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PubMed2003

Apical leakage in maxillary type IV premolars with three different endodontic treatments.

The aim of this study was to evaluate the sealing ability in orthogradely filled, apicoectomised and retrogradely filled maxillary premolars with two canals and two separate apical foramina. The root canals of 51 extracted maxillary premolars of type IV were uniformly shaped and filled by means of lateral condensation and subsequently randomly divided into three groups of 17 teeth each. The teeth of groups II and III received an apicoectomy. In group III an additional retrograde seal (Ketac Fil) was applied. Group I served as control. All specimens were immersed in a methylene blue solution for 24 h. The teeth were cross-sectioned and the maximal dye-penetration was measured. The significantly least dye-penetration was observed in group II (apicoectomy only), followed by group I and group III. The differences among all groups were statistically significant (p<0.05). Most of the retrograde restorations in group III revealed circular colouration around the retrograde fillings extending to the gutta percha. Although the teeth of group II revealed the least dye-penetration, an apicoectomy cannot be favoured against an endodontic retreatment in maxillary premolars of type IV. The application of retrograde fillings using Ketac Fil must be considered critically.

Apicoectomy↗
PubMed1985

A follow-up study of apicoectomized teeth with total loss of the buccal bone plate.

Opinions differ as to whether or not teeth with advanced marginal bone loss should be subjected to periapical surgery. The purpose of this retrospective investigation was to study the results after apicoectomy on teeth that showed total buccal bone loss at the time of the operation. The material consisted of twenty-seven teeth in 27 patients, fifteen males and twelve females, 23 to 63 years old at the time of the operation. The observation time varied from 0.5 to 7 years (mean, 3 years). Ten operations (37%) were regarded as successful, nine (33%) as uncertain, and eight (30%) as unsuccessful. The success rate was not so low that an apicomarginal communication should be regarded as a contraindication for apicoectomy. Apicoectomy should be performed, especially if the alternative is an otherwise unnecessary prosthetic reconstruction.

Adult↗
PubMed2003

Vestibular surgical access to the palatine root of the superior first molar: "low-dose cone-beam" CT analysis of the pathway and its anatomic variations.

Apicoectomy of the superior first molar palatine root until recently involved relatively destructive and laborious surgery because of the palatal access route, which not only necessitates an extensive flap, but also the readying of procedures required to deal with a possible hemorrhage from the palatine artery. With the advent of operative microscopy, endodontic surgery has become more precise and less invasive and its technical potential has increased; a possible innovative surgical technique may entail vestibular root access. The possibility of using low-dose, low-cost computed tomography (CT) dedicated to the jaw to obtain anatomic information to plan apicoectomy via the vestibular approach was evaluated; 31 patients were referred to CT with the NewTom apparatus. In 43 superior first molars, the mean distance of the palatine root from the external vestibular cortex was measured, and the frequency that the maxillary sinus lateral recess lay between the roots was determined. The mean root apex-vestibular cortex distance was 9.73 mm. In 25% of cases the maxillary sinus recessus lay between vestibular and palatine roots. CT may play an important role in optimizing palatine root apicoectomy through vestibular access, with regard to precision and preventing complications, with relatively low biological and economic cost, also possibly contributing to the affirmation of this new surgical procedure.

Adolescent↗
PubMed1998

[Relapse after endodontic treatment: endodontic retreatment or apex resection?].

In many cases, unsuccessful endodontic treatment is followed by apicoectomy. Endodontic retreatment, however, could be an appropriate alternative for apicoectomy more frequently. In this paper indications, specific problems and treatment methods are presented for endodontic retreatment, apicoectomy and intentional replantation.

Apicoectomy↗
PubMed1985

Healing and revascularization of apical periodontium and dental pulps in apicoectomized and nonapicoectomized tooth replants in monkeys. A study of fully developed teeth.

This report primarily concerns an experimental study of the effect of apicoectomy on the healing and revascularization of the periodontal membrane and dental pulps in tooth replants. Five rhesus monkeys (Macaca mulatta) were subjected to surgical procedures in which twenty incisor teeth were extracted and immediately replanted. Ten of these incisors were subjected to apicoectomy. Healing and revascularization of periapical tissues and dental pulps were evaluated by histologic and India-ink-perfusion techniques. Apicoectomized replants were characterized by (1) loss of dental substance (tooth apex) and creation of large periapical spaces, (2) exposure of dental pulps and production of periapical inflammatory processes with destruction of alveolar bone, and (3) blocking of normal healing because of persistence of chronic periapical inflammatory processes. In contrast, nonapicoectomized replants depicted short-lived primary inflammatory responses and healing processes characterized by variable histologic responses.

Animals↗
PubMed1999

Results of intentional replantation of molars.

PURPOSE: This study evaluated the treatment outcome of intentional replantation of molars. PATIENTS AND METHODS: Twenty-nine patients were treated with intentional replantation because conventional apicoectomy was not possible. The success rate was judged by clinical and radiographic parameters. RESULTS: One molar (3%) had to be removed because of pain and mobility 4 weeks postsurgery, and three molars (11%) had to be removed during the first year because of periodontal problems. Four molars (14%) showed periodontal problems or root resorption, but are still in function and causing no obvious problems to the patients. Twenty-one molars (72%) were successfully treated. CONCLUSION: Intentional replantation is a reliable and predictable treatment for those cases in which conventional apicoectomy is hampered because of anatomic limitations or patient factors.

Adult↗
PubMed1981

Pulpal changes in replanted and autotransplanted apicoectomized mature teeth of dogs.

The purpose of the present investigation was to study whether apicoectomy, performed at the time of the operation, affects the tissue reactions of the pulp of replanted and autotransplanted mature teeth. The material consisted of 45 teeth from six adult dogs. Twenty-six teeth were replanted or autotransplanted after removal of about one fourth of the length of the root. Nineteen teeth were replanted or autotransplanted without apicoectomy. The observation periods were 10, 30 and 120 days. The teeth were longitudinally sectioned at 7 micrometers in a bucco-lingual direction. the sections were stained with hematoxylin and eosin or according to the van Gieson or Brown and Brenn methods. No difference was noted in the tissue reactions of the pulp of replanted and autotransplanted teeth. In the apicoectomized teeth the pulp initially became necrotic, but repair occurred through ingrowth of connective tissue that had reached the pulp horn in 14 of 15 teeth after 120 days. Cell-containing hard tissue had formed postoperatively on the root canal walls and in some teeth also centrally in the pulp. In the 19 non-apicoectomized teeth the pulp necrotized and repair did not occur.

Animals↗
PubMed2003

A systematic review of in vivo retrograde obturation materials.

