model to investigate factors involved in regenerative endodontics. Six young male ferrets between the ages of 36-133 days were used in this investigation. Each animal was anesthetized and perfused with 10% buffered formalin. Block sections including the mandibular and maxillary cuspid teeth and their surrounding periapical tissues were obtained, radiographed, decalcified, sectioned, and stained with hematoxylin-eosin to determine various stages of apical closure in these teeth. The permanent mandibular and maxillary cuspid teeth with open apices erupted approximately 50 days after birth. Initial signs of closure of the apical foramen in these teeth were observed between 90-110 days. Complete apical closure was observed in the cuspid teeth when the animals were 133 days old. Based on the experiment, ferret cuspid teeth can be used to investigate various factors involved in regenerative endodontics that cannot be tested in human subjects. The most appropriate time to conduct the experiments would be when the ferrets are between the ages of 50 and 90 days. Copyright © 2011. Published by Elsevier Inc.

"Ferrule Comes First. Post Is Second!" Fake News and Alternative Facts? A Systematic Review.

PubMed

Naumann, Michael; Schmitter, Marc; Frankenberger, Roland; Krastl, Gabriel

2018-02-01

Both the role of an endodontic post and the ferrule effect have been discussed for decades. The clinical impact of endodontic posts compared with post-free restoration with or without ferrule support was not systematically reviewed so far. It was assumed that the effect of an endodontic post compared with a post-free restoration can be evaluated only when at the same time a ferrule or no-ferrule situation was clinically compared. The specific PICO question was as follows: Patient: adults with sufficient endodontic treatment needing a core or post; Intervention: post-endodontic treatment using posts with or without ferrule; Comparison: post-endodontic treatment without posts with or without ferrule; Outcomes: failure rates of post/core complexes with or without ferrule support. A Medline search was performed via PubMed in June 2017 using relevant electronic databases. Additionally, hand search was performed. Only prospective clinical studies in humans comparing the success/survival of teeth restored with or without posts over a minimum time of observation of 5 years were included. In total, 7 randomized controlled trials and 1 prospective clinical trial met inclusion criteria. Cochrane rating showed high risk of bias in 5 studies. Two of 3 studies support the ferrule-effect concept. Seven of 8 show no post effect. Clinical evidence regarding the influence of tooth location on its survival is scarce. Ferrule effect and maintaining cavity walls are the predominant factors with regard to tooth and restoration survival of endodontically treated teeth. Most studies do not confirm a positive effect of post placement. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Stress analysis of different post-luting systems: a three-dimensional finite element analysis.

PubMed

Romeed, S A; Dunne, S M

2013-03-01

The longevity of endodontically treated teeth is usually determined by the adequacy of root canal treatments, coronal seal and favourable stress distribution within the remaining tooth tissues. The aim of this study was to investigate the influence of post material and luting cement on the biomechanics of endodontically treated teeth using three-dimensional finite element analysis (3-D FEA). A 3 mm section of endodontically treated canine tooth was scanned and reconstructed for 3-D modelling and FE analyses. A metal post (MP) and a glass fibre post (GFP) were tested individually with four luting cements [zinc phosphate (ZPH), glass ionomer (GI), resin modified glass ionomer (RMGI) and resin based cements (RC)]. A push-out test was conducted by subjecting all models to 100 N perpendicular loading at the post. The maximum stresses generated along the MP-cement interface were significantly higher than corresponding stresses in the GFP-cement interface regardless of the cement type. GFP generated seven times higher stresses within the root dentine than metal posts when ZPH and GI were used, and three times higher when RMGI and RC were used. The displacement of GFP was double (50 μ) the displacement of MP (20 μ) in all groups. The low elastic modulus of GFP generated lower stresses along its interface and higher stresses within the root dentine, therefore the probability of debonding and root fracture in the GFP group was lower. © 2013 Australian Dental Association.

One-appointment endodontic therapy: biological considerations.

PubMed

Lin, Louis M; Lin, Jarshen; Rosenberg, Paul A

2007-11-01

The authors conducted a literature review to present the best available biological evidence concerning one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. Because of recent advances in technology, such as rotary engines and nickel-titanium instruments, some practitioners are performing one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. The authors reviewed the literature, which revealed only a small number of randomized, controlled clinical trials that have been conducted on one-appointment versus multiple-appointment endodontic therapy. As the apical canal preparation is enlarged, a greater percentage of bacteria is eradicated from infected root canals. In addition, sufficiently large apical root canal enlargement facilitates the delivery of antimicrobial irrigant to the apical portion of the canal. However, an association between positive or negative preobturation root canal culture results and the outcome of endodontic treatment has not been well-established. The best available evidence, based on a systematic literature review, indicates that one-appointment endodontic therapy may be feasible in selected cases of apical periodontitis in asymptomatic teeth. However, additional randomized, controlled clinical trials are required.

A retrospective long term study of teeth restored with prefabricated carbon fiber reinforced epoxy resin posts.

PubMed

Segerström, Susanna; Astbäck, Johnny; Ekstrand, Karl D

2006-01-01

The Composipost endodontic post, made of stretched aligned carbon fibers embedded in an epoxy-resin matrix, has since the beginning of the nineties been widely used for the restoration of endodontically treated teeth. The aim of this retrospective study was to evaluate the treatment outcome of the Composipost system up to 7 years. In a study published 1998, 236 patients treated during 1992-93 by seven Swedish general dental private practitioners were studied. Five of the former seven private practitionersi consented to participate in this follow up of that study. Thus the material was reduced to 138 patients. Thirty-nine of these were excluded due to insufficient data. For the remaining 99 patients, data were collected from dental records. All patients were offered a clinical examination but only 25 accepted. Data were collected from dental records for the remaining 74 patients. The mean follow up time was 6,7 years with a range from 1 month to 10 years (median 7.6 years, SD 2.5 years), (five teeth were extracted during the previous study). The outcome was considered successful if the post and core was in situ and showed no clinical or radiographic signs of technical failures. Sixty-four teeth (65%) restored with the Composipost system were successful after a mean time of 6.7 years. Thirty-two teeth were extracted due to fractures, periapical lesions and periodontitis. Dislodgment of post was observed in three cases. In conclusion, within the limitations of this study, after a mean time of 6.7 years, the Composipost restored teeth had shorter survival times than those of previously documented cast posts.

Endodontic photodynamic therapy ex vivo

PubMed Central

Ng, Raymond; Singh, Fiza; Papamanou, Despoina A.; Song, Xiaoqing; Patel, Chitrang; Holewa, Colleen; Patel, Niraj; Klepac-Ceraj, Vanja; Fontana, Carla R.; Kent, Ralph; Pagonis, Tom C.; Stashenko, Philip P.; Soukos, Nikolaos S.

2010-01-01

Objective To evaluate the anti-microbial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Materials and Methods Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl and twenty-six teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 µg/ml for 5 minutes followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm2. The contents of root canals were sampled by flushing the canals at baseline and following CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFU). Partial characterization of root canal species at baseline and following CMD alone or CMD+PDT was performed using DNA probes to a panel of 39 endodontic species in the checkerboard assay. Results The Mantel-Haenszel chi-square test for treatment effects demonstrated the better performance of CMD+PDT over CMD (P=0.026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone (P=0.0003). Following CMD+PDT, 45 of 52 canals (86.5%) had no CFU as compared to 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17/22 (77.3%) and 15/29 (51.7%) of canals in the CMD and CMD+PDT group, respectively (P= 0.034). Conclusion Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD. PMID:21238805

Rotary endodontics in primary teeth – A review

PubMed Central

George, Sageena; Anandaraj, S.; Issac, Jyoti S.; John, Sheen A.; Harris, Anoop

2015-01-01

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel–titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed. PMID:26792964

Rotary endodontics in primary teeth - A review.

PubMed

George, Sageena; Anandaraj, S; Issac, Jyoti S; John, Sheen A; Harris, Anoop

2016-01-01

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the "gold-standard" over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel-titanium (Ni-Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel-titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

Comparison of Radicular Peroxide Leakage from four Commonly used Bleaching agents following Intracoronal Bleaching in Endodontically treated teeth - An In Vitro Study.

PubMed

Madhu, Ks; Hegde, Swaroop; Mathew, Sylvia; Lata, DA; Bhandi, Shilpa H; N, Shruthi

2013-08-01

Non vital bleaching is simple, conservative procedure for esthetic correction of discolored endodontically treated teeth. The aim of this study was to determine and compare the amount of peroxide leakage from four different bleaching agents i.e superoxol, sodium perborate, combination of superoxol & sodium perborate and carbamide peroxide during intracoronal bleaching, as the safe and effective bleaching is the need of the hour. 50 extracted maxillary centrals were selected for the study. Following standardized protocol access, cleaning and shaping by step back technique and obturation was done using guttapercha and AH plus sealer. Access was sealed with Cavit G and outer root surface was coated with wax and nail varnish. The teeth were separated into crown and root and the root portion was placed in plastic tube containing distilled water for 7days.After incubation, 3mm of gutta-percha was removed below CEJ and 2mm glass ionomer cement base was placed. Grouped into five categories based on the bleaching agent placed in pulp chamber as -group1 (control)-distilled water, group 2-sodium perborate with distilled water , group 3- 30% hydrogen peroxide ,group 4-mixture of sodium perborate and 30% hydrogen peroxide and group 5-10% carbamide peroxide gel. Peroxide leakage was measured after 24hrs using ferrothiocyanate method and optical density using spectrophotometer. Statistical analysis of the data was conducted using ANOVA and multiple comparisons within the groups was done using BONFERRONI method (Post-Hoc tests). The results showed highest peroxide penetration from 30% hydrogen peroxide followed by mixture of sodium perborate with 30% hydrogen peroxide, mixture of sodium perborate with distilled water and least penetration from 10% carbamide peroxide gel. The results were statistically significant. Radicular peroxide leakage in 10% carbamide peroxide was significantly lower than the other tested bleaching agents making it a very safe alternative for intracoronal bleaching. How to cite this article: Madhu KS, Hegde S, Mathew S, Lata DA, Bhandi SH, Shruthi N. Comparison of Radicular Peroxide Leakage from four Commonly used Bleaching agents following Intracoronal Bleaching in Endodontically treated teeth - An In Vitro Study. J Int Oral Health 2013; 5(4):49-55.

In-vitro comparison of instrumentation time and cleaning capacity between endodontic handpiece and manual preparation techniques in primary molar teeth.

PubMed

Seraj, B; Ramezani, G; Ghadimi, S; Mosharrafian, S H; Motahhary, P; Safari, M

2013-01-01

The aim of this study was to evaluate and compare the cleaning ability and instrumentation time of manual method and use of endodontic handpiece for preparation of primary molar teeth. Forty primary teeth canals were used in this experimental study. Access cavities were prepared and India ink was injected into the canals. The samples were divided into three groups according to the preparation technique. In the first group the root canals were manually instrumented by k_files. Endodontic handpiece (TEP-ER10, NSK, Japan) were used for canal preparation in the second group and the samples in the third group (control) were not instrumented. After preparing the canal, the teeth were cleared with methyl salicylate and the removal of India ink was measured in the cervical, middle and apical thirds. The instrumentation time was transcribed by chronometer. Statistical analysis was performed using Mann-Whitney and t-test. There was no significant difference in cleaning capacity between the two techniques, but results of the first and second group differ from those of the control group. In fact, time taken for preparation was significantly shorter with endodontic handpiece system. Seen the shorter working time of endodontic handpiece and the similar cleaning ability of the two techniques, the application of the endodontic handpiece is recommended for preparation of deciduous root canals during pulpectomy.

Management of 2 teeth diagnosed with dens invaginatus with regenerative endodontics and apexification in the same patient: a case report and review.

PubMed

Kumar, Harleen; Al-Ali, Muna; Parashos, Peter; Manton, David J

2014-05-01

This review and case report present the treatment of a 10-year-old boy with both permanent maxillary lateral incisors demonstrating Oehlers type II dens invaginatus and pulpal involvement. Treatment was complicated by dental anxiety, supraventricular tachycardia, immature tooth development, and facial cellulitis. An infected necrotic pulp of the permanent maxillary left lateral incisor was treated by apexification and endodontic treatment with mineral trioxide aggregate. The necrotic pulp of the permanent maxillary right lateral incisor was treated with canal debridement and dressing under general anesthesia. Periapical healing of both teeth occurred, with the right lateral incisor showing continued root growth, thickening of the dentinal root walls, and completed apex formation. This tooth responded normally to pulp testing. Twenty-eight months after initial treatment, the right lateral incisor displayed progressive sclerosis of the canal. This case demonstrates possible pulpal regeneration of an infected maxillary right lateral incisor with dens invaginatus and an immature apex after minimal canal debridement. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Long-term observation of endodontic surgical intervention to treat root perforation and apical periodontitis: a case report of an amalgam-restored tooth.

PubMed

Tsurumachi, Tamotsu; Hayashi, Makoto

2003-10-01

A case of crestal root perforation and periapical lesion in a maxillary left lateral incisor is reported. Teeth with root perforation present technical difficulties in their clinical management because of their complex defects. In the present case, surgical endodontic treatment was chosen. The apical and lateral pathology was curetted, the tooth root was resected, and a retrograde root restoration of amalgam was placed in a root-end cavity and perforation site. A 10-year follow-up clinical and radiographic examination showed an asymptomatic tooth with osseous healing proceeding.

A 5 yr clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars.

PubMed

Wolcott, James; Ishley, Dave; Kennedy, Wade; Johnson, Scott; Minnich, Scott; Meyers, John

2005-04-01

An examination of 5616 endodontically treated and retreated maxillary first and second molars was made in an attempt to determine the percentage of MB2 canals that could be located routinely, and evaluate if there were any significant differences between initial treatments and retreatments. The teeth examined were 3578 first molars and 2038 second molars treated consecutively over a 5-yr period by six endodontists. Overall the MB2 canal was found in 2133 (60%) first molars, and 712 (35%) second molars. The incidence of a MB2 canal in first molar retreatments was 66% compared to a 58% incidence in initial treatments. Whereas in second molars the retreatment incidence was 40% compared to 34% in initial treatments. The significant difference in the incidence of a MB2 canal between initial treatments and retreatments suggests that failure to find and treat existing MB2 canals will decrease the long-term prognosis.

Comparison of the Relative Risk of Molar Root Perforations Using Various Endodontic Instrumentation Techniques.

DTIC Science & Technology

1983-03-01

sodium hypochlorite using a standard endodontic irrigating syringe (Monoject Endodontic Syringe, Sherwood Medical Co., St. Louis, MO), and the...the sample. The Joel R. Kessler 8 teeth were placed in a 5.25% sodium hypochlorite solution for 30 minutes in order to remove soft tissue on the root...molars. J Endodon 1975;1:211-14. 7. Senia ES, Marshall FJ, Rosen S. The solvent action of sodium hypochlorite on pulp tissue of extracted teeth. Oral

Cone Beam Computed Tomography Evaluation of the Diagnosis, Treatment Planning, and Long-Term Followup of Large Periapical Lesions Treated by Endodontic Surgery: Two Case Reports

PubMed Central

Shekhar, Vijay; Shashikala, K.

2013-01-01

The aim of this case report is to present two cases where cone beam computed tomography (CBCT) was used for the diagnosis, treatment planning, and followup of large periapical lesions in relation to maxillary anterior teeth treated by endodontic surgery. Periapical disease may be detected sooner using CBCT, and their true size, extent, nature, and position can be assessed. It allows clinician to select the most relevant views of the area of interest resulting in improved detection of periapical lesions. CBCT scan may provide a better, more accurate, and faster method to differentially diagnose a solid (granuloma) from a fluid-filled lesion or cavity (cyst). In the present case report, endodontic treatment was performed for both the cases followed by endodontic surgery. Biopsy was done to establish the confirmatory histopathological diagnosis of the periapical lesions. Long-term assessment of the periapical healing following surgery was done in all the three dimensions using CBCT and was found to be more accurate than IOPA radiography. It was concluded that CBCT was a useful modality in making the diagnosis and treatment plan and assessing the outcome of endodontic surgery for large periapical lesions. PMID:23762646

The Impact of Apical Patency in the Success of Endodontic Treatment of Necrotic Teeth with Apical Periodontitis: A Brief Review.

PubMed

Machado, Ricardo; Ferrari, Carlos Henrique; Back, Eduardo; Comparin, Daniel; Tomazinho, Luiz Fernando; Vansan, Luiz Pascoal

2016-01-01

Accumulation of soft tissue or dentinal remnants in the apical region is a common event that can cause blockage of root canals. This event can be avoided if apical patency is performed during the root canal shaping procedures. However, there is no consensus on the role of apical patency in relation to the success of endodontic treatment of necrotic teeth with apical periodontitis. Therefore, the purpose of this paper was to conduct a brief review on the role of apical patency in guaranteeing the success of endodontic treatments of necrotic teeth with apical periodontitis considering two other key points; the root canal anatomy and microbiology.

Spontaneous resolution of a periapical lesion during orthodontic treatment: a case report.

PubMed

Bainbridge, Mark; Cousley, Richard R J

2013-03-01

Teeth with periapical lesions can undergo successful orthodontic treatment, but conventional protocols indicate that such teeth should be endodontically stabilized prior to such treatment. A case report is presented where such endodontic stabilization was not possible, yet a chronic periapical lesion resolved as orthodontic treatment progressed. This paper will discuss the possible causes of the initial lesion, and reasons why it resolved without endodontic treatment. This report illustrates the possible combined roles of trauma, occlusion and periodontal disease in the development of a perio-endo lesion, and how orthodontic treatment potentially relieved some of the exacerbating factors, thus enabling resolution of the infection without endodontic treatment.

Regenerative endodontics: a comprehensive review.

PubMed

Kim, S G; Malek, M; Sigurdsson, A; Lin, L M; Kahler, B

2018-05-19

The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

PubMed Central

Alam, Sharique; Zia, Afaf; Khan, Masood Hasan; Kumar, Ashok

2014-01-01

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment. PMID:25110646

Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients.

PubMed

Chang, J; Kim, H-Y

2017-02-01

The aim of this study was to evaluate the longevity of teeth with single-visit endodontic and restorative treatment under general anaesthesia (GA) for special needs patients and to investigate factors associated with survival and success. Data were collected from 381 teeth in 203 patients [mean (s.d.) age = 27·0 (14·1)]. All endodontic and restorative procedures were performed during a single GA session except for cementation of crowns in the cases requiring crown restoration (38%). A total of 267 teeth (70·6%) were followed-up for 6-81 months [mean (s.d.): 32·7 (20·0)]. Patients and teeth with and without follow-up were compared. Kaplan-Meier analysis with generalised Wilcoxon test was used to compare the mean survival and success period. Cox proportion hazard regression model was applied for multivariate analysis. At the end of the observation period, 10 teeth had a crown fracture (5-year survival rate = 89·8%), and an additional 10 teeth had primary or secondary caries (5-year success rate = 86·4%). Risk factors associated with survival were age (>40), non-parental caregiver, cooperation level and periodontal disease. A soft diet was an additional risk factor against the success of teeth. Single-visit endodontic and restorative treatment under GA showed favourable outcomes, suggesting a promising treatment option for special needs patients. Patient- and dental-specific circumstances need to be carefully considered to enhance the longevity of reconstructed teeth. © 2016 John Wiley & Sons Ltd.

[Quantitive study of interleukin 1beta in periapical exudates of chronic periapical periodontitis in the course of root canal therapy].

PubMed

Yan, Pei-fang; Liang, Jing-ping; Chen, Wei-min; Gu, Shen-sheng

2007-06-01

To evaluate the relationship between IL-1beta and clinical findings of chronic apical periodontitis and to explore the function of IL-1beta during the endodontic interappointment flare-ups. Periapical exudates samples were obtained from 19 teeth suffering from endodontic flare-ups after root canal preparation and 20 teeth without any symptoms and signs at the second visit after root canal preparation. The levels of IL-1beta were determined by ELISA and the data was analyzed by SAS6.12 software package. Significantly higher levels of IL-1beta were found in periapical exudates from teeth suffering from endodontic flare-ups than that before canal preparation(P<0.001). The mean IL-1beta levels significantly decreased following the endodontic therapy if there were no symptom at the second visit (P<0.001). The level of IL-1beta in the exudates of root canals were related with the exist of infection which might take an active part in the occurrence of endodontic interappointment flare-up.

Prevalence of Apical Periodontitis in Endodontically Treated Premolars and Molars with Untreated Canal: A Cone-beam Computed Tomography Study.

PubMed

Karabucak, Bekir; Bunes, Alf; Chehoud, Christel; Kohli, Meetu R; Setzer, Frank

2016-04-01

The purpose of this retrospective cohort study was to evaluate the incidence of missed canals in endodontically treated teeth in the Greater Philadelphia area patient population and to evaluate the effect of untreated canals on endodontic outcome. A total of 1397 cone-beam computed tomography (CBCT) volumes taken from January 2013 to July 2015 were investigated. Limited view CBCT images were taken with Kodak 9000 3D System field of view at voxel size, 76 μm or Morita Veraviewpocs 3D F40 field of view at voxel size, 125 μm. All root canal-treated premolars and molars were included in the study. Unfilled canals appearing from cementoenamel junction to apex including splitting from a main canal at coronal, mid, or apical third were defined as missed-untreated canal. A periapical lesion was diagnosed when disruption of the lamina dura was detected and the low density area associated with the radiographic apex was at least twice the width of the periodontal ligament space. The overall incidence of missed canals was 23.04%. The incidence of missed canals per tooth was highest in tooth #14 at 46.5% and tooth #3 at 41.3%. The incidence of missed canals was highest in the upper molars at 40.1% and lowest in the upper premolars at 9.5%. There was a significant difference in lesion prevalence when a canal was missed-untreated (P < .05). Teeth with a missed canal were 4.38 times more likely to be associated with a lesion. Limited field-of-view CBCT should be examined before any endodontic retreatment to identify missed canals. This knowledge would not only help clinicians to locate missed canals clinically but would also help in deciding the surgical approach. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Anatomical analysis of the resected roots of mandibular first molars after failed non-surgical retreatment

PubMed Central

2018-01-01

Objectives Understanding the reason for an unsuccessful non-surgical endodontic treatment outcome, as well as the complex anatomy of the root canal system, is very important. This study examined the cross-sectional root canal structure of mandibular first molars confirmed to have failed non-surgical root canal treatment using digital images obtained during intentional replantation surgery, as well as the causative factors of the failed conventional endodontic treatments. Materials and Methods This study evaluated 115 mandibular first molars. Digital photographic images of the resected surface were taken at the apical 3 mm level and examined. The discolored dentin area around the root canal was investigated by measuring the total surface area, the treated areas as determined by the endodontic filling material, and the discolored dentin area. Results Forty 2-rooted teeth showed discolored root dentin in both the mesial and distal roots. Compared to the original filled area, significant expansion of root dentin discoloration was observed. Moreover, the mesial roots were significantly more discolored than the distal roots. Of the 115 molars, 92 had 2 roots. Among the mesial roots of the 2-rooted teeth, 95.7% of the roots had 2 canals and 79.4% had partial/complete isthmuses and/or accessory canals. Conclusions Dentin discoloration that was not visible on periapical radiographs and cone-beam computed tomography was frequently found in mandibular first molars that failed endodontic treatment. The complex anatomy of the mesial roots of the mandibular first molars is another reason for the failure of conventional endodontic treatment. PMID:29765897

Incidence of post-operative pain following single visit endodontics in vital and non-vital teeth: An in vivo study

PubMed Central

Bhagwat, Sumita; Mehta, Deepil

2013-01-01

This clinical study was conducted to compare the post-operative pain following single visit endodontics in vital and non-vital teeth, with and without periapical radiolucency. A total of 60 adult patients requiring root canal therapy in anterior and premolar teeth were selected for this study. Single sitting root canal treatment was carried out and the subjects were recalled after 2 weeks and instructed to fill out a series of self-report questionnaires for responses about pain in the interim after 1 day, 2 day, 3 day, 1 week and 2 weeks. In vital teeth (Group I) 60% of the treated cases had pain, of which 36% had mild pain (non-significant) and 24% had moderate pain (significant). In non-vital teeth without periapical radiolucency (Group II) 64% of cases had pain, of which 48% had mild pain (non-significant) and 16% had moderate pain (significant). In non-vital teeth with periapical radiolucency (Group III) 32% of the cases had pain of which 24% had mild pain (non-significant) and 8% had moderate pain (significant). None of the teeth in any of the groups had severe pain. There was no statistical difference between incidence of pain in vital and non-vital teeth without periapical radiolucency. Non-vital teeth with periapical radiolucency exhibited relatively less pain as compared with non-vital teeth without periapical radiolucency, but the pain continued in a significant percent of teeth even after 2 weeks. Pain incidence dropped significantly within a period of 1 day to 2 weeks in vital teeth and non-vital teeth without periapical radiolucency. There was a tendency for less incidence of significant pain after a single visit root canal treatment in these groups. Results obtained were comparable with those obtained by several investigators. PMID:24124293

Broken instrument retrieval with indirect ultrasonics in a primary molar.

PubMed

Pk, Musale; Sc, Kataria; As, Soni

2016-02-01

The separation of a file during pulpectomy is a rare incident in primary teeth due to inherently wider and relatively straighter root canals. A broken instrument hinders the clinician from optimal preparation and obturation of the root canal system invariably leading to failure, although in such teeth, an extraction followed by suitable space maintenance is considered as the treatment of choice. This case report demonstrates successful nonsurgical retrieval of a separated H file fragment in 84. A 7-year-old girl was referred to the Department of Paedodontics and Preventive Dentistry for endodontic management of a primary tooth 84 with a dento-alveolar abscess. Her medical history was noncontributory. After diagnosing a broken H file in the mesio-lingual canal, the tooth was endodontically treated in two appointments. At the first session, a broken file was successfully retrieved after using low intensity ultrasonic vibrations through a DG 16 endodontic explorer viewed under an operating microscope. After abscess resolution, Vitapex root canal obturation with a preformed metal crown cementation was completed at a second session. The patient was recalled at 3, 6, 12 and 15 month interval and reported to be clinically asymptomatic and radiographically with complete furcal healing. Integration of microscopes and ultrasonics in paediatric dental practice has made it possible to save such teeth with a successful outcome. Favourable location of the separated file, relatively straighter root canal system and patient cooperation resulted in successful nonsurgical management in this case.

Regeneration and Repair in Endodontics-A Special Issue of the Regenerative Endodontics-A New Era in Clinical Endodontics.

PubMed

Saoud, Tarek Mohamed A; Ricucci, Domenico; Lin, Louis M; Gaengler, Peter

2016-02-27

Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of 'regenerative endodontics' emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists' Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis.

Is the glass half empty or half full? A novel "philosophical" approach to the "mystery" of the so-called ferrule effect.

PubMed

Stavridakis, Minos; Brokos, Yiannis; Krejci, Ivo

2018-06-01

The prognosis of endodontically treated teeth has traditionally been associated with the presence of the so-called ferrule effect that is generally related with the presence of a minimum of 1-2 mm of sound tooth structure at the cervical area of parallel axial walls that totally encircle the tooth. Even though all of these factors are well desired, one should question if their absence should condemn a tooth and compel extraction as the only logical treatment plan option. For this reason an hypothesis is being formed that associates the aforementioned factors not with the presence of the so-called ferrule effect, but rather with the resistance form of the preparation that is being provided by the sound tooth structure at the cervical area of the tooth. When the desired resistance form is provided by sound tooth structure of endodontically treated teeth, then less lateral forces are being transferred to the post & core and subsequently to the root of the teeth, thus minimizing the chances of decementation of the post & core or worst fracture of the root. Even more important, if this hypothesis may be further entertained, then even when the so-called ferrule effect is not present, the teeth may not be extracted, but alternative strategies for post & core restorations may be investigated, such a more flexible carbon- or glass-fiber posts & core build ups made from flowable resin composite that may accommodate for the increased lateral forced exerted to the post & core complex during function. Copyright © 2018 Elsevier Ltd. All rights reserved.

Principles of endodontic therapy.

PubMed

Lobprise, H B

1993-08-01

Endodontics is that branch of dentistry concerned with the treatment of damaged or diseased dental pulp. Veterinarians are now being asked to preserve tooth function and structure rather than to extract injured or diseased teeth. A variety of instruments are available that facilitate endodontic treatment. Endodontic treatment involves preparation (filing), sterilization, and obturation (filling) of the pulp cavity. Properly performed, endodontic therapy can effectively preserve dental structure and function. Complications of endodontic therapy will be discussed in "Problem Solving in Veterinary Endodontics" on page 165 in this issue.

Regenerative endodontics: a true paradigm shift or a bandwagon about to be derailed?

PubMed

Nazzal, H; Duggal, M S

2017-02-01

Regenerative endodontic techniques (RETs) have been hailed as a paradigm shift for the management of traumatised non-vital immature permanent anterior teeth. In this article the aim was to critically appraise the literature with regards to the outcome of regenerative endodontics on root development. Critical review of the literature where regenerative endodontic techniques have been used in the management of immature non-vital teeth with continuation of root development as the main outcome reported. Most studies published were in the form of case reports and series with very few randomised controlled trials with a high risk of bias. Continuation of root development following the use of RET has been shown to be unpredictable at best with lower success in those teeth losing vitality as a result of dental trauma. Despite the high success of regenerative endodontics in terms of periodontal healing including resolution of clinical and radiographic signs and symptoms of infection, continuation of root development remains an unpredictable outcome. The use of a blood clot as a scaffold in regenerative endodontics should be reviewed carefully as that might offer an environment for repair rather than regeneration. In addition, preservation of structures, such as Hertwig's epithelial root sheath, may have an important bearing on the success of this approach and should be further investigated.

Single crowns versus conventional fillings for the restoration of root filled teeth.

PubMed

Fedorowicz, Zbys; Carter, Ben; de Souza, Raphael Freitas; Chaves, Carolina de Andrade Lima; Nasser, Mona; Sequeira-Byron, Patrick

2012-05-16

Endodontic treatment, involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth which may influence long term survival and cost. The comparative in service clinical performance of crowns or conventional fillings used to restore root filled teeth is unclear. To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials. We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME and the reference lists of articles as well as ongoing trials registries.There were no restrictions regarding language or date of publication. Date of last search was 13 February 2012. Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth which have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration, as well as indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any. Two review authors independently assessed trial quality and extracted data. One trial judged to be at high risk of bias due to missing outcome data, was included. 117 participants with a root filled premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. At 3 years there was no reported difference between the non-catastrophic failure rates in both groups. Decementation of the post and marginal gap formation occurred in a small number of teeth. There is insufficient evidence to support or refute the effectiveness of conventional fillings over crowns for the restoration of root filled teeth. Until more evidence becomes available clinicians should continue to base decisions on how to restore root filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Factors associated with endodontic flare-ups: a prospective study.

PubMed

Imura, N; Zuolo, M L

1995-09-01

The purpose of this prospective study was to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment by the two authors in their respective practices during a period of one year, and also to examine the correlation with pre-operative and operative variables. The results showed an incidence of 1.58% for flare-ups from 1012 endodontically treated teeth. Statistical analysis using the chi-square test (P<0.05) indicated that flare-ups were found to be positively correlated with multiple appointments, retreatment cases, periradicular pain prior to treatment, presence of radiolucent lesions, and patients taking analgesic or anti-inflammatory drugs. In contrast, there was no correlation between flare-up, and age, sex, different arch/tooth groups and the status of the pulp.

Effect of Aquatine Endodontic Cleanser on smear layer removal in the root canals of ex vivo human teeth.

PubMed

Garcia, Faustino; Murray, Peter E; Garcia-Godoy, Franklin; Namerow, Kenneth N

2010-01-01

The purpose of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of Aquatine Endodontic Cleanser (Aquatine EC) when used as an endodontic irrigating solution in comparison with 6% sodium hypochlorite (NaOCl). Forty-five human teeth were randomly allocated to five treatment groups; the pulp chamber was accessed, cleaned, and shaped by using ProTaper and ProFile rotary instrumentation to an ISO size #40. The teeth were then processed for scanning electron microscopy, and the root canal cleanliness and removal of smear layer were examined. The most effective removal of smear layer occurred with Aquatine EC and NaOCl, both with a rinse of EDTA. Aquatine EC appears to be the first hypochlorous acid approved by the FDA to be a possible alternative to the use of NaOCl as an intracanal irrigant. Further research is needed to identify safer and more effective alternatives to the use of NaOCl irrigation in endodontics.

Endodontic photodynamic therapy ex vivo.

PubMed

Ng, Raymond; Singh, Fiza; Papamanou, Despina A; Song, Xiaoqing; Patel, Chitrang; Holewa, Colleen; Patel, Niraj; Klepac-Ceraj, Vanja; Fontana, Carla R; Kent, Ralph; Pagonis, Tom C; Stashenko, Philip P; Soukos, Nikolaos S

2011-02-01

The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm(2). The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay. The Mantel-Haenszel χ(2) test for treatment effects demonstrated the better performance of CMD+PDT over CMD (P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone (P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively (P = .034). Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Flare-ups incidence and severity after using calcium hydroxide as intracanal dressing.

PubMed

Ghoddusi, Jamileh; Javidi, Maryam; Zarrabi, Mohammad Hasan; Bagheri, Hossein

2006-01-01

Acute pain and swelling following endodontic treatment are a challenge for both the patient and the dentist. According to previous studies, the incidence of flare-ups increases after endodontic treatment of teeth with necrotic pulps. Calcium hydroxide is currently used as a multi-purpose drug in root canal therapy. The aim of this study was to evaluate the incidence and severity of flare-ups after treatment of pulpless teeth using calcium hydroxide as an intracanal dressing. Sixty patients with single-root necrotic teeth participated in this study. These patients were randomly divided into three groups of 20. The patients were treated in Group A in a single-visit approach, in group B with a two-visit approach without any intracanal dressing and group C with a two-visit approach using calcium hydroxide as an intracanal dressing for one week. All of the patients were followed for 72 hours after each treatment session. The information about the incidence and severity of pain and swelling was recorded in tables, using a modified Visual Analogue Scale for pain severity measurement and a scale with four degrees for measuring the severity of swelling. The data were analyzed by chi-square test and GENMODE procedure.

Assessment of Pulp Oxygen Saturation Levels by Pulse Oximetry for Pulpal Diseases -A Diagnostic Study.

PubMed

Anusha, Bander; Madhusudhana, Koppolu; Chinni, Suneel Kumar; Paramesh, Yelloji

2017-09-01

Diagnosis of pulpal inflammation is a key to endodontics. Pulse oximetry is a true vitality testing device which relies on oxygen saturation levels of pulp and helps in diagnosis of different pulpal conditions. The aim of the study was to analyse oxygen saturation levels of different pulpally inflamed teeth by using pulse oximetry. Hundred patients were included in the study and categorized into five groups based on pulpal status of the test tooth by using heat test and cold test. Twenty patients were recruited in each of the experimental groups i.e., Reversible Pulpitis (RP), Irreversible Pulpitis (IP), Pulpal Necrosis (PN), Positive Control (PC, healthy teeth), and Negative Control (NC, endodontically treated teeth). Oxygen saturation levels of all the groups were measured along with each patient index finger oxygen saturation readings. Results were analysed by using ANOVA and Tukey HSD tests. The mean oxygen saturation levels of RP, IP, PN, PC and NC were 85.4%, 81.6%, 70.7%, 94.6% and 0 respectively. There was significant difference in the oxygen saturation levels between all the groups. Pulse oximeter is an effective tool in diagnosing different pulpal pathologies especially PN which was interpreted inaccurately by thermal tests.

A novel anatomical short glass fiber reinforced post in an endodontically treated premolar mechanical resistance evaluation using acoustic emission under fatigue testing.

PubMed

Wang, Hsuan-Wen; Chang, Yen-Hsiang; Lin, Chun-Li

2017-01-01

This study evaluates the fracture resistance in an endodontically treated tooth using circular fiber-reinforced composite (FRC) and innovated anatomical short glass fiber reinforced (SGFR) posts under fatigue testing, monitored using the acoustic emission (AE) technique. An anatomical SGFR fiber post with an oval shape and slot/notch design was manufactured using an injection-molding machine. Crown/core maxillary second premolar restorations were executed using the anatomical SGFR and commercial cylindrical fiber posts under fatigue test to understand the mechanical resistances. The load versus AE signals in the fracture and fatigue tests were recorded to evaluate the restored tooth failure resistance. The static fracture resistance results showed that teeth restored using the anatomical SGFR post presented higher resistance than teeth restored using the commercial FRC post. The fatigue test endurance limitation (1.2×10 6 cycles) was 207.1N for the anatomical SGFR fiber post, higher than the 185.3N found with the commercial FRC post. The average accumulated number of AE signals and corresponding micro cracks for the anatomical SGFR fiber post (153.0 hits and 2.44 cracks) were significantly lower than those for the commercial FRC post (194.7 hits and 4.78 cracks) under 40% of the static maximum resistance fatigue test load (pass 1.2×10 6 cycles). This study concluded that the anatomical SGFR fiber post with surface slot/notch design made using precise injection molding presented superior static fracture resistance and fatigue endurance limitation than those for the commercial FRC post in an endodontically treated premolar. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparative evaluation of the vertical fracture resistance of endodontically treated roots filled with Gutta-percha and Resilon: a meta-analysis of in vitro studies.

PubMed

Tan, Minmin; Chai, Zhaowu; Sun, Chengjun; Hu, Bo; Gao, Xiang; Chen, Yunjia; Song, Jinlin

2018-06-13

Teeth treated endodontically are more susceptible to vertical root fracture (VRF). Some studies have suggested that obturating the root canals with Gutta-percha or Resilon can reinforce endodontically treated teeth, but a few others have presented conflicting results. These inconsistent results cannot guide clinicians in determining clinical approaches. The objective of this meta-analysis is to evaluate and compare the vertical fracture resistance of endodontically treated root canals obturated with Gutta-percha/AH plus and the Resilon system. Comprehensive literature searches were performed in the PubMed, Cochrane Library, ScienceDirect, Web of Science and Embase databases. The titles and abstracts of all of the retrieved articles were independently assessed by two authors according to predefined selection criteria. Data in the included articles were independently extracted. Statistical analyses were conducted using Review Manager 5.3 and Stata 12.0 software. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for the outcome indicators. The level of statistical significance was set at p < 0.05. The Cochran Q test (I 2 test) was used to test for heterogeneity among studies. Fourteen randomized controlled in vitro trials were included in the meta-analysis. The results demonstrated that the vertical root fracture resistance of unprepared and unfilled roots was significantly higher than that of roots obturated with Gutta-percha/AH plus (SMD = - 0.69, 95% CI = - 1.34 to - 0.04, p = 0.04) or the Resilon system (SMD = - 0.54, 95% CI = - 1.07 to - 0.00, p = 0.05). The differences in fracture resistance between the roots filled with Gutta-percha/AH plus and the prepared unfilled root canals was not significant (SMD = 0.59, 95% CI = - 0.02 to 1.21, p = 0.06). Roots obturated with Resilon had higher fracture resistance than instrumented unfilled roots (SMD = 0.83, 95% CI = 0.44 to 1.22, p < 0.0001) or roots filled with Gutta-percha/AH plus (SMD = 0.62, 95% CI = 0.01 to 1.23, p = 0.05). The present study suggests that filling with Gutta-percha/AH plus dose not reinforce endodontically treated roots, whereas obturating with the Resilon system can increase vertical root fracture resistance of prepared roots. As this meta-analysis was based on in vitro studies, it should be careful to extrapolate its conclusion to the clinical context.

3D Computer aided treatment planning in endodontics.

PubMed

van der Meer, Wicher J; Vissink, Arjan; Ng, Yuan Ling; Gulabivala, Kishor

2016-02-01

Obliteration of the root canal system due to accelerated dentinogenesis and dystrophic calcification can challenge the achievement of root canal treatment goals. This paper describes the application of 3D digital mapping technology for predictable navigation of obliterated canal systems during root canal treatment to avoid iatrogenic damage of the root. Digital endodontic treatment planning for anterior teeth with severely obliterated root canal systems was accomplished with the aid of computer software, based on cone beam computer tomography (CBCT) scans and intra-oral scans of the dentition. On the basis of these scans, endodontic guides were created for the planned treatment through digital designing and rapid prototyping fabrication. The custom-made guides allowed for an uncomplicated and predictable canal location and management. The method of digital designing and rapid prototyping of endodontic guides allows for reliable and predictable location of root canals of teeth with calcifically metamorphosed root canal systems. The endodontic directional guide facilitates difficult endodontic treatments at little additional cost. Copyright © 2016. Published by Elsevier Ltd.

[Desmoplastic fibroma. Differential diagnosis of a periapical lesion from endodontic failure].

PubMed

Zabalegui, B; Gil, J; Zabalegui, I

1989-01-01

Treatment of endodontically involved teeth requires accurate diagnosis of the clinical pulpal condition to determine the primary cause of pathosis. The case presented shows the differential diagnosis between a desmoplastic fibroma and a failure of a misdiagnosed endodontic treatment. The initial direction of treatment should had never been the endodontic therapy but local surgical curettage of the lesion.

Prevalence of Asymptomatic Apical Periodontitis and its Association with Coronary Artery Disease in a Brazilian Subpopulation

PubMed Central

Câmara, Andréa Cruz; Aguiar, Carlos Menezes

2017-01-01

Objective The aim of the present study was to determine the prevalence of asymptomatic apical periodontitis (AAP) and its association with coronary artery disease (CAD) in a Brazilian subpopulation, and to examine the correlation of AAP with gender, age and most frequently affected dental elements. Methods The data were collected from medical records of the patients (n = 1346) treated at the Specialization in Endodontics Clinic of the Federal University of Pernambuco in the period between 2003 and 2010. From each patient, the following variables were recorded: gender, age, endodontically compromised teeth, endodontic diseases diagnosed and the history of CAD. The data were analyzed using Pearson's chi-square test adopting a significance level of 5%. Results AAP was diagnosed in 574 patients (42.6%), corresponding to 641 teeth (40.1%). Both genders (p = 0.082), and all age groups (p = 0.190) were affected similarly. The upper incisors (52.8%, p <0.001) had a higher prevalence of AAP. The patients with AAP showed 1.45 times more chance of exhibiting CAD (p = 0.307). Conclusions The results pointed out that the prevalence of AAP in this population was high and similar to that observed in other countries. A positive association, but not statistically significant, between AAP and CAD was found. PMID:28827847

Prevalence of Asymptomatic Apical Periodontitis and its Association with Coronary Artery Disease in a Brazilian Subpopulation.

PubMed

Paloma de Oliveira, Bruna; Câmara, Andréa Cruz; Aguiar, Carlos Menezes

2017-06-01

The aim of the present study was to determine the prevalence of asymptomatic apical periodontitis (AAP) and its association with coronary artery disease (CAD) in a Brazilian subpopulation, and to examine the correlation of AAP with gender, age and most frequently affected dental elements. The data were collected from medical records of the patients (n = 1346) treated at the Specialization in Endodontics Clinic of the Federal University of Pernambuco in the period between 2003 and 2010. From each patient, the following variables were recorded: gender, age, endodontically compromised teeth, endodontic diseases diagnosed and the history of CAD. The data were analyzed using Pearson's chi-square test adopting a significance level of 5%. AAP was diagnosed in 574 patients (42.6%), corresponding to 641 teeth (40.1%). Both genders (p = 0.082), and all age groups (p = 0.190) were affected similarly. The upper incisors (52.8%, p <0.001) had a higher prevalence of AAP. The patients with AAP showed 1.45 times more chance of exhibiting CAD (p = 0.307). The results pointed out that the prevalence of AAP in this population was high and similar to that observed in other countries. A positive association, but not statistically significant, between AAP and CAD was found.

Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study.

PubMed

Serafino, Cinzia; Gallina, Giuseppe; Cumbo, Enzo; Ferrari, Marco

2004-03-01

To evaluate surface cleanliness of root canal walls along post space after endodontic treatment using 2 different irrigant regimens, obturation techniques, and post space preparation for adhesive bonding. Forty teeth, divided into 4 groups, were instrumented, using Ni-Ti rotary files, irrigated with NaOCl or NaOCl+EDTA and obturated with cold lateral condensation (CLC) or warm vertical condensation (WVC) of gutta-percha. After post space preparation, etching, and washing procedure, canal walls were observed using a scanning electron microscope (SEM). Amount of debris, smear layer, sealer/gutta-percha remnants, and visibility of open tubules were rated. Higher amounts of rough debris, large sealer/gutta-percha remnants, thick smear layer, and no visibility of tubule orifices were recorded in all the groups at apical level of post space. At middle and coronal levels areas of clean dentin, alternating with areas covered by thin smear layer, smaller debris, gutta-percha remnants, and orifices of tubules partially or totally occluded by plugs were frequently observed. After endodontic treatment, obturation, and post space preparation SEM analysis of canal walls along post space shows large areas (covered by smear layer, debris, and sealer/gutta-percha remnants) not available for adhesive bonding and resin cementation of fiber posts.

[Non-destructive, preclinical evaluation of root canal anatomy of human teeth with flat-panel detector volume CT (FD-VCT)].

PubMed

Heidrich, G; Hassepass, F; Dullin, C; Attin, T; Grabbe, E; Hannig, C

2005-12-01

Successful endodontic diagnostics and therapy call for adequate depiction of the root canal anatomy with multimodal diagnostic imaging. The aim of the present study is to evaluate visualization of the endodont with flat-panel detector volume CT (FD-VCT). 13 human teeth were examined with the prototype of a FD-VCT. After data acquisition and generation of volume data sets in volume rendering technology (VRT), the findings obtained were compared to conventional X-rays and cross-section preparations of the teeth. The anatomical structures of the endodont such as root canals, side canals and communications between different root canals as well as denticles could be detected precisely with FD-VCT. The length of curved root canals was also determined accurately. The spatial resolution of the system is around 140 microm. Only around 73 % of the main root canals detected with FD-VCT and 87 % of the roots could be visualized with conventional dental X-rays. None of the side canals, shown with FD-VCT, was detectable on conventional X-rays. In all cases the enamel and dentin of the teeth could be well delineated. No differences in image quality could be discerned between stored and freshly extracted teeth, or between primary and adult teeth. FD-VCT is an innovative diagnostic modality in preclinical and experimental use for non-destructive three-dimensional analysis of teeth. Thanks to the high isotropic spatial resolution compared with conventional X-rays, even the minutest structures, such as side canals, can be detected and evaluated. Potential applications in endodontics include diagnostics and evaluation of all steps of root canal treatment, ranging from trepanation through determination of the length of the root canal to obturation.

The dental cavities of equine cheek teeth: three-dimensional reconstructions based on high resolution micro-computed tomography

PubMed Central

2012-01-01

Background Recent studies reported on the very complex morphology of the pulp system in equine cheek teeth. The continuous production of secondary dentine leads to distinct age-related changes of the endodontic cavity. Detailed anatomical knowledge of the dental cavities in all ages is required to explain the aetiopathology of typical equine endodontic diseases. Furthermore, data on mandibular and maxillary pulp systems is in high demand to provide a basis for the development of endodontic therapies. However, until now examination of the pulp cavity has been based on either sectioned teeth or clinical computed tomography. More precise results were expected by using micro-computed tomography with a resolution of about 0.1 mm and three-dimensional reconstructions based on previous greyscale analyses and histological verification. The aim of the present study was to describe the physiological configurations of the pulp system within a wide spectrum of tooth ages. Results Maxillary teeth: All morphological constituents of the endodontic cavity were present in teeth between 4 and 16 years: Triadan 06s displayed six pulp horns and five root canals, Triadan 07-10s five pulp horns and four root canals and Triadan 11s seven pulp horns and four to six root canals. A common pulp chamber was most frequent in teeth ≤5 years, but was found even in a tooth of 9 years. A large variety of pulp configurations was observed within 2.5 and 16 years post eruption, but most commonly a separation into mesial and distal pulp compartments was seen. Maxillary cheek teeth showed up to four separate pulp compartments but the frequency of two, three and four pulp compartments was not related to tooth age (P > 0.05). In Triadan 06s, pulp horn 6 was always connected to pulp horns 1 and 3 and root canal I. In Triadan 11s, pulp horns 7 and 8 were present in variable constitutions. Mandibular teeth: A common pulp chamber was present in teeth up to 15 years, but most commonly seen in teeth ≤5 years. A segmented pulp system was found in 72% of the investigated teeth. Segmentation into separate mesial and distal pulp compartments was most commonly present. Pulp horn 4 coalesced either with the mesial pulp horns 1 and 3 or with the distal pulp horns 2 and 5. Conclusions Details of the pulpar anatomy of equine cheek teeth are provided, supporting the continuous advancement in endodontic therapy. Numerous individual configurations of the pulp system were obtained in maxillary cheek teeth, but much less variability was seen in mandibular cheek teeth. PMID:23006500

Effect of Ibuprofen on masking endodontic diagnosis.

PubMed

Read, Jason K; McClanahan, Scott B; Khan, Asma A; Lunos, Scott; Bowles, Walter R

2014-08-01

An accurate diagnosis is of upmost importance before initiating endodontic treatment; yet, there are occasions when the practitioner cannot reproduce the patient's chief complaint because the patient has become asymptomatic. Ibuprofen taken beforehand may "mask" or eliminate the patient's symptoms. In fact, 64%-83% of patients with dental pain take analgesics before seeing a dentist. The purpose of this study was to examine the possible "masking" effect of ibuprofen on endodontic diagnostic tests. Forty-two patients with endodontic pain underwent testing (cold, percussion, palpation, and bite force measurement) and then received either placebo or 800 mg ibuprofen. Both patients and operators were blinded to the medication received. One hour later, diagnostic testing was repeated and compared with pretreatment testing. Ibuprofen affected testing values for vital teeth by masking palpation 40%, percussion 25%, and cold 25% on affected teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis. There was no observed masking effect in the placebo group on palpation, percussion, or cold values. When nonvital teeth were included, the masking effect of ibuprofen was decreased. However, little masking occurred with the bite force measurement differences. Analgesics taken before the dental appointment can affect endodontic diagnostic testing results. Bite force measurements can assist in identifying the offending tooth in cases in which analgesics "mask" the endodontic diagnosis. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Clinical and radiographic evaluation of one- and two-visit endodontic treatment of asymptomatic necrotic teeth with apical periodontitis: a randomized clinical trial.

PubMed

Molander, Anders; Warfvinge, Johan; Reit, Claes; Kvist, Thomas

2007-10-01

The present investigation recorded the 2-year clinical and radiographic outcome of one- and two visit endodontic treatment and studied the significance of the bacteriologic sampling results on the outcome. A randomization procedure allocated 53 teeth to one-visit treatment and 48 teeth to two-visit treatment. At the end of the study period, 32 teeth (65%) in the one-visit group and 30 teeth (75%) in the two-visit group were classified as healed. The statistical analysis of the healing results did not show any significant difference between the groups (p = 0.75). Forty-nine (80%) of the 61 teeth that were obturated after a negative micobiologic sample were classified as healed. Teeth sealed after positive samples healed in 44%. The present study gave evidence that similar healing results might be obtained through one- and two-visit antimicrobial treatment.

The use of optical fiber in endodontic photodynamic therapy. Is it really relevant?

PubMed

Garcez, Aguinaldo S; Fregnani, Eduardo R; Rodriguez, Helena M; Nunez, Silvia C; Sabino, Caetano P; Suzuki, Hideo; Ribeiro, Martha S

2013-01-01

This study analyzed the necessity of use of an optical fiber/diffusor when performing antimicrobial photodynamic therapy (PDT) associated with endodontic therapy. Fifty freshly extracted human single-rooted teeth were used. Conventional endodontic treatment was performed using a sequence of ProTaper (Dentsply Maillefer Instruments), the teeth were sterilized, and the canals were contaminated with Enterococcus faecalis 3 days' biofilm. The samples were divided into five groups: group 1--ten roots irradiated with a laser tip (area of 0.04 cm(2)), group 2--ten roots irradiated with a smaller laser tip (area of 0.028 cm(2)), and group 3--ten teeth with the crown, irradiate with the laser tip with 0.04 cm(2) of area. The forth group (G4) followed the same methodology as group 3, but the irradiation was performed with smaller tip (area of 0.028 cm(2)) and G5 ten teeth with crown were irradiated using a 200-mm-diameter fiber/diffusor coupled to diode laser. Microbiological samples were taken after accessing the canal, after endodontic therapy, and after PDT. Groups 1 and 2 showed a reduction of two logs (99%), groups 3 and 4 of one log (85% and 97%, respectively), and group 5 of four logs (99.99%). Results suggest that the use of PDT added to endodontic treatment in roots canals infected with E. faecalis with the optical fiber/diffusor is better than when the laser light is used directed at the access of cavity.

Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review.

PubMed

Dawson, V S; Amjad, S; Fransson, H

2015-07-01

Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Prevalence of apical periodontitis and quality of root canal treatment in an adult Saudi population

PubMed Central

Al-Nazhan, Saad A.; Alsaeed, Suliman A.; Al-Attas, Hussan A.; Dohaithem, Abdullah J.; Al-Serhan, Mohamed S.; Al-Maflehi, Nassr S.

2017-01-01

Objectives: To determine the health status of periradicular tissue and the quality of root canal fillings in an adult Saudi population attending dental clinics for the first time. Methods: This cross sectional study was conducted in the dental clinics at King Saud University, Riyadh and other dental centers (Jeddah, Najran, and Albaha City), Kingdom of Saudi Arabia between year 2010 and 2012. Good-quality panoramic radiographs of 926 Saudi subjects (540 males and 386 females)were analyzed based on the gender, age, health status, smoking habits, periapical status of the endodontically treated teeth, technical quality of the root canal fillings, and the presence or absence of coronal restoration. Data were calibrated and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 17. Results: Of the 25,028 teeth examined, 1,556 teeth (6.2%) had apical periodontitis (AP). Male subjects aged over 55 years and females between 36 and 45 years had higher AP. A total of 36 diabetic and 87 smokers subjects had AP. The AP was more common in male diabetics than female (p=0.383), and in female smokers more than male (p=0.44). Only 42.2% of male and 57.7% of female teeth had adequate root canal treatment. Conclusions: Apical periodontitis was significantly related to diabetes, smoking, and inadequate endodontic treatment. PMID:28397949

Comparison of hand-instrumented, heated gutta-percha and engine-driven, cold gutta-percha endodontic techniques.

PubMed

Stein, Keith E; Manfra Marretta, Sandra; Siegel, Arthur; Vitoux, Jeanne

2004-09-01

An in vitro study compared two gutta-percha obturation techniques of the mandibular first molar in dogs. The mandibular first molars were instrumented and obturated using either K-files and the SuccessFil vertical compaction technique or rotary instruments and the Simplifill/guttapercha master cone technique. Instrumentation and obturation times were recorded for each tooth. Radiographs were used for evaluation of overall appearance of the final fill. A modified apical dye leakage technique was used to evaluate the ability of each method to provide an adequate barrier to apical leakage. The endodontic technique utilizing rotary instruments and Simplifill/gutta-percha master cone required less time and provided a better radiographic appearance to the endodontic fill. In addition, there was no apical dye leakage associated with this technique compared with a 44% leakage incidence in teeth treated with K-file instrumentation and SuccessFil.

The influence of pressure changes on the retentive force and coronal microleakage of different types of posts in endodontically treated teeth during simulated dives.

PubMed

Mitov, Gergo; Draenert, Florian; Schumann, Paul; Stötzer, Marcus; von See, Constantin

2016-12-01

We assessed the influence of a simulated diving environment on the interfacial microleakage and retentive forces of different post types in root-canal-filled teeth. One-hundred-and-twenty extracted, single-rooted teeth were endodontically treated and were randomly divided into three groups according to the post and cement used: ER Post/Harvard cement (Titanium), CeraPost/DentinBuild Evo (Zirconia), DT Light Post/Calibra (FRC). Each group was randomly divided into two equal subgroups, a control group, and an experimental group, subjected to simulated dives to 456 kPa in a diving chamber. For 10 specimens of each subgroup the pull-out strength and the coronal microleakage were measured. Significant differences in the linear coronal penetration were observed between the Titanium and FRC groups (experimental group P ≤ 0.001; control group P = 0.02). Diving simulation had no significant impact on the microleakage for the three post types. The FRC groups showed significantly higher retentive strength values compared to the Titanium and Zirconia groups before and after simulated diving. The pull-out strength of the titanium experimental group was significantly less than the control group (P = 0.008). Following root canal treatment the combination of fibre-reinforced posts and resin cement should be preferred for patients requiring retention for tooth restorations using posts that are likely to be exposed to hyperbaric conditions.

Effect of ferrule on the fracture resistance of mandibular premolars with prefabricated posts and cores

PubMed Central

2017-01-01

PURPOSE This study evaluated fracture resistance with regard to ferrule lengths and post reinforcement on endodontically treated mandibular premolars incorporating a prefabricated post and resin core. MATERIALS AND METHODS One hundred extracted mandibular premolars were randomly divided into 5 groups (n=20): intact teeth (NR); endodontically treated teeth (ETT) without post (NP); ETT restored with a prefabricated post with ferrule lengths of either 0 mm (F0), 1 mm (F1), or 2 mm (F2). Prepared teeth were restored with metal crowns. A thermal cycling test was performed for 1,000 cycles. Loading was applied at an angle of 135 degrees to the axis of the tooth using a universal testing machine with a crosshead speed of 2.54 mm/min. Fracture loads were analyzed by one-way ANOVA and Tukey HSD test using a statistical program (α=.05). RESULTS There were statistical differences in fracture loads among groups (P<.001). The fracture load of F2 (237.7 ± 83.4) was significantly higher than those of NP (155.6 ± 74.3 N), F0 (98.8 ± 43.3 N), and F1 (152.8 ± 78.5 N) (P=.011, P<.001, and P=.008, respectively). CONCLUSION Fracture resistance of ETT depends on the length of the ferrule, as shown by the significantly increased fracture resistance in the 2 mm ferrule group (F2) compared to the groups with shorter ferrule lengths (F0, F1) and without post (NP). PMID:29142639

Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia and Prevotella nigrescens in endodontic lesions detected by culture and by PCR.

PubMed

Gomes, B P F A; Jacinto, R C; Pinheiro, E T; Sousa, E L R; Zaia, A A; Ferraz, C C R; Souza-Filho, F J

2005-08-01

he aim of this study was to investigate the presence of four black-pigmented bacteria, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia and Prevotella nigrescens, in endodontic infections by culture and polymerase chain reaction (PCR) analyses. Microbial samples were obtained from 50 teeth with untreated necrotic pulps (primary infection) and from 50 teeth with failing endodontic treatment (secondary infection). Microbiological strict anaerobic techniques were used for serial dilution, plating, incubation, and identification. For PCR detection, the samples were analyzed using species-specific primers of 16S rDNA and the downstream intergenic spacer region. Culture and PCR detected the test species in 13/100 and 50/100 of the study teeth, respectively. The organisms were cultured from 11/50 (22%) of primarily infected root canal samples and from 2/50 (4%) of secondary root canal samples. PCR detection identified the target species in 32/50 (64%) and 18/50 (36%) of primary and secondary infections, respectively. P. gingivalis was rarely isolated by culture methods (1%), but was the most frequently identified test species by PCR (38%). Similarly, P. endodontalis was not recovered by culture from any tooth studied, but was detected by PCR in 25% of the sampled teeth. PCR-based identification also showed higher detection rates of P. intermedia (33%) and P. nigrescens (22%) than culture (13%). In conclusion, P. gingivalis, P. endodontalis, P. intermedia, and P. nigrescens were identified more frequently in teeth with necrotic pulp than in teeth with failing endodontic treatment. Also, a higher frequency of black-pigmented species was detected by PCR than by culture.

Outcome of Endodontically Treated Cracked Teeth

DTIC Science & Technology

2016-06-01

condition associated with pain during chewing and with temperature changes. According to the American Association of Endodontists (AAE), a cracked...stress that localized at the center groove and cervical region of the molar model under equivalent loads. A higher, unfavorable, tensile stress was...dilemma. The diagnosis is primarily based on a patient’s subjective symptoms and chief complaint. These can include the presence of pain during

[Direct restoration of the tooth crown using various core build-up materials].

PubMed

Maksimovskaya, L N; Krutov, V A; Kuprin, P V; Kuprina, M A

The aim of the study was to assess direct restorations mechanical properties (both in vitro and in vivo) to improve dental restorations quality after root canal treatment. Laboratory tests showed that using nanocomposite materials of dual curing with the fiberglass reinforced posts improves restoration strength in endodontically treated teeth: by 3.9±5.8% in class II Peroz restorations, 12.6±5.9 and 24.2±4.2% in class III and IV, correspondently. Using fiberglass reinforced posts (LuxaPost) for the restoration of the tooth crown after endodontic treatment significantly decreases the number of complications associated with marginal leakage of the restoration during first 2 years after treatment (p<005).

Root Canal Treatment of Mandibular Second Premolar with Three Separate Roots and Canals Using Spiral Computed Tomographic

PubMed Central

Hariharavel, V. P.; Kumar, A. Ashok; Ganesh, C.; Aravindhan, R.

2014-01-01

Anatomic and internal morphology of a root canal system is more complex and differs for each individual tooth of which mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate foramina in mandibular second premolars is very rare. A wider knowledge on both clinical and radiological anatomy especially spiral computed tomographic is absolutely essential for the success of endodontic treatment. These teeth may require skillful and special root canal special shaping and obturating techniques. This paper reports an unusual case of a mandibular second premolar with atypical canal pattern that was successfully treated endodontically. PMID:25101187

Post-endodontic treatment of incisors and premolars among dental practitioners in Saarland: an interactive Web-based survey.

PubMed

Mitov, Gergo; Dörr, Michael; Nothdurft, Frank P; Draenert, Florian; Pospiech, Peter R

2015-06-01

The aim of the present study was to evaluate the trend of dental practitioners in the federal state of Saarland in Germany in regard to restoring endodontically treated teeth using a Web-based survey. An interactive Web-based survey instrument was developed, including seven clinical scenarios, presented by photographs of natural incisor and premolar with different types of cavities. Following a decision tree adapted to the clinical treatment, questions on different aspects of the post-endodontic treatment were asked. All 615 members of the Saarland Dental Association (SDA) were asked to participate in the survey. A total of 33 % completed the survey. The majority of the participants believed in the reinforcement effect of the ferrule design, as well as the post placement. The vast majority of the responding practitioners (92 %) adapted their treatment strategies to a high extent to the destruction degree of the endodontically treated tooth. Fiber-reinforced composite (FRC) posts are the most popular prefabricated post type, regardless of the cavity size and tooth localization. Significant differences between the dentists according to the degree of experience were detected only for the use of glass-ionomer cements as core buildup material. The predominant post-endodontic treatment strategies of German dental practitioners are only partly in agreement with the current literature. There is a clear trend toward the increasing use of metal-free post and core materials. Although the participants showed a general adoption of modern materials and techniques, different patterns of post-endodontic treatment were revealed that were not consistent with approaches supported by the literature.

Effect of aquatine endodontic cleanser on smear layer removal in the root canals of ex vivo human teeth

PubMed Central

GARCIA, Faustino; MURRAY, Peter E.; GARCIA-GODOY, Franklin; NAMEROW, Kenneth N.

2010-01-01

Objectives The purpose of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of Aquatine Endodontic Cleanser (Aquatine EC) when used as an endodontic irrigating solution in comparison with 6% sodium hypochlorite (NaOCl). Material and Methods Forty-five human teeth were randomly allocated to five treatment groups; the pulp chamber was accessed, cleaned, and shaped by using ProTaper and ProFile rotary instrumentation to an ISO size #40. The teeth were then processed for scanning electron microscopy, and the root canal cleanliness and removal of smear layer were examined. Results The most effective removal of smear layer occurred with Aquatine EC and NaOCl, both with a rinse of EDTA. Conclusions Aquatine EC appears to be the first hypochlorous acid approved by the FDA to be a possible alternative to the use of NaOCl as an intracanal irrigant. Further research is needed to identify safer and more effective alternatives to the use of NaOCl irrigation in endodontics. PMID:20835577

Preparation time and perceptions of Brazilian specialists and dental students regarding simulated root canals for endodontic teaching: a preliminary study.

PubMed

dos S Luz, Diandra; de S Ourique, Fernanda; Scarparo, Roberta K; Vier-Pelisser, Fabiana V; Morgental, Renata D; Waltrick, Silvana B G; de Figueiredo, José A P

2015-01-01

The aim of this preliminary study was to evaluate the desirability of alternative models of artificial teeth versus extracted natural teeth for use in preclinical dental education. Specifically, the study was designed to compare the preparation time and perceptions of difficulty of undergraduate dental students and endodontists in carrying out root canal preparations on resin models (both clear and opaque) and extracted natural teeth. Twenty participants-ten fifth-year students at a Brazilian dental school and ten endodontists with at least five years' experience in the specialty-performed root canal instrumentation on two samples of each model. Preparation times were recorded, and the participants completed a questionnaire about the anatomical and physical characteristics of these models. The results showed that the time required for performing endodontic procedures in the natural teeth was higher than in the alternative models. The perceptions of the students and specialists regarding some topics on the questionnaire were significantly different. The students had more positive opinions about artificial teeth made of opaque resin, while the specialists had more positive opinions about simulated root canals in clear resin blocks. This study suggests that neither of the alternative models fulfilled requirements to replace natural teeth in endodontic teaching; improvements are still necessary to accomplish this goal.

[Comparison of long-term dental treatment effects of children treated under general anesthesia and passive restraint].

PubMed

Zhou, F; Xia, B; Zhang, S; Ma, W L; Xiao, Y M; Ge, L H

2017-02-09

Objective: To compare the long-term dental treatment effects, oral health habits and oral-health-related qualities of life of children treated under general anesthesia (GA) and passive restraint (PR), respectively. Methods: Twenty seven 2 to 4-year-old children treated under GA and thirty four children treated under PR were recruited in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. Up to 2 years after the treatment, a follow up assessment was conducted. The data of general information, dental plaque level and the unplanned treatments were recorded and analyzed. The questionnaire of oral health habits and early childhood oral health impact scale (ECOHIS) for each child was also completed and analyzed. The survival rate and median survival time of the deciduous teeth were calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results: Twenty-five children under GA and 32 under PR were finally included, with a total of 1 098 deciduous teeth. The postoperative dental plaque indicesin both GA and PR groups had significantly improved than that of before the treatments ( P= 0.019, P< 0.001). The oral health habits had also improved, and the improvement in PR group was more obvious than that in GA group. Totally 128 teeth (27.0%) appeared unplanned treatments in GA group and 232 teeth (37.2%) in PR group during the follow-ups. The new caries and recurrent caries in PR group were significantly more than that in GA group ( P< 0.001, P= 0.012). No significant differences were found between the two groups in restoration failure, secondary caries and endodontic diseases ( P= 0.129, P= 0.822, P= 0.642). However, the time of occurrence of endodontic disease and secondary caries in GA group were significantly longer than that in PR group ( P< 0.01, P< 0.001). The median survival time of teeth in GA group was 1 018 days comparing to 944 days in PR group. The difference was statistically significant ( P< 0.05). The survival rate was associated with such factors as decayed-missing-filled tooth (dmft), anterior or posterior teeth, feeding frequency, brushing habits and behavior management techniques. Conclusions: The long-term dental treatment effects of children treated under GA was significantly better than that of PR group. Continuous reinforcement of proper dietary and oral hygiene habits might help in maintaining the long-term treatment effect.

Outcomes of regenerative endodontic procedures.

PubMed

Law, Alan S

2012-07-01

The use of regenerative endodontic techniques holds great promise for the treatment of immature teeth with necrotic pulp tissue. Several published case reports and case series have demonstrated radiographic evidence of apical bone healing, increases in root length, and root wall thickness. Although histologic changes have been demonstrated in animal models, histology in human teeth is lacking. A summary of these outcomes is discussed in this article. Copyright © 2012 Elsevier Inc. All rights reserved.

Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: an in vitro study.

PubMed

Ambica, Khetarpal; Mahendran, Kavitha; Talwar, Sangeeta; Verma, Mahesh; Padmini, Govindaswamy; Periasamy, Ravishankar

2013-01-01

This investigation sought to compare the fracture resistance under static and fatigue loading of endodontically treated teeth restored with fiber-reinforced composite posts and experimental dentin posts milled from human root dentin by using computer-aided design/computer-aided manufacturing. Seventy maxillary central incisors were obturated and divided into 4 groups: control group without any post (n = 10), carbon fiber post group (n = 20), glass fiber post group (n = 20), and dentin post group (n = 20). Control group teeth were prepared to a height of 5 mm. In all other teeth, post space was prepared; a post was cemented, and a core build-up was provided. Half the samples from each group were statistically loaded until failure, and the remaining half were subjected to cyclic loading, followed by monostatic load until fracture. One-way analysis of variance and Bonferroni multiple comparisons revealed a significant difference among test groups. The control group demonstrated highest fracture resistance (935.03 ± 33.53 N), followed by the dentin post group (793.12 ± 33.69 N), glass fiber post group (603.44 ± 46.67 N), and carbon fiber post group (497.19 ± 19.27 N) under static loading. These values reduced to 786.69 ± 29.64 N, 646.34 ± 26.56 N, 470 ± 36.34 N, and 379.71 ± 13.95 N, respectively, after cyclic loading. Results suggest that human dentin can serve as post material under static and fatigue loading. Although at an early stage in research, the use of dentin posts in root-filled teeth looks promising. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Alternative techniques in root canal debridement

NASA Astrophysics Data System (ADS)

Luca, Ruxandra; Todea, Carmen; Bǎlǎbuc, Cosmin; Nica, Luminita; Armani, Giacomo; Locovei, Cosmin

2014-01-01

Studies have demonstrated that conventional chemo-mechanical preparation is limited regarding the decontamination of the endodontic space, which is why alternative techniques such as laser radiation have their importance in the modern endodontic treatment. The present study aims to assess the possibility of improving the debridement of the root canals by removing smear layer using Er: YAG laser radiation. We used 18 extracted teeth, which were subjected to the same initial protocol and then divided into 5 study groups: the control group has not been treated with laser; the other 4 groups were exposed to laser radiation using two different geometries peaks of quartz and two energy levels. Scanning electronic microscopy revealed an increased efficiency in the debridement of all interested areas when using PIPS and XPulse tips at proper energy. In the two groups treated with inferior laser energy, the debridement didn't prove to be superior to the conventional treatment.

Fabricating fiber-reinforced composite posts.

PubMed

Manhart, Jürgen

2011-03-01

Endodontic posts do not increase the strength of the remaining tooth structure in endodontically treated teeth. On the contrary, depending on the post design employed (tapered versus parallel-sided), the root can be weakened relative to the amount of tooth removed during preparation. In many cases, if there has been a high degree of damage to the clinical crown, conservative preparation for an anatomic tapered (biomimetic) post with the incorporation of a ferrule on solid tooth structure is necessary to protect the reaming root structure as well as for the long-term retention of the composite resin core and the definitive restoration. Adhesively luted endodontic posts reinforced with glass or quartz fiber lead to better homogeneous tension distribution when loaded than rigid metal or zirconium oxide ceramic posts. Fiber-reinforced posts also possess advantageous optical properties over metal or metal oxide post systems. The clinician should realize that there are admittedly substantial differences in the mechanical loading capacity of the different fiber-reinforced endodontic posts and should be aware of such differences in order to research and select a suitable post system for use.

Endodontic-periodontic bifurcation lesions: a novel treatment option.

PubMed

Lin, Shaul; Tillinger, Gabriel; Zuckerman, Offer

2008-05-01

The purpose of this preliminary clinical report is to suggest a novel treatment modality for periodontal bifurcation lesions of endodontic origin. The study consisted of 11 consecutive patients who presented with periodontal bifurcation lesions of endodontic origin (endo-perio lesions). All patients were followed-up for at least 12 months. Treatment included calcium hydroxide with iodine-potassium iodide placed in the root canals for 90 days followed by canal sealing with gutta-percha and cement during a second stage. Dentin bonding was used to seal the furcation floor to prevent the ingress of bacteria and their by-products to the furcation root area through the accessory canals. A radiographic examination showed complete healing of the periradicular lesion in all patients. Probing periodontal pocket depths decreased to 2 to 4 mm (mean 3.5 mm), and resolution of the furcation involvement was observed in post-operative clinical evaluations. The suggested treatment of endo-perio lesions may result in complete healing. Further studies are warranted. This treatment method improves both the disinfection of the bifurcation area and the healing process in endodontically treated teeth considered to be hopeless.

Polymerase chain reaction detection of Propionibacterium propionicus and Actinomyces radicidentis in primary and persistent endodontic infections.

PubMed

Siqueira, José F; Rôças, Isabela N

2003-08-01

Propionibacterium propionicus and the recently described species Actinomyces radicidentis have been isolated from infections of endodontic origin; nevertheless, the possibility exists that their actual prevalence may have been underestimated by culture. The purpose of our study was to assess the occurrence of these 2 species in different types of endodontic infections by using the sensitive 16S rDNA-based nested polymerase chain reaction approach. To detect these 2 species, nested polymerase chain reaction was performed directly in samples taken from primary endodontic infections associated with asymptomatic periradicular lesions, acute apical periodontitis, or acute periradicular abscesses and in samples from patients in whom endodontic therapy had failed. DNA was extracted from the samples and initially amplified by using universal 16S rDNA primers. In the second round of amplification, the first polymerase chain reaction products were used to detect a specific 16S rDNA fragment of either P propionicus or A radicidentis. P propionicus was detected in 6/21 (29%) root canal samples from teeth with chronic periradicular lesions, in 5/10 (50%) cases diagnosed as acute apical periodontitis, and in 7/19 (37%) pus samples aspirated from acute periradicular abscesses. Overall, this species was found in 18/50 (36%) samples taken from primary endodontic infections. Of the root canal samples obtained from root-filled teeth with chronic periradicular lesions, P propionicus was detected in 7/12 (58%) cases. A radicidentis was detected in 1/21 (5%) root canal samples from teeth with chronic periradicular lesions and in 1/10 (10%) cases of acute apical periodontitis. No pus sample yielded this species. In general, A radicidentis was detected in 2/50 (4%) samples taken from primary endodontic infections and in 1/12 (8%) root canal samples taken from patients in whom endodontic treatment had failed. P propionicus was found in a relatively large number of patients with primary and persistent endodontic infections. This strengthens the assumption that this bacterial species is an endodontic pathogen associated with different forms of periradicular diseases. In contrast, A radicidentis was only occasionally detected in the patients examined. The role played by this species in endodontic infections remains to be clarified.

Effect of photodynamic therapy (PDT) on Enterococcus faecalis biofilm in experimental primary and secondary endodontic infections.

PubMed

Tennert, Christian; Feldmann, Katharina; Haamann, Edwina; Al-Ahmad, Ali; Follo, Marie; Wrbas, Karl-Thomas; Hellwig, Elmar; Altenburger, Markus J

2014-11-04

To determine the antibacterial effect of photodynamic Therapy on Enterococcus faecalis (E. faecalis) biofilms in experimentally infected human root canals in primary infections and endodontic retreatments. One hundred and sixty single-rooted extracted teeth with one root canal were prepared using ProTaper instruments. Seventy specimens were left without root canal filling and autoclaved. The root canals of another 70 specimens were filled with Thermafil and AH Plus and the root canal fillings were removed after 24 hours using ProTaper D files and plasma sterilized. The specimens were infected with a clinical isolate of E. faecalis for 72 hours. Samples were taken using sterile paper points to determine the presence of E. faecalis in the root canals. The specimens were randomly divided into groups according to their treatment with 20 teeth each and a control. In the PDT group the teeth were treated using PDT, consisting of the photosensitizer toluidine blue and the PDT light source at 635 nm. In the NaOCl (sodium hypochlorite) group the root canals were rinsed with 10 mL of 3% NaOCl. In the NaOCl-PDT group the root canals were rinsed with 10 mL of 3% of sodium hypochlorite and then treated with PDT. Samples were taken after treatments using sterile paper points. Additionally, remaining root canal filling material was recovered from the root canal walls. Survival fractions of the samples were calculated by counting colony-forming units. A one-way analysis of variance (ANOVA) was applied to the data to assess the effect of different treatment techniques. Antimicrobial treatment of root canals caused a significant reduction of bacterial load in all groups. NaOCl irrigation eliminated E. faecalis most effectively. PDT alone was less effective compared to NaOCl irrigation and the combination of NaOCl irrigation and PDT. CFU levels recovered from the filling material after NaOCl irrigation of the root canals were 10fold higher compared to PDT and the combination of NaOCl irrigation and PDT. Photodynamic therapy killed E. faecalis in experimental primary endodontic infections and retreated human root canals. PDT is an effective supplement in root canal disinfection, especially in endodontic retreatments.

A Comprehensive Review of New Attachment Therapy.

DTIC Science & Technology

1981-01-01

365 Forty percent potassium hydroxide was Once used, "neutralized" by hydrochloric acid. 4 1 Antiformin, a mixture of sodium hypochlorite , sodium ...biological agents, selected from a number of chemicals capable of dissociating or degrading endotoxins. 1 38 Sodium deoxycholate followed by human plasma...of humans led to resorption or exfoliation.1 9 2 The replantation of endodontically -prepared monkey teeth which had been treated with acid caused

[Frequency of Candida in root canals of teeth with primary and persistent endodontic infections].

PubMed

Bernal-Treviño, Angel; González-Amaro, Ana María; Méndez González, Verónica; Pozos-Guillen, Amaury

Microbiological identification in endodontic infections has focused mainly on bacteria without giving much attention to yeasts, which, due to their virulence factors, can affect the outcomes of root canal treatment. To determine the frequency of Candida in anaerobic conditions in root canals with primary and persistent endodontic infection, as well as to evaluate a microbiological sampling method using aspiration compared to the traditional absorption method with paper points. Fifty microbiological samples were obtained from teeth of 47 patients requiring endodontic treatments, due to either primary or persistent infections. Two microbiological sampling methods were used: an aspiration method, and the traditional paper point absorption method. In each of these methods, two types of medium were used (M 1 -M 4 ). Samples were cultured under anaerobic conditions until reaching 0.5 McFarland turbidity, and then inoculated on Sabouraud dextrose, as well as on anaerobic enriched blood agar plates. Macroscopic and microscopic observations of the colonies were performed. The germ-tube test, growth on CHROMagar, and biochemical identification were performed on the isolated yeasts. Fungal infection was found in 18 (36%) samples out of the 50 teeth evaluated. In the 18 samples positive for fungal infection, 15 out of 36 (41.6%) teeth were taken from a primary infection, and 3 out of 14 (21.4%) from a persistent infection. The aspiration method using Sabouraud dextrose medium recovered a greater diversity of species. Yeasts frequency was higher in teeth with primary infections compared to teeth with persistent infections. The predominant yeast species was Candida albicans. The aspirating sampling method was more efficient in the recovery of Candida isolates than the traditional absorption method. Copyright © 2018 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

Does endodontic post space irrigation affect smear layer removal and bonding effectiveness?

PubMed

Gu, Xin-Hua; Mao, Cai-Yun; Liang, Cong; Wang, Hui-Ming; Kern, Matthias

2009-10-01

The effect of different post space irrigants on smear layer removal and dentin bond strength was evaluated. Sixty-six extracted sound maxillary central incisors were endodontically treated. After post space preparation, the teeth were assigned to three groups of 22 teeth each. The teeth of these three groups were irrigated for 1 min with 17% ethylenediaminetetracetic acid (EDTA) (group 1), 5.25% sodium hypochlorite (NaOCl) (group 2), or 0.9% sodium chloride (NaCl) (group 3). In each group, eight specimens were split longitudinally for smear layer evaluation, and the other fourteen specimens were filled with a self-etching adhesive system (Panavia F). Four of 14 specimens of each group were prepared for evaluation of the resin-dentin interdiffusion zone (RDIZ) and resin tags, and the other 10 specimens were serially sectioned for push-out test analysis. Smear layer removal and bond strength were affected by different post space irrigants. EDTA removed the smear layer extremely effectively and, as a result, improved the bond strength at each region (apical, middle, and coronal) of the roots. Resin tag formation and the RDIZ were also affected by different irrigants and in accordance with bond strength. Therefore, removal of the smear layer use a self-etching luting system plays an important role in bonding effectiveness.

Ex vivo fracture resistance of endodontically treated maxillary central incisors restored with fiber-reinforced composite posts and experimental dentin posts

PubMed Central

Kathuria, Ambica; Kavitha, M; Khetarpal, Suchit

2011-01-01

Aim: To compare the fracture resistance of teeth restored with fiber-reinforced composite (FRC) posts and experimental dentin posts milled from human root dentin. Materials and Methods: Thirty maxillary central incisors were divided into three groups of ten each. Twenty teeth were restored with FRC posts and solid dentin posts and numbered as Groups 2 and 3 respectively while Group 1 acted as the control, without any post. The teeth were loaded at 135° angle to their long axes after core build-up and the failure loads were recorded. Results: One-way Analysis of Variance (ANOVA) and Bonferroni multiple comparisons revealed a significant difference among test groups with the control group showing the highest fracture resistance, followed by the dentin post group and lastly the FRC post group. Conclusions: Teeth restored with dentin posts exhibited better fracture resistance than those restored with FRC posts. PMID:22144812

A retrospective study of 236 patients with teeth restored by carbon fiber-reinforced epoxy resin posts.

PubMed

Fredriksson, M; Astbäck, J; Pamenius, M; Arvidson, K

1998-08-01

The Composipost dowel is made of stretched, aligned carbon fibres embedded in an epoxy-resin matrix. It is widely used in Europe and Canada for the restoration of endodontically treated teeth and was introduced in the United States 2 years ago as the C-Post dowel. This retrospective study evaluated treatment outcome of the Composipost system after 2 to 3 years. A total of 236 patients treated during a 1-year period by seven Swedish dental practitioners were included. Of those, 146 patients consented and data were collected from the dental records of the remaining patients. Thus, the material comprised 236 teeth restored with carbon fiber-reinforced epoxy resin post, 130 maxillary and 106 mandibular teeth, with a mean restoration time of 32 months (range 27 to 41). Periodontal conditions, radiographic signs, and prosthodontic results were recorded. Five teeth (2%) had been extracted for reasons unrelated to the Composipost system. Periodontal conditions such as plaque accumulation, gingival health, bleeding on probing, and pocket depth around the teeth with Composipost dowels were similar to the control teeth. No dislodgment or root or post fractures were observed clinically or on radiographs. Radiographic examination of bone height measured from the apex to the bone margin mesially and distally showed differences on the mesial side but not on the distal surface (p < 0.05) between the Composipost-treated teeth and the controls. Promising results after 2 to 3 years of clinical service indicate that this system can be a viable alternative to conventional post-and-core systems.

Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review.

PubMed

Fang, Yanjun; Wang, Xinhuan; Zhu, Jingjing; Su, Chaonan; Yang, Ying; Meng, Liuyan

2018-03-01

The aim of this review was to evaluate whether the apical diameter of teeth with necrotic pulp affects the outcomes of regenerative endodontic treatment and to determine the minimal apical size needed to obtain proper pulp revascularization. A literature search was performed from January 1, 2001, to November 25, 2016. Studies that satisfied the inclusion criteria were subjected to data extraction and analysis. In total, 14 studies with 85 patients were included. There were 10 case reports, 3 case series, and 1 prospective cohort study. The apical diameters of the teeth were divided into 3 groups: a narrow-sized group (group N), <0.5 mm (n = 10); a medium-sized group (group M), 0.5-1.0 mm (n = 25); and a wide-sized group (group W), >1.0 mm (n = 60). In group N, 1 tooth failed, 2 teeth completely healed, and 7 teeth incompletely healed. In group M, 2 teeth were excluded, and 1 tooth failed. In group W, 3 teeth were excluded, and 4 teeth failed. The clinical success rates were 90%, 95.65%, and 92.98% in groups N, M, and W, respectively. Within the limitations, the teeth with apical diameters <1.0 mm achieved clinical success after regenerative endodontic treatment. Meanwhile, the teeth with apical diameters of 0.5-1.0 mm attained the highest clinical success rate, which may be related to other potential factors, including patient age, pulp necrosis etiology, preoperative apical radiolucency, procedure details, follow-up period, and sample size. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice.

PubMed

Koch, M; Wolf, E; Tegelberg, Å; Petersson, K

2015-07-01

To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR). A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fisher's exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression. Follow-up data were available for 229 (55%) of teeth treated pre- and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both pre- and post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up. Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Assessment of the Incidence of Posttreatment Endodontic Flare-ups in Patients undergoing Single-sitting Root Canal Therapies: A Clinical Study.

PubMed

Priyank, Harsh; Devi, T M Chaitra; Goel, Pallavi; Sahu, Nivedita; Nihalani, Shweta; Shandilya, Ashutosh

2016-10-01

Endodontic therapy is one of the commonly used procedures for treating the teeth affected by various pathologies. One of the major problems for endodontists despite the advancements in the root canal procedures is the posttreatment endodontic flare-ups. Much debate exists regarding the completion of endodontic therapy in a single sitting or multiple sittings. Hence, we assessed the incidence of endodontic flare-ups in patients undergoing single-sitting root canal therapies. The present study included 200 patients who underwent single-sitting endodontic therapy. Clinical details and conditions of each and every tooth of every patient were recorded before and after the completion of endodontic therapy. Irrigation during the root canal procedures was done by 2.5% NaOCl solution in most of the cases while others were irrigated with various combinations of ethylenediaminetetraacetic acid (EDTA) and cycloheximide (CHX) solutions. Follow-up records and readings of the patents were noted and were subjected to statistical analysis. Four groups were formed which divided the patients equally on the basis of their age. Out of 50 patients in the age group of 21 to 30 years, only 4 showed posttreatment endodontic flare-ups, while no endodontic flare-up was recorded in patients with age group of 31 to 50 years. Only two male and four females showed flare-ups postoperatively. A nonsignificant correlation was obtained when flare-up cases were compared on the basis of type of irrigation solution used during canal preparation. Single-sitting endodontic therapy appears to be a successful procedure with good prognosis and minimal posttreatment flare-up results, even in patients with periapical pathologies. Single-sitting root canal procedures can be successfully carried in patients with vital or nonvital pulp tissues and also in patients with periapical lesions.

The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.

PubMed

Davies, A; Patel, S; Foschi, F; Andiappan, M; Mitchell, P J; Mannocci, F

2016-07-01

Part 2 of this prospective clinical study aimed to compare the 1-year outcome of root canal retreatments, when individual roots and teeth were assessed by periapical radiographs and cone beam computed tomography (CBCT). Subjects participating in this study had been referred for management of an endodontic problem associated with one or more root filled teeth. Root canal retreatment was performed by Specialists or postgraduate students under the direct supervision of Specialist endodontic staff. A total of 98 teeth (84 patients) were reassessed clinically and radiographically 1 year after completion of root canal retreatment. The postoperative periapical radiographs and CBCT scans were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The increase or decrease in size of existing periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two calibrated examiners. They also determined an appropriate management plan for each case based on the radiographical findings. Comparison of the outcome diagnosis of individual roots and teeth and case management, when assessed by periapical radiographs and CBCT scans, was performed using chi-squared and McNemar's tests. An overall favourable result of 93% success for teeth (96% roots) was recorded when the assessment was undertaken by periapicals compared with 77% success for teeth (87% roots) when assessed by CBCT. A significant difference in outcome diagnosis of single paired roots (P < 0.0001) and teeth (P = 0.0001) was observed when comparing periapicals to CBCT for the cohort of teeth as a whole. When comparing the future management plan on the basis of radiographic information alone, there was a significant difference between periapicals and CBCT-based management (P = 0.01). Diagnosis using CBCT revealed a significantly lower number of favourable outcomes than periapicals in root canal retreatment. This significantly affected the future management of cases attending for a review. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Anesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis.

PubMed

Parente, S A; Anderson, R W; Herman, W W; Kimbrough, W F; Weller, R N

1998-12-01

The purpose of this study was to determine the efficacy of a supplemental intraosseous injection (IOI) of 2% lidocaine with 1:100,000 epinephrine using the Stabident device, after conventional anesthetic methods had failed. Patients who experienced pain during endodontic access and required a supplemental IOI using 0.45 to 0.90 ml of the local anesthetic were identified. All 37 of the patients treated had teeth diagnosed with irreversible pulpitis. Thirty-four of the teeth were mandibular posterior teeth, 2 were maxillary posterior teeth, and 1 was a maxillary anterior tooth. Patients with maxillary teeth had received infiltration anesthesia, and those with mandibular teeth had received an inferior alveolar nerve block in conjunction with long buccal infiltration. A minimum of 3.6 ml of local anesthetic was used with the conventional techniques. Modified visual analogue scales, coupled with operator evaluations, were used to measure success. The Stabident IOI was an effective supplemental anesthetic technique in 89% (+/- 5.1) or 33/37 patients evaluated. The 95% confidence interval was 74 to 97%. The IOI was successful in 91% (+/- 4.9) of the mandibular posterior teeth (31/34), and 67% of the maxillary teeth (2/3).

3D printed replicas for endodontic education.

PubMed

Reymus, M; Fotiadou, C; Kessler, A; Heck, K; Hickel, R; Diegritz, C

2018-06-14

To assess the feasibility of producing artificial teeth for endodontic training using 3D printing technology, to analyse the accuracy of the printing process, and to evaluate the teeth by students when used during training. Sound extracted human teeth were selected, digitalized by cone beam computed tomography (CBCT) and appropriate software and finally reproduced by a stereolithographic printer. The printed teeth were scanned and compared with the original ones (trueness) and to one another (precision). Undergraduate dental students in the third and fourth years performed root canal treatment on printed molars and were subsequently asked to evaluate their experience with these compared to real teeth. The workflow was feasible for manufacturing 3D printed tooth replicas. The absolute deviation after printing (trueness) ranged from 50.9μm to 104.3μm. The values for precision ranged from 43.5μm to 68.2μm. Students reported great benefits in the use of the replicated teeth for training purposes. The presented workflow is feasible for any dental educational institution who has access to a CBCT unit and a stereolithographic printer. The accuracy of the printing process is suitable for the production of tooth replicas for endodontic training. Undergraduate students favoured the availability of these replicas and the fairness they ensured in training due to standardization. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Technological advances in endodontics: treatment of a mandibular molar with internal root resorption using a reciprocating single-file system.

PubMed

de Souza, Samir Noronha; Marques, André Augusto Franco; Sponchiado-Júnior, EmÍlio Carlos; Roberti Garcia, Lucas da Fonseca; da Frota, Matheus Franco; de Carvalho, Fredson Márcio Acris

2017-01-01

The field of endodontics has become increasingly successful due to technological advances that allow clinicians to solve clinical cases that would have been problematic a few years ago. Despite such advances, endodontic treatment of teeth with internal root resorption remains challenging. This article presents a clinical case in which a reciprocating single-file system was used for endodontic treatment of a mandibular molar with internal root resorption. Radiographic examination revealed the presence of internal root resorption in the distobuccal root canal of the mandibular right first molar. A reciprocating single-file system was used for root canal instrumentation and final preparation, and filling was obtained through a thermal compaction technique. No painful symptoms or periapical lesions were observed in 12 months of follow-up. The results indicate that a reciprocating single-file system is an adequate alternative for root canal instrumentation, particularly in teeth with internal root resorption.

Oral health status in a population in Northern Norway.

PubMed

Norheim, P W

1979-01-01

Information concerning oral health status was obtained through a clinical and radiographic examination of 297 persons aged 20--69 years out of a population of 358 persons living in a coastal community in Northern Norway. The oral health was generally poor. 71% had one or more remaining teeth and the dentulous persons had a mean number of 18 remaining teeth. The mean number of DMF teeth was 27,3 while the mean number of decayed teeth was 4,9 and filled teeth 12,0 giving a percent of decayed and filled teeth of 27 and 65 respectively. Only every fourth dentulous person had one or more crowns and/or bridge units and 4% of all teeth had been treated endodontically. 41% of the teeth had visible plaque and 56% of the teeth had one or more gingival margins bleeding after gentle probing. One fourth of all teeth had gingival pockets exceeding 3 mm and 17% of all teeth showed a bone loss of 20% or more. The number of remaining teeth decreased with increasing age and decreasing income and/or social class. In general, women, young people and people with a high socioeconomic status had less caries, better oral hygiene and periodontal condition and had received more restorative dental care than the remaining part of the population.

The Sensitivity of Endodontic Enterococcus spp. Strains to Geranium Essential Oil.

PubMed

Łysakowska, Monika E; Sienkiewicz, Monika; Banaszek, Katarzyna; Sokołowski, Jerzy

2015-12-21

Enterococci are able to survive endodontic procedures and contribute to the failure of endodontic therapy. Thus, it is essential to identify novel ways of eradicating them from infected root canals. One such approach may be the use of antimicrobials such as plant essential oils. Enterococcal strains were isolated from endodontically treated teeth by standard microbiological methods. Susceptibility to antibiotics was evaluated by the disc-diffusion method. The minimal inhibitory concentration (MIC) of geranium essential oil was investigated by microdilution in 96-well microplates in Mueller Hinton Broth II. Biofilm eradication concentrations were checked in dentin tests. Geranium essential oil inhibited enterococcal strains at concentrations ranging from 1.8-4.5 mg/mL. No correlation was shown between resistance to antibiotics and the MICs of the test antimicrobials. The MICs of the test oil were lower than those found to show cytotoxic effects on the HMEC-1 cell line. Geranium essential oil eradicated enterococcal biofilm at concentrations of 150 mg/mL. Geranium essential oil inhibits the growth of endodontic enterococcal species at lower concentrations than those required to reach IC50 against the HMEC-1 cell line, and is effective against bacteria protected in biofilm at higher concentrations. In addition, bacteria do not develop resistance to essential oils. Hence, geranium essential oil represents a possible alternative to other antimicrobials during endodontic procedures.

Coronal leakage in endodontically treated teeth restored with posts and complete crowns using different luting agent combinations.

PubMed

Nissan, Joseph; Rosner, Ofir; Gross, Ora; Pilo, Raphael; Lin, Shaul

2011-04-01

To evaluate the influence of different cement combinations on coronal microleakage in restored endodontically treated teeth using dye penetration. Human, noncarious single-rooted extracted premolars (n = 60) were divided into four experimental groups (each n = 15). After endodontic treatment, different combinations of cements were used to lute prefabricated posts and complete crown restorations: zinc phosphate cement applied on posts and cast crowns (Z) or on zinc phosphate cement posts and resin cement applied on cast crowns (ZR); resin cement applied on posts and zinc phosphate cement applied on cast crowns (RZ); and resin cement applied on posts and cast crowns (R). After artificial aging through thermal cycling (5°C to 55°C) for 2,000 cycles at 38 seconds for each cycle and 15 seconds of dwell time, specimens were immersed for 72 hours in basic fuchsin at 37°C. A buccolingual section was made through the vertical axis of specimens. A Toolmaker's microscope (Mitutoyo) was used to measure (um) dye penetration. The Kruskal-Wallis nonparametric test was used to determine intergroup difference. A nonparametric Mann-Whitney test compared each group regarding its maximal linear penetration depths on the mesial and distal aspects of each specimen (a = 0.05). Dye staining was evident to some degree in all specimens. Among groups Z, ZR, and RZ, no significant difference was shown in dye-penetration depths (mean penetration scores 1,518 to 1,807 um). However, dyepenetration depth was significantly lower in group R compared to the other groups (mean penetration score 1,073 um) (P < .05). Under study conditions, the cement combination offering the best coronal sealing was the one using only resin cement for both posts and crown restorations.

Detection of Porphyromonas endodontalis, Porphyromonas gingivalis and Prevotella intermedia in primary endodontic infections in a Chinese population.

PubMed

Cao, H; Qi, Z; Jiang, H; Zhao, J; Liu, Z; Tang, Z

2012-08-01

To assess the prevalence of three black-pigmented bacterial species (Porphyromonas endodontalis, Porphyromonas gingivalis and Prevotella intermedia) using microarray technology in root canals of teeth associated with primary endodontic infections in a Chinese population. Microbial samples were taken from root canals of 80 teeth with pulp necrosis and primary endodontic infections in a Chinese population. DNA extracted from the samples was amplified by PCR with universal bacterial primers based on 16S rRNA gene sequences, and the products hybridized with the microarrays in which the specific oligonucleotide probes were added. The results of hybridization were screened by a confocal laser scanner. Pearson chi-square test and the two-sided Fisher exact test were used to analyse whether a significant association existed between the species and symptoms as well as in co-existence of two target organisms by a statistical software package (SAS 8.02). The 16S rRNA gene microarray detected at least one of the three test species in 76% of the study teeth. P. endodontalis, P. gingivalis and P. intermedia were found in 50%, 33% and 45%, respectively. A significant association was found in the presence of the pair P. endodontalis / P. gingivalis (P < 0.005). Both P. endodontalis (P <0.05) and P. gingivalis (P <0.005) had a statistically significant association with the presence of a sinus tract. The simultaneous presence of P. endodontalis and P. gingivalis was also associated with the presence of a sinus tract (P<0.005) and abscess formation (P<0.05). The three black-pigmented bacteria were prevalent in teeth with pulp necrosis and primary endodontic infections in a Chinese population. P. gingivalis and P. endodontalis were associated with the presence of sinus tract and abscess formation. © 2012 International Endodontic Journal.

Microbiologic endodontic status of young traumatized tooth.

PubMed

Baumotte, Karla; Bombana, Antonio C; Cai, Silvana

2011-12-01

Traumatic dental injuries could expose the dentin and, even the pulp, to the oral environment, making possible their contamination. The presence of microorganisms causes pulpal disease and further a tecidual clutter in the periradicular region. The therapy of periradicular pathosis is the consequence of a correct diagnoses which depends on the knowledge of the nature and complexity of endodontic infections. As there is no information on the microbiology of primary endodontic infection in young teeth, the aim of the current study was to investigate the microbiologic status of root canals from permanent young teeth with primary endodontic infection. Twelve patients with the need for endodontic treatment participated in the study. The selected teeth were uniradicular and had an incomplete root formation. They had untreated necrotic pulp. After the access preparation, nineteen microbiologic samples were obtained from the root canals with sterile paper points. Afterwards, the paper points were pooled in a sterile tube containing 2 ml of prereduced transport fluid. The samples were diluted and spread onto plates with selective medium for Enterococcus spp. and for yeast species and onto plates with non-selective medium. A quantitative analysis was performed. The mean number of cultivable bacterial cells in the root canals was 5.7 × 10(6). In four samples (21.05%) black pigmented species were recovered and the mean number of cells was 6.5 × 10(5). One specimen (5.25%) showed the growth of Enterococcus species and the mean number of cells in this case was of 1.5 × 10(4) . The results showed a root canal microbiota with similar design as seen in completely formed teeth. © 2011 John Wiley & Sons A/S.

[A retrospective study of 180 cases of apical microsurgery].

PubMed

Wang, Hanguo; Li, Dan; Tian, Yu; Yu, Qing

2014-07-01

To evaluate the outcome and the potential prognostic factors of apical microsurgery. The teeth with persistent periapical diseases were treated by microsurgery using micro instruments, ultrasonic retrotips and mineral trioxide aggregate (MTA) under dental operate microscope. The procedure includes incision and flap retraction, osteotomy, apicoectomy, retro- preparation and retro- filling of root canal. Patients were recalled at 1, 3, 6, and 12- month intervals. The outcome was evaluated by clinical and radiographic examinations, and the potential prognostic factors were analyzed. One hundred and eighty cases (240 teeth), including 132 upper anterior teeth, 22 lower anterior teeth, 31 upper premolars, 18 lower premolars, 19 upper molars and 18 lower molars, were treated by microsurgery between July 2010 and December 2012. A total of 152 cases (207 teeth) were recalled. The application of the apical microsurgery included failure of previous endodontic treatment, periapical lesion with post, periapical cyst, calcified canals, separated instruments, overfilling, open apex, root facture, failure of previous apical surgery, apical fenestration, and special root canal system. The success rate was 90.8% (188/207). Age, sex, tooth position, type of periapical radiolucency, fistula and clinical application type appeared to have a negative effect on the outcome. Endo-perio lesion was a significant factor. Eighteen cases (19 teeth) failed mainly because of periodontally involved lesion and vertical root fracture. Apical microsurgery, which combines the magnification and illumination provided by the microscope with the proper use of micro instruments, can treat the teeth with persistent periapical diseases precisely and less traumatically with high success rate. Case selection and standardized operations play a key role for success.

Revitalization of open apex teeth with apical periodontitis using a collagen-hydroxyapatite scaffold.

PubMed

Nevins, Alan J; Cymerman, Jerome J

2015-06-01

An enhanced revision of the revitalization endodontic technique for immature teeth with apical periodontitis has been described. It includes the addition of collagen-hydroxyapatite scaffold to the currently practiced revascularization technique. Four cases treated in series are presented in this report, 1 case involving 2 teeth. Periapical diagnoses of immature teeth included "asymptomatic apical periodontitis," "symptomatic apical periodontitis," and "acute apical abscess." Additionally, 1 fully developed tooth that had undergone root canal treatment that failed had a periapical diagnosis of acute apical abscess. An established revascularization protocol was used for all teeth. In addition to stimulating blood clots, all teeth were filled with collagen-hydroxyapatite scaffolds. Periapical radiolucencies healed in all teeth, and diffuse radiopacity developed within the coronal portions of canal spaces. Root development with root lengthening occurred in the immature nonvital maxillary premolar that had not undergone prior treatment. The technique of adding a collagen-hydroxyapatite scaffold to the existing revitalization protocol has been described in which substantial hard tissue repair has occurred. This may leave teeth more fully developed and less likely to fracture. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The effect of Emdogain and 24% EDTA root conditioning on periodontal healing of replanted dog's teeth.

PubMed

Guzmán-Martínez, Nayelli; Silva-Herzog, Flores Daniel; Méndez, González Verónica; Martín-Pérez, Silvia; Cerda-Cristerna, Bernardino Isaac; Cohenca, Nestor

2009-02-01

Controversies still exist as for the regenerative role of enamel matrix derivatives and the need for removal of the periodontal ligament in replanted teeth. The purpose of this study was to evaluate the effect of Emdogain and 24% ethylenediamine tetraacetic acid (EDTA) root conditioning on periodontal healing of replanted dog's teeth. Teeth were extracted, endodontically treated and preconditioned as follows: group 1, Emdogain; group 2, Emdogain + EDTA and group 3, EDTA. Teeth were replanted after 30 min extraoral time, splinted for 15 days and animals sacrificed after 8 weeks of observation. Histological evaluation was performed using hematoxylin/eosin and Masson trichrome and results scored based on previously reported criteria for histological evaluation. Replacement root resorption was histologically diagnosed in all groups except in the negative control. A parametric analysis showed no statistically significant differences between experimental groups. Root preconditioning with Emdogain alone or in combination with 24% EDTA showed no evidence of regeneration of collagen fibers and consequently did not prevent the development of replacement root resorption on replanted dog's teeth.

Coronal leakage inhibition in endodontically treated teeth using resin-coating technique.

