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PubMed1992

[Lack of healing following adequate endodontic treatment].

When an endodontic treatment is to be redone, generally the X-ray reveals some form of poor or inadequate filling. Most endodontic cases fail because of inadequate endodontic treatment (cleaning, shaping, filling). However, sometimes good clinical treatment isn't followed by healing! This article sums up the possible reasons to consider. In order to improve the success rate of the endodontic treatments, practical hints are given regarding the non-surgical as well as the surgical (re)treatments.

Apicoectomy↗
PubMed2005

Evaluation of endodontic treatments performed by students in a Brazilian Dental School.

The aims of this study were to evaluate the clinical outcomes of root canal treatments performed by final-year students in the Dental School of Piracicaba, State University of Campinas, SP, Brazil, during the year 2000 and to evaluate the success rate of these treatments at follow-ups conducted one and three years later (2001-03). All 579 endodontic treatments performed by final-year students were selected for this investigation. Detailed personal and dental history was obtained from the patient's records. Clinical and radiographic follow-up examinations were performed. For 78.8 percent of the cases, dental caries was recorded as the cause for performing endodontic treatment; for 8.8 percent, prosthetic reasons were given; and for 12.4 percent, failure of the endodontic treatment was the reason. The largest percentage (30.7 percent) of recalled patients was examined after one year; the success rate at this follow-up evaluation ranged from 83 percent to 96 percent depending on the pulp status prior to the root canal treatment. After three years, only 8 percent of treated patients returned; assessment for them revealed a 75.5 percent success rate. Dental caries is still the main reason for endodontic treatment. This level of success of the root canal treatment in a Brazilian dental school is similar to other reports in the literature.

Adult↗
PubMed2005

[Investigation of the current situation on clinical application of endodontic treatments in Shanghai municipality].

PURPOSE: To investigate the present state of endodontic treatments applied in Shanghai municipality. METHODS: A questionnaire survey about clinic application of three endodontic treatments including pulp mummification (PM), resinifying therapy(RT) and root canal therapy(RCT) was conducted by 136 dentists of 42 hospitals selected from three different types of hospitals in Shanghai. The questionnaire concerned the proportion and the scale of three treatments used clinically , the indications, the evaluation of the curative effect and the prospective application in future. SAS6.04 statistical software was used for Chi square test and Kruskal-Wallis test. RESULTS: (1) PM and RCT were applied widely, RT was seldom used. There was significant difference in the proportion using PM among three different types of hospitals (P<0.001). (2) PM was primarily applied to the teeth suffering from acute or chronic pulpitis, especially molars with vital pulp.(3)Good long-term curative effect was the primary factor affecting dentists to chose endodontic treatment.(4) Most dentists affirm that the best curative effect would be obtained for RCT, however, the effect was uncertain for PM to treat acute or chronic pulpitis. CONCLUSION: The current situation of clinical use of endodontic therapeutic methods in Shanghai falls some short of the concepts accepted internationally. But in general, RCT should be popularized while PM should be eliminated gradually.

China↗
PubMed1989

Endodontics and litigation: an American perspective.

Dentists can reduce the risk of legal entanglements following endodontic treatment. Dentists should not fail to meet the standard of care required at one or more of the several stages in endodontic treatment: at diagnosis, in record keeping, by accidentally treating the wrong tooth, by not using rubber dam, by breaking endodontic instruments in the root canal, by using inappropriate endodontic implants, by creating root perforations, by failing to give adequate instructions for home care and by not providing emergency care. Recognition of problems likely to rise to litigation and the methods to be used in their avoidance are emphasized.

Dental Implantation, Endosseous, Endodontic↗
PubMed1984

A simulation program for reviewing endodontics.

To reduce repetitive endodontic errors by senior dental students, a formal review program was established. It consisted of a slide-tape and a written, latent-image simulation of an endodontic case requiring diagnostic and treatment decisions. Before undertaking any endodontic cases in the senior year, each student had to complete the program successfully. The program significantly reduced diagnostic errors in six categories for posterior teeth and in four of six categories for anterior teeth. Errors were also significantly reduced in eight of 12 treatment categories for posterior teeth and in five of 12 categories for anterior teeth. Students' opinions of the endodontic review program were quite favorable.

Audiovisual Aids↗
PubMed2006

The effect of fiber insertion on fracture resistance of endodontically treated molars with MOD cavity and reattached fractured lingual cusps.

In this study, the effect of flowable composite reinforced with a leno wave ultra high modulus (LWUHM) polyethylene fiber (Ribbond) on fracture resistance of endodontically treated molars with MOD cavity and lingual cuspal fracture was evaluated. Sixty sound extracted human mandibular molars were randomly assigned to six groups (n = 10). Group 1 served as control. Teeth in groups 2-6 received root canal treatment and a MOD cavity preparation. Teeth in group 2 were kept unrestored. Lingual walls of specimens in groups 3-6 were fractured at the CEJ and reattached (C&B Super-Bond). Group 3 was kept unrestored, and group 4 was restored with a composite resin (CR) (AP-X). In group 5, a flowable resin (FR, Protect Liner F) and in group 6, a Ribbond in combination with FR were inserted inside the cavity before CR restoration. After finishing and polishing, the specimens were subjected to compressive loading perpendicular to the occlusal surface at a crosshead speed of 1 mm/min. The mean load necessary to fracture were recorded in Newton and the results were statistically analyzed. MOD cavity preparation reduced fracture resistance of endodontically treated teeth (p < 0.05). Fracture resistance of rebonded fractured specimens was found to be similar to that of the nonfractured samples (p > 0.05). Use of LWUHM polyethylene fiber Ribbond increased fracture strength of endodontically treated molar teeth with MOD cavity preparation and cuspal fracture (p < 0.05). As a result, it was concluded that the insertion of Ribbond inside the cavity has a positive effect on fracture strength of endodontically treated molar teeth with MOD cavity preparation and cuspal fracture.

Dental Materials↗
PubMed1991

Threaded endodontic dowels: effect of post design on incidence of root fracture.

The use of threaded endodontic dowels is a controversial issue. The purpose of this study was to compare the potential for root fracture resulting from the cementation of nine threaded and three nonthreaded endodontic dowel systems. The clinical crowns of 140 extracted premolars were removed at the cementoenamel junction. The teeth were randomly assigned to the following treatment groups of 10 teeth each: Group 1, endodontically instrumented but not obturated; group 2, instrumented and obturated; group 3, instrumented, obturated, and restored with custom-cast gold dowel and cores; groups 4 and 5, instrumented, obturated, and restored with prefabricated, nonthreaded dowels; and groups 6 through 14, instrumented, obturated, and restored with one of nine prefabricated, threaded dowels. All dowels were inserted according to manufacturer's directions, removed, and cemented with vinyl polysiloxane impression material. Each specimen was demineralized and cleared. Photographs at 1:1 magnification were taken to assess dowel fractures. Fisher's test and chi square analysis were performed to evaluate the differences between post types, and between posted and nonposted controls (p less than 0.05). The results indicate no statistically significant differences between dowel types when compared with each other, regardless of dowel shape, taper, or presence or absence of threads, or when compared to instrumented, nonobturated controls. The amount of remaining dentin and existing root morphology may be a determining factor for endodontically treated teeth to resist fracture during dowel placement.

Cementation↗
PubMed1984

A histologic comparison of Hydron and zinc oxide-eugenol as endodontic filling materials in the primary teeth of dogs.

Currently available endodontic filling materials for primary teeth demonstrate several inadequacies. Therefore, this study histologically evaluates Hydron (2-hydroxyethylmethacrylate) and zinc oxide and eugenol (ZOE) as primary tooth endodontic filling materials in dogs to compare the materials' biocompatibility and to determine whether they undergo resorption in a physiologic manner. Primary molars of six mongrel dogs, 2 to 3 months old, received one-step endodontic therapy. By random selection, two thirds of the molars were filled with either Hydron or ZOE and the remainder were used as unoperated controls. Block sections taken during physiologic root resorption were used to obtain serial hematoxylin and eosin sections of periapical regions. Hydron was phagocytosed by mononuclear macrophages in a physiologic manner and at a rate comparable to that of root tissues. In contrast, ZOE demonstrated delayed resorption and transitory inflammation. Neither material showed cytotoxicity. Hydron may therefore be a suitable endodontic material for human primary teeth.

Animals↗
PubMed1985

Analysis of endodontic therapy in patients irradiated for head and neck cancer.

The outcome of endodontic therapy in 16 patients irradiated for head and neck cancer was studied. Thirty-five postradiation endodontically treated teeth (54 roots) were included in the study. The follow-up period ranged from 6 months to 54 months. At the time of last follow-up, 46 of 54 roots were being maintained. No osteoradionecroses were seen in association with teeth that had been endodontically treated. From this review, it is clear that endodontic therapy is a viable method of treating diseased teeth in patients irradiated for oral neoplasms.

Aged↗
PubMed1987

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.

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).

Adolescent↗
PubMed1989

A prospective randomized double-blind trial on efficacy of dexamethasone for endodontic interappointment pain in teeth with asymptomatic inflamed pulps.

To determine whether a relatively large dose of oral dexamethasone given for a short period of time would be effective in reducing endodontic interappointment pain, the current double-blind, placebo-controlled study was undertaken. After the visit for instrumentation, 40 patients with asymptomatic teeth having vital-inflamed pulps were randomly given either dexamethasone (3 tablets of 4 mg each) or a dextrose placebo identical in appearance (same dosage schedule). The outcome showed that the oral administration of dexamethasone resulted in a statistically significant reduction in endodontic interappointment pain at all three time periods evaluated, that is, at 8 hours, 24 hours, and 48 hours (p less than 0.01). It appears from the results of this study that this dosage schedule of oral dexamethasone is sufficient to significantly reduce endodontic interappointment pain for teeth with asymptomatic vital-inflamed pulps. Further studies are needed for teeth with other endodontic pulpal-periapical conditions and for symptomatic teeth.

Clinical Trials as Topic↗
PubMed1991

Healing assessment of osseous defects of periapical lesions associated with failed endodontically treated teeth with use of freeze-dried bone allograft.

Freeze-dried bone allograft (FDBA) has been used extensively in periodontal surgery and in the treatment of pocket osseous defects resulting from inflammatory periodontal disease. No other endodontic investigation has used this type of graft material in the treatment of bony resorptive defects of the periapical lesions associated with failed endodontic therapy. Therefore this study was conducted with the use of FDBA, to assess healing ability of osseous defects after removal of periapical lesions associated with failed endodontically treated teeth. In all patients periapical lesions were surgically removed with retrograde amalgam seal and the graft material was then carefully packed without pressure into the bony defect. The lesions were fixed in 10% neutral buffered formalin and prepared for histologic examination. Long-term recall demonstrated bone regeneration and good tolerance of allograft material by the periapical tissues. The periapical lesions were either periapical granulomas or apical periodontal cysts. We conclude that FDBA is a biocompatible material of osteogenic potential and can be used effectively in treating osseous defects of periapical lesions associated with failed endodontically treated teeth.

Adolescent↗
PubMed1988

Allotransplantation and autotransplantation of mature teeth in monkeys: the influence of endodontic treatment.

This study investigated the effect of endodontic treatment on root resorption of autotransplanted and allotransplanted mature teeth in unmatched monkeys. The material comprised 40 mature maxillary central incisors in 20 green Vervet monkeys (Cercopithecus aethiops). Teeth were either allotransplanted or autotransplanted in pairs of monkeys matched only for the size of the root. Endodontic treatment was performed at random peroperatively with gutta percha and Kerr sealer in 10 of each of the 20 autografts and 20 allografts. The extra-alveolar period was 18 minutes in all groups. Histometric analysis, which included registration of surface and inflammatory and replacement resorption (ankylosis), was done on serial sections of the grafts 8 weeks after transplantation. Endodontic treatment almost completely reduced inflammatory resorption in both allotransplanted and autotransplanted mature teeth (p less than 0.01). Peroperative endodontics elicited a small increase in ankylosis in autografts. In allografts, it unmasked a high amount of ankylosis, presumably primarily due to alloimmune reactions against the donor periodontal ligament, leaving only a small portion of normal ligament almost exclusively located along the cervical region of the root surface. Downgrowth of periodontal pocket epithelium was limited in all groups.

Animals↗
PubMed1990

A comparison of apical root resorption during orthodontic treatment in endodontically treated and vital teeth.

The purpose of this study was to determine whether vital and endodontically treated incisors exhibit a similar severity of apical root resorption in response to orthodontic treatment. Forty-three patients who had one or more endodontically treated incisors before orthodontic treatment and who exhibited signs of apical root resorption after treatment were studied. In each patient the vital contralateral incisor served as a control. Vital incisors resorbed to a significantly greater degree than endodontically treated incisors (p less than or equal to 0.05). When patients were separated by gender, control teeth in males exhibited a statistically significant increase in resorption over control teeth in females. No significant differences were apparent between males and females when endodontically treated incisors were compared.

Adolescent↗
PubMed2006

Culture-independent detection of Eikenella corrodens and Veillonella parvula in primary endodontic infections.

Eikenella corrodens and Veillonella parvula are normal cultivable inhabitants of the oral cavity but their presence in endodontic infections has not been as common as it could be anticipated. This might have been because of shortcomings of culture techniques when it comes to bacterial isolation or identification. The present study intended to survey samples from primary endodontic infections for the presence of E. corrodens and V. parvula using a culture-independent 16S rRNA gene-based nested PCR protocol. Genomic DNA was isolated directly from samples taken from different forms of periradicular lesions, and the presence of E. corrodens and V. parvula was determined by nested PCR. Specificity for each primer pair was confirmed by sequence analysis of PCR products from positive clinical samples. V. parvula and E. corrodens were, respectively, detected in 33% and 14% of the root canals associated with chronic apical periodontitis. Both V. parvula and E. corrodens were found in 10% of the cases diagnosed as acute apical periodontitis. V. parvula and E. corrodens were detected in 21% and 26% of the samples from acute apical abscesses, respectively. In general, species-specific nPCR allowed the detection of V. parvula in 24% and E. corrodens in 18% of the samples taken from primary endodontic infections. Findings confirmed that V. parvula and E. corrodens can take part in the microbiota of primary endodontic infections, but in prevalence values somewhat higher when compared to most of the previous culture studies that had reported recovery of these species.

Acute Disease↗
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

Healing of apical periodontitis after endodontic treatment with and without obturation in dogs.

The principle of obturation of the root canal space is generally accepted. This belief has dominated the field of endodontics despite the absence of credible scientific evidence. Little information is available on the possible relationships between endodontic success and obturation of the root canal system. The present study compares the healing of instrumented and obturated versus instrumented and nonobturated root canal systems with apical periodontitis. Fifty-six root canals in 28 third and fourth bilateral lower premolar teeth with completely formed apices in seven mixed German Shepherd dogs were used. Apical lesions were created by accessing the canals, removing the pulp and leaving them open to the oral environment for 42 days. The teeth in the control group were instrumented, irrigated, and then obturated using a lateral condensation technique with gutta-percha cones and AH26 Plus as the endodontic sealer. The teeth in the experimental group were instrumented and irrigated without obturation. All teeth in both groups were sealed coronally. After 190 days, the animals were euthanized. Vital perfusion with 10% formalin through common carotid artery was performed. Thirty to 40 serial 5-microm thick sections were obtained from each root and stained with hematoxylin and eosin for histological evaluation by observer blinded to the treatment allocation. The control group showed less cementum and dentin resorption in comparison with test group (p < 0.5). No statistically significant difference was found in other parameters between the control and test groups (p > 0.05). The noteworthy finding of this study was that there was no difference in healing of apical periodontitis between the instrumented and obturated and instrumented and nonobturated root canal system. The success of endodontic treatment ultimately depends on the elimination of the microorganism, host response and mechanical closure (coronal seal) of treated root canals that may provide a potential for future bacterial contamination.

Alveolar Bone Loss↗
PubMed2006

Detection and quantitation of E. faecalis by real-time PCR (qPCR), reverse transcription-PCR (RT-PCR), and cultivation during endodontic treatment.

Enterococcus faecalis is frequently recovered from refractory endodontic infections and has been implicated in endodontic treatment failures. This study compared real-time quantitative PCR (qPCR) assay to cultivation for E. faecalis detection and quantitation during endodontic treatment. A reverse-transcription PCR (RT-PCR) assay was also developed to detect the bacterium clinically in the viable but nonculturable (VBNC) state. Intra-canal samples (n = 87) were collected upon access, post-instrumentation/irrigation and postcalcium hydroxide treatment from 15 primary and 14 refractory infections involving 29 single-rooted teeth, and analyzed by the three methods. The bacterium was up to three times more prevalent in refractory than primary infections at each collection step. Overall, qPCR detected significantly more E. faecalis-positive teeth and samples than cultivation (p < 0.001). VBNC E. faecalis was detected by RT-PCR in four samples that were negative by cultivation. These findings support qPCR and RT-PCR as more sensitive methods than cultivation for detecting E. faecalis in endodontic infections.

DNA, Bacterial↗