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PubMed2004

Cardiovascular effects and efficacy of a hemostatic agent in periradicular surgery.

The purpose of this study was to evaluate the hemostatic efficacy and systemic cardiovascular effects of CollaCote collagen sponges saturated with 2.25% racemic epinephrine during endodontic surgery. A total of 48 patients participated in the study. Patients received CollaCote-saline or CollaCote-epinephrine placed in the bony crypt, after which hemostatic efficacy was evaluated. Blood pressure and pulse rate was recorded before and after administration of the local anesthetic, after the application of the test solutions, and before the patient's dismissal. Results showed no significant difference in blood pressure or pulse rate between the experimental and control groups. In the CollaCote-saline group, five of six cases failed to achieve hemorrhage control. In the CollaCote-epinephrine group, 1 of 42 cases had no hemorrhage control. Two patients had slight but apparent intermittent bleeding. Complete hemostasis was achieved in 39 of 42 cases. In conclusion, the results suggest that CollaCote collagen sponges saturated with 2.25% racemic epinephrine provide excellent hemostasis with no evident changes in blood pressure or pulse rate.

Absorbable Implants↗

PubMed2004

Clinical management of a maxillary lateral incisor with vital pulp and type 3 dens invaginatus: a case report.

A maxillary right lateral incisor with a type 3 dens invaginatus and a large periapical lesion with vital pulp in a separate root canal was treated both nonsurgically and surgically. Care was taken not to expose or devitalize the vital pulp in the main root canal system during the treatment. The signs and symptoms ceased after the treatment, and 4-month recall showed complete bone healing with pulp vitality maintained.

Adult↗

PubMed2005

Levels of evidence for the outcome of endodontic surgery.

The purpose of this investigation was twofold: (1) to search for clinical articles pertaining to success and failure of periapical surgery and (2) to assign levels of evidence to these studies except case reports. Electronic and manual searches were conducted to identify all the literature regarding success and failure of periapical surgery since 1970. Articles were reviewed, and each article was assigned to a level of evidence from 1 (highest level) to 5 (lowest level). This search located 79 clinical studies. Among these studies, there were no level of evidence-1 randomized clinical trial studies. Five of the seven level of evidence-2 randomized clinical trials compared postoperative pain between surgical and nonsurgical retreatment. Only two level of evidence-2 randomized clinical trials compared the outcomes of surgical treatment with that of nonsurgical treatment. The majority of frequently quoted "success and failure" studies were case series (level of evidence 4).

Apicoectomy↗

PubMed2004

Treatment outcome in endodontics-The Toronto Study. Phases I and II: apical surgery.

This study prospectively assessed the 4 to 8 yr outcome of apical surgery performed by graduate students in phases I and II of the Toronto Study. The study cohort included 155 teeth in 138 patients. Outcome was assessed by a blinded and calibrated examiner. Clinical and radiographic measures were used for a dichotomous outcome: healed (no signs and symptoms, Periapical Index score </= 2 or scar), or diseased (presence of signs and symptoms, or Periapical Index score >/= 3). The recall rate was 85% and the overall healed rate 74%. Healed rate was significantly higher for teeth with small (</= 5 mm) than larger preoperative lesions (chi, p = 0.02). Logistic Regression revealed an increased odds of disease persistence for teeth with larger preoperative lesions (OR = 3.81, CI = 1.2-12.1), and preoperative root-filling of adequate length (OR = 3.7, CI = 1.1-11.1). Preoperative lesion size and root-filling length were significant predictors of outcome of apical surgery.

Apicoectomy↗

PubMed2005

Periapical tissue responses and cementum regeneration with amalgam, SuperEBA, and MTA as root-end filling materials.

The purpose of this study was to compare the periapical tissue responses and cementum regeneration in response to three widely used root-end filling materials, amalgam, SuperEBA, and Mineral Trioxide Aggregate (MTA). These materials were placed using modern microsurgical techniques on endodontically treated dog premolars and molars. After 5 months, the cell and tissue reactions of surface-stained un-decalcified ground sections were evaluated by light microscopy and statistically analyzed. The major difference in the tissue responses to the three retrofilling materials were the degree of inflammation and types of inflammatory cells, number of fibrous capsule formations, cementum neoformation over these materials, osseous healing and resulting periodontal ligament thickness. MTA showed the most favorable periapical tissue response, with neoformation of cemental coverage over MTA. SuperEBA was superior to amalgam as a root-end filling material.

