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PubMed1995

A study of the apical microleakage of a gallium alloy as a retrograde filling material.

The feasibility of utilizing mercury-free Gallium alloy GF for retrograde filling was investigated by comparing apical microleakage in 184 extracted human teeth. The teeth were divided into four experimental and two control groups. Three experimental groups were apical cavity retrofillings with the Gallium alloy GF, a mercury-containing amalgam, and a glass ionomer. The fourth experimental group was filled with gutta-percha and heat-burnished after apicoectomy. After 24 h, 1 wk, 4 wk, and 12 wk immersion in dye solution, the roots were vertically sectioned, and the deepest point of dye penetration was recorded. The glass ionomer showed the least leakage, followed by the amalgam group and the gallium group (no significant difference). The gutta-percha heat-burnished group displayed the greatest leakage. Gallium alloy GF was shown to have an equivalent sealing potential to dental amalgam for a retrograde filling material.

Analysis of Variance↗
PubMed1991

A 24-week study of the microleakage of four retrofilling materials using a fluid filtration method.

The microleakage after retrofillings of amalgam, amalgam with cavity varnish, silver-containing glass ionomer cement, and intermediate restorative material was compared in vitro. Thirty-six extracted human incisors and canines were instrumented, obturated with gutta-percha without sealer, subjected to apicoectomy, and retrofilled with the materials described above. After removal of the gutta-percha filling, the microleakage from both directions (apically and coronally) was measured quantitatively and longitudinally for 24 wk after filling by a fluid filtration technique. All four retrofilling materials revealed some apical and coronal leakage at all time periods. The amalgam group showed statistically significant (p less than 0.001) apical leakage at 1.5 h. The use of cavity varnish significantly reduced the apical leakage of the amalgam group at 1.5 h. The silver-containing glass ionomer cement and intermediate restorative material groups showed significantly (p less than 0.05) less coronal leakage compared with the amalgam group at 1.5 h. Scanning electron microscopy of selected samples showed marginal defects of approximately 5 microns between the root dentin and the retrofilling material.

Cermet Cements↗
PubMed1989

The comparative leakage behavior of reverse filling materials.

This study compares the in vitro apical seal achieved with thermoplasticized gutta-percha used with and without a sealer cement and that achieved with dental amalgam and a varnish liner following an apicoectomy and a Class I preparation of single root teeth. The teeth were immersed in methylene blue dye for 10 days, were sectioned longitudinally, and the amount of leakage was determined. No difference in leakage was found between the apical seals achieved with thermoplasticized gutta-percha used with a sealer cement and that obtained with dental amalgam with varnish. The leakage found with thermoplasticized gutta-percha used without a sealer cement was significantly greater.

Dental Amalgam↗
PubMed1997

Short-term tissue response to potential root-end filling materials in infected root canals.

The short-term tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol), were compared with that to amalgam using a previously devised experimental model. In 24 premolar teeth of beagle dogs (47 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periradicular lesions. On each root, an apicoectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 2 weeks (23 roots) and 1 week (24 roots); they were then prepared for histological examination. The tissue response to amalgam fillings after 2 weeks and 1 week was marked by moderate or severe inflammation on all roots, and extended to < or = 0.5 mm or > 0.5 mm in 15 out of 16 roots. In contrast, after 2 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation, while the tissue response to Vitrebond was the best of the three materials, and was also the least extensive. After 1 week, the overall best tissue response was with Vitrebond, followed by Kalzinol. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were not statistically significant (P < 0.02). However, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Apart from amalgam, in which healing was marked by the persistence of a localized focus of inflammation adjacent to the root-end filling, even though there were intersample variations, there was little overall difference in the temporal and qualitative healing response to Vitrebond and Kalzinol. Both Vitrebond and Kalzinol have potential as root-end filling materials, as the tissue response was considerably more favourable than that to amalgam even in the short-term.

Animals↗
PubMed2003

Oral and maxillofacial surgery in patients with chronic orofacial pain.

PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. PATIENTS AND METHODS: The study population included patients seen at the Center for Oral, Facial and Head Pain at New York Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.

Adenocarcinoma↗
PubMed2003

Incidence of endodontic treatment: a 48-month prospective study.

The purpose of this study was to determine the incidence of endodontic services provided to participants in a longitudinal cohort study. The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. An in-person interview and clinical dental exam were conducted at baseline, 24, and 48 months after baseline, with telephone interviews every 6 months between those times. Dental record information was abstracted afterward. Thirteen percent of participants received at least one endodontic procedure after baseline. Endodontic services constituted approximately 2% of all dental procedures performed. Conventional root canal therapy comprised 94% of the endodontic services and was approximately evenly distributed among anterior teeth, premolars, and molars. Retreatment and apicoectomy each accounted for 3% of the endodontic procedures. The most common self-reported reasons for the dental visit in which a root canal occurred were "toothache," "abscess," and "dental sensitivity." A significant percentage of persons received some type of endodontic treatment in this diverse adult sample. Dental abscesses or toothaches were the main reason(s) for endodontic treatment, but not all persons with these conditions during follow-up sought dental treatment of any variety.

Aged↗
PubMed1989

An enigmatic sinus tract origin.

Diagnosis of the origin of a sinus tract is very complex. In this case report, a sinus tract stoma appeared above the left maxillary incisor, but the causative tooth was the right maxillary incisor. Incorrect diagnosis led to endodontic treatment of a healthy tooth followed by apicoectomy, which was also ineffective. An endodontic consultation revealed the true origin of the sinus tract. Five days after completing conservative endodontic treatment of the right maxillary incisor, the sinus tract disappeared. This case confirms the need to include a diagnostic tracing radiograph as part of routine diagnostic procedures.

Adult↗
PubMed1991

Retrograde root filling with composite and a dentin-bonding agent. 1.

A method is described, by which retrograde root filling with a composite resin can be performed. The cavity design is a slightly concave dissection of the apical part of the root, which is treated with the bonding agent Gluma followed by an application of Retroplast. Retroplast is a chemically curable composite containing silver for radiopacity and aerosil to obtain a suitable consistency. Endodontically treated teeth with a eugenol-containing root canal sealer did not affect the strength of the bond between Retroplast and apical dentin. A tight seal between the composite and the cavity surface was observed by light and SEM microscopy, and histology of tissue surrounding fillings placed in monkeys revealed absence of inflammatory cells around the filling and a close contact between filling and fibroblasts with collagenous fibers. In some cases, cementum and Sharpey's fibers formed in contact with the filling. Fillings placed in humans performed successfully in most cases, and the main causes of failure were either inadequate hemostasis during filling, or root fracture unnoticed by the time of filling. The retrograde technique promises a new treatment principle, with a root canal effectively sealed and the periapical ligament restored after apicoectomy.

Adolescent↗
PubMed2005

Surgical endodontics in dogs: a review.

Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage--a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst--a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez--cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwigs epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.

Animals↗
PubMed1976

Role of endodontics in current dental practice.

The findings presented in this statistical study are applicable to a representative sample of dentists in general practice in Illinois. Almost 90% of the respondents in this survey do some or all of their root canal therapy. The majority of those who do some or all of their root canal therapy do so because they enjoy it. Most of the respondents (77.3%) do not take root canal cultures. Kerr's Root Canal Sealer is the most widely used sealer, followed by Kerr's Tubli-Seal and Dr. Wach's sealer, respectively. The preferred technique of filling root canals among the respondents is by means of guttapercha and lateral condensation for most canals and the use of silver points for narrow or constricted canals. A technique that is not taught in any American dental school, the Sargenti N2 technique, is used by almost 20% of the responding dentists. Most of the respondents try to fill the canal 0.5 to 1 mm from the apex. Although dozens of intracanal medicaments exist, the most commonly used one is camphorated parachlorophenol, which is used by more than 50% of the dentists who participated in this survey. A chelating agent is used by almost two fifths of the dentists surveyed and use of such an agent is increasing. More than half the respondents carry out some sort of endodontic surgery in their practice' apicoectomy is the most common endodontic surgery performed. The data show that 48.9% of the dentists who participated in this survey feel that dental schools should devote more time to teaching endodontics, 50.5% believe that the amount of time should remain the same, and only 0.5% feel that the amount of time should be decreased. About 70% of those who feel that the amount of time for teaching endodontics should be increased specified an increase in clinical training.

Education, Dental↗
PubMed2005

Combined application of amoxicillin and clavulanic acid after oral surgical interventions.

