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The rubber dam is an absolute essential in all endodontic procedures. In documentation of that fact, we have presented the case of a 50-year-old man who swallowed an endodontic broach during endodontic treatment; the instrument passed through the gastrointestinal tract without difficulty.
This study evaluates the effect of cyclic autoclave sterilization and simulated clinical usage on a mechanical property of one brand of stainless steel endodontic files. The angular deflection moments were measured by a torque apparatus approved by the American Dental Association for such purposes. Comparisons of values for sterilized and nonsterilized files were made. 1. A significant decrease in angular deflection values exists for stainless steel endodontic files having undergone ten cycles of autoclave sterilization versus files having undergone only two or five similar cyclings. 2. All file sizes (15, 20, 25, 30, 35, 40) tested in torsion were detrimentally affected by the autoclave sterilization. 3. Of the files investigated, sizes 35 and 40 were the most adversely affected by the steam-under-pressure sterilization. 4. The angular deflection values of those files subjected to repeated autoclavings were not decreased below the minimum value accepted by the American Dental Association for resistance to torquing forces. It can therefore be concluded that repeated sterilization of a stainless steel endodontic file does result in a significant reduction in the torque resistance of that file. This reduction of the metal property is not significant clinically, however.
OBJECTIVE: A chart review was performed at 3 private general practices in different regions of Alabama to compare success of endodontic treatment provided by specialists versus generalists. STUDY DESIGN: To qualify for the study the general dentists had to perform some endodontic treatment and to refer some to endodontists. Success was defined as the treated tooth being present at 5 years after the date of treatment initiation. This criterion, was chosen because of its unequivocal categorization of results. Calibrated dentists reviewed over 3,000 charts. RESULTS: 350 met the inclusion criteria. 195 teeth were treated by generalists, with an 89.7% success rate. 155 teeth were treated by endodontists, with a 98.1% success rate. CONCLUSION: In this limited survey, endodontic treatment by specialists was significantly more successful.
Little information exists in the dental literature regarding the range of treatment provided by specialist endodontists. This study was undertaken to analyze the range and incidence of treatment procedures performed on 2000 patients referred to a specialist endodontist in Perth, Western Australia. There were 312 people that did not require endodontic treatment, resulting in 1688 patients having treatment on 2221 teeth. Routine treatment without complications was provided to 313 teeth (14%) while a total of 451 teeth (20.3%) had calcified or blocked canals. Endodontic retreatment was necessary in 815 teeth (36.7%), 210 teeth (9.4%) had posts removed, and 236 (10.6%) had endodontic surgery. Perforations were present in 119 teeth (5.4%) and these were treated either conservatively (81 teeth, 3.6%) or with surgery (38 teeth, 1.7%). Dental trauma was the reason for referral of 258 patients who required treatment on 217 teeth (9.8%). The wide range of treatment procedures required indicates that endodontists must be highly skilled in all aspects of the discipline.
With the recent influx of osseointegrated endosseous implants in dentistry, attention has been drawn away from using endodontic stabilizers as a means of stabilizing and retaining teeth. It is our opinion that endodontic stabilizers should be considered in the treatment planning of seemingly nonretainable teeth. They are biocompatible and have the additional advantage of maintaining the periodontal membrane attachment of the remaining tooth. Extraction and subsequent replacement with osseointegrated implants should only be considered after all other means of retaining the natural tooth have been fully explored. Selective case studies from various areas of the dentition demonstrate the broad applicability of stabilizers. A technique is presented for the use of endodontic stabilizers.
The endodontic endosseous implant (EEI) enjoyed wide use in the United States after it was introduced in the 1960's. For various reasons including incorrect case selection, improper use of the materials, and poor preparation for the implant a high number of failures resulted. Following opposition by some members of the dental community, the procedure fell into disuse. The authors of this article had treated a number of cases with the endodontic endosseous implant from 1965 to 1975, many of which did fail. However, we have noted some remarkable very long-term successes with the technique, two of which are presented here. We suggest that the endodontic endosseous implant should not be discarded totally, but, with further research to improve the materials and technique, it still may be used in carefully selected cases.
Endodontic endosseous implants stabilize teeth that have crown-root ratios compromised by periodontal disease, trauma, or apical resorption. By increasing the crown-root ratio, the implant improves the prognosis of the tooth, thus increasing its longevity. The purpose of this study was to evaluate, in vivo, the healing response to a newly introduced titanium endodontic implant. Eight implants were placed in the maxillary incisors and mandibular premolars of two adult beagle dogs after completion of root canal and osseous preparation. Peri-implant tissues were examined radiographically and histologically at 6 months postinsertion. Radiographically, the periapical area and tissue surrounding the implants seemed normal. Histologically, fibrous connective tissue and healthy bone intimately surrounded the implant. Epithelium or chronic inflammatory cells were not observed along the length of the implant. These findings suggest that titanium is a biocompatible metal when used as an endodontic endosseous implant.
Clinical success rates in endodontics can be improved if the causes of failures can be determined, prevented, or corrected. The endodontic autopsy is recommended as a method for determining preoperative, operative, and postoperative causes of failures in endodontics.
OBJECTIVES: The aims of this retrospective study were (1) to compare the outcome of periapical surgery performed in endodontic and in oral surgery units of a teaching dental hospital and (2) to evaluate the influence of factors affecting outcome. STUDY DESIGN: A total of 176 teeth (endodontic unit, 83; oral surgery unit, 93) surgically treated more than 4 years previously were examined clinically and radiographically by means of strict criteria. Multiple logistic regression analysis was used. RESULTS: The rate of complete healing for patients treated in the endodontic unit (37.4%) was significantly (P = .009) higher than that for patients treated in the oral surgery unit (19.4%). The technical quality of surgery (P < .001), placement of root-end filling (P = .039), absence of a preoperative periapical lesion (P = .042), absence of a post (P = .047), and presence of an adequate coronal restoration (P = .056, odds ratio = 3.71) had significant effects on treatment outcome. CONCLUSION: The technical quality of periapical surgery, the presence of a periapical lesion, and adequate apical and coronal seal are important prognostic determinants of successful periapical surgery.
An unusual accident in clinical endodontic practice is described. The Gates Glidden drill is currently being used for establishing straight-line access in endodontic practice (1). One potential hazard in using the Gates Glidden drill is that it can separate within the canal (2). This article reports an accident involving a Gates Glidden drill separating in the elbow of a dentist during endodontic practice and to discuss the safety of using a Gates Glidden drill.
The current status of dental education in the United States and Canada with respect to faculty recruitment and retention is reviewed; poor salaries and lack of interest are major reasons for dwindling numbers. The pros and cons of an academic career and what the American Association of Endodontists' (AAE) and other constituencies have done to help alleviate the problem are presented. The results of an on-line survey to full-time endodontic educators on their perspectives on education are presented; personal fulfillment, sharing knowledge, giving back to the profession, and passion for teaching were reasons for teaching whereas income disparity, lack of mentoring, and high demands of the job were reasons against an academic career. The final phase of the paper proposes various strategies on how the AAE and its membership, dental schools, and the American Board of Endodontics (ABE) can further work together to alleviate the critical problems facing endodontic education.
Considerable preparation, planning and detailed organization are necessary if endodontic 'hands-on' courses are to be stimulating and worthwhile for participant and teacher alike. Projection facilities, lighting, seating and working surface requirements must be checked immediately on arrival at the venue. The format, although flexible enough to allow for the wide range of knowledge and practical ability found within any one group, must adhere to and stress the current fundamentals in endodontic teaching. Not only can information and skill in diagnosis, root canal preparation and obturation be taught in a 'hands-on' format, but rubber dam isolation techniques can also be practised very successfully. Tutors must be prepared to demonstrate personally their clinical ability and experience of principles and techniques taught during the course. Post-course feedback can be an extremely useful means of ensuring that 'hands-on' courses are relevant, with the appropriate practical emphasis required by the general dental practitioner, as well as the necessary stress on endodontic principles.