PubMed

Maruoka, Rena; Nikaido, Toru; Ikeda, Masaomi; Ishizuka, Tomoyasu; Foxton, Richard M; Tagami, Junji

2006-03-01

The purpose of this study was to evaluate coronal leakage inhibition using a resin-coating technique after endodontic treatment. Thirty-six human incisors were cut at the cementoenamel junction, and endodontic obturations were performed. The specimens were randomly divided into three groups according to post space preparation (10 mm depth), resin coating, and temporization. For the resin coating, the dentin surface was coated with either a combination of Clearfil SE Bond and Protect Liner F (SE/PLF) or RZII (RZ). Then, the specimens were stored in 37 degrees C distilled water for 24 hours and placed in 1% methylene blue solution for 48 hours. After which, the specimens were sectioned faciolingually along the root canal and the length of dye penetration was measured from the cementoenamel junction. Three-way ANOVA revealed that the dye penetration scores were influenced by post space preparation, resin coating, and temporization. Resin coating with RZ significantly reduced the dye penetration score and SE/PLF completely eliminated dye penetration.

Live Helicobacter pylori in the root canal of endodontic-infected deciduous teeth.

PubMed

Hirsch, Christian; Tegtmeyer, Nicole; Rohde, Manfred; Rowland, Marion; Oyarzabal, Omar A; Backert, Steffen

2012-08-01

Many polymerase chain reaction (PCR)-based studies have shown that Helicobacter pylori DNA is prevalent in the oral cavity, but reports on the isolation of live bacteria are extremely rare. Thus, it is still unclear whether H. pylori can indeed survive in the oral environment. Here we used electron microscopy, selective growth techniques, urease assays, 16S rRNA PCR, and western blotting to investigate the possible presence of live H. pylori in 10 root canal and corresponding plaque samples of endodontic-infected deciduous teeth in three children. Although H. pylori DNA was verifiable by PCR in several plaque and root canal samples, bacterial colonies could only be grown from two root canals, but not from plaque. These colonies were unequivocally identified as H. pylori by microscopic, genetic, and biochemical approaches. Our findings show that root canals of endodontic-infected teeth may be a reservoir for live H. pylori that could serve as a potential source for transmission.

Prevalence and clonal analysis of Porphyromonas gingivalis in primary endodontic infections.

PubMed

Siqueira, José F; Rôças, Isabela N; Silva, Marlei G

2008-11-01

This study investigated the prevalence of Porphyromonas gingivalis in 62 teeth with primary endodontic infections by using a species-specific 16S rRNA gene-based nested polymerase chain reaction assay. P. gingivalis isolates recovered from 2 infected root canals were also analyzed for clonal diversity by using arbitrarily primed PCR. Overall, P. gingivalis was found in 48% of the samples. This species was specifically detected in 36% of canals of teeth with chronic apical periodontitis, in 46% of the cases of acute apical periodontitis, and in 67% of acute apical abscesses. P. gingivalis was significantly more frequent in abscess aspirates than in canals of teeth with chronic apical periodontitis (P < .05). Typing of colonies retrieved from 2 infected canals revealed 2 clones per individual. These findings confirmed that P. gingivalis can be an important endodontic pathogen, mostly associated with acute abscesses, and demonstrated that different clonal types of this species can colonize the root canal in the same individual.

Cone beam computed tomography in Endodontics - a review.

PubMed

Patel, S; Durack, C; Abella, F; Shemesh, H; Roig, M; Lemberg, K

2015-01-01

Cone beam computed tomography (CBCT) produces undistorted three-dimensional information of the maxillofacial skeleton, including the teeth and their surrounding tissues with a lower effective radiation dose than computed tomography. The aim of this paper is to: (i) review the current literature on the applications and limitations of CBCT; (ii) make recommendations for the use of CBCT in Endodontics; (iii) highlight areas of further research of CBCT in Endodontics. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Non-surgical root canal treatment of Dens invaginatus: reports of three cases.

PubMed

Cengiz, Sevi Burcak; Korasli, Deniz; Ziraman, Fatmagul; Orhan, Kaan

2006-02-01

Dens invaginatus is a rare developmental malformation of teeth showing a deep infolding of enamel and dentine which may extend deep into the root. To date, conventional root canal therapy, endodontic surgery and extraction have been reported as treatment modalities, when the pulpo-dentinal complex of such teeth is affected. In the present report, non-surgical endodontic treatment of three maxillary lateral incisors with invaginatus (DI) is discussed. The Tri Auto ZX rotary system was used for shaping the root canals of two affected teeth and the Profile system was used in the third. Teeth with periradicular lesions received calcium hydroxide as an interim therapy. Two teeth were obturated with gutta percha points and AH Plus sealer using cold lateral compaction. In the third case, obturation was accomplished using a coated carrier system (Thermafil) due to the specific shape of the root canal system. Twelve months postoperatively all teeth were asymptomatic with resolution of the periapical radiolucency on two affected teeth, as confirmed radiographically. Healing was achieved without any need for further surgical intervention.

An evaluation of the periapical status of teeth with necrotic pulps using periapical radiography and cone-beam computed tomography.

PubMed

Abella, F; Patel, S; Durán-Sindreu, F; Mercadé, M; Bueno, R; Roig, M

2014-04-01

To evaluate the presence or absence of periapical (PA) radiolucencies on individual roots of teeth with necrotic pulps, as assessed with digital PA radiographs and cone-beam computed tomography (CBCT). Digital PA radiographs and CBCT scans were taken from 161 endodontically untreated teeth (from 155 patients) diagnosed with non-vital pulps (pulp necrosis with normal PA tissue, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess and chronic apical abscess). Images were assessed by two calibrated endodontists to analyse the radiographic PA status of the teeth. A consensus was reached in the event of any disagreement. The data were analysed using a McNemar's test, and significance was set at P ≤ 0.05. Three hundred and forty paired images of roots were assessed with both digital PA radiographs and CBCT images. Fifteen additional roots were identified with CBCT. PA radiolucencies were present in 132 (38.8%) roots when assessed with PA radiographs, and in 196 (57.6%) roots when assessed with CBCT. This difference was statistically significant (P < 0.05). In teeth diagnosed with pulp necrosis, symptomatic apical periodontitis or acute apical abscess, CBCT images revealed a statistically larger number of PA radiolucencies than did PA radiographs (P < 0.05). No statistical differences were observed between PA radiographs and CBCT in teeth classified with asymptomatic apical periodontitis (P = 0.31) or chronic apical abscess (P = 1). Unlike PA radiographs, CBCT revealed a higher prevalence of PA radiolucencies when endodontically untreated teeth with non-vital pulps were examined. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

An In Vitro Evaluation of the Use of Resin Liners to Reduce Microleakage and Improve Bond Strength of Amalgam Restorations

DTIC Science & Technology

1991-01-01

posterior teeth, but also to provide a substructure for cast restorations and to seal endodontically treated roots following surgery.5 Although...in class V cavity preparations in the canines, mandibular second molars , and maxillary bicuspids of dogs. Evaluations were performed 48 hours, 30, 60...Cavit and amalgam prevented leakage under both temperature treatment conditions. Mormati and Chan4 8 immersed extracted molars restored with either

Comparative evaluation of the effect of different crown ferrule designs on the fracture resistance of endodontically treated mandibular premolars restored with fiber posts, composite cores, and crowns: An ex-vivo study

PubMed Central

Dua, Nikita; Kumar, Bhupendra; Arunagiri, D.; Iqbal, Mohammad; Pushpa, S.; Hussain, Juhi

2016-01-01

Introduction: In cases of severe hard tissue loss, 2 mm circumferential ferrule is difficult to achieve which leads to incorporation of different ferrule designs. Aim: To compare and evaluate the effect of different crown ferrule designs on the fracture resistance of mandibular premolars restored with fiber posts, composite cores, and crowns. Materials and Methods: Fifty freshly extracted mandibular premolars were endodontically treated and divided into five groups: Group I - 2 mm circumferential ferrule above the cementoenamel junction (CEJ); Group II - 2 mm ferrule on the facial aspect above CEJ; Group III - 2 mm ferrule on the lingual aspect above CEJ; Group IV - 2 mm ferrule on the facial and lingual aspects above CEJ with interproximal concavities, and Group V - no ferrule (control group) and were later restored with fiber posts, composite cores, and crowns. Specimens were mounted on a universal testing machine, and compressive load was applied at a crosshead speed of 1 mm/min until fracture occurred. Results: The results showed that circumferential ferrule produced the highest mean fracture resistance and the least fracture resistance was found in the control group. Conclusion: Circumferential ferrule increases the fracture resistance of endodontically treated teeth restored with bonded post, core, and crown. PMID:27217642

Regeneration and Repair in Endodontics—A Special Issue of the Regenerative Endodontics—A New Era in Clinical Endodontics

PubMed Central

Saoud, Tarek Mohamed A.; Ricucci, Domenico; Lin, Louis M.; Gaengler, Peter

2016-01-01

Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of ‘regenerative endodontics’ emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists’ Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis. PMID:29563445

Endodontic medicine: connections between apical periodontitis and systemic diseases.

PubMed

Segura-Egea, J J; Martín-González, J; Castellanos-Cosano, L

2015-10-01

The prevalence of apical periodontitis (AP) in Europe has been reported to affect 61% of individuals and 14% of teeth, and increase with age. Likewise, the prevalence of root canal treatment (RCT) in Europe is estimated to be around 30-50% of individuals and 2-9% of teeth with radiographic evidence of chronic persistent AP in 30-65% of root filled teeth (RFT). AP is not only a local phenomenon and for some time the medical and dental scientific community have analysed the possible connection between apical periodontits and systemic health. Endodontic medicine has developed, with increasing numbers of reports describing the association between periapical inflammation and systemic diseases. The results of studies carried out both in animal models and humans are not conclusive, but suggest an association between endodontic variables, that is AP and RCT, and diabetes mellitus (DM), tobacco smoking, coronary heart disease and other systemic diseases. Several studies have reported a higher prevalence of periapical lesions, delayed periapical repair, greater size of osteolityc lesions, greater likelihood of asymptomatic infections and poorer prognosis for RFT in diabetic patients. On the other hand, recent studies have found that a poorer periapical status correlates with higher HbA1c levels and poor glycaemic control in type 2 diabetic patients. However, there is no scientific evidence supporting a causal effect of periapical inflammation on diabetes metabolic control. The possible association between smoking habits and endodontic infection has also been investigated, with controversial results. The aim of this paper was to review the literature on the association between endodontic variables and systemic health (especially DM and smoking habits). © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Effects of fiber-glass-reinforced composite restorations on fracture resistance and failure mode of endodontically treated molars.

PubMed

Nicola, Scotti; Alberto, Forniglia; Riccardo, Michelotto Tempesta; Allegra, Comba; Massimo, Saratti Carlo; Damiano, Pasqualini; Mario, Alovisi; Elio, Berutti

2016-10-01

The study evaluated the fracture resistance and fracture patterns of endodontically treated mandibular first molars restored with glass-fiber-reinforced direct composite restorations. In total, 60 extracted intact first molars were treated endodontically; a mesio-occluso-distal (MOD) cavity was prepared and specimens were then divided into six groups: sound teeth (G1), no restoration (G2), direct composite restoration (G3), fiber-post-supported direct composite restoration (G4), direct composite reinforced with horizontal mesio-distal glass-fibers (G5), and buccal-palatal glass-fibers (G6). Specimens were subjected to 5000 thermocycles and 20,000 cycles of 45° oblique loading force at 1.3Hz and 50N; they were then loaded until fracture. The maximum fracture loads were recorded in Newtons (N) and data were analyzed with one-way ANOVA and post-hoc Tukey tests (p<0.05). Fractured specimens were analyzed with a scanning electron microscope (SEM). The mean static loads (in Newtons) were: G1, 831.83; G2, 282.86; G3, 364.18; G4, 502.93; G5, 499.26; and G6, 582.22. Fracture resistance did not differ among G4, G5, and G6, but was significantly higher than G3 (p=0.001). All specimens fractured in a catastrophic way. In G6, glass fibers inducted a partial deflection of the fracture, although they were not able to stop crack propagation. For the direct restoration of endodontically treated molars, reinforcement of composite resins with glass-fibers or fiber posts can enhance fracture resistance. The SEM analysis showed a low ability of horizontal glass-fibers to deviate the fracture, but this effect was not sufficient to lead to more favorable fracture patterns above the cement-enamel junction (CEJ). The fracture resistance of endodontically treated molars restored with direct composite restorations seems to be increased by reinforcement with fibers, even if it is insufficient to restore sound molar fracture resistance and cannot avoid vertical fractures. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fiber-reinforced resin coating for endocrown preparations: a technical report.

PubMed

Rocca, G T; Rizcalla, N; Krejci, I

2013-01-01

Coronal rehabilitation of endodontically treated posterior teeth is still a controversial issue. Although the use of classical crowns supported by radicular metal posts remains widespread in dentistry, their invasiveness has been largely criticized. New materials and therapeutic options based entirely on adhesion are available nowadays, from direct composite resins to indirect endocrowns. They allow for a more conservative, faster, and less expensive dental treatment. However, the absence of a metal or high-strength ceramic substructure as in full-crown restorations can expose this kind of restoration to a higher risk of irreversible fracture in case of crack propagation. The aim of this case report is to present a technique to reinforce the cavity of an endodontically treated tooth by incorporating a fiber-reinforced composite (FRC) layer into the resin coating of the tooth preparation, before the final impressions of the cavity. This technique allows the use of FRCs in combination with any kind of restorative material for an adhesive overlay/endocrown.

Periodontal-endodontic lesion of a three-rooted maxillary premolar: report of a case.

PubMed

Blanchard, Steven B; Almasri, Amjad; Gray, Jonathon L

2010-05-01

A 43-year-old African American male initially presented for a dental evaluation of a recurrent swelling on the buccal aspect of tooth #12. His medical history was unremarkable except for a 20-pack year history of smoking. He was eventually diagnosed as having a necrotic pulp #12, and received root canal treatment. The patient's problem was unresolved, and he was subsequently referred for a periodontal evaluation with a presumptive diagnosis of a periodontal abscess. A flap was reflected from teeth #11 through #15. A buccal furcation invasion was discovered on #12. Shortly thereafter, three distinct roots with three grade III furcation invasions were located. The tooth was deemed untreatable, and was extracted. The thin buccal plate of the extraction socket was preserved using freeze-dried bone allograft to facilitate future prosthodontic replacement. Healing was uneventful. Periodontal open flap debridement surgery was provided for the remainder of the mouth, and the patient was placed on a 3-month recall program. Periodontitis associated with endodontic lesions are among the most daunting diagnostic and therapeutic challenges faced by periodontists. This is particularly true for maxillary premolars with multiple roots. The tooth in this case, once periodontally involved, had a very poor prognosis. The prognosis was further compromised by the pulpal involvement. Therapy consisted of extraction of the tooth to relieve the patient's discomfort and treating the adjacent teeth with periodontal open flap debridement surgery. A review of the literature pertinent to the diagnosis and management of periodontal-endodontic lesions is also presented.

Frequency, microbial interactions, and antimicrobial susceptibility of Fusobacterium nucleatum and Fusobacterium necrophorum isolated from primary endodontic infections.

PubMed

Jacinto, Rogério C; Montagner, Francisco; Signoretti, Fernanda G C; Almeida, Geovania C; Gomes, Brenda P F A

2008-12-01

This study assessed the prevalence and microbial interactions of Fusobacterium nucleatum and Fusobacterium necrophorum in primary endodontic infections from a Brazilian population and their antimicrobial susceptibility to some antibiotics by the E-test. One hundred ten samples from infected teeth with periapical pathologies were analyzed by culture methods. Five hundred eighty individual strains were isolated; 81.4% were strict anaerobes. F. nucleatum was found in 38 root canals and was associated with Porphyromonas gingivalis, Prevotella spp., and Eubacterium spp. F. necrophorum was found in 20 root canals and was associated with Peptostreptococcus prevotii. The simultaneous presence of F. nucleatum and F. necrophorum was not related to endodontic symptoms (p > 0.05). They were 100% susceptible to amoxicillin, amoxicillin/clavulanate, and cephaclor. Fusobacterium spp. is frequently isolated from primary-infected root canals of teeth with periapical pathologies. Amoxicillin is a useful antibiotic against F. nucleatum and F. necrophorum in endodontic infections and has been prescribed as the first choice in Brazil.

The comparison of the effect of endodontic irrigation on cell adherence to root canal dentin.

PubMed

Ring, Karla C; Murray, Peter E; Namerow, Kenneth N; Kuttler, Sergio; Garcia-Godoy, Franklin

2008-12-01

The purpose of this study was to compare the effect of 10 different endodontic irrigation and chelating treatments on dental pulp stem cell (DPSC) attachment to root canal surfaces. Thirty-eight extracted human nondiseased single-canal teeth were cleaned and shaped using ProTaper and ProFile rotary instrumentation (Tulsa Dentsply, Tulsa, OK). The irrigation treatments investigated were 6% sodium hypochlorite, 2% chlorhexidine gluconate, Aquatine Endodontic Cleanser, and Morinda citrifolia juice. The irrigation treatments were used in conjunction with EDTA or MTAD. The instrumented teeth were immediately placed in cell culture with confluent DPSCs for 1 week. The number of attached DPSCs appeared to be correlated with the cytotoxicity of the root canal irrigating solution (analysis of variance, p < 0.0001). The presence or absence of the smear layer had little influence on DPSC activity (chi-square, p > 0.05). The results suggest that biocompatible irrigants are needed to promote DPSC attachment to root canal dentin, which is essential to accomplish some regenerative endodontic therapies.

Restoration of Long Standing Traumatized Teeth: A Case Report

PubMed Central

Kadkol, Prasanna Kumar; Reddy, K. Veera Kishore Kumar; Ainapur, Raghavendra

2015-01-01

Children are uniquely susceptible to craniofacial trauma. Injuries to the teeth occur often as a result of falls and sport activities. The pulp often gets infected after dental trauma resulting in to numerous complications. The authors present a case report of successful restoration of traumatized teeth with open apex which were weakened due to long standing infection and internal resorption. Initially antibiotic combination of 3- mix was used to disinfect the root canals. One tooth is treated with conventional endodontic treatment and the other tooth with open apex and perforation is managed by MTA apexification followed by canal reinforcement using glass ionomer cement and fiber reinforced composite post. Core build up is done using light cure composite resin followed by aesthetic crowns. The patient also presented with the peg shaped lateral incisors, which were built to an aesthetic appearance using light cure composite resins. PMID:26436062

Effect of cementum defects on radicular penetration of 30% H2O2 during intracoronal bleaching.

PubMed

Rotstein, I; Torek, Y; Misgav, R

1991-05-01

Bleaching pulpless teeth with 30% hydrogen peroxide has been reported to cause external cervical root resorption. It has been hypothesized that H2O2 penetrating through open dentin tubules can initiate an inflammatory reaction which could result in root resorption. Extracted human premolars were treated endodontically and bleached intracoronally using the thermocatalytic technique. The teeth were divided into three groups; one group with no cementum defects at the cementoenamel junction, one group with artificial cementum defects at the cementoenamel junction, and another group with artificial cementum defects at the middle third of the root. The radicular penetration of 30% hydrogen peroxide in the three groups was assessed directly and compared using an in vitro model. Radicular penetration of hydrogen peroxide was found in all of the groups tested. The penetration of hydrogen peroxide was significantly higher in teeth with cementum defects at the cementoenamel junction than in those without defects.

[A study of the related factors and prophylactic measures of endodontic interappointment emergencies].

PubMed

Pi, Gen-li; Yin, Shi-hai

2004-12-01

To estimate the related factors and prophylactic measures of endodontic interappointment emergencies (EIE). The clinical cases were divided into three groups. Cases in the routine group were treated according to the routine procedures of root canal therapy. Cases in the medicament group took dexamethasone tablets after the instrumentation. Root canals in the drainage group were prepared at the first visit and had been left open for two or three days. The related factors were recorded. The incidences and flare-up index (FUI) value of EIE were statistically analyzed. The EIE incidence of the routine group was 19.1%. The EIE incidence and FUI value of the overinstrumented teeth were significantly higher than those of other teeth (P < 0.05). EIE were not significantly related to the age, gender, tooth location and pathosis of the pulpal and periapical tissue (P > 0.05). The FUI value of the medicament group was significantly lower than that of the routine group (P < 0.05). Less severe EIE occurred in the cases of the drainage group than those of the control group (P > 0.05). The occurrence of EIE was significantly related to overinstrumentation. Taking dexamethasone may relieve EIE.

Regenerative endodontics: barriers and strategies for clinical translation.

PubMed

Mao, Jeremy J; Kim, Sahng G; Zhou, Jian; Ye, Ling; Cho, Shoko; Suzuki, Takahiro; Fu, Susan Y; Yang, Rujing; Zhou, Xuedong

2012-07-01

Regenerative endodontics has encountered substantial challenges toward clinical translation. The adoption by the American Dental Association of evoked pulp bleeding in immature permanent teeth is an important step for regenerative endodontics. However, there is no regenerative therapy for most endodontic diseases. Simple recapitulation of cell therapy and tissue engineering strategies that are under development for other organ systems has not led to clinical translation in regeneration endodontics. Recent work using novel biomaterial scaffolds and growth factors that orchestrate the homing of host endogenous cells represents a departure from traditional cell transplantation approaches and may accelerate clinical translation. Copyright © 2012 Elsevier Inc. All rights reserved.

Unusual anatomy of a maxillary first molar with two palatal roots: a case report.

PubMed

Tomazinho, Flávia S F; Baratto-Filho, Flares; Zaitter, Suellen; Leonardi, Denise P; Gonzaga, Carla C

2010-03-01

The success of endodontic therapy is based on good endodontic access, correct cleaning and shaping, and adequate root canal obturation. However, endodontic treatment is also dependent on a sound knowledge of the internal anatomy of human teeth, especially when anatomical variations are present. Certain anatomical changes may be present to varying degrees, and it is important to report these to improve the understanding and expertise of endodontic specialists. With this aim in mind, this study reports an example of a maxillary first molar showing unusual anatomy (four roots and six root canals) and describes the endodontic treatment that was employed.

Endodontic management of mandibular first molars with mid mesial canal: A case series.

PubMed

Nagmode, Pradnya Sunil; Patel, Ankit Vasant; Satpute, Archana Bhaskar; Gupta, Pooja L

2017-01-01

The purpose of this study is to demonstrate the importance of knowledge of the internal anatomy of root canals for the success of endodontic treatment. Lack of knowledge of anatomic variations and their characteristics in different teeth has been pointed out as one of the main cause of endodontic therapy failure. Dental operating microscope plays a key role in the identification of canal and success of endodontic treatment. This case series describes the endodontic treatment of mandibular first molars with extra root canals, evaluate the occurrence of this extra canal, and discuss the importance of their identification and treatment.

Single visit nonsurgical endodontic therapy for periapical cysts: A clinical study

PubMed Central

Maity, Ipsita; Meena, N.; Kumari, R. Anitha

2014-01-01

Aims: The aim of this study was to assess the outcome of single sitting root canal treatment (RCT) of asymptomatic teeth with periapical cysts. Materials and Methods: Ten maxillary anterior teeth showing periapical lesion on the radiograph was further screened by ultrasound with color power Doppler (CPD) for confirmation of a cyst. The average dimension of the lesions ranged from 1.3 to 1.9 cm. Single sitting RCT was performed on all the selected teeth. Postoperative healing was monitored at regular interval of 3 months, 6 months, and 1 year by using subjective feedback, radiograph, and ultrasound with CPD study. Results: Eight among the ten cases showed either signs of complete healing or healing in progress by the end of 6-12 months. Conclusions: It was observed that single sitting nonsurgical endodontic management of asymptomatic teeth with periapical cyst confirmed by ultrasound was successful in selected cases. PMID:24963246

Single visit nonsurgical endodontic therapy for periapical cysts: A clinical study.

PubMed

Maity, Ipsita; Meena, N; Kumari, R Anitha

2014-04-01

The aim of this study was to assess the outcome of single sitting root canal treatment (RCT) of asymptomatic teeth with periapical cysts. Ten maxillary anterior teeth showing periapical lesion on the radiograph was further screened by ultrasound with color power Doppler (CPD) for confirmation of a cyst. The average dimension of the lesions ranged from 1.3 to 1.9 cm. Single sitting RCT was performed on all the selected teeth. Postoperative healing was monitored at regular interval of 3 months, 6 months, and 1 year by using subjective feedback, radiograph, and ultrasound with CPD study. Eight among the ten cases showed either signs of complete healing or healing in progress by the end of 6-12 months. It was observed that single sitting nonsurgical endodontic management of asymptomatic teeth with periapical cyst confirmed by ultrasound was successful in selected cases.

Anatomical relationship between mental foramen, mandibular teeth and risk of nerve injury with endodontic treatment.

PubMed

Chong, Bun San; Gohil, Kajal; Pawar, Ravikiran; Makdissi, Jimmy

2017-01-01

The objective of the present study was to evaluate the anatomical relationship between mental foramen (MF), including the incidence of the anterior loop of the inferior alveolar nerve (AL), and roots of mandibular teeth in relation to risk of nerve injury with endodontic treatment. Cone-beam computed tomography (CBCT) images, which included teeth either side of the MF, were randomly selected. The anonymised CBCT images were reconstructed and examined in coronal, axial and sagittal planes, using three-dimensional viewing software, to determine the relationship and distance between MF and adjacent mandibular teeth. The actual distance between the root apex and MF was calculated mathematically using Pythagoras' theorem. If present, the incidence of an AL in the axial plane was also recorded. The root apex of the mandibular second premolar (70 %), followed by the first premolar (18 %) and then the first molar (12 %), was the closest to the MF. Ninety-six percent of root apices evaluated were >3 mm from the MF. An AL was present in 88 % of the cases. With regards to endodontic treatment, the risk of nerve injury in the vicinity of the MF would appear to be low. However, the high incidence of the AL highlights the need for clinicians to be aware and careful of this important anatomical feature. The risk of injury to the MN with endodontic treatment would appear to be low, but given the high incidence, it is important to be aware and be careful of the AL.

Diagnostic validity of periapical radiography and CBCT for assessing periapical lesions that persist after endodontic surgery.

PubMed

Kruse, Casper; Spin-Neto, Rubens; Reibel, Jesper; Wenzel, Ann; Kirkevang, Lise-Lotte

2017-10-01

Traditionally, healing after surgical endodontic retreatment (SER); i.e. apicectomy with or without a retrograde filling, is assessed in periapical radiographs (PR). Recently, the use of cone beam CT (CBCT) has increased within endodontics. Generally, CBCT detects more periapical lesions than PR, but basic research on the true nature of these lesions is missing. The objective was to assess the diagnostic validity of PR and CBCT for determining inflammation in SER cases that were re-operated (SER-R) due to unsuccessful healing, using histology of the periapical lesion as reference for inflammation. Records from 149 patients, receiving SER 2004-10, were screened. In total 108 patients (119 teeth) were recalled for clinical follow-up examination, PR and CBCT, of which 74 patients (83 teeth) participated. Three observers assessed PR and CBCT as "successful healing" or "unsuccessful healing" using Rud and Molven's criteria. SER-R was offered to all non-healed teeth with expected favourable prognosis for subsequent functional retention. During SER-R, biopsy was performed and histopathology verified whether or not inflammation was present. All re-operated cases were assessed non-healed in CBCT while 11 of these were assessed successfully healed in PR. Nineteen biopsies were examined. Histopathologic diagnosis revealed 42% (teeth = 8) without periapical inflammation, 16% (teeth = 3) with mild inflammation and 42% (teeth = 8) with moderate to intense inflammation. A correct diagnosis was obtained in 58% with CBCT (true positives) and 63% with PR (true positives+true negatives). Of the re-operated teeth, 42% had no periapical inflammatory lesion, and hence no benefit from SER-R. Not all lesions observed in CBCT represented periapical inflammatory lesions.

Esthetic management of a primary double tooth using a silicone putty guide: a case report.

PubMed

Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Munshi, Autar Krishen

2013-03-01

The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide.

Submergence of Roots for Alveolar Bone Preservation. I. Endodontically Treated Roots.

DTIC Science & Technology

1977-05-10

and lingual of the mandible. Inv erse bevel incisions were used so creviculectomy could be accomplished . All excess soft tissue around the teeth was...CARLOS E. del RIO , B.S. , D.D.S. MAJ , DC Periodontic Resident , US Army Inst itute of Denta l Research , Walter Reed Army Medica l Center, Washington...20012 ***COL, DC Chief , Dept. of Cl inical Specialties ; Di rector, Periodontic Residency , US Army Ins t i tute of Dental Research , Walter Reed Army

Possibilities and limits of imaging endodontic structures with CBCT.

PubMed

Weber, Marie-Theres; Stratz, Nadja; Fleiner, Jonathan; Schulze, Dirk; Hannig, Christian

2015-01-01

An adequate portrayal of the root canal anatomy by diagnostic imaging is a prerequisite for a successful diagnosis and therapy in endodontics. The introduction of dental cone beam computed tomography (CBCT) has considerably expanded the scope of imaging diagnostics. The aim of the following study was to evaluate the imaging of endodontic structures with CBCT. One hundred and twenty teeth were examined with a CBCT device (ProMax 3D). Subsequently, the findings of the three-dimensional images were evaluated and compared to those of dental radiographs and tangential section preparations of the examined teeth. Results with high prevalence, such as existing roots and root canals, as well as results with low prevalence, e.g., extremely fine anatomical structures of the endodontic tissue, could be visualized precisely by dental CBCT; side canals, ramifications, communications, pulp stones, and obliterations could also be detected. Additionally, the length of curved root canals could be determined accurately. Likewise, root fractures were visualized reliably with CBCT. However, carious lesions could not be diagnosed adequately, and the evaluation of fillings and prosthetic restorations was complicated due to scattered X-ray artifacts. CBCT datasets qualify to visualize and diagnose small anatomical structures of the endodontic tissue.

Endodontic Treatment of Hypertaurodontic Mandibular Molar Using Reciprocating Single-file System: A Case Report.

PubMed

C do Nascimento, Adriano; A F Marques, André; C Sponchiado-Júnior, Emílio; F R Garcia, Lucas; M A de Carvalho, Fredson

2016-01-01

Taurodontism is a developmental tooth disorder characterized by lack of constriction in the cementoenamel junction and consequent vertical stretch of the pulp chamber, accompanied by apical displacement of the pulpal floor. The endodontic treatment of teeth with this type of morpho-anatomical anomaly is challenging. The purpose of this article is to report the successful endodontic treatment of a hypertaurodontic mandibular molar using a reciprocating single-file system.

Endodontic decisions based on clinical appearance.

PubMed

Lobprise, H B; Bloom, B C

2001-08-01

Too often, endodontically compromised teeth are ignored because they are not accurately identified, nor their significance realized. By systematically evaluating each potentially affected tooth, a practitioner can correctly diagnose endodontic cases and plan therapy accordingly. Endodontic pathology, with non-vital pulps and subsequent abscessation, can affect not only the tooth but also the rest of the patient. Physical examination, both external and oral, can be combined with tactile and transillumination assessment. Radiographic appraisal is essential in determining periapical health, both to determine the vitality of the tooth and to ascertain if endodontic therapy is appropriate, of if extraction is the best choice. This report aims to provide the reader with a clearer understanding of diagnosing endodontic cases to facilitate selection of the appropriate treatment.

Presence of Candida Albicans in Root Canal System of Teeth Requiring Endodontic Retreatment with and without Periapical Lesions

PubMed Central

Ashraf, Hengameh; Samiee, Mohammad; Eslami, Gita; Ghodse Hosseini, Mohammad Reza

2007-01-01

INTRODUCTION: An important consideration in endodontic treatment is the elimination of microorganisms, including fungi, from the complex three- dimensional root canal system. Candida Albicans (CA) has a major role in endodontic treatment failure as the most important fungus isolated from the root canal system. The present study was carried out to evaluate the presence of CA in the teeth requiring endodontic retreatment, with or without periapical lesions. MATERIALS AND METHODS: This study was carried out on 60 root canals from human molars requiring endodontic retreatment. The root canals were randomly divided into two equal groups of 30 canals with versus without periapical lesions. Samples were collected from the root canals and cultured on MacConkey and blood agar culture media. The samples suspected of having CA were streaked on Sabouraud’s Dextrose Agar (SDA) and evaluated under a light microscope. Data was analyzed and compared using Chi- square and Kappa tests. RESULTS: CA was found in 11 patients (36.7%) with periapical lesions. In the patients without periapical lesions only 4 samples demonstrated CA in the root canal systems (13.3%). The difference between the two groups as to the presence of CA was statistically significant (p<0.037). In addition, evaluation of salivary samples revealed 15 cases (50%) of CA presence in the patients with periapical lesions and 16 cases (53.3%) of CA in the patients without periapical lesions, demonstrating no statistically significant difference between the two groups. CONCLUSION: Considering the fact that the presence of CA in the root canal systems of teeth with periapical lesions was more noticeable and statistically significant compared to the teeth without periapical lesions, the elimination of this microorganism from the root canal system, using appropriate intracanal solutions and medications is of utmost importance. PMID:24348654

The relationship between self-reported history of endodontic therapy and coronary heart disease in the Atherosclerosis Risk in Communities Study

PubMed Central

Caplan, Daniel J.; Pankow, James S.; Cai, Jianwen; Offenbacher, Steven; Beck, James D.

2009-01-01

Background Results from numerous studies have suggested links between periodontal disease and coronary heart disease (CHD), but endodontic disease has not been studied extensively in this regard. Methods The authors evaluated the relationship between self-reported history of endodontic therapy (ET) and prevalent CHD in the Atherosclerosis Risk in Communities (ARIC) Study, aprospective epidemiologic study sponsored by the National Heart, Lung, and Blood Institute. The authors used multivariable logistic regres-sionto analyze data obtained from oral health questionnaires, medical evaluations and clinical dental examinations. Results Of 6,651 participants analyzed, 50.4 percent reported never having had ET; 21.5 percent reported having had ET one time; and 28.0 percent reported having had ET two or more times. Final multivariable regression models indicated that among participants with 25 or more teeth, those reporting having had ET two or more times had 1.62 (95 percent confidence interval [CI], 1.04–2.53) times the odds of prevalent CHD compared with those reporting never having had ET. Among participants with 24 or fewer teeth, no significant differences in CHD prevalence were observed among groups regardless of their history of ET. Conclusions Among participants with 25 or more teeth, those with a greater self-reported history of ET were more likely to have CHD than were those reporting no history of ET. Clinical Implications More accurate epidemiologic quantification of endodontic infection and inflammation is required before definitive conclusions can be made about potential relationships between endodontic disease and CHD. PMID:19654253

Arresting rampant dental caries with silver diamine fluoride in a young teenager suffering from chronic oral graft versus host disease post-bone marrow transplantation: a case report.

PubMed

Chu, Chun-Hung; Lee, Angeline Hui-Cheng; Zheng, Liwu; Mei, May Lei; Chan, Godfrey Chi-Fung

2014-01-03

Rampant caries is an advanced and severe dental disease that affects multiple teeth. This case describes the management of rampant caries in a young teenager suffering from chronic oral graft versus host disease after allogeneic bone marrow transplantation. A 14-year-old Chinese boy suffering from β-thalassemia major was referred to the dental clinic for the management of rampant dental caries. An oral examination revealed pale conjunctiva, bruising of lips, and depapillation of tongue indicating an underlying condition of anemia. The poor oral condition due to topical and systemic immunosuppressants was seriously aggravated, and rampant caries developed rapidly, affecting all newly erupted, permanent teeth. The teeth were hypersensitive and halitosis was apparent. Strategies for oral health education and diet modification were given to the patient. Xylitol chewing gum was used to stimulate saliva flow to promote remineralization of teeth. Silver diamine fluoride was topically applied to arrest rampant caries and to relieve pain from hypersensitivity. Carious teeth with pulpal involvement were endodontically treated. Stainless steel crowns were provided on molars to restore chewing function, and polycarbonate crowns were placed on premolars, upper canines and incisors. This case report demonstrates success in treating a young teenager with severe rampant dental decay by contemporary caries control and preventive strategy.

Immediate implants placed into infected sockets: a case report with 3-year follow-up.

PubMed

Naves, Marina de Melo; Horbylon, Bruna Zacharias; Gomes, Camila de Freitas; Menezes, Helder Henrique Machado de; Bataglion, César; Magalhães, Denildo de

2009-01-01

The esthetics and functional integrity of the periodontal tissue may be compromised by dental loss. Immediate implants became a viable option to maintain the periodontal architecture because of their anatomic compatibility with the dental socket and the possibility of eliminating local contamination. This article describes the procedure of immediate implant placement in the anterior maxilla replacing teeth with chronic periapical lesions, which were condemned due to endodontic lesions persisting after failed endodontic treatment and endodontic surgery, and discusses the relationship between the procedure and periapical lesions. Surgical removal of hopeless teeth 11, 12 and 21 was performed conservatively in such a way to preserve the anatomy and gingival esthetics. A second surgical access was gained at the apical level, allowing the debridement of the surgical chamber for elimination of the periapical lesion, visual orientation for setting of the implants and filling of the surgical chamber with xenogenous bovine bone graft. After this procedure, the bone chamber was covered with an absorbent membrane and the healing screws were positioned on the implants. Later, a provisional partial removable denture was installed and the implants were inserted after 6 months. After 3 years of rehabilitation, the implants present satisfactory functional and esthetic conditions, suggesting that immediate implant placement combined with guided bone regeneration may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history in the anterior maxilla.

Root canal revascularization. The beginning of a new era in endodontics.

PubMed

Alrahabi, Mothanna K; Ali, Mahmoud M

2014-05-01

Endodontic management of immature anterior teeth with necrotic pulps is a great challenge. Although there are different treatment procedures to deal with this problem such as apexification by using calcium hydroxide dressings or applying a barrier of mineral trioxide aggregate and gutta-percha obturation, the outcomes are still unsatisfactory and the root might still be weak. Recently, a new treatment protocol by revascularization of immature non-vital, infected teeth was introduced to regenerate dental structure and complete the root maturation. However, larger case series with longer follow-up periods are required to accept revascularization as the standard protocol for management of immature non-vital, infected teeth. In this review, we discuss the concept of root canal revascularization, revascularization mechanisms, and the structure of the regenerated tissues.

Endodontic flare-ups: a prospective study.

PubMed

Alves, Vanessa de Oliveira

2010-11-01

The objective of this prospective clinical study was to evaluate the incidence of flare-ups (pain and/or swelling requiring endodontic interappointment and emergency treatment) and identify the risk factors associated with their occurrence in patients who received endodontic treatment from June 2006 to June 2007 at the endodontics clinic of the São Paulo Dental Association (APCD), Jardim Paulista branch, São Paulo, Brazil. The incidence of flare-ups was 1.71% out of 408 teeth that had received endodontic therapy. Statistical analysis using the chi-squared test (P < .05) indicated a direct correlation between the flare-up rate and the presence of a periradicular radiolucency. Copyright © 2010 Mosby, Inc. All rights reserved.

Flare up rate related to root canal treatment of asymptomatic pulpally necrotic central incisor teeth in patients attending a military hospital.

PubMed

Al-Negrish, Abdul Rohman Salem; Habahbeh, Riyad

2006-10-01

This prospective study was conducted to determine the flare up rate related to root canal treatment of asymptomatic non vital maxillary central incisor teeth performed in one and two appointments and the relationship, if any between pain and number of treatment visits. The frequency of postobturation pain and swelling was recorded and evaluated over an observation period of 1 week in a 120 consecutive patients undergoing root canal treatment. The patients were assigned randomly into one of two groups of 60 patients each. The canals of all teeth were prepared and filled using the step-back preparation and lateral condensation filling techniques. The data were analyzed statistically using Mann-Whitney test. Eight of the 120 patients were excluded from the analysis as they failed to attend for postoperative reviews. Out of the 112 patients involved in the study 90 patients had no pain, 9 patients had slight pain, 8 patients had moderate pain, and 5 patients had severe pain after 2 days. After 7 days 104 patients had no pain, 4 patients had slight pain, 3 patients had moderate pain and 1 patient had severe pain. No statistically significant difference in the incidence and degree of postoperative pain was found between one and two visit Endodontic procedures. The rate of post obturation flare up in asymptomatic Endodontically treated non vital maxillary centarl incisors was 11.6 and 3.6% after 2 and 7 days, respectively.

Natural reversal of tooth discoloration and pulpal response to testing following removal of a miniscrew implant for orthodontic anchorage: a case report.

PubMed

Qin, Y J; Zhang, G D; Zhang, Y; Ping, Y F; Zhao, C Y

2016-04-01

To highlight the reversal of signs suggesting pulpal necrosis following removal of a mini-implant without endodontic intervention. A 23-year-old woman presented with a class III malocclusion, with crowded and malformed teeth and excessive gingival display. During orthodontic treatment, a Tomas orthodontic miniscrew was placed between the root apices of the maxillary central incisors. This was carried out by an orthodontic specialist who had treated more than 700 patients (with more than 2000 mini-implants) over the past 9 years. After 2 weeks of treatment, the right maxillary central incisor discoloured and did not respond to electrical pulp tests (EPT) but was sensitive to endo-ice. The miniscrew was removed under local anaesthesia. Teeth 11 and 21 were fixed with ligation wire, and glass-ionomer cement (GIC) was added to the occlusal surfaces of the first and second maxillary molars to heighten the occlusion and disclude the maxillary anterior teeth. After 4 months, the colour and pulp reactions to EPT and endo-ice of tooth 11 returned to normal. Because the use of a miniscrew had appeared to damage the pulp, subsequent a conservative orthodontic treatment using, traditional 'J' hooks was used and achieved satisfactory results. After 23 months of orthodontic treatment, the treatment was complete and a 15-month follow-up showed a successful outcome. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Florid Cemento-osseous Dysplasia: A Case of Misdiagnosis.

PubMed

Delai, Débora; Bernardi, Anarela; Felippe, Gabriela Santos; da Silveira Teixeira, Cleonice; Felippe, Wilson Tadeu; Santos Felippe, Mara Cristina

2015-11-01

Florid cemento-osseous dysplasia (FCOD) belongs to the group of fibro-osseous lesions in which normal bone is replaced by fibrous connective tissue and calcified cementum tissue of the avascular type. Among the various types of fibro-osseous lesions, FCOD is one of the most commonly encountered diseases in clinical practice and may involve 3 or 4 of the quadrants. FCOD is located in the periapical regions of teeth, and the lesions are predominantly radiolucent (osteolytic phase), become mixed over time (cementoblast phase), and ultimately become radiopaque (osteogenic phase) with a thin radiolucent peripheral halo. The characteristics of FCOD in the initial stages are similar to those of periapical lesions of inflammatory origin, which may lead to misdiagnosis. A 38-year-old woman sought dental care because of complaints of pain on the right side of her face. A clinical examination revealed no marked alterations; a panoramic radiograph was therefore requested and revealed the presence of radiolucent lesions associated with the periapical regions of some of the lower teeth. Thus, the professional referred the patient for endodontic treatment of the associated teeth with the justification that the lesions were of endodontic origin. However, the endodontist found that the teeth responded positively to a sensitivity test. The initial diagnosis could have resulted in unnecessary root canal treatment, but after careful clinical, radiographic, and tomographic assessments by different professionals, FCOD was diagnosed, conservatively treated, and regularly monitored. It is important that dentists have a basic knowledge of the various injuries that affect the jaw bones to prevent errors in diagnosis and treatment and to promote oral health. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Influence of cone beam CT enhancement filters on diagnosis ability of longitudinal root fractures

PubMed Central

Nascimento, M C C; Nejaim, Y; de Almeida, S M; Bóscolo, F N; Haiter-Neto, F; Sobrinho, L C

2014-01-01

Objectives: To determine whether cone beam CT (CBCT) enhancement filters influence the diagnosis of longitudinal root fractures. Methods: 40 extracted human posterior teeth were endodontically prepared, and fractures with no separation of fragments were made in 20 teeth of this sample. The teeth were placed in a dry mandible and scanned using a Classic i-CAT® CBCT device (Imaging Sciences International, Inc., Hatfield, PA). Evaluations were performed with and without CBCT filters (Sharpen Mild, Sharpen Super Mild, S9, Sharpen, Sharpen 3 × 3, Angio Sharpen Medium 5 × 5, Angio Sharpen High 5 × 5 and Shadow 3 × 3) by three oral radiologists. Inter- and intraobserver agreement was calculated by the kappa test. Accuracy, sensitivity, specificity and positive and negative predictive values were determined. McNemar test was applied for agreement between all images vs the gold standard and original images vs images with filters (p < 0.05). Results: Means of intraobserver agreement ranged from good to excellent. Angio Sharpen Medium 5 × 5 filter obtained the highest positive predictive value (80.0%) and specificity value (76.5%). Angio Sharpen High 5 × 5 filter obtained the highest sensitivity (78.9%) and accuracy (77.5%) value. Negative predictive value was the highest (82.9%) for S9 filter. The McNemar test showed no statistically significant differences between images with and without CBCT filters (p > 0.05). Conclusions: Although no statistical differences was observed in the diagnosis of root fractures when using filters, these filters seem to improve diagnostic capacity for longitudinal root fractures. Further in vitro studies with endodontic-treated teeth and research in vivo should be considered. PMID:24408819

The antimicrobial effectiveness of 25% propolis extract in root canal irrigation of primary teeth.

PubMed

Verma, Manjesh Kumar; Pandey, Ramesh Kumar; Khanna, Richa; Agarwal, Jyotsna

2014-01-01

The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. STAISTISTICAL ANALYSIS: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post) in bacterial colony counts of groups in the study. Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

A nonsurgical endodontic treatment in open-apex and immature teeth affected by dens invaginatus: using a collagen membrane as an apical barrier.

PubMed

Gharechahi, Maryam; Ghoddusi, Jamileh

2012-02-01

The authors' objective in this case report is to demonstrate an effective nonsurgical endodontic treatment in open-apex teeth affected by dens invaginatus (DI) by using a collagen membrane as an apical barrier and using a mineral trioxide aggregate (MTA) apical plug. . The authors present two cases of DI with open apexes in maxillary lateral incisors. In the first case, an adolescent had bilateral Oehlers type II DI and extensive periradicular radiolucency, internal root resorption and a vestibular fistula in the left maxillary lateral incisor. In the second case, an adult had Oehlers type II DI and an incomplete apex in the left maxillary lateral incisor. For both patients, the clinician placed a collagen membrane through the apexes of the left maxillary incisors to provide a resorbable extraradicular barrier against which MTA cement could be packed. The clinician obturated the adolescent's right lateral incisor. In the adolescent, the vestibular sinus tract was closed after one week. At subsequent follow-up examinations, the periradicular regions were completely healed, and postoperative radiographs revealed good bone healing in the lateral incisors. The teeth were asymptomatic and healing was achieved without any need for further endodontic surgical intervention. In the adult patient, the tooth was symptom free after one week, and radiography performed six months after the procedure showed complete healing. and Despite complex anatomy and diagnoses of DI and open apexes, both patients successfully underwent nonsurgical endodontic treatment involving the use of a collagen membrane and an MTA apical plug. Using an extraradicular barrier clinically can help improve the adaptation of MTA in the apexes of open-apex teeth to achieve a complete seal.

Pulp regeneration concepts for non-vital teeth: from tissue engineering to clinical approaches.

PubMed

Orti, Valérie; Collart-Dutilleul, Pierre-Yves; Piglionico, Sofía Silvia; Pall, Orsolya; Cuisinier, Frédéric; Panayotov, Ivan Vladislavov

2018-05-04

Following the basis of tissue engineering (Cells - Scaffold - Bioactive molecules), regenerative endodontic has emerged as a new concept of dental treatment. Clinical procedures have been proposed by endodontic practitioners willing to promote regenerative therapy. Preserving pulp vitality was a first approach. Later procedures aimed to regenerate a vascularized pulp in necrotic root canals. However, there is still no protocol allowing an effective regeneration of necrotic pulp tissue either in immature or mature teeth. This review explore in vitro and preclinical concepts developed during the last decade, especially the potential use of stem cells, bioactive molecules and scaffolds, and makes a comparison with the goals achieved so far in clinical practice. Regeneration of pulp-like tissue has been shown in various experimental conditions. However, the appropriate techniques are currently in a developmental stage. The ideal combination of scaffolds and growth factors to obtain a complete regeneration of the pulp-dentin complex is still unknown. The use of stem cells, especially from pulp origin, sounds promising for pulp regeneration therapy, but it has not been applied so far for clinical endodontics, in case of necrotic teeth. The gap observed between the hope raised from in vitro experiments and the reality of endodontic treatments suggests that clinical success may be achieved without external stem cell application. Therefore, procedures using the concept of cell homing, through evoked bleeding, that permit to recreate a living tissue that mimics the original pulp have been proposed. Perspectives for pulp tissue engineering in a near future include a better control of clinical parameters and pragmatic approach of the experimental results (autologous stem cells from cell homing, controlled release of growth factors). In the coming years, this therapeutic strategy will probably become a clinical reality, even for mature necrotic teeth.

Endodontic management of C-shaped root canal system of mandibular first molar by using a modified technique of self-adjusting file system.

PubMed

Helvacioglu-Yigit, Dilek

2015-01-01

C-shaped canal system is a seldom-found root canal anatomy which displays a challenge in all stages of endodontic treatment. According to the literature, this type of canal morphology is not a common finding in the mandibular first molar teeth. This case report presents endodontic management of a mandibular first molar with a C-shaped canal system. Root canal system was cleaned and shaped by nickel-titanium (NiTi) rotary instruments combined with self-adjusting file (SAF). Obturation was performed using warm, vertical condensation combined with the injection of warm gutta-percha. Follow-up examination 12 months later showed that the tooth was asymptomatic. The radiological findings presented no signs of periapical pathology. The clinician must be aware of the occurence and complexity of C-shaped canals in mandibular first molar teeth to perform a successful root canal treatment. The supplementary use of SAF after application of rotary instruments in C-shaped root canals might be a promising approach in endodontic treatment of this type of canal morphology.

The failures of root canal preparation with hand ProTaper.

PubMed

Bătăiosu, Marilena; Diaconu, Oana; Moraru, Iren; Dăguci, C; Tuculină, Mihaela; Dăguci, Luminiţa; Gheorghiţă, Lelia

2012-07-01

The failures of root canal preparation are due to some anatomical deviation (canal in "C" or "S") and some technique errors. The technique errors are usually present in canal root cleansing and shaping stage and are the result of endodontic treatment objectives deviation. Our study was made on technique errors while preparing the canal roots with hand ProTaper. Our study was made "in vitro" on 84 extracted teeth (molars, premolars, incisors and canines). The canal root of these teeth were cleansed and shaped with hand ProTaper by crown-down technique and canal irrigation with NaOCl(2,5%). The dental preparation control was made by X-ray. During canal root preparation some failures were observed like: canal root overinstrumentation, zipping and stripping phenomenon, discarded and/or fractured instruments. Hand ProTaper represents a revolutionary progress of endodontic treatment, but a deviation from accepted rules of canal root instrumentation can lead to failures of endodontic treatment.

Comparison of endotoxin levels found in primary and secondary endodontic infections.