Aluminum Compounds↗

PubMed2005

Erbium:YAG laser versus ultrasonic in preparation of root-end cavities.

The aim of this in vitro study was to compare the sealing effectiveness of the Erbium:YAG laser to the sealing effectiveness of an ultrasonic device in the preparation of similar retrograde cavities using different retrograde filling materials. After root-canal instrumentation and filling, apices of 60 single-rooted teeth were resected. Retrograde class I cavities 3 mm deep were prepared using an ultrasonic device (group A) and Er:YAG laser (group B). An ultrasonic unit was used with CT-5 retrotip at the frequency of 32 KHz. Laser beam parameters were a pulse of very short duration (100 micros), energy of 280 mJ, and repetition rate of 10 Hz. Cavities of each group of 10 samples were filled with mineral trioxide aggregate (MTA), Super-EBA, and IRM. Microleakage was measured using a fluid transport model. The results showed that cavities prepared with Er:YAG laser have significantly lower microleakage for all tested materials.

Aluminum Compounds↗

PubMed2004

A standard for radiopacity of root-end (retrograde) filling materials is urgently needed.

AIM: To assess the radiopacity of materials used, or recommended for use, as apical root-end (retrograde) fillings. METHODOLOGY: The radiopacity of 14 materials falling into the category of root-end filling materials was measured in equivalent millimetres of aluminium (mm Al) using a new computerized method. These included temporary or intermediate sealing materials; composite, compomer and GIC filling materials; EBA-derived cements; amalgam, etc. Gutta-percha cone material was added as a control. Samples of 1 mm thickness were radiographed on periapical film alongside an aluminium step wedge calibrated in millimetres, and the opacity of the materials, in greyscale or pseudo-colour, was compared with the equivalent step. RESULTS: The radiopacity ranged from 1.75 mm Al to >10 mm Al. The lower range appears insufficient for routine clinical detection when it is compared with the minimal requirement for intracanal fillings. CONCLUSIONS: Because of the proliferation of root-end filling materials with a broad range of radiopacity, an international standard stipulating the required minimal radiopacity, as well as other properties, is needed urgently. It should be based on in vitro results and on large-scale clinical radiographic surveys.

Contrast Media↗

PubMed2004

Marginal adaptation of mineral trioxide aggregate (MTA) compared with amalgam as a root-end filling material: a low-vacuum (LV) versus high-vacuum (HV) SEM study.

AIM: To compare the marginal adaptation of mineral trioxide aggregate (MTA) or amalgam root-end fillings in extracted teeth under low-vacuum (LV) versus high-vacuum (HV) scanning electron microscope (SEM) viewing conditions. METHODOLOGY: Root-end fillings were placed in 20 extracted single-rooted maxillary teeth. Ten root ends were filled with MTA and the other 10 root ends were filled with amalgam. Two 1 mm thick transverse sections of each root-end filling were cut 0.50 mm (top) and 1.50 mm (bottom) from the apex. Gap size was recorded at eight fixed points along the dentine-filling material interface on each section when uncoated wet (LV wet (LVW)) and dry under LV (0.3 Torr) in a JEOL JSM-5800 SEM and backscatter emission (LV dry uncoated (LVDU)). The sections were then air-dried, gold-coated and gap size was recorded once again at the fixed points under HV (10(-6) Torr; HV dry coated (HVDC)). Specimen cracking, and the size and extent of the crack were noted. RESULTS: Gap sizes at fixed points were smallest under LVW and largest under HVDC SEM conditions. Gaps were smallest in MTA root-end fillings. A General Linear Models Analysis, with gap size as the dependent variable, showed significant effects for extent of crack in dentine, material and viewing condition (P = 0.0001). CONCLUSIONS: This study showed that MTA produced a superior marginal adaptation to amalgam, and that LVW conditions showed the lowest gap size. Gap size was influenced by the method of SEM viewing. If only HV SEM viewing conditions are used for MTA and amalgam root-end fillings, a correction factor of 3.5 and 2.2, respectively, may be used to enable relative comparisons of gap size to LVW conditions.

Aluminum Compounds↗

PubMedDate not supplied