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[Today's trends in endodontics].

Some new means and innovative operative techniques in the field of endodontics are presented that have been developed and perfected over time. Instruments such as the operative microscope, ultrasonography, miniaturised tools for surgery, new materials such as mineral trioxide aggregate (MTA) should become part of the daily routine of the endodontist. For example, the operative microscope plays a role in diagnosing pulp damage after removal of deep caries; in orthograde endodontics in diagnosing perforations; alongside ultrasonography in the search for calcified canals, removal of pins (screw-type, fibre, etc.) and also in positioning MTA. In all these cases, the operative microscope is used discontinuously, alternating working and observation phases. In endodontic surgery, the operative microscope is on the contrary used continuously, enabling the surgeon to observe details of anatomy of the root apex at high magnification, and above all enabling positioning of canal obturation with perfect seal. It is clear that the operative microscope used in all surgical phases will enable complete management of the operation and facilitate the endodontist in observing the operative field, otherwise very difficult to control.

Dental Instruments↗

PubMed2003

The major factors that influence endodontic retreatment decisions.

The presence of a new or persistent periapical radiolucency adjacent to a rootfilled tooth is often used as a criterion of endodontic treatment "failure". However, clinicians' suggested management of such cases is subject to substantial interindividual variation. Several components that might influence endodontic retreatment decision making have been explored, but data on which factors dentists actually think they consider, are missing. The aim was to interview 20 general dental practitioners (GDPs) and 20 endodontists about factors they thought would influence the prescription of endodontic retreatment. Six simulated cases were presented as cartoons accompanied with a clinical history. In two of the cases the teeth were planned to serve as an abutment tooth in a fixed prosthodontic construction. The status of the periapical bone tissue and the quality of rootfilling seal were varied. Between 1 and 6 factors per case were reported to influence decision making. In cases not planned to serve as abutment teeth most dentists considered that the periapical condition was the most important factor, whilst they considered the fixed prosthodontic construction to be the most important factor in cases planned as abutment teeth. Generally, endodontists seem to be more inclined to retreat and act on the mere presence of a periapical lesion regardless of size than GDPs. In a real clinical setting in direct contact with patients, additional factors like economy and patients' preferences might be expected to exert a major influence. The majority of the dentists stated that they thought that their colleagues would make similar decisions as they did themselves.

Attitude of Health Personnel↗

PubMed2003

Endodontics and new graduates, Part 2: Undergraduate experience and course evaluation.

A postal survey of recent United Kingdom dental graduates was undertaken to establish the amount of their undergraduate endodontic experience and their opinions of their training. A 75% response was achieved from all but two schools. Recent graduates had generally undertaken fewer cases as students than older graduates. Several had undertaken very few endodontic procedures as students. Differences and trends were seen in the opinions of students and their experiences among the schools, and between the two year groups studied. Most students were not very confident to undertake molar endodontics. Many felt they needed more practical experience as students and training in newer techniques and instrumentation.

Attitude of Health Personnel↗

PubMed2004

A cost-effective simulation curriculum for preclinical endodontics.

A challenge in contemporary dental education is to achieve a smooth transition from preclinical teaching environments to patient-care clinics in a cost-effective manner. The preclinical endodontic courses at The University of Texas, Dental Branch at Houston provide a unique learning environment that enables the student to perform endodontic treatment on extracted teeth in a typodont, and be involved in diagnosis and treatment-planning discussions. The specially designed stone typodont used has built-in radiographic capability, and is mounted at each chair in the clinic. During each preclinical session, students are assigned clinical cubicles and proper aseptic protocol is followed. Students are required to wear gloves, masks and eyewear, and place a rubber dam during treatment. Written self-assessment evaluations based upon prescribed criteria are utilised; feedback is given by faculty composed of both full-time endodontists and graduate students who periodically rotate and are calibrated on a regular basis. In the lecture phase, clinical case scenarios are presented to reinforce concepts of diagnosis and emergency care and to help integrate endodontics with other disciplines; a Socratic-like teaching style is established by the faculty facilitator to create an environment for developing critical-thinking and problem-solving skills. The overall feedback from graduating students has been very positive. Advantages of this format are an easier transition to patient management, a more keen interest in specialsation and a perceived increase in levels of confidence.

Clinical Competence↗

PubMed2005

[Endodontic diagnosis].

In this article endodontic diagnosis is discussed following the clinical diagnostic process. A description is given about pain from endodontic origin and a comprehensive overview of the clinical diagnostic tests is discussed. In the chapter clinical classification of pulpal and periapical disorders all the possible endodontic diagnoses are extensively discussed.

Dental Pulp Diseases↗

PubMed2006

[Nonsurgical micro-endodontics and its outcome].

The introduction of dental operating microscope and microscopic instruments including ultrasonic tips has revealed the endodontic therapy. Dental operating microscope provides magnification and illumination for the operational area. Cases which should be treated by surgical approach in the past can be managed predictably by nonsurgical micro-endodontics. The use of dental operating microscope and ultrasonics in non-surgical endodontics includes location of missed canal, removal of intracanal post and separated instruments, negotiation of ledged canals, management of apical transportation and perforation repair.

Endodontics↗

PubMed2006

[Achievement of endodontics at the edge of the century].

Endodontics is the branch of dentistry which deals with dental pulp pathology and treatment of root canals. There has been noted a significant improvement in this discipline recently, which has made a substantial increase in therapeutical efficiency and made dentists' work easier. It was possible due to dynamic development of new material technologies and clinical procedures. Aim of this paper was to present the current state of knowledge in endodontics. The most important achievements were especially stressed. Among the most important for development of present endodontics there are: new methods of canal length estimation, modem methods of visualization, nickel titanium rotary instrumentation, numerous gutta-percha obturation systems and also more biocompatible obturation materials.

Dental Instruments↗

PubMed1980

Technique models: an endodontic teaching aid.

Many endodontic techniques are difficult to explain and to understand because the student finds them difficult to visualize. The technique model described above enables the student to visualize the relationship between the canals and surrounding anatomical structures. This model also enables the teacher to prepare and compose a step-by-step procedure; many times this is impossible to do in a clinical case. The technique model is a vivid, simple, and inexpensive way to demonstrate various endodontic procedures, and can be an invaluable tool in endodontic education.

Audiovisual Aids↗

PubMed1981

Characteristics of predoctoral endodontic education in the United States and Canada.

A survey was conducted to assess the current state of predoctoral endodontic education programs in United States and Canadian dental schools. The investigation focused on faculty characteristics, the learning climate for endodontics, and problems of administration. Comparison was made between current learning conditions in the schools and desirability of these conditions. Comparisons also were made between large and small schools. Endodontic program directors identified numerous conditions associated with the enhancement of learning. Problems reported were inadequate time to pursue research and scarcity of full-time faculty in some programs.

Administrative Personnel↗

PubMed1977

A plastic tube technique for direct vision of endodontic procedures.

A technique for the direct visualization of endodontic procedures utilizing clear plastic tubes machined to simulate root canals is described. The visualization of endodontic procedures allows for their evaluation by the clinician as well as their use as an adjunct to didactic courses in endodontics. During mechanical instrumentation it is evident that a concerted effort must be made to debride all of the walls of a canal. Hydraulic forces are seen to play a major role in irrigation and in applying root canal cement. The technique also reveals voids in the completed root canal filling when verticle condensation is used to obturate the canals.

Audiovisual Aids↗

PubMed2006

Innovative wavelengths in endodontic treatment.

BACKGROUND AND OBJECTIVES: The sanitation of the root canal system and the adjacent dentin has always been a key requirement for successful endodontics. In recent years, various laser systems have provided a major contribution to this aim, namely the Nd:YAG-, the 810 nm Diode-, the Er:YAG-, and the Er,Cr:YSGG laser. Numerous studies could prove their efficiency within the endodontic procedure. Recently, two new wavelengths have been introduced to the field of oral laser applications: The KTP laser emitting at 532 nm and the 980 nm diode laser. The present in vitro investigation was performed to evaluate the effects of these laser systems focusing on their antibacterial effect in deep layers of dentin and their impact on the root canal dentin. STUDY DESIGN/MATERIALS AND METHODS: Two-hundred slices of root dentin with a thickness of 1 mm were obtained by longitudinal cuts of freshly extracted human premolars. The samples were steam sterilized and subsequently inoculated with a suspension of either Escherichia coli or Enterococcus faecalis. After the incubation, the samples were randomly assigned to the two different laser systems tested. Each laser group consisted of two different operational settings and a control. The dentinal samples underwent "indirect" laser irradiation through the dentin from the bacteria-free side and were then subjected to a classical quantitative microbiologic evaluation. To assess the temperature increase during the irradiation procedure, additional measurements were carried out using a thermocouple. To assess the impacts on the root canal walls, 20 additional samples underwent laser irradiation at two different settings and were subjected to scanning electron microscopy. RESULTS: Microbiology indicated that both laser systems were capable of significant reductions in both test strains. At an effective output power of 1 W, E. coli was reduced by at least 3 log steps in most of the samples by the tested wavelengths, with the best results for the KTP laser showing complete eradication of E. coli in 75% of the samples. E. faecalis, a stubborn invader of the root canal, showed minor changes in bacterial count at 1 W. Using the higher setting of 1.5 W, significant reductions of E. coli were again observed with both laser systems, where the lasers were capable of complete eradication of E. faecalis to a significant extent. There was no significant relation between the temperature increase and the bactericidal effect. CONCLUSIONS: The present study demonstrates that both wavelengths investigated could be suitable for the disinfection of even the deeper layers of dentin and equal the results achieved by established wavelengths in state-of-the-art endodontics.

Bacterial Infections↗

PubMed2001

Antimicrobial activity of four root canal sealers against endodontic pathogens.