PubMed

Gomes, Brenda P F A; Endo, Marcos S; Martinho, Frederico C

2012-08-01

This clinical study was conducted to compare the levels of endotoxins (lipopolysaccharides [LPSs]) found in primary and secondary endodontic infections with apical periodontitis by correlating LPS contents with clinical/radiographic findings. In addition, the presence of target gram-negative anaerobic bacteria was also investigated. Samples were taken from 15 root canals with primary infections and 15 with secondary infections by using paper points. The limulus amebocyte lysate assay was used to quantify endotoxins, and the polymerase chain reaction technique (16S rDNA) was used for bacterial investigation. Endotoxins were detected in 100% of the root canal samples collected from primary (15/15) and secondary (15/15) infections with median values of 7.49 EU/mL and 3.96 EU/mL, respectively (P < .05). The median value of endotoxins found in the presence of clinical symptoms was significantly higher than in asymptomatic teeth with primary infections (P < .05). A positive correlation was found between endotoxin contents and a larger size of the radiolucent area (>3 mm) (P < .05). Prevotella nigrescens (10/15, 4/15), Fusobacterium nucleatum (5/15, 1/15), Treponema denticola (3/15, 1/15), and Treponema socranskii (5/15, 1/15) were detected in teeth with primary and secondary infections, respectively. P. endodontalis was present only in teeth with primary infections (5/15). Teeth with primary endodontic infections had higher contents of endotoxins and a more complex gram-negative bacterial community than teeth with secondary infections. Moreover, the levels of endotoxins were related to the severity of bone destruction in periapical tissues as well as the development of clinical features in teeth with primary infections. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of Debridement Techniques for Endodontic Instruments

DTIC Science & Technology

1976-08-20

were used to instrument canals on extracted teeth. The instrumentation was per- formed first in wet canals irrigated with 2.5% sodium hypochlorite ...Cstf3 everse OFd neeO a 1 d IIeif by locLETEa WE~~ CLJANIATO OF TH)S PAITIE OFh~ Iat NOVnteSred) EVALUATION OF DEBRIDEMENT TECHNIQUES FOR ENDODONTIC ...INSTRUMENTS *RONALD 0. SEGALL, DMD **CARLOS E. del RIO, DDS ***JOHN M. BRADY, DDS, MSPH ****WILLIAM A. AYER, DDS, PhD :f*MAJ, DC Endodontic Resident, US

Abstracts of Research Project Reports by Naval Dental Clinic First- and Second-Year Residents - June 1983.

DTIC Science & Technology

1983-12-01

The teeth were boiled in water and soaked in a 5.25-percent solution of sodium hypochlorite to clean the root surfaces of any soft tissue and debris...UOSBATR- BOWED DENTAL INVESTMNT 6 Z.T. Nelar CONTENTS (cmt’d) Abstract pase NO. 13. CLINICAL AND HISTOLOGIC EVALUATION OF EXTRUDED ENDODONTICALLY THUR M...AN IN VITRO EVALUATION OF PERFLUOROCTYLBRONIDE AS AN ENDODONTIC - IRRIGATING SOLUTION IN ENDODONTIC TREATMENT J. D. Allemang Perfluoroctylbromide (POD

Endodontic treatment of a fused tooth. Report of a case.

PubMed

Gallottini, L; Barbato Bellatini, R C; Migliau, G

2007-01-01

Dental fusion, a rare developmental anomaly present in 0.2% of the general population, consists of the union of two teeth originating from two different tooth germs. The irregular coronal morphology and the complex endodontic anatomy, characterized by the partial or total union of the pulp chambers, together with the peculiarity of the root canal systems, make diagnosis, therapy and rehabilitation difficult. The authors describe the endodontic treatment of a permanent lower second molar fused with a third molar and having four root canals.

Mandibular molar with five root canals.

PubMed

Barletta, Fernando Branco; Dotto, Sidney Ricardo; Reis, Magda de Sousa; Ferreira, Ronise; Travassos, Rosana Maria Coelho

2008-12-01

The purpose of this study was to demonstrate the importance of knowledge of the internal anatomy of root canals for the success of endodontic treatment. Lack of knowledge of anatomic variations and their characteristics in different teeth has been pointed out as one of the main causes of endodontic therapy failure. In this report, the authors describe the endodontic treatment of a mandibular first molar with five root canals, evaluate the rate of occurrence of this number of canals, and discuss the importance of their identification and treatment.

Volumetric Evaluation of Different Obturation Techniques in Primary Teeth Using Spiral Computed Tomography.

PubMed

Nagaveni, N B; Yadav, Sneha; Poornima, P; Reddy, Vv Subba; Roshan, N M

Various obturation techniques have been evaluated for better filling of the root canals in primary teeth using different methods. Spiral Computed Tomography (SCT) is a new revolution in the pediatric endodontics for assessment of quality of the obturation from 3 dimensions. To evaluate the efficiency of 5 different obturation methods in delivering the filling material into the canals of primary teeth using Spiral Computed Tomography scan. A total of 50 canals of primary teeth were prepared, divided into 5 groups with 10 canals in each group and obturated with Zinc Oxide Eugenol cement using 5 different obturation techniques such as Local anesthetic syringe, Tuberculin syringe, Endodontic plugger, hand held Lentulo-spiral, and Lentulo-spiral mounted on slow speed hand piece. The pre and post obturation volume and finally the Percentage of Obturated Volume (POV) were calculated using SCT scan for each group. The data obtained was statistically analyzed using One-way Analysis of Variance (ANOVA) and Tukey's post-hoc test. Lentulo-spiral hand held showed highest POV value followed by Lentulospiral mounted to hand piece, Tuberculin syringe and Endodontic plugger; whereas Anesthetic syringe had least POV (P < 0.05). Lentulo-spiral hand held is the best obturating technique among the 5 groups evaluated as the canals of this group showed maximum percentage of filled material. However, a further study with large sample size is highly essential.

Relationship of intracanal medicaments to endodontic flare-ups.

PubMed

Trope, M

1990-10-01

The purpose of the study was to compare the effect of three intracanal medicaments on the incidence of post-instrumentation flare-ups. All teeth were instrumented to a predetermined minimum size using a 0.5% solution of sodium hypochlorite as the irrigant. Formocresol, Ledermix, and calcium hydroxide were placed in strict sequence irrespective of the presence or absence of symptoms or radiographic signs of apical periodontitis. The patients were given written post-operative instructions and a prescription for 600 mg ibuprofen to be taken if mild to moderate pain developed. If severe pain and/or swelling developed the patient was instructed to call the office immediately and was considered to have had a flare-up. Twelve flare-ups occurred in teeth with radiographic signs of apical periodontitis; none in teeth without periapical radiolucencies. Six of the twelve flare-ups occurred in retreatment cases and the other six occurred in teeth without previous endodontic treatment. No significant difference was found in the flare-up rate among the three intracanal medicaments.

Matrix metalloproteinase-8 and substance P levels in gingival crevicular fluid during endodontic treatment of painful, nonvital teeth.

PubMed

Shin, Su-Jung; Lee, Woocheol; Lee, Jae-Il; Baek, Seung-Ho; Kum, Kee-Yeon; Shon, Won-Jun; Bae, Kwang-Shik

2011-10-01

The aim of this study was to investigate levels of matrix metalloproteinase-8 (MMP-8) and substance P (SP) in gingival crevicular fluid (GCF) during root canal treatment (RCT) of nonvital teeth. Patients scheduled for nonsurgical RCT were prospectively selected; all patients provided informed consent. GCF samples were collected from teeth scheduled for RCT and their contralateral teeth across 3 different time periods. MMP-8 and SP levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a mixed model analysis and the Pearson correlation analysis. Patients' subjective pain levels were significantly related to both MMP-8 and SP levels. MMP-8 and SP levels in GCF were decreased during RCT, and they showed a positive correlation with each other (P < .05). This study demonstrated that periradicular inflammation of endodontic origin can elevate SP and MMP-8 levels in GCF. Copyright © 2011 Mosby, Inc. All rights reserved.

Efficacy of intraosseous injections of anesthetic in children and adolescents.

PubMed

Sixou, Jean-Louis; Barbosa-Rogier, Maria Elizena

2008-08-01

The goal of this study was to determine the efficacy of the intraosseous (IO) injections of anesthetic as a primary technique in children and adolescents. A cohort of 181 children and adolescents underwent a total of 225 sessions of IO injections of 4% articaine with 1:200,000 epinephrine using the Quick Sleeper 2 system. Evaluations could be performed in 215 sessions (171 patients, 247 teeth), yielding success rates of 91.2% (sessions) and 91.9% (teeth). The success rate was 95% (133 of 140) for temporary teeth (endodontics 96.6%, restorations 100%, extractions 88%) and 87.9% (94 of 107) for permanent teeth (endodontics 92.3%, restorations 89.9%, extractions 75%). No difference was noted in terms of age (P > .05). No cases of biting of mucosa or postinjection pain were noted. The IO injection of anesthetic using a computer-controlled osseous perforation and delivery system can be considered as a good alternative or supplement to classic infiltration techniques in children and adolescents.

Interdisciplinary Full Mouth Rehabilitation of a Patient with Amelogenesis Imperfecta: A Case Report with 8 Years Follow-up

PubMed Central

Sreedevi, S; Sanjeev, R; Ephraim, Rena; Joseph, Mathai

2014-01-01

This case report deals with the interdisciplinary approach of a 28-year-old lady with Amelogenesis imperfecta of the hypoplastic kind. The patient came with a chief illness of worn out teeth, unsatisfactory esthetics and severe sensitivity of teeth. Her family history revealed a related situation in her father’s brother and her sister. On clinical assessment, the crowns of all teeth were worn out. The plan of the treatment was to protect as much tooth structure, restore the vertical dimension, and improve esthetics and masticatory function. The treatment procedures involved prosthodontic, endodontic, and periodontic interventions. After recording the vertical height, endodontic treatment and crown lengthening were performed with respect to the lower anteriors. The lost vertical height was regained in stages by insertion of full coverage crowns for all the teeth. The patient’s esthetic and functional needs were met with systematic and sequential interdisciplinary treatment approach. PMID:25628493

A Novel Treatment Decision Tree and Literature Review of Retrograde Peri-Implantitis.

PubMed

Sarmast, Nima D; Wang, Howard H; Soldatos, Nikolaos K; Angelov, Nikola; Dorn, Samuel; Yukna, Raymond; Iacono, Vincent J

2016-12-01

Although retrograde peri-implantitis (RPI) is not a common sequela of dental implant surgery, its prevalence has been reported in the literature to be 0.26%. Incidence of RPI is reported to increase to 7.8% when teeth adjacent to the implant site have a previous history of root canal therapy, and it is correlated with distance between implant and adjacent tooth and/or with time from endodontic treatment of adjacent tooth to implant placement. Minimum 2 mm space between implant and adjacent tooth is needed to decrease incidence of apical RPI, with minimum 4 weeks between completion of endodontic treatment and actual implant placement. The purpose of this study is to compile all available treatment modalities and to provide a decision tree as a general guide for clinicians to aid in diagnosis and treatment of RPI. Literature search was performed for articles published in English on the topic of RPI. Articles selected were case reports with study populations ranging from 1 to 32 patients. Any case report or clinical trial that attempted to treat or rescue an implant diagnosed with RPI was included. Predominant diagnostic presentation of a lesion was presence of sinus tract at buccal or facial abscess of apical portion of implant, and subsequent periapical radiographs taken demonstrated a radiolucent lesion. On the basis of case reports analyzed, RPI was diagnosed between 1 week and 4 years after implant placement. Twelve of 20 studies reported that RPI lesions were diagnosed within 6 months after implant placement. A step-by-step decision tree is provided to allow clinicians to triage and properly manage cases of RPI on the basis of recommendations and successful treatments provided in analyzed case reports. It is divided between symptomatic and asymptomatic implants and adjacent teeth with vital and necrotic pulps. Most common etiology of apical RPI is endodontic infection from neighboring teeth, which was diagnosed within 6 months after implant placement. Most common findings, radiographically and clinically, are lesions around implant apex and sinus tract. A small number of implants did not improve with treatment. Decision tree provides a path to diagnose and treat lesions to facilitate their management. Further studies are needed to focus on histologic data around periapical microbiota to establish specific etiology and differential diagnoses compared with marginal peri-implantitis and other implant-related conditions.

Surgical management of vertical root fractures for posterior teeth: report of four cases.

PubMed

Floratos, Spyros G; Kratchman, Samuel I

2012-04-01

The objective of this article was to present a surgical treatment option for teeth with incomplete vertical root fracture in maxillary and mandibular posterior teeth. Four cases are presented in which 1 endodontically treated maxillary or mandibular molar had an incomplete vertical root fracture involving 1 of the roots. The tooth underwent a flap elevation procedure to visualize the pattern of bone loss and assess the extent of root fracture. The fracture line was eliminated by resecting the root in a beveled manner, after which root-end preparation and root-end filling were performed by using mineral trioxide aggregate. The osteotomy was covered with an absorbable collagen membrane. Cases were followed up for 8-24 months after surgery. The procedure was shown to be predictable and successful in this series. Root length was preserved, and tooth extraction was avoided. The microsurgical treatment option for multirooted teeth with incomplete vertical root fracture resulted in long-term clinical success. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[Root canal treatment of mandibular first premolar with 4 root canals: a case report].

PubMed

Liu, Xin-yang; Zhan, Fu-Liang

2015-10-01

The mandibular first premolar can be considered one of the most challenging teeth to treat, due to the complexity of its root canal morphology and increased incidence of multiple canals. A case of endodontic treatment of a mandibular first premolar exhibiting a total of 4 distinct root canals and 4 apical foramina was described. Anatomic variation of root canal morphology should be considered in endodontic treatment to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation might allow the flow of sealer into the narrowed but unprepared part of the canal, thereby facilitating optimum chemo-mechanical debridement of the root canal system.

Post-instrumentation pain after the use of either Mtwo or the SAF system: a randomized controlled clinical trial.

PubMed

Saumya-Rajesh, P; Krithikadatta, J; Velmurugan, N; Sooriaprakas, C

2017-08-01

This randomized controlled trial compared the incidence of post-instrumentation pain associated with Mtwo rotary NiTi files and the self-adjusting file system following canal shaping and cleaning. Following sample size estimation, a total of 130 patients were randomized into two groups based on selection criteria [group Mtwo and group SAF (self-adjusting file)]. Root canal treatment was carried out in two appointments. The teeth were endodontically treated with the appropriate allotted systems following the similar clinical parameters. Patients were asked to rate the intensity of pre-instrumentation and post-instrumentation pain (at 2, 4, 6, 8, 24, 48 h) using the VAS score. The Kruskal-Wallis test was carried out for the overall comparisons of the two systems. The Friedman test was used to compare between time-points with each system. Subgroup analyses for independent variables (gender, pulp status and diagnosis) used the Mann-Whitney test and Wilcoxon signed ranks test (P < 0.05). No significant difference was found between the two groups with respect to post-instrumentation pain. Teeth with pulpal necrosis had significant pain at 8 h compared with teeth with vital pulps (P = 0.04). Teeth with vital pulps in the SAF group had significantly less post-instrumentation pain compared with those in the Mtwo group at 6 h (P = 0.042). Patients who had teeth with nonvital pulps in the SAF group experienced more post-instrumentation pain at 8 h (P = 0.017) and 24 h (P = 0.005). The incidence of post-instrumentation pain at different time intervals in patients undergoing root canal treatment was similar for both the self-adjusting file and Mtwo file systems. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Single Versus Multi-visit Endodontic Treatment of Teeth with Apical Periodontitis: An in vivo Study with 1-year Evaluation

PubMed Central

Gill, GS; Bhuyan, AC; Kalita, C; Das, L; Kataki, R; Bhuyan, D

2016-01-01

Background: Apical periodontitis (AP) is one of the most prevalent diseases of the teeth. Treatment of AP is based on the removal of the cause, i.e., bacteria from the root canals. Achievement of adequate bacterial eradication in one appointment treatment remains a controversy. Aim: This prospective study was conducted with the objective to compare the periapical healing of teeth with AP treated in (a) single visit versus (b) two visits, either with or without Vitapex as an intracanal medicament. Subjects and Methods: Patients were selected randomly from the Department of Conservative Dentistry and Endodontics. Forty-three patients (81 teeth) met the inclusion criteria, i.e., AP (both symptomatic and asymptomatic) visible radiographically size ≥2 mm × 2 mm, not suffering from any immune-compromising disease, age between 16 and 65 years and tooth not accessed previously. Patients were randomly divided into three groups, i.e., single-visit group (Group 1), multi-visit group without any intracanal medicament (Group 2), and multi-visit group with Vitapex as interim intracanal medicament (Group 3). Comparison was done radiographically using periapical index (PAI). The primary outcome measure was the change in periapical radiolucency after 1 year assessed by PAI scores. The Mann-Whitney U-test was used to evaluate differences between groups at baseline (immediate postoperative) and at the 12-month follow-up evaluation. Change in PAI score for each group from baseline to 12-month follow-up evaluation was tested with the Wilcoxon signed rank test. The secondary outcome measures, proportion of teeth in each group that could be considered improved (decreased PAI score) or healed (PAI <2), were assessed with the Chi-square test. Results: No statistically significant difference in periapical healing was found between three groups. Conclusion: After 1-year evaluation, no difference in periapical healing was found between single-visit treatment and multi-visit treatment groups with the given sample size. PMID:27144072

Single Versus Multi-visit Endodontic Treatment of Teeth with Apical Periodontitis: An in vivo Study with 1-year Evaluation.

PubMed

Gill, G S; Bhuyan, A C; Kalita, C; Das, L; Kataki, R; Bhuyan, D

2016-01-01

Apical periodontitis (AP) is one of the most prevalent diseases of the teeth. Treatment of AP is based on the removal of the cause, i.e., bacteria from the root canals. Achievement of adequate bacterial eradication in one appointment treatment remains a controversy. This prospective study was conducted with the objective to compare the periapical healing of teeth with AP treated in (a) single visit versus (b) two visits, either with or without Vitapex as an intracanal medicament. Patients were selected randomly from the Department of Conservative Dentistry and Endodontics. Forty-three patients (81 teeth) met the inclusion criteria, i.e., AP (both symptomatic and asymptomatic) visible radiographically size ≥2 mm × 2 mm, not suffering from any immune-compromising disease, age between 16 and 65 years and tooth not accessed previously. Patients were randomly divided into three groups, i.e., single-visit group (Group 1), multi-visit group without any intracanal medicament (Group 2), and multi-visit group with Vitapex as interim intracanal medicament (Group 3). Comparison was done radiographically using periapical index (PAI). The primary outcome measure was the change in periapical radiolucency after 1 year assessed by PAI scores. The Mann-Whitney U-test was used to evaluate differences between groups at baseline (immediate postoperative) and at the 12-month follow-up evaluation. Change in PAI score for each group from baseline to 12-month follow-up evaluation was tested with the Wilcoxon signed rank test. The secondary outcome measures, proportion of teeth in each group that could be considered improved (decreased PAI score) or healed (PAI <2), were assessed with the Chi-square test. No statistically significant difference in periapical healing was found between three groups. After 1-year evaluation, no difference in periapical healing was found between single-visit treatment and multi-visit treatment groups with the given sample size.

Endodontic treatment of a maxillary second molar with developmental anomaly: a case report.

PubMed

Asgary, Saeed

2007-01-01

Fusion is a rare occurrence in molar teeth. The purpose of this rare case presentation is to describe the nonsurgical endodontic treatment of maxillary molar. A 28-year-old patient was referred for endodontic treatment of her chronic apical abscess of right maxillary second molar. In the clinical examination, a sinus tract adjacent to involved tooth and a small crown of supernumerary tooth fused to the buccal surface of the molar at gingival margin was observed. Endodontic treatment was decided for the involved molar for functional reason. Recall examination, a year after completion of endodontic and restorative treatments, showed the tooth was clinically asymptomatic and there was no radiographic lucency around the apical region.

Dental Pulp Revascularization of Necrotic Permanent Teeth with Immature Apices.

PubMed

El Ashiry, Eman A; Farsi, Najat M; Abuzeid, Sawsan T; El Ashiry, Mohamed M; Bahammam, Hammam A

The treatment of immature necrotic teeth with apical periodontitis presents challenges in endodontic and pediatric dentistry. Revascularization is a recent treatment for such cases as an alternative to conventional apexification. The purpose is to examine the effect of a pulpal revascularization procedure on immature necrotic teeth with apical periodontitis. Twenty patients were enrolled for pulp revascularization procedure by root canal disinfection using a triple antibiotic mixture for 1-2 weeks, followed by creating a blood clot, sealing the root canal orifice using white mineral trioxide aggregate and a coronal seal of composite resin. Patients were recalled periodically for up to 24 months. During follow-up, all patients were asymptomatic. Three cases of chronic apical periodontitis showed clinical disappearance of the sinus tract 2 weeks after treatment. Radiography revealed progressive periapical radiolucency resolution within the first 12 months. Within 12-24 months, the treated teeth showed progressive increases in dentinal wall thickness, root length and continued root development. Clinical and radiographic evidence showed successful revascularization treatments of immature necrotic permanent teeth with apical periodontitis. More studies are necessary to understand the underlying mechanisms and to perform histopathology of the pulp space contents after revascularization procedures.

Post and core build-ups in crown and bridge abutments: Bio-mechanical advantages and disadvantages.

PubMed

Mamoun, John

2017-06-01

Dentists often place post and core buildups on endodontically treated abutments for crown and bridge restorations. This article analyzes the bio-mechanical purposes, advantages and disadvantages of placing a core or a post and core in an endodontically treated tooth and reviews literature on post and core biomechanics. The author assesses the scientific rationale of the claim that the main purpose of a post is to retain a core, or the claim that posts weaken teeth. More likely, the main function of a post is to help prevent the abutment, on which a crown is cemented, from fracturing such that the abutment separates from the tooth root, at a fracture plane that is located approximately and theoretically at the level of the crown (or ferrule) margin. A post essentially improves the ferrule effect that is provided by the partial fixed denture prosthesis. This paper also explores the difference between bio-mechanical failures of crowns caused by lack of retention or excess taper, versus failures due to a sub-optimal ferrule effect in crown and bridge prostheses.

Regenerative endodontics--biologically-based treatment for immature permanent teeth: a case report and review of the literature.

PubMed

Thomson, A; Kahler, B

2010-12-01

A paradigm shift in the treatment of immature, necrotic teeth has occurred with biologically-based principles and regenerative endodontic protocols replacing traditional 'apexification' procedures. Preliminary research suggests that stem and progenitor cells from the pulp and/or periodontium contribute to continued root development when regenerative procedures are followed. A mandibular premolar tooth with a chronic periapical abscess was irrigated with sodium hypochlorite with minimal instrumentation and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was evoked in the canal by irritating periapical tissues and the canal sealed with mineral trioxide aggregate, glass ionomer cement and composite resin. Resolution of apical periodontitis and the draining sinus, continued root maturation and apical closure occurred over an 18-month period. The tooth became responsive to pulp sensibility testing. It is important that dentists recognize the potential of regenerative endodontics in the treatment of necrotic, immature teeth. Initial management should involve irrigation with sodium hypochlorite only. Intra-canal medicaments, such as calcium hydroxide, are contraindicated as they inhibit further root growth. This report uses a variation of the tri-antibiotic paste currently recommended for regenerative procedures that avoided the discolouration of the crown associated with current protocols. Regenerative endodontics with continued root growth may reduce the risk of fracture and premature tooth loss associated with traditional 'apexification' procedures where the root remains thin and weak. © 2010 Australian Dental Association.

Calcium-enriched mixture cement as artificial apical barrier: A case series

PubMed Central

Nosrat, Ali; Asgary, Saeed; Eghbal, Mohammad Jafar; Ghoddusi, Jamileh; Bayat-Movahed, Saeed

2011-01-01

In comparison to the conventional apexification using calcium hydroxide, artificial apical barrier technique is more valuable and less time consuming. This article describes successful use of calcium-enriched mixture (CEM) cement as an artificial apical barrier in open apices. In this study, 13 single-rooted teeth with necrotic pulps and open apices were treated non-surgically. After copious irrigation of the root canals with NaOCl 5.25% and gentle filing, based on need for interappointment dressing, treatments were followed by CEM cement (BioniqueDent, Tehran, Iran) apical plug insertion in the first or second appointment. All cases were then permanently restored. All subjects were followed until radiographic evidence of periradicular healing was seen (mean 14.5 months). Clinically, all cases were functional and asymptomatic and complete osseous healing was observed in all the teeth. Considering the biological properties of CEM cement, this new endodontic biomaterial might be appropriate to be used as artificial apical barrier in the open apex teeth. PMID:22144818

Microbial profile of root canals of primary teeth with pulp necrosis and periradicular lesion.

PubMed

Triches, Thaisa Cezária; de Figueiredo, Luciene Cristina; Feres, Magda; de Freitas, Sérgio Fernando Torres; Zimmermann, Gláucia Santos; Cordeiro, Mabel Mariela Rodríguez

2014-01-01

The purpose of this study was to assess the microbial content of root canals of human primary teeth with pulp necrosis and periradicular lesion. Microbial samples were collected from 24 canals of children treated at a pediatric dentistry clinic. Microbiological identification was performed using checker-board DNA-DNA hybridization for 40 different bacteria. Data were analyzed per canal based on the mean count and frequency of each bacterial species. Detectable levels of bacterial species were observed for 35 probes (88%). The most frequent bacteria were Fusobacterium nucleatum sp. nucleatum, Fusobacterium periodonticum, Prevotella melaninogenica, Prevotella nigrescens, and Prevotella intermedia. Facultative species were identified in 20 root canals (83%), anaerobic species were identified in 24 root canals (100%), and aerobic species in 18 root canals (75%). Black-pigmented bacilli were found in 23 samples (96%). The number of different bacterial species detected per canal ranged from five to 33. Endodontic infection in primary teeth with pulp necrosis and periradicular lesion is multimicrobial, including aerobic, facultative, and anaerobic micro-organisms.

Endodontic retreatment: clinical comparison of reciprocating systems versus rotary system in disinfecting root canals.

PubMed

Martinho, Frederico C; Freitas, Lilian F; Nascimento, Gustavo G; Fernandes, Aleteia M; Leite, Fabio R M; Gomes, Ana P M; Camões, Izabel C G

2015-07-01

This clinical study was conducted to compare the effectiveness of single-file reciprocating systems and rotary systems in removing endotoxins and cultivable bacteria in endodontic retreatment. Thirty endodontically treated teeth with post-treatment apical periodontitis were selected. The specimens were divided into three groups according to the system used: WaveOne (n = 10), Reciproc instrument (n = 10), and ProTaper Universal Retreatment system (n = 10). Samples were collected before and after chemomechanical preparation. The irrigation was performed by using 2.5% sodium hypochlorite. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial colony-forming unit counts. At baseline, endotoxins and cultivable bacteria were recovered from 100% of the root canal samples in a median value of 5.84 EU/mL and 4.98 × 10(3) CFU/mL, respectively. After CMP, no differences were found in the median percentage values of endotoxin reduction achieved with reciprocating systems-WaveOne [94.11%] and Reciproc [93.29%] and with rotary systems-ProTaper [94.98%] (P > 0.05). Both single-file reciprocating systems [WaveOne (98.27%) and Reciproc (99.54%)] and rotary system [ProTaper (98.73%)] were effective in reducing bacterial load (P > 0.05). Moreover, no differences were found among the systems tested. The Reciproc and WaveOne reciprocating systems were as effective as the ProTaper system for removal of endotoxins and bacteria in endodontic retreatment. All systems tested were effective to remove cultivable bacteria and endotoxin in endodontic retreatment. As no differences among systems were observed, it is possible to suggest that clinicians should choose the preferred technique to perform endodontic.

Iatrogenic Errors during Root Canal Instrumentation Performed by Dental Students

PubMed Central

Hendi, Seyedeh Sareh; Karkehabadi, Hamed; Eskandarloo, Amir

2018-01-01

Introduction: The present study was set to investigate the training quality and its association with the quality of root canal therapy performed by fifth year dentistry students. Methods and Materials: A total number of 432 records of endodontic treatment performed by fifth year dentistry students were qualified to be further investigated. Radiographs were assessed by two independent endodontists. Apical transportation, apical perforation, gouging, ledge formation, and the quality of temporary restoration were error types investigated in the present study. Results: the prevalence of apical transportation, ledge formation, and apical perforation errors were significantly higher in molars in comparison with other types of teeth. The most prevalent type of error was the apical transportation, which was significantly higher in mandibular teeth. There was no significant differences among teeth in terms of other types of errors. Conclusion: The quality of training provided for dentistry students should be improved and endodontic curriculum should be modified. PMID:29692848

Interpretation of Endodontic File Length Adjustments Using Radiovisiography

DTIC Science & Technology

1993-01-01

periapical tissues would cause apical granulomas, and sometimes epithelial proliferation leading to cyst formation. They believed that better results...RVG) images. Comparisons were made between RVG images and conventional periapical radiographs. Maxillary and mandibular human cadaver sections with a...Biologic aspects of endodontics IV. Periapical tissue reactions to root-filled teeth whose canals had been instrumented short of their apices. Oral

Comparison of an adaptive local thresholding method on CBCT and µCT endodontic images

NASA Astrophysics Data System (ADS)

Michetti, Jérôme; Basarab, Adrian; Diemer, Franck; Kouame, Denis

2018-01-01

Root canal segmentation on cone beam computed tomography (CBCT) images is difficult because of the noise level, resolution limitations, beam hardening and dental morphological variations. An image processing framework, based on an adaptive local threshold method, was evaluated on CBCT images acquired on extracted teeth. A comparison with high quality segmented endodontic images on micro computed tomography (µCT) images acquired from the same teeth was carried out using a dedicated registration process. Each segmented tooth was evaluated according to volume and root canal sections through the area and the Feret’s diameter. The proposed method is shown to overcome the limitations of CBCT and to provide an automated and adaptive complete endodontic segmentation. Despite a slight underestimation (-4, 08%), the local threshold segmentation method based on edge-detection was shown to be fast and accurate. Strong correlations between CBCT and µCT segmentations were found both for the root canal area and diameter (respectively 0.98 and 0.88). Our findings suggest that combining CBCT imaging with this image processing framework may benefit experimental endodontology, teaching and could represent a first development step towards the clinical use of endodontic CBCT segmentation during pulp cavity treatment.

Photodynamic therapy versus ultrasonic irrigation: interaction with endodontic microbial biofilm, an ex vivo study.

PubMed

Muhammad, Omid H; Chevalier, Marlene; Rocca, Jean-Paul; Brulat-Bouchard, Nathalie; Medioni, Etienne

2014-06-01

Photodynamic therapy was introduced as an adjuvant to conventional chemo-mechanical debridement during endodontic treatment to overcome the persistence of biofilms. The aim of this study was to evaluate the ability of photodynamic therapy (PDT) to disrupt an experimental microbial biofilm inside the root canal in a clinically applicable working time. Thirty extracted teeth were prepared and then divided in three groups. All samples were infected with an artificially formed biofilm made of Enterococcus faecalis, Streptococcus salivarius, Porphyromonas gingivalis and Prevotella intermedia bacteria. First group was treated with Aseptim Plus® photo-activated (LED) disinfection system, second group by a 650 nm Diode Laser and Toluidine blue as photosensitizer, and the third group, as control group, by ultrasonic irrigation (PUI) using EDTA 17% and NaOCl 2.6% solutions. The working time for all three groups was fixed at 3 min. Presence or absence of biofilm was assessed by aerobic and anaerobic cultures. There was no statistically significant difference between results obtained from groups treated by Aseptim Plus® and Diode Laser (P<0.6267). In cultures of both groups there was a maximal bacterial growth. The group that was treated by ultrasonic irrigation and NaOCl and EDTA solutions had the best results (P<0.0001): there was a statistically significant reduction of bacterial load and destruction of microbial biofilm. Under the condition of this study, Photodynamic therapy could not disrupt endodontic artificial microbial biofilm and could not inhibit bacterial growth in a clinically favorable working time. Copyright © 2014 Elsevier B.V. All rights reserved.

Postoperative pain after endodontic retreatment: single- versus two-visit treatment.

PubMed

Yoldas, Oguz; Topuz, Aysin; Isçi, A Sehnaz; Oztunc, Haluk

2004-10-01

The purpose of this clinical study was to determine the effect of 1- or 2-visit root canal treatment on the postoperative pain in the retreatment cases. Two hundred eighteen cases that required retreatment were included in the study. Obturated and unfilled canal space and the status of periapical tissues were evaluated according to the PAI index. The patients were subcategorized in regard to the presence or the absence of preoperative pain. Approximately half of each category was treated in 1 appointment. After removing the previous root canal obturation materials and biomechanic preparation of root canals, the teeth in the 1-visit group were obturated at the first appointment by using AH 26 sealer and laterally compacted gutta-percha, and those in the 2-visit group were medicated with calcium hydroxide-chlorhexidine combination and then closed with a temporary filling material. One week after the initial appointment, patients were asked about the occurrence of postoperative pain. The level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain (flare-up). Data were statistically analyzed using the chi-squared and Fischer exact tests. Eight patients from the 1-visit group and 2 patients from the 2-visit group had flare-ups. There was a statistical difference between the groups (P <.05). Two-visit root canal treatment was more effective in completely eliminating pain than 1-visit treatment of previously symptomatic teeth (P <.05). Two-visit endodontic treatment with intracanal medication was found to be effective in reducing postoperative pain of previously symptomatic teeth and decreased the number of flare-ups in all retreatment cases.

Influence of dental restorations and mastication loadings on dentine fatigue behaviour: Image-based modelling approach.

PubMed

Vukicevic, Arso M; Zelic, Ksenija; Jovicic, Gordana; Djuric, Marija; Filipovic, Nenad

2015-05-01

The aim of this study was to use Finite Element Analysis (FEA) to estimate the influence of various mastication loads and different tooth treatments (composite restoration and endodontic treatment) on dentine fatigue. The analysis of fatigue behaviour of human dentine in intact and composite restored teeth with root-canal-treatment using FEA and fatigue theory was performed. Dentine fatigue behaviour was analysed in three virtual models: intact, composite-restored and endodontically-treated tooth. Volumetric change during the polymerization of composite was modelled by thermal expansion in a heat transfer analysis. Low and high shrinkage stresses were obtained by varying the linear shrinkage of composite. Mastication forces were applied occlusally with the load of 100, 150 and 200N. Assuming one million cycles, Fatigue Failure Index (FFI) was determined using Goodman's criterion while residual fatigue lifetime assessment was performed using Paris-power law. The analysis of the Goodman diagram gave both maximal allowed crack size and maximal number of cycles for the given stress ratio. The size of cracks was measured on virtual models. For the given conditions, fatigue-failure is not likely to happen neither in the intact tooth nor in treated teeth with low shrinkage stress. In the cases of high shrinkage stress, crack length was much larger than the maximal allowed crack and failure occurred with 150 and 200N loads. The maximal allowed crack size was slightly lower in the tooth with root canal treatment which induced somewhat higher FFI than in the case of tooth with only composite restoration. Main factors that lead to dentine fatigue are levels of occlusal load and polymerization stress. However, root canal treatment has small influence on dentine fatigue. The methodology proposed in this study provides a new insight into the fatigue behaviour of teeth after dental treatments. Furthermore, it estimates maximal allowed crack size and maximal number of cycles for a specific case. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of cone beam computed tomography (CBCT) on diagnostic thinking in endodontics of posterior teeth: A before- after study.

PubMed

Al-Salehi, S K; Horner, K

2016-10-01

The aim of this study was to evaluate the impact of limited volume CBCT upon diagnosis as part of endodontic management of posterior teeth. The null hypothesis that CBCT does not make any difference in endodontic diagnosis was tested. A single-centre "before-after" study was conducted in a secondary healthcare establishment. Eligible patients were all adults aged 18 years or over who were referred to a specialist endodontic unit. Further inclusion criteria were that the cases were either re-treatment or de novo root canal treatment where the anatomy was judged to be complex. Exclusion criteria included vulnerable groups and de novo endodontic treatment with uncomplicated root canal anatomy. As well as a full history and clinical examination, a high quality colour photographic intraoral image, two paralleling technique periapical radiographs and limited volume CBCT examination were carried out for each patient. All components, except the CBCT dataset, were combined into a Powerpoint presentation and assessed by 4 observers. A questionnaire was designed for the observers as part of the study. CBCT information only changed the radiological findings and the final diagnosis in a minority of cases. There was no clear evidence that CBCT increases the confidence of observers or that CBCT was helpful in making a diagnosis. Routine use of CBCT cannot not be justified on the basis of a change in diagnosis and carefully selected use is appropriate. CBCT is being increasingly used in the field of endodontics. The benefits gained from the use of CBCT must be carefully balanced against the increased radiation dosage. Determination of selection criteria for the use of CBCT in endodontics is, therefore, essential. Copyright © 2016 Elsevier Ltd. All rights reserved.

Clinical features and endodontic treatment of two-rooted mandibular canines: report of four cases.

PubMed

Stojanac, Igor; Premović, Milica; Drobac, Milan; Ramić, Bojana; Petrović, Ljubomir

2014-01-01

Predictable endodontic treatment depends on the dentist's knowledge about root canal morphology and its possible anatomic variations. The majority of mandibular canines have one root and root canal, but 15% may have two canals and a smaller number may have two distinct roots. The following clinical reports describe endodontic treatment of mandibular canines with two roots and two root canals. OUTLINE OF CASES Four clinical case reports are presented to exemplify anatomical variation in the human mandibular canine. Detailed analysis of the preoperative radiographs and careful examination of the pulp chamber floor detected the presence of two root canal orifices in all canines. Working length was determined with an electronic apex locator and biomechanical preparation was carried out by using engine driven BioRaCe Ni-Ti rotary instruments in a crown-down manner, followed by copious irrigation with 1% sodium hypochlorite. Definitive obturation was performed using cold lateral condensation with gutta-percha cones and Top Seal paste. The treatment outcome was evaluated using postoperative radiographs. Endodontists should be aware of anatomical variations of the treated teeth, and should never presume that canal systems are simple.

Infection Related Inferior Alveolar Nerve Paresthesia in the Lower Premolar Teeth

PubMed Central

2016-01-01

Introduction. The aim of this paper was to describe two cases of IAN infection-induced paresthesia and to discuss the most appropriate treatment solutions. Methods. For two patients, periapical lesions that induced IAN paresthesia were revealed. In the first case, the tooth was previously endodontically treated, whereas in the second case the lesion was due to pulp necrosis. Results. For the first patient, a progressive healing was observed only after the tooth extraction. In the second patient, the paresthesia had resolved after endodontic treatment. Conclusions. The endodontic-related paresthesia is a rare complication that can be the result of a combination of etiopathogenic mechanisms such as mechanical pressure on the nerve fibers due to the expanding infectious process and the production of microbial toxins. Paresthesia resulting from periapical lesions usually subsides through elimination of infection by root canal treatment. However, if there are no signs of enhancement, the immediate extraction of the tooth is the treatment of choice in order to prevent irreversible paresthesia because it was demonstrated that there is a correlation between the duration of mechanical or chemical irritation and the risk of permanent paresthesia. PMID:27597904

Clinical and radiographic evaluation of zinc oxide with aloe vera as an obturating material in pulpectomy: an in vivo study.

PubMed

Khairwa, Abhishek; Bhat, Manohar; Sharma, Rajesh; Satish, V; Maganur, Prabhadevi; Goyal, Anil Kumar

2014-01-01

Pulp therapy for pulpally involved primary teeth continues to be a challenge to clinicians. One of the major areas of continued research is in the area of finding obturating materials to suit the specific properties of these teeth. Zinc oxide eugenol is used frequently in pulpectomy for the obturation of the primary teeth. To evaluate clinically and radiographically a mixture of zinc oxide eugenol and aloe vera as an obturating material. A total of 50 children, aged between 4 and 9 years, who were screened for unilateral or bilateral carious deciduous molars were studied. Out of these, 15 children were randomly selected for endodontic treatment. Obturation was done with a mixture of zinc oxide powder and aloe vera gel. Clinical and radiographic evaluation was done after 7 days, 1 month, 3 months, 6 months, and 9 months. The data were statistically analyzed. Endodontic treatment using a mixture of zinc oxide powder and aloe vera gel in primary teeth has shown good clinical and radiographic success. A detailed observational study with longer follow-up will highlight the benefits of aloe vera in primary teeth as an obturating medium.

Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.

PubMed

Nusstein, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-07-01

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.

Clinical and microbiological effectiveness of photodynamic therapy on primary endodontic infections: a 6-month randomized clinical trial.

PubMed

de Miranda, Rachel Garcia; Colombo, Ana Paula Vieira

2018-05-01

This short-term randomized controlled trial evaluated the effectiveness of photodynamic therapy (PDT) on clinical success (periapical healing) and on the microbiota of primary endodontic infections. Thirty-two patients presenting mandibular molars with apical periodontitis (one tooth/patient) were selected and randomly allocated into two therapeutic groups: control (chemo-mechanical debridement [CMD]; n = 16) and PDT (CMD + PDT; n = 16). All teeth in both groups had intracanal medication with calcium hydroxide for 7 days before final obturation. Follow-up radiographs were made at 3 and 6 months. Periapical healing was evaluated by the periapical index (PAI). Samples were obtained at baseline, after CMD with or without PDT, and just before root filling to determine the frequency and levels of 37 taxa by checkerboard. Significant decreases in PAI scores were observed in both groups over time, although at 6 months, the PDT group presented a significantly better healing score than the control (p < 0.05). At baseline, the most prevalent species in all samples were Candida albicans (46.9%), Dialister pneumosintes (31.2%), Prevotella nigrescens (28.2%), Prevotella tannerae (28.1%), and Peptostreptococcus anaerobius (25%). Most species reduced over time in both groups, and no significant differences in frequency and levels of the tested species were observed between groups in any time point evaluated. C. albicans and D. pneumosintes were still detected in high frequency in both groups at 3 months post-therapy. Conventional endodontic therapy with or without PDT is effective in reducing microbial load, resulting in periapical healing. Nevertheless, adjunctive PDT provides better periapical healing at 6-month follow-up. Teeth with apical periodontitis treated with PDT adjunct to conventional treatment would demonstrate superior healing and reduction of microorganisms.

Incidence and factors related to flare-ups in a graduate endodontic programme.

PubMed

Iqbal, M; Kurtz, E; Kohli, M

2009-02-01

To investigate the incidence and factors related to endodontic flare-ups in nonsurgical root canal treatment (NSRCT) cases completed by graduate endodontic residents at University of Pennsylvania, USA. Residents at University of Pennsylvania enter all clinical patient records into an electronic database called PennEndo database. Analysis of records of 6580 patients treated from September 2000 to July 2005 revealed a total of 26 patients with flare-ups (0.39%). Patients were categorized to have undergone flare-up when they attended for an unscheduled visit and active treatment, and when they suffered from severe pain and or swelling after initiation or continuation of NSRCT. SAS software was used to develop a logistic regression model with flare-up as a dependent variable. Independent variables included in the model were: history of previous pain, one vs. two visit NSRCT, periapical diagnosis, tooth type, rotary versus hand instrumentation, and lateral versus vertical compaction of gutta-percha. The odds for developing a flare-up in teeth with a periapical radiolucency were 9.64 times greater than teeth without a periapical radiolucency (P = 0.0090). There was no statistically significant difference in flare-ups between one and two visits NSRCT. The odds of developing a flare-up increased 40 fold when NSRCT was completed in three or more visits. However, this result may have been confounded by addition of an unscheduled visit in patients suffering from flare-ups. Other independent variables did not have any statistically significant correlations. A low percentage of patients experienced flare-ups during NSRCT procedures. The presence of a periapical lesion was the single most important predictor of flare-ups during NSRCT.

Endocrown with Leucite-Reinforced Ceramic: Case of Restoration of Endodontically Treated Teeth

PubMed Central

da Cunha, Leonardo Fernandes; Mondelli, José; Auersvald, Caroline Moreira; Gonzaga, Carla Castiglia; Mondelli, Rafael Francisco Lia; Correr, Gisele Maria; Furuse, Adilson Yoshio

2015-01-01

A common problem encountered by dentists is the restorative treatment of nonvital teeth. When the pulp chamber presents appropriate conditions for retention, the endocrown is indicated. This monolithic, ceramic adhesive restoration is singularly used yet warrants wider recognition and use. The endocrown allows preservation of the tooth structure and is minimally invasive. Currently, this treatment option, of a core buildup and full coverage restoration, reduces tooth structure excessively. This treatment presents not only functional limitations but also aesthetic concerns. Recently, the VITA-PM9 system, a leucite-reinforced glass ceramic, has been increasingly used in a variety of clinical situations due to its satisfactory physical-mechanical and aesthetic properties. Therefore, the present study describes a case of surgical restoration of a nonvital tooth using the endocrown technique and the VITA-PM9. PMID:26557391

Cleaning of endodontic files, Part I: The effect of bioburden on the sterilization of endodontic files.

PubMed

Johnson, M A; Primack, P D; Loushine, R J; Craft, D W

1997-01-01

Ninety-two new endodontic files were randomly assigned to five groups with varying parameters of contamination, cleaning method, and sterilization (steam or chemical). Files were instrumented in bovine teeth to accumulate debris and a known contaminant, Bacillus stearothermophilus. Positive controls produced growth on both T-soy agar plates and in T-soy broth. Negative controls and experimental files (some with heavy debris) failed to produce growth. The results showed that there was no significant difference between contaminated files that were not cleaned before sterilization and contaminated files that were cleaned before sterilization. Bioburden present on endodontic files does not appear to affect the sterilization process.

The failures of root canal preparation with hand ProTaper

PubMed Central

Bătăiosu, Marilena; Diaconu, Oana; Moraru, Iren; Dăguci, C.; Ţuculină, Mihaela; Dăguci, Luminiţa; Gheorghiţă, Lelia

2012-01-01

The failures of root canal preparation are due to some anatomical deviation (canal in “C” or “S”) and some technique errors. The technique errors are usually present in canal root cleansing and shaping stage and are the result of endodontic treatment objectives deviation. Objectives: Our study was made on technique errors while preparing the canal roots with hand ProTaper. Methodology: Our study was made “in vitro” on 84 extracted teeth (molars, premolars, incisors and canines). The canal root of these teeth were cleansed and shaped with hand ProTaper by crown-down technique and canal irrigation with NaOCl(2,5%). The dental preparation control was made by X-ray. Results: During canal root preparation some failures were observed like: canal root overinstrumentation, zipping and stripping phenomenon, discarded and/or fractured instruments. Conclusions: Hand ProTaper represents a revolutionary progress of endodontic treatment, but a deviation from accepted rules of canal root instrumentation can lead to failures of endodontic treatment. PMID:24778848

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association.

PubMed

Fontes, Tatiana Vasconcellos; Ferreira, Sonia Maria Soares; Silva-Júnior, Arley; Dos Santos Marotta, Patrícia; Noce, Cesar Werneck; Ferreira, Dennis de Carvalho; Gonçalves, Lucio Souza

2014-09-01

The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection.

Does apical root resection in endodontic microsurgery jeopardize the prosthodontic prognosis?

PubMed Central

Cho, Sin-Yeon

2013-01-01

Apical surgery cuts off the apical root and the crown-to-root ratio becomes unfavorable. Crown-to-root ratio has been applied to periodontally compromised teeth. Apical root resection is a different matter from periodontal bone loss. The purpose of this paper is to review the validity of crown-to-root ratio in the apically resected teeth. Most roots have conical shape and the root surface area of coronal part is wider than apical part of the same length. Therefore loss of alveolar bone support from apical resection is much less than its linear length.The maximum stress from mastication concentrates on the cervical area and the minimum stress was found on the apical 1/3 area. Therefore apical root resection is not so harmful as periodontal bone loss. Osteotomy for apical resection reduces longitudinal width of the buccal bone and increases the risk of endo-perio communication which leads to failure. Endodontic microsurgery is able to realize 0 degree or shallow bevel and precise length of root resection, and minimize the longitudinal width of osteotomy. The crown-to-root ratio is not valid in evaluating the prosthodontic prognosis of the apically resected teeth. Accurate execution of endodontic microsurgery to preserve the buccal bone is essential to avoid endo-perio communication. PMID:23741707

Association between the Presence of Apical Periodontitis and Clinical Symptoms in Endodontic Patients Using Cone-beam Computed Tomography and Periapical Radiographs.

PubMed

Weissman, Jake; Johnson, James D; Anderson, Melissa; Hollender, Lars; Huson, Tim; Paranjpe, Avina; Patel, Shanon; Cohenca, Nestor

2015-11-01

Cone-beam computed tomographic (CBCT) imaging is a valuable adjunct to endodontic practice. Among the endodontic applications of CBCT imaging, it aids in the diagnosis of apical periodontitis, often in cases in which there is no evidence of pathosis identified by conventional imaging. The purpose of this study was to correlate the presence of apical periodontitis of teeth evaluated with 2-dimensional periapical (PA) radiographs and 3-dimensional CBCT volumes with clinical signs and symptoms. Clinical records were reviewed from patients examined at the graduate endodontics clinic. The examination included clinical examination, sensibility tests, PA radiographs, and limited field-of-view CBCT scans. Of 498 cases, 67 fulfilled the inclusion criteria and were evaluated for apical periodontitis and symptomology. CBCT slices and PA radiographs were evaluated by 2 board-certified endodontists and a board-certified oral and maxillofacial radiologist for the presence of apical periodontitis. Thirty eight of 67 teeth showed the presence of apical radiolucencies on PA radiographs and on CBCT imaging, whereas 14 teeth had no evidence of apical radiolucencies on either imaging modality. Fifteen cases showed the presence of apical radiolucencies visible on CBCT imaging that were not visible on PA radiographic images. The presence of apical radiolucencies on CBCT slices and PA radiographic images was correlated with clinical signs and symptoms, including the chief complaint. This research has important implications to prevent overexposure to radiation and to provide treatment for those patients with persistent symptoms lacking proper diagnosis based on conventional (2D) radiographs. Copyright © 2015. Published by Elsevier Inc.

Assessment of the amount of remaining coronal dentine in root-treated teeth.

PubMed

Bandlish, R B; McDonald, A V; Setchell, D J

2006-10-01

There is currently no standardised technique to measure the amount of coronal dentine remaining in a root-treated tooth after crown preparation. The aim of this study was to develop a method of measuring remaining coronal dentine in root-treated teeth and to propose an index for grading tooth restorability. The study recruited 20 patients who had completed molar endodontic treatment at the Eastman Dental Hospital and had been prescribed an amalgam coronal-radicular core with a full coverage cast restoration. Using a series of interlocking special trays and impressions, a method was devised to produce a cast of the amount of remaining dentine coronal to the finish line after crown preparation. This cast was scanned using a laser profilometer and the volume of remaining dentine was calculated. A tooth restorability index (TRI) was developed to assess the strategic value of the remaining dentine. The TRI allowed scores of 0-3 in each sextant with a maximum score of 18 per tooth. Twenty teeth were scored by three examiners and the TRI scores varied from 2 to 13. The volume of coronal dentine varied from 61.73 to 232.22 mm(3). A tooth restorability index has been devised to assess the strategic value of remaining dentine. A Kappa statistic was calculated to produce values of 0.584, 0.688 and 0.720, giving moderate-good agreement between the examiners.

Influence of Cone-beam Computed Tomography on Endodontic Retreatment Strategies among General Dental Practitioners and Endodontists.

PubMed

Rodríguez, Gustavo; Patel, Shanon; Durán-Sindreu, Fernando; Roig, Miguel; Abella, Francesc

2017-09-01

Treatment options for endodontic failure include nonsurgical or surgical endodontic retreatment, intentional replantation, and extraction with or without replacement of the tooth. The aim of the present study was to determine the impact of cone-beam computed tomographic (CBCT) imaging on clinical decision making among general dental practitioners and endodontists after failed root canal treatment. A second objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan. Eight patients with endodontically treated teeth diagnosed as symptomatic apical periodontitis, acute apical abscess, or chronic apical abscess were selected. In the first session, the examiners were given the details of each case, including any relevant radiographs, and were asked to choose 1 of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 8 cases with the additional information from the CBCT data. The examiners altered their treatment plan after viewing the CBCT scan in 49.8% of the cases. A significant difference in the treatment plan between the 2 imaging modalities was recorded for endodontists and general practitioners (P < .05). After CBCT evaluation, neither group altered their self-reported level of difficulty when choosing a treatment plan (P = .0524). The extraction option rose significantly to 20% after viewing the CBCT scan (P < .05). CBCT imaging directly influences endodontic retreatment strategies among general dental practitioners and endodontists. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

New bacterial composition in primary and persistent/secondary endodontic infections with respect to clinical and radiographic findings.