Undergraduate endodontology is taught in Australian Universitiies in Restorative or Conservative departments. Courses generally consist of twelve lectures, three seminars and technique courses. Average clinical experience is six to eight endodontic treatments in anterior and posterior teeth. Comparison with American and Scandinavian teaching, staff and facilities indicates that this subject is receiving considerably less emphasis in Australia. As endodontic therapy is eseential in any dental health programme based on preventive dentistry there is a considerable need to upgrade undergraduate endodontic teaching in Australia.
BACKGROUND: The advantage of using a faster film for length determination in endodontic therapy is obvious. However, for such a film to be generally accepted, it must demonstrate comparable diagnostic quality to traditionally used films. METHODS: The comparative accuracy of canal length determination of Ultraspeed and Ektaspeed Plus dental X-ray films was assessed in maxillary first and second molars; for different canals, for different teeth, for different exposures, and for different examiners (five general dentists and three endodontic specialists). RESULTS: In general, there were no significant differences between films, among examiners, or any interaction between films and exposures. That is, an assessor's ability to estimate lengths was not significantly influenced by the film type or by exposure used. There was a wide divergence in the individual assessor's ability to estimate lengths. Specialists estimated lengths more accurately than general practitioners and estimated lengths more accurately with Ektaspeed Plus film. Length determination in distobuccal and mesiobuccal canals was more accurate than in palatal canals. Most palatal canals were underestimated in length by more than 1mm. The use of file sizes larger in number than size 15 is recommended in these canals. CONCLUSION: For length determination, Ektaspeed Plus dental X-ray film is as effective as Ultraspeed film. Given the acceptable quality and accuracy of Ektaspeed Plus film, there seems to be no clinical reason to subject patients to greater radiation by using a slower film during endodontic therapy.
During 200 years of progress in endodontics, various sciences have contributed to our understanding of the physiology and pathology of the dental pulp. Early treatment included cauterization of the pulp, the use of poultices or leeches, and tooth transplantation or replantation. Various methods of pulp devitalization are reviewed. Near the turn of the century, the discovery of X rays made diagnosis more accurate and the discovery of local anesthetics eliminated pain during endodontic treatment. Although the focal infection theory slowed the acceptance of endodontic treatment in this century, the biomechanical concept of treatment and research have recently opened new avenues for treatment and have initiated improvements in medicaments and filling materials.
This study compared the ability of various intracanal restorative materials to restore the stiffness of endodontically treated teeth. We randomly placed bovine central incisors into six groups. We did not instrument negative control teeth, and we instrumented, but did not restore, positive control teeth. We restored teeth in the experimental groups with resin-based composite, resin-based composite plus a fiberglass post, or resin-based composite plus a cemented metal post. We subjected all teeth to nondestructive, compressive testing and recorded the stiffness of each sample. Results indicated that performing endodontic access and instrumentation alone resulted in a 24% loss in tooth stiffness. Teeth restored using an intracanal resin bonding technique alone or in combination with a post regained the stiffness lost from access and instrumentation, and teeth that were restored with bonded resin and a metal post cemented with Panavia 21 cement were significantly stiffer than the untreated negative control group (p < 0.05). Our results suggest that intracanal resin bonding techniques may reduce the need for immediate crown placement after endodontic therapy.
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.
The aim of this paper is to propose a single stage global treatment of endodontic, periapical and periodontal lesions in a lateral maxillary incisor with dens invaginatus. A 24 year-old woman presenting a lateral maxillary incisor with dens invaginatus in association with periapica1 and periodontal lesions underwent simultaneous surgical, endodontic and periodontal regenerative procedures. At 2, 6, 12, 18 months follow-up the radiographic healing appeared to be improved and the periapical lesion healed completely 1 year after surgical intervention. Surgery in association with endodontic and periodontal procedures represents the treatment of choice to maximize long term prognosis in cases of dens invaginatus with chronic periapical and periodontal lesions.