PURPOSE: The aim of this study was to answer the question: For patients requiring apicoectomy (apicectomy/root-end resection) and retrograde (root-end) obturation (filling), which retrograde obturation (root-end filling) material(s) is/are the most effective, as determined by reduction in periapical radiolucency and elimination of signs and symptoms? MATERIALS AND METHODS: A MEDLINE and a Cochrane search (two specified searches) were conducted to identify randomised (RCT) and nonrandomised controlled clinical trials (CCT), cohort studies (CS) and case-control studies (CCS), published between 1966 and 2002, October week 4, conducted on humans, and published in English, German and French language, relating to retrograde obturation materials following apicoectomy. RESULTS: The MEDLINE and the Cochrane search identified 324 and 21 published articles, respectively. The Cochrane search identified three additional articles to the MEDLINE-search articles. Fourteen studies met the inclusion criteria: two were RCTs, six were CCTs, none was a CS and six were retrospective CCSs. Nine of the 14 studies compared a new retrograde (root-end)-filling material to amalgam, 4 of the 14 studies compared orthograde root canal fillings to retrograde (root-end) amalgam and the fourteenth study compared variations of a resin composite (Retroplast) when used in combination with the bonding agent Gluma (Bayer AG, Gluma 1 and 2). The two RCTs indicated that glass ionomer cement appeared to be equivalent to amalgam. The six CCTs indicated that orthograde filling with gutta-percha and sealer was more effective than amalgam retrograde (root-end)-filling (one trial). Similarly, retrograde (root-end)-filling with (i) composite and Gluma (Bayer AG, Leverkusen, Germany) as bonding agent (one trial), (ii) reinforced zinc oxide eugenol cement (EBA cement) (Stailine, Staident, Middlesex, England; one trial) and (iii) gold leaf (one trial) appeared to be better than amalgam retrograde (root-end)-filling. Finally, gutta-percha retrograde (root-end)-filling appears to be less effective than amalgam (one trial) and Retroplast with ytterbium trifluoride is better than Retroplast with silver, when they are both used with Gluma as bonding agent (one trial). CONCLUSIONS: For the highest level of evidence (RCT) retrograde (root-end)-filling with glass ionomer cement is almost as effective as amalgam. However, there was a significant caveat as there were only two RCTs. At the next highest level of evidence (CCT), and given the additional caveat that there was only one controlled trial for each material, retrograde (root-end) EBA cement, composite with Gluma and gold leaf, as well as orthograde gutta-percha, may be more effective than retrograde (root-end) amalgam filling. In conclusion, these results suggest that additional validating CCTs and RCTs are needed.

Apicoectomy↗
PubMed1990

[Clinical and roentgenographic follow-up study of tricalcium phosphate ceramic in bone cavities of apicoectomized teeth].

In 8 patients aged 16-30 years with periapical osteolytic areas (1,5-2 cm) of anterior maxillary and mandibular teeth root canal treatment and apicoectomy were performed. The bone cavity following apicoectomy was filled with tricalcium phosphate ceramic (small spheres diameter more than 1 mm and less than 2 mm). Patients were re-examined the following day as well as on the 4th, 7th, and 15th postoperative day. Follow up at the 1, 3, 6, 12 and 18 postoperative months did not show any problem of the healed wood nor any rejection of the implanted material. Radiographically, some resorption of the material as well as new bone formation were noticed 12 and 18 month after the operation.

Adolescent↗
PubMed1989

[The prognosis of autologous tooth transplants in orthodontic treatment planning].

Autogenous tooth transplantation is an alternative treatment for preserving continuity of the dental arch following early loss of teeth. The prognosis of transplants determines the indication as compared with other methods of space closure. Transplanted buds of upper premolars as well as of lower third molars continue their root growth. The clinical and roentgenological analysis of 81 autogenously transplanted upper canines, following different operative procedures, indicates, that 50% of the transplants remain in situ for five years and only 25% remain in situ longer than six years. The statistical chances of survival of vitally transplanted, apicoectomied teeth are more favourable. Short-term prognosis is determined by inflammatory bone and/or tooth resorption due to odontogenic infection or occlusal trauma. Long-time prognosis is determined by different forms of tooth resorption. Regular radiographic examination as reveal early odontogenic infections which can then be treated endodontically. The doubtful prognosis necessitates strict indications.

Adolescent↗
PubMed1987

The effect of excision of the root apex on the intrusive mobility of anterior teeth in adult monkeys (Macaca fascicularis).

Intrusive tooth mobility was recorded on anterior teeth in four adult male animals by linear variable-differential transformers. Reflection of the labial mucosa caused a significant increase in mobility at 4 N when the loading rate was slow (1 N s-1) but not when fast (100 N s-1). No significant additional increase in mobility was recorded after the apices were removed from eight incisors and canines. A further study on five incisors was made in which the displacement at 4 N load was noted half hourly during a control period of 5 or 6 h. Some weeks later, the sequence was repeated but the apices were resected after 3 or 4 h. As there was no increase in mobility for the majority of teeth following apicoectomy and, for two teeth studied in detail where there was an increase, that change was short lived; it seems that compression in the fundus of the socket is not a mechanism of importance in supporting the tooth against small intrusive loads.

Animals↗
PubMed1991

A new endodontic stabilizer implant device.

A new endodontic stabilizer implant device is presented that can be used immediately after enucleation of large periapical cysts. The force transmission characteristics of this implant were evaluated by means of photoelasticity. The implant served to distribute incisal forces within the supporting structure. Improved stress conditions resulted at the tooth apex and between the apex and the superior border of the implant when the tooth was subjected to apicoectomy.

Apicoectomy↗
PubMed1980

A comparison of the marginal adaptation of retrograde techniques: a scanning electron microscopic study.

An investigation of the most popular retrograde technique for their marginal adaptation to dentin was attempted. Forty extracted maxillary central incisors were instrumented and obturated, and various apical procedures were performed. The scanning electron microscope was used to record the results. Retrograde amalgam, heat-sealed gutta-percha, and the apicoectomy control showed average marginal defects from 22 micron to 104 micron, while cold-burnished gutta-percha exhibited an average defect of only 1.8 micron. The marginal defect produced by cold-burnished gutta-percha is less than one tenth as large as the best of the other techniques.

Apicoectomy↗
PubMed1982

A comparison of the marginal leakage of retrograde techniques.

An investigation of the apical seal of the most popular retrograde techniques was attempted. Ninety extracted maxillary central incisors were instrumented and obturated, and various apical procedures were performed. The depth of penetration of 2 percent methylene blue dye was used to evaluate the apical seal. Retrograde amalgam, heat-sealed gutta-percha, and the apicoectomy control showed average depths of penetration of 3.1, 4.0, and 4.6 mm., respectively, while cold-burnished gutta-percha yielded an average depth of penetration of 1.5 mm. The apical seal produced by cold-burnished gutta-percha allows less than half the penetration of the best of the other techniques and gave the most consistent results.

Apicoectomy↗
PubMed1983

Clinical and radiologic re-examination of apicoectomized teeth.

Healing after periapical surgery was studied clinically and radiologically in 108 patients in whom apicoectomy had been performed on 174 teeth. Histologic diagnosis was used to determine healing results; teeth with periapical granuloma tend to heal less successfully than teeth showing inflammation or cysts. Postoperative treatment played an important role in the healing process. In making a prognosis one must include preoperative status (including periodontal status), operating method, and postoperative treatment. The age of the patient also has some influence on healing.

Adolescent↗
PubMed1985

Electrochemical corrosion in the failure of apical amalgam. Report of two cases.

Apicoectomy with retrograde amalgam is an accepted procedure for treating teeth that cannot be treated by nonsurgical methods. Some of these fail to heal for no apparent reason. Evidence is presented that indicates that some of these failures are caused by corrosion of the apical amalgam. Two cases are described in which the sinus tract that was associated with the failing retrograde amalgam was resolved without further surgery. To bring about the resolution, a zinc-enriched amalgam was placed in the crown that through an intervening conductor, reduced the rate of corrosion at the apex.

Adult↗
PubMed1987

Surgical treatment of iatrogenic canal blockages.

The endodontist of today is confronted with managing retreatment failures. Some of these can involve the retreatment of intracanal blockages. Many times, conventional endodontics cannot be redone, so a surgical approach may be needed. This article reviews four basic surgical techniques that can be used for retreatment of intracanal blockages. When the blockage cannot be removed, a standard retrograde amalgam technique or the Nygaard Ostby procedure of reverse instrumentation-obturation can be used. Two other surgical techniques used to eliminate the blockage are the apical loosening technique and a true apicoectomy procedure. Each of these procedures is reviewed, and the advantages and disadvantages are discussed.

Adolescent↗