PubMed

Tennert, Christian; Fuhrmann, Maximilian; Wittmer, Annette; Karygianni, Lamprini; Altenburger, Markus J; Pelz, Klaus; Hellwig, Elmar; Al-Ahmad, Ali

2014-05-01

The aim of the present study was to analyze the microbiota of primary and secondary/persistent endodontic infections of patients undergoing endodontic treatment with respect to clinical and radiographic findings. Samples from the root canals of 21 German patients were taken using 3 sequential sterile paper points. In the case of a root canal filling, gutta-percha was removed with sterile files, and samples were taken using sterile paper points. The samples were plated, and microorganisms were then isolated and identified morphologically by biochemical analysis and sequencing the 16S rRNA genes of isolated microorganisms. In 12 of 21 root canals, 33 different species could be isolated. Six (50%) of the cases with isolated microorganisms were primary, and 6 (50%) cases were endodontic infections associated with root-filled teeth. Twelve of the isolated species were facultative anaerobic and 21 obligate anaerobic. Monomicrobial infections were found for Enterococcus faecalis and Actinomyces viscosus. E. faecalis was most frequently isolated in secondary endodontic infections (33%). Moraxella osloensis was isolated from a secondary endodontic infection that had an insufficient root canal filling accompanied by a mild sensation of pain. A new bacterial composition compromising Atopobium rimae, Anaerococcus prevotii, Pseudoramibacter alactolyticus, Dialister invisus, and Fusobacterium nucleatum was recovered from teeth with chronic apical abscesses. New bacterial combinations were found and correlated to clinical and radiographic findings, particularly to chronic apical abscesses. M. osloensis was detected in root canals for the second time and only in German patients. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Prevalence of Sinus Tract in the Patients Visiting Department of Endodontics, Kermanshah School of Dentistry.

PubMed

Miri, Shima Sadat; Atashbar, Omid; Atashbar, Fardin

2015-04-23

Sinus tract is one of the manifestations of chronic dental infections, which is a path for the drainage of the infection and pus. The present study was aimed to investigate the prevalence of sinus tract with dental origin analyze the correlation between sinus tract and related factors. This study was conducted on 1527 patients, visiting Kermanshah school of dentistry, in 2014.The related teeth were examined in terms of vitality test and exact location of sinus tract. Moreover, the causes of this lesion and the needs for root canal treatment were assessed in these teeth. Having obtained the data from the patients, analyzed by Mann-Whitney, Chi-square tests. The frequency of sinus tract was 9.89% patients. There was a significant correlation between the prevalence of sinus tract and factors such as age, general health status, location of sinus tract and history of root canal treatment. The prevalence of sinus tract in maxilla was higher than the mandible (p=0.087). The prevalence of sinus tract in the posterior teeth (69.54%) was significantly higher than that of anterior teeth (30.46%) (p=0.000). From 724 teeth with periapical inflammation and radiolucency, 9.89% teeth had odontogenic sinus tract, and 23.42% teeth with history of root canal treatment had sinus tract. The most common cause of sinus tract incidence was previous root canal treatment. Therefore, clinicians need to pay a more attention to examining the posterior teeth referred for endodontic treatment.

[Colonization of Porphyromonas endodontalis in primary and secondary endodontic infections].

PubMed

Hong, Li; Hai, Ji; Yan-Yan, He; Shenghui, Yang; Benxiang, Hou

2015-02-01

This study aims to assess and compare the prevalence of Porphyromonas endodontalis (P. endodontalis) in root canals associated with primary and secondary endodontic infections by using 16s rDNA PCR and real-time fluorescence quantitative polymerase chain reaction (RTFQ-PCR). A total of 120 adult patients with one radiographically documented periapical lesion were included. Sixty teeth presented with primary endodontic infections and 60 with secondary endodontic infections requiring retreatment. P. endodontalis was identified by using 16s rDNA PCR techniques. The positive DNA expression of P. endodontalis in two types of infected root canals were quantitatively compared by using SYBR GREEN I RTFQ-PCR. The prevalence of P. endodontalis in the root canals with primary endodontic infections was significantly higher than that in root canals with secondary endodontic infections (P = 0.001). However, RTFQ-PCR results showed no significant difference in DNA expression quantities between the primary and secondary endodontic infections root canals (P = 0.303). P. endodontalis is more highly associated with root canals having primary endodontic infections, although P. endodontalis colonize in both root canals with primary and secondary chronic apical periodontitis.

Impact of cone beam computed tomography on periapical assessment and treatment planning five to eleven years after surgical endodontic retreatment.

PubMed

Kruse, C; Spin-Neto, R; Wenzel, A; Vaeth, M; Kirkevang, L-L

2018-01-18

To evaluate how additional information from Cone Beam CT (CBCT) impacts on periapical assessment and treatment planning based on clinical examination and periapical radiographs (PR) in cases followed up five to eleven years after surgical endodontic retreatment (SER). Patients receiving SER during 2004-2010 were reinvited for follow-up examination including clinical examination, PR, and CBCT. In total, 108 patients (119 teeth) were reinvited, 74 patients (83 teeth) accepted to participate. Three observers initially assessed PR according to the four-scaled, increasing disease severity criteria by Rud et al. (International Journal of Oral Surgery, 1, 1972 and 195) and Molven et al. (International Journal of Oral and Maxillofacial Surgery, 16, and 432): 'Radiographic assessment A'. By including clinical information 'Treatment plan A' was made as follows: 1) no treatment, 2) further observation, 3) SER reoperation (SER-R), or 4) extraction. Hereafter, the CBCT volume was assessed and the information incorporated for 'Radiographic assessment B' followed by 'Treatment plan B'. Agreement between radiographic assessments and between treatment plans was recorded and assessed statistically by Stuart-Maxwell test for marginal homogeneity. Nine teeth had been extracted; thus, the final analysis included 74 teeth (66 patients). The radiographic assessment was changed as a result of the CBCT evaluation in 38 cases (51.4%), of which 35 (47.3%) were to a higher Rud & Molven score, P < 0.001. The treatment plan was changed for 18 teeth (24.3%). For 14 teeth (18.9%), the change was from no treatment or further observation to a more invasive treatment plan (SER-R or extraction), P = 0.005. The use of CBCT for long-term follow-up after SER led to more cases diagnosed with persisting or recurrent apical periodontitis and hence often to the recommendation of a more invasive treatment modality. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology.

PubMed

Mohammadi, Z; Abbott, P V

2009-07-01

Antibiotics are a valuable adjunctive to the armamentarium available to health professionals for the management of bacterial infections. During endodontic treatment and when managing trauma to the teeth, antibiotics may be applied systemically (orally and/or parenterally) or locally (i.e. intra-dentally via irrigants and medicaments). Due to the potential risk of adverse effects following systemic application, and the ineffectiveness of systemic antibiotics in necrotic pulpless teeth and the periradicular tissues, the local application of antibiotics may be a more effective mode for delivery in endodontics. The aim of this article was to review the history, rationale and applications of antibiotic-containing irrigants and medicaments in endodontics and dental traumatology. The search was performed from 1981 to 2008 and was limited to English-language papers. The keywords searched on Medline were 'Antibiotics AND endodontics', 'Antibiotics AND root canal irrigation', 'Antibiotics AND intra-canal medicament', 'Antibiotics AND Dental trauma' and 'Antibiotics AND root resorption'. The reference section of each article was manually searched to find other suitable sources of information. It seems that local routes of antibiotic administration are a more effective mode than systemic applications. Various antibiotics have been tested in numerous studies and each has some advantages. Tetracyclines are a group of bacteriostatic antibiotics with antibacterial substantivity for up to 12 weeks. They are typically used in conjunction with corticosteroids and these combinations have anti-inflammatory, anti-bacterial and anti-resorptive properties, all of which help to reduce the periapical inflammatory reaction including clastic-cell mediated resorption. Tetracyclines have also been used as part of irrigating solutions but the substantivity is only for 4 weeks. Clindamycin and a combination of three antibiotics (metronidazole, ciprofloxacin and minocycline) have also been reported to be effective at reducing bacterial numbers in the root canal systems of infected teeth.

Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure.

PubMed

Lovelace, Tyler W; Henry, Michael A; Hargreaves, Kenneth M; Diogenes, Anibal

2011-02-01

Immature teeth with open apices treated with conventional nonsurgical root canal treatment often have a poor prognosis as a result of the increased risk of fracture and susceptibility to recontamination. Regenerative endodontics represents a new treatment modality that focuses on reestablishment of pulp vitality and continued root development. This clinical procedure relies on the intracanal delivery of a blood clot (scaffold), growth factors (possibly from platelets and dentin), and stem cells. However, to date, the clinical presence of stem cells in the canal space after this procedure has not been demonstrated. The purpose of this clinical study was to evaluate whether regenerative endodontic procedures are able to deliver stem cells into the canal space of immature teeth in young patients and to identify the possible tissue origin for these cells. After informed consent, the first appointment consisted of NaOCl irrigation and treatment with a triple antibiotic paste. One month later, the root canal space was irrigated with sterile saline, and bleeding was evoked with collection of samples on paper points. Real-time reverse-transcription polymerase chain reaction and immunocytochemistry were conducted to compare the gene transcripts and proteins found in the root canal sample with levels found in the systemic circulation. Molecular analyses of blood collected from the canal system indicated the significant accumulation of transcripts for the stem cell markers CD73 and CD105 (up to 600-fold), compared with levels found in the systemic blood. Furthermore, this effect was selective because there was no change in expression of the differentiation markers ALK-P, DSPP, ZBTB16, and CD14. Histologic analyses demonstrated that the delivered cells expressed both CD105 and STRO-1, markers for a subpopulation of mesenchymal stem cells. Collectively, these findings demonstrate that the evoked-bleeding step in regenerative procedures triggers the significant accumulation of undifferentiated stem cells into the canal space where these cells might contribute to the regeneration of pulpal tissues seen after antibiotic paste therapy of the immature tooth with pulpal necrosis. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Iatrogenic Subcutaneous Emphysema of Endodontic Origin – Case Report with Literature Review

PubMed Central

Mishra, Lora; Patnaik, Swarnav; Patro, Sangram; Debnath, Nitai; Mishra, Satyaranjan

2014-01-01

Surgical emphysema is well known and many case reports have been published on this. Many authors have reported this as a complication post dentoalveolar treatment. Diffusion of air into facial planes and periorbital area during endodontic procedures has been rarely reported. The use of three way air syringe and forceful irrigation of root canal can lead to surgical emphysema of subcutaneous tissue planes in and around the teeth which are involved. This case report highlights one such complication seen during endodontic treatment, discusses aetiology, complications and conservative management of this dental office emergency. PMID:24596796

Traumatic bone cyst suggestive of a chronic periapical abscess: a case report.

PubMed

Kahler, Bill

2011-08-01

Traumatic bone cysts can mimic the signs and symptoms of an endodontic lesion. This case reports on a 19-year-old male patient who was referred for endodontic assessment of a symptomatic tooth with a gingival swelling and a draining sinus at the furcation of a mandibular second molar. Radiographically, a periradicular radiolucency is evident. A prior history of trauma as well as removal of the wisdom teeth was determined. After careful diagnosis unnecessary endodontic intervention was avoided. Surgical exploration, curettage and the generation of a blood clot resulted in healing at the 6 month review appointment. The tooth remained responsive to pulp sensibility testing at that time. © 2010 The Author. Australian Endodontic Journal © 2010 Australian Society of Endodontology.

[A ten-year clinical study of cracked teeth restored with glass ceramic crowns].

PubMed

Luo, X P; Yuan, Y; Shi, Y J; Qian, D D

2016-10-09

Objective: To evaluate the clinic performance of high strength glass ceramic crowns for the painful cracked teeth during a 10-year observation period. Methods: Forty-two posterior teeth from 36 patients were diagnosed as having a crack, biting painful and sensitivity to cold were selected in the Department of Prosthodontic, Institute and Hospital of Stomatology, Nanjing University Medical School. The lost-wax hot pressed glass ceramic crowns were bonded on the minimally invasive prepared teeth by modern adhesive technology. Patients were interviewed and went through clinic examination after one week, one month, and every six months. Results: The effectiveness of 42 glass ceramic crowns for cracked teeth was evaluated for a mean observation time over 10-year. At the first week, 29(81%) patients were free of pain, three still had sensitivity to cold and chewing pain, three still had sensitivity to cold, one had painful to cold and hot. After one month, two patients still had chewing pain, and one tooth needed endodontic treatment after six months. In 10 years, 2(5%) all ceramic crowns were broken, the other 40 restorations kept good clinical performances with a 10-year survival rate of 95%. Conclusions: The high strength glass ceramic crowns are very effective and successful in treating the cracked teeth and then keep the good mastication function and appearance.

Radiographic and Clinical Outcomes of the Treatment of Immature Permanent Teeth by Revascularization or Apexification: A Pilot Retrospective Cohort Study

PubMed Central

Alobaid, Adel S.; Cortes, Lina M.; Lo, Jeffery; Nguyen, Thuan T.; Albert, Jeffery; Abu-Melha, Abdulaziz S; Lin, Louis M.; Gibbs, Jennifer L.

2014-01-01

Introduction This retrospective cohort study compared clinical and radiographic outcomes of endodontic treatment performed in immature non-vital permanent teeth, by apexification (calcium hydroxide or apical barrier with Mineral Trioxide Aggregate (MTA)), versus revascularization. Methods A comprehensive chart review was performed to obtain a cohort of sequential previously completed cases with recalls. Clinical and radiographic data were collected for 31 treated teeth (19 revascularization and 12 apexification) with an average follow up time of 17 months and a recall rate of 63%. Tooth survival, success rate, and adverse events were analyzed. Changes in radiographic root length, width and area were quantified. Results The majority of treated teeth survived throughout the study period with 30/31 (97%) teeth surviving (18/19 (95%) revascularization, 12/12 apexification). Most cases were also clinically successful with 27/31 (87%) meeting criteria for success, (15/19 (78%) revascularization and 12/12 apexification; non-significant difference). A greater incidence of adverse events was observed in the revascularization group (8/19 (42%) versus 1/12 (11%) in apexification (Risk Ratio= 5.1, p=0.04, 95%CI (0.719, 35.48)). Although more revascularization cases than apexification cases demonstrated an increase in radiographic root area and width, the effect was not statistically significant. Conclusion In this study, revascularization was not superior to other apexification techniques in either clinical or radiographic outcomes. Studies with large subject cohorts, and long follow up periods are needed to evaluate outcomes of revascularization and apexification, while accounting for important co-variants relevant to clinical success. PMID:25069909

Interferon-gamma improves impaired dentinogenic and immunosuppressive functions of irreversible pulpitis-derived human dental pulp stem cells

PubMed Central

Sonoda, Soichiro; Yamaza, Haruyoshi; Ma, Lan; Tanaka, Yosuke; Tomoda, Erika; Aijima, Reona; Nonaka, Kazuaki; Kukita, Toshio; Shi, Songtao; Nishimura, Fusanori; Yamaza, Takayoshi

2016-01-01

Clinically, irreversible pulpitis is treated by the complete removal of pulp tissue followed by replacement with artificial materials. There is considered to be a high potential for autologous transplantation of human dental pulp stem cells (DPSCs) in endodontic treatment. The usefulness of DPSCs isolated from healthy teeth is limited. However, DPSCs isolated from diseased teeth with irreversible pulpitis (IP-DPSCs) are considered to be suitable for dentin/pulp regeneration. In this study, we examined the stem cell potency of IP-DPSCs. In comparison with healthy DPSCs, IP-DPSCs expressed lower colony-forming capacity, population-doubling rate, cell proliferation, multipotency, in vivo dentin regeneration, and immunosuppressive activity, suggesting that intact IP-DPSCs may be inadequate for dentin/pulp regeneration. Therefore, we attempted to improve the impaired in vivo dentin regeneration and in vitro immunosuppressive functions of IP-DPSCs to enable dentin/pulp regeneration. Interferon gamma (IFN-γ) treatment enhanced in vivo dentin regeneration and in vitro T cell suppression of IP-DPSCs, whereas treatment with tumor necrosis factor alpha did not. Therefore, these findings suggest that IFN-γ may be a feasible modulator to improve the functions of impaired IP-DPSCs, suggesting that autologous transplantation of IFN-γ-accelerated IP-DPSCs might be a promising new therapeutic strategy for dentin/pulp tissue engineering in future endodontic treatment. PMID:26775677

Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology.

PubMed

Krastl, Gabriel; Zehnder, Marc S; Connert, Thomas; Weiger, Roland; Kühl, Sebastian

2016-06-01

To present a new treatment approach for teeth with pulp canal calcification (PCC) which require root canal treatment. A 15-year-old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC, location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography (CBCT) and an intra-oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta-percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Bacterial and dye penetration through interim restorations used during endodontic treatment of molar teeth.

PubMed

Chailertvanitkul, Pattama; Abbott, Paul V; Riley, Thomas V; Sooksuntisakoonchai, Namchai

2009-07-01

The purpose of this study was to investigate the association between dye and bacterial penetration through interim restorations used during endodontic treatment. Sixty-four extracted human teeth were used, with 2 teeth each as positive and negative controls. Endodontic access with a mesio-occluso-distal cavity was prepared. Palatal cusps of maxillary molars and buccal cusps of mandibular molars were removed. Cotton was placed over the canals and covered with Cavit. Thirty teeth were restored with Ketac Silver (KS) and 30 with KS reinforced with a stainless steel band (KSSB). Samples were submersed in India ink mixed with brain heart infusion broth containing Streptococcus gordonii. After 3 months of simulated chewing, structural integrity and dye and bacterial penetration were assessed. Positive controls had both dye and bacterial penetration. Negative controls had no dye or bacterial penetration. All KS restorations debonded, whereas 18 KSSB restorations (60%) debonded. KS restorations were 1.67 times more likely to debond than KSSB restorations (Fisher exact test). KS was 1.3 times more likely to have dye penetration than KSSB (Fisher exact test) and 3 times more likely to have bacterial penetration, although not statistically significant (chi(2) test). Overall, 88.3% of specimens had dye penetration, and 20% had bacterial penetration. This 68.3% difference indicated no association between dye and bacterial penetration (exact McNemar test). Stainless steel bands helped maintain structural integrity of KS restorations under masticatory function. Bands helped prevent dye penetration but not bacterial penetration. There was no association between dye and bacterial penetration.

Comparative evaluation of endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe in obturation of primary teeth: An in vitro study.

PubMed

Hiremath, Mallayya C; Srivastava, Pooja

2016-01-01

The purpose of this in vitro study was to compare four methods of root canal obturation in primary teeth using conventional radiography. A total of 96 root canals of primary molars were prepared and obturated with zinc oxide eugenol. Obturation methods compared were endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe. The root canal obturations were evaluated by conventional radiography for the length of obturation and presence of voids. The obtained data were analyzed using Chi-square test. The results showed significant differences between the four groups for the length of obturation (P < 0.05). The endodontic pressure syringe showed the best results (98.5% optimal fillings) and jiffy tube showed the poor results (37.5% optimal fillings) for the length of obturation. The insulin syringe (79.2% optimal fillings) and local anesthetic syringe (66.7% optimal fillings) showed acceptable results for the length of root canal obturation. However, minor voids were present in all the four techniques used. Endodontic pressure syringe produced the best results in terms of length of obturation and controlling paste extrusion from the apical foramen. However, insulin syringe and local anesthetic syringe can be used as effective alternative methods.

Copper ion as a new leakage tracer.

PubMed

Modaresi, J; Baharizade, M; Shareghi, A; Ahmadi, M; Daneshkazemi, A

2013-12-01

Most failures of root canal treatments are caused by bacteria. Studies showed that the most common cause of endodontic failures were the incomplete obturation of the root canal and the lack of adequate apical seal. Some in-vitro methods are used to estimate sealing quality, generally by measuring microleakage that allows the tracer agent to penetrate the filled canal. Conventional methods of evaluating the seal of endodontically treated teeth are complicated and have some drawbacks. We used copper ion diffusion method to assess the leakage and the results were compared to dye penetration method. The crowns of 21 extracted teeth were cut off at the CEJ level. After preparing the canals, the teeth were placed in tubes containing saline. They were divided randomly into 15 experimental cases; 3 positive and 3 negative controls. Positive controls were filled by single cone without sealer while the experimental and the negative control groups were filled by lateral technique. The coronal portion of gutta was removed and 9mm was left. The external surface of each tooth was coated with nail polish. Two millimeters of apical portion was immersed into 9ml of distilled water and 0.3ml of CuSO4 solution was injected into the coronal portion. After 2 days, copper sulfate was measured by an atomic absorption spectrophotometer. The teeth were then immersed in 2% methylene blue for 24 hours, sectioned and the extent of dye penetration was measured by a stereomicroscope. The maximum and minimum recorded copper ion concentrations for the experimental group were 18.37 and 2.87ppm respectively. The maximum and minimum recorded dye penetrations for the experimental group were 8.5 and 3.5mm respectively. The statistical analysis, adopting paired samples test, showed poor correlation between average recorded results of two methods. Based on our results, there was no significant correlation between the dye penetration and the copper ion diffusion methods.

An In Vitro Comparison of Non-Vital Bleaching Techniques in the Discolored Tooth.

DTIC Science & Technology

1981-03-01

Thirty-nine extracted anterior teeth with intact crowns were immersed in 5.25% sodium hypochlorite solution for approximately eight hours to loosen...tooth" model described previously was utilized.10 The experimental teeth with lingual access openings were placed in 5.25% sodium hypochlorite ...time was highly significant (p<O.O000). The bleaching of discolored non-vital teeth is an important phase of endodontic therapy. Bleaching is an attempt

[Fiber reinforced composite posts: literature review].

PubMed

Frydman, G; Levatovsky, S; Pilo, R

2013-07-01

FRC (Fiber-reinforced composite) posts have been used since the beginning of the 90s with the introduction of carbon fiber posts. Fiber posts are widely used to restore endodontically treated teeth that have insufficient coronal tooth structure. Many in vitro and in vivo studies have shown the advantage of using FRC over prefabricated and cast metal post especially indicated in narrow root canals which are prone to vertically root fracture. The most frequent failure of FRC is debonding of a post at the resin cement/dentin interface. Bonding to dentin may be achieved by using etch-and-rinse and self-etch adhesives. The bond strength formed by self-adhesive cements is noticeably lower in comparison to the bond strength formed with resin cements applied in combination with etch-and-rinse adhesives. In an attempt to maximize resin bonding to fiber posts, several surface treatments have been suggested. Sandblasting with alumina particles results in an increased surface roughness and surface area without affecting the integrity of the post as long as it is applied by 50 microm alumina particles at 2.5 bars for maximally 5 seconds at a distance of 30 mm. The efficiency of post salinization is controversial and its contribution to the retention is of minor importance. Hydrofluoric acid has recently been proposed for etching glass fiber posts but this technique produced substantial damage to the glass fibers and affected the integrity of the post. Delayed cementation of fiber post (at least 24h post endodontic treatment) resulted in higher retentive strengths in comparison to immediate cementation and the best results were obtained when the luting agent was brought into the post space with lentulo spirals or specific syringes. The resin cement film thickness also influences the pullout strengths of fiber-reinforced posts .The highest bond strength values were obtained when the cement layer oversized the post spaces but not larger than 0.3 mm. The use of core build-up materials as post luting cements is not recommended. The use of FRC post, combined with proper adhesive cementation technique can give an excellent solution when restoring endodontically treated teeth that are prone to fracture.

Analysis of Resin-Dentin Interface Morphology and Bond Strength Evaluation of Core Materials for One Stage Post-Endodontic Restorations

PubMed Central

Bitter, Kerstin; Gläser, Christin; Neumann, Konrad; Blunck, Uwe; Frankenberger, Roland

2014-01-01

Purpose Restoration of endodontically treated teeth using fiber posts in a one-stage procedure gains more popularity and aims to create a secondary monoblock. Data of detailed analyses of so called “post-and-core-systems” with respect to morphological characteristics of the resin-dentin interface in combination with bond strength measurements of fiber posts luted with these materials are scarce. The present study aimed to analyze four different post-and-core-systems with two different adhesive approaches (self-etch and etch-and-rinse). Materials and Methods Human anterior teeth (n = 80) were endodontically treated and post space preparations and post placement were performed using the following systems: Rebilda Post/Rebilda DC/Futurabond DC (Voco) (RB), Luxapost/Luxacore Z/Luxabond Prebond and Luxabond A+B (DMG) (LC), X Post/Core X Flow/XP Bond and Self Cure Activator (Dentsply DeTrey) (CX), FRC Postec/MultiCore Flow/AdheSE DC (Ivoclar Vivadent) (MC). Adhesive systems and core materials of 10 specimens per group were labeled using fluorescent dyes and resin-dentin interfaces were analyzed using Confocal Laser Scanning Microscopy (CLSM). Bond strengths were evaluated using a push-out test. Data were analyzed using repeated measurement ANOVA and following post-hoc test. Results CLSM analyses revealed significant differences between groups with respect to the factors hybrid layer thickness (p<0.0005) and number of resin tags (p = 0.02; ANOVA). Bond strength was significantly affected by core material (p = 0.001), location inside the root canal (p<0.0005) and incorporation of fluorescent dyes (p = 0.036; ANOVA). CX [7.7 (4.4) MPa] demonstrated significantly lower bond strength compared to LC [14.2 (8.7) MPa] and RB [13.3 (3.7) MPa] (p<0.05; Tukey HSD) but did not differ significantly from MC [11.5 (3.5) MPa]. Conclusion It can be concluded that bond strengths inside the root canal were not affected by the adhesive approach of the post-and-core-system. All systems demonstrated homogenous hybrid layer formation and penetration into the dentinal tubules in spite of the complicating conditions for adhesion inside the root canal. PMID:24586248

Periodontal treatment in a generalized severe chronic periodontitis patient: A case report with 7-year follow-up.

PubMed

Agrali, Omer Birkan; Kuru, Bahar Eren

2015-01-01

The aim of the periodontal treatment is to provide healthy and functional dentition all through a lifetime. In this report, periodontal treatment of a 42-year-old male patient with generalized severe chronic periodontitis is presented. He received initial periodontal treatment together with adjunctive antimicrobials. The devital teeth were endodontically treated, and free gingival grafts were placed at the inadequate keratinized tissue zones before regenerative surgery. Following the surgical treatment using enamel matrix derivatives and xenogenic bone graft combination, the patient was put on a strict recall program. After 12 months, favorable clinical and radiographical improvements were obtained. The 7-year maintenance of the present case with several initially hopeless teeth has been shown and discussed in this report. It can be concluded that optimum oral hygiene level as well as the positive cooperation of the patient enhanced the success of periodontal treatment results even in extremely severe periodontal destruction.

Intraosseous anaesthesia in children with 4 % articaine and epinephrine 1:400,000 using computer-assisted systems.

PubMed

Sixou, J-L; Marie-Cousin, A

2015-12-01

To assess retrospectively the efficacy of computer-assisted intraosseous anaesthesia (CAIO) in children using an anaesthetic solution with a lower concentration of epinephrine (1:400,000). In a retrospective study, CAIO was evaluated in healthy children and adolescents for restorative and endodontic treatments, uncomplicated tooth extractions or scalings using articaine 4 % plus epinephrine 1:400,000. Anaesthesia was performed in children who showed enough compliance (score of 0-3 according to modified behaviour Venham scale). Efficacy, amount of anaesthetic solution as well as need of a complementary injection was assessed. A total of 421 consecutive sessions were performed on 278 patients aged 7.1 ± 2.9 years with 518 teeth involved in the anaesthetic process and analysed process. When teeth to be anaesthetised were considered, the overall success rate was 97.2 %. In most of the cases, only 0.9 mL was needed to achieve anaesthesia. Permanent teeth needed significantly more anaesthetics than primary teeth. Sensitivity of the teeth anaesthetized reappeared in 5.7 % of cases after 30-60 min of treatment. These results suggest that CAIO with 4 % articaine and epinephrine diluted 1:400,000 can be an alternative to usual infiltration techniques or IO with epinephrine at a higher concentration for most of treatments in primary and permanent teeth. Further studies are needed to evaluate its efficacy in permanent teeth in case of endodontic treatment or extraction.

Molecular characterization of the microbial flora residing at the apical portion of infected root canals of human teeth.

PubMed

Chugal, Nadia; Wang, Jen-Kuei; Wang, Renke; He, Xuesong; Kang, Mo; Li, Jiyao; Zhou, Xuedong; Shi, Wenyuan; Lux, Renate

2011-10-01

This study investigated the bacterial communities residing in the apical portion of human teeth with apical periodontitis in primary and secondary infections by using a culture-independent molecular biology approach. Root canal samples from the apical root segments of extracted teeth were collected from 18 teeth with necrotic pulp and 8 teeth with previous endodontic treatment. Samples were processed for amplification via polymerase chain reaction and separated with denaturing gradient gel electrophoresis. Selected bands were excised from the gel and sequenced for identification. Comparable to previous studies of entire root canals, the apical bacterial communities in primary infections were significantly more diverse than in secondary infections (P = .0003). Interpatient and intrapatient comparisons exhibited similar variations in profiles. Different roots of the same teeth with secondary infections displayed low similarity in bacterial composition, whereas an equivalent sample collected from primary infection contained almost identical populations. Sequencing revealed a high prevalence of Fusobacteria, Actinomyces species, and oral Anaeroglobus geminatus in both types of infection. Many secondary infections contained Burkholderiales or Pseudomonas species, both of which represent opportunistic environmental pathogens. Certain microorganisms exhibit similar prevalence in primary and secondary infection, indicating that they are likely not eradicated during endodontic treatment. The presence of Burkholderiales and Pseudomonas species underscores the problem of environmental contamination. Treatment appears to affect the various root canals of multirooted teeth differently, resulting in local changes of the microbiota. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Prevalence of Enterococcus faecalis in saliva and filled root canals of teeth associated with apical periodontitis

PubMed Central

Wang, Qian-Qian; Zhang, Cheng-Fei; Chu, Chun-Hung; Zhu, Xiao-Fei

2012-01-01

To investigate the prevalence of Enterococcus faecalis in saliva and filled root canals of patients requiring endodontic retreatment for apical periodontitis. Patients with apical periodontitis who were referred for endodontic retreatment were examined. The type and quality of the restoration, symptoms, quality of obturation were recorded. During retreatment, an oral rinse sample and root canal sample were cultured using brain-heart infusion agar and bile esculinazide agar to select for E. faecalis. The 16S rRNA technique was used to identify E. faecalis. A total of 32 women and 22 men (mean age: 38 years; s.d.: 11 years) and 58 teeth were studied. The prevalence of E. faecalis was 19% in the saliva and 38% in the root canals. The odds that root canals harbored E. faecalis were increased if the saliva habored this bacterium (odds ratio=9.7; 95% confidence interval=1.8–51.6; P<0.05). Teeth with unsatisfactory root obturation had more cultivable bacterial species in root canals than teeth with satisfactory root obturation (P<0.05). E. faecalis is more common in root canals of teeth with apical periodontitis than in saliva. The prevalence of E. faecalis in root canals is associated with the presence of E. faecalis in saliva. PMID:22422085

PCR-based identification of selected pathogens associated with endodontic infections in deciduous and permanent teeth.

PubMed

Cogulu, Dilsah; Uzel, Atac; Oncag, Ozant; Eronat, Cemal

2008-09-01

The aim of the present study was to evaluate the presence of the selected pathogens in samples from deciduous and permanent tooth root canals by using PCR method and to determine the association of these organisms with clinical symptoms. A total of 145 children, 5 to 13 years old, were involved in this study. The presence of selected pathogens (Actinomyces israelii, Candida albicans, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Streptococcus intermedius, Treponema denticola, Parvimonas micra, Tannerella forsythensis, Enterococcus faecium, Prevotella melaninogenica) in infected root canals was studied using PCR. T. denticola (P = .012, .02) and E. faecalis (P = .012, .04) were highly associated with periapical radiolucency and previous pain, while P. gingivalis was associated with tenderness to percussion in both deciduous and permanent teeth (P = .01, .015). The results of the present study confirm that certain species of microorganisms are associated with clinical signs and symptoms of endodontic disease in both deciduous and permanent teeth.

Detection of Porphyromonas endodontalis in infected root canals by 16S rRNA gene-directed polymerase chain reaction.

PubMed

Machado de Oliveira, J C; Siqueira, J F; Alves, G B; Hirata, R; Andrade, A F

2000-12-01

Porphyromonas endodontalis has been isolated from the endodontic infections mainly in symptomatic teeth. This study evaluated the occurrence of P. endodontalis in both symptomatic and asymptomatic endodontic infections using 16S rRNA gene-directed polymerase chain reaction. P. endodontalis was detected in 39.5% of the cases (17 of 43 teeth). It was present in 4 of the 6 cases with acute periradicular abscess (66.7%) and in 13 of the 37 other cases (35.1%). The presence of P. endodontalis was associated with an asymptomatic periradicular lesion in 6 cases (25%) and in 10 teeth with tenderness to percussion (52.6%). P. endodontalis was also found in one asymptomatic case without evidence of periradicular pathosis. Our results indicated that, although P. endodontalis is commonly detected in symptomatic cases, it can be present in asymptomatic root canal infections. Further studies should determine if this bacterial species is really an important endodontopathogen.

Chondroblastic osteosarcoma mimicking periapical abscess

PubMed Central

YAMAMOTO-SILVA, Fernanda Paula; SILVA, Brunno Santos de Freitas; BATISTA, Aline Carvalho; de MENDONÇA, Elismauro Francisco; PINTO-JÚNIOR, Décio dos Santos; ESTRELA, Carlos

2017-01-01

Abstract Lesions of non-endodontic origin may mimic periapical abscess. Osteosarcoma is a rare malignant lesion. Case report The present report describes a case of chondroblastic osteosarcoma in the periapical region of teeth #29, #30, and #31 of an 18-year-old male. Clinical history showed self-reported discomfort in the right posterior gingiva for over a month. Physical examination showed a small expansion and redness of the right mandibular buccal and lingual cortical plates, but no signs of pain or inflammation were observed. All the teeth responded positively to pulp sensibility. Periapical and panoramic radiographs showed slight periapical radiolucency in the roots of teeth #29 and #30, clear periodontal ligament space widening, and evident loss of lamina dura. Incisional biopsy was performed, and based on microscopic findings the diagnosis of chondroblastic osteosarcoma was confirmed. Conclusions Non-endodontic diseases associated with tooth root apex, such as chondroblastic osteosarcoma, should be included in differential diagnosis of jaw lesions that resemble periapical abscess. PMID:28877285

Interrelationships in the Variability of Root Canal Anatomy among the Permanent Teeth: A Full-Mouth Approach by Cone-Beam CT

PubMed Central

Peters, Ove A.; Maury, Elisabeth; Telmon, Norbert; Georgelin-Gurgel, Marie; Maret, Delphine

2016-01-01

Objectives In endodontic practice, clinicians should be aware of possible root canal anatomic variations. The aim of this study was to assess using CBCT acquisitions regarding whether one root canal anatomy of a tooth is associated with a specific anatomy of another tooth. Methods A total of 106 CBCT acquisitions were obtained using a CBCT scanner with 200μm voxel size. Numbers of roots and canals of the entire dentition were described. Bivariate analyses and logistic regressions were conducted to explore root canal anatomy on one tooth according to age, gender, jaw, side and the others teeth. Multiple correspondence analysis (MCA) was performed to correlate the different numbers of canals profiles. Results A total of 2424 teeth were analyzed. Independently from the other variables, the presence of an additional root canal on a mandibular incisor increases the risk of having an additional root canal on a mandibular premolar (OR [95%] 3.7 [1.0;13.2]). The mandibular molar variability increases in women compared to men (OR [95%] 0.4 [0.1; 0.9]). MCA showed correspondence between 2-canals maxillary incisor and canines and 5-canals maxillary molars, and some correlation between additional canal on maxillary and mandibular premolars. Conclusions Although CBCT examinations are conducted in the first intention of making a diagnosis or prognostic evaluation, medium FOV acquisitions could be used as an initial database thus furnishing preliminary evaluations and information. In endodontic practice, clinicians should be aware of possible root canal anatomic variations. The visualization of all canals is considered essential in endodontic therapy. The use of multi-correspondence analysis for statistics in endodontic research is a new approach as a prognostic tool. PMID:27764246

Antimicrobial Activity of Calcium Hydroxide in Endodontics: A Review

PubMed Central

Shalavi, S; Yazdizadeh, M

2012-01-01

The purpose of endodontic therapy is to preserve the patient's natural teeth without compromising the patient's local or systemic health. Calcium hydroxide has been included in several materials and antimicrobial formulations that are used in several treatment modalities in endodontics, such as inter-appointment intracanal medicaments. The purpose of this article was to review the antimicrobial properties of calcium hydroxide in endodontics. Calcium hydroxide has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. Calcium hydroxide has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also a valuable anti-endotoxin agent. However, its effect on microbial biofilms is controversial. PMID:23323217

Single crowns versus conventional fillings for the restoration of root-filled teeth.

PubMed

Sequeira-Byron, Patrick; Fedorowicz, Zbys; Carter, Ben; Nasser, Mona; Alrowaili, Eman F

2015-09-25

Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012. To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials. We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015. Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any. Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI). We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs. There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Predictive models of pain following root canal treatment: a prospective clinical study.

PubMed

Arias, A; de la Macorra, J C; Hidalgo, J J; Azabal, M

2013-08-01

To determine the probability of the incidence, intensity, duration and triggering of post-endodontic pain, considering factors related to the patient (age, gender, medical evaluation) and to the affected tooth (group, location, number of canals, pulp vitality, preoperative pain, periapical radiolucencies, previous emergency access, presence of occlusal contacts with antagonist). A total of 500 one-visit root canal treatments (RCTs) were performed on patients referred to an endodontist. Shaping of root canals was performed manually with Gates-Glidden drills and K-Flexofiles, and apical patency was maintained with a size 10 file. A 5% NaOCl solution was used for irrigation, and canals were filled with lateral compaction and AH-Plus sealer. Independent factors were recorded during the treatment, and characteristics of post-endodontic pain (incidence, intensity, type and duration) were later surveyed through questionnaires. Of the 500 questionnaires, 374 were properly returned and split in two groups for two different statistical purposes: 316 cases were used to adjust the logistic regression models to predict each characteristic of post-endodontic pain using predictive factors, and the remaining 58 cases were used to test the validity of each model. The predictive models showed that the incidence of post-endodontic pain was significantly lower when the treated tooth was not a molar (P = 0.003), demonstrated periapical radiolucencies (P = 0.003), had no history of previous pain (P = 0.006) or emergency endodontic treatment (P = 0.045) and had no occlusal contact (P < 0.0001). The probability of experiencing moderate or severe pain was higher with increasing age (P = 0.09) and in mandibular teeth (P = 0.045). The probability of pain lasting more than 2 days was increased with age (P = 0.1) and decreased in males (P = 0.007) and when a radiolucent lesion was present on radiographs (P = 0.1). Predictive formulae for the incidence, the intensity and the duration of post-endodontic pain were generated and validated taking account of the interrelation of multiple concomitant clinical factors. A predictive model for triggering post-endodontic pain could not be established. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Prevalence of Sinus Tract in the Patients Visiting Department of Endodontics, Kermanshah School of Dentistry

PubMed Central

Miri, Shima Sadat; Atashbar, Omid; Atashbar, Fardin

2015-01-01

Introduction: Sinus tract is one of the manifestations of chronic dental infections, which is a path for the drainage of the infection and pus. The present study was aimed to investigate the prevalence of sinus tract with dental origin analyze the correlation between sinus tract and related factors. Methods: This study was conducted on 1527 patients, visiting Kermanshah school of dentistry, in 2014.The related teeth were examined in terms of vitality test and exact location of sinus tract. Moreover, the causes of this lesion and the needs for root canal treatment were assessed in these teeth. Having obtained the data from the patients, analyzed by Mann-Whitney, Chi-square tests. Results: The frequency of sinus tract was 9.89% patients. There was a significant correlation between the prevalence of sinus tract and factors such as age, general health status, location of sinus tract and history of root canal treatment. The prevalence of sinus tract in maxilla was higher than the mandible (p=0.087). The prevalence of sinus tract in the posterior teeth (69.54%) was significantly higher than that of anterior teeth (30.46%) (p=0.000). From 724 teeth with periapical inflammation and radiolucency, 9.89% teeth had odontogenic sinus tract, and 23.42% teeth with history of root canal treatment had sinus tract. Conclusions: The most common cause of sinus tract incidence was previous root canal treatment. Therefore, clinicians need to pay a more attention to examining the posterior teeth referred for endodontic treatment. PMID:26153170

Clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars.

PubMed

Wolcott, James; Ishley, Dave; Kennedy, Wade; Johnson, Scott; Minnich, Scott

2002-06-01

An examination of 1873 conventionally treated and retreated maxillary first and second molars was made in an attempt to determine the percentage of second mesiobuccal (MB2) canals that could be located routinely and evaluate if there were any significant differences between initial treatments and retreatments. The teeth examined were 1193 first molars and 680 second molars treated consecutively over a 2-yr period by five endodontists. Overall the MB2 canal was found in 724 (61%) first molars and 245 (36%) second molars. The incidence of a MB2 canal in first molar retreatments was 67% compared to a 59% incidence in initial treatments. Whereas in second molars, the retreatment incidence was 44% compared with 35% in initial treatments. The significant difference in the incidence of a MB2 canal between initial treatments and retreatments suggests that failure to find and treat existing MB2 canals will decrease the long-term prognosis.

Photodynamic therapy with water-soluble phtalocyanines against bacterial biofilms in teeth root canals

NASA Astrophysics Data System (ADS)

Gergova, Raina; Georgieva, Tzvetelina; Angelov, Ivan; Mantareva, Vanya; Valkanov, Serjoga; Mitov, Ivan; Dimitrov, Slavcho

2012-06-01

The study presents the PDT with metal phthalocyanines on biofilms grown in root canals of ten representatives of the Gram-positive and the Gram-negative bacterial species and a fungus Candida albicans which cause aqute teeth infections in root canals.. The extracted human single-root teeth infected for 48 h with microorganisms in conditions to form biofilms of the above pathogens were PDT treated. The stage of biofilm formation and PDT effect of the samples of the teeth were determined by the scaning electron microscopy and with standard microbial tests. The PDT treating procedure included 10 min incubation with the respected phthalocyanine and irradiated with 660 nm Diode laser for 10 min. The most strongly antibacterial activity was achieved with zinc(II) phthalocyanine (ZnPc) against Enterococcus faecalis, Staphylococcus aureus and Moraxella catarrhalis. The other Gram-negative bacteria and Candida albicans were 10-100 times more resistant than the Gram-positive species. The Gram-negative Moraxella catarrhalis and Acinetobacter baumannii were more sensitive than the enterobacteria, but eradication of Pseudomonas aeruginosa in biofilm was insignificant. The influence of the stage of biofilm formation and the initial conditions (bacterial density, photosensitizer concentration and energy fluence of radiation) to the obtained level of inactivation of biofilms was investigated. The PDT with ZnPc photosensitizers show a powerful antimicrobial activity against the most frequent pathogens in endodontic infections and this method for inactivation of pathogens may be used with sucsses for treatment of the bacterial biofilms in the root canals.

[Three dimensional mathematical model of tooth for finite element analysis].

PubMed

Puskar, Tatjana; Vasiljević, Darko; Marković, Dubravka; Jevremović, Danimir; Pantelić, Dejan; Savić-Sević, Svetlana; Murić, Branka

2010-01-01

The mathematical model of the abutment tooth is the starting point of the finite element analysis of stress and deformation of dental structures. The simplest and easiest way is to form a model according to the literature data of dimensions and morphological characteristics of teeth. Our method is based on forming 3D models using standard geometrical forms (objects) in programmes for solid modeling. Forming the mathematical model of abutment of the second upper premolar for finite element analysis of stress and deformation of dental structures. The abutment tooth has a form of a complex geometric object. It is suitable for modeling in programs for solid modeling SolidWorks. After analysing the literature data about the morphological characteristics of teeth, we started the modeling dividing the tooth (complex geometric body) into simple geometric bodies (cylinder, cone, pyramid,...). Connecting simple geometric bodies together or substricting bodies from the basic body, we formed complex geometric body, tooth. The model is then transferred into Abaqus, a computational programme for finite element analysis. Transferring the data was done by standard file format for transferring 3D models ACIS SAT. Using the programme for solid modeling SolidWorks, we developed three models of abutment of the second maxillary premolar: the model of the intact abutment, the model of the endodontically treated tooth with two remaining cavity walls and the model of the endodontically treated tooth with two remaining walls and inserted post. Mathematical models of the abutment made according to the literature data are very similar with the real abutment and the simplifications are minimal. These models enable calculations of stress and deformation of the dental structures. The finite element analysis provides useful information in understanding biomechanical problems and gives guidance for clinical research.

Prevalence of new candidate pathogens Prevotella baroniae, Prevotella multisaccharivorax and as-yet-uncultivated Bacteroidetes clone X083 in primary endodontic infections.

PubMed

Rôças, Isabela N; Siqueira, José F

2009-10-01

Culture-independent studies have revealed a broad spectrum of oral bacterial taxa that may be associated with disease. This study investigated the prevalence of three new candidate oral pathogens: Prevotella baroniae, Prevotella multisaccharivorax, and as-yet-uncultivated Bacteroidetes oral clone X083 in primary endodontic infections using a devised culture-independent approach. Genomic DNA was isolated from samples taken from 52 teeth with different forms of apical periodontitis and used as template in a taxon-specific 16S rRNA gene-based nested polymerase chain reaction assay to determine the prevalence of the 3 target taxa. Bacteroidetes clone X083, P. baroniae, and P. multisaccharivorax were respectively detected in 81%, 43%, and 38% of the root canals of teeth associated with chronic apical periodontitis, in 60%, 40% and 40% of the canals of teeth with acute apical periodontitis, and in 14%, 24%, and 5% of the pus aspirates from acute apical abscesses. No targeted taxon was positively associated with abscesses or clinical symptoms. Overall, Bacteroidetes clone X083, P. baroniae, and P. multisaccharivorax were found in 50%, 35%, and 25% of the samples taken from primary endodontic infections, respectively. Findings confirmed that the two newly named species and the uncultivated phylotype targeted in this study are associated with different forms of apical periodontitis, and a pathogenetic or at least an ecologic role is suspected.

Evaluation of dental students’ perception and self-confidence levels regarding endodontic treatment

PubMed Central

Tanalp, Jale; Güven, Esra Pamukçu; Oktay, Inci

2013-01-01

Objectives: The aim of this study was to obtain information about senior dental students’ perceptions and self-confidence levels regarding endodontic practice. Materials and Methods: Anonymous survey forms were handed out to senior students at Yeditepe University, Faculty of Dentistry. The students were asked to score their level of confidence using a 5-point scale and comment about future practices. Results: The response rate of the survey was 88%. 11.9% expressed endodontics as the first branch in terms of difficulty. The majority (90.5%) indicated they would perform root canal treatments within their expertise limit in the future but refer difficult cases to an endodontist. Bleaching of endodontically treated teeth, managing flare-ups, placement of a rubber dam were procedures in which students reported the lowest confidence (2.55 ± 1.17, 3.24 ± 0.96, 3.24 ± 1.19, respectively). On the other hand, students felt the lowest confidence in the treatment of maxillary molars followed by mandibular molars (3.43 ± 1.02 and 3.93 ± 0.97, respectively). Students also reported the lowest confidence in root resorptions, endo-perio lesions, traumas, retreatments and apexifications (2.93 ± 1.16, 3.07 ± 0.89, 3.24 ± 0.85, 3.33 ± 1.7 and 3.36 ± 1.1, respectively). Conclusions: The results showing students’ lower confidence in more challenging aspects of dentistry may be related with the attitude of dental schools to refer these cases to post graduate students and instilling information about these cases on a theoretical basis only. Though there seems to be a tendency for students to refer challenging cases to a specialist in future, authorities should give priority to enhance the way information and experience is conveyed regarding various aspects of endodontic treatment. PMID:24883030

Evaluation of dental students' perception and self-confidence levels regarding endodontic treatment.

PubMed

Tanalp, Jale; Güven, Esra Pamukçu; Oktay, Inci

2013-04-01

The aim of this study was to obtain information about senior dental students' perceptions and self-confidence levels regarding endodontic practice. Anonymous survey forms were handed out to senior students at Yeditepe University, Faculty of Dentistry. The students were asked to score their level of confidence using a 5-point scale and comment about future practices. The response rate of the survey was 88%. 11.9% expressed endodontics as the first branch in terms of difficulty. The majority (90.5%) indicated they would perform root canal treatments within their expertise limit in the future but refer difficult cases to an endodontist. Bleaching of endodontically treated teeth, managing flare-ups, placement of a rubber dam were procedures in which students reported the lowest confidence (2.55 ± 1.17, 3.24 ± 0.96, 3.24 ± 1.19, respectively). On the other hand, students felt the lowest confidence in the treatment of maxillary molars followed by mandibular molars (3.43 ± 1.02 and 3.93 ± 0.97, respectively). Students also reported the lowest confidence in root resorptions, endo-perio lesions, traumas, retreatments and apexifications (2.93 ± 1.16, 3.07 ± 0.89, 3.24 ± 0.85, 3.33 ± 1.7 and 3.36 ± 1.1, respectively). The results showing students' lower confidence in more challenging aspects of dentistry may be related with the attitude of dental schools to refer these cases to post graduate students and instilling information about these cases on a theoretical basis only. Though there seems to be a tendency for students to refer challenging cases to a specialist in future, authorities should give priority to enhance the way information and experience is conveyed regarding various aspects of endodontic treatment.

Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications.

PubMed

Bianchi, Bernardo; Ferri, Andrea; Varazzani, Andrea; Bergonzani, Michela; Sesenna, Enrico

2017-07-01

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve.Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors.Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal.The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction.Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement.The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

Scaffolds in regenerative endodontics: A review

PubMed Central

Gathani, Kinjal M.; Raghavendra, Srinidhi Surya

2016-01-01

Root canal therapy has enabled us to save numerous teeth over the years. The most desired outcome of endodontic treatment would be when diseased or nonvital pulp is replaced with healthy pulp tissue that would revitalize the teeth through regenerative endodontics. ‘A search was conducted using the Pubmed and MEDLINE databases for articles with the criteria ‘Platelet rich plasma’, ‘Platelet rich fibrin’, ‘Stem cells’, ‘Natural and artificial scaffolds’ from 1982–2015’. Tissues are organized as three-dimensional structures, and appropriate scaffolding is necessary to provide a spatially correct position of cell location and regulate differentiation, proliferation, or metabolism of the stem cells. Extracellular matrix molecules control the differentiation of stem cells, and an appropriate scaffold might selectively bind and localize cells, contain growth factors, and undergo biodegradation over time. Different scaffolds facilitate the regeneration of different tissues. To ensure a successful regenerative procedure, it is essential to have a thorough and precise knowledge about the suitable scaffold for the required tissue. This article gives a review on the different scaffolds providing an insight into the new developmental approaches on the horizon. PMID:27857762

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

PubMed Central

Fontes, Tatiana Vasconcellos; Ferreira, Sonia Maria Soares; Silva-Júnior, Arley; dos Santos Marotta, Patrícia; Noce, Cesar Werneck; de Carvalho Ferreira, Dennis; Gonçalves, Lucio Souza

2014-01-01

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection. PMID:25318095

Endodontic management of permanent mandibular molars with 6 root canals: report of 3 cases.

PubMed

Malhotra, Amit; Ahlawat, Jyoti; Bansal, Chirag; Tahiliani, Divya

2016-01-01

Aberrations in the internal dental anatomy present challenges for clinicians performing endodontic therapy. These challenges have been partly resolved in recent years by a more comprehensive knowledge of root canal anatomy as well as advancements in the endodontic armamentarium. The aim of this case series is to describe successful root canal treatment, under magnification, in 3 cases of mandibular first molars with 6 root canals. Two of these teeth had 2 roots (mesial and distal) with 3 canals in each root; the third tooth had 3 root canals located mesially and 3 present distally as well as a radix entomolaris. A distal root with 3 canals is rare; however, it is important to look for such anatomical variations to ensure successful endodontic therapy.