Antibiotics represent a powerful weapon against infections. As dentists we are faced almost on a daily basis with the need to prescribe antibiotics. At the same time, we can often see that the antibiotics use tends to get out of control or that they are used indiscriminately with no real need. The aim of this case study is to investigate the effectiveness of amoxicillin and clavulanic acid combination in various dental ailments but also to demonstrate possible difference in the severity of symptoms after the use of amoxicillin and antibiotic combination of amoxicillin and clavulanic acid after surgical and oral interventions. The investigation involved 102 patients who were divided into two groups (the first group consisting of 59 and the second one of 43 patients). Following surgical treatment the first group of patients was prescribed antibiotic combination of amoxicillin and clavulanic acid in the dosage of 625 mg, 3 times per day. The second group of 43 patients was prescribed amoxicillin in the dosage of 500 mg, 4 times per day. The recommended therapy for antibiotic combination of amoxicillin and clavulanic acid was 5 to 10 days after the operation and 8 to 10 days for amoxicillin. In other words, both groups of patients started to use antibiotics after the surgical or oral intervention such as operative removal of impacted wisdom teeth, apicoectomy or complicated extractions, and also after the treatment of odontogenic abscesses etc. The same parameters were measured prior to the surgical intervention in cases when patients demonstrated the symptoms before the operational treatment while in all other cases the parameters were measured 48 hours and seven days following the operation. The measured parameters were: pain, swelling, body temperature, dysfunction such as dysphagus trismus, chewing disorder and possible allergic or gastrointestinal reactions. All parameters observed were precisely set in order to harmonize the investigation criteria and facilitate statistical data processing. With respect to pain before the operation there was no substantial statistical difference, p>0.05 (t=0.56; t=0.69). With respect to the onset of pain and the use of antibiotics after 48 hours there is a significant difference in favor of antibiotic combination of amoxicillin and clavulanic acid (X= 14.83, p= 0.002; p <0.01). Thus, pain is less acute if antibiotic combination of amoxicillin and clavulanic acid is administered. With respect to swelling and administration of antibiotics 48 hours after the operation there is no significant difference between the use of the two antibiotic therapies (X= 4.89; p=0.18; p>0.05). The investigation conducted seven days after the operation with regard to pain and the use of either antibiotic therapies demonstrated significant statistical difference (X=9.35, p<0.01) in favor of antibiotic combination of amoxicillin and clavulanic acid. In other words, patients who used amoxicillin and clavulanic acid felt significantly less intense pain. With respect to swelling, significant statistical difference between the two groups of patients was established in favor of antibiotic combination of amoxicillin and clavulanic acid, i.e. p<0.05 (X=6.45, p=0.03). The combination of amoxicillin and clavulanic has proven to be significantly more effective in comparison with the use of amoxicillin after oral-surgical interventions, and therefore antibiotic combination of amoxicillin and clavulanic acid is recommended for use in further practice.

Amoxicillin↗
PubMed1978

[A new method for combined auto-alloplastic tooth reimplantation with a parallel A1203-ceramic root].

The operative procedure for partially replacing the root with A12O3 ceramic represents a good possibility for preserving teeth in which the pulpa is devitalized. The method used in connection with the well known autoplastic reimplantation not only presents an alternative to the traditional apicoectomy but also provides additional stabilization of the tooth by lengthing the root with cocotostabile and biocompatible A1203 ceramic. The method was tested in humans and monkeys. Argumentation was based on histological examination via light microscopy.

Aluminum Oxide↗
PubMed1997

Bone regeneration around an osseointegrated implant. A simultaneous approach in a fenestrated defect: a case report.

The use of a barrier membrane, with or without osseous allograft, has been shown to establish regeneration of osseous tissue around dental implants. Following three episodes of persistent symptomatic failed apicoectomy and subsequent tooth extraction, an osseointegrated implant was placed in a wide fenestrated defect. Demineralized freeze-dried bone allograft was covered by an occlusive expanded polytetrafluorethylene membrane. The reentry procedure revealed complete bone fill that followed the texture of the augmentation material beyond the previous buccal bony envelope.

Adult↗
PubMed1997

Endodontics in the '90s: old dogma and new tricks ... can we be re-taught?

Endodontics has gone through many changes in the past several years. Electronic apex locators and surgical microscopes have taken a lot of the guess work out of doing root canal. Digital radiograpy has expanded our diagnostic abilities. Ultrasonic intrumentation and the advent of new filing systems have increased the efficacy of canal cleaning. There have also been some major refinements in how we can now obturate canals. Apicoectomies can now be performed with refined ultrasonic root end preparations, and we have increased our ability to better seal root ends with new filling materials. The result is that endodontic procedures can now be performed more expediently and with a more predictable outcome. This article is written from the perspective of a full-time practicing endodontist, and describes the various changes occurring within the specialty of endodontics.

Endodontics↗
PubMed2000

Immune response in chronic periapical parodonititis.

