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PubMed1987

A comparison of four simulation and instructional methods for endodontic review.

The effects of four different endodontic self-instructional review formats (slide-tape, latent-image simulation, computer text simulation, and computer-assisted video interactive simulation) on senior clinical endodontic performance are compared. The senior class of 105 students was divided into eight groups of 13-14 academically equivalent students prior to initiating endodontic treatment in the 1985-86 academic year. With the exception of the control group, each participated in a program designed to review principles of endodontic diagnosis and treatment. All clinical endodontic cases were subsequently critiqued by a calibrated panel of two general dentist and one endodontist. Overall, students in the study group made fewer diagnostic errors compared with those in the control group, while the error reduction in clinical treatment was not significantly reduced between the two groups. No significant difference in error reduction was noted between the simulation formats. Student evaluations, as well as comparative developmental expenditures, are discussed.

Attitude↗
PubMed1991

Acute pulpal-alveolar cellulitis syndrome. V. Apical closure of immature teeth by infection control: the importance of an endodontic seal with therapeutic factors. Part 2.

During orthodontic treatment to promote eruption of maxillary and mandibular second bicuspids, a young male patient had a severe endodontic cellulitis of a mandibular bicuspid. Apexogenesis and resolution of the periapical lesion was achieved by infection control with nonspecific intracanal medication without calcium hydroxide, as stated by Das. A mild periodontal cellulitis occurred shortly thereafter and rapidly resolved. A second endodontic cellulitis, after apexogenesis without an endodontic seal, occurred shortly after completion of orthodontic treatment. This also quickly resolved, and the canal was effectively sealed. This case indicates the importance of an effective endodontic seal shortly after apexogenesis is induced by infection control. This report and others on the subject indicate that apexogenesis of nonvital permanent immature teeth by infection control is a predictable endodontic treatment procedure.

Acute Disease↗
PubMed2006

Interrelation between endodontic status, pathologic cemental granules and periodontal ligament adhering to the root of extracted teeth.

OBJECTIVES: To evaluate if the endodontic status has influence on the adherence of periodontal ligament (PDL) to extracted teeth and if the presence of "pathologic granules" is correlated to the endodontic status and/or the amount of adhering PDL. STUDY DESIGN: Extracted teeth with different endodontic status and exhibiting no marginal periodontitis were histologically examined. RESULTS: Observation of pathologic granules was related to a nonvital endodontium and to acute peroperative inflammation. Pathologic granules and denudation of the extracted roots were significantly related. Acute peroperative inflammation and low extraction forces were related to denudation of the roots. Such relation was not found for endodontic status, tooth type, root-form, and age of patients. CONCLUSION: The existence of pathologic granules in unexposed cementum is strictly related to teeth with a nonvital endodontium. There is no effect of the endodontic status on the adherence of PDL when an acute inflammation is absent.

Adolescent↗
PubMed1995

Cuspal deflection in molars in relation to endodontic and restorative procedures.

The extent of cuspal flexure following endodontic and restorative procedures has important consequences for potential fracture. This study was undertaken to determine the extent to which cusps of molars are weakened by progressively larger restorative preparations and endodontic access. Cuspal flexure of 13 extracted, intact human mandibular molars was measured under controlled occlusal loading. A ramped load of 100 N was applied to the mesial cusps via a steel sphere, using a closed-loop servohydraulic testing machine. Lateral cuspal displacement was recorded by linear measuring devices (direct current differential transformers) accurate to 1 micron. Increasingly extensive MO or MOD cavity preparations followed by endodontic access were cut in each tooth. Cuspal deflection increased with increasing cavity size and was greatest following endodontic access. Cuspal deflections of more than 10 microns were observed. These findings reinforce the importance of cuspal coverage to minimize the danger of marginal leakage and cuspal fracture in endodontically treated teeth.

Analysis of Variance↗
PubMed1998

Host mediators in endodontic exudates. I. Indicators of inflammation and humoral immunity.