Endodontic Management of Maxillary First Molar With Two Palatal Canals Aided With Cone Beam Computed Tomography: A Case Report.

PubMed

Pamboo, Jaya; Hans, Manoj Kumar; Chander, Subhas; Sharma, Kapil

2017-04-01

The success of endodontic therapy is based on having sufficient endodontic access, correct cleaning and shaping, and adequate root canal obturation. However, endodontic treatment is also dependent on having a sound knowledge of the internal anatomy of human teeth, especially when anatomic variations are present. Reporting these alterations is important for improving the understanding and expertise of endodontists. The aim of this case report is to describe a unique case of maxillary first molar with 2 palatal canals within a single root, as confirmed by cone-beam computed tomography (CBCT) scans. This article also reviews recent case reports of extra palatal root canals in the maxillary first molars and the role of CBCT analysis in successfully diagnosing them.

Permanent molar pulpotomy with a new endodontic cement: A case series

PubMed Central

Asgary, Saeed; Ehsani, Sara

2009-01-01

The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC), in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14 – 62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day) no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth. PMID:20379438

[Combination of periodontal, orthodontic and endodontic therapy in upper anterior teeth with hopeless prognosis and long-time follow-up: a case report].

PubMed

Li, Y; Xu, L; Zhou, Y H; Ouyang, X Y; Cao, T

2017-08-18

It is complicated to decide the treatment plan of hopeless anterior teeth in esthetic zone due to severe periodontitis, periodontal-endodontic combined lesion or teeth trauma. The optional treatment plan for this kind of teeth includes retention after periodontal treatment, extraction and implant treatment, extraction and prosthodontic treatment and so on. To make an appropriate treatment plan, patients' periodontal conditions, periodontal biotype, local anatomy, esthetic demand, economic condition and social psychological status should be comprehensively considered. A combine of periodontal, endodontic and orthodontic therapy may achieve a good treatment effect in hopeless anterior teeth with severe periodontal destruction, tooth extrusion and occlusal trauma. In this case, a 20-year-old female who presented with symptoms of bleeding on brushing and upper incisors loosening for 1 month came to the Department of Periodontology, Peking University School and Hospital of Stomatology. The clinical examinations revealed that the patient's right upper incisor had signs of mobility (III°), intrusion of 1-2 mm, and probing depth (PD) of 9-10 mm. The periapical radiograph showed that the alveolar bone of right upper incisor absorbed horizontally to the apex. And the patients showed Angle II° malocclusion with II° overbite in anterior teeth and maxillary protrusion. A diagnosis of aggressive periodontitis and Angle II° malocclusion was made. The treatment of this patient lasts for 5 years which include periodontal initial therapy, orthodontic therapy, guided tissue regeneration (GTR) of right upper incisor and supportive periodontal therapy and the clinical result is fine. A hopeless upper incisor was successfully retained and the longtime clinical condition was stable. The strategy of retention of hopeless upper anterior teeth, the relationship of periodontal treatment and orthodontic treatment, and the indications of periodontal and orthodontic combined therapy were also discussed on the basis of this case. Generally, the positive factors in retention of hopeless teeth includes young age, absence of systemic conditions, strong motivation for maintaining the tooth, single root anatomy, integrated dentition, good response to cause-related therapy, intrabony alveolar bone defect, thick periodontal biotype, and regular supportive periodontal therapy. And in the progress of orthodontic therapy, regular supportive periodontal therapy and good plaque control is extremely important.

Maxillary First Molars with 2 Distobuccal Canals: A Case Series.

PubMed

Fogel, Howard M; Cunha, Rodrigo Sanches

2017-11-01

An appreciation of the anatomic complexity of the root canal system is essential at every step of endodontic treatment. Endodontic treatment of teeth with unusual root canal anatomy presents a unique challenge. Eight patients underwent nonsurgical root canal treatment of 3-rooted maxillary first molars in a specialty endodontic private practice. Four cases of Weine type II and 4 cases of Weine type III canal configurations in the distobuccal root of maxillary first molars were presented.This article highlighted an uncommon anatomic variation of 2 canals in the distobuccal root of the maxillary first molar. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Bioactive Glass Scaffolds for Dental Pulp and Dentin Tissue Engineering

NASA Astrophysics Data System (ADS)

Shawli, Hassan Talat

Current and historical endodontic "root canal" treatments employ inert obturating materials inserted into the teeth's pulp chambers and root canals, often saving teeth but without adequate function. Furthermore, the occurrence of pulpal necrosis in the immature permanent tooth is considered to be a challenging situation, clinically, in treatment because the thin and often short roots increase the risk of fracture. The ideal treatment would be to promote continued root development. This work demonstrated that endodontically-shaped and durable scaffolds of slowly resorbable fibrous (HT) glass and faster-resorbing small-particle Bioglass can be sintered at 900 degrees C for such placement, and that cell growth of osteoblasts in these scaffolds shows good early results. Retained bioactivity in the sintered specimen was revealed by Multiple Attenuated Internal Reflection Infrared Spectroscopy.

Ribbond for treatment of complicated crown fractures: report of 3 cases.

PubMed

Akgun, Ozlem Marti; Altun, Ceyhan; Guven, Gunseli; Basak, Feridun

2012-01-01

Dental trauma is relatively common and can occur secondary to sporting injuries, falls, fights, or accidents. According to the International Association of Dental Traumatology, 50% of children experience dental trauma between the ages of 8 to 12. There are many options for endodontic and restorative treatments of traumatized teeth. Ribbond, which was introduced in the market in 1992, consists of bondable, reinforced ultra-high strength polyethylene fibers. Ribbond may be an option for the treatment of traumatized teeth because of its aesthetic properties; absence of additional tooth preparation; and its high resistance to traction, which allows it to easily adapt to tooth morphology. In this report, we describe endodontic and restorative treatments using Ribbond for 3 female patients with horizontal complicated crown fractures of the maxillary incisors.

Long-term clinical evaluation of endodontically treated teeth by 15 F CO2 laser microprobe: three years clinical follow-up of 1512 root canals--in-vivo study

NASA Astrophysics Data System (ADS)

Kesler, Gavriel; Koren, Rumelia; Kesler, Anat; Hay, Nissim; Gal, Rivka

1999-05-01

The purpose of this study was to determine the efficiency of 15 F CO2 laser microprobe, in cases of periapical lesions, by eliminating the pathological reaction caused by certain species of bacteria, reduction of reinfection and stimulation of osteogenesis in the periapical region. Until now, no suitable delivery fiber existed for CO2 laser endodontic radiation in the apical region where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, Sharplan laser designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal, thus favorably increasing the thermal effects. The study was conducted on 900 teeth, divided in two groups. 468 were new case, carefully selected according to strict parameters such as: wide periapical translucency over 1mm, supported by digital x-ray, with a lesion of 3mm and more. All root canals were mechanically prepared in the conventional method up to size 35, Physiological saline solution served as finding solution and were treated by 15 F CO2 laser microprobe for 60 pulses repeatedly. The temperature at the surrounding tissue of the root did not exceed 38 degrees C filling of the canal was possible at the same appointment, without antibiotical treatment. 432 of the cases, which were referred to us by other dentists, after an unsuccessful treatment according to the classical therapy, were treated by the same laser therapy. Follow up was performed by clinical examination, and digital x-ray taken, during and after treatment as well as after 3, 6, 9, 12 month. The result demonstrate 98% success rate in both study groups, according to objective criteria for a successful treatment such as: reduction of apical translucency after 2- 6 months, freedom form clinical complains, and no need for periapical surgery.

Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs' teeth with apical periodontitis.

PubMed

da Silva, Lea Assed Bezerra; Nelson-Filho, Paulo; da Silva, Raquel Assed Bezerra; Flores, Daniel Silva Herzog; Heilborn, Carlos; Johnson, James D; Cohenca, Nestor

2010-05-01

The objective of this study was to evaluate in vivo the revascularization and the apical and periapical repair after endodontic treatment using 2 techniques for root canal disinfection (apical negative pressure irrigation versus apical positive pressure irrigation plus triantibiotic intracanal dressing) in immature dogs' teeth with apical periodontitis. Two test groups of canals with experimentally induced apical periodontitis were evaluated according to the disinfection technique: Group 1, apical negative pressure irrigation (EndoVac system), and Group 2, apical positive pressure irrigation (conventional irrigation) plus triantibiotic intracanal dressing. In Group 3 (positive control), periapical lesions were induced, but no endodontic treatment was done. Group 4 (negative control) was composed of sound teeth. The animals were killed after 90 days and the maxillas and mandibles were subjected to histological processing. The sections were stained with hematoxylin and eosin and Mallory Trichrome and examined under light microscopy. A description of the apical and periapical features was done and scores were attributed to the following histopathological parameters: newly formed mineralized apical tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, dentin resorption, and bone tissue resorption. Intergroup comparisons were done by the Kruskal-Wallis and Dunn's tests (alpha = 0.05). Although statistically significant difference was found only for the inflammatory infiltrate (P < .05), Group 1 presented more exuberant mineralized formations, more structured apical and periapical connective tissue, and a more advanced repair process than Group 2. From the histological observations, sodium hypochlorite irrigation with the EndoVac system can be considered as a promising disinfection protocol in immature teeth with apical periodontitis, suggesting that the use of intracanal antibiotics might not be necessary. Copyright (c) 2010 Mosby, Inc. All rights reserved.

Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry.

PubMed

Duggal, M; Tong, H J; Al-Ansary, M; Twati, W; Day, P F; Nazzal, H

2017-06-01

This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development. Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation. Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors. Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.

Nonsurgical management of periapical lesions: a prospective study.

PubMed

Shah, N

1988-09-01

A total of 93 cases comprising 132 teeth with signs and symptoms or radiographic evidence of periapical pathoses were treated endodontically and were followed up for a period of 2 years. Nonsurgical management was successful in 84.4% of the cases. Histopathologic examination of tissue specimens from cases in which treatment failed revealed that only 35.7% of the cases involved apical cysts, while the remaining 64.3% involved chronic inflammatory tissue. Interestingly, 50% of the failures were observed at or 1 year after completion of treatment, which stresses the need for long-term follow-up of treated endodontic cases. In this study, a successful outcome did not seem to be dependent on either the nature or the size of the lesion, even though it is true that treatment of larger lesions failed more frequently. There seems to be some individual immunologic response variation, which may influence the final outcome of the treatment. Gyromatic instruments were used in 44 of the 93 cases treated and were evaluated and compared with hand instruments in clinical situations. Gyromatic instruments were found to be more convenient and safer to use, since their use improved visibility and eliminated the risk of the instruments' falling into the throat and being aspirated. They exhibited good flexibility and could easily negotiate curved canals without breaking. Used judiciously, these would be efficient tools in the endodontist's armamentarium.

An analysis of the timing and materials associated with pulp disease following restorative dental treatment.

PubMed

Yong, J B; Sivarajan, S; Abbott, P V

2018-05-19

To assess whether the timing of pulp disease after tooth restoration was associated with type of restorative dental material used, extent of the restoration, or tooth type. A comprehensive search and analysis of data using the Titanium Oral Health Management software program at The Oral Health Centre of Western Australia was performed to correlate procedural codes for teeth that had restorations placed and subsequently developed pulp disease requiring endodontic treatment or extraction from 1 st January 2009 to 31 st December 2013. Manual analysis of paper and/or electronic patient record cards was also performed. Data collected included restoration type, restored tooth surfaces, tooth type, and the dates of restoration and subsequent endodontic intervention or extraction. Of 330 teeth that met the inclusion criteria, 84 (26%) had composite resin restorations, 80 (24%) had amalgams, 119 (36%) had GICs and 47 (14%) had crowns. The average time between restoration and further intervention was 330 days with a range from 3 days to 1,775 days (approx. 5 years). Teeth restored with crowns or five-surface restorations were significantly more likely to require earlier intervention than other restorations. Premolar and anterior teeth were also more likely to require earlier intervention. Teeth that developed pulp disease requiring further intervention that were restored with crowns and five-surface GIC developed the disease sooner than teeth that were restored with amalgam or composite. In teeth with five surface restorations that developed pulp disease requiring further intervention, premolar and anterior teeth developed the pulp disease sooner than molars. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Endodontic management of supernumerary tooth fused with maxillary first molar by using cone-beam computed tomography.

PubMed

Song, Chang-Kyu; Chang, Hoon-Sang; Min, Kyung-San

2010-11-01

Fusion is a rare occurrence, and its definitive diagnosis is of prime importance for successful root canal treatment. This case report discusses the endodontic management of a supernumerary tooth fused with a right maxillary first molar by using cone-beam computed tomography (CBCT). Nonsurgical endodontic retreatment was performed on the supernumerary tooth. A communication between the maxillary first molar and the supernumerary tooth was repaired by using flowable resin. After 1 year of follow-up, there were no clinical symptoms, and the maxillary first molar remained vital. Recall radiographs and CBCT showed satisfactory healing of the periapical pathosis. Proper diagnosis and treatment planning for endodontic management of fused teeth by using CBCT can ensure predictable and successful results. Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach

PubMed Central

Asgary, Saeed

2014-01-01

As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning. PMID:24790924

Local anesthetics: special considerations in endodontics.

PubMed

Jeske, Arthur H

2003-03-01

Local anesthetics are essential for successful endodontic treatment, and their pharmacologic characteristics have special implications for the treatment of painful, chronically-inflamed or necrotic teeth. Their dosages must be limited to prevent toxicity, which may be enhanced by the coadministration of sedative agents or drugs which affect hepatic drug metabolism. Endodontic patients with established central and peripheral sensitization represent special challenges for pain control, since morphogenetic changes resulting from neurogenic inflammation can render pain fibers more resistant to local anesthesia. The use of vasconstrictors with conventional and alternative injection techniques, e.g., intraosseous injections, are necessary to prolong the duration of action of local anesthesia but can place patients with cardiovascular disease at some risk. An appreciation of all of these aspects of local anesthesia in endodontics will better prepare the operator for predictably safe and effective patient care.

Introduction of implants into postdoctoral endodontic residency programs.

PubMed

Aminoshariae, Anita; Montagnese, Thomas A; Solanki, Poonam D; Mickel, Andre K

2011-09-01

The purpose of this study was to survey the directors of postdoctoral endodontic programs in the United States to ascertain their attitudes and approaches regarding incorporation of implants into the endodontic curriculum. We hypothesized that program directors would agree that implant training should be incorporated into the endodontic curriculum. We also hypothesized that they would all prefer apical surgeries and retreatment over implants when plausible. A twenty-item online survey was emailed to all fifty-two postdoctoral endodontic program directors in the United States. A 100 percent response was received. The results showed that 78.6 percent agreed that implant training should be incorporated, 85.7 percent preferred the didactic approach, and 42.9 percent preferred clinical implant training. One hundred percent preferred apical surgeries and retreatment over implants when plausible, and 53.8 percent did not prefer implants over endodontic treatment for teeth with a questionable prognosis. This survey indicates that implant training has been incorporated into postdoctoral endodontic programs and that the Commission on Dental Accreditation standards are being met. The trend may be to become more hands-on in the future if program directors believe there is a need to provide training in actual placement of implants.

Antimicrobial photodynamic therapy combined with conventional endodontic treatment to eliminate root canal biofilm infection.

PubMed

Garcez, Aguinaldo S; Ribeiro, Martha S; Tegos, George P; Núñez, Silvia C; Jorge, Antonio O C; Hamblin, Michael R

2007-01-01

To compare the effectiveness of antimicrobial photodynamic therapy (PDT), standard endodontic treatment and the combined treatment to eliminate bacterial biofilms present in infected root canals. Ten single-rooted freshly extracted human teeth were inoculated with stable bioluminescent Gram-negative bacteria, Proteus mirabilis and Pseudomonas aeruginosa to form 3-day biofilms in prepared root canals. Bioluminescence imaging was used to serially quantify bacterial burdens. PDT employed a conjugate between polyethylenimine and chlorin(e6) as the photosensitizer (PS) and 660-nm diode laser light delivered into the root canal via a 200-micro fiber, and this was compared and combined with standard endodontic treatment using mechanical debridement and antiseptic irrigation. Endodontic therapy alone reduced bacterial bioluminescence by 90% while PDT alone reduced bioluminescence by 95%. The combination reduced bioluminescence by >98%, and importantly the bacterial regrowth observed 24 hours after treatment was much less for the combination (P<0.0005) than for either single treatment. Bioluminescence imaging is an efficient way to monitor endodontic therapy. Antimicrobial PDT may have a role to play in optimized endodontic therapy. (c) 2006 Wiley-Liss, Inc.

An in-vitro evaluation of the effect of 980 nm diode laser irradiation on intra-canal dentin surface and dentinal tubule openings after biomechanical preparation: Scanning electron microscopic study

PubMed Central

Jhingan, Pulkit; Sandhu, Meera; Jindal, Garima; Goel, Deepti; Sachdev, Vinod

2015-01-01

Context: Very recently, diode laser has been used for disinfecting the root canals in endodontic treatment and increasing its success rate and longevity utilizing the thermal effect of laser on surrounding tissues. Aims: The aim of this study is to evaluate the effect of 980 nm laser irradiation on intra-canal dentin surface – scanning electron microscopic (SEM) - in-vitro study. Methods: A total of 40 single-rooted freshly extracted permanent teeth were collected. Teeth were sectioned at the cemento-enamel junction using diamond disc. Root canals of all samples were prepared using hand ProTaper, which were randomly assigned into two groups (n = 20 each). Group 1: Receiving no treatment after biomechanical preparation; Group 2: 980 nm diode laser-treated root canals. Teeth were prepared for SEM analysis to check the size of intra-canal dentinal tubule openings. Statistical Analysis Used: Data were analyzed using SPSS V.16 software and compared using Levene's and independent t-test. Results: On statistical analysis, width of intracanal dentinal tubule openings in Group 1 (control) was significantly higher than those observed in Group 2 (diode laser-treated) (P < 0.001). Conclusion: This study showed that the application of 980 nm diode laser on intra-radicular dentin resulted in ultrastructural alterations resulting in melting of dentin. PMID:26097338

Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series.

PubMed

Cehreli, Zafer C; Isbitiren, Beste; Sara, Sezgi; Erbas, Gizem

2011-09-01

Revascularization is an emerging regenerative treatment protocol with little published data available in immature molar teeth. The present case series demonstrates the outcome of revascularization treatment with intracanal medicament of calcium hydroxide in immature necrotic molars. Immature necrotic permanent first molars (n = 6) of patients 8-11 years old were treated by a revascularization protocol that used 2.5% NaOCl irrigation, medication with calcium hydroxide placed in the coronal third of the root canals, induction of apical bleeding, and coronal sealing with white mineral trioxide aggregate. Among the treated teeth, 4 molars had undergone prior root canal instrumentation by the referring dentists. National Institutes of Health Image-J program with TurboReg plug-in was used for standardization of the radiographs and to determine the increase in root length and root width. After a follow-up period of 10 months, all teeth demonstrated radiographic evidence of complete periapical healing, progressive thickening of dentinal walls, and continued apical development in the absence of clinical symptoms. Two uninstrumented molars showed a positive response to cold testing at 9 months. On the basis of a follow-up period of 10 months, the present cases demonstrate a favorable outcome of the revascularization procedure in immature necrotic molars by using calcium hydroxide medication in the coronal third of the root canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Prevalence of vertical root fracture as the reason for tooth extraction in dental clinics.

PubMed

Yoshino, Koichi; Ito, Koji; Kuroda, Masahiko; Sugihara, Naoki

2015-07-01

The aim of this study was to investigate the prevalence, by gender, of vertical root fracture (VRF) as the main reason for the extraction of permanent teeth in dental clinics in Tokyo. Participating dentists were requested to provide information about extractions of permanent teeth they had performed from 1 January 2013 to 30 June 2013. The main reasons for extraction were categorized as follows: VRF, caries (horizontal root fracture included), periodontal disease and others. At a total of 24 clinics, 736 teeth were extracted from 626 patients during the 6-month period. A total of 233 teeth were extracted by VRF (31.7%), and 93.6% of these were endodontically treated teeth. Among non-vital extracted teeth, 82.1% (179/218) had cast posts or screw posts. The percentage of extraction due to VRF was 29.4% in males and 34.7% in females. In females, the percentage of extractions due to VRF (34.7%) was higher than for periodontal disease (28.1%). In males, the percentage of extractions due to VRF increased with age (p < 0.05). The tooth types with the highest percentage of extractions due to VRF were the upper canine (46.7%), lower second premolar (48.0%) and lower first molar (50.0%) in males and the upper first premolar (43.3%), upper second premolar (44.4%), lower second premolar (53.8%) and lower first molar (54.5%) in females. These results indicate that we need to pay more attention to maintaining vital teeth while being aware of the particular tooth types in which VRF most frequently occurs.

Antigenicity of primary endodontic infection against macrophages by the levels of PGE(2) production.

PubMed

Martinho, Frederico C; Chiesa, Wanderson Miguel Maia; Leite, Fabio R M; Cirelli, Joni A; Gomes, Brenda P F A

2011-05-01

Root canal contents are potent stimuli for proinflammatory cytokines involved in apical periodontitis. This study investigated target gram-negative bacterial species and endotoxins in primary endodontic infection with apical periodontitis, determined their antigenicity against macrophages through the levels of PGE(2), and evaluated their relationship with clinical findings. Samples were taken from 21 root canals with primary infection and apical periodontitis by using paper points. Polymerase chain reaction (16S rDNA) was used for bacterial detection and limulus amebocyte lysate assay for endotoxin measurement. Levels of prostaglandin E2 (PGE(2)) were measured by enzyme-linked immunosorbent assay (Duoset Kit; R&D, Minneapolis, MN). Prevotella nigrescens (13/21), Fusobacterium nucleatum (6/21), and Porphyromonas endodontalis (6/21) were the most frequently observed species. A positive association was found between F. nucleatum and P. endodontalis (P < .05). A correlation was found between the number of gram-negative bacterial species and the levels of endotoxins, such as PGE(2) (P < .05). Higher levels of endotoxin were detected in teeth with exudation, whereas elevated levels of PGE(2) were found in teeth with tenderness to percussion and pain on palpation. Our findings imply an additive effect between the number of gram-negative bacterial species involved in endodontic infection regarding the induction of proinflammatory cytokine by macrophage cells. Moreover, teeth with clinical symptomatology were related to higher levels of endotoxins and PGE(2) secretion. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Cone beam computed tomography evaluation and endodontic management of permanent mandibular second molar with four roots: A rare case report and literature review

PubMed Central

Rajasekhara, Subhashini; Sharath Chandra, SM; Parthasarathy, Late Bharath

2014-01-01

The morphological variation in the number of roots and root canals, especially in multi-rooted teeth is a constant challenge for diagnosis and successful endodontic therapy. Knowledge of the most common anatomic characteristics and their possible variations is fundamental. Although, endodontic management of four-rooted mandibular first molars have been observed on a few occasions in the literature, to the best of our knowledge four-rooted mandibular second molars having two mesial and two distal roots have not been reported. This paper highlights endodontic management of mandibular second molar with four roots (two mesial and two distal) with one canal in each root and its cone beam computed tomography (CBCT) evaluation which was primarily done for post treatment assessment for diagnosing post-endodontic complications, at the same time confirmed our radiographic diagnosis of this variation. This also helped us portraying the anatomy of this rare variation. PMID:25125856

Endodontic complications of root canal therapy performed by dental students with stainless-steel K-files and nickel-titanium hand files.

PubMed

Pettiette, M T; Metzger, Z; Phillips, C; Trope, M

1999-04-01

Straightening of curved canals is one of the most common procedural errors in endodontic instrumentation. This problem is commonly encountered when dental students perform molar endodontics. The purpose of this study was to compare the effect of the type of instrument used by these students on the extent of straightening and on the incidence of other endodontic procedural errors. Nickel-titanium 0.02 taper hand files were compared with traditional stainless-steel 0.02 taper K-files. Sixty molar teeth comprised of maxillary and mandibular first and second molars were treated by senior dental students. Instrumentation was with either nickel-titanium hand files or stainless-steel K-files. Preoperative and postoperative radiographs of each tooth were taken using an XCP precision instrument with a customized bite block to ensure accurate reproduction of radiographic angulation. The radiographs were scanned and the images stored as TIFF files. By superimposing tracings from the preoperative over the postoperative radiographs, the degree of deviation of the apical third of the root canal filling from the original canal was measured. The presence of other errors, such as strip perforation and instrument breakage, was established by examining the radiographs. In curved canals instrumented by stainless-steel K-files, the average deviation of the apical third of the canals was 14.44 degrees (+/- 10.33 degrees). The deviation was significantly reduced when nickel-titanium hand files were used to an average of 4.39 degrees (+/- 4.53 degrees). The incidence of other procedural errors was also significantly reduced by the use of nickel-titanium hand files.

Dentine sialoprotein and collagen I expression after experimental pulp capping in humans using emdogain gel.

PubMed

Fransson, H; Petersson, K; Davies, J R

2011-03-01

To characterize the hard tissue formed in human teeth experimentally pulp capped either with calcium hydroxide or with Emdogain Gel (Biora AB, Malmö, Sweden) - a derivative of enamel matrix (EMD), using two markers for dentine; dentine sialoprotein (DSP) and type 1 collagen (Col I). Affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies were used to stain histological sections from nine pairs of contra-lateral premolars that had been experimentally pulp amputated and randomly capped with EMDgel or calcium hydroxide. Twelve weeks after the teeth had been pulp capped, they were extracted, fixed, demineralized and serially sectioned prior to immunohistochemical staining. In the calcium hydroxide treated teeth DSP was seen in the new hard tissue which formed a bridge. DSP was also seen in the newly formed hard tissue in the EMDgel-treated teeth. Proliferated pulp tissue partly filled the space initially occupied by EMDgel and DSP-stained hard tissue was observed alongside exposed dentine surfaces as well as in isolated masses within the proliferated pulp tissue, although the new hard tissue did not cover the pulp exposure. DSP staining was also seen in the cells lining the hard tissue in both groups. Col I staining was seen in the newly formed hard tissue in both groups. The new hard tissue formed after pulp capping with EMDgel or calcium hydroxide contained DSP and Col I, considered to be markers for dentine. Thus, the newly formed hard tissue can be characterized as dentine rather than unspecific hard tissue. © 2010 International Endodontic Journal.

Single-rooted maxillary first molar with a single canal: endodontic retreatment.

PubMed

de la Torre, Francisco; Cisneros-Cabello, Rafael; Aranguren, José Luis; Estévez, Roberto; Velasco-Ortega, Eugenio; Segura-Egea, Juan José

2008-12-01

This case report presents an unusual root canal system in a maxillary first molar tooth: a single canal in a single root. The endodontic access cavity displayed only 1 canal orifice. This case demonstrated that: 1) clinicians must have adequate knowledge about root canal morphology and its variations; 2) the location and morphology of root canals should be identified radiologically before the root canal treatment; and 3) careful examination of radiographs and the internal anatomy of teeth is essential.

Fracture resistance of simulated immature teeth filled with Biodentine and white mineral trioxide aggregate - an in vitro study.

PubMed

Elnaghy, Amr M; Elsaka, Shaymaa E

2016-04-01

The purpose of this study was to evaluate the long-term fracture resistance of simulated immature teeth filled with Biodentine (BD) and white mineral trioxide aggregate (WMTA) as pulp space barriers for regenerative endodontic procedures (REPs). Sixty extracted human maxillary anterior teeth were divided into four groups of 15 teeth each. Positive control teeth received no treatment. The remaining teeth were prepared until a size 6 Peeso (1.7 mm) could be passed 1 mm beyond the apex. Then, an engineering twist drill of 3 mm diameter was used to extend the preparation of the canal 3 mm below CEJ. The root canals were irrigated and disinfected according to AAE considerations for REPs. The canals were filled with either BD or WMTA. The negative control canals were left unfilled. The coronal access cavities were restored with glass ionomer followed by composite resin. The teeth were placed in phosphate-buffered saline solution and stored for 12 months. Each specimen was then subjected to fracture testing using a universal testing machine. The peak load to fracture and the fracture resistance were recorded, and the data were analysed statistically. The positive control group had the highest fracture resistance and differed significantly (P < 0.05) from the other experimental groups. No significant difference was found between BD and WMTA (P > 0.05). Considering the risk of cervical root fracture for pulpless infected immature teeth treated with REPs, after 12 months, there was no difference between WMTA and BD regarding the resistance to root fracture. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of Fractured Teeth Utilizing Digital Microscopy: A Pilot Study

DTIC Science & Technology

2016-06-01

ANALYSIS OF FRACTURED TEETH UTILIZING DIGITAL MICROSCOPY: A PILOT STUDY by Thomas Gene Cooper, D.M.D., M.P.H. Lieutenant Commander, Dental Corps...United States Navy A thesis submitted to the Faculty of the Endodontic Graduate Program Naval Postgraduate Dental School Uniformed Services...Postgraduate Dental School Uniformed Services University of the Health Sciences Bethesda, Maryland CERTIFICATE OF APPROVAL MASTER’S THESIS This is to

Incidence of flare-ups and evaluation of quality after retreatment of resorcinol-formaldehyde resin ("Russian Red Cement") endodontic therapy.

PubMed

Gound, Tom G; Marx, David; Schwandt, Nathan A

2003-10-01

The purpose of this retrospective study was to evaluate the quality of treatment and incidence of flare-ups when teeth with resorcinol-formaldehyde resin are retreated in a postgraduate endodontic clinic. Fifty-eight cases were included in this study. Obturated and unfilled canal space was measured on radiographs. Forty-eight percent of the total canal space was filled before retreatment; 90% was filled after retreatment. After retreatment, obturations were rated as optimal in 59%, improved in 33%, unchanged in 6%, and worse in 2%. Seven patients (12%) had postretreatment flare-ups. Data were statistically analyzed using the Cochran-Armitage Test for Discrete Variables. No statistical difference in the incidence of flare-ups was found in teeth that before treatment had more than half the canal space filled compared to teeth with less than half, cases with pre-existing periradicular radiolucencies compared to cases with normal periradicular appearance, symptomatic cases compared to asymptomatic cases, or cases with optimal fillings after retreatment compared to less than optimal cases. It was concluded that teeth with resorcinol-formaldehyde fillings might be retreated with a good prognosis for improving the radiographic quality, but a higher than normal incidence of flare-ups may occur.

Cytokine analysis in lesions refractory to endodontic treatment.

PubMed

Henriques, Luiz Carlos Feitosa; de Brito, Luciana Carla Neves; Tavares, Warley Luciano Fonseca; Vieira, Leda Quércia; Ribeiro Sobrinho, Antônio Paulino

2011-12-01

Failure in endodontic treatment is often caused by the persistence of microorganisms in the root canal after therapy. When treatment fails, an immune response develops that is characterized by an extensive network of immunologic mechanisms that lead to the production of cytokines and chemokines. The objective of this study was to determine the relative messenger RNA (mRNA) expression of IFN-γ, TNF-α, IL-1β, IL-17A, IL-10, and MCP-1 in periapical dental lesions refractory to treatment. Clinical samples were taken from teeth presenting periapical lesions refractory to endodontic treatment (the experimental group) or from healthy teeth with pulp vitality (the control group). Three paper points passing through the root apex (2 mm) were used to collect the samples. The total RNA was extracted from each sample, complementary DNA was synthesized, and quantitative polymerase chain reaction analysis was performed. The Mann-Whitney U test was used to determine the statistical significance of our findings (P < .05). Significant differences in the levels of IFN-γ, TNF-α, IL-17A, and MCP-1 mRNA expression were observed in cases refractory to endodontic treatment as compared with the control group. The expression of IL-1β mRNA was not significantly different between the groups. The expression of IL-10 mRNA was insignificant in both the experimental and control groups. A significantly increased expression of TNF-α, IFN-γ, IL-17A, and MCP-1 mRNA was observed in the periapical immune response in cases of endodontic failure. These results suggest that a proinflammatory cytokine profile predominates in these types of dental lesions. Copyright © 2011 American Association of Endodontists. All rights reserved.

Endodontic treatment associated with photodynamic therapy: Case report.

PubMed

Firmino, Ramon Targino; Brandt, Lorenna Mendes Temóteo; Ribeiro, Gustavo Leite; Dos Santos, Katia Simone Alves; Catão, Maria Helena Chaves de Vasconccelos; Gomes, Daliana Queiroga de Castro

2016-09-01

The complete elimination of bacteria inside the root canal is a difficult task, and inconsistent removal of the innermost layer of contaminated dentin leaves bacteria behind. PDT is an adjunct to conventional endodontic treatment due to its potential to reduce bacteria and its biocompatibility. Report a case of endodontic treatment associated with Photodynamic Therapy (PDT). A patient with chronic dentoalveolar abscess with radiolucent lesion next to the apexes of teeth 11 and 21 was submitted to conventional endodontic treatment associated with PDT. The canals were filled after two PDT sessions with an interval of 15days between applications. After six months, total regression of apical periodontitis and no fistula or associated symptoms were observed. The treatment proposed is a viable option for the clinician as it is easy to perform, has relatively low-cost and allows the improvement of symptoms in a short period of time. Copyright © 2016 Elsevier B.V. All rights reserved.

Searching for Helicobacter pylori and Chlamydia pneumoniae in primary endodontic infections.

PubMed

Rôças, Isabela N; Siqueira, José F

2012-04-01

The purpose of this study was to search samples from primary endodontic infections for the presence of two common human bacterial pathogens - Helicobacter pylori and Chlamydia pneumoniae. Genomic DNA isolated from samples taken from 25 root canals of teeth with asymptomatic (chronic) apical periodontitis and 25 aspirates from acute apical abscess was initially amplified by the multiple displacement amplification approach and then used as template in species-specific polymerase chain reaction (PCR) for detection of H. pylori and C. pneumoniae. All clinical samples were positive for the presence of bacterial DNA. However, no clinical sample was positive for either H. pylori or C. pneumoniae. Neither H. pylori nor C. pneumoniae were found in samples from primary endodontic infections. These findings suggest that these species are not candidate endodontic pathogens and that the necrotic root canal does not serve as a reservoir for these human pathogens in healthy patients.

Regenerative endodontic treatment of an immature tooth with a necrotic pulp and apical periodontitis using platelet-rich plasma (PRP) and mineral trioxide aggregate (MTA): a case report.

PubMed

Sachdeva, G S; Sachdeva, L T; Goel, M; Bala, S

2015-09-01

To report the successful clinical and radiographic outcome of a regenerative endodontic treatment. A 16-year-old male patient presented with a discoloured, maxillary left lateral incisor with a necrotic pulp. Radiographic examination revealed an incompletely developed root with an open apex. Under local anaesthesia and rubber dam isolation, an access cavity was prepared and the necrotic pulpal remnants were removed. The canal was disinfected without mechanical instrumentation with 5.25% NaOCl solution and dried with sterile paper points. A triple antibiotic (metronidazole, ciprofloxacin and minocycline) mixed with distilled water was packed in the canal and left for 28 days. Ten millimetres of whole blood was drawn by venipuncture from the patients antecubital vein for preparation of platelet-rich plasma (PRP). After removal of the antibiotic mixture, the PRP was injected into the canal space up to the cementoenamel junction level. Three millimetres of white MTA was placed directly over the PRP clot. Two days later, the tooth was restored with permanent filling materials. The patient was recalled for 3, 6, 12, 24 and 36 months clinical/radiographic follow-up. A 3-year follow-up radiograph revealed resolution of the periapical lesion, increased thickening of the root walls, further root development and continued apical closure of the root apex. The tooth was not responsive to cold tests; however, sensitivity tests with an electric pulp tester (EPT) elicited a delayed positive response. Regeneration is a viable treatment modality that allows continued root development of immature teeth with open apices and necrotic pulps. Platelet-rich plasma appears to be a suitable scaffold for regeneration of vital tissues in teeth with a necrotic pulps and an associated periapical lesion. Regenerative endodontic procedures may offer an effective treatment option to save teeth with compromised structural integrity. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

The maxillary second molar - anatomical variations (case report).

PubMed

Beshkenadze, E; Chipashvili, N

2015-01-01

To be acquainted with dental anatomical specificity is of great importance for dental endodontic treatment algorithm. The subject of present publication is 2 clinical cases of upper second molars, detailed characterization of, which is considered very important for enrichment of anatomical knowledge about dental anatomical variations. In one case, the reason for admission to the clinic of a 38-year-old woman was complains as of esthetic character as well as functional misbalance (disturbance of chewing function due to the damage of orthopedic construction). The patient indicated to the existence of coronary defects of large size aesthetic discomforts, damage and discolouration of old orthopedic construction (denture) in maxillary right molar area. According to the data obtained after clinical and visiographical examinations, chronic periodontitis of 17 teeth was identified as a result of incomplete endodontic treatment. According to the data obtained after clinical and visiographical examinations, the diagnosis of chronic periodontitis of 17 teeth was identified, tooth 17 with 2 roots and 2 canals. In the second clinical case, the reason for admission to the clinic of a 39-year-old woman was severe pain in the upper right molar area. The patient indicated to the caries on the tooth 17. After completion of proper survey clinical and visiographical examinations, acute pulpitis (K04.00) - with three roots and 4 canals was diagnosed. In both cases after the proper examinations and agreement with the patients a treatment plan envisaging: 17 teeth endodontic treatment, filling of caries defects and their preparation on one hand for orthopedic construction (denture) and on the other hand for restoration of anatomical integrity by light-cured composite, was scheduled. The present study is designed to prevent complications of endodontic treatment of the second molar, to optimize diagnosis and treatment algorithm, once again proving reliable information indicating to the individuality of treatment tactics.

[Fracture strength of elastic and conventional fibre-reinforced composite intraradicular posts--an in vitro pilot study].

PubMed

Fráter, Mark; Forster, András; Jantyik, Ádám; Braunitzer, Gábor; Nagy, Katalin

2015-12-01

The purpose of this in vitro investigation was to evaluate the reinforcing effect of different fibre-reinforced composite (FRC) posts and insertion techniques in premolar teeth when using minimal invasive post space preparation. Thirty two extracted and endodontically treated premolar teeth were used and divided into four groups (n = 8) depending on the post used (Group 1-4). 1: one single conventional post, 2: one main conventional and one collateral post, 3: one flexible post, 4: one main flexible and one collateral post. After cementation and core build-up the specimens were submitted to static fracture toughness test. Fracture thresholds and fracture patterns were recorded and evaluated. The multi-post techniques (group 2 and 4) showed statistically higher fracture resistance compared to group one. Regarding fracture patterns there was no statistically significant difference between the tested groups. The application of multiple posts seems to be beneficial regarding fracture resistance independent from the used FRC post. Fracture pattern was not influenced by the elasticity of the post.

Colorimeter and scanning electron microscopy analysis of teeth submitted to internal bleaching.

PubMed

Martin-Biedma, Benjamin; Gonzalez-Gonzalez, Teresa; Lopes, Manuela; Lopes, Luis; Vilar, Rui; Bahillo, José; Varela-Patiño, Purificación

2010-02-01

This in vitro study compared the tooth color and the ultrastructure of internal dental tissues before and after internal bleaching. Sodium perborate was placed in the pulp chamber of endodontically treated molars and sealed with intermediate restorative material. The test samples were stored in a physiologic solution, and the bleaching agent was replaced every 7 days. A control group was used. After 1 month, the colors of the test and control samples were measured with a colorimeter, and the internal surfaces were observed under field emission scanning electron microscopy (FESEM). Statistically significant differences were found between the test and control sample colors. The FESEM ultrastructure analysis of the internal enamel and dentin surfaces did not show any changes after the internal bleaching. The results of the present study show that sodium perborate is effective in bleaching nonvital teeth and does not produce ultrastructural changes in the dental tissues. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Maxillary Interdental Osteotomies Have Low Morbidity for Alveolar Crestal Bone and Adjacent Teeth: A Cone Beam Computed Tomography-Based Study.

PubMed

Rodrigues, Daniel B; Campos, Paulo S F; Wolford, Larry M; Ignácio, Jaqueline; Gonçalves, João R

2018-02-19

Maxillary segmentation involving interdental osteotomies can have an adverse effect on the interdental crestal bone and adjacent teeth. The purpose of the present study was to evaluate the effect of interdental osteotomies on surrounding osseous and dental structures, including adjacent teeth, using cone beam computed tomography (CBCT), in patients who underwent segmental maxillary osteotomies. The present retrospective cohort study evaluated interdental osteotomy (IDO) sites between the lateral incisors and canines in patients treated with 3-piece Le Fort I osteotomies. CBCT scans were assessed using Kodac Dental Imaging software at specific intervals: T0 (before surgery), T1 (immediately after surgery), and T2 (a minimum of 11 months after surgery). The statistical analysis using a linear regression model was adjusted to compare the variables at the different intervals. Injury to the dental structures was assessed by radiological evidence of dental damage, the requirement for endodontic treatment, or tooth loss. We evaluated 94 IDO sites in 47 patients in the present study. The mean inter-radicular distance at T0 was 2.5 mm. A statistically significant increase was seen in the inter-radicular distance (between T1 and T0) of 0.72 mm, with a reduction of the alveolar bone crest height (between T2 and T0) of 0.19 mm (P < .001) for the group that underwent IDO. A weak correlation was found for this increase in the inter-radicular distance, with changes in the alveolar crest bone height. The potential complications associated with interdental osteotomies such as iatrogenic damage to the tooth structure, the need for endodontic treatment, and tooth loss were not encountered in any patients. We found very low morbidity for the interdental alveolar crest and the integrity of teeth adjacent to interdental osteotomies for patients who underwent maxillary segmentation between the lateral incisors and canines. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Endodontic management of horizontally placed molars after gunshot injury to mandible: a case report.

PubMed

Nawal, Ruchika Roongta; Sehgal, Ritu; Ansari, Irfan; Talwar, Sangeeta; Sood, Abhinav; Verma, Mahesh

2009-11-01

A 37-year-old man reported to our department with the history of gunshot injury to the mandible 15 years before. His anterior mandible had been resected earlier and bone graft was seen. Intraoral examination of lower jaw revealed 4 remaining mandibular molars. These teeth were severely rotated such that they lay horizontal with respect to the mandibular base. Preoperative Dentascan spiral computerized tomography (CT) of the patient revealed obliteration of the mesial canals of the mandibular right first molar and pear-shaped internal resorption defect in the distal canal of the same tooth. This paper reports the challenging endodontic management of a rare case of severely angulated teeth also exhibiting traumatic sequelae in both roots of the impact tooth. It also highlights the usefulness of spiral CT scan in diagnosis of traumatic sequelae such as pulp canal obliteration and internal resorption.

Microflora of root filled teeth with apical periodontitis in Latvian patients.

PubMed

Mindere, Anda; Kundzina, Rita; Nikolajeva, Vizma; Eze, Daina; Petrina, Zaiga

2010-01-01

The aim of the present study was to investigate the microbial flora of root filled teeth with apical periodontitis and to determine the prevalence of β-lactamase producing strains in isolated bacteria in Latvian patients. 33 root filled teeth with asymptomatic persisting periapical lesions were selected for the present study. During nonsurgical endodontic retreatment, the root filling material was removed and canals were sampled. Determination of microbial species was based on series of biochemical tests using identification kits. All strains of bacteria were tested for β-lactamase production by using chromogenic nitrocefin-impregnated slides. Bacteria were found in 32 (97%) of initial specimens from the teeth. The number of isolated microbial strains in the specimens ranged from one to six (mean 2.7). 79% of the isolated microbial species were Gram-positive bacteria. The most common isolates were Streptococcus (27%), Actinomyces (27%), Staphylococcus (18%), Enterococcus (18%) and Lactobacillus (18%) spp. Yeasts were found as four isolates in 3 cases (9%). β-lactamase-producing bacterial strains were detected in 12 specimens, 36% of the patients. The most common enzyme-producing bacteria belonged to Actinomyces and Staphylococcus spp. The microbial flora in previously treated root canals with apical periodontitis is limited to a small number of predominantly Gram-positive microbial species. The most common isolates are Streptococcus, Actinomyces, Staphylococcus, Enterococcus and Lactobacillus spp. A moderately high prevalence of β-lactamase producing bacterial strains was detected in patients with root filled teeth with apical periodontitis.

Antimicrobial Photodynamic Therapy Combined With Conventional Endodontic Treatment to Eliminate Root Canal Biofilm Infection

PubMed Central

Garcez, Aguinaldo S.; Ribeiro, Martha S.; Tegos, George P.; Núñez, Silvia C.; Jorge, Antonio O.C.; Hamblin, Michael R.

2011-01-01

Background and Objective To compare the effectiveness of antimicrobial photodynamic therapy (PDT), standard endodontic treatment and the combined treatment to eliminate bacterial biofilms present in infected root canals. Study Design/Materials and Methods Ten single-rooted freshly extracted human teeth were inoculated with stable bioluminescent Gram-negative bacteria, Proteus mirabilis and Pseudomonas aeruginosa to form 3-day biofilms in prepared root canals. Bioluminescence imaging was used to serially quantify bacterial burdens. PDT employed a conjugate between polyethylenimine and chlorin(e6) as the photosensitizer (PS) and 660-nm diode laser light delivered into the root canal via a 200-µ fiber, and this was compared and combined with standard endodontic treatment using mechanical debridement and antiseptic irrigation. Results Endodontic therapy alone reduced bacterial bioluminescence by 90% while PDT alone reduced bioluminescence by 95%. The combination reduced bioluminescence by >98%, and importantly the bacterial regrowth observed 24 hours after treatment was much less for the combination (P<0.0005) than for either single treatment. Conclusions Bioluminescence imaging is an efficient way to monitor endodontic therapy. Antimicrobial PDT may have a role to play in optimized endodontic therapy. PMID:17066481

Endodontic-related inferior alveolar nerve injuries: A review and a therapeutic flow chart.

PubMed

Castro, R; Guivarc'h, M; Foletti, J M; Catherine, J H; Chossegros, C; Guyot, L

2018-05-03

Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed ® and Google Scholar ® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable. Copyright © 2018. Published by Elsevier Masson SAS.

Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin: A Conservative Orthograde Approach

PubMed Central

Karunakaran, J. V.; Abraham, Chris Susan; Karthik, A. Kaneesh; Jayaprakash, N.

2017-01-01

Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy. PMID:29284973

Diagnosis and Endodontic Management of Fused Mandibular Second Molar and Paramolar with Concrescent Supernumerary Tooth Using Cone-beam CT and 3-D Printing Technology: A Case Report.

PubMed

Kato, Hiroshi; Kamio, Takashi

2015-01-01

Supernumerary teeth in the molar area are classified as paramolars or distomolars based on location. They occur frequently in the maxilla, but only rarely in the mandible. These teeth are frequently fused with adjacent teeth. When this occurs, the pulp cavities may also be connected. This makes diagnosis and planning of endodontic treatment extremely difficult. Here we report a case of a mandibular second molar fused with a paramolar, necessitating dental pulp treatment. Intraoral and panoramic radiographs were obtained for an evaluation and diagnosis. Although the images revealed a supernumerary tooth-like structure between the posterior area of the mandibular second molar and mandibular third molar, it was difficult to confirm the morphology of the tooth root apical area. Subsequent cone-beam computed tomography (CBCT) revealed that the supernumerary tooth-like structure was concrescent with the root apical area of the mandibular second molar. Based on these findings, the diagnosis was a fused mandibular second molar and paramolar with a concrescent supernumerary tooth. A 3-dimensional (3-D) printer was used to produce models based on the CBCT data to aid in treatment planning and explanation of the proposed procedures to the patient. These models allowed the complicated morphology involved to be clearly viewed, which facilitated a more precise diagnosis and better treatment planning than would otherwise have been possible. These technologies were useful in obtaining informed consent from the patient, promoting 3-D morphological understanding, and facilitating simulation of endodontic treatment.

Effect of the Army Oral Health Maintenance Program (AOHMP) on the Dental Health Status of Army Personnel. AOHMP Evaluation Study. Part 3. Dental Care Requirements of Active Duty Army Personnel, 1978

DTIC Science & Technology

1979-06-01

endodontics , crown and bridge, full and partial dentures, and periodontal therapy , account for about one- third of the time requirements for the...Examiners indicated the numbers of restorations, extractions, teeth needing endodontic therapy , units of crown and bridge, complete den- tures...might be that lieutenants and captains are in a younger age range where the removal of third molars is usually recommended. (3) In the care need areas

An Innovative Regenerative Endodontic Procedure Using Leukocyte and Platelet-rich Fibrin Associated with Apical Surgery: A Case Report.

PubMed

Pinto, Nelson; Harnish, Alexandra; Cabrera, Carolina; Andrade, Catherine; Druttman, Tony; Brizuela, Claudia

2017-11-01

Regenerative endodontic procedures (REPs) associated with apical surgery could represent an alternative treatment strategy for patients whose teeth present incomplete root formation and extensive apical lesions. Leukocyte platelet-rich fibrin (L-PRF) has potential benefits in REPs; it could promote apical root formation and optimal bone healing. The aim of this case report was to describe innovative regenerative endodontic therapy using L-PRF in the root canal and an extensive apical lesion in an immature tooth with dens invaginatus and asymptomatic apical periodontitis. A healthy 20-year-old woman was referred to the dental clinic of the Universidad de Los Andes, Santiago, Chile, for endodontic treatment in tooth # 22 with incomplete root development and an extensive apical lesion. The diagnosis was asymptomatic apical periodontitis associated with dens invaginatus type II. The patient was treated with an innovative approach using L-PRF in REPs associated with apical surgery. Follow-ups were performed at 6 months and 1 year later. They included periapical radiographs, cone-beam computed tomographic imaging, sensitivity, and vitality tests. The clinical evaluations performed at 6 months and 1 year revealed an absence of symptoms. The radiographic evaluations showed that the apical lesion was resolved. The cone-beam images indicated that the root length increased and the walls had thickened. The sensitivity tests were positive, and the laser Doppler flowmetry showed positive blood flow after 1 year. The success of the results in this case report indicate that L-PRF can be used as a complement in apical surgery and REPs and could provide an innovative alternative treatment strategy for complex clinical cases like these. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of three different rotary systems during endodontic retreatment - Analysis by scanning electron microscopy

PubMed Central

Vidal, Flávia-Teixeira; Nunes, Eduardo; Horta, Martinho-Campolina-Rebello; Freitas, Maria-Rita-Lopes-da Silva

2016-01-01

Background Endodontic therapy is considered a series of important and interdependent steps, and failure of any of these steps may compromise the treatment outcome. This study aimed to evaluate the effectiveness of three different rotary systems in removing obturation materials during endodontic retreatment using scanning electron microscopy (SEM) analysis. Material and Methods Thirty-six endodontically treated teeth were selected and divided into 3 groups of 10 and 1 control group with 6 dental elements. The groups were divided according to the rotary system used for removing gutta-percha, as follows: G1: ProTaper system; G2: K3 system; G3: Mtwo system; and G4: Control group. Thereafter, the roots were split and the sections were observed under SEM, for analysis and counting of clear dentinal tubules, creating the variable “degree of dentinal tubule patency” (0: intensely clear; 1: moderately clear; 2: slightly clear; 3: completely blocked). The data were subjected to the Friedman and Kruskal-Wallis statistical tests. Results No differences were observed in the “degree of dentinal tubule patency” neither between the root thirds (to each evaluated group) nor between the groups (to each evaluated third). Nevertheless, when the three root thirds were grouped (providing evaluation of all root extension), the “degree of dentinal tubule patency” was lower in G1 than in G3 (p<0.05), but showed no differences neither between G1 and G2 nor G2 and G3. Conclusions No technique was able to completely remove the canal obturation material, despite G1 having shown better results, although without significant difference to G2 Key words:Scanning electron microscopy, NiTi, retreatment. PMID:27034750

Prevalence of ciliated epithelium in apical periodontitis lesions.

