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PubMed2003

A retrospective radiographic study of root-end surgery with amalgam and intermediate restorative material.

OBJECTIVE: We sought to compare amalgam with intermediate restorative material in terms of their effectiveness as root-end filling materials during root-end surgeries. STUDY DESIGN: A root-end operation was performed on 228 patients with 262 endodontically treated teeth with periapical lesions. Of these teeth, 122 from 101 patients were available for follow-up. Radiographs were taken immediately postoperatively and again at a mean of 11.25 months (range, 6-45 months) postoperatively. The radiographs were digitized, and the diameter of the periapical lesion was measured by means of a computerized system. The mesiodistal distance at the cementoenamel junction served as an internal standard. Radiographic findings were classified into 1 of 3 groups: complete healing, incomplete healing, or unsatisfactory (no) healing. RESULTS: Complete healing was observed in 44.3% of the teeth, incomplete healing in 21.3%, and unsatisfactory healing in 34.4%. No statistical significance was found for amalgam versus intermediate restorative material, but teeth that underwent additional operations had a significantly worse success rate than those that underwent only first-time operations. No correlation was found between the subjective prognosis by the surgeons and the long-term outcome. CONCLUSION: As root-end filling materials, amalgam and intermediate restorative material had the same clinical effectiveness. The classic root-end operation is unpredictable. Reoperations should be reconsidered and avoided if possible.

Adolescent↗
PubMed2004

Influence of the thickness of mineral trioxide aggregate on sealing ability of root-end fillings in vitro.

The purpose of this study was to compare the ability of different thicknesses of mineral trioxide aggregate (MTA) to prevent apical leakage through the use of a protein-dye complex with Coomassie Brilliant Blue G. Sixty-four teeth were divided into 4 groups, then filled with MTA to depths of 1, 2, 3, or 4 mm. Two teeth served as the positive controls. Another 2 teeth served as the negative controls. Root-filled teeth were mounted in an apparatus and then challenged with protein solution. The evaluation was conduced at 24-hour intervals for 60 days. The 1-mm-thick MTA was the least effective in preventing apical leakage (P <.05). No significance difference was found between 2- and 3-mm-thick MTA (P >.05). Four-millimeter-thick MTA was significantly more effective than the other thicknesses tested (P <.05). The results of this study suggest that the thickness of 4 mm is most adequate for the use of MTA as a root-end filling material.

Aluminum Compounds↗
PubMed1995

Long-term results of amalgam versus glass ionomer cement as apical sealant after apicectomy.

A total of 67 teeth in 64 patients were treated with apicectomy and retrograde fillings. They were randomized to receive fillings of amalgam or glass ionomer cement in a comparative clinical study. Healing was evaluated clinically and radiographically after 1 and 5 years. Evaluation showed no difference in healing capacity between the two materials. Overall success rates in both groups were registered as 90% at 1 year and 85% at 5 years. Contamination with blood or saliva during insertion of the filling material did not affect healing adversely. The study shows that the 5-year follow-up result can be predicted in more than 95% of the cases at the 1-year follow-up. It can be concluded that glass ionomer cement is a valid alternative to amalgam as an apical sealant after apicectomy with equally good long-term clinical results.

Aluminum Silicates↗
PubMed1996

Radiopacity of potential root-end filling materials.

OBJECTIVES: In recent years various root-end filling materials have been suggested for clinical use. The purpose of this study was to assess the radiopacity of some potential materials according to ISO specification 6876. STUDY DESIGN: Radiographs were taken of 1-mm thick specimens of eight materials (amalgam, Kalzinol, IRM, Super EBA, Vitrebond, Fuji II LC, Chemfil, gutta-percha); light transmission was assessed densitometrically and related to equivalent thickness of aluminum. RESULTS: Commercial glass ionomer cements (Vitrebond, Fuji II LC, Chemfil) had radiopacities below the international standard for root canal sealers (< 3-mm aluminum); three zinc oxide-eugenol cements (Kalzinol, Super EBA, IRM) had radiopacities equivalent to 5 to 8 mm aluminum; and gutta-percha had a radiopacity equivalent to 6.1-mm aluminum. CONCLUSIONS: We recommend that root-end filling materials should have a radiopacity greater than that for root canal sealers.

Absorptiometry, Photon↗
PubMed1996

Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment.

OBJECTIVES: This prospective randomized study compared the outcome of retreatment and surgical intervention in root canal treated teeth with nonhealing periradicular pathosis. STUDY DESIGN: One such tooth from each of 38 patients was randomly allotted to retreatment or root-end resection and root-end filling. Treatment outcome after 1 year was evaluated and compared clinically and radiographically. RESULTS: The success rate for surgery was higher than for conventional retreatment, but the difference was not statistically significant. CONCLUSIONS: For management of nonhealing periradicular pathosis associated with root canal treated teeth, surgical intervention should be considered as an alternative to retreatment. In cases with a similar prognosis for both modes of treatment, the choice should be governed by consideration of intrinsic and extrinsic factors.

Adult↗
PubMed1996

Transantral endodontic surgery.

A case is presented in which periradicular maxillary molar surgery was performed with the transantral approach. Included is a discussion of the related anatomy, physiology, and pathology of the maxillary sinus.

Adult↗
PubMed1996

Healing of apical periodontitis in dogs after apicoectomy and retrofilling with various filling materials.

OBJECTIVE: To histologically assess the efficacy of various retrofilling materials in apical surgery. STUDY DESIGN: The pulps of mandibular premolars in seven beagle dogs were infected; this resulted in periapical lesions. Apical surgery was performed without disinfection of the root canals. Super EBA (Harry J. Bosworth Co., Skokie, III.), two formulations of glass ionomer cement, amalgam with varnish, IRM,(Caulk Co., Ltd., Densply International, Milford, Del.) and a light-cured composite resin were the retrofilling materials used. Roots infected and apicoectomized without retrofilling were positive controls. After 6 months the dogs were killed. The experimental roots and surrounding apical tissues were prepared and histologically examined and relative percentages of bone and inflammation were calculated. RESULTS: Super EBA was consistently the best. In overall periapical condition, Super EBA was statistically superior to all materials except IRM. IRM was superior to the glass ionomer cements but not the other materials. As to percentage of bone, Super EBA was the best overall; it was superior to glass ionomer, composite resin, and the positive control but not different from amalgam or IRM. When comparing remaining numbers of inflammatory cells, Super EBA was superior with the lowest number of inflammatory cells present. CONCLUSION: Although not statistically different from IRM, Super EBA was consistently the best retrofilling material tested when compared with all retrofilling materials studied.

Alveolar Process↗
PubMed1997

Relationship between apical and marginal healing in periradicular surgery.

OBJECTIVE: The purpose of the present study was to evaluate the relationship between apical and marginal periodontal healing after periapical surgery. STUDY DESIGN: The investigation was conducted on 59 patients referred for periradicular surgery. A radiographic examination as well as assessments of periodontal attachment and pocket depth of teeth undergoing surgery and control teeth were performed at the time of surgery and 1 year after surgery. The radiographic periapical healing pattern was evaluated. RESULTS: After an observation time of 1 year, 85% of the healing patterns were classified as successful or uncertain. Teeth within the surgical area showed a significant loss of clinical attachment during the observation period. The mean clinical attachment loss in teeth with an unsuccessful healing was 0.85 mm and differed significantly from successfully healed cases (mean, 0.15 mm). CONCLUSIONS: A persisting endodontic infection may be regarded as a contributing risk factor for a progressing marginal attachment loss.

Adult↗
PubMed1997

Surgical treatment of a lateroradicular lesion on an invaginated lateral incisor (dens in dente).

The complex anatomy of invaginated teeth makes their endodontic treatment difficult. The case described here reports the successful management of an invaginated tooth presenting with a lateroradicular lesion. After the root was surgically exposed and the radicular defect was cleaned, gutta percha was sealed with a zinc oxide eugenol cement, heat-compacted under 5 degrees, and then cold-burnished. The osseous cavity was filled with Biocorail. Radiographs at 1 month and 5 years show periapical healing with osseous formation. This procedure, resulting in minimal loss of hard tissues, permitted retention of the tooth.

Adult↗
PubMed1999

Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars.

OBJECTIVE: This report describes 6 cases that demonstrate persistent periapical radiolucent lesions after conventional root canal treatment. STUDY DESIGN: Six teeth that had conventional root canal treatment or re-treatment with nonresolving periapical radiolucencies underwent periapical surgery. Biopsies were obtained and analyzed descriptively by correlative light and transmission electron microscopy for general features and microbial findings. RESULTS: Three findings were identified: periapical lesions with persisting infection in the apical root canal system (2 cases); a cyst (1 case); and periapical healing by scar tissue formation (2 cases). CONCLUSIONS: These results confirm previous observations that associated factors in the failure of endodontic treatment include persistent intraradicular infection and periapical cysts. In addition, unresolved periapical radiolucencies may occasionally be due to healing by scar tissue, which may be mistaken as a sign of failed endodontic treatment.

Adult↗
PubMed1999

Considerations in the selection of a root-end filling material.

Surgical root canal treatment often includes the placement of a root-end filling material. New materials have recently emerged to challenge the long-standing position of amalgam as the root-end filling material of choice. This review discusses several of the commonly used root-end filling materials, with emphasis on indications and contraindications for the use of each.

Aluminum Compounds↗
PubMed1999

Success and failure in periradicular surgery: a longitudinal retrospective analysis.

The objective of the present study was to compare the success rates of 2 different periapical surgical techniques, the traditional technique with rotary instruments and the ultrasonic technique, which uses ultrasonic retrotips. A longitudinal retrospective study was carried out on 302 apices (181 teeth) that had undergone periapical surgery. Surgical outcome was evaluated by 2 independent operators using standardized periapical radiographs. Each radiographic finding was classified into 1 of 4 groups: complete healing, incomplete healing, uncertain healing, and unsatisfactory outcome (failure). An SAS statistical analysis system was used for data management and analysis. Prognostic factors were determined by means of the Fisher exact test. Complete healing after 4.6 years (the average follow-up period) was observed in 68% of the teeth treated through the use of the standard technique and 85% of those treated through the use of the ultrasonic technique. The success rate increased as the follow-up period lengthened (68.4% at 2 years vs 80% at 6 years). The success rate was higher in maxillary (77.9%) than in mandibular (66.1%) teeth. A comparison between the retrofilling materials was not feasible because all teeth in the standard technique group were retrofilled with amalgam and all teeth in the ultrasonic group were retrofilled with Super-EBA.

Adult↗
PubMed1999

Outcomes of periradicular surgery in cases with apical pathosis and untreated canals.

OBJECTIVE: Surgical management is intended to eliminate or block infection originating in the root canals. The root end is customarily sealed to prevent pathogenic products remaining in the root canal from reaching the periradicular tissues. The purpose of this study was to evaluate the microbiologic and radiographic outcomes of surgical treatment of periradicular pathosis associated with teeth with necrotic pulps. STUDY DESIGN: One tooth from each of 10 patients was root-end resected and root-end filled without prior root canal treatment. One year postoperatively, the outcomes were assessed radiographically and the root canals were sampled for bacteria. RESULTS: Radiographic examination showed complete or incomplete (scar tissue) healing in 5 teeth and uncertain healing in the other 5 teeth. Bacteriologic samples from the root canals were positive in 9 of the 10 cases. CONCLUSIONS: In teeth with necrotic pulps, treatment of periradicular pathosis by surgery and root-end filling may show radiographic evidence of satisfactory healing 1 year postoperatively. However, viable bacteria may persist in the canals, constituting a potential risk factor for recurrence of periradicular pathosis.

Adult↗
PubMed2000

Microsurgical instruments for root-end cavity preparation following apicoectomy: a literature review.

Root-end cavities have traditionally been prepared by means of small round or inverted cone burs in a micro-handpiece. Since sonically or ultrasonically driven microsurgical retrotips became commercially available in the early 1990s, this new technique of retrograde root canal instrumentation has been established as an essential adjunct in periradicular surgery. At first glance, the most relevant clinical advantages are the enhanced access to root ends in limited working space and the smaller osteotomy required for surgical access because of the various angled designs and small size of the retrotips. However, a number of experimental studies comparing root-end preparations made with microsurgical tips to those made with burs have demonstrated other advantages of this new technique, such as deeper cavities that follow the original path of the root canal more closely. The more centered root-end preparation also lessens the risk of lateral perforation. In addition, the geometry of the retrotip design does not require a beveled root-end resection for surgical access thus decreasing the number of exposed dentinal tubules. A controversial issue of sonic or ultrasonic root-end preparation is the formation of cracks or microfractures, and its implication on healing success. The present paper reviews experimental and clinical studies about the use of microsurgical retrotips in periradicular surgery and discusses many issues raised in previous papers.

Apicoectomy↗
PubMed2000

Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment.

Endodontic retreatment decision-making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety-two patients with 95 root-filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post-treatment week patients assessed their degree of swelling and pain on horizontal 100-mm visual analog scales (VAS). The scales ranged from "no swelling" to "very severe swelling" and "no pain" to "intolerable pain", respectively. Consumption of self-prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment.

Decision Making↗
PubMed2001

Periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces.

The purpose of the study was to evaluate periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces. Ten teeth with hopeless prognoses because of extensive alveolar bone loss and deep pockets extending to the apexes only on one or two surfaces, but with a healthy periodontal apparatus on the other surfaces, were selected. A mucogingival flap was elevated and the teeth were extracted carefully so as not to damage the healthy remnant of the periodontal membrane remaining on the root surfaces. Thorough extra-oral debridement was performed on the contaminated root surface and the remnant was carefully conserved. Retrofilling was also done to eliminate an endodontic cause of attachment loss. The teeth were horizontally rotated and then replanted so that the healthy root would face the connective tissue at the initially periodontally involved sites, and the root planed surfaces, which had been periodontally involved, would face the surfaces of the alveolar sockets at initially healthy sites. The teeth were splinted with adjacent teeth. Clinical parameters and radiographic examination were performed pre-operatively, and at 3 or 6 months, 1, 2, and 3 years postoperatively. One tooth was extracted 1.5 years postoperatively due to reduced support and the treatment strategy of the patient. The other nine teeth were well maintained without any discomfort for the whole maintenance period of 3 years. In all teeth, areas that previously had no pocketing but were now against denuded root surfaces maintained the previous pocket depth readings. In areas where a deep pocket was present but now had a root surface with healthy periodontium, a distinct decrease of mean pocket depth was observed at the first reexamination 3 months postoperatively. The mean radiographic alveolar bone level increased from 0.3% to 45.3% in 2 years and was thereafter maintained for the entire observation period. Loss of periodontal space and possible root resorption were observed in only one case without other ankylotic symptoms. These results suggest that the healing without ankylosis of an extensive denuded root surface may occur by mechanisms other than the maintenance of a viable periodontal ligament on the root surface.

Adult↗