The antibacterial effects of various types of widely used endodontic sealers have not been compared systematically on facultative or obligate anaerobic endodontic pathogens. The aim of this study was to evaluate the antimicrobial properties of four commonly used endodontic sealers: two epoxy-resin-based sealers (AH26, AH plus), one zinc-oxide eugenol-based sealer (N2), and one calcium hydroxide-based sealer (Sealapex). The testing microbes were four facultative anaerobic species (Streptococcus mutans, Streptococcus sanguis, Escherichia coli, and Staphylococcus aureus) and four obligate anaerobic species (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, and Prevotella intermedia). The freshly mixed sealers were placed into the prepared wells of agar plates inoculated with the test microorganisms. After varying periods of incubation (2 days for facultative anaerobic species and 7 days for obligate anaerobic species), the zones of growth inhibition were observed and measured. All the sealers were distinctly different from each other in their antimicrobial activity. The sealers showed different inhibitory effects depending on the types and bacterial strains. N2 containing formaldehyde and eugenol proved to be the most effective against the microorganisms. The extreme antimicrobial potency of this root canal sealer must be weighted against its pronounced tissue toxic effect.

Analysis of Variance↗

PubMed1983

Punch shear testing of extracted vital and endodontically treated teeth.

Plano-parallel specimens of human dentin cut from vital and endodontically treated teeth were tested by the punch shear test. Shear strength values were found to positively correlate with approximate toughness values. Statistically significant differences were found between shear strength and toughness values for vital and endodontically treated teeth, the latter showing lower values. The clinical impression that endodontically treated teeth are weaker and more brittle than vital teeth has therefore been quantitated. Anatomically different teeth or the methods used to store and cut teeth could not be consistently correlated with punch shear and toughness values. When dentin slices were constrained during punching so that bending was prevented, the precision of the results was improved and higher values were recorded.

Adult↗

PubMed1981

An endodontic-prosthodontic approach to internal tooth reinforcement.

Recent years have seen an emphatic surge of using root canal therapy as a means of retaining teeth which otherwise would have been extracted. Many of those endodontically treated teeth are badly broken down, requiring extensive rebuilding to make them restorable as individual units or units in fixed or removable prosthetic designs. The authors present an endodontic-prosthodontic approach in evaluating those teeth and in resolving problems on how best to strengthen the endodontically treated tooth to make it a viable component of the mouth.

Crowns↗

PubMed1988

Evaluation of shear strength at the cement-endodontic post interface.

The strength characteristics of the cement-implant interface were evaluated for smooth-tapered, threaded, and porous-surfaced endodontic implants with the use of different cements. Specifically, tensile and torsional shear strengths were measured for zinc phosphate, polycarboxylate, glass-ionomer, silicophosphate, and AH-26 cements. The results indicated superior shear strength characteristics for threaded endodontic implants on axial loading. However, this strength was diminished when torsional forces were applied. Porous-surfaced endodontic implants showed strong resistance to both axial and torsional loading.

Bismuth↗

PubMed1989

The labial endodontic access: a rational treatment approach in anterior teeth.

Labial endodontic access is an alternative to the conventional lingual endodontic access in permanent teeth. The labial approach facilitates visibility and provides direct access to the root apex. Current restorative procedures offer improved methods to overcome the esthetic impairment resulting from this approach. Labial access is especially beneficial for patients with limited mandibular opening. Other indications are in Angle's class II division 2 dentitions or in teeth with resin-bonded cast restorations. Anatomic studies for the single tooth that corroborate the labial endodontic approach are reviewed.

Cuspid↗

PubMed1990

Effect of post adaptation on fracture resistance of endodontically treated teeth.

This study determined the effect of different post designs and varying amounts of post-to-canal adaptation on the fracture resistance of endodontically treated teeth. Forty freshly extracted maxillary central incisors were endodontically treated. Groups of 10 teeth were prepared according to four experimental designs. Cast post and cores and crowns were waxed, cast, and luted with zinc phosphate cement on a static loading device. The teeth were embedded in acrylic resin and the crowns were loaded on a universal testing machine at 130 degrees to the long axis of the tooth until failure. Maximum adaptation of the residual root structure with a tapered post significantly increases the fracture resistance of endodontically treated teeth, but upon failure renders the tooth nonrestorable. Tapered posts resulted in fractures that were directed more apically and lingually. Parallel-sided posts had a lower frequency of fracture upon failure, involving less tooth structure. Parallel-sided posts surrounded by large amounts of cement had no significant effect on failure loads.

Analysis of Variance↗

PubMed1993

Comparison of the retention of endodontic posts after preparation with EDTA.

Significant differences in the retention of preformed endodontic posts for endodontically treated teeth were determined with (1) parallel-sided, passively placed Para-Post dowel versus mechanically engaging, threaded Flexi-Post dowel; (2) irrigation of canals with EDTA; (3) cementation with urethane dimethacrylate resinous or zinc phosphate cement. It was hypothesized that EDTA would substantially increase retention by removing the smear layer on the prepared canal wall and create micromechanical retention in the dentin. Extracted teeth were prepared with endodontic posts and divided in groups representing combinations of variables. The forces for post removal and the locations of the retentive bond failures were recorded. The results indicated that EDTA did not significantly affect retention. The Flexi-Post dowel was significantly more retentive than the Para-Post dowel but also exhibited a greater potential for tooth damage compared with the Para-Post dowel during retentive failure loads.

Analysis of Variance↗