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PubMed2006

Antibacterial effect of selected root-end filling materials.

The purpose of this study was to evaluate the antibacterial activity of leachable components of selected root-end filling materials: amalgam, ProRoot MTA (mineral trioxide aggregate), Intermediate Restorative Material (IRM), Super Bond C&B, Geristore, Dyract, Clearfil APX composite with SE Bond, or Protect Bond. The direct contact test (DCT) with Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa, was used. The materials were tested immediately after application to the microtiter wells (fresh samples) and after setting for 3 days (set samples). Ten microliters of bacterial suspension was added to each well for direct contact with each material for 1 h at 37 degrees C. Growth of surviving bacteria was then measured in a microplate spectrophotometer hourly at 620 nm for 15 h. Twelve uncoated wells using identical inoculum size served as positive controls. The data obtained at the end of 15 h was subjected to one-way ANOVA and post hoc comparisons were done using Tamhane's T2 test. Fresh samples of all materials showed a 3-h delay in exponential growth of both E. faecalis and S. aureus, and a 5-h delay in growth of P. aeruginosa. Set samples of IRM and ProRoot MTA cements showed generally greater antibacterial activity than the other materials: both completely inhibited P. aeruginosa, and both delayed or limited growth of E. faecalis. The DCT, by being quantitative and virtually independent of solubility and diffusion, was found suitable to assay solid root-end filling materials. IRM and ProRoot MTA were generally more potent inhibitors of bacterial-growth than the other tested materials.

Aluminum Compounds↗
PubMed2006

Comparison of the physical and mechanical properties of MTA and portland cement.

This study evaluated and compared the pH, radiopacity, setting time, solubility, dimensional change, and compressive strength of ProRoot MTA (PMTA), ProRoot MTA (tooth colored formula) (WMTA), white Portland cement (WP), and ordinary Portland cement (OP). The results showed that PMTA and Portland cement have very similar physical properties. However, the radiopacity of Portland cement is much lower than that of PMTA. The compressive strength of PMTA was greater than Portland cement at 28 days. The major constituent of PMTA is Portland cement. Given the low cost of Portland cement and similar properties when compared to PMTA, it is reasonable to consider Portland cement as a possible substitute for PMTA in endodontic applications. However, industrially manufactured Portland cement is not approved currently for use in the United States and therefore no clinical recommendation can be made for its use in the human body. Further in vitro and in vivo tests, especially with regards its biocompatibility, should be conducted to ascertain if it meets the FDA requirements for use as a medical device.

Aluminum Compounds↗
PubMed2006

Capillary flow porometry to assess the seal provided by root-end filling materials in a standardized and reproducible way.

This in vitro study evaluated the root-end sealing ability of gutta-percha + AH26 (GP), Ketac-Fil, Fuji IX (FIX), tooth-colored MTA (MTA), IRM, Ketac-Fil + conditioner (Ketac-FilC), and Fuji IX + conditioner (FIXC). A total of 140 standardized bovine root sections were divided into seven groups, filled with the mentioned root-end filling materials, and, at 48 h, submitted to capillary flow porometry to assess minimum, mean flow and maximum pore diameters. Results were statistically analyzed using nonparametric Kruskal-Wallis and Dunn tests. Level of significance was set at 0.05. Using the Kruskal-Wallis tests we found that there was no significant difference between the minimum pore diameters of the different materials, but significant differences between the mean flow (p < 0.001) and maximum (p < 0.001) pore diameters could be demonstrated. For the mean flow pore diameters, there was a significant difference between FIX and all other materials, between Ketac-Fil and IRM and between Ketac-FilC and IRM. Concerning maximum pore diameters, there was a significant difference between FIX and all other materials, between Ketac-Fil and MTA, GP and IRM, FIXC and IRM, and Ketac-FilC and IRM. The data showed that each sample had leaked. Glass ionomer cements leaked more than other materials, although dentin conditioning diminished the maximum through pore diameters. This maximum pore diameter, which corresponds to the largest leak in the sample, together with the size of bacteria and their metabolites, will be indicative of the eventual leakage along the root-end filling materials.

Acid Etching, Dental↗
PubMed2006

Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique.

The aim of this retrospective study was to compare the outcome of surgical endodontic treatment preformed using the traditional versus modern techniques. There were 110 patients who were treated by surgical endodontic treatment between 2000 and 2002 and evaluated from their dental charts. The surgical endodontic treatment was preformed using a traditional or modern technique. The traditional technique included root-end resection with a 45 degrees bevel angle, and retrograde preparation using a carbide round bur. The modern technique included root-end resection with minimal or no bevel, and retrograde preparation using ultrasonic retro-tips with the aid of a dental operating microscope. The retrograde filling material for both techniques was intermediate restorative material. There were 71 patients with 88 treated teeth that were compatible with the inclusion criteria. Complete healing rate for the teeth treated with the modern technique (91.1%) was significantly higher than that for teeth treated using the traditional technique (44.2%) (p < 0.0001). In the traditional technique a significant (p = 0.032) negative influence of the tooth type was found. Modern surgical endodontic treatment using operative microscope and ultrasonic tips significantly improves the outcome of the therapy compared to the traditional technique.

Adolescent↗
PubMed2006

Modern endodontic surgery concepts and practice: a review.

Endodontic surgery has now evolved into endodontic microsurgery. By using state-of-the-art equipment, instruments and materials that match biological concepts with clinical practice, we believe that microsurgical approaches produce predictable outcomes in the healing of lesions of endodontic origin. In this review we attempted to provide the most current concepts, techniques, instruments and materials with the aim of demonstrating how far we have come. Our ultimate goal is to assertively teach the future generation of graduate students and also train our colleagues to incorporate these techniques and concepts into everyday practice.

Aluminum Compounds↗
PubMed2006

Pain and inflammation after periapical surgery in 60 patients.

PURPOSE: Periapical surgery is followed by manifestations such as pain and swelling, the magnitude of which depends on the degree of tissue damage produced. A study is made of pain and inflammation in the 7 days after periapical surgery and its relation to patient age, gender, smoking, oral hygiene, the location and number of teeth implicated, the duration of the operation, the type of incision and flap involved, and the extent of ostectomy. MATERIALS AND METHODS: Sixty patients (22 males, 38 females) with a mean age of 38.7 years underwent periapical surgery with ultrasound and retrograde filling with silver amalgam. The postoperative course was evaluated based on a descriptive 4-point scale of pain and swelling. The SPSS statistical package for Microsoft Windows (SPSS, Chicago, IL) was used for the statistical analysis of the results. RESULTS: The greatest prevalence of maximum intensity pain was recorded after 2 days (in 14.6% of all patients); at this point two-thirds of the patients reported either no pain or only mild intensity pain. Swelling likewise peaked on the second postoperative day, when two-thirds of the patients presented moderate inflammation. Patient age, gender, oral hygiene, and smoking exerted no influence on the postoperative period (P > .05). Pain was greater when treating anterior sector mandibular teeth and when trapezoidal incisions were made. Inflammation in turn increased with longer surgical times, and pain and swelling increased with the number of teeth treated. CONCLUSIONS: Periapical surgery caused little pain and moderate swelling during the first 2 days after the intervention. The secondary manifestations increased with the number of teeth treated and with the duration of surgery.

Adult↗
PubMed2004

The effectiveness of compomer as a root-end filling: a clinical investigation.

OBJECTIVE: This study investigates the treatment outcome of a root-end filling technique that uses a light-cured compomer combined with a light-cured dental adhesive. STUDY DESIGN: The study used 34 single-rooted teeth restored with post, core, and crowns. A shallow concave apical preparation was filled with a light-cured compomer with a light-cured dental adhesive. As a control, a chemically cured glass ionomer was used with a conventional root-end preparation. A follow-up clinical and radiographic evaluation of the treatment result was conducted after 1 year. RESULTS: A significantly higher success rate (P<.015) was observed in the treatment group that used a compomer (89% complete healing) compared to glass ionomer (44% complete healing). CONCLUSIONS: When used as a retrograde root filling in a shallow concave preparation, a light-cured compomer and a dental adhesive improves healing regardless of the quality of the remaining root filling.

Adult↗
PubMed2004

Evaluation of different methods for the root-end cavity preparation.

