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PubMed1995

Long-term evaluation of endodontic and periodontal treatment.

One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodontal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive supportive periodontal treatment.

Adult↗
PubMed2005

Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing.

AIMS: To (i) determine the prevalence of persistent dento-alveolar pain following nonsurgical and/or surgical endodontic treatment conducted in a teaching dental hospital and (ii) identify the risk factors associated with persistent pain after apparently successful root canal treatment. STUDY DESIGN: A total of 175 patients/teeth were reviewed 12-59 months following treatment. The patients were examined clinically and radiographically and a detailed pain history obtained. Multiple logistic regression analysis was used to investigate the association between potential risk factors and persistent pain after successful endodontic treatment. RESULTS: The prevalence of persistent pain after successful root canal treatment was 12% (21/175). Treatment success was determined by the absence of clinical and radiographic signs of dental disease. The factors that were significantly (P < 0.05) associated with persistent pain following endodontic treatment were: 'duration of preoperative pain' [odds ratio (OR) = 8.6], 'preoperative pain from the tooth' (OR = 7.8), 'preoperative tenderness to percussion' (OR = 7.8), 'previous chronic pain problems' (OR = 4.5), 'gender' (OR = 4.5) and 'history of painful treatment in the orofacial region' (OR = 3.8). 'Type of treatment received (surgical or nonsurgical treatment)' showed borderline significance at the 10% level. CONCLUSIONS: The presence and duration of preoperative pain from the tooth site, lasting at least 3 months, a positive history of previous chronic pain experience or painful treatment in the orofacial region, and female gender were important risk factors associated with persistent pain after successful endodontic treatment.

Adolescent↗
PubMed1993

In vitro antimicrobial susceptibility to combinations of drugs on bacteria from carious and endodontic lesions of human deciduous teeth.

The purpose of this study was to clarify the antibacterial efficacy of mixed antibacterial drugs on bacteria of carious and endodontic lesions of human deciduous teeth in vitro. The antibacterial drugs used in this study were mixtures of ciprofloxacin, metronidazole, plus a third antibiotic: amoxicillin, cefaclor, cefroxadine, fosfomycin or rokitamycin. Samples taken from carious dentin (17 cases) and infected pulpal tissues (14 cases) were cultured on control plates and plates containing the mixed drugs. No bacteria were recovered in the presence of any combination of the mixture of the drugs (100 micrograms each/ml), and the bacterial growth occurred on control plates (10(1) to 10(7) colony-forming units), indicating that the mixed drugs inhibit the growth of bacteria in the samples. When carious and endodontic lesions on split surfaces of freshly extracted teeth were covered overnight with alpha-tricalcium phosphate cement containing a mixture of ciprofloxacin, metronidazole and cefaclor (1% each; 5 cases), no bacteria were recovered from the lesions. No bacteria were recovered from carious and endodontic lesions when these lesions were immersed in a solution of the mixture (200 micrograms each/ml; 5 cases). These findings indicate that carious and endodontic lesions can be sterilized by the mixed drugs in situ.

Amoxicillin↗
PubMed2005

Occurrence of two newly named oral treponemes - Treponema parvum and Treponema putidum - in primary endodontic infections.

BACKGROUND/AIMS: Recent evidence from molecular genetic studies has revealed that oral Treponema species are involved in infections of endodontic origin. This study assessed the occurrence of two newly named oral treponemes - Treponema parvum and Treponema putidum - in primary endodontic infections using a culture-independent identification technique. METHODS: Genomic DNA was isolated directly from clinical samples, and a 16S rRNA gene-based nested polymerase chain reaction (PCR) assay was used to determine the presence of T. parvum and T. putidum. Species-specific primer pairs were developed by aligning closely related 16S rRNA gene sequences. The specificity for each primer pair was validated by running PCR against a panel of oral bacteria and by sequence analysis of PCR products from positive clinical samples. RESULTS: T. parvum was detected in 52% of the root canals associated with chronic apical periodontitis, in 20% of the cases diagnosed as acute apical periodontitis, and in no abscessed case. In general, T. parvum was detected in 26% of the samples from primary endodontic infections. T. putidum was found in only one case of acute apical periodontitis (2% of the total number of cases investigated). CONCLUSIONS: The devised nested PCR protocol was able to identify both T. parvum and T. putidum directly in clinical samples and demonstrated that these two treponemes can take part in endodontic infections.

DNA, Bacterial↗
PubMed1995

The influence of endodontic infection on progression of marginal bone loss in periodontitis.

The purpose of the present investigation was to determine magnitude and rate of proximal radiographic attachment loss in relation to endodontic infection in periodontally involved teeth. The investigation was conducted as a retrospective longitudinal study on a periodontitis-prone randomly selected referral population, including 175 single-rooted, root-filled teeth in 133 patients. An observation period of at least 3 years was required. Periapical conditions of the selected sample at baseline and re-examination were evaluated on radiographs, independently by 3 investigators. Each single-rooted, root-filled tooth of the sample was given a score according to the combined registrations. Radiographic attachment level was measured as the distance between the most coronal point of the alveolar bone and the apex at the mesial and distal sides of the tooth, and expressed as relative radiographic attachment level (RRAL) (radiographic attachment level at baseline/root length) at proximal sites for every tooth. Multiple regression analysis was used to study change in RRAL over time. Teeth in periodontitis-prone patients with progressing periapical pathology indicating a continuous root canal infection were found to lose comparatively more radiographic attachment than teeth with no signs of periapical pathology or teeth with an established periapical destruction which subsided during the observation period. An approximate 3-fold amplification of the rate of marginal proximal radiographic bone loss by endodontic infection in periodontitis-prone patients was found with an average 0.19 mm/year, while 0.06 mm/year was lost for teeth without endodontic infection or subsiding endodontic involvement.

Adult↗
PubMed2005

Effect of endodontic irrigation on bonding of resin cement to radicular dentin.

The influence of endodontic irrigation on shear bond strengths of resin cement to radicular dentin was investigated. Human radicular dentin blocks were divided into four groups and subjected to one of four endodontic irrigations: ethylenediaminetetraacetic acid (EDTA) group, 17% EDTA for 60 s; EDTA/sodium hypochlorite (NaOCl) group, 17% EDTA for 60 s followed by 10 ml of 5% NaOCl for 15 s; NaOCl group, 10 ml of 5% NaOCl for 15 s; and control group, no treatment. Morphological changes of dentin surface after endodontic irrigation were observed by scanning electron microscopy (SEM). A resin block was bonded to the radicular dentin after irrigation using resin cement with either wet-bonding (Uni-Etch/One-Step; Bisco) or self-etching (Tyrian SPE/One-Step Plus; Bisco) adhesives. Shear bond strengths were measured and the penetration of resin tags into dentinal tubules at resin-dentin interface was observed by SEM. With the wet-bonding system, the shear bond strengths for the EDTA/NaOCl group, in which dentinal tubules openings and uniform resin tag penetration into dentinal tubules were observed, were significantly higher than the EDTA and control groups. With the self-etching system, the shear bond strengths were significantly lower in the EDTA group compared with the NaOCl and control groups. The effects of endodontic irrigation on the bonding of resin cement to radicular dentin depended on the dentin bonding system used.

Acid Etching, Dental↗
PubMed1989

Endodontic status and suggested treatment in a population requiring substantial dental care.

The purpose of this study was to analyse endodontic status and treatment suggested for Swedish citizens requiring substantial dental care. According to the Swedish dental insurance system, treatment plans including radiographs have to be submitted for approval if the estimated cost of treatment exceeds a certain level (USD 500 in 1977). A sample of 1094 treatment plans received during 1977 and 1978 was randomly selected. In the radiographs the number of remaining teeth was recorded, periapical condition was evaluated and the quantity and quality of previous endodontic treatment were estimated. In addition, treatment plans concerning the teeth with periapical lesions were studied. The results indicated that patients analysed in this study that needed expensive treatment had more missing teeth, more root-filled teeth and more teeth with periapical lesions than what has been reported in previous studies of samples supposed to accurately represent the Swedish population. However, the technical quality of the root fillings and the frequency of periapical lesions in root-filled teeth were the same as in previous studies, with high frequencies of inadequate root fillings and related unfavourable responses. Thus the patients in this study retained a significant need for endodontic treatment despite having already received a great deal of endodontic care. Further, it was found that nearly half of the observed periapical lesions would not be treated based on the submitted plans.

Adolescent↗
PubMed1990

Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population.

A random sample of 967 subjects selected from the total population in a Swedish county were examined radiographically regarding prevalence and quality of endodontic treatment and occurrence of periapical lesions. The relationship between the technical standard of endodontic treatment and the occurrence of periapical lesions was also analyzed. Of the selected individuals, 95% attended examination (751 dentate and 169 edentulous individuals). Of the 17,430 teeth examined, 1,492 (8.6%) were endodontically treated. Approximately 70% of the treated root canals were inadequately obturated; 10% showed excess of root filling beyond the apex. The prevalence of periapical lesions was 2.9%, and 24.5% of the endodontically treated roots demonstrated periapical lesions. Root fillings ending more than 2 mm from apex had a significantly lower frequency of periapical lesions than root fillings ending within 2 mm of the apex. No difference in the frequency of periapical lesions was found between properly and improperly obturated root canals. Excess of root filling material beyond the apex was related to a significantly higher frequency of periapical lesions.

Adult↗
PubMed1994

Testing of sealing ability of endodontic filling materials.

Incomplete obturation of the root canal system is the major cause of endodontic failure. Endodontic filling materials with ability to seal the root canal are, therefore, essential for successful endodontic therapy. However, assessment of sealing ability is not included in the requirements specified in the current international standard covering root canal sealers. A number of different in vitro methods have been used to evaluate the sealing quality of endodontic filling materials. The tests have usually been leakage tests, i.e. based on assessment of penetration of a tracer along the obturated root canal. Leakage tests have poor reproducibility and are, therefore, not suited for standardized test programs. By selecting the properties necessary for sealing ability and testing them separately, it might be possible to find a number of tests, which individually are suitable for a standardized test program, and which combined will give information on the sealing ability of the test material.

Animals↗
PubMed2004

Federal University of Santa Catarina endodontic treatment of traumatized primary teeth - part 2.

This research sought to evaluate periapical repair in 28 traumatized deciduous teeth that had suffered endodontic intervention due to the presence of internal or external inflammatory resorption or replacement root resorption. After obtaining endodontic access, work length and biomechanical preparation, the root canals were filled with calcium hydroxide and propylene glycol under the form of a dense slurry, during 12 months. Replacement of the intracanal dressing was performed when monthly radiographic examinations showed its absence. After 12 months the teeth were obturated with zinc oxide and eugenol cement. Halting of the inflammatory and replacement root resorption (64.3%; n = 28) occurred 9 months after the use of calcium hydroxide dressings, in a total of 18 successful cases. Fisher's test was applied to relate success with the type of trauma, work length time, child's age and pulpal condition. The test did not present statistical significance (P < 0.05). However, in the qualitative analysis, failure was observed in those cases (35.7%) where replacement resorption was already present at the moment of treatment (up to two-thirds) associated with severe trauma cases. The authors concluded that endodontic treatment must be initiated at an early stage, and must be coincident with the radiographic signs of resorption. Success of the treatment is directly related to the seriousness of the sequelae at the moment of the first examination or the endodontic treatment.

Child, Preschool↗
PubMed2004

Endodontic considerations in the elderly.

Tooth retention has increased significantly in older adults, and dentists are now challenged by the need to preserve critical teeth. There will be a need to consider endodontic therapy, and this paper describes how successful endodontics can be provided for elderly patients. Strategic treatment planning is essential, and preservation of key teeth will facilitate satisfactory oral function for elderly patients. These teeth may be important in achieving and maintaining an intact anterior dental arch, for removable partial denture retention or preservation of alveolar bone. In some cases, this can only be achieved if endodontic procedures are undertaken. When infection of a root canal is present, there is no reason why good quality endodontic therapy should not work in a healthy elderly patient. Elimination of infection can be challenging in narrow root canals, and a systematic approach for improving access into and negotiating these canals is outlined.

Age Factors↗
PubMed2005

What we leave behind in root canals after endodontic treatment: some issues and concerns.

The benefits of using sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) as endodontic irrigants, and calcium hydroxide as an inter-appointment medicament, are well known to dentists. Many steps undertaken during endodontic treatment and retreatment are rather mechanical in nature, and less attention is committed to understanding the biological issues underlying endodontic treatment and retreatment. It should be noted that dentine is the fundamental substrate in endodontic treatment, and its properties and characteristics are the key determinant of nearly all disease and post-disease processes in the teeth. In this article the effects and counter-effects of NaOCl and EDTA on root canal dentine, and some other related issues are reviewed. This information will enable clinicians to use the beneficial effects of these chemicals, while necessary steps are considered to reduce their harmful effects on dentine substrate.

Dental Pulp Cavity↗
PubMed2006

Radiographic and rheological properties of a new endodontic sealer.

A new dual-cured resin sealer has recently been proposed as an innovative endodontic filling material. Being a new endodontic material, no in vitro research has been published yet on Real Seal's (RS) physical properties. Therefore, the aim of the present study was to evaluate and compare radiopacity and rheological properties of the RS sealer with those of currently available endodontic sealers (Roeko Seal Automix and Bioseal). All tests strictly followed American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 57, which indicates test methods and establishes minimal requirements of flow, film thickness and radiopacity of endodontic sealers. Results showed that significant differences were found among sealers in the different test methods. However, RS showed values complying with ANSI/ADA specification No. 57 requirements in all tests. Hence, the new RS sealer exhibited radiographic and rheological properties suitable for clinical use.

Absorptiometry, Photon↗
PubMed2004

A cleaning protocol for rotary nickel-titanium endodontic instruments.

BACKGROUND: The cleaning of endodontic and all dental instruments prior to sterilization is a prerequisite for their processing for re-use. This study aimed to develop a clinically practical cleaning protocol for rotary nickel-titanium (NiTi) endodontic files prior to sterilization. METHODS: Cleaning experiments were conducted on six different types of files that had been used on human teeth. The experiments involved three components of mechanical and chemical removal of root canal debris from the files: the use of sponges soaked with chlorhexidine to remove gross debris, pre-soaking, and ultrasonication. After cleaning, the files were immersed in Van Gieson's solution and examined under magnification for stained debris. New unused files were also examined. RESULTS: Macroscopically, there were no instances of visible debris and all files appeared clean after all cleaning sequences. Microscopically, new files showed both stained and unstained debris, and several experimental cleaning regimens produced files that were free of stained debris. Combining elements of the most effective cleaning sequences resulted in a cleaning protocol that predictably produced clean files. CONCLUSIONS: The results do not support the recommendation for the single use of endodontic files based on inability to clean files between uses. Under experimental conditions the cleaning protocol developed rendered rotary NiTi files 100 per cent free of stained debris. The protocol comprises 10 vigorous strokes in a scouring sponge soaked in 0.2 per cent chlorhexidine solution, a 30 minute pre-soak in an enzymatic cleaning solution, 15 minutes ultrasonication in the same solution, and a 20 second rinse in running tap water. The protocol can be applied to all endodontic files.

Chlorhexidine↗
PubMed2000

Endodontic patient profile of Hacettepe University, Faculty of Dentistry in Ankara, Turkey.

AIM: To assess previous patient experience of endodontic treatment and to quantify their satisfaction with the endodontic treatment provided in a dental school clinic. DESIGN: Self-completed questionnaire. SETTING: Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey. PARTICIPANTS: 200 randomly selected, scheduled non-emergency patients in good health and older than 11 years who were to be treated by undergraduate, graduate students and academics. MAIN OUTCOME MEASURES: Patient satisfaction and attitudes to root canal therapy. RESULTS: 96 per cent of patients, regardless their level of education, age and sex, reported that they expected RCT would save their teeth. 15 per cent of the patients were in favour of extraction versus RCT before the therapy, but this reduced to only 2.5 per cent post treatment. 82 per cent of patients reported that they were satisfied with their treatment and the clinic. CONCLUSIONS: Increasing public knowledge of and interest in endodontic treatment indicates that the need for an increase in teaching of the subject and associated resources will be required.

Adolescent↗
PubMed2005

A pilot study of treatment of periodontal-endodontic lesions.