Exudate is often found in the root canal when entering the chamber and canal of teeth with periapical lesions. The aim of this study was to determine possible relationships between clinical or radiographic findings and the concentrations of different host mediators in endodontic exudates. Thirty-two nonvital teeth with periapical symptoms were included in the study. A Clinical Periapical Index was developed to quantify clinical findings. Endodontic exudates were collected with methylcellulose filter paper strips every 3 min, after opening of the pulp chamber. The concentrations of the lysosomal acid glycohydrolase beta-glucuronidase, IgG, IgA, IgM, and interleukin-1 beta in the endodontic exudates were analyzed. The results demonstrated that exudates collected from teeth with suppuration (cloudy exudates), and teeth with higher periapical index scores (Orstavik et al., 1986) contained higher concentrations of beta-glucuronidase and interleukin-1 beta. Furthermore, when the periapical index indicated severe involvement, higher IgG was observed in the first samples. The exudates from patients who presented with a sinus tract or swelling contained higher concentrations of IgM, compared with the patients with only periapical sensitivity. Data showed that endodontic exudates from patient with endodontic lesions can be analyzed for host mediators, and differences in the mediators were seen with different clinical and radiographic symptoms.

Adolescent↗
PubMed2003

PCR methodology as a valuable tool for identification of endodontic pathogens.

OBJECTIVES: This paper reviews the principles of polymerase chain reaction (PCR) methodology, its application in identification of endodontic pathogens and the perspectives regarding the knowledge to be reached with the use of this highly sensitive, specific and accurate methodology as a microbial identification test. DATA SOURCES: Studies published in the medical, dental and biological literature. STUDY SELECTION: Evaluation of published epidemiological studies examining the endodontic microbiota through PCR methodology. CONCLUSIONS: PCR technology has enabled the detection of bacterial species that are difficult or even impossible to culture as well as cultivable bacterial strains showing a phenotypically divergent or convergent behaviour. Moreover, PCR is more rapid, much more sensitive, and more accurate when compared with culture. Its use in endodontics to investigate the microbiota associated with infected root canals has expanded the knowledge on the bacteria involved in the pathogenesis of periradicular diseases. For instance, Tannerella forsythensis (formerly Bacteroides forsythus), Treponema denticola, other Treponema species, Dialister pneumosintes, and Prevotella tannerae were detected in infected root canals for the first time and in high prevalence when using PCR analysis. The diversity of endodontic microbiota has been demonstrated by studies using PCR amplification, cloning and sequencing of the PCR products. Moreover, other fastidious bacterial species, such as Porphyromonas endodontalis, Porphyromonas gingivalis and some Eubacterium spp., have been reported in endodontic infections at a higher prevalence than those reported by culture procedures.

Bacteria↗
PubMed2000

Isolation and identification of Prevotella tannerae from endodontic infections.

Black-pigmented bacteria are often isolated from endodontic infections. Five strains of black-pigmented bacteria isolated from endodontic infections could not be identified in our laboratory. The purpose of this study was to sequence the 16S rRNA gene of the five unknown isolates and identify the organisms. The 16S rRNA genes from the unknown organisms were cloned, sequenced, and determined to be Prevotella tannerae. In addition, samples from endodontic infections were surveyed for the presence of the organism. When 118 samples from endodontic infections were examined using polymerase chain reaction with specific primers for P. tannerae, 60% of the samples were positive for the presence of the organism. This suggests that P. tannerae is commonly present in endodontic infections and could be a potential pathogen.

Bacteroidaceae Infections↗
PubMed2005

A study of visual and blood contamination on reprocessed endodontic files from general dental practice.

OBJECTIVE: This study examined methods used for reprocessing endodontic instruments in general dental practice and determined the degree of residual visual contamination and blood contamination on 250 reprocessed files collected from 25 general dental practices. MATERIALS AND METHODS: A questionnaire was administered to 25 general dental practitioners to obtain information on the re-processing of used endodontic files. Ten files which had been used and reprocessed were also collected from each practice. These were examined visually under a dissecting light microscope for residual contamination and then tested for blood deposits using the Kastle-Meyer test. RESULTS: Nineteen of the 25 practices used stainless steel hand files. No practitioners used endodontic files as single use devices. Ninety-two per cent of the practitioners discarded and replaced files when they were bent or damaged. Several decontamination methods were reported. The two combinations employed most frequently were manual cleaning and autoclaving or manual cleaning, followed by ultrasonic cleaning and autoclaving. Of the 250 files, 75% showed some degree of visual contamination and seven percent tested positive for residual blood. Blood contaminated files were significantly more heavily contaminated when examined visually. Large variations were found in residual contamination of files collected from practices using the same methods of decontamination. CONCLUSIONS: While all practitioners re-used endodontic files, the variations in decontamination methods reported indicate a lack of clarity on best practice. This study demonstrates that endodontic files are not reliably decontaminated by methods currently employed in dental practice.

Blood↗
PubMed2003

An evaluation of the usefulness of two endodontic case assessment forms by general dentists.

AIM: To evaluate the use of two forms to assess the risks and difficulty of root-canal treatment. METHODOLOGY: Two criterion-based forms, containing 15 and 16 items, respectively, were distributed to 83 general dentists to evaluate the potential difficulty of root-canal treatment. The participants were asked to assess the difficulty of 15 endodontic cases using the Dutch Endodontic Treatment Index (DETI) and the Endodontic Treatment Classification (ETC) forms. A questionnaire was also provided to evaluate the time needed to complete the two forms, their ease of use, the clarity and/or appropriateness of the criteria and any other comments. The outcomes of the assessment were compared with the assessment of each case as carried out by the authors. RESULTS: The response rate was 53%. The DETI was an easy and rapid way to differentiate between uncomplicated and complicated cases. In 13 of the 15 cases, 88-100% of the dentists scored the cases in agreement with the authors. Use of the ETC form was more complicated, as a result of the larger number of variables. However, most respondents recognized the complicated cases, and 91% found the ETC form valuable to help in assessing the difficulty of endodontic cases. CONCLUSIONS: These two forms may help general practitioners to assess the difficulty of endodontic problems and to decide whether to treat the case or to refer it to a specialist.

Decision Making↗
PubMed2002

Endodontic infections: concepts, paradigms, and perspectives.

Overwhelming evidence indicates that periradicular diseases are infectious disorders. The question now is no longer whether microorganisms are involved in the pathogenesis of such diseases, but which specific microbial species are. The list of microorganisms involved in periradicular diseases keeps expanding and has the potential to become increasingly more accurate during the next few years. Molecular methods have contributed significantly to the knowledge about the microbial species involved. Undoubtedly, a great deal of additional research is needed to define the specific role played by suspected endodontic pathogens in the etiology of each form of periradicular disease and to determine the best therapeutic measures for the pathogen's eradication. In addition, there is an emergent need to define markers that permit the clinician to know when he or she should conclude the treatment and to predict the outcome of the treatment. Although endodontic procedures and some acute endodontic infections can cause bacteremia, there is no clear evidence that microorganisms from the root canal can cause diseases in remote sites of the body. However, there is a risk in some compromised individuals, and prophylactic measures should be taken. Prescription of systemic antibiotics in endodontic therapy is rarely necessary. Because of the emergence of bacterial resistance against most known antibiotics, their use in endodontics should be highly limited and restricted to a few cases.

Animals↗
PubMed2002

Identification of bacteria in acute endodontic infections and their antimicrobial susceptibility.

OBJECTIVE: The purpose of the study was to identify the bacterial composition of the microbiota from acute endodontic abscesses/cellulitis and their antimicrobial susceptibilities. STUDY DESIGN: Purulence from 17 patients with acute endodontic abscesses/cellulitis was obtained by needle aspiration and processed under anaerobic conditions. Bacteria were isolated and identified by biochemical or molecular methods. The antimicrobial susceptibility of isolated bacteria was determined by using the Etest. RESULTS: All 17 aspirates contained a mix of microorganisms. A total of 127 strains of bacteria were isolated. Of 127 strains, 80 strains were anaerobes and 47 strains were aerobes. The mean number of strains per sample was 7.5 (range, 3 to 13). The average number of viable bacteria was 6.37 x 10(7) (range, 10(4) to 10(8)) colony-forming units/mL. Strict anaerobes and microaerophiles were the dominant bacteria in 82% (14 of 17) of the cases. The genera of bacteria most frequently encountered were Prevotella and Streptococcus. Prevotella and Peptostreptococcus were frequently found to dominate the mixture. The combination of Prevotella and Streptococcus was found in 53% (9 of 17). The previously reported uncultured Prevotella clone PUS9.180 was frequently identified. The percentage of bacteria susceptible/intermediate for each antibiotic in this study was penicillin V, 81% (95 of 118); metronidazole, 88% (51 of 58); amoxicillin, 85% (100 of 118); amoxicillin + clavulanic acid, 100% (118 of 118); and clindamycin, 89% (105 of 118). CONCLUSIONS: The present results confirm the existence of mixed infection with the predominance of anaerobic bacteria in acute endodontic abscesses/cellulitis. The frequency of uncultured Prevotella clone PUS9.180 suggests the possible key role of this Prevotella species in acute endodontic infections. Penicillin V still possesses antimicrobial activity against the majority of bacteria isolated from acute endodontic infections. However, if penicillin V therapy has failed to be effective, the combination of penicillin V with metronidazole or amoxicillin with clavulanic acid is recommended. Switching to clindamycin is another good alternative.

