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PubMed2002

Endodontic implications of the maxillary sinus: a review.

The anatomical and clinical significance of the maxillary sinus in relation to conventional and surgical endodontic therapy is considered. The discussion includes a review on the development, anatomy and physiology of the maxillary sinus, the diagnostic evaluation of the sinus and the differential diagnosis of sinusitis. Endodontic implications of the maxillary sinus include extension of periapical infections into the sinus, the introduction of endodontic instruments and materials beyond the apices of teeth in close proximity to the sinus and the risks and complications associated with endodontic surgery.

Analgesics↗
PubMed2003

Endodontic and orthodontic treatment of a cross-bite fused maxillary lateral incisor.

AIM: To describe combined endodontic and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: A rare case is presented in which combined endodontic and orthodontic treatment was performed on a cross-bite fused tooth. Clinical and radiographic examination showed the maxillary lateral incisor fused with a supernumerary and an impacted canine. The fused tooth required nonsurgical and surgical endodontic treatment for functional and aesthetic reasons. The root canals were dressed with calcium hydroxide for 2 months before they were obturated with thermoplasticized injectable gutta-percha. Then, the distal part of the fused tooth was removed and the mesial part of the tooth was replanted and fixed. Three months after the completion of orthodontic therapy, the impacted canine erupted between the remaining tooth and the first premolar. Recall examination, 3 years after completion of root canal treatment, showed clinical and radiographic evidence of healing. KEY LEARNING POINTS: Fusion has been described as a development anomaly characterized by the union of two adjacent teeth. Proper combined endodontic and orthodontic treatment resulted in maintaining one tooth half and solving the aesthetic and functional problem of a fused tooth.

Child↗
PubMed2003

Bacteria recovered from teeth with apical periodontitis after antimicrobial endodontic treatment.

UNLABELLED: Chávez de Paz LE, Dahlén G, Molander A, Möller A, Bergenholtz G. Bacteria recovered from teeth with apical periodontitis after antimicrobial endodontic treatment. International Endodontic Journal, 36, 500-508, 2003. AIM: To determine whether there is a pattern for certain bacteria to remain after chemo-mechanical treatment of root canals in teeth with apical periodontitis. METHODOLOGY: Consecutive root-canal samples of 200 teeth receiving root-canal treatment, referred from general practitioners and endodontic specialists for analyses of cultivable microbes, were studied prospectively. To be included, samples had to be taken at a treatment session subsequent to the one at which endodontic therapy was initiated. All samples were from teeth that either presented with clinical or radiographic evidence of apical periodontitis or both. Bacteriological findings were linked to clinical and radiographic parameters including status of the root canal prior to treatment, namely, vital pulp, necrotic pulp or root filled. RESULTS: A total of 248 strains were isolated from 107 teeth giving bacterial growth. Gram-positives predominated (85%). Lactobacillus spp. (22%), nonmutans streptococci (18%), and Enterococcus spp. (12%) were the most common isolates. Gram-negative anaerobes were relatively sporadic. Large radiographic bone lesions, persistent pain and use of intracanal calcium hydroxide dressing correlated with bacterial presence (P < 0.05). CONCLUSIONS: Once established, nonmutans streptococci, enterococci and lactobacilli appear to survive commonly following root-canal treatment of teeth with clinical and radiographical signs of apical periodontitis.

Adolescent↗
PubMed2001

Relationship between oral surgical and endodontic procedures and episodic cluster headache.

OBJECTIVE: We sought to evaluate the possible relationship between oral surgery and endodontic procedures and the subsequent appearance of cluster headache (CH) in 54 patients. STUDY DESIGN: This study included 54 patients diagnosed and treated for episodic CH. The characteristics of pain, the extractions, and the endodontic procedures performed in the same or a contralateral quadrant were recorded and analyzed by using the chi-square test. RESULTS: Prior tooth extraction or endodontics had been performed in the pain-affected quadrant in 58% of cases and in the contralateral quadrant in 33%. The differences between quadrants were statistically significant. After the onset of pain, extractions were performed in the affected quadrant in 44% of patients. CONCLUSIONS: Although the appearance of pain after dental extraction could suggest a relationship between damage to the nerve supply and the development of CH, the possibility that dental extraction and endodontics may have been performed in response to CH-related pain must also be taken into account. With respect to the differential diagnosis of pain, it is easy for CH to be misdiagnosed as dental pulp pain.

Adult↗
PubMed2001

Microleakage of endodontically treated teeth restored with fiber posts and composite cores after cyclic loading: a confocal microscopic study.

STATEMENT OF PROBLEM: The effectiveness of the seal obtained with carbon fiber posts and composite cores is still unclear. Both 3-step dental adhesives and self-etching adhesive primers have been suggested as adhesive systems. PURPOSE: This confocal microscopic study evaluated the microleakage of teeth endodontically treated and restored with fiber posts and composites with 3 adhesive systems. MATERIAL AND METHODS: A total of 72 human mandibular premolars were endodontically treated and divided into 6 groups of 12 teeth each. The first 3 groups were treated with an endodontic sealer containing zinc oxide-eugenol (ZOE) and restored with temporary filling materials containing ZOE. The last 3 groups were treated with ZOE-free materials. Post spaces were prepared in the root canals. The first group treated with ZOE-based materials was restored with fiber posts cemented with zinc phosphate cement and composite cores without adhesive. The other 2 groups of ZOE-treated teeth were restored with fiber posts cemented with All Bond 2 and Panavia 21 dental adhesives, respectively. The last 3 groups were restored with fiber posts cemented with All Bond 2, Panavia 21, and Panavia Fluoro cement, respectively. The teeth were loaded intermittently at 2 cycles per second in a moist environment and, after 300,000 cycles, immersed in a solution of Rhodamine B dye for 48 hours. A confocal microscope was used to observe the teeth. The ratio between the length of the interfaces observed and the length of the dye penetration was evaluated. Two teeth from each group acted as controls and were not subjected to dynamic loads. RESULTS: All resin cement groups leaked significantly less than the group cemented with zinc phosphate cement. No statistically significant difference was found between the microleakage of teeth treated with ZOE-based and non-ZOE-based materials. Teeth restored with All Bond 2 dental adhesive leaked significantly less than those restored with Panavia cement. CONCLUSION: The 3-step dental adhesive (All Bond 2) resulted in a better marginal seal than that obtained with the self-etching primers (Panavia 21 and Panavia F). The use of endodontic sealers and temporary filling materials containing ZOE had no detrimental effect on the marginal seal of carbon fiber post/composite resin core restorations.

Adhesives↗
PubMed2003

Effects of post-core design and ferrule on fracture resistance of endodontically treated maxillary central incisors.

STATEMENT OF PROBLEM: Studies concerning the effects of post-core design and ferrule on the fracture resistance of endodontically treated teeth remain controversial. PURPOSE: The purpose of this study was to investigate in vitro the effects of post-core design and ferrule on the fracture resistance of root canal treated human maxillary central incisors restored with metal ceramic crowns. MATERIAL AND METHODS: Forty-eight extracted human maxillary central incisors were endodontically treated and divided into 4 groups of 12. The following treatments were evaluated: group A: restored with metal ceramic (porcelain fused to metal [PFM]) crowns as control; group B: 2-mm ferrule/custom cast post-core/PFM crowns; group C: no ferrule/custom cast post-core/PFM crowns; and group D: 2-mm ferrule/prefabricated post and resin core/PFM crowns. Each specimen was subjected to load (N) on the lingual surface at a 135-degree angle to the long axis with a MTS 810 material testing machine until fracture at a crosshead speed of 0.02 cm/min. One-way analysis of variance and nonparametric chi-square test were used to compare the results. A significant analysis of variance result was followed by Newman-Keuls pairwise multiple comparisons (P<.05). RESULTS: There were significant differences among the 4 groups studied (P<.01). Group B had the highest fracture strength (1793.59 +/- 387.93 N). There was no significant difference among the fracture resistances of the other 3 groups (group A: 958.49 +/- 286.02 N; group C: 992.98 +/- 291.00 N; group D: 994.94 +/- 285.04 N). CONCLUSION: Within the limitations of this study, not all of the post-core structures tested improved the strength of the endodontically treated teeth. Those prepared with a 2-mm dentin ferrule more effectively enhanced the fracture strength of custom cast post-core restored endodontically treated maxillary central incisors.

Analysis of Variance↗
PubMed2003

Endodontic variables and coronary heart disease.

This cross-sectional study was designed to explore a possible association between endodontic disease variables and coronary heart disease (CHD). Dental infections are hypothesized to be linked to atherosclerosis and could be a cause of vascular changes crucial for the development of CHD. Most studies have focused on periodontal disease. To our knowledge, no one has specifically studied endodontic variables as risk factors for the development of CHD. In 1992-93, a representative sample (n = 1056) of women in Göteborg, Sweden, aged between 38 and 84 years, took part in a combined dental and medical survey. The dependent variable was CHD, i.e. subjects with angina pectoris and/or a history of myocardial infarction (n = 106). The independent variables were number of root-filled teeth (RF), number of teeth with periapical radiolucencies (PA), tooth loss (TL), age, life situation, marital status, smoking, alcohol habits, body mass index, waist-hip ratio, serum cholesterol and triglyceride concentrations, hypertension and diabetes. The multivariate logistic regression analysis did not prove the endodontic variables to be predictive of CHD. Only age and tooth loss were significantly associated with CHD, with OR = 1.07 (CI = 1.03-1.12) and OR = 2.70 (CI = 1.49-4.87), respectively. The bivariate logistic regression analysis showed a positive significant association between subjects with RF = 2 and CHD, but for PA the bivariate analysis did not support an association with CHD. This cross-sectional study did not reveal a significant association between endodontically treated teeth and CHD nor between teeth with periapical disease and CHD.

Adult↗
PubMed2001

Wear of nickel-titanium endodontic instruments evaluated by scanning electron microscopy: effect of ion implantation.

The present work analyzes possible increases in resistance to wear of nickel-titanium endodontic instruments that have undergone a process of ionic implantation. ProFile .04 taper #25 instruments were subjected to ionic implantation with bands of nitrogen ions of 250 KeV, currents in the order of 10 microA/cm2, and doses of 2 x 10(17) ions/ cm2. The instruments were used to make preparations in acrylic endodontic training blocks. Scanning electron microscopic investigations showed that after 60 s of work inside the endodontic training blocks nonionic implanted control instruments showed small modifications in their blades, and their tips showed the first signs of wear. After 240 s the control instruments showed consistent signs of wear and frequent changes to their surfaces. After 240 s of use the ionic-implanted instruments did not present any significant changes in the micromorphology of their surfaces. The implanted instruments did not manifest the typical signs of wear and did not show the surface changes that quickly affect the working life of untreated endodontic instruments manufactured from nickel-titanium.

Dental Instruments↗
PubMed2003

Taxonomic changes of bacteria associated with endodontic infections.

There have been major recent reorganizations among bacterial taxa as a result of phylogenetic taxonomic approaches. As a consequence, old species have been renamed and novel species have been proposed. The introduction of molecular technology for microbial identification has also allowed the detection of microbial taxa never previously found in endodontic infections. Therefore, the list of putative endodontic pathogens is frequently changing and expanding. The purpose of this review is twofold: to cover the taxonomic changes that the major putative endodontic pathogens have undergone in the recent years and to compile data from studies regarding the detection of known or novel bacterial species that had been only recently reported to occur in endodontic infections.

Bacteria, Anaerobic↗
PubMed2003

Pseudoramibacter alactolyticus in primary endodontic infections.

A nested polymerase chain reaction (PCR)-based method was used to directly survey samples taken from primary endodontic infections for the occurrence of Pseudoramibacter alactolyticus. Identification by nested PCR was performed in root-canal samples from teeth associated with asymptomatic periradicular lesions or acute apical periodontitis, and in pus samples from acute periradicular abscesses. DNA was extracted from the samples and initially amplified using universal 16S rDNA primers. A second round of amplification used the first PCR products to detect a specific fragment of P. alactolyticus 16S rDNA. P. alactolyticus was detected in 76% of root-canal samples from teeth showing asymptomatic periradicular lesions, in 60% of samples taken from root canals associated with acute apical periodontitis, and in 32% of pus samples aspirated from acute periradicular abscesses. No significant association of this species with clinical symptoms was observed (p > 0.01). In general, P. alactolyticus occurred in 56% of samples taken from infections of endodontic origin. The high prevalence of P. alactolyticus in infections of endodontic origin as detected by nested PCR in this study, and its apparent pathogenicity, particularly in mixed infections, indicate that this bacterial species is a candidate endodontic pathogen that can participate in the etiology of different forms of periradicular diseases.

Adolescent↗
PubMed2004

The outcome of endodontic retreatment: a 2-yr follow-up.

Retreatment is common in endodontics. The purpose of this article was to classify the different clinical situations encountered in retreatment cases and relate them to the outcome after an observation period of 24 months. A total of 425 patients (452 teeth) from 451 patients, consecutively admitted for root-canal retreatment, were monitored during a 24-month period. All teeth (254 molars, 107 premolars, and 91 single-root anterior teeth) were divided into two major categories: teeth with modified anatomy from previous endodontic treatment (root-canal-morphology altered) and teeth in which no significant anatomical changes were made by the former endodontic treatment (root-canal-morphology respected). Although the overall success was 69.03%, the success in the root-canal-morphology-respected group was 86.8% and in the root-canal-morphology-altered group 47% (Mann-Whitney U test p < 0.0001). The clinical success of an endodontic retreatment seems to depend on whether alterations in the natural course of the root canals were caused by previous root-canal treatment.

Adolescent↗
PubMed2004

Nonsurgical endodontic treatment of dens invaginatus with large periradicular lesion: a case report.

The endodontic treatment of teeth with severe Type 3 dens invaginatus, characterized by an infolding of enamel and dentin, extending deep into the pulp cavity near the root apex, may be complicated and challenging. Because of the bizarre root canal anatomy and widely open apex, a combination of nonsurgical and surgical endodontic treatment or extraction is the most common choice of therapy. This article describes a nonsurgical endodontic treatment of a tooth with severe Type 3 dens invaginatus and an associated large periradicular lesion. After complete removal of the invaginated central mass of hard tissue and long-term calcium hydroxide treatment, nonsurgical endodontic treatment was performed. Complete healing of the periradicular lesion was observed at 25-month and 74-month follow-up examinations.

Adult↗
PubMed2004

Simultaneous detection of Dialister pneumosintes and Filifactor alocis in endodontic infections by 16S rDNA-directed multiplex PCR.

Dialister pneumosintes and Filifactor alocis have been recently considered as candidate endodontic pathogens. In this study, we devised a 16S rDNA-directed multiplex PCR protocol for simultaneous detection of these two bacterial species in endodontic infections. Samples were taken from infected root canals associated with asymptomatic periradicular lesions as well as from cases of acute periradicular abscesses. DNA extracted from the samples was used as template for simultaneous detection of D. pneumosintes and F. alocis through a multiplex PCR assay. Two fragments of the expected sizes, one specific for D. pneumosintes and the other for F. alocis, were simultaneously amplified from a mixture of reference genomic DNA containing DNA from both species. Clinical samples that were positive for the target species showed a single band of the predicted size for each species. D. pneumosintes was detected by multiplex PCR in 11 samples (7 asymptomatic and 4 abscesses) and F. alocis was identified in 9 cases (6 asymptomatic and 3 abscesses). Six samples (3 asymptomatic and 3 abscesses) shared the two species. Data from the present study confirmed that D. pneumosintes and F. alocis are common members of the microbiota present in primary endodontic infections and thereby may participate in the pathogenesis of periradicular lesions. The proposed multiplex PCR assay is a simple, rapid, and accurate method for the simultaneous detection of these two candidate endodontic pathogens.

Adult↗
PubMed2005

Soft tissue management in endodontic surgery.

Modern endodontic surgery involves both root-end preparation and proper sealing of all apical portals of exit. Both components are requirements for mechanical and biological success, but the management of soft tissues becomes increasingly important for an esthetically successful treatment. A healthy appearance of soft tissues plays an important role in the esthetic outcome of periradicular surgery. This is true considering maintenance of attachment levels and regarding the amount of possible recession after surgical procedures. Complete, recession-free and predictable healing of gingival tissue is one important goal of endodontic surgical treatment. A critical review of currently used techniques based on clinical and scientific data reveals great potential for improvements. Possible reasons for scar formation and recession specifically in healthy periodontal conditions requiring surgical endodontic intervention are highlighted. Based on anatomical considerations various incision types are evaluated and recommendations made. Clear understanding of wound closure and tissue-healing patterns call for the use of atraumatic procedures, nonirritating suture materials and adequate suturing techniques. This article gives an overview and guidance for integrating current and new successful flap designs and wound closure methods. The methods described have the intention of maintaining the attachment level and avoiding postoperative recession after surgical endodontic therapy.

Apicoectomy↗
PubMed2005

Application of denaturing gradient gel electrophoresis (DGGE) to the analysis of endodontic infections.

The recent expanding use of cultivation-independent techniques for bacterial identification is reliant on the lack of knowledge of the conditions under which most bacteria are growing in their natural habitat and the difficulty to develop culture media that accurately reproduce these conditions. A molecular method that has been recently used in several areas to examine the bacterial diversity living in diverse environments is the denaturing gradient gel electrophoresis (DGGE). In DGGE, polymerase chain reaction (PCR)-generated DNA fragments of the same length but with different base-pair sequences can be separated. Separation is based on electrophorectic mobility of a partially melted double-strand DNA molecule in polyacrylamide gels, which is decreased when compared with that of the completely helical form of the molecule. Molecules with different sequences may have a different melting behavior and will therefore stop migrating at different positions in the gel. Application of the PCR-DGGE method in endodontic research has revealed that there are significant differences in the predominant bacterial composition between asymptomatic and symptomatic cases. This suggests that the structure of the bacterial community can play a role in the development of symptoms. In addition, new bacterial phylotypes have been disclosed in primary endodontic infections. PCR-DGGE has also confirmed that intra-radicular infections are a common finding in root-filled teeth associated with persistent periradicular lesions. The microbiota in failed cases significantly vary from teeth to teeth, with a mean number of species far higher than previously shown by culturing approaches. Application of the PCR-DGGE technique in endodontic microbiology research has the potential to shed light on several aspects of the different types of endodontic infection as well as on the effects of treatment procedures with regard to infection control.

Bacteria↗
PubMed2004

The use of glass ionomer cements in both conventional and surgical endodontics.

The capacity to bond to dental tissues, especially to dentine, their long-term fluoride release and their biocompatibility make glass ionomer cements (GICs) advantageous for use in endodontics, as well as in restorative dentistry. This review provides information on the basic properties of GICs, such as adhesion, antimicrobial effects and biocompatibility, particularly as they relate to use in endodontics. Indications for the use of GICs in endodontics are orthograde root canal sealing, root-end filling, repair of perforations and root resorption defects, treatment of vertical fractures and maintenance of the coronal seal. The paper includes a review on each of these indications. It is concluded that in spite of the critical handling characteristics and the inconclusive findings regarding sealing ability and antimicrobial activity, there is substantial evidence to confirm their satisfactory clinical performance. Both soft tissue and bone compatibility make them suitable for use during endodontic surgery.

Anti-Infective Agents, Local↗
PubMed1993

Endodontic leakage studies reconsidered. Part II. Statistical aspects.

The aim of many endodontic studies is to compare two or more treatment methods, techniques or materials, for example, to detect differences in mean leakage scores. As it is not feasible to study large populations, samples are taken. The important question then arises as to how large the sample sizes have to be in order to establish the 'true' (= populations') mean scores. First, it must be determined which magnitude of the difference (= v) between the mean scores is of endodontic interest. Based upon v and a few related statistical parameters, one may calculate how large the samples must be in order that a statistical test yields a significant result for a difference that is of endodontic importance. In other words, the 'power' of a test, depending on the sample size among other factors, must be large enough to detect the 'true' a priori determined difference between the populations. The use of small sample sizes may imply that a rather large difference between two mean leakage scores is not found to be significant, thereby leading to incorrect conclusions. This article describes the power and the statistical related factors that determine the adequate size of samples. Examples of power calculation are presented. Next, the power of publicized endodontic leakage studies was evaluated. Almost two-thirds of the sample sizes were 10 or less, and about 90% were 20 or less. Less than one-half of the tests had an adequate power (conventionally > or = 0.80). It is necessary to be cautious when extrapolating the results of such studies, because of the limited power of the statistical tests. The power may be increased by using larger sample sizes or, alternatively, by enlarging the 'effect size', by either taking an interest in a larger difference between the mean scores, or by minimizing the variability of the data.

Analysis of Variance↗
PubMed1995

Endodontically treated teeth and periapical findings in the elderly.

The radiographic quality of root-canal fillings, the prevalence of periapical findings and their associations with gender and age were investigated in 133 dentate old people living at home (45 males and 88 females, aged 76, 81, and 86 years and who had endodontically treated teeth or periapical lesions. Sixteen per cent of the endodontically treated teeth (n=507) exhibited periapical lesions, compared with 4% for the teeth not endodontically treated (P<0.0001) (chi-square test). Lesions were least prevalent in association with radiographically adequate root canal fillings (10%), and most prevalent in teeth with root canal post perforation (100%). Overfilled root canals and multi-rooted teeth with one or more unfilled roots also showed a high percentage of lesions (19% and 22%, respectively). Men had more periapical lesions than women in endodontically treated teeth (P<0.001, Mann-Whitney U-test), a finding contrary to previous studies in younger subjects. There were no other statistically significant differences between the sexes or age groups, although the percentage of root-filled teeth increased with age.

Age Factors↗