OBJECTIVE: The dentinal walls of root-end cavities were examined for the presence of cracks and debris in correlation with the area of the root surfaces that remained after the resection. STUDY DESIGN: One hundred extracted single-rooted teeth were endodontically treated, mounted in acrylic resin blocks, and the apical 2 mm of the root-apex was resected. According to the resected root surface area the teeth were divided into 2 groups having large (>2 mm(2)) or small (<2 mm(2)) surface area. For retrograde cavity preparation 4 devices were used: slow-speed handpiece, diamond coated stainless steel ultrasonic tip, smooth stainless steel ultrasonic tips, and sonic diamond-coated tips. Teeth were examined under a videomicroscope for the presence of fractures, dentin chips, and gutta-percha remnants on cavity walls. Preparation time was also recorded. RESULTS: Preparation with smooth stainless steel ultrasonic tips produced few intradentin cracks. Dentin debris was more frequently seen in rotary preparations whereas gutta-percha remnants were seen mainly at ultrasonically prepared teeth. CONCLUSIONS: Sonic and ultrasonic devices produced cleaner, well-centered, and more conservative root-end cavities than the rotary instrumentation. Cracks do not correlate directly with the surface area of the root-end surfaces but rather with the type of retrotip used to prepare the root-end cavity.

Apicoectomy↗
PubMed2004

Effects of ultrasonic root end preparation on resected root surfaces: SEM evaluation.

OBJECTIVE: The purpose of this study was to investigate the in vitro effect of ultrasonic retrotips on root end surfaces. STUDY DESIGN: Root end resection was performed on 45 single-root teeth endodontically treated after extraction. Setting the ultrasonic device at full power, a retrograde cavity was made by a stainless steel tip in 9 specimens (SS-FP). In another 9 samples a diamond tip was used (D-FP). Setting the intensity of the ultrasonic device at half power, 9 specimens were treated using stainless steel tips (SS-HP) and 9 using diamond tip (D-HP). Nine teeth were only apically resected and used as controls. Histologic serial sections were examined by scanning electron microsope to assess the number of root-face cracking, the marginal quality, and the crack type. RESULTS: No significant difference between diamond and stainless steel groups was found at a given power setting. Significant differences were found between SS-FP and SS-HP group for both the number of cracks and the marginal quality.

Adolescent↗
PubMed2005

Comparison of quality of life after surgical endodontic treatment using two techniques: a prospective study.

OBJECTIVE: The purpose of this prospective study was to compare patient experience of quality of life following surgical endodontic treatment using 2 different techniques: a technique that included the use of a dental operating microscope, root resection with minimal bevel and retrograde preparation with ultrasonic tips, and a traditional technique that included root resection with a 45 degrees bevel and retrograde preparation by bur performed without magnification. STUDY DESIGN: The study consisted of 66 patients referred for surgical endodontic treatment. One operator (I.T.) carried out all treatment. An equal number of patients were assigned to each group. Group 1 was treated by the traditional technique without an operating microscope and Group 2 by a technique using an operating microscope and minimal osteotomy. All patients were given a questionnaire with 15 questions to evaluate their quality of life for 7 days postsurgery. RESULTS: On day 5, patients in Group 1 reported significantly more pain and took significantly more analgesics (P < .05). On days 1 and 2, patients in Group 2 reported significantly more difficulty in mouth opening, mastication, and the ability to speak (P < .05). CONCLUSION: Patients in both groups reported a high incidence of symptoms. The technique using the operating microscope provided significantly less postoperative pain, but more difficulties in mouth opening, mastication, and the ability to speak immediately postoperatively.

Adult↗
PubMed2005

An investigation of microleakage from root-end fillings in ultrasonic retrograde cavities with or without finishing: a quantitative analysis.

OBJECTIVE: The aim of this study was to make a quantitative assessment of the sealing ability of Super-EBA, IRM, and Pro Root MTA root-end fillings subjected to 3 different finishing techniques. STUDY DESIGN: Eighty-one ultrasonically prepared root-end cavities in human canines were separated randomly into 3 test groups of 27 roots each. The cavities were filled with Super-EBA, IRM, or Pro Root MTA and finished by ball burnishing. Sequentially, 18 roots from each group received a final smoothing with either a 30-fluted tungsten carbide finishing bur or a Zekrya carbide 28-mm bur. Samples were prepared and immersed in 2% methylene blue dye neutral solution for 12 hours. Roots were ground into a powder and prepared for analysis in an absorbency spectrophotometer. RESULTS: The results revealed that Pro Root MTA displayed significantly less mean dye microleakage ( P < .05) than Super-EBA and IRM root-end fillings. The Super-EBA root-end fillings, although presenting a greater mean dye microleakage, did not differ significantly from IRM ( P > .05). The finishing technique did not significantly ( P > .05) affect the incidence of microleakage among the materials tested. CONCLUSIONS: The favorable results obtained with MTA in leakage studies may be related to its good marginal adaptation. Spectrophotometric analysis may provide valuable information about the sealing capacity of root-end fillings. None of the procedures tested were able to avoid leakage, a finding that stresses the importance of the eradication of irritants within the root canal system.

Aluminum Compounds↗
PubMed2005

The clinical effect of LLLT in endodontic surgery: a prospective study on 72 cases.

OBJECTIVES: The purpose of this prospective study was to evaluate a possible clinical benefit of LLLT in endodontic surgery. STUDY DESIGN: Seventy-two endosurgery cases on incisors and premolars were included to the study and were split randomly into an LLLT test group, a placebo group, and a control group. In the LLLT group, irradiation was performed intraoperatively and postoperatively 1, 3, and 7 days after surgery. In the placebo group, irradiation was performed without laser activation. In the control group, neither LLLT nor placebo therapy was used. Swelling, wound healing, and pain were evaluated by a blinded investigator 1, 3, and 7 days postoperatively. RESULTS: No statistically relevant differences between the LLLT and the placebo groups were found. Patients in the control group reported on statistically relevant stronger pain. CONCLUSION: In routine endodontic surgery cases, LLLT does not achieve a significant clinical benefit. Further, the results indicate a prominent placebo effect of the soft laser therapy.

Adult↗
PubMed2005

Endodontic surgery with ultrasonic retrotips: one-year follow-up.

OBJECTIVE: The purpose of this prospective clinical study was to monitor the outcome of ultrasonic root-end preparation, in relation to tooth type and location, presence of post restoration and type of retrotip. STUDY DESIGN: Teeth treated surgically showed a periradicular lesion of strictly endodontic origin. Fifty teeth were included in the study, according to specific selection criteria. Cases were followed for a period of 1 year and then classified in 3 groups (success, uncertain healing, and failure) according to radiographic and clinical criteria. RESULTS: Of the 46 teeth evaluated at 1-year follow-up, 42 teeth (91.3%) successfully healed, 1 tooth had uncertain healing, and 3 failed. We found no statistically significant differences in treatment results related to the type of tooth, tooth location, post restoration, and type of retrotip. CONCLUSION: Adherence to a strict endodontic surgical protocol and the use of contemporary techniques and materials can lead to a predictable outcome.

Adult↗
PubMed2005

Postoperative pain after root-end resection and filling.

OBJECTIVE: To evaluate the pain experience following root-end resection and filling with Mineral Trioxide Aggregate or Intermediate Restorative Material. STUDY DESIGN: Referred adult patients recruited using strict entry criteria were randomly allocated to receive either material. A standardized surgical technique was employed. Postoperative instructions and a pain questionnaire were given to each patient to record the severity of their pain at 3 time intervals-3-5 hours, 24 hours, and 48 hours after surgery-on a standard visual analog scale (VAS). Patients were also asked to record consumption of any self-prescribed analgesics, the type, and dosage. RESULTS: At 3-5 hours after surgery, regardless of the material used, 90% of all patients experienced some level of postoperative pain. Twenty-four hours after surgery 82% of patients experienced pain, as did 72% after 48 hours. Thirty-seven percent of patients did not take any analgesics at all. In order of popularity, the analgesics taken were ibuprofen, acetaminophen, and acetaminophen plus codeine phosphate. The VAS measurements were reduced over time in both treatment groups (P < .001). There was no statistically significant difference in the proportion of subjects taking analgesics in each treatment group. Patients who used analgesics showed higher median VAS measurements at all time periods (P < .05). CONCLUSIONS: There was no significant difference in the pain experienced by both treatment groups. The postoperative pain was of a relatively short duration, at its maximum intensity early in the postoperative period but progressively decreased with time. Even if pain relief medication was needed, nonprescription analgesics were adequate and effective.

Adult↗
PubMed2005

A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery.

OBJECTIVE: Randomized clinical prospective study to evaluate the application of MTA and IRM as retrograde sealers in surgical endodontics. STUDY DESIGN: One hundred single-rooted teeth were surgically treated. After randomization, MTA or IRM was used as a retrosealer. Radiographs were taken 1 week, 3 months, and 1 year postoperatively. Assessment was performed by 2 independent assessors 1 year after surgery. Both treatment groups were homogeneous in their composition, and clinical features and radiographic findings were classified according to Rud's classification. RESULTS: Complete healing was observed in 64% of the MTA-treated teeth vs 50% of the IRM-treated teeth. Incomplete healing was seen in 28% (MTA) vs 36% (IRM), and unsatisfactory in 6% (MTA) vs 14% (IRM). Only 1 failure was seen (MTA). No statistically significant differences were found between the 2 retrofilling materials. CONCLUSION: As root-end filling materials in this clinical prospective randomized design on single rooted teeth, MTA and IRM had the same clinical effectiveness.

Adolescent↗
PubMed2006

Etodolac versus dexamethasone effect in reduction of postoperative symptoms following surgical endodontic treatment: a double-blind study.

OBJECTIVE: The purpose of this prospective study was to analyze the effect of etodolac versus dexamethasone in reducing postoperative pain in patients who had surgical endodontic treatment using a strict protocol. STUDY DESIGN: The study consisted of 90 patients (38 males and 52 females) referred for surgical endodontic treatment. All procedures were performed using a microsurgical technique with a strict protocol. Patients were randomly premedicated with placebo or with one of both protocols: either a single dose of oral dexamethasone, 8 mg, preoperatively and 2 single doses, 4 mg, 1 and 2 days postoperatively, or a single dose of etodolac, 600 mg, and 2 single doses, 600 mg, 1 and 2 days postoperatively. Pain was recorded at 8, 24, and 48 hours, as well as 7 days postoperatively, on a 1-10 scale. The influence of different variables on postoperative sequelae was analyzed. RESULTS: On a 1-10 scale, the mean values of pain report recorded were 3.8 +/- 2.9 (8 hours postoperatively), 2.93 +/- 2.4 (24 hours), 2.31 +/- 2.2 (48 hours), and 1.4 +/- 0.9 (7 days postoperatively). One day postoperatively, 41.8% of the patients reported no or very mild pain (score 1 or 2), whereas after 7 days, 87.9% reported no or very mild pain (score 1 or 2). Both etodolac and dexamethasone had a significant effect of reducing postoperative pain in patients who had surgical endodontic procedure compared with placebo (P < or = .001). CONCLUSION: Postoperative pain following endodontic surgical treatment is not uncommon. Etodolac as well as dexamethasone might serve as a pain relief measure for postoperative pain in these patients.

Adolescent↗
PubMed2006

Evaluation of periapical repair following retrograde filling with different root-end filling materials in dog teeth with periapical lesions.

OBJECTIVE: The objective of this study was to evaluate periapical repair following retrograde filling using different root-end filling materials. STUDY DESIGN: After induction of periapical lesions, 48 root canals from dog teeth were partially filled. Endodontic surgery was performed and 3 different materials were used for root-end filling: Sealer 26, Sealapex plus zinc oxide, or mineral trioxide aggregate (MTA). No additional procedures were performed in the control group after partial filling of the root canal. After 180 days, the animals were killed, the maxillas and mandibles were removed, and specimens were submitted for histologic processing. RESULTS: Histopathologic analysis revealed similar periapical repair for the groups in which Sealer 26, Sealapex plus zinc oxide, and MTA were used (P > .05). The control group showed unsatisfactory periapical repair (P < .05). CONCLUSION: There was no difference in periapical tissue healing after retrograde filling with the tested materials, which indicates that these 3 root-end filling materials are equally useful.

Aluminum Compounds↗