The purpose of our study was to investigate the immune response in chronical periapical parodontitis (CPP) by using multidisciplinary approach. 30 CPP samples were obtained after surgical removal--apicoectomy. Each CPP sample was examined by histological, bacteriological and flow cytometrical (FC) analysis of lymphocytes infiltrating CPP samples. Ten percent of bacteriological samples were sterile, others had significant aerobic and anaerobic growth. We used pathohistologic and microbiologic findings and compared them to the results of immunological analysis. By FC we found a significant increase in proportions of T lymphocytes expressing interleukin-2 receptors and ICAM-1 compared to peripheral blood lymphocytes. Proportions of T helper cells that produce interferon-gama (IFN-gamma) was higher in CPP samples predominantly colonized by anaerobic bacteria. There were no differences in IL-4 expression by T cells in both groups (anaerobic and streptococcal). Among anaerobic CPP samples differences in proportion of T cells that express IL-2 receptors expression was also found between samples colonised by P. acnes and Bacteroides sp. Oral streptococci cause relatively limited tissue destruction and induce Th2 type of immune response accompanied by non-cytotoxic inflammatory reaction. On the contrary, anaerobic bacteria induce Th1 type of immune response that cause more severe inflammatory reaction (type 4) of hypersensitivity that damage the tissue by the action of cytotoxic T cell activation.

Antibody Formation↗
PubMedDate not supplied

Mandibular nerve paresthesia caused by endodontic treatment.

The paresthesias of the inferior dental nerve consists of a complication that can occur after performing various dental procedures such as cystectomies, extraction of impacted teeth, apicoectomies, endodontic treatments, local anesthetic deposition, preprosthetic or implantologic surgery. The possible mechanisms of nervous lesions are mechanical, chemical and thermal. Mechanical injury includes compression, stretching, partial or total resection and laceration. The lesion can cause a discontinuity to the nerve with Wallerian degeneration of the distal and integrated fibers of the covering (axonotmesis) or can cause the total sectioning of the nerve (neurotmesis). Chemical trauma can be due to certain toxic components of the endodontic filling materials (paraformaldehyde, corticoids or eugenol) and irrigating solutions (sodium hypochlorite) or local anesthetics. Thermal injury is a consequence of bone overheating during the execution of surgical techniques. We present a clinical case of paresthesia of the inferior dental nerve after the introduction of a gutta-percha point in the mandibular canal during the performance of a root canal therapy of the inferior first molar. The etiology and the treatment of this endodontic complication are described.

Cranial Nerve Diseases↗
PubMed2003

[Oral health state in dentistry students of Medical College, Jagiellonian University in Cracow].

The aim of the study was to analyse the oral health status of the fourth and fifth year dentistry students of Collegium Medicum of the Jagiellonian University in Cracow. The data were collected using the anonymous questionnaire concerning the general health, using medications, dietary habits, smoking and drinking alcohol, present and previous oral complaints and selected health behaviour patterns (follow-up examination of oral cavity, teeth brushing and other hygienic procedures, using dental floss). The oral cavity status was estimated by clinical examination conducted with the use of artificial lighting and basic diagnostic set: dental probe and dental mirror. The data for 120 persons were analysed: 75 (62.5%) fourth year students and 45 (37.5%) fifth year students aged 21-27 years (mean age 23.2). Among the examined persons 84.2% descended from cities and 15.8% from the villages. During the medical review it was stated that among chronic diseases allergies (27.5%) were on the first position, cardio-vascular diseases (8.33%) were on the second and respiratory system diseases were on the third position. The review about smoking and drinking alcohol stated that 71.7% never smoked cigarettes, 10% gave up smoking and 18.3% were daily smokers, 81.7% of students occasionally drink alcohol, mainly beer. The dental history stated that all of examined students (100%) were subjected to teeth caries treatment, 48.7% had endodontic treatment, 38.1% extraction (mainly for orthodontic reasons), 5.9% prosthetic, 3.9% apicoectomy, 0.8% had dental implant. The estimation of oral cavity hygiene (API index) and frequency of decay (DMF index-Decayed Missing Filling) was included in the examination. The mean value of DMF was 13.56, API 22.51 in the whole examined group. The assessment of periodontal tissues was made with the support of treatment needs: 60.0% of examined persons don't need any periodontal treatment, 14.17% need to improve their oral cavity hygiene and 25.83% require the dental calculus removal. The study revealed that 39.1% suffer from temporo-mandibular arthropathies. Normal occlusion is characteristic for 45.69% of examined students, small abnormalities for 48.28 and 6.03% have advanced malocclusion. The presented results are a part of examination performed in four Polish academic centres that estimates oral health status of students of dentistry in our country.

Adult↗
PubMed1991

[Clinical comparative study of local anesthetics. Random double blind study with four commercial preparations].

In a randomized double blind study effects and tolerability of the local anesthetics Prilocaine 3% with Felypressin, Articaine 4% with Epinephrine 1/200,000 and 1/100,000, and Lidocaine 2% with Epinephrine 1/100,000 were tested. There was no significant difference between the four agents as far as effect on blood pressure, pulse, and tissue rehabilitation are concerned. Prilocaine can be used for extractions and surgical tooth removal. It can not be recommended for apicoectomy or implantation. The better results of Articaine 4% compared to Lidocaine 2% were statistically not significant.

Anesthetics, Local↗