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PubMed2006

Endodontic re-treatment or implants: a contemporary conundrum.

In recent years, dental implants have become a common alternative in dental care. Of course, not all patients present with clear-cut treatment needs. Treatment planning an endodontically treated tooth that may require re-treatment vs extracting that same tooth and placing an implant may be one such conundrum. Given the disparity between the implant and endodontic re-treatment literature and the relative paucity of data-based results for indications and contraindications of endosseous root-form implants vs endodontic re-treatment, treatment planning can become a complex task. This article presents a few criteria to consider when treatment planning endodontic re-treatment vs extraction and subsequent implant placement. Because treatment planning can become such a complex issue, using all the varied resources of the dental team is imperative.

Dental Implants↗
PubMed2006

Rules of engagement: mastering the endodontic game, part 2.

The rules of engagement are an overview of the essential elements needed to reconstruct endodontically volved teeth back to successful, healthy members of the dental arch that function and are biologically healthy, structurally strong, aesthetic, and valuable. Endodontics just keeps getting better and better, and the future of endodontic success is bright. Now more than ever patients value and appreciate dental aesthetics. Everyone wants to look good, smell good, and appear successful. Teeth will always play a major role in these human desires. The endodontic tooth can either be the "weakest link" or it can be as strong a link as any other healthy tooth. The choice is ours...if we play by the rules.

Edetic Acid↗
PubMed1991

The treatment of endodontically treated teeth.

Recently published studies on the treatment of endodontically treated teeth have confirmed and expanded on the restorative directions outlined in earlier work. The significance of endodontic treatment in reducing tooth strength has been questioned, and the potential influence of previous operative cavity designs highlighted. Other work has supported the contention that following the placement of a well-fitting crown, the strength of the post foundation, the core foundation, or both is relatively unimportant in determining the overall strength of endodontically treated teeth. In particular, it appears unnecessary to incorporate a ferrule effect as part of a post-and-core foundation. It seems that the height of the remaining tooth structure between the core and the crown margin is a much more significant factor in determining the fracture resistance of these teeth. Many articles have demonstrated the potential influence of material interactions at all stages of the restorative process. Further work in this area is likely to greatly complicate clinical decision making when restoring endodontically treated teeth.

Corrosion↗
PubMed1991

A standard predetermined endodontic preparation concept.

Cleaning and shaping the root canal system is the most tedious and demanding phase of endodontic therapy. Using a predetermined endodontic preparation allows for a routine approach to instrumentation and produces high-quality results with better efficiency. Schilder states, "Inherent in the concept of cleaning and shaping is the fact that each root canal system, like each carious lesion, is different from another and that, within certain prescribed guidelines no two root canal preparations should be exactly alike, anymore than any two intracoronal preparations are exactly alike." The concept of predetermined preparation does not conflict with Schilder's statement, it merely refines prescribed instrumentation guidelines and establishes instrumenting parameters. The goals of endodontic instrumentation are to: (1) instrument with control so that there is enlargement without deviation from the original canal; (2) instrument to a size that is consistent with total mechanical and chemical debridement; (3) debride the root canal system from its coronal orifice to the periodontal ligament, regardless of canal curvature; and (4) create a canal shape that tapers from the coronal orifice to the apical opening. The authors will discuss each endodontic goal as it is accomplished in the predetermined preparation. Techniques for instrumenting to the predetermined sizes are also described.

Dental Cavity Preparation↗
PubMed1991

Radiographic evaluation of apical periodontitis and endodontic treatment results: a computer approach.

Chronic apical periodontitis is diagnosed primarily by radiography. Whereas subjective, chairside evaluations of radiographs have serious limitations as regards accuracy of endodontic diagnosis, digitalization of radiological data allows quantification of the information obtained. In clinical practice, digitalization may improve the diagnostic sensitivity and reduce the radiation dose; in clinical endodontic research, digitalization of radiographs provides a means of unbiased and quantitative assessment of apical periodontitis. Automated measurements of the radiographic density of the periapical area have been applied in a study of the effect of different endodontic sealers on the healing of apical periodontitis. Changes in radiographic density could be detected as early as 3 weeks after completion of endodontic treatment, and the computer-based analyses provided numeric values for the progression of the healing process in the periapical region.

Adult↗
PubMedDate not supplied

[Evaluation of postoperative pain comparing manual and ultrasonic endodontic instrumentation in patients with cleft lip and palate].

Our purpose was to compare incidence of post-surgical pain associated to the endodontic therapy where the instrumentation on the root canal was performed by the method of Marshall & Pappin and the method of Marshall & Pappin complemented by the ultrasonic. Seventy patients with only one tooth needing endodontic treatment were treated by one of the methods and, posteriorly, evaluated. The endodontic treatment was performed at one time and from the seventy teeth, thirty have been instrumented by the manual method complemented by the ultrasonic and forty by the manual instrumentation. The patients were clinically controlled after the endodontic treatment was finished during periods of 24, 48 and 72 hours to evaluate their post-surgical condition. The results suggest that were no statistically significant differences (p less than 0.05) in the incidence of pain between the employed methods or according to the pulpar semiologic condition in any of the observed periods. However, we have realized that there was a tendency for a smaller percentage of a postoperative pain in those cases of necropulpectamy treated by the endosonic ultrasonic synergistic system. In those cases of biopulpectomy this has been not observed.

Cleft Lip↗
PubMedDate not supplied

[Sonic and ultrasonic instruments for endodontics. 2. Operative sequence and clinical advantages].

The authors describe the differential characteristics between sonic and ultrasonic endodontic devices: the former type is pneumatic and uses the air coning from the odontoiatric chair that gives to the endodontic instrument only a lateral way of swinging. The latter type changes the ultrasonic activity coming from piezoeletric phenomena into swinging mechanical energy (operating at 25 KHz). The authors specify the characteristics of endodontic instruments and explain their operating ways, demonstrating that reaming by endosonic instruments increases effects of hypochlorite. They also describe the operating train, pausing on the opportunity that the root canal should be manually probed, measured and reamed up to a diameter that gives sufficient space to the file vibration. They conclude listing the advantages that gives the correct use of sonic and ultrasonic devices; they also augur that with their use endodontics could have a greater diffusion.

Dental Pulp Diseases↗
PubMed1986

Success rate in endodontic therapy--a retrospective study. Part I.

A survey was undertaken to review the success rate of endodontic treatment carried out by the undergraduates of the Dental Faculty, University of Singapore over a seven year period. A recall system resulted in a total of 385 cases which were successfully recalled and reviewed. The survey comprised of two parts:--A) history-taking from the endodontic record charts and B) clinical and radiographic evaluation of the cases. The cases in the survey had a minimum 2-year recall period. The success rate obtained was 90.6% which compared favourably with other studies. Root canals that were underfilled and root-fillings showing satisfactory apical compression were found to be more successful, the results being statistically significant (P less than 0.05). Endodontic therapy in non-vital teeth and a recall period of at least 2 years were also associated with a higher success rate. This paper discusses the overall success rate of endodontic therapy and the success and failure rate in relation to age and sex. The success rate in relation to other factors such as level of root-filling, apical compression and period of recall will be reported in a separate part of this paper.

Adult↗
PubMed1984

Management of periapical lesions in endodontically treated teeth. A study on clinical decision making.

Alternative actions available in a certain clinical situation can be built up as a decision tree. An example of a decision tree with possible alternatives in the clinical management of an endodontically treated tooth with periapical lesion is shown in the present study. Five alternative actions were distinguished: no therapy indicated, wait 12 months, endodontic retreatment, periapical surgery and extraction. Thirty-five chief dental officers from the Public Dental Health Organization in Sweden examined 33 endodontically treated teeth with periapical lesions. Large interindividual variations in attitudes to treatment of asymptomatic periapical lesions were recorded. In no case was one particular decision shared by all examiners. The number of teeth suggested for therapy (endodontic retreatment, periapical surgery or extraction) had an interexaminer range enclosing seven to 26 cases. The decision making is discussed in view of published literature and reasons to the interexaminer variations are speculated on.

Decision Making↗
PubMed1993

[Evaluation of the apical seal of endodontically treated teeth by the ion-diffusion method].

It is generally accepted that improper preparation of the post space in endodontically treated teeth may damage sealing of the filling and cause treatment failure. Conventional method of detecting the sealing ability of endodontically treated teeth are quite complicated and inconvenient. To avoid the shortcomings of these traditional methods, the law of diffusion was adopted in this experimental design, and the results were compared with those of the traditional dye penetration method. Fifty sound molar teeth were treated by routine endodontic procedures, and were instrumented to 35# endodontic file. In 20 teeth in the control group, half were treated as a positive control by leaving the apical foramen open, and the remaining half were used as a negative control by sealing the foramen with two layers of nail polish. The other 30 experimental teeth were filled with gutta-percha points and sealer Canals by the lateral condensation method. Two weeks later, the filling material was removed to apical 3 mm, then 60 microL 2915 mM KCl solution was placed into the pulp cavity. The root was immersed into 1 mL 24.17 mM KCl solution. During the following 30 days, the concentration of the potassium ions in the outer solution was monitored by an ion-selective electrode. Finally, all 50 teeth were immersed in 1% methylene blue for 24 hours, sectioned with Isomet, and the extent of dye penetration was measured under a stereomicroscope with a digital caliper. The results of both methods were compared by means of regression analysis. There was a good correlation between the dye penetration method and the newly designed ion-diffusion method (r = 0.812).(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Leakage↗
PubMed1994

The importance of endodontic access in locating maxillary and mandibular molar canals.

The principle of straight-line access is discussed with particular reference to endodontic access of either maxillary or mandibular molar teeth. Modifications to the traditional triangular access opening are described that will make it easier for a practitioner to locate and instrument the fourth canal system commonly found in molar teeth. The high frequency of a fourth canal in molar teeth makes it essential to anticipate and find all canals during molar endodontic therapy. Quite frequently, the general practitioner attempting molar endodontic therapy should expect to locate a second canal in the mesiobuccal root of the maxillary molar and a second canal in the distal root of a mandibular molar. The possibility of extra roots over and above the norm should also be anticipated and looked for carefully. Proper angulation and interpretation of radiographs help to identify chamber and root anatomy. A two-step access opening is advocated when making access openings on molar teeth if a coronal crack in the crown is to be seen early in treatment. A method of unroofing the pulp chamber and pre-flaring the canal orifice to facilitate the subsequent shaping of the entire root-canal system is described. Clinical and laboratory examples are pictured to illustrate modifications or errors in the standard endodontic access opening.

Dental Pulp Cavity↗
PubMed1993

Patient comfort using three methods of endodontic therapy: traditional, paraformaldehyde, and hybrid sealer techniques.

This paper is not a study, but rather a clinical evaluation of three endodontic techniques based solely on subjective postoperative symptoms reported by patients. From 1968 to 1972 (four years), the author treated 452 teeth with a traditional endodontic technique. During 1973-1981 (eight years), he treated 625 additional teeth by instrumenting the root canals in the same manner as in the traditional method, but without the employment of sodium hypochlorite. In this procedure, the canals were obturated with a paraformaldehyde-steroid-zinc oxide and eugenol paste (PSZOE). A third "hybrid" endodontic technique was used in treating 522 other teeth during 1982-1991 (nine years). During the latter period, the teeth were instrumented in the same manner as in the first two modes of therapy, sodium hypochlorite was not used, and the root canals were filled with gutta percha cones covered with the PSZOE paste. Based on subjective reports of postoperative swelling and pain, there was a 10% incidence of swelling and a 20% incidence of pain in cases treated by the traditional technique and their root canals filled with gutta percha cones coated with Tubliseal by Kerr Dental Manufacturing Company of Detroit. Based on these same criteria, there was only a 1.6% prevalence of swelling and a 1.9% prevalence of pain when the root canals of 625 teeth were completely filled with a PSZOE paste. When the root canals of 522 other endodontically treated teeth were filled with gutta percha cones coated with PSZOE, postoperative swelling was reported in 1.5% of the cases and postoperative pain in 3.2% of the treated teeth.(ABSTRACT TRUNCATED AT 250 WORDS)

Formaldehyde↗
PubMed1993

The effect of the Relaxodont brain wave synchronizer on endodontic anxiety: evaluation by galvanic skin resistance, pulse rate, physical reactions, and questionnaire responses.

The effects of a brain wave synchronizer (BWS) on endodontic (root canal) anxiety was evaluated in the clinical practices of the senior author. The experimental groups were: (1) a verbal method (routine calming words by dentist) plus BWS (N = 10) and (2) verbal method plus BWS and alpha relaxation tape (N = 10). The control group was verbal method alone (N = 10). All three groups were evaluated during a complete endodontic treatment by the use of galvanic skin resistance (GSR), pulse rate (PR), physical responses, and pre- and post-treatment questionnaires. Recordings were made during the following periods: (1) start; (2) local anesthetic injection; (3) rubber dam application; (4) drilling; (5) x-ray taking; (6) instrumentation; (7) obturation; and (8) conclusion. Results showed that the experimental groups were significantly better than the control group in the reduction of endodontic anxiety. The findings reinforced the belief that local anesthetic injection is the most anxiety producing aspect of endodontic treatment.

Adult↗
PubMedDate not supplied

Myths of single-visit endodontics.

There has been much controversy about the safety and efficacy of initiating and completing endodontic therapy in a single visit. The literature concerning single- and multiple-visit endodontics is reviewed, and advantages and disadvantages of single-visit endodontics are discussed. Single visit endodontic therapy is shown to be a safe, effect alternative to multi-visit treatment for most vital and nonvital teeth.

Episode of Care↗
PubMed1996

Effects of aging on the endodontic system, reserve crown, and roots of equine mandibular cheek teeth.

OBJECTIVE: To document age-related changes in the morphology of the endodontic system, reserve crown, and roots of equine mandibular cheek teeth. DESIGN: Equine mandibular cheek teeth from horses of various ages were compared, using radiography, x-ray computed tomography, and histologic examinations. SAMPLE POPULATION: 48 right hemi-mandibles from horses 2 to 9 years old. PROCEDURE: Hemi-mandibles were radiographed, imaged by computed tomographic reconstruction, and reformatted. Histologic examination was used to identify and correlate tissue types. RESULTS: Permanent mandibular cheek teeth of the horse, at the time of eruption, consisted of an exposed crown and a reserve crown with a widely dilated apex. The endodontic system consisted of 5 or 6 pulp horns that connected to an expansive pulp in the reserve crown, which was confluent with the primordial pulp bulb surrounding the tooth's apex. At the time of eruption, mandibular cheek teeth did not have a distinct pulp chamber, roots, or evidence of root formation. However, within 2 years after eruption, mesial and distal roots and a pulp chamber were present. A distinct pulp chamber, communicating with the pulp horns and both root pulp canals, was identifiable for 4 to 5 years from the time of root formation. The endodontic system of cheek teeth, 6 to 8 years after eruption, consisted of 2 unattached compartments, made up of a root canal, pulp chamber, and 2 or 3 pulp horns. CLINICAL RELEVANCE: The age-related morphologic changes in equine mandibular cheek teeth have important implications for application of endodontic therapy in horses.

Aging↗
PubMed1997

Microleakage of endodontic access cavities restored with composites.

A proper seal of restorative composites in endodontic access cavities is mandatory to prevent ingress of microorganisms and debris into the tooth-restoration interface. Chemically cured composites tend to have less polymerization shrinkage than photopolymerization composites. This study compared in vitro sealing performance of a chemically cured and a photopolymerization composite for access cavity restorations in endodontically treated teeth. In addition, the effects of four dentin pretreatments on the seal were evaluated. One hundred twenty-eight roots of extracted human incisors were cleansed, shaped and obturated with gutta percha and Grossman's sealer. The endodontic access cavities were later treated by Scotchbond Multipurpose, All-Bond 2, Vitrebond and Ketac-Bond. Half the access cavities within each group were filled by Coltene Microhybrid H.P., a chemically cured microhybrid composite. The other half were filled with Aelitfil, a photopolymerized composite. The filled teeth were thermocycled, submerged in silver nitrate solution, sectioned longitudinally, and their dye penetration measured and statistically analyzed by two-way ANOVA at 95 percent confidence level. The results show that the chemically cured composite allowed less dye penetration than the photopolymerized composite. As for the dentin pretreatments, the Scotchbond Multipurpose and All-Bond 2 exhibited less microleakage than Vitrebond and Ketac-Bond for both chemical and photopolymerized composite. Ketac-Bond allowed the highest amount of dye penetration, followed by Vitrebond, Scotchbond Multipurpose, then All-Bond, which had the least depth of microleakage. Chemically cured composites bonded with All-Bond 2 and Scotchbond Multipurpose may exhibit less microleakage than photopolymerized composites in endodontic access cavity restoration.

Analysis of Variance↗
PubMed2003

Autotransplantation of endodontically treated third molars.

OBJECTIVE: To determine the success rate in autotransplantation of endodontically treated third molars. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: This study was carried out at Armed Forces Institute of Dentistry (AFID), Rawalpindi (Pakistan) from January 2002 to December 2002. PATIENTS AND METHODS: A total of 50 patients meeting the inclusion criteria were selected who had their first or second molars in unrestorable condition with intact third molars. The donor teeth were extracted after the preparation of recipient site. After endodontically treated in vitro the donor teeth were carried to the recipient site and immobilized. Postoperative variables were recorded and analyzed on SPSS version 10. RESULTS: The overall success rate after six months of the transplantation of third molars was 88% with complete root formation after endodontic treatment. All the patients(12%) who had complaints were more than 35 years of age. CONCLUSION: Third molars are good substitute for the unrestorable first or second molars and would be as effective as endosseous implants. The procedure is likely to have complications in the advanced age group.

Adult↗
PubMedDate not supplied

Threaded versus porous-surfaced designs for implant stabilization in bone-endodontic implant model.

An endodontic implant model system was used to compare the effect of implant design on stabilization in bone. Specifically a porous-surfaced design was compared to conventional threaded and smooth-tapered endodontic implant designs. All implants were placed in immediate function thereby assessing the effect of early limited movement on the fixation achieved. A total of eighty-three endodontic implants were inserted in the mandibles of six adult mongrel dogs. Animals were sacrificed immediately after implantation and after 3, 6, and 12 months. Implants were evaluated by clinical and radiographic examination and after animal sacrifice by pull-out tests of the implant from the tissues, SEM examination of the pulled-out implants and, finally, histology. The pull-out test results indicated increasing shear strength with implantation time for the porous-surfaced implants in contrast to the gradual loss of fixation for the threaded implants and the continuous low shear strength for the smooth implants. Histological studies and SEM examination indicated the reason for these changes. Smooth implants became encapsulated by fibrous connective tissue from early post-implantation time periods. Threaded implants, although initially mechanically interlocked with bone, developed a fibrous connective tissue capsule that gradually thickened with time until, by 6 months, little mechanical interlock of bone and implant was present. It was assumed that this fibrous capsule thickening was caused by implant movement. The porous-surfaced implants, however, became stabilized by bone ingrowth and showed more extensive bone formation within the surface pores with time. It is concluded that for implants that are made functional immediately after implantation, as in this study, porous-surfaced implants can become strongly fixed by bone ingrowth, in contrast to conventional threaded or smooth-surfaced designs, thus presenting a more favourable long term prognosis.

Alloys↗