Abscess↗
PubMed2000

Influence of post placement in the fracture resistance of endodontically treated incisors veneered with direct composite.

STATEMENT OF PROBLEM: Veneer preparations are considered to weaken endodontically treated maxillary incisors. Prefabricated posts have been controversially indicated to reinforce endodontically treated teeth before final restoration. PURPOSE: This in vitro study evaluated whether (1) veneer preparation in enamel or in enamel/dentin weakens endodontically treated maxillary incisors, (2) bonding of direct composite veneer restores the original strength of the unprepared teeth, and (3) use of prefabricated metal posts increases fracture resistance of prepared and restored teeth. MATERIAL AND METHODS: Ninety extracted human maxillary central incisors were submitted to conventional root canal treatment. Specimens were randomly divided into 8 experimental groups (veneer preparation in enamel or dentin with/without post and with/without direct composite veneer restoration) and a control group (n = 10). Specimens were loaded to fracture, and the data were analyzed statistically. RESULTS: Statistical analysis revealed that a conservative veneer preparation does not significantly reduce maxillary incisors' fracture resistance. For prepared incisors, bonding of direct composite veneer restored their original strength, and the use of posts did not increase their fracture resistance. CONCLUSION: Conservative veneer preparations involving enamel and enamel/dentin did not significantly reduce the fracture resistance of endodontically treated maxillary incisors. In addition, restoration of the intraenamel preparations with direct composite resulted in teeth more resistant to fracture than teeth having restorations in dentin. The use of posts did not improve fracture resistance of endodontically treated maxillary incisors reduced and veneered with direct composite.

Analysis of Variance↗
PubMed2002

Relationship between crown placement and the survival of endodontically treated teeth.

STATEMENT OF PROBLEM: Crowns have been considered the restoration of choice for endodontically treated teeth, but their selection has been based primarily on anecdotal evidence. PURPOSE: This study tested the hypothesis that crown placement (coronal coverage) is associated with improved survival of endodontically treated teeth when preaccess, endodontic, and restorative factors are controlled. MATERIAL AND METHODS: A University of Iowa College of Dentistry treatment database was used to identify permanent teeth that had undergone initial obturation between July 1, 1985, and December 31, 1987. Study patients were restricted to persons with at least 1 dental visit in each 2-year interval from 1985 to 1996; a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 203 teeth that satisfied study inclusion criteria. Multivariate Cox proportional hazards regression models were developed, with standard errors adjusted to account for clustering of teeth within patients. RESULTS: When tooth type and radiographic evidence of caries at access were controlled, the final Cox model showed that endodontically treated teeth not crowned after obturation were lost at a 6.0 times greater rate than teeth crowned after obturation (95% confidence interval: 3.2 to 11.3). CONCLUSION: Within the limitations of this study, a strong association between crown placement and the survival of endodontically treated teeth was observed. These results may impact treatment planning if long-term tooth retention is the primary goal.

Aged↗
PubMed1989

Root canal microflora: qualitative changes after endodontic instrumentation.

The changes in the pattern of bacteria in root canal after repeated washing with NaOCl and endodontic instrumentation were evaluated. Samples were obtained from the root canals of patients before and after endodontic instrumentation, and analyzed according to the usual microbiological techniques. Washing with NaOCl and endodontic instrumentation act against bacteria such as Peptostreptococci, Streptococcus sanguis, Actinomyces israelii, Proteus mirabilis, Bacteroides, whereas Streptococcus lactis and Aerococcus were present before and after endodontic instrumentation. Environmental conditions such as low pH could be responsible for the persistence of gram-positive bacteria. The use of topical treatment and the associated endodontic instrumentation seem useful in the eradication of some bacteria in the root canal.

