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PubMed2004

Lasers in endodontics.

With the rapid development of laser technology, new lasers with a wide range of characteristics are now available and being used in various fields of dentistry. In the past two decades, much experience and knowledge has been gained. This article provides an overview of the current and possible future clinical applications of lasers in endodontics, including their use in alleviating dentinal hypersensitivity, modification of the dentin structure, pulp diagnosis, pulp capping and pulpotomy, cleaning and shaping of the root canal system, and endodontic surgery. Endodontic procedures for which conventional treatments cannot provide comparable results or are less effective are emphasized.

Dental Pulp Diseases↗
PubMed2006

The effect of alveolar bone loss on the load capability of restored endodontically treated teeth: a comparative in vitro study.

OBJECTIVES: The aim of the present investigation was to study the influence of a reduced bone support on the fracture resistance of endodontically treated teeth restored with glass fibre-reinforced posts (FRC). METHODS: 30 caries-free maxillary central incisors were divided into 3 groups (n=10). Endodontic treatment was performed. Teeth were flattened 2 mm above the cemento-enamel junction. Group I (control) simulated a clinical situation without horizontal bone loss. In group II a horizontal bone loss of 25% and in group III of 50% was simulated. All specimens received FRC posts and composite core restorations. All-ceramic crowns were adhesively cemented. Specimens were exposed to thermal cycling and mechanical loading (TCML) and finally statically loaded until failure in a universal testing machine (v=1 mm/min). Non-parametric tests were used to compare median fracture loads between groups. Fracture modes were compared using Fisher's exact test. RESULTS: The median fracture load values (min/max) in [N] were: group I=501 (326/561), group II=422 (323/495); group III=352 (266/406), p=0.004. Two specimens in each group II and III failed during TCML. Statistical analysis revealed statistically significant differences between all test groups regarding maximum fracture load and mode of fracture. CONCLUSIONS: The fracture resistance of endodontically treated teeth restored adhesively with a FRC post, composite core, and all-ceramic crown is dependent on the level of surrounding supporting periodontal bone. Loss of alveolar bone loss due to periodontal disease may lead to an increased risk of failure.

Alveolar Bone Loss↗
PubMed2006

Microbial contamination of endodontic files received from the manufacturer.

This study was conducted to test the sterility of new unused endodontic files received from manufacturers. Fifteen types of hand and rotary files from five manufacturers were tested. Positive microbial cultures were obtained from 13% of the 150 files tested. Autoclaved files were intentionally contaminated with bacterial species recovered from the positive cultures to evaluate a chairside sterilization method. Immersion of contaminated files in 5.25% sodium hypochlorite for five minutes sterilized the files. The results of this study indicate that endodontic files should be sterilized before clinical use. It is also suggested that manufacturers list the sterility state of their endodontic files on their packaging.

Bacillaceae↗
PubMed2006

Autoaggregation and coaggregation of bacteria associated with acute endodontic infections.

Biofilms and microbial aggregates are a common mechanism for the survival of bacteria in nature. Microbial aggregates have been associated with intraradicular and extraradicular endodontic disease. One objective of this study was to assess bacteria isolated from acute endodontic infections for autoaggregation and coaggregation. Another objective was to use both a conventional visual assay and a novel fluorescent dye-staining technique to study bacterial aggregation. Sixty-two strains of bacteria were isolated from 10 clinical samples of endodontic abscesses or cellulitis. Autoaggregation was detected in 35/62 (56.45%) of the bacteria using the visual assay. Coaggregation of bacteria from each of the samples was demonstrated for 29/183 (15.85%) bacterial pairs using the visual assay and 148/183 (80.87%) using the dye-staining assay. Coaggregation was observed for each of the 15 genera assayed, especially Prevotella, Streptococcus, and Fusobacterium. The dye-staining assay using a confocal microscope was a highly sensitive method to detect aggregation of bacteria.

Acute Disease↗
PubMed2006

Modern endodontic surgery concepts and practice: a review.