OBJECTIVE: A pilot study to evaluate a standardised treatment protocol for combined periodontal-endodontic lesions (involving staged endodontic and periodontal treatment). PARTICIPANTS: Nine patients with a diagnosis of a combined periodontal-endodontic lesion. METHODS: At baseline, root canal treatment (RCT) was performed by a standard protocol, and simple scaling/oral hygiene instruction provided. After one month, a standardised episode of non-surgical periodontal treatment was undertaken to address residual pocketing. Clinical measurements, including probing depths, attachment levels and bleeding on probing were recorded at baseline, month one and month three. Long-cone periapical radiographs taken using standardised projection geometry at baseline and month three were analysed for bone changes using digital subtraction radiography (DSR). RESULTS: During the study, one patient's affected tooth was extracted. From baseline to month three, there were statistically significant mean probing depth reductions (delta= 0.95mm, 95% CI= 0.20mm, 1.70mm; p= 0.02), mean attachment gains (delta= 1.13mm, 95% CI= 0.29mm, 1.96mm; p= 0.02) and reduction in mean bleeding on probing (delta= 29%, 95% CI= 10%, 49%; p= 0.01). DSR analysis revealed that between month 0 and month three, four teeth demonstrated bone gain, two teeth exhibited bone loss and two teeth showed no change. The mean bone change was in favour of bone gain but failed to achieve statistical significance (p>0.05). CONCLUSIONS: Within the limitations of this pilot study, treatment of periodontal-endodontic lesions by performing RCT prior to periodontal treatment was effective, resulting in improvements in clinical parameters together with alveolar bone gains in a majority of teeth.

Alveolar Bone Loss↗
PubMed2001

Molecular identification of microorganisms from endodontic infections.

A relatively wide range of bacteria have been isolated from root canals using standard culture techniques. However, only 50% of the bacteria in the oral cavity are cultivable (S. S. Socransky et al., Arch. Oral Biol. 8:278-280, 1963); hence, bacterial diversity in endodontic infections is underestimated. This study used a PCR-based 16S rRNA gene assay, followed by cloning and sequencing of 16S rRNA amplicons from a small subset of samples to assess the diversity of bacteria present in infected root canals. A total of 41 clinical samples from 15 de novo and 26 refractory cases of endodontic infections were assessed. Of these samples, 44% were positive by culture and 68% were positive by PCR. Eight samples were selected for further analysis. Of these, the two de novo cases yielded sequences related to those of the genera Enterococcus, Lactobacillus, Propionibacterium, and Streptococcus and two clones were related to previously uncultivated bacteria, while the sinus-associated, de novo case yielded sequences related to those of the genera Lactobacillus, Pantoea, Prevotella, and Selenomonas. The five refractory cases produced clones which were related to the genera Capnocytophaga, Cytophaga, Dialister, Eubacterium, Fusobacterium, Gemella, Mogibacterium, Peptostreptococcus, Prevotella, Propionibacterium, Selenomonas, Solobacterium, Streptococcus, and Veillonella and two clones representing previously uncultivated bacteria. The phylogenetic positions of several clones associated with the Clostridiaceae and Sporomusa subgroups of the Firmicutes grouping are also shown. This study demonstrates that molecular techniques can detect the presence of bacteria in endodontic infections when culture techniques yield a negative result and can be used to identify a wider range of endodontic-infection-related bacteria including the presence of previously unidentified or unculturable bacteria.

Bacteria↗
PubMed2006

Lesions of endodontic origin and risk of coronary heart disease.

A paucity of epidemiologic research exists regarding systemic health consequences of endodontic disease. This study evaluated whether incident radiographically evident lesions of endodontic origin were related to development of coronary heart disease (CHD) among 708 male participants in the VA Dental Longitudinal Study. At baseline and every three years for up to 32 years, participants (who were not VA patients) received complete medical and dental examinations, including full-mouth radiographs. Cox regression models estimated the relationship between incident lesions of endodontic origin and time to CHD diagnosis. Among those < or = 40 years old, incident lesions of endodontic origin were significantly associated with time to CHD diagnosis (p < 0.05), after adjustment for covariates of interest, with hazard ratios decreasing as age increased. Among those > 40 years old, no statistically significant association was observed. These findings are consistent with research that suggests relationships between chronic periodontal inflammation and the development of CHD, especially among younger men.

Adult↗