PubMed

Ricucci, Domenico; Loghin, Simona; Siqueira, José F; Abdelsayed, Rafik A

2014-04-01

This article reports on the morphologic features and the frequency of ciliated epithelium in apical cysts and discusses its origin. The study material consisted of 167 human apical periodontitis lesions obtained consecutively from patients presenting for treatment during a period of 12 years in a dental practice operated by one of the authors. All of the lesions were obtained still attached to the root apices of teeth with untreated (93 lesions) or treated canals (74 lesions). The former were obtained by extraction and the latter by extraction or apical surgery. Specimens were processed for histopathologic and histobacteriologic analyses. Lesions were classified, and the type of epithelium, if present, was recorded. Of the lesions analyzed, 49 (29%) were diagnosed as cysts. Of these, 26 (53%) were found in untreated teeth, and 23 (47%) related to root canal-treated teeth. Ciliated columnar epithelium was observed partially or completely lining the cyst wall in 4 cysts, and all of them occurred in untreated maxillary molars. Three of these lesions were categorized as pocket cysts, and the other was a true cyst. Ciliated columnar epithelium-lined cysts corresponded to approximately 2% of the apical periodontitis lesions and 8% of the cysts of endodontic origin in the population studied. This epithelium is highly likely to have a sinus origin in the majority of cases. However, the possibility of prosoplasia or upgraded differentiation into ciliated epithelium from the typical cystic lining squamous epithelium may also be considered. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The Influence of a New Clinical Motion for Endodontic Instruments on the Incidence of Postoperative Pain.

PubMed

Gambarini, G; Di Nardo, D; Miccoli, G; Guerra, F; Di Giorgio, R; Di Giorgio, G; Glassman, G; Piasecki, L; Testarelli, L

2017-01-01

Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain. 100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test. For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique. Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation.

A preliminary report on histological outcome of pulpotomy with endodontic biomaterials vs calcium hydroxide.

PubMed

Nosrat, Ali; Peimani, Ali; Asgary, Saeed

2013-11-01

The purpose of the study was to evaluate human dental pulp response to pulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement. A total of nine erupted third molars were randomly assigned to each pulpotomy group. The same clinician performed full pulpotomies and coronal restorations. The patients were followed clinically for six months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulp inflammation, and calcified bridge formation. All patients were free of clinical signs/symptoms of pulpal/periradicular diseases during the follow up period. In CH group, one tooth had necrotic radicular pulp; other two teeth in this group had vital uninflamed pulps with complete dentinal bridge formation. In CEM cement and MTA groups all teeth had vital uninflamed radicular pulps. A complete dentinal bridge was formed beneath CEM cement and MTA in all roots. Odontoblast-like cells were present beneath CEM cement and MTA in all samples. This study revealed that CEM cement and MTA were reliable endodontic biomaterials in full pulpotomy treatment. In contrast, the human dental pulp response to CH might be unpredictable.

Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates

PubMed Central

Castellanos-Cosano, Lizett; Machuca-Portillo, Guillermo; Segura-Sampedro, Juan J.; Torres-Lagares, Daniel; López-López, José; Velasco-Ortega, Eugenio

2013-01-01

Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects. Material and Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression. Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects. Key words:Apical periodontitis, endodontics, hepatic cirrhosis, liver disease, liver transplant, oral health, root-canal treatment. PMID:23722148

[Current perspectives on endodontic treatment of teeth with chronic periapical lesions].

PubMed

Canalda Sahli, C

1990-01-01

The author study in this article histopathological aspects of periapical lesions, intra-granulomatous epithelial proliferation phenomenon as pathogenic mechanism of microscopic cystic cavities formation, diagnostic problems of them all, as well as the most actual therapeutic perspectives.

In vitro evaluation of the effectiveness of ProTaper universal rotary retreatment system for gutta-percha removal with or without a solvent.

PubMed

Takahashi, Cristiane Midori; Cunha, Rodrigo Sanches; de Martin, Alexandre Sigrist; Fontana, Carlos Eduardo; Silveira, Cláudia Fernandes M; da Silveira Bueno, Carlos Eduardo

2009-11-01

Effective removal of gutta-percha in endodontic retreatment is a significant factor to ensure a favorable outcome from failed procedures. The purpose of this study was to evaluate the efficacy of a nickel-titanium rotary instrument system with or without a solvent versus stainless steel hand files for gutta-percha removal. Forty extracted human maxillary anterior teeth were prepared and filled. They were divided into 4 groups: Gates-Glidden and K-files, Gates-Glidden and K-files with chloroform, ProTaper Universal rotary retreatment system, and ProTaper Universal rotary retreatment system with chloroform. The operating time was recorded. The teeth were longitudinally sectioned and photographed. The images were analyzed and the filling remnants were quantified by using the IMAGE TOOL software. With Kruskall-Wallis test, statistical analysis showed that there was no significant difference between the techniques in regard to the amount of the endodontic filling remnants (P < .05); however, the ProTaper Universal rotary retreatment system was faster than the hand files (P < .05). All of the techniques proved helpful for the removal of endodontic filling material, and they were similar in material remaining after retreatment, but the ProTaper Universal rotary retreatment system without chloroform was faster.

Prevalence of Three-Rooted Mandibular First Molars among Indians Using SCT

PubMed Central

Garg, Amit Kumar; Tewari, Rajendra Kumar; Agrawal, Neha

2013-01-01

Undetected extra roots or root canals are a major reason for failure of endodontic treatment. Failure to recognize an extra distolingual (DL) root in mandibular first molar may lead to incomplete debridement of the root canal system and eventually treatment failure. Therefore, it is crucial that atypical anatomy is identified before and during dental treatment. Spiral computed tomography (SCT) images can show 3D images, and therefore much detail can be used when traditional methods prevent adequate endodontic treatment. The overall incidence of DL roots on the mandibular first molars was 6.40% for all patients and 5.00% for all teeth, respectively. The occurrence of DL roots on the right side and on the left side showed a statistically significant difference. The bilateral incidence of symmetrical distribution of DL roots was 56.25%. The DL root canal orifice was separated from DB canal orifice by 2.79 ± 0.34 mm, from the MB canal orifice by 4.23 ± 0.81 mm, and from the ML canal orifice by 3.29 ± 0.52 mm. The high prevalence of the DL root in permanent mandibular first molars among the Indian population by using SCT and estimations of the interorifice distance of such teeth might be useful for successful endodontic treatments. PMID:23840212

Effect of topical alendronate on root resorption of dried replanted dog teeth.

PubMed

Levin, L; Bryson, E C; Caplan, D; Trope, M

2001-06-01

Alendronate (ALN) is a third generation bisphosphonate with demonstrated osteoclast inhibitory activity that may slow down the resorptive process after severe traumatic injuries. Eighty-two premolar roots of five mongrel dogs were endodontically treated and restored, extracted and treated as follows: 70 roots were bench dried for either 40 or 60 min. Thirty-eight of these roots were then soaked for 5 min in a 1 mM solution of ALN in Hanks' Balanced Salt Solution (HBSS) and replanted. Thirty-two roots were soaked for 5 min in HBSS and replanted. In the remaining 12 roots which were not exposed to the bench drying procedure, a 0.5 mM deep lingual mid-root cemental defect was made. Six of these roots were soaked in a 1 mM solution of ALN in HBSS for 5 min and replanted. The other six roots were soaked for 5 min in HBSS and replanted. Historical negative and positive controls were used from similarly treated teeth in our previous studies. After 4 months the dogs were killed and the roots prepared for histological evaluation. Five-microm-thick cross-sections of the root and surrounding tissue taken every 70 microm were evaluated for healing according to the criteria of Andreasen. In the 12 roots with cemental defects, healing with cementum of the damaged root surface was evaluated. In addition, residual root mass was also measured to determine the extent of root structure loss for each soaking method. Cemental healing took place in all 12 artificially damaged roots, indicating that these soaking media did not inhibit cementogenesis. The alendronate-soaked roots had statistically significantly more healing than the roots soaked in HBSS without alendronate. This improvement in healing was seen in all dogs except one and in all teeth except the first premolar. Soaking in alendronate also resulted in significantly less loss in root mass due to resorption compared to those teeth soaked in HBSS without alendronate.

A survey of Australian prosthodontists: The use of posts in endodontically treated teeth.

PubMed

Sambrook, Raelene; Burrow, Michael

2018-05-09

This study aimed to gain insight into common practices of Australian prosthodontists when placing a post in an endodontically treated tooth (ETT). A 17-question open- and closed- format questionnaire was sent to registered Australian prosthodontists. The response rate was 55% (n=95). The majority of respondents indicated the purpose of a post was to retain a core (n=94, 99%). The decision to place a post is affected by the quantity of remaining tooth structure (n=91, 96%) and the definitive restoration (n=68, 72%). The ideal post length is neither a short nor long post with the most frequent response (n=52, 34%) being 'as long as possible without disturbing the apical seal'. The apical seal requirements were defined as 4-5mm of Gutta Percha for 77% of respondents. The most preferred post type was a custom cast metal post (n=85, 49%). The most popular luting cement was resin composite (n=84, 39%). The results from this survey do not provide a definitive guide for restoring an ETT. However, it illustrates how Australian prosthodontists address this clinical challenge. The multiple responses received for a number of questions suggest that the material and technique employed in the Australian context is influenced by the individual clinical case. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Tooth loss in well-maintained patients with chronic periodontitis during long-term supportive therapy in Brazil.

PubMed

Chambrone, Luiz A; Chambrone, Leandro

2006-10-01

The objective of this retrospective study was to assess the reasons for tooth loss in a sample of patients who underwent periodontal therapy and supportive periodontal therapy (SPT) in a Brazilian private periodontal practice. A sample of 120 subjects who had been treated and maintained for 10 years or longer was selected from patients attending a periodontal practice. All patients followed a similar treatment: basic procedures, re-evaluation and periodontal surgery where indicated. Reasons for tooth loss were categorized as periodontal, caries, endodontal, root fractures and extraction of retained or partially erupted third molars. Of the 2927 teeth present at the completion of active periodontal treatment, 53 (1.8%) were lost due to periodontal disease, 16 (0.5%) for root fracture, six (0.2%) to caries, five (0.2%) for endodontic reasons and 31 (1.0%) were lost to extraction of retained or partially erupted third molars. Logistic regression analysis was performed to investigate the association between five independent variables with tooth loss due to periodontitis. Only age (> 60 years) and smoking were statistically significant (p < 0.05). The findings of this survey were consistent with previous studies. Older subjects and smokers were more susceptible to periodontal tooth loss. In addition, patients with generalized chronic periodontitis were treated and maintained for long-term periods with low rates of tooth loss.

Impact of three radiographic methods in the outcome of nonsurgical endodontic treatment: a five-year follow-up.

PubMed

Fernández, Rafael; Cadavid, Diego; Zapata, Sandra M; Alvarez, Luis G; Restrepo, Felipe A

2013-09-01

The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success. A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05. CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration. The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Detection and clonal analysis of anaerobic bacteria associated to endodontic-periodontal lesions.

PubMed

Pereira, Cássio V; Stipp, Rafael N; Fonseca, Douglas C; Pereira, Luciano J; Höfling, José F

2011-12-01

Microbial agents in root canal systems can induce periodontal inflammation. The aims of this study are to detect anaerobic microorganisms in endodontic-periodontal lesions, determine the genetic diversity among them, and assess the simultaneous colonization of the pulp and periodontal microenvironments by a single clone. Twenty-seven teeth of patients with endodontic-periodontal lesions were selected. Samples were spread on an agar-blood medium, the detection of each species was performed using a polymerase chain reaction, and the determination of the simultaneous presence of the same species in the microenvironments by one or more clones was determined using arbitrarily primed PCR. Prevotella intermedia (Pi) was the most prevalent species of the colonies in periodontal pockets, whereas Porphyromonas gingivalis (Pg) and Pi were the more prevalent in root canals. Isolates of Pi and Pg were simultaneously identified in root canals and periodontal pockets. Eighteen percent of teeth exhibited the simultaneous colonization by Pg, Tannerella forsythia (previously T. forsythensis), and Porphyromonas endodontalis in the pulp and periodontal microenvironments. The presence of these species was noted even in niches from which no colonies were isolated. Seventeen different genotypes were found in periodontal and pulp sites, with the majority of sites colonized by one or two different genotypes. A high degree of genotype similarity was found for samples of Pg isolated from only one site as well as for those isolated from both microenvironments. Different clones of Pi and Pg with a high intraspecific genotype similarity were found to colonize the same anatomic sites in endodontic-periodontal infections.

Cytotoxicity evaluation of five different dual-cured resin cements used for fiber posts cementation

PubMed Central

Dioguardi, M; Perrone, D; Troiano, G; Laino, L; Ardito, F; Lauritano, F; Cicciù, M; Lo Muzio, L

2015-01-01

Custom-cast posts and cores are usually used to treat endodontically treated teeth. However, several researches have underlined how these devices may be a much higher elastic modulus than the supporting dentine and the difference in the modulus could lead to stress concentrating in the cement lute, leading to failure. The role of the cement seems to play a fundamental role in order to transfer the strength during the chewing phases. Aim of this research is to record the rate of cytotoxicity of five different dual-cured resin cements used for fiber posts cementation. We tested the cytotoxicity of this five materials on MG63 osteoblast-like cells through two different methods: MTT ([3-4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide succinate) assay which tests for mitochondrial enzyme activity6 and xCELLigence® system. PMID:26309592

Histological changes induced by 15 F CO2 laser microprobe especially designed for root canal sterilization: an in-vivo study

NASA Astrophysics Data System (ADS)

Kesler, Gavriel; Koren, Rumelia; Gal, Rivka

1998-04-01

Until now, no suitable delivery fiber existed for CO2 laser endodontic radiation in the apical region where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, we designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal, thus favorably increasing the thermal effects. The 15 F CO2 microprobe is a flexible, hollow, metal fiber, 300 micrometer in diameter and 20 mm in length, coupled onto a handpiece, with the following radiation parameters: wavelength -- 10.6 micrometer; pulse duration -- 50m/sec; energy per pulse 0.25 joule; energy density -- 353.7J/cm2 per pulse; power on tissue -- 5 W. The study was conducted on 30 vital maxillary or mandibulary; central, lateral, or premolar teeth destined for extraction due to periodontal problems. Twenty were experimentally treated with pulsed CO2 laser delivered by this newly developed fiber after conventional root canal preparation. Temperature measured at three points on the root surface during laser treatment did not exceed 38 degrees Celsius. Ten teeth represented the control group in which only root canal preparation was performed in the conventional method. Histological examination of the laser treated teeth showed coagulation necrosis and vacuolization of remaining pulp tissue in the root canal periphery. Primary and secondary dentin appeared normal, in all cases treated with 15 F CO2 laser. Gramm stain and bacteriologic examination revealed complete sterilization. These results demonstrate the unique capabilities of this special microprobe in sterilization of the root canal, and no thermal damage to the surrounding tissue.

Histological changes induced by CO2 laser microprobe specially designed for root canal sterilization: in vivo study.

PubMed

Kesler, G; Koren, R; Kesler, A; Hay, N; Gal, R

1998-10-01

Until now, no suitable delivery fiber has existed for CO2 laser endodontic radiation in the apical region, where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, we have designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal and thus favorably increasing the thermal effects. A CO2 laser microprobe coupled onto a special hand piece was attached to the delivery fiber of a Sharplan 15-F CO2 laser. The study was conducted on 30 vital maxillary or mandibulary, central, lateral, or premolar teeth destined for extraction due to periodontal problems. Twenty were experimentally treated with pulsed CO2 laser delivered by this newly developed fiber after conventional root canal preparation. Temperature measured at three points on the root surface during laser treatment did not exceed 38 degrees C. Ten teeth represented the control group, in which only root canal preparation was performed in the conventional method. Histological examination of the laser-treated teeth showed coagulation necrosis and vacuolization of the remaining pulp tissue in the root canal periphery. Primary and secondary dentin appeared normal in all cases treated with 15-F CO2 laser. Gram stain and bacteriologic examination revealed complete sterilization. These results demonstrate the unique capabilities of this special microprobe in sterilization of the root canal, with no thermal damage to the surrounding tissue. The combination of classical root canal preparation with CO2 laser irradiation using this special microprobe before closing the canal can drastically change the quality of root canal fillings.

Endodontic cellulitis 'flare-up'. Case report.

PubMed

Matusow, R J

1995-02-01

Endodontic cellulitis involves facial swelling which can vary from mild to severe and can occur as a primary case or a flare-up following initial treatment of asymptomatic teeth with periapical lesions. The microbial spectrum in primary cases involves a significant mixture of anaerobic and facultative aerobic microbes, chiefly streptococci. In a previous study, cultures from flare-up cases, utilizing the same anaerobic techniques as in primary cases, revealed an absence of obligate anaerobes and an 80 per cent incidence of facultative aerobic streptococci. These cases also revealed a significant time lapse from onset of symptoms to the cellulitis phase. No sex or age factors were noted in the primary or flare-up cases. The purpose of this case report is to restate a traditional theory, namely, the alteration of the oxidation/reduction potential (Eh), as a major factor for endodontic cellulitis flare-ups; to confirm the pathogenic potential of oral facultative streptococci; and that asymptomatic endodontic lesions tend to exist with mixed aerobic/anaerobic microbial flora.

Endodontic management of mandibular third molar with three mesial roots using spiral computed tomography scan as a diagnostic aid: a case report.

PubMed

Tomar, Deepak; Dhingra, Anil; Tomer, Anil; Sharma, Shalini; Sharma, Vivek; Miglani, Anjali

2013-05-01

Aberrant root canal anatomy is diagnostically and clinically challenging for clinicians. The most common root canal configuration of human molars is 2 roots and 3 canals, but various combinations may still exist. Third molars are known to have the most unusual anatomy among human teeth. Restorative, prosthetic, and orthodontic considerations often require endodontic treatment of third molars in order for them to be retained as functional components of the dental arch. The present case report demonstrates unusual root canal morphology of the mandibular third molar. Roentgenographic examination, which included spiral CT scan, revealed 3 separate mesial roots in tooth #48 with 3 independent canals and 3 canal orifices, indicating an endodontic rarity. The present case report puts impetus on exploration of additional canals using advanced diagnostic aids, such as spiral computed tomography, which can have a huge impact on the successful outcome of endodontic therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

Effectiveness of a new method of disinfecting the root canal, using Er, Cr:YSGG laser to kill Enterococcus faecalis in an infected tooth model.

PubMed

Licata, M E; Albanese, A; Campisi, G; Geraci, D M; Russo, R; Gallina, G

2015-02-01

Some lasers have demonstrated to provide effective disinfection when used as adjunctive device to the conventional treatment. The aim of this in vitro study was to determine the effectiveness of the erbium, chromium:yttrium scandium gallium garnet (Er, Cr:YSGG) laser by measuring its bactericidal effect inside the root canal experimentally colonized with Enterococcus faecalis. The laser was tested at different irradiation times (30 and 60 s) and energy of impulses (75 and 25 mJ). A total of 52 single-rooted extracted human teeth were endodontically prepared with rotary instrumentation. All were sterilized and inoculated with a suspension of E. faecalis (105 bacteria/ml). The teeth were randomized into three treatment (group 1, group 2, and group 3) and one control groups. In all groups, teeth were chemically irrigated with 5.25% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Groups 1 and 2 were also irradiated at 30 and 60 s, respectively, with an Er, Cr:YSGG laser at 75 mJ. Teeth of group 3 were treated with laser for 60 s at 25 mJ. Samples were processed to detect the presence of E. faecalis. For all groups, a bactericidal effect was observed. The use of laser at 75 mJ with an irradiation time of 30 and 60 s eliminated a percentage of 92.3 and 100% of E. faecalis, respectively. In the control group, a reduction of 92.3% was observed. Lower percentage of reduction (46.1%) was obtained in teeth treated with laser at 25 mJ for 60 s. No statistical differences were observed between the groups (P = 0.543, Fisher's exact test). The results indicated a bactericidal effect of Er, Cr:YSGG laser irradiation at the settings used in this study. The highest bactericidal effect of this laser was observed at 60 s of irradiation time, using an energy pulse of 75 mJ.

Morphological and chemical changes in dentin after using endodontic agents: Fourier transform Raman spectroscopy, energy-dispersive x-ray fluorescence spectrometry, and scanning electron microscopy study

NASA Astrophysics Data System (ADS)

Pascon, Fernanda Miori; Kantovitz, Kamila Rosamilia; Soares, Luís Eduardo Silva; Santo, Ana Maria do Espírito; Martin, Airton Abraha~o.; Puppin-Rontani, Regina Maria

2012-07-01

We examine the morphological and chemical changes in the pulp chamber dentin after using endodontic agents by scanning electron microscopy (SEM), Fourier transform Raman spectroscopy (FT-Raman), and micro energy-dispersive x-ray fluorescence spectrometry (μEDXRF). Thirty teeth were sectioned exposing the pulp chamber and divided by six groups (n=5): NT-no treatment; CHX-2% chlorhexidine; CHXE-2% chlorhexidine+17% EDTA E-17% EDTA; SH5-5.25% NaOCl; SH5E-5.25% NaOCl+17% EDTA. The inorganic and organic content was analyzed by FT-Raman. μEDXRF examined calcium (Ca) and phosphorus (P) content as well as Ca/P ratio. Impressions of specimens were evaluated by SEM. Data were submitted to Kruskal-Wallis and Dunn tests (p<0.05). Differences were observed among groups for the 960 cm-1 peak. Ca and P content differences were significant (SH5>NT=SH5E>CHX>E>CHXE). CHXE and E presented the highest Ca/P ratio values compared to the other groups (p<0.05). The SEM images in the EDTA-treated groups had the highest number of open tubules. Erosion in the tubules was observed in CHX and SH5E groups. Endodontic agents change the inorganic and organic content of pulp chamber dentin. NaOCl used alone, or in association with EDTA, was the most effective agent considering chemical and morphological approaches.

Laser Application in Dentistry: Irradiation Effects of Nd:YAG 1064 nm and Diode 810 nm and 980 nm in Infected Root Canals-A Literature Overview.

PubMed

Saydjari, Yves; Kuypers, Thorsten; Gutknecht, Norbert

2016-01-01

Objective. In endodontics, Nd:YAG laser (1064 nm) and diode laser (810 nm and 980 nm) devices are used to remove bacteria in infected teeth. A literature review was elaborated to compare and evaluate the advantages and disadvantages of using these lasers. Methods. Using combined search terms, eligible articles were retrieved from PubMed and printed journals. The initial search yielded 40 titles and 27 articles were assigned to full-text analysis. The studies were classified based upon laser source, laser energy level, duration/similarity of application, and initial and final bacterial count at a minimum of 20 prepared root canals. Part of the analysis was only reduced microorganisms and mechanically treated root canals upon preparation size of ISO 30. All studies were compared to evaluate the most favorable laser device for best results in endodontic therapy. Results. A total of 22 eligible studies were found regarding Nd:YAG laser 1064 nm. Four studies fulfilled all demanded criteria. Seven studies referring to the diode laser 980 nm were examined, although only one fulfilled all criteria. Eleven studies were found regarding the diode laser 810 nm, although only one study fulfilled all necessary criteria. Conclusions. Laser therapy is effective in endodontics, although a comparison of efficiency between the laser devices is not possible at present due to different study designs, materials, and equipment.

Laser Application in Dentistry: Irradiation Effects of Nd:YAG 1064 nm and Diode 810 nm and 980 nm in Infected Root Canals—A Literature Overview

PubMed Central

Kuypers, Thorsten; Gutknecht, Norbert

2016-01-01

Objective. In endodontics, Nd:YAG laser (1064 nm) and diode laser (810 nm and 980 nm) devices are used to remove bacteria in infected teeth. A literature review was elaborated to compare and evaluate the advantages and disadvantages of using these lasers. Methods. Using combined search terms, eligible articles were retrieved from PubMed and printed journals. The initial search yielded 40 titles and 27 articles were assigned to full-text analysis. The studies were classified based upon laser source, laser energy level, duration/similarity of application, and initial and final bacterial count at a minimum of 20 prepared root canals. Part of the analysis was only reduced microorganisms and mechanically treated root canals upon preparation size of ISO 30. All studies were compared to evaluate the most favorable laser device for best results in endodontic therapy. Results. A total of 22 eligible studies were found regarding Nd:YAG laser 1064 nm. Four studies fulfilled all demanded criteria. Seven studies referring to the diode laser 980 nm were examined, although only one fulfilled all criteria. Eleven studies were found regarding the diode laser 810 nm, although only one study fulfilled all necessary criteria. Conclusions. Laser therapy is effective in endodontics, although a comparison of efficiency between the laser devices is not possible at present due to different study designs, materials, and equipment. PMID:27462611

Endodontic management of an unusual foreign body in a maxillary central incisor.

PubMed

Chand, Keerthi; Joesph, Sam; Varughese, Jolly Mary; Nair, Mali G; Prasanth, Santhosh

2013-09-01

The discovery of foreign bodies in the teeth is often diagnosed accidentally. It is commonly seen in children. These foreign objects may act as a potential source of infection and may later lead to a painful condition. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and the difficulty involved in its retrieval. This paper discusses the types of foreign objects found in and around the teeth and reports an unusual case of a stapler pin in the root canal of a tooth, its retrieval, and associated management of the involved teeth.

An Innovative Approach for Management of Vertical Coronal Fracture in Molar: Case Report

PubMed Central

Kathuria, Ambica; Kavitha, M.; Ravishankar, P.

2012-01-01

Unlike anterior teeth, acute exogenous trauma is an infrequent cause of posterior coronal vertical tooth fractures. Endodontic and restorative management of such fractures is a great challenge for the clinician. Newer advancements in adhesive techniques can provide successful intracoronal splinting of such teeth to reinforce the remaining tooth structure. This paper describes the diagnosis and management of a case of complicated vertical coronal fracture in mandibular first molar induced by a traffic accident. PMID:22567453

Current overview on challenges in regenerative endodontics

PubMed Central

Bansal, Ramta; Jain, Aditya; Mittal, Sunandan

2015-01-01

Introduction: Regenerative endodontics provides hope of converting the non-vital tooth into vital once again. It focuses on substituting traumatized and pathological pulp with functional pulp tissue. Current regenerative procedures successfully produce root development but still fail to re-establish real pulp tissue and give unpredictable results. There are several drawbacks that need to be addressed to improve the quality and efficiency of the treatment. Aim: The aim of this review article is to discuss major priorities that ought to be dealt before applications of regenerative endodontics flourish the clinical practice. Materials and Methods: A web-based research on MEDLINE was done using filter terms Review, published in the last 10 years and Dental journals. Keywords used for research were “regenerative endodontics,” “dental stem cells,” “growth factor regeneration,” “scaffolds,” and “challenges in regeneration.” This review article screened about 150 articles and then the relevant information was compiled. Results: Inspite of the impressive growth in regenerative endodontic field, there are certain loopholes in the existing treatment protocols that might sometimes result in undesired and unpredictable outcomes. Conclusion: Considerable research and development efforts are required to improve and update existing regenerative endodontic strategies to make it an effective, safe, and biological mode to save teeth. PMID:25657518

Regenerative Endodontics: Barriers and Strategies for Clinical Translation

PubMed Central

Kim, Sahng G.; Zhou, Jian; Ye, Ling; Cho, Shoko; Suzuki, Takahiro; Fu, Susan Y.; Yang, Rujing; Zhou, Xuedong; Mao, Jeremy J.

2014-01-01

SYNOPSIS Despite a great deal of enthusiasm and effort, regenerative endodontics has encountered substantial challenges towards clinical translation. Recent adoption by the American Dental Association (ADA) of evoked pulp bleeding in immature permanent teeth is an important step for regenerative endodontics. However, there is no regenerative therapy for the majority of endodontic diseases. Simple recapitulation of cell therapy and tissue engineering strategies that are under development for other organ systems has not led to clinical translation in regeneration endodontics. Dental pulp stem cells may appear to be a priori choice for dental pulp regeneration. However, dental pulp stem cells may not be available in a patient who is in need of pulp regeneration. Even if dental pulp stem cells are available autologously or perhaps allogeneically, one must address a multitude of scientific, regulatory and commercialization barriers, and unless these issues are resolved, transplantation of dental pulp stem cells will remain a scientific exercise, rather than a clinical reality. Recent work using novel biomaterial scaffolds and growth factors that orchestrate the homing of host endogenous cells represents a departure from traditional cell transplantation approaches and may accelerate clinical translation. Given the functions and scale of dental pulp and dentin, regenerative endodontics is poised to become one of the early biological solutions in regenerative dental medicine. PMID:22835543

Concept and clinical application of the resin-coating technique for indirect restorations.

PubMed

Nikaido, Toru; Tagami, Junji; Yatani, Hirofumi; Ohkubo, Chikahiro; Nihei, Tomotaro; Koizumi, Hiroyasu; Maseki, Toshio; Nishiyama, Yuichiro; Takigawa, Tomoyoshi; Tsubota, Yuji

2018-03-30

The resin-coating technique is one of the successful bonding techniques used for the indirect restorations. The dentin surfaces exposed after cavity preparation are coated with a thin film of a coating material or a dentin bonding system combined with a flowable composite resin. Resin coating can minimize pulp irritation and improve the bond strength between a resin cement and tooth structures. The technique can also be applied to endodontically treated teeth, resulting in prevention of coronal leakage of the restorations. Application of a resin coating to root surface provides the additional benefit of preventing root caries in elderly patients. Therefore, the coating materials have the potential to reinforce sound tooth ("Super Tooth" formation), leading to preservation of maximum tooth structures.

Composite resin reinforcement of flared canals using light-transmitting plastic posts.

PubMed

Lui, J L

1994-05-01

Composite resins have been advocated as a reinforcing build-up material for badly damaged endodontically treated teeth with flared canals. However, the control of an autocuring composite resin is difficult because it polymerizes rapidly within the root canal. While the light-curing composite resins are more user friendly, their polymerization can be a problem deep in the root canal. Light-transmitting plastic posts allow the transmission of light into the root canal and enable intraradicular composite resin reconstitution and reinforcement of weakened roots. At the same time, the light-transmitting plastic post forms an optimal post canal in the rehabilitated root and can accurately fit a matching retentive final post. These light-transmitting posts are a useful addition to the dental armamentarium.

Evaluation of fracture resistance in simulated immature teeth using Resilon and Ribbond as root reinforcements--an in vitro study.

PubMed

Hemalatha, Hiremath; Sandeep, Metgud; Kulkarni, Sadanand; Yakub, Shoeb Sheikh

2009-08-01

To compare the reinforcement and strengthening ability of resilon, gutta-percha, and ribbond in endodontically treated roots of immature teeth. Sixty five freshly extracted human maxillary anterior teeth were prepared with a Peeso no. 6 to simulate immature teeth (Cvek's stage 3 root development). After instrumentation, each root was irrigated with sodium hypochlorite and with ethylene diamino tetra acetic acid to remove the smear layer. To simulate single visit apexification technique a 4-5 mm white Pro Root mineral trioxide aggregate plug was placed apically using schilder carrier. The teeth were divided into three experimental groups and one control group. Group I--control group (root canals instrumented but not filled); Group II--backfilled with thermoplastisized gutta-percha using AH plus sealer; Group III--reinforced with Resilon using epiphany sealer; Group IV--reinforced with Ribbond fibers using Panavia F luting cement. A Universal Testing Machine was used to apply a load, at the level of the lingual cementoenamel junction with a chisel-shaped tip The peak load to fracture was recorded and statistical analysis was completed using student's t-test. Values of peak load to fracture were 1320.8, 1604.88, 1620, and 1851 newtons for Group I to Group IV respectively. The results of student's t-test, revealed no significant difference (P > 0.05,) between Group II and Group III. Comparison between Group IV and Group III and between Group IV and Group II revealed highly significant difference (P > 0.001). Teeth reinforced with Ribbond fibers using Panavia F luting cement showed the highest resistance to fracture. Resilon could not strengthen the roots and showed no statistically significant difference when compared with thermoplastisized gutta-percha in reinforcing immature tooth when tested with universal testing machine in an experimental model of immature tooth.

Comparison Of Pre-Operative Curvature With Postoperative Curvature In Root Canals Treated With K-3 Rotary Systems.

PubMed

Nagi, Sana Ehsen; Khan, Farhan Raza

2017-01-01

With root canal treatment, the organic debris and micro-organisms from pulp space is removed and an ideal canal preparation is achieved that is conducive of hermetic obturation. The purpose of this study was to correlate the pre-operative canal curvature with the postoperative curvature in human extracted teeth prepared with K-3 rotary systems. The root canal preparation was carried out on extracted human molars and premolars using K-3 endodontic rotary files. A pre and post-operative image of the teeth using digital radiograph were taken in order to compare pre and post-operative canal curvature. The images were saved in an images retrieval system (Gendex software, USA). Change in the canal curvature was measured using the software measuring tool (Vixwin software, USA). Student paired t-test and Pearson correlation test was applied at 0.05 level of significance. There is a statistically significant difference between pre-operative and post-operative canal curvature (p-value <0.001) and a strong positive correlation (91% correlation) between pre-operative and post-operative canal curvature in teeth prepared with the K-3 rotary files. A significant difference between pre and post instrumentation curvature was found. Degree of canal curvature was not correlated with time taken for canal preparation.

The effect of high-frequency electrical pulses on organic tissue in root canals.

PubMed

Lendini, M; Alemanno, E; Migliaretti, G; Berutti, E

2005-08-01

To evaluate debris and smear layer scores after application of high-frequency electrical pulses produced by the Endox Endodontic System (Lysis Srl, Nova Milanese, Italy) on intact pulp tissue and organic and inorganic residues after endodontic instrumentation. The study comprised 75 teeth planned for extraction. The teeth were randomly divided into two groups (60 teeth) and a control group (15 teeth): group 1 (30 teeth) was not subjected to instrumentation; group 2 (30 teeth) was instrumented by Hero Shaper instruments and apical stops were prepared to size 40. Each group was subdivided into subgroups A and B (15 teeth); two electrical pulses were applied to subgroups 1A and 2A (one in the apical third and one in the middle third, respectively, at 3 and 6 mm from the root apices); four electrical pulses were applied to subgroups 1B and 2B (two in the apical third, two in the middle third). The control group (15 teeth) was prepared with Hero Shapers and irrigated with 5 mL of EDTA (10%) and 5 mL of 5% NaOCl at 50 degrees C but not subjected to the electrical pulse treatment. Roots were split longitudinally and canal walls were examined at 80x, 200x, 750x, 1500x and 15,000x magnifications, using a scanning electron microscope. Smear layer and debris scores were recorded at the 3 and 6 mm levels using a five-step scoring scale and a 200-microm grid. Means were tested for significance using the one-way anova model and the Bonferroni post-hoc test. The differences between groups were considered to be statistically significant when P < 0.05. The mean value for debris scores for the three groups varied from 1.80 (+/-0.77) to 4.50 (+/-0.68). The smear layer scores for group 2 and the control specimens varied from 2.00 (+/-0.91) to 2.33 (+/-0.99). A significant difference was found in mean debris scores at the 3 and 6 mm levels between the three groups (P < 0.001). The Bonferroni post-hoc test confirmed that the difference was due to group 1. In the two subgroups treated with four high-frequency pulses (1B and 2B) a substantial reduction in mean debris scores was found at the 3 and 6 mm level; subgroup 2B was practically free of organic residue. No significant differences for mean smear layer and debris scores were recorded between group 2 and the control group at the two levels; a significant difference was found only for mean smear layer scores at the 3 mm level between subgroup 2B and the control group (P < 0.05). The Endox device used with four electrical pulses had optimal efficacy when used after mechanical instrumentation. Traditional canal shaping and cleaning was essential to ensure an effective use of high-frequency electrical pulses in eliminating residues of pulp tissue and inorganic debris.

Second Mesiobuccal Canal Treatment in a Predoctoral Dental Clinic: A Retrospective Clinical Study.

PubMed

Coelho, Marcelo Santos; Parker, Jeffrey M; Tawil, Peter Z

2016-06-01

The aim of this retrospective clinical study was to evaluate the location and treatment of second canals in mesiobuccal roots (MB2) of first and second maxillary molars in a predoctoral endodontic clinic by the graduating classes of 2008 to 2015. These results were compared to similar clinical studies. Included in the study were 368 root canal treatments performed by 310 third- and fourth-year dental students at one U.S. dental school. All cases were done under faculty supervision, and the students were instructed to use dental loupe magnification. Students' evaluation sheets were used to deteremine the total MB2 canals treated in first and second maxillary molars. The results showed that, overall, 72.55% of the teeth had an MB2 canal treated. The frequency was higher in first molars (75.91%) than in second molars (56.92%) (p<0.05). Third-year students were able to detect 39 MB2 canals in 57 maxillary molars (68.42%), while fourth-year students detected 228 MB2 canals in 311 teeth (73.31%) (p>0.05). Under proper supervision by experienced endodontists, these dental students were capable of treating MB2 canals in maxillary molars. The frequency of MB2 canals located and treated by dental students with the assistance of experienced professionals was higher in first than in second molars. No significant difference was found between third- and fourth-year students. The incidence of MB2 canals located and treated in this study was found to be similar to that in other clinical studies.

Survival of Endodontically Treated Roots/Teeth Based on Periapical Health and Retention: A 10-year Retrospective Cohort Study.

PubMed

Fernández, Rafael; Cardona, Jaime A; Cadavid, Diego; Álvarez, Luis G; Restrepo, Felipe A

2017-12-01

The purpose of this retrospective longitudinal cohort study was to evaluate the outcome of nonsurgical root canal treatment (NSRCT), expressed as survival for both periapical health and retention of roots/teeth, as determined by clinical evaluation, periapical film/digital radiography (PFR/DPR), and cone-beam computed tomography (CBCT) over 10 years, to determine the prognostic factors that influenced successful treatment outcomes. A total of 132 teeth (208 roots) with vital pulp received NSRCT at a university clinic. Eighteen factors (preoperative, intraoperative, and postoperative) were documented from the dental records and radiographs. Periapical indices with scores ≥2 (PFR/DPR) and ≥1 (CBCT) indicated the presence of a periapical lesion. Data were analyzed using the Kaplan-Meier test and the Cox proportional hazards regression model (P < .05). The estimated 10-year overall survival rates for periapical health of roots/teeth were 89.4%/88.6% with PFR, 89.4%/89.3% with DPR, and 72.6%/69.7% with CBCT; the survival rate for root/tooth retention was 90.4%/91.6%. The long-term outcome of NSRCT expressed as survival for periapical health was different with each radiographic method. Approximately more than 90% of the roots/teeth were retained for up to 10 years. The prognostic factors for periapical health were the disinfection of gutta-percha, missed canals, age, treatment sessions, and density of root filling (voids); the age and presence of a post were for root/tooth retention. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Prevalence of apical periodontitis and quality of root canal treatment in an adult Palestinian sub-population

PubMed Central

Mukhaimer, Raed; Hussein, Emad; Orafi, Ibtesam

2012-01-01

Purpose The aim of this study was to determine the prevalence of apical periodontitis and the technical quality of root canal fillings in a Palestinian sub-population. Methods The panoramic radiographs of 258 patients (142 females, 116 males) attending dental clinics in 2010 were examined to identify the presence of apical lesions associated with any remaining teeth, excluding third molars. The technical quality of root canal fillings was also evaluated by assessing apical extension from the radiographic apex. The panoramic radiographs were taken by a well-trained radiology assistant and evaluated by a radiologist and an endodontist. Statistical analysis was performed with the chi-square test with a significant level set at P < 0.05%. Results Of 6482 teeth examined radiographically, 978 (15.1%) had radiographic signs of apical periodontitis (AP). The prevalence of AP was 8.3% in teeth without filled roots and 59.5% (509/855) in root canal-treated teeth. The prevalence of AP and endodontic treatment increased with age and differed significantly (p < 0.05) between males and females. The majority (74.5%) of root canal fillings was performed inadequately, and most (77.2%) inadequate fillings were >2 mm short of the radiographic apex. The presence of AP was correlated significantly with poorly executed root canal fillings (p < 0.05). Conclusions The present study found a high prevalence and incidence of AP in association with root-filled teeth. The technical quality of many root canal treatments was unacceptable. PMID:23960544

Periodontal and endodontic pathology delays extraction socket healing in a canine model

PubMed Central

2017-01-01

Purpose The aim of the present exploratory study was to evaluate extraction socket healing at sites with a history of periodontal and endodontic pathology. Methods The mandibular 4th premolar teeth in 5 adult beagle dogs served as experimental units. Periodontal and endodontic lesions were induced in 1 premolar site in each animal using wire ligatures and pulpal exposure over 3 months (diseased sites). The contralateral premolar sites served as healthy controls. The mandibular 4th premolar teeth were then extracted with minimal trauma, followed by careful wound debridement. The animals were sacrificed at days 1, 7, 30, 60, and 90 post-extraction for analysis, and the healing patterns at the healthy and diseased extraction sites were compared using radiography, scanning electron microscopy, histology, and histometry. Results During the first 7 days of healing, a significant presence of inflammatory granulation tissue was noted at the diseased sites (day 1), along with a slightly accelerated rate of fibrin clot resolution on day 7. On day 30, the diseased extraction sites showed a greater percentage of persistent fibrous connective tissue, and an absence of bone marrow formation. In contrast, healthy sites showed initial signs of bone marrow formation on day 30, and subsequently a significantly greater proportion of mature bone marrow formation on both days 60 and 90. Radiographs exhibited sclerotic changes adjoining apical endodontic lesions, with scanning electron microscopy showing collapsed Volkmann canals protruding from these regions in the diseased sites. Furthermore, periodontal ligament fibers exhibited a parallel orientation to the alveolar walls of the diseased sites, in contrast to a perpendicular arrangement in the healthy sites. Conclusions Within the limitations of this study, it appears that a history of periodontal and endodontic pathology may critically affect bone formation and maturation, leading to delayed and compromised extraction socket healing. PMID:28680710

A comparison of the antibacterial activity of the two methods of photodynamic therapy (using diode laser 810 nm and LED lamp 630 nm) against Enterococcus faecalis in extracted human anterior teeth.

PubMed

Asnaashari, Mohammad; Mojahedi, Seyed Masoud; Asadi, Zahra; Azari-Marhabi, Saranaz; Maleki, Alireza

2016-03-01

Failure of endodontic treatment is usually due to an inadequate disinfection of the root canal system. Enterococcus faecalis has been widely used as a valuable microbiological marker for in-vitro studies because of its ability to colonize in a biofilm like style in root canals, invading dentinal tubules and resistance to some endodontic treatments. The aim of this study was to investigate the antibacterial effects of two methods of photodynamic therapy using a light emitting diode lamp (LED lamp, 630 nm) and a diode laser (810 nm) on E. faecalis biofilms in anterior extracted human teeth. Fifty six single-rooted extracted teeth were used in this study. After routine root canal cleansing, shaping and sterilization, the teeth were incubated with E. faecalis for a period of two weeks. Teeth were then divided into two experimental groups (nu=23) and two control groups (nu=5). Teeth in one experimental group were exposed to a diode laser (810 nm), and in the other group samples were exposed to a LED lamp (630 nm). Intracanal bacterial sampling was done, and bacterial survival rate was then evaluated for each group. The Colony Forming Unit (CFU) in LED group (log10 CFUs=4.88±0.82) was significantly lower than the laser group (log CFUs=5.49±0.71) (p value=0.021). CFUs in positive control group (Log10 CFUs=10.96±0.44) were significantly higher than the treatment group (p˂0.001). No bacterial colony was found in negative control group. The results of this research show that photodynamic therapy could be an effective supplement in root canal disinfection. PDT using LED lamp was more effective than diode laser 810 nm in reducing CFUs of E. faecalis in human teeth. Copyright © 2015 Elsevier B.V. All rights reserved.

Interleukin 1 gene cluster SNPs (rs1800587, rs1143634) influences post-orthodontic root resorption in endodontic and their contralateral vital control teeth differently.

PubMed

Iglesias-Linares, A; Yañez-Vico, R M; Ballesta, S; Ortiz-Ariza, E; Mendoza-Mendoza, A; Perea, E; Solano-Reina, E

2012-11-01

To investigate whether the genetic variants of the interleukin-1 gene cluster (IL1) are associated with a possible genetically induced variability in post-orthodontic external apical root resorption (EARR) in root filled teeth and their control counterparts with vital pulps. One hundred and forty-six maxillary premolars were evaluated radiographically following orthodontic treatment. Genetic screening was performed on orthodontic patients for two single-nucleotide polymorphisms (SNPs: rs1800587 and rs1143634) in the IL1 gene cluster. Subjects were divided into two groups according to the presence or absence of radiographic post-orthodontic EARR (>2 mm) in root filled teeth and their controls with vital pulps. Logistic regression analysis was performed to obtain an adjusted estimation between EARR and IL1 polymorphisms. Allelic frequencies, genotype distributions, and adjusted odds ratio (OR), at 95% confidence interval, were also calculated. Whilst no clear statistical association was found for gene variations in IL1A, a sound association was found in the comparative analysis of subjects homozygous [2/2(TT)] for the IL1B gene, which resulted in a two times increased risk of suffering post-orthodontic EARR in root filled teeth [OR, 2.032 (P = 0.031); CI,1.99-14.77] when compared with their controls with vital pulps. There was, however, a shared predisposition to EARR in controls with vital pulps and root filled teeth of subjects homozygous for allele 1 [OR, 5.05 (P = 0.002)] and [OR, 2.77 (P = 0.037)], respectively. Genetic variations in the interleukin-1β gene (rs1143634) predispose root filled teeth to EARR for matched pairs secondary to orthodontic treatment in a different way from their control teeth with vital pulps in subjects homozygous for allele 2 [2/2(TT)]. © 2012 International Endodontic Journal.

Association of Endodontic Lesions with Coronary Artery Disease.

PubMed

Liljestrand, J M; Mäntylä, P; Paju, S; Buhlin, K; Kopra, K A E; Persson, G R; Hernandez, M; Nieminen, M S; Sinisalo, J; Tjäderhane, L; Pussinen, P J

2016-11-01

An endodontic lesion (EL) is a common manifestation of endodontic infection where Porphyromonas endodontalis is frequently encountered. EL may associate with increased risk for coronary artery disease (CAD) via similar pathways as marginal periodontitis. The aim of this cross-sectional study was to delineate the associations between EL and CAD. Subgingival P. endodontalis, its immune response, and serum lipopolysaccharide were examined as potential mediators between these 2 diseases. The Finnish Parogene study consists of 508 patients (mean age, 62 y) who underwent coronary angiography and extensive clinical and radiographic oral examination. The cardiovascular outcomes included no significant CAD ( n = 123), stable CAD ( n = 184), and acute coronary syndrome (ACS; n = 169). EL was determined from a panoramic tomography. We combined data of widened periapical spaces (WPSs) and apical rarefactions to a score of EL: 1, no EL ( n = 210); 2, ≥1 WPS per 1 apical rarefaction ( n = 222); 3, ≥2 apical rarefactions ( n = 76). Subgingival P. endodontalis was defined by checkerboard DNA-DNA hybridization analysis, and corresponding serum antibodies were determined by ELISA. In our population, 50.4% had WPSs, and 22.8% apical rarefactions. A total of 51.2% of all teeth with apical rarefactions had received endodontic procedures. Subgingival P. endodontalis levels and serum immunoglobulin G were associated with a higher EL score. In the multiadjusted model (age, sex, smoking, diabetes, body mass index, alveolar bone loss, and number of teeth), having WPSs associated with stable CAD (odds ratio [OR] = 1.94, 95% confidence interval [95% CI] = 1.13 to 3.32, P = 0.016) and highest EL score were associated with ACS (OR = 2.46, 95% CI = 1.09 to 5.54, P = 0.030). This association was especially notable in subjects with untreated teeth with apical rarefactions ( n = 59, OR = 2.72, 95% CI = 1.16 to 6.40, P = 0.022). Our findings support the hypothesis that ELs are independently associated with CAD and in particular with ACS. This is of high interest from a public health perspective, considering the high prevalence of ELs and CAD.

Instrument separation analysis of multi-used ProTaper Universal rotary system during root canal therapy.

PubMed

Wu, Jintao; Lei, Gang; Yan, Ming; Yu, Yan; Yu, Jinhua; Zhang, Guangdong

2011-06-01

The purpose of this study was to identify the influential factors responsible for clinical instrument separation of reused ProTaper Universal rotary instruments (Dentsply Maillefer, Ballaigues, Switzerland). Six thousand one hundred fifty-four root canals in 2,654 teeth were prepared using ProTaper Universal files in endodontic clinics. Separation incidence was determined based on the number of treated teeth or canals. Data were collected including the size of fractured instrument, the length and location of a broken segment within the root canal, and the curvature of canal. The chi-square test and independent samples t test were used to determine the statistical significance. The overall instrument separation incidences were 2.6% according to the number of teeth and 1.1% according to the canal number, respectively. Separation incidences according to the number of teeth or canals were significantly higher (P < .05) in molars than those in premolars or anterior teeth. Because of its largest diameter, F3 file presented the highest separation incidence according to the number of teeth (1.0%) or canals (0.4%); 47.5% instrument separation of mandibular molars and 61.5% instrument separation of maxillary molars happened in the mesiobuccal canals. Moreover, 91.4% fragments were located in the apical third of root canals, and 54.2% instrument separation occurred in severely curved canals. There was a significant difference (P < .05) in the mean fracture length between shaping (2.42 ± 0.73 mm) and finishing files (3.32 ± 0.73 mm). Separation incidence according to the canal number is more reliable than that according to the number of teeth because of the variable canal number in different teeth. The tooth type, rotary file size, canal location, and anatomy were correlated with the instrument separation of reused ProTaper Universal files. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Er:YAG laser for endodontics: efficiency and safety

NASA Astrophysics Data System (ADS)

Hibst, Raimund; Stock, Karl; Gall, Robert; Keller, Ulrich

1997-12-01

Recently it has been shown that bacterias can be sterilized by Er:YAG laser irradiation. By optical fiber transmission the bactericidal effect can also be used in endodontics. In order to explore potential laser parameters, we further investigated sterilization of caries and measured temperatures in models simulating endodontic treatment. It was found out that the bactericidal effect is cumulative, with single pulses being active. This offers to choose all laser parameters except pulse energy (radiant exposure) from technical, practical or safety considerations. For clinical studies the following parameter set is proposed for efficient and safe application (teeth with a root wall thickness > 1 mm, and prepared up to ISO 50): pulse energy: 50 mJ, repetition rate: 15 Hz, fiber withdrawal velocity: 2 mm/s. With these settings 4 passes must be performed to accumulate the total dose for sterilization.

Mixed periapical lesion: an atypical radicular cyst with extensive calcifications.

PubMed

Ramos-Perez, Flávia Maria de Moraes; Pontual, Andréa dos Anjos; França, Talita Ribeiro Tenório de; Pontual, Maria Luiza dos Anjos; Beltrão, Ricardo Villar; Perez, Danyel Elias da Cruz

2014-01-01

The radicular cyst is an inflammatory odontogenic cyst of endodontic origin. Radiographically, the lesion appears as a periapical radiolucent image. This report describes a very rare case of a mixed periapical radiographic image diagnosed as a radicular cyst. A 37-year-old female patient presented a mixed, well-circumscribed image located in the periapical region of the left maxillary central incisor, which presented unsatisfactory endodontic treatment. Microscopic examination revealed a cavity lined by non-keratinized squamous epithelium and extensive calcifications in the cystic lumen and lining epithelium. Diagnosis of radicular cyst with extensive calcifications was established. Endodontic retreatment was performed and no radiographic signs of recurrence were observed 18 months after treatment. Although very rare, a radicular cyst should be considered in the differential diagnosis of a mixed periapical image associated to teeth with pulp necrosis.

Characterization of the dental pulp using optical coherence tomography

NASA Astrophysics Data System (ADS)

Kauffman, C. M. F.; Carvalho, M. T.; Araujo, R. E.; Freitas, A. Z.; Zezell, D. M.; Gomes, A. S. L.

2006-02-01

The inner structure of teeth, i.e. the root canal anatomy, is very complex. However a good knowledge of endodontic architecture is the first step towards successful endodontic treatment. Optical coherence tomography (OCT) is a powerful technique to generate images of hard and soft tissue. Its images show dependency on the optical properties of the tissue under analysis. Changes in the scattering and absorption of tissues can be observed through the OCT images. In this work, we used optical coherence tomography to perform in vitro studies of the inner structure of the first molar of albino rats (Rattus norvegicus). Focusing on the pulp chamber and in the root canal, we compare the images generated with the OCT technique to the histology. We are analyzing the feasibility of OCT to help on the diagnostic of endodontic diseases.

The effect of MTAD, an endodontic irrigant, on fibroblast attachment to periodontally affected root surfaces: A SEM analysis.

PubMed

Ghandi, Mostafa; Houshmand, Behzad; Nekoofar, Mohammad H; Tabor, Rachel K; Yadeghari, Zahra; Dummer, Paul M H

2013-03-01

Root surface debridement (RSD) is necessary to create an environment suitable for reattachment of the periodontium. Root surface conditioning may aid the formation of a biocompatible surface suitable for cell reattachment. BioPure™ MTAD (mixture of Doxycycline, citric acid and a detergent) is an endodontic irrigant with antibacterial properties and the ability to remove smear layer. It was hypothesized that MTAD may be useful for root surface conditioning. The efficacy of MTAD as a conditioner was measured by examining fibroblast attachment to root surfaces. Thirty-two specimens of human teeth with advanced periodontal disease were used. The surfaces were root planed until smooth. Half of the specimens were treated with 0.9% saline and the other samples with Biopure MTAD. As a negative control group, five further samples were left unscaled with surface calculus. Human gingival fibroblast cells HGF1-PI1 were cultured and poured over the tooth specimens and incubated. After fixation, the samples were sputter-coated with gold and examined with a SEM. The morphology and number of attached, fixed viable cells were examined. The data was analysed using the Mann-Whitney-U statistical test. There was no significant difference between the numbers of attached cells in the experimental group treated with MTAD and the control group treated with saline. Little or no attached cells were seen in the negative control group. RSD created an environment suitable for cell growth and attachment in a laboratory setting. The use of MTAD did not promote the attachment and growth of cells on the surface of human roots following RSD.

The design of an fast Fourier filter for enhancing diagnostically relevant structures - endodontic files.

PubMed

Bruellmann, Dan; Sander, Steven; Schmidtmann, Irene

2016-05-01

The endodontic working length is commonly determined by electronic apex locators and intraoral periapical radiographs. No algorithms for the automatic detection of endodontic files in dental radiographs have been described in the recent literature. Teeth from the mandibles of pig cadavers were accessed, and digital radiographs of these specimens were obtained using an optical bench. The specimens were then recorded in identical positions and settings after the insertion of endodontic files of known sizes (ISO sizes 10-15). The frequency bands generated by the endodontic files were determined using fast Fourier transforms (FFTs) to convert the resulting images into frequency spectra. The detected frequencies were used to design a pre-segmentation filter, which was programmed using Delphi XE RAD Studio software (Embarcadero Technologies, San Francisco, USA) and tested on 20 radiographs. For performance evaluation purposes, the gauged lengths (measured with a caliper) of visible endodontic files were measured in the native and filtered images. The software was able to segment the endodontic files in both the samples and similar dental radiographs. We observed median length differences of 0.52 mm (SD: 2.76 mm) and 0.46 mm (SD: 2.33 mm) in the native and post-segmentation images, respectively. Pearson's correlation test revealed a significant correlation of 0.915 between the true length and the measured length in the native images; the corresponding correlation for the filtered images was 0.97 (p=0.0001). The algorithm can be used to automatically detect and measure the lengths of endodontic files in digital dental radiographs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of Metal Artifacts on Detection of Vertical Root Fractures Using Two Cone Beam Computed Tomography Systems.

PubMed

Safi, Yaser; Aghdasi, Mohammad Mehdi; Ezoddini-Ardakani, Fatemeh; Beiraghi, Samira; Vasegh, Zahra

2015-01-01

Vertical root fracture (VRF) is common in endodontically treated teeth. Conventional and digital radiographies have limitations for detection of VRFs. Cone-beam computed tomography (CBCT) offers greater detection accuracy of VRFs in comparison with conventional radiography. This study compared the effects of metal artifacts on detection of VRFs by using two CBCT systems. Eighty extracted premolars were selected and sectioned at the level of the cemento enamel junction (CEJ). After preparation, root canals were filled with gutta-percha. Subsequently, two thirds of the root fillings were removed for post space preparation and a custom-made post was cemented into each canal. The teeth were randomly divided into two groups (n=40). In the test group, root fracture was created with Instron universal testing machine. The control teeth remained intact. CBCT scans of all teeth were obtained with either New Tom VGI or Soredex Scanora 3D. Three observers analyzed the images for detection of VRF. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for VRF detection and percentage of probable cases were calculated for each imaging system and compared using non-parametric tests considering the non-normal distribution of data. The inter-observer reproducibility was calculated using the weighted kappa coefficient. There were no statistically significant differences in sensitivity, specificity, PPV and NPV between the two CBCT systems. The effect of metal artifacts on VRF detection was not significantly different between the two CBCT systems.

Survival of two post systems--five-year results of a randomized clinical trial.

PubMed

Schmitter, Marc; Hamadi, Khaled; Rammelsberg, Peter

2011-01-01

To assess the survival rate of two different post systems after 5 years of service with a prospective randomized controlled trial. One hundred patients in need of a post were studied. Half of the patients received long glass fiber-reinforced posts, while the other half received long metal screw posts. The posts were assigned randomly. After at least 5 years (mean, 61.37 months), follow-ups were established. When a complication occurred prior to this recall, the type and time of the complication was documented. Statistical analysis was performed using the log-rank test and Kaplan-Meier analysis. Additionally, a Cox regression was performed to analyze risk factors. The survival rate of fiber-reinforced posts was 71.8%. In the metal screw post group, the survival rate was significantly lower, 50.0% (log-rank test, P = .026). Metal posts resulted more often in more unfavorable complications (eg, root fractures); consequently, more teeth (n = 17) had to be extracted. The Cox regression identified the following risk factors: position of the tooth (anterior vs posterior teeth), degree of coronal tooth destruction, and the post system (fiber-reinforced post vs metal screw post). Fiber-reinforced restorations loosened in several patients; in some of these cases (n = 6), patients did not notice this, leading to the extraction of teeth. Long metal screw posts should be used with great care in endodontically treated teeth. Besides the selection of the post system, other factors influence the survival of the restoration.

Surgical intervention of complex endo-perio lesions.

PubMed

Adcock, John E; Bright, David

2007-08-01

Complex endo-perio lesions are infrequent, but pose treatment dilemmas. The lesions are complex with bone loss involving adjacent teeth that are not part of the initial endodontic lesion. The aggressive bone loss is not clearly understood and apparently has some differences from the usual apical periodontitis.

Comparison of fracture and deformation in the rotary endodontic instruments: Protaper versus K-3 system.

PubMed

Nagi, Sana Ehsen; Khan, Farhan Raza; Rahman, Munawar

2016-03-01

This experimental study was done on extracted human teeth to compare the fracture and deformation of the two rotary endodontic files system namely K-3 and Protapers. It was conducted at the dental clinics of the Aga Khan University Hospital, Karachi, A log of file deformation or fracture during root canal preparation was kept. The location of fracture was noted along with the identity of the canal in which fracture took place. The fracture in the two rotary systems was compared. SPSS 20 was used for data analysis. Of the 172(80.4%) teeth possessing more than 15 degrees of curvature, fracture occurred in 7(4.1%) cases and deformation in 10(5.8%). Of the 42(19.6%) teeth possessing less than 15 degrees of curvature, fracture occurred in none of them while deformation was seen in 1(2.4%). There was no difference in K-3 and Protaper files with respect to file deformation and fracture. Most of the fractures occurred in mesiobuccal canals of maxillary molars, n=3(21.4%). The likelihood of file fracture increased 5.65-fold when the same file was used more than 3 times. Irrespective of the rotary system, apical third of the root canal space was the most common site for file fracture.

Fracture resistance and reinforcement of immature roots with gutta percha, mineral trioxide aggregate and calcium phosphate bone cement: a standardized in vitro model.

PubMed

Cauwels, Rita G E C; Pieters, Ilse Y; Martens, Luc C; Verbeeck, Ronald M H

2010-04-01

Endodontic treatment of immature teeth is often complicated because of flaring root canals and open apices for which apexification is needed. Long-term prognosis for these teeth is surprisingly low because of cervical root fractures occurring after an impact of weak forces. In this study, an experimental model was developed to determine the fracture resistance of immature teeth and to test the hypothesis that endodontic materials succeed in reinforcing them. Compact and hollow bone cylinders from bovine femurs were used as standardized samples. In order to evaluate the experimental model, fracture resistance in both groups was evaluated by determining the ultimate force to fracture (UFF) under diametral tensile stress. Analysis of variance (ANOVA) revealed a statistically significant difference between the mean values of UFF for both groups, independently of the sampling location or subject. In a following setting, the hypothesis that obturation with gutta percha (GP), mineral trioxide aggregate (MTA), or calcium phosphate bone cement (CPBC) reinforces the hollow bone samples was investigated. Obturation resulted in a significant reinforcement for all materials, but the degree of reinforcement depended on the material. The experimental model appeared to be suitable for in vitro investigation of reinforcement and fracture resistance in a standardized way.

Comparison of the cleaning capacity of Mtwo and Pro Taper rotary systems and manual instruments in primary teeth

PubMed Central

Azar, Mohammad Reza; Safi, Laya; Nikaein, Afshin

2012-01-01

Background: Root canal cleaning is an important step in endodontic therapy. In order to develop better techniques, a new generation of endodontic instruments has been designed. The aim of this study was to compare the effectiveness of manual K-files (Mani Co, Tokyo, Japan) and two rotary systems–Mtwo (Dentsply-Maillefer, Ballaigues, Switzerland) and ProTaper (VDW, Munich, Germany)–for root canal preparation in primary molars. Materials and Methods: India ink was injected to 160 mesiobuccal and distal root canals of mandibular primary molars. The teeth were randomly divided into three experimental groups and one control group. In each experimental group, either manual instruments (K-files) or rotary instruments (Mtwo or ProTaper) were used to prepare root canals. After cleaning the canals and clearing the teeth, ink removal was evaluated with a stereomicroscope. Statistical analysis was done with Kruskal–Wallis and Friedman tests. Results: There were no significant differences in cleaning efficiency between manual and rotary instruments. Only ProTaper files performed significantly better in the coronal and middle thirds than in the apical third of the root canal. Conclusion: Manual K-files and the Mtwo and ProTaper rotary systems showed equally acceptable cleaning ability in primary molar root canals. PMID:22623929

A preliminary report on histological outcome of pulpotomy with endodontic biomaterials vs calcium hydroxide

PubMed Central

Peimani, Ali; Asgary, Saeed

2013-01-01

Objectives The purpose of the study was to evaluate human dental pulp response to pulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement. Materials and Methods A total of nine erupted third molars were randomly assigned to each pulpotomy group. The same clinician performed full pulpotomies and coronal restorations. The patients were followed clinically for six months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulp inflammation, and calcified bridge formation. Results All patients were free of clinical signs/symptoms of pulpal/periradicular diseases during the follow up period. In CH group, one tooth had necrotic radicular pulp; other two teeth in this group had vital uninflamed pulps with complete dentinal bridge formation. In CEM cement and MTA groups all teeth had vital uninflamed radicular pulps. A complete dentinal bridge was formed beneath CEM cement and MTA in all roots. Odontoblast-like cells were present beneath CEM cement and MTA in all samples. Conclusions This study revealed that CEM cement and MTA were reliable endodontic biomaterials in full pulpotomy treatment. In contrast, the human dental pulp response to CH might be unpredictable. PMID:24303358

Bacterial analysis of combined periodontal-endodontic lesions by polymerase chain reaction-denaturing gradient gel electrophoresis.

PubMed

Xia, Minghui; Qi, Qingguo

2013-01-01

We used denaturing gradient gel electrophoresis (DGGE) to compare bacterial profiles in periodontium and root canals of teeth with combined periodontal-endodontic lesions. Samples of dental plaque and necrotic pulp were collected from thirteen extracted teeth with advanced periodontitis. Genomic DNA was extracted for polymerase chain reaction (PCR) analysis using universal bacterial primers. The PCR products were then loaded onto DGGE gels to obtain fractionated bands. Characteristic DGGE bands were excised and DNA was cloned and sequenced. The number of bands, which indicates the number of bacterial species, was compared between dental plaques and necrotic pulp tissues from the same tooth. Although the difference was statistically significant (P < 0.01), there was no positive correlation; similarity (Dice coefficient) was 13.1% to 62.5%. Some bacteria species were present in both the periodontal pockets and root canals of the same tooth; however, periodontal bacteria did not always invade the root canals, and some bacteria in root canals were not present in periodontal pockets of the same tooth. In some teeth, unique bacteria in root canals had not passed from periodontal pockets. A basic local alignment search tool (BLAST) sequence search in Genbank indicated that new bacteria species were present in periodontal pockets and root canals. Their characteristics must thus be further analyzed.

Evaluation of the interaction between sodium hypochlorite and several formulations containing chlorhexidine and its effect on the radicular dentin--SEM and push-out bond strength analysis.

PubMed

Graziele Magro, Miriam; Kuga, Milton Carlos; Regina Victorino, Keli; Vázquez-Garcia, Fernando Antonio; Aranda-Garcia, Arturo Javier; Faria-Junior, Norberto Batista; Faria, Gisele; Luis Shinohara, André

2014-01-01

The aim of the current study was to evaluate the presence of debris and smear layer after endodontic irrigation with different formulations of 2% chlorhexidine gluconate (CHX) and its effects on the push-out bond strength of an epoxy-based sealer on the radicular dentin. One hundred extracted human canines were prepared to F5 instrument and irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Fifty teeth were divided into five groups (n = 10), according to the final irrigation protocol with different 2% CHX formulations: G1 (control, no final rinse irrigation), G2 (CHX solution), G3 (CHX gel), G4 (Concepsis), and G5 (CHX Plus). In sequence, the specimens were submitted to scanning electron microscopy (SEM) analysis, in the cervical-medium and medium-apical segments, to evaluate the presence of debris and smear layer. The other 50 teeth were treated equally to a SEM study, but with the root canals filled with an epoxy-based endodontic sealer and submitted to a push-out bond strength test, in the cervical, middle, and apical thirds. G2, G3, G4, and G5 provided higher precipitation of the debris and smear layer than G1 (P < 0.05), but these groups were similar to each other (P > 0.05), in both segments. The values obtained in the push out test did not differ between groups, independent of the radicular third (P > 0.05). The CHXs formulations caused precipitation of the debris and smear layer on the radicular dentin, but these residues did not interfere in the push-out bond strength of the epoxy-based sealer. Copyright © 2013 Wiley Periodicals, Inc.

The confidence of undergraduate dental students when performing root canal treatment and their perception of the quality of endodontic education.

PubMed

Davey, J; Bryant, S T; Dummer, P M H

2015-11-01

This article aims to gain understanding into the perception of undergraduate dental students in terms of their confidence and competence at performing root canal treatment and their perception of the quality of endodontic education. An online questionnaire was distributed to all 3rd, 4th and 5th year dental students at Cardiff University via their academic e-mail addresses. The questionnaire utilised both scaled response and open questions to gain an insight into undergraduate opinion. Out of a possible 208 students, 98 responses were obtained (response rate = 47%). Perception of competence and confidence were significantly greater amongst the more senior year groups (P < 0.01). However, 49% (n = 38) of participants did not feel competent performing root canal treatment on anterior, single-rooted teeth, whilst 74% (n = 70) did not feel competent performing root canal treatment on posterior, multirooted teeth. Free comments from participants indicated that this was due to a lack of clinical experience. Approximately, 80% of participants ranked education in endodontics at Cardiff University as ≤5 on a Likert scale (1 = inadequate to 10 = good), indicating that improvement was required. Improvements that were suggested by the students included the provision of further information within lectures, a broader range of lecturers, an increased number of shorter, more organised practical sessions, additional training equipment, greater supervision and online reference guides to root canal treatment. Enhancing undergraduate education in endodontics is necessary to increase students' perception of their confidence and competence when performing root canal treatment. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Squamous cell carcinoma presenting as an endodontic-periodontic lesion.

PubMed

Levi, Paul A; Kim, David M; Harsfield, Scott L; Jacobson, Erica R

2005-10-01

Regardless of advances in diagnosis and treatment during the past 40 years, the overall 5-year survival rates for oral and oropharyngeal squamous cancers have only slightly improved and remain around 50%. Thus, the early diagnosis and treatment of carcinoma by health care providers are essential in achieving a good prognosis. We report a case of invasive squamous cell carcinoma that presented as a benign endodontic-periodontic lesion with a 7-mm periodontal pocket on tooth #15 in a 40-year-old, non-smoking woman. The subsequent management of the case is also discussed. The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000. Our patient was seen for a comprehensive periodontal examination including a periodontal charting, occlusal analysis, study casts, electronic pulp test for tooth #15, and complete mouth periapical radiographs. As there was a periapical radiolucency, an endodontic consultation was obtained. A periodontal flap surgical procedure was performed on teeth #13 to #15, and as there was bone erosion into the maxillary sinus, a biopsy of the soft tissue was submitted to the local hospital for histological analysis. The biopsied lesion was diagnosed as invasive, moderately differentiated squamous cell carcinoma with focal spindle and clear cell differentiation (grade II to III of IV). Bone invasion was also identified. The treatment of the carcinoma involved a hemimaxillectomy with the removal of the maxillary left posterior teeth. The patient remained free of tumor for 5 years after the initial presentation. Patient education and periodic oral cancer examinations by dental professionals are necessary to reduce diagnostic delay and improve prognosis. This case report emphasizes the important role of dental professionals, especially periodontists and endodontists, of being aware that squamous cell carcinoma may manifest itself clinically and/or radiographically as a common periodontal or endodontic lesion.

Use of photoactivated disinfection and platelet-rich fibrin in regenerative Endodontics

PubMed Central

Johns, Dexton Antony; Shivashankar, Vasundara Yayathi; Krishnamma, Shoba; Johns, Manu

2014-01-01

Aim: Photoactivated disinfection has been used as an adjunct to conventional endodontic treatment. Its use in regenerative endodontics is not reported in literature. The aim of this case report was to describe a new proposal for pulp revascularization with disinfection of pulp canal space using a unique combination of a photosensitizer solution and low-power laser light. Materials and Methods: A 9-year-old boy came with the chief complaint of discolored upper central incisors (#8, #9). A diagnosis of pulp necrosis was made on the basis of clinical and radiographic findings. The canal was irrigated with 5.25% sodium hypochlorite solution and dried with paper points. Photodynamic therapy was used to disinfect the root canal and platelet-rich fibrin was used to revitalize the pulp. Three millimeters of gray mineral trioxide aggregate was placed directly over the platelet-rich plasma clot. Three days later, the tooth was double-sealed with permanent filling materials. Results: Clinical examination revealed no sensitivity to percussion or palpation tests. Radiograph revealed continued thickening of the dentinal walls, root lengthening, regression of the peri-apical lesion and apical closure. Both the roots showed complete apical closure at the 10-month follow-up. However, the teeth were not responsive to electric pulp test. Conclusion: This report of pulp revascularization shows that disinfection with photodynamic therapy combined with platelet-rich fibrin leads to satisfactory root development in necrotic immature teeth. PMID:25298655

Endodontic management of an unusual foreign body in a maxillary central incisor

PubMed Central

Chand, Keerthi; Joesph, Sam; Varughese, Jolly Mary; Nair, Mali G; Prasanth, Santhosh

2013-01-01

The discovery of foreign bodies in the teeth is often diagnosed accidentally. It is commonly seen in children. These foreign objects may act as a potential source of infection and may later lead to a painful condition. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and the difficulty involved in its retrieval. This paper discusses the types of foreign objects found in and around the teeth and reports an unusual case of a stapler pin in the root canal of a tooth, its retrieval, and associated management of the involved teeth. PMID:24082582

A simple working classification proposed for the latrogenic lesions of teeth and associated structures in the oral cavity.

PubMed

Shamim, Thorakkal

2013-09-01

Iatrogenic lesions can affect both hard and soft tissues in the oral cavity, induced by the dentist's activity, manner or therapy. There is no approved simple working classification for the iatrogenic lesions of teeth and associated structures in the oral cavity in the literature. A simple working classification is proposed here for iatrogenic lesions of teeth and associated structures in the oral cavity based on its relation with dental specialities. The dental specialities considered in this classification are conservative dentistry and endodontics, orthodontics, oral and maxillofacial surgery and prosthodontics. This classification will be useful for the dental clinician who is dealing with diseases of oral cavity.

Survival of extensively damaged endodontically treated incisors restored with different types of posts-and-core foundation restoration material.

PubMed

Lazari, Priscilla Cardoso; de Carvalho, Marco Aurélio; Del Bel Cury, Altair A; Magne, Pascal

2018-05-01

Which post-and-core combination will best improve the performance of extensively damaged endodontically treated incisors without a ferrule is still unclear. The purpose of this in vitro study was to investigate the restoration of extensively damaged endodontically treated incisors without a ferrule using glass-ceramic crowns bonded to various composite resin foundation restorations and 2 types of posts. Sixty decoronated endodontically treated bovine incisors without a ferrule were divided into 4 groups and restored with various post-and-core foundation restorations. NfPfB=no-ferrule (Nf) with glass-fiber post (Pf) and bulk-fill resin foundation restoration (B); NfPfP=no-ferrule (Nf) with glass-fiber post (Pf) and dual-polymerized composite resin core foundation restoration (P); NfPt=no-ferrule (Nf) with titanium post (Pt) and resin core foundation restoration; and NfPtB=no-ferrule (Nf) with titanium post (Pt) and bulk-fill resin core foundation restoration (B). Two additional groups from previously published data from the same authors (FPf=2mm of ferrule (F) and glass-fiber post (Pf) and composite resin core foundation restoration; and NfPf=no-ferrule (Nf) with glass-fiber post (Pf) and composite resin core foundation restoration), which were tested concomitantly and using the same experimental arrangement, were included for comparison. All teeth were prepared to receive bonded glass-ceramic crowns luted with dual-polymerized resin cement and were subjected to accelerated fatigue testing under submerged conditions at room temperature. Cyclic isometric loading was applied to the incisal edge at an angle of 30 degrees with a frequency of 5 Hz, beginning with a load of 100 N (5000 cycles). A 100-N load increase was applied every 15000 cycles. The specimens were loaded until failure or to a maximum of 1000 N (140000 cycles). The 6 groups (4 groups from the present study and 2 groups from the previously published study) were compared using the Kaplan-Meier survival analysis (log-rank post hoc test at α=.05 for pairwise comparisons). None of the tested specimen withstood all 140 000 cycles. All specimens without a ferrule were affected by an initial failure phenomenon (wide gap at the lingual margin between the core foundation restoration/crown assembly and the root). NfPfP, NfPt, and NfPtB had similar survival (29649 to 30987 mean cycles until initial failure). NfPfB outperformed NfPt and NfPtB. None of the post-and-core foundation restoration materials were able to match the performance of the ferrule group FPf (72667 cycles). In all groups, 100% of failures were catastrophic. The survival of extensively damaged endodontically treated incisors without a ferrule was slightly improved by the use of a fiber post with a bulk-fill composite resin core foundation restoration. However, none of the post-and-core techniques was able to compensate for the absence of a ferrule. The presence of the posts always adversely affected the failure mode. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Endoscopic root canal treatment.

PubMed

Moshonov, Joshua; Michaeli, Eli; Nahlieli, Oded

2009-10-01

To describe an innovative endoscopic technique for root canal treatment. Root canal treatment was performed on 12 patients (15 teeth), using a newly developed endoscope (Sialotechnology), which combines an endoscope, irrigation, and a surgical microinstrument channel. Endoscopic root canal treatment of all 15 teeth was successful with complete resolution of all symptoms (6-month follow-up). The novel endoscope used in this study accurately identified all microstructures and simplified root canal treatment. The endoscope may be considered for use not only for preoperative observation and diagnosis but also for active endodontic treatment.

Nonsurgical Treatment of Two Periapical Lesions with Calcium Hydroxide Using Two Different Vehicles

PubMed Central

Dixit, Seema; Dixit, Ashutosh; Kumar, Pravin

2014-01-01

Calcium hydroxide is used extensively as an intracanal medicament in endodontics for many years. It is used in various clinical situations such as to promote apexification, to repair perforation, to enhance healing of periapical lesions, to control root resorption, and to control exudation in teeth with persistent periapical inflammation. This paper presents a case report in which Ca(OH)2 was used as an intracanal medicament for treatment of periradicular lesions using two different vehicles in two different teeth of same patient. PMID:25133000

Diabetes mellitus, periapical inflammation and endodontic treatment outcome

PubMed Central

Castellanos-Cosano, Lizett; Machuca, Guillermo; López-López, Jose; Martín-González, Jenifer; Velasco-Ortega, Eugenio; Sánchez-Domínguez, Benito; López-Frías, Francisco J.

2012-01-01

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol. Key words: Apical periodontitis, diabetes mellitus, endodontics, root canal treatment. PMID:22143698

Diversity of spirochetes in endodontic infections.

PubMed

Sakamoto, Mitsuo; Siqueira, José F; Rôças, Isabela N; Benno, Yoshimi

2009-05-01

The diversity of spirochetes in primary endodontic infections of teeth with chronic apical periodontitis or acute apical abscesses was investigated using 16S rRNA gene clone library analysis. The prevalences of three common cultivable oral Treponema species were also determined using species-specific nested PCR. All detected spirochetes belonged to the genus Treponema. Overall, 28 different taxa were identified from the 431 clones sequenced: 9 cultivable and validly named species, 1 cultivable as-yet-uncharacterized strain, and 18 as-yet-uncultivated phylotypes, 17 of which were novel. The large majority of clones (94%) were from cultivable named species. The numbers of Treponema species/phylotypes per selected positive sample ranged from 2 to 12. Species-specific nested PCR detected T. denticola, T. socranskii, and T. maltophilum in 59 (66%), 33 (37%), and 26 (29%) of the 90 cases of primary endodontic infections, respectively. Clone library analysis revealed diverse Treponema species/phylotypes as part of the microbiota associated with asymptomatic and symptomatic (abscess) endodontic infections. Although several as-yet-uncultivated Treponema phylotypes were disclosed, including novel taxa, cultivable named species were more abundant and frequently detected.

Photodynamic therapy for endodontic disinfection.

PubMed

Soukos, Nikolaos S; Chen, Peter Shih-Yao; Morris, Jason T; Ruggiero, Karriann; Abernethy, Abraham D; Som, Sovanda; Foschi, Federico; Doucette, Stephanie; Bammann, Lili Luschke; Fontana, Carla Raquel; Doukas, Apostolos G; Stashenko, Philip P

2006-10-01

The aims of this study were to investigate the effects of photodynamic therapy (PDT) on endodontic pathogens in planktonic phase as well as on Enterococcus faecalis biofilms in experimentally infected root canals of extracted teeth. Strains of microorganisms were sensitized with methylene blue (25 microg/ml) for 5 minutes followed by exposure to red light of 665 nm with an energy fluence of 30 J/cm2. Methylene blue fully eliminated all bacterial species with the exception of E. faecalis (53% killing). The same concentration of methylene blue in combination with red light (222 J/cm2) was able to eliminate 97% of E. faecalis biofilm bacteria in root canals using an optical fiber with multiple cylindrical diffusers that uniformly distributed light at 360 degrees. We conclude that PDT may be developed as an adjunctive procedure to kill residual bacteria in the root canal system after standard endodontic treatment.

Experimental model: dye penetration of extensive interim restorations used during endodontic treatment while under load in a multiple axis chewing simulator.

PubMed

Jensen, Arna-Lee; Abbott, Paul V

2007-10-01

The purpose of this study was to design an experimental model that allowed extensive endodontic interim restorations to be tested for dye penetration while under simulated masticatory load. Extracted premolar teeth had standardized mesio-occluso-distal cavities prepared, and the root canals were instrumented. A cotton wool pellet was placed in the pulp chamber, and the cavities were restored with Cavit, IRM, Ketac-Fil Plus, Ketac-Silver, or composite resin (Z100). They were subjected to the equivalent of 3 months of clinical load while exposed to methylene blue dye. Results of this study could not support IRM as a suitable interim endodontic restorative material to use in extensive cavities. The dye penetration in the Ketac-Fil Plus and Ketac-Silver specimens was not predictable, and the results suggested Cavit and Z100 composite resin require further investigations as potentially useful materials for this purpose.

Aberration in the palatal root of the maxillary first molar

PubMed Central

Rajalbandi, Sandeep; Shingte, Sandhya Narayan; Sundaresh, K J; Mallikarjuna, Rachappa

2013-01-01

Thorough knowledge of root canal morphology is essential for the endodontic therapy. Variations in the root and root canal morphology, especially in multirooted teeth, are a constant challenge for diagnosis and management. The dentist needs to be familiar with the various root canal configurations and their variations for successful endodontic therapy. There are rare variations in canal number and configuration in maxillary molars, which could affect treatment outcome. Two lingual root structures are occasionally found on human permanent maxillary molars. One of these is the normal lingual root, which is always present, the other is a supernumerary structure which can be located either mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). The purpose of this paper is to review the literature and to demonstrate a case report which describes the successful non-surgical endodontic management of an unusual maxillary first molar with four separate roots and four canals. PMID:23632609

Development of a handheld smart dental instrument for root canal imaging

NASA Astrophysics Data System (ADS)

Okoro, Chukwuemeka; Vartanian, Albert; Toussaint, , Kimani C., Jr.

2016-11-01

Ergonomics and ease of visualization play a major role in the effectiveness of endodontic therapy. Using only commercial off-the-shelf components, we present the pulpascope-a prototype of a compact, handheld, wireless dental instrument for pulp cavity imaging. This instrument addresses the current limitations of occupational injuries, size, and cost that exist with current endodontic microscopes used for root canal procedures. Utilizing a 15,000 coherent, imaging fiber bundle along with an integrated illumination source and wireless CMOS sensor, we demonstrate images of various teeth with resolution of ˜48 μm and angular field-of-view of 70 deg.

Tissue engineering in endodontics.

PubMed

Saber, Shehab El-Din M

2009-12-01

Tissue engineering is the science of design and manufacture of new tissues to replace impaired or damaged ones. The key ingredients for tissue engineering are stem cells, the morphogens or growth factors that regulate their differentiation, and a scaffold of extracellular matrix that constitutes the microenvironment for their growth. Recently, there has been increasing interest in applying the concept of tissue engineering to endodontics. The aim of this study was to review the body of knowledge related to dental pulp stem cells, the most common growth factors, and the scaffolds used to control their differentiation, and a clinical technique for the management of immature non-vital teeth based on this novel concept.

Endodontic management of a fused mandibular third molar and distomolar: a case report.

PubMed

Zeylabi, Ali; Shirani, Farzaneh; Heidari, Fatemeh; Farhad, Ali Reza

2010-04-01

Careful management of fused teeth is essential as abnormal morphology can predispose a tooth to caries and periodontal disease. In this paper, a rare case of successful endodontic management of unilateral mandibular third molar fused to a distomolar is reported. Caries was removed from the tooth complex under local anaesthesia. The pulp chambers of the third molar and supernumerary tooth were accessed and the root canals were prepared using rotary instrumentation and copious irrigation with 2.5% sodium hypochlorite. Obturation using the lateral condensation technique with gutta-percha and AH26 sealer was subsequently performed. A 1-year recall showed a good treatment result.

Analysis of the internal anatomy of maxillary first molars by using different methods.

PubMed

Baratto Filho, Flares; Zaitter, Suellen; Haragushiku, Gisele Aihara; de Campos, Edson Alves; Abuabara, Allan; Correr, Gisele Maria

2009-03-01

The success of endodontic treatment depends on the identification of all root canals so that they can be cleaned, shaped, and obturated. This study investigated internal morphology of maxillary first molars by 3 different methods: ex vivo, clinical, and cone beam computed tomography (CBCT) analysis. In all these different methods, the number of additional root canals and their locations, the number of foramina, and the frequency of canals that could or could not be negotiated were recorded. In the ex vivo study, 140 extracted maxillary first molars were evaluated. After canals were accessed and detected by using an operating microscope, the teeth with significant anatomic variances were cleared. In the clinical analysis, the records of 291 patients who had undergone endodontic treatment in a dental school during a 2-year period were used. In the CBCT analysis, 54 maxillary first molars were evaluated. The ex vivo assessment results showed a fourth canal frequency in 67.14% of the teeth, besides a tooth with 7 root canals (0.72%). Additional root canals were located in the mesiobuccal root in 92.85% of the teeth (17.35% could not be negotiated), and when they were present, 65.30% exhibited 1 foramen. Clinical assessment showed that 53.26%, 0.35%, and 0.35% of the teeth exhibited 4, 5, and 6 root canals, respectively. Additional root canals were located in this assessment in mesiobuccal root in 95.63% (27.50% could not be negotiated), and when they were present, 59.38% exhibited 1 foramen. CBCT results showed 2, 4, and 5 root canals in 1.85%, 37.05%, and 1.85% of the teeth, respectively. When present, additional canals showed 1 foramen in 90.90% of the teeth studied. This study demonstrated that operating microscope and CBCT have been important for locating and identifying root canals, and CBCT can be used as a good method for initial identification of maxillary first molar internal morphology.

Contrast-to-noise ratio with different settings in a CBCT machine in presence of different root-end filling materials: an in vitro study.

PubMed

Demirturk Kocasarac, Husniye; Helvacioglu Yigit, Dilek; Bechara, Boulos; Sinanoglu, Alper; Noujeim, Marcel

2016-01-01

To compare the contrast-to-noise ratio (CNR) of multiple acquisition settings for four types of retrograde filling materials in CBCT images taken for endodontic surgery follow-up. 20 maxillary central incisors were endodontically treated and obturated with 4 different root-end filling materials: amalgam, mineral trioxide aggregate, SuperEBA(™) (Harry J Bosworth Company, Skokie, IL) and Biodentine™ (Septodont, Saint-Maur-des-Faussés, France). Teeth were placed in a skull and scanned, one by one, with the Planmeca ProMax(®) 3D Max (Planmeca, Helsinki, Finland); at different voltages: 66, 76, 84 and 96 kVp; with low, normal and high resolution and high definition (HD); with and without metal artefact reduction (MAR). Images were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD) to calculate the CNR. The dose-area product was registered, and the effective dose calculated. No statistically significant difference was noted between the four materials. 84 and 96 kVp with low resolution and the use of MAR-generated images that have statistically better CNR than 66 and 76 kVp with HD, normal and high resolutions and without MAR. The use of low resolution also generated the smallest value of effective dose. The best setting for radiographic follow-up in an endodontic surgery with retrograde filling on the Planmeca ProMax is 96 kVp with low resolution and high MAR; this setting produced one of the lowest effective doses.

The Effect of Photobiomodulation on the Depth of Anesthesia During Endodontic Treatment of Teeth With Symptomatic Irreversible Pulpitis (Double Blind Randomized Clinical Trial)

PubMed Central

Ghabraei, Sholeh; Chiniforush, Nasim; Bolhari, Behnam; Aminsobhani, Mohsen; Khosarvi, Abbas

2018-01-01

Introduction: Achieving appropriate anesthesia in patients with symptomatic irreversible pulpitis in mandibular molars during endodontic treatment is always one of the most challenging aspects. Photobiomodulation (PBM) has been used in dentistry due to its anti-inflammatory properties and regenerative effects. This study evaluates the effects of PBM in the depth of anesthesia in inferior alveolar nerve block. Methods: In this randomized clinical trial, 44 patients requiring endodontic treatment in lower molar, left or right were selected, half of them were randomly treated with PBM therapy. Laser irradiation by 980 nm diode laser with a single dose (15 J/cm2, for 20 seconds) before anesthesia was performed at the buccal aspect. Inferior alveolar nerve block was performed once. Success was defined as no or mild pain (no need for any supplemental injection), based on the visual analogue scale during access cavity preparation. Results were evaluated using SPSS software. Results: The results of this study showed that the necessity for supplemental injection was lower in the group receiving laser than in the group without laser (P = 0.033). The mean pain intensity during dentin cutting was lower in the group receiving laser than in the group without laser (P = 0.031). Also, the mean pain intensity during pulp dropping was lower in the group receiving laser, than the group without laser (P = 0.021). Conclusion: Based on the results of this study, it seems that the application of PBM before anesthesia is effective on increasing depth of anesthesia. PMID:29399304

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite.

PubMed

von Arx, Thomas; Hänni, Stefan; Jensen, Simon Storgård

2010-07-01

The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Root canal configurations of third molar teeth. A comparison with first and second molars in the Turkish population.

PubMed

Sert, Semih; Sahinkesen, Güneş; Topçu, Fulya T; Eroğlu, Seyda E; Oktay, Elif A

2011-12-01

The purpose of the current study was to determine the similarities of maxillary and mandibular third molars with the other molar teeth. A total of 2016 extracted maxillary and mandibular permanent teeth were evaluated. The teeth were divided into six groups. The teeth were stored in 5% nitric acid solution for 7 days, then placed in increasing concentrations of ethyl alcohol. The teeth were rendered transparent by immersion in xylene solution for 4 days until complete transparency was achieved. Three roots were present in 93.0% of the maxillary molars, and 91.3% of the second molars. Among the maxillary third molars, 35.5% were single-rooted and 24.9% of the mandibular third molars had single roots. Double roots were present in 69.2% of the mandibular third molars, and 5.4% had three roots. Four new root canal configurations were encountered in this study. The root canal configurations of the mandibular and maxillary teeth showed similarities with the results of other studies performed in different populations. © 2010 The Authors. Australian Endodontic Journal © 2010 Australian Society of Endodontology.

Musical Auditory Stimulation Influences Heart Rate Autonomic Responses to Endodontic Treatment

PubMed Central

Martiniano, Eli Carlos; Monteiro, Larissa Raylane Lucas; Valenti, Vitor E.; Sorpreso, Isabel Cristina Esposito; de Abreu, Luiz Carlos

2017-01-01

We aimed to evaluate the acute effect of musical auditory stimulation on heart rate autonomic regulation during endodontic treatment. The study included 50 subjects from either gender between 18 and 40 years old, diagnosed with irreversible pulpitis or pulp necrosis of the upper front teeth and endodontic treatment indication. HRV was recorded 10 minutes before (T1), during (T2), and immediately (T3 and T4) after endodontic treatment. The volunteers were randomly divided into two equal groups: exposed to music (during T2, T3, and T4) or not. We found no difference regarding salivary cortisol and anxiety score. In the group with musical stimulation heart rate decreased in T3 compared to T1 and mean RR interval increased in T2 and T3 compared to T1. SDNN and TINN indices decreased in T3 compared to T4, the RMSSD and SD1 increased in T4 compared to T1, the SD2 increased compared to T3, and LF (low frequency band) increased in T4 compared to T1 and T3. In the control group, only RMSSD and SD1 increased in T3 compared to T1. Musical auditory stimulation enhanced heart rate autonomic modulation during endodontic treatment. PMID:28182118

Infectious flare-ups and serious sequelae following endodontic treatment: a prospective randomized trial on efficacy of antibiotic prophylaxis in cases of asymptomatic pulpal-periapical lesions.

PubMed

Morse, D R; Furst, M L; Belott, R M; Lefkowitz, R D; Spritzer, I B; Sideman, B H

1987-07-01

Without peritreatment antibiotics, infectious flare-ups (about 15% incidence) and serious sequelae follow endodontic treatment of asymptomatic teeth with necrotic pulps and associated periapical lesions. Antibiotics administered after endodontic treatment (4-day regimen) reduce the flare-up incidence to about 2%, but hypersensitivity responses, sensitization, resistant microbes, and drug-taking compliance are potential problems. To ascertain whether a specific prophylactic antibiotic (high-dose, 1-day regimen) would preferentially maintain this low flare-up incidence while overcoming antibiotic-related problems, 315 patients with quiescent pulpal necrosis and an associated periapical lesion were randomly given either penicillin V or erythromycin (base or stearate). Evaluations of flare-up after endodontic treatment were done at 1 day, 1 week, and 2 months. A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred. Gastrointestinal side effects were found primarily with the erythromycins (12.4%). A comparative analysis of the data from our first study (no peritreatment antibiotics) and the pooled data from our last two investigations (including the current trial) showed that peritreatment antibiotic coverage significantly reduced flare-ups and serious sequelae after endodontic treatment (p less than 0.001).

Temperature increases on the external root surface during endodontic treatment using single file systems.

PubMed

Özkocak, I; Taşkan, M M; Gökt Rk, H; Aytac, F; Karaarslan, E Şirin

2015-01-01

The aim of this study is to evaluate increases in temperature on the external root surface during endodontic treatment with different rotary systems. Fifty human mandibular incisors with a single root canal were selected. All root canals were instrumented using a size 20 Hedstrom file, and the canals were irrigated with 5% sodium hypochlorite solution. The samples were randomly divided into the following three groups of 15 teeth: Group 1: The OneShape Endodontic File no.: 25; Group 2: The Reciproc Endodontic File no.: 25; Group 3: The WaveOne Endodontic File no.: 25. During the preparation, the temperature changes were measured in the middle third of the roots using a noncontact infrared thermometer. The temperature data were transferred from the thermometer to the computer and were observed graphically. Statistical analysis was performed using the Kruskal-Wallis analysis of variance at a significance level of 0.05. The increases in temperature caused by the OneShape file system were lower than those of the other files (P < 0.05). The WaveOne file showed the highest temperature increases. However, there were no significant differences between the Reciproc and WaveOne files. The single file rotary systems used in this study may be recommended for clinical use.

The use of guided tissue regeneration principles in endodontic surgery for induced chronic periodontic-endodontic lesions: a clinical, radiographic, and histologic evaluation.

PubMed

Britain, Steven K; Arx, Thomas von; Schenk, Robert K; Buser, Daniel; Nummikoski, Pirkka; Cochran, David L

2005-03-01

Chronic periodontic-endodontic lesions are not uncommon in clinical practice and their regenerative capacity has long been questioned. However, there are no published studies investigating the application of guided tissue regeneration techniques in combination with endodontic surgery using an induced perio-endo defect model. This study evaluated the clinical, radiographic, and histologic outcomes of three surgical procedures used to treat induced perio-endo lesions. Pulpal necrosis was induced in foxhounds along with surgical removal of radicular buccal bone. After 4 weeks, chronic lesions were clinically and radiographically assessed. Treatment surgery consisted of apicoectomy, root canal instrumentation, and retrofilling with mineral trioxide aggregate. Teeth were then assigned to one of the following treatment groups: open flap debridement only (OFD), OFD with bioabsorbable porcine-derived collagen membrane (BG), or OFD with BG and anorganic bovine bone matrix (BO/BG). Clinical parameters and standardized radiographs were assessed at defect creation; treatment surgery; and at 1, 2, 4, and 6 months. Animals were sacrificed at 6 months and specimens prepared for histometric analysis. Clinical and radiographic conditions improved during the study period. Mean epithelial attachment was similar between all groups. Mean connective tissue attachment for groups OFD, BG, and BO/BG was 3.79 mm, 2.63 mm, and 1.75 mm, respectively, and mean radicular bone height was 2.16 mm, 3.24 mm, and 3.45 mm, respectively. Statistically significant increases in the amount of new cementum were observed in groups BG and BO/BG when compared with OFD (P <0.05). Treatment of combined induced perio-endo lesions using bioabsorbable collagen membranes alone or in combination with anorganic bovine bone matrix resulted in increased amounts of bone, periodontal ligament, and significant increases in the amount of new cementum when compared to open flap debridement in a canine model.

Decellularized Human Dental Pulp as a Scaffold for Regenerative Endodontics.

PubMed

Song, J S; Takimoto, K; Jeon, M; Vadakekalam, J; Ruparel, N B; Diogenes, A

2017-06-01

Teeth undergo postnatal organogenesis relatively late in life and only complete full maturation a few years after the crown first erupts in the oral cavity. At this stage, development can be arrested if the tooth organ is damaged by either trauma or caries. Regenerative endodontic procedures (REPs) are a treatment alternative to conventional root canal treatment for immature teeth. These procedures rely on the transfer of apically positioned stem cells, including stem cells of the apical papilla (SCAP), into the root canal system. Although clinical success has been reported for these procedures, the predictability of expected outcomes and the organization of the newly formed tissues are affected by the lack of an available suitable scaffold that mimics the complexity of the dental pulp extracellular matrix (ECM). In this study, we evaluated 3 methods of decellularization of human dental pulp to be used as a potential autograft scaffold. Tooth slices of human healthy extracted third molars were decellularized by 3 different methods. One of the methods generated the maximum observed decellularization with minimal impact on the ECM composition and organization. Furthermore, recellularization of the scaffold supported the proliferation of SCAP throughout the scaffold with differentiation into odontoblast-like cells near the dentinal walls. Thus, this study reports that human dental pulp from healthy extracted teeth can be successfully decellularized, and the resulting scaffold supports the proliferation and differentiation of SCAP. The future application of this form of an autograft in REPs can fulfill a yet unmet need for a suitable scaffold, potentially improving clinical outcomes and ultimately promoting the survival and function of teeth with otherwise poor prognosis.

A clinical evaluation of mineral trioxide aggregate for root-end closure of non-vital immature permanent incisors in children-a pilot study.

PubMed

Sarris, Spyridoula; Tahmassebi, Jinous F; Duggal, Monty S; Cross, Ian A

2008-02-01

The aim of this pilot study was to evaluate the clinical efficacy of mineral trioxide aggregate (MTA) as an apexification material when used in non-vital immature permanent incisors in children. Fifteen children with a mean age of 11.7 years and 17 non-vital permanent incisors were ajudged suitable for inclusion. Standard endodontic procedures were followed and an apical plug of 3-4 mm was created by using MTA after a calcium hydroxide intracanal dressing had been applied for at least 1 week. Final obturation was completed by using thermoplastisized Gutta-Percha (Obtura II) at least 1 week following MTA placement. Subjects were reviewed clinically and radiographically at 3-month intervals. Mean follow-up time for MTA was 12.53 months (+/-2.94 SD). Of the total of 17 teeth treated, MTA placement was considered to be adequate in 13 teeth. The procedure showed clinical success in 94.1% of the cases, radiographic success was found to be 76.5% and in further three cases (17.6%) the outcome was considered to be uncertain. This is one of the very few studies that have reported the out coming of MTA as an apexification material in children with non-vital teeth and incomplete root development. However, larger clinical studies are required to evaluate the long-term success of this procedure.

Efficacy of chlorhexidine as a final irrigant in one-visit root canal treatment: a prospective comparative study.

PubMed

Miçooğullar Kurt, S; Çalışkan, M K

2018-03-30

To evaluate postoperative pain and radiographic evidence of periapical healing in teeth with apical periodontitis treated in one visit with an additional final irrigation using 2% chlorhexidine (CHX) and to compare the results with conventional two-visit root canal treatment (RCT) with an intracanal calcium hydroxide (CH) dressing as a control group. Ninety asymptomatic maxillary anterior teeth with periapical lesions were treated by a single operator. Root canals were prepared using the step-back technique with manual instrumentation with 2.5% NaOCl and 5% EDTA as irrigants. Half of the teeth were randomly assigned to the one-visit (OV) group and received an additional final rinse with 2% CHX before canal filling. The other teeth were treated in two visits (TV) with a CH paste made by mixing CH powder and distilled water as an interappointment dressing. All patients were recalled and investigated clinically and radiographically for 24 months. Postoperative pain at 24-48 h and changes in apical bone density indicating radiographic healing were evaluated statistically using the Mann-Whitney U-test followed by the Friedman and the Wilcoxon tests (α = 0.05). There were no significant differences between two groups regarding the incidence of postoperative pain at 24 h (OV group 50% no pain, 47.6% mild, 2.4% moderate pain/TV group 55% no pain, 42.5% mild, 2.5% moderate pain) and at 48 h (OV group 95% no pain, 5% mild pain/TV group 98% no pain, 2% mild pain). None of the patients reported severe postoperative pain, swelling and/or flare-ups during the follow-up period. There was no significant difference in the radiographic healing rates (OV group 97.6% PAI 1 and/or PAI 2 and 2.4% PAI 3/TV group 95% PAI 1 and/or PAI 2 and 5% PAI 3; P > 0.05). Both groups provided favourable and similar postoperative pain and periapical healing rates at 24 months. Thus, one-visit RCT with a final rinse with 2% CHX is an acceptable alternative to two-visit RCT with CH as temporary dressing in maxillary anterior teeth. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

A Comparison of Coronal Tooth Discoloration Elicited by Various Endodontic Reparative Materials

DTIC Science & Technology

2015-06-17

operating microscope at 12.8x magnification to be completely intact and free of restorations, cracks , and/or defects. Each tooth was stored separately in...microscope. The buccal enamel -dentin thickness was standardized to 3mm using spring calipers. Teeth were irrigated with 6% NaOCl and dried. All

Effect of endodontic irrigating solutions on the microhardness and roughness of root canal dentin: an in vitro study.

PubMed

Patil, Chetan R; Uppin, Veerendra

2011-01-01

To evaluate the effect of widely used endodontic irrigating solutions on root dentin microhardness and surface roughness. One hundred twenty, non-carious extracted human permanent incisor teeth were selected. The crowns of the teeth were sectioned and the roots were separated longitudinally to get 240 specimens. These specimens were then divided into six groups according to the irrigating solutions used. The solutions used were 5% and 2.5% NaOCl solutions, 3% H2 O2 , 17% EDTA solution, 0.2% chlorhexidine gluconate, and distilled water. Then, the specimens were subjected to microhardness and roughness testing. The data were analyzed using ANOVA and Tukey's multiple comparison tests. The results of this study indicated that all irrigation solutions, except 0.2% chlorhexidine gluconate, decreased the microhardness of root dentin, and 3% H2 O2 and 0.2% chlorhexidine gluconate had no effect on surface roughness. Within the limitation of this study, it is concluded that 0.2% chlorhexidine gluconate seems to be an appropriate irrigation solution, because of its harmless effect on the microhardness and surface roughness of root canal dentin.

Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis.

PubMed

Bigby, Jason; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2006-11-01

The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The Stabident system was used to administer 1.8 ml of 4% articaine with 1:100,000 epinephrine. Success of the intraosseous injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 86% (32 of 37) of the patients. Maximum mean heart rate was increased 32 beats/minute during the intraosseous injection. We can conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

Technical quality of root canal treatment of posterior teeth after rotary or hand preparation by fifth year undergraduate students, The University of Jordan.

PubMed

Abu-Tahun, Ibrahim; Al-Rabab'ah, Mohammad A; Hammad, Mohammad; Khraisat, Ameen

2014-12-01

The aim of this study was to investigate the technical quality of root canal treatment provided by the undergraduate students as their first experience in molar endodontics using nickel-titanium (NiTi) files in a crown-down approach compared with stainless steel standard technique. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training programme, using two different questionnaires to assess the overall technical quality and potential problems regarding endodontic complications after root canal preparation with these two techniques. The overall results indicated a statistically significant difference in the performance of the two instrument techniques in difficult cases showing better performance of the NiTi system and mean rotary preparation time (P < 0.001). Under the conditions of this study, novice dental students, using NiTi ProTaper rotary files, were able to prepare root canals faster with more preparation accuracy compared with canals of same teeth prepared with hand instruments. © 2014 Australian Society of Endodontology.