Dental Care↗
PubMed2004

Nested PCR detection of Centipeda periodontii in primary endodontic infections.

In recent years, molecular genetic methodologies have provided significant additional knowledge about components of the microbiota associated with infections of endodontic origin. Following this research line, the purpose of the present study was to investigate the prevalence of Centipeda periodontii in primary endodontic infections using a species-specific nested PCR assay. Samples were collected from fifty teeth having carious lesions, necrotic pulps, and different forms of periradicular diseases. DNA extracted from the samples was initially amplified using universal 16S rDNA primers, and a second round of amplification used the first PCR products to detect a specific fragment of C. periodontii 16S rDNA. This species was detected in 3 (13%) of 23 asymptomatic cases, in 1 (14%) of 7 cases diagnosed as acute apical periodontitis, and in 3 (15%) of 20 pus samples aspirated from acute periradicular abscesses. There was no significant association between C. periodontii and the presence of clinical symptoms. Overall, C. periodontii was detected in 14% of the cases of endodontic infections. This is probably the hitherto first study to detect C. periodontii in primary endodontic infections. The specific role played by this bacterial species in infections of endodontic origin awaits further clarification.

Adolescent↗
PubMed2004

Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study.

Outcome assessment of endodontic treatment is critical for appropriate case selection and treatment planning. However, reports on outcomes of nonsurgical endodontic treatment vary considerably. Epidemiological studies done in a large patient population and over a long follow-up period can provide the clinician with useful tools for clinical decision-making and assessment of tooth prognosis. In this study, outcomes of initial endodontic treatment done in 1,462,936 teeth of 1,126,288 patients from 50 states across the USA was assessed over a period of 8 yr. Treatment was done by private general practitioners and endodontists participating in the Delta Dental Insurance plan that insures approximately 14 million individuals in the USA. Overall, 97% of teeth were retained in the oral cavity 8 yr after initial nonsurgical endodontic treatment. The combined incidence of untoward events such as retreatments, apical surgeries, and extractions was 3% and occurred mostly within 3 yr from completion of treatment. Analysis of the extracted teeth revealed that 85% had no full coronal coverage. A significant difference was found between covered and noncovered teeth for all tooth groups tested (p < 0.001). In conclusion, it appears that initial nonsurgical endodontic treatment is a predictable procedure with high incidence of tooth retention after 8 yr.

Dental Restoration Failure↗
PubMed1993

Periapical status and prevalence of endodontic treatment in an adult Dutch population.

This study examined the prevalence of endodontic treatment in a group of 184 Dutch adults, and determined the periapical status of all teeth using panoramic radiographs. The results indicate that in this group, 2.3% of the teeth were root-filled, and that 5.2% of all non-endodontically treated teeth showed signs of periapical pathology. Around the apices of 39.2% of the endodontically treated teeth in this survey, radiographic signs of periapical pathology were observed. Using the level of the root canal filling as a criterion for evaluating the quality of the root canal treatment, 50.6% of the endodontic treatments were qualified as inadequate. There was a significant correlation between the presence of periapical pathology and underfilling of the root canal(s). 44.6% of the patient sample had at least one tooth with radiographic signs of periapical pathology, indicating a substantial future need for endodontic treatment.

Adult↗
PubMed1995

Endodontic pathogens in periodontal disease augmentation.

Periapical pathology indicating endodontic infection, when present in periodontitis-affected teeth, has recently been shown to be correlated to marginal periodontal breakdown. This has been associated with patency of dentinal tubules in the tooth cervix, an area normally devoid of cementum following periodontal therapy. These studies are, however hampered by that only circumstantial evidence such as presence of periapical destruction have been applied as criteria of endodontic infection. The aim of the present investigation was to assess the effects of endodontic pathogens on marginal periodontal wound healing on root surfaces devoid of cementum but surrounded by healthy periodontal membrane. Significant differences between infected and non-infected teeth were found with respect to pathological pocket and connective tissue: The experimental defects were covered by approximately 20% more pocket epithelium in infected teeth while defects in non-infected teeth showed approximately 10% more connective tissue coverage. It was concluded, that an intra-canal infection of endodontic pathogens stimulates epithelial downgrowth along denuded dentin surfaces with marginal communication. Extrapolated to the clinical situation, endodontic infections in periodontitis-prone patients may augment periodontitis propagation.

Animals↗