Endodontic surgery has now evolved into endodontic microsurgery. By using state-of-the-art equipment, instruments and materials that match biological concepts with clinical practice, we believe that microsurgical approaches produce predictable outcomes in the healing of lesions of endodontic origin. In this review we attempted to provide the most current concepts, techniques, instruments and materials with the aim of demonstrating how far we have come. Our ultimate goal is to assertively teach the future generation of graduate students and also train our colleagues to incorporate these techniques and concepts into everyday practice.

Aluminum Compounds↗
PubMed2006

Initial in vitro biological response to contemporary endodontic sealers.

The objective of this study was to evaluate the cytotoxicity of three endodontic sealers (AH Plus/Maillefer-Dentsply, Epiphany/Pentron, GuttaFlow, Coltene-Whaledent). Materials were mixed according to the manufacturer instructions and packed into Teflon molds (10 x 1 mm). For cytotoxicity testing (MTT method), the specimens were placed in contact with cultured cells, then evaluated at two subsequent time points (24 or 72 h). In addition to testing the mixed materials, 5 microl of primer liquid (GuttaFlow and Epiphany) and resin solvents (HEMA, ethanol, sterile water, or acetone) were added directly in culture for 24 and 72 h. The results showed that most materials pose significant cytotoxic risks and that cytotoxicity generally increased with time. At 72 h, GuttaFlow became significantly less toxic than AH Plus, Epiphany sealer, and Resilon. The current results support the need to continue to develop better endodontic sealers that combine the excellent sealing and bonding properties of resins with acceptable biological properties for endodontic applications.

Acetone↗
PubMed2006

Survival rate of endodontically treated teeth with posts after prosthetic restoration.

The purpose of this retrospective clinical study was to evaluate the survival rate of teeth that were endodontically treated and restored with endodontic posts and prosthodontic restorations. A total of 864 teeth in 360 patients were included in the study. Dental records and radiographs of the patients were evaluated and four parameters were documented. The parameters were type of post, type of prosthodontic restoration, observation time, and, in cases of failure, failure mode. Statistical survival analyses were performed according to Kaplan-Meier. The mean observation time was 22.5 +/- 14.9 months. The calculated survival rates of the abutments were statistically significant different for fixed partial dentures (FPDs) and for removable partial dentures (RPDs) with survival rates of 92.7% and 51.0% after 60 months, respectively. Most of the presumed factors influencing the survival rate of endodontically treated abutment teeth only affected the outcome in the RPD group. Teeth restored with post and cores present a high risk for failure when used as abutments for conical-double-crown-retained RPDs.

Adult↗
PubMed2006

Endodontic surgery using 2 different magnification devices: preliminary results of a randomized controlled study.

PURPOSE: The introduction of microsurgical instruments and magnification devices has brought advantages in root-end management and the application of root-end filling materials. The main purpose of this prospective clinical study was to monitor the outcome of ultrasonic root-end preparation using magnification loupes or an endoscope. Tooth location and the presence of post restoration were also examined as potentially affecting the outcome. MATERIALS AND METHODS: Teeth treated surgically showed a periradicular lesion of strictly endodontic origin. A total of 59 patients were included in the study, according to specific selection criteria. Following the reflection of a full mucoperiosteal tissue flap, residual soft tissues were curetted, root ends were resected, and root-end cavities were prepared ultrasonically with a zirconium nitrate tip, and zinc oxide EBA-reinforced cement root-end fillings were placed. Thirty-two root-end management procedures were performed using magnification loupes and 39 using an endoscope. All cases followed for a period of 1 year were classified into 3 groups (success, uncertain healing, and failure) according to radiographic and clinical criteria. RESULTS: Of the 71 teeth evaluated at 1-year follow-up, 67 teeth (92.95%) successfully healed, 3 teeth had uncertain healing, and 2 failed. In the group using endoscopy, 94.9% of successful healing was achieved, while for the other group, 90.6% was recorded. We found no statistically significant differences in treatment results related to the arch (P = .20), post restoration (P = .21), or type of magnification device (P = .08). CONCLUSIONS: In the present study, adherence to a strict endodontic surgical protocol and the use of modern surgical endodontic procedures, together with visual magnifications, resulted in an overall high success rate.

Adult↗
PubMed2004

Endodontic retreatment strategies used by general dental practitioners.

PURPOSE: Root-filled teeth with persistant periapical radiolucencies are often classified as endodontic failures. Studies have shown that general dental practitioners (GDP) do not consistantly suggest retreatment of "failures." The "Praxis Concept" (PC) theory hypothesizes that dentists conceive periapical health and disease as different states on a continuum. This study examined endodontic retreatment concepts among 157 GDPs from Värmland, Sweden. STUDY DESIGN: In 6 simulated cases the periapical condition, quality of root filling and presence of a root canal-retained post were systematically varied. Five options were offered: no therapy, wait and see, nonsurgical retreatment, surgical retreatment, and extraction. RESULTS: The investigation showed large interindividual variation in retreatment behavior among the GDPs. Only 9 dentists (6%) where found to repeatedly suggest retreatment of endodontic failures. A majority of GDPs (79%) performed in accordance with PC. CONCLUSIONS: The data indicate that several retreatment decision rules are used by Swedish GDPs, but PC-derived strategies attract the majority.

Adult↗
PubMed2004

Mycetoma of the maxillary sinus: endodontic and microbiological correlations.

OBJECTIVE: The purpose was to show the capacity of zinc oxide and eugenol to affect the growth of Aspergillus fumigatus. STUDY DESIGN: An in vitro microbiological analysis was conducted on samples from infected maxillary sinuses and on 3 different endodontic sealers. RESULTS: Tests showed that zinc oxide in solution favors the growth of Aspergillus fumigatus, while eugenol inhibits this growth, even when mixed with zinc oxide powder. This inhibiting effect decreases over time. A reduced effectiveness was demonstrated over a 75-day period. CONCLUSIONS: The hypothesis is that the diminishing concentration of eugenol over time in endodontic sealers allows the zinc oxide to support growth of Aspergillus fumigatus. This is reinforced by clinical experience, where mycetoma has developed years after endodontic therapy with excess sealer in the maxillary sinus.

Antifungal Agents↗
PubMed2005

Differences in prevalence of selected bacterial species in primary endodontic infections from two distinct geographic locations.

OBJECTIVE: This study intended to compare the prevalence of 7 putative endodontic pathogens in samples of primary endodontic infections taken from patients of 2 distant geographic locations. STUDY DESIGN: Samples from infected root canals associated with asymptomatic periradicular lesions or from pus aspirated from acute periradicular abscesses were collected from patients in Rio de Janeiro, Brazil, and Seoul, South Korea. South Korean samples were frozen and delivered to Brazil, where all steps in the molecular analysis were performed. DNA was extracted and a species-specific nested polymerase chain reaction assay was used to detect 7 target bacterial species. RESULTS: The most prevalent species detected in Brazilian samples were Porphyromonas endodontalis (79% of the cases) , Treponema denticola (79%), and Dialister pneumosintes (76%). The most prevalent species found in South Korean samples were Fusobacterium nucleatum (38% of the cases) , Tannerella forsythia (26%), and Treponema maltophilum (24%). Overall, P endodontalis, D pneumosintes, Filifactor alocis, T denticola, and T forsythia were significantly more detected in Brazilian samples than in South Korean samples ( P < .05). CONCLUSIONS: Findings indicated that the prevalence of some species in infections of endodontic origin may significantly differ from one geographic location to another.

Adolescent↗
PubMed2005

Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after "one-visit" endodontic treatment.

OBJECTIVE: To assess the in vivo intracanal microbial status of apical root canal system of mesial roots of human mandibular first molars with primary apical periodontitis immediately after one-visit endodontic treatment. The residual intracanal infection was confirmed by correlative light and transmission electron microscopy. STUDY DESIGN: Sixteen diseased mesial roots of mandibular first molars were treated endodontically, each in one visit. Mesio-buccal canals were instrumented using stainless steel hand files and mesio-lingual canals with a nickel-titanium rotary system. The canals were irrigated with 5.25% sodium hypochlorite (NaOCl) during the instrumentation procedures, rinsed with 10 mL of 17% ethylenediamine tetraacetic acid (EDTA), and obturated with gutta-percha and zinc oxide eugenol cement. Thereafter, the apical portion of the root of each tooth was removed by flap-surgery. The specimens were fixed, decalcified, subdivided in horizontal plane, embedded in plastic, processed, and evaluated by correlative light and transmission electron microscopy. RESULTS: Fourteen of the 16 endodontically treated teeth revealed residual intracanal infection after instrumentation, antimicrobial irrigation, and obturation. The microbes were located in inaccessible recesses and diverticula of instrumented main canals, the intercanal isthmus, and accessory canals, mostly as biofilms. CONCLUSIONS: The results show (1) the anatomical complexity of the root canal system of mandibular first molar roots and (2) the organization of the flora as biofilms in inaccessible areas of the canal system that cannot be removed by contemporary instruments and irrigation alone in one-visit treatment. These findings demonstrate the importance of stringent application of all nonantibiotic chemo-mechanical measures to treat teeth with infected and necrotic root canals so as to disrupt the biofilms and reduce the intraradicular microbial load to the lowest possible level so as to expect a highly favorable long-term prognosis of the root canal treatment.

Adolescent↗
PubMed2005

Observations on healing following endodontic surgery in nonhuman primates (Macaca fascicularis): effects of rhBMP-2.

OBJECTIVES: The potential of recombinant human bone morphogenetic protein-2 (rhBMP-2) to enhance bone healing following endodontic surgery was tested. The pattern and timing of de novo bone formation and cementum regeneration, and the potential for root resorption and ankylosis to accompany bone formation were evaluated. STUDY DESIGN: Pulpal infections were induced in maxillary and mandibular incisor teeth in young adult Cynomolgus monkeys. The teeth received conventional endodontic treatment immediately followed by surgical root resection. In a randomized split-mouth design, contralateral apical bone defects received rhBMP-2 in absorbable collagen sponge (ACS) carrier or served as sham-surgery controls to provide histological and radiographic evaluations following 1 (mandibular incisors) and 4.5 (maxillary incisors) month(s) postsurgery. RESULTS: At 1 month postsurgery trabecular bone filled the apical bone defects. The newly formed bone appeared considerably more mature and had assumed characteristics of the contiguous resident bone at 4.5 months postsurgery. The resected root tips were almost completely covered by new cementum with a maturing functionally oriented periodontal ligament. Localized inflammatory infiltrates were associated with the filled root canals and extruded root-filling material. Root resorption and ankylosis were not observed. There were no apparent differences in healing patterns between sites implanted with rhBMP-2/ACS and those serving as sham-surgery controls. CONCLUSIONS: Under conditions where the influence of infectious elements and irritation caused by root filling material are minimized, bone formation and cementum regeneration appears rapid following endodontic surgery. rhBMP-2/ACS did not offer an obvious benefit above and beyond that of the native osteogenic potential in this animal model.

Alveolar Bone Loss↗
PubMed2006

Catonella morbi and Granulicatella adiacens: new species in endodontic infections.

OBJECTIVE: This study intended to examine samples from primary endodontic infections for the presence of Catonella morbi and Granulicatella adiacens, 2 species that have been recently suggested to be involved with infections in other oral sites. STUDY DESIGN: Genomic DNA was isolated directly from samples taken from teeth with different forms of apical periodontitis, and a devised culture-independent 16S rRNA gene-based heminested PCR assay was used to determine the prevalence of these 2 target species. Species-specific primers were developed by aligning closely related 16S rRNA gene sequences. Species-specificity for each primer pair was confirmed by running PCR against a panel of oral bacteria and by sequencing of DNA from representative positive samples. RESULTS: C morbi and G adiacens were detected in 33% and 19%, respectively, of the root canals associated with chronic apical periodontitis; 30% and 10%, respectively, of the cases diagnosed as acute apical periodontitis, and 16% and 11%, respectively, of the pus samples taken from acute apical abscesses. Overall, C morbi occurred in 26% and G adiacens in 14% of the samples taken from primary endodontic infections. CONCLUSIONS: Our findings demonstrate that C morbi and G adiacens can take part in the microbiota associated with primary endodontic infections, and their specific role in the disease process warrants further elucidation.

Adolescent↗
PubMed2006

Dens invaginatus in an immature maxillary lateral incisor: a case report of complex endodontic treatment.

This case report presents the surgical endodontic treatment of an Oehlers Class II invaginated immature tooth. In this case, communication between the invagination and the pulp caused pulp necrosis, periapical inflammation, and cessation of root formation. The initial treatment goal was to achieve apexification and then fill both the root canal and the canal of the invagination. After a 6-month treatment with calcium hydroxide dressings, there was no healing radiographically and no sign of a hard tissue barrier in the apex. Periapical surgery with the placement of mineral trioxide aggregate (MTA) root-end filling was deemed successful at the 1-year recall. To treat dens invaginatus, both conventional and surgical endodontic treatment techniques should be considered. In dens invaginatus, conventional endodontic treatment modalities may be unsuccessful because of inadequate debridement and disinfection; however, subsequent periapical surgery and retrofilling with MTA may promote healing.

Adult↗
PubMed2006

Mental nerve paresthesia associated with endodontic paste within the mandibular canal: report of a case.

The present study describes a case of endodontic paste (Endomethasone) penetration within and along the mandibular canal from the periapical zone of a lower first premolar following endodontic treatment of the latter. The clinical manifestations comprised anesthesia of the right side of the lower lip and paresthesia of the gums in the fourth quadrant, appearing immediately after endodontic treatment. The lip anesthesia was seen to decrease, with persistence of the gingival paresthesia, after 7 months.

Adult↗
PubMed2006

Danish practitioners' assessment of factors influencing the outcome of endodontic treatment.

OBJECTIVE: This investigation explored the hypothesis that among general dental practitioners (GDPs), the performance of root fillings of substandard quality might be associated with deficient knowledge of factors important to the outcome of endodontic treatment. STUDY DESIGN: A questionnaire was mailed to 600 randomly selected GDPs. The influence of 24 factors on treatment outcome was assessed on 100 mm visual analog scales. A gold standard (GS) was established by an external group of researchers. Comparisons between the GDP response and the GS were analyzed using Wilcoxon tests. RESULTS: Despite large variation, the responses were significantly associated with sex, year of education, and exposure to endodontic treatment. Compared with the GS, the GDPs emphasized factors associated with clinical symptoms and underevaluated factors related to the microbial situation in the root canal. CONCLUSIONS: The GDPs seemed to regard endodontics mainly to be a procedure to keep a patient free of symptoms.

Age Factors↗
PubMed1997

Influence of different metal restorations bonded with resin on fracture resistance of endodontically treated maxillary premolars.

STATEMENT OF PROBLEM: Fracture of endodontically treated teeth has been of great interest because it is a common clinical occurrence. PURPOSE OF STUDY: This research evaluated the fracture resistance of endodontically treated first maxillary premolars restored with different metal restorations and bonded with Panavia Ex resin. MATERIAL AND METHODS: Fifty teeth were randomly divided into five groups with MOD tooth preparation: (1) inlay with an isthmus width of one third the intercuspal distance for a silver amalgam restoration (negative control), (2) inlay with an isthmus width equal to that in group 1, (3) inlay with an isthmus width of half the intercuspal distance, (4) equal to group 3 with lingual and proximal preparation, and (5) onlay (positive control). The cast restorations of groups 2, 3, and 4 were bonded with Panavia Ex resin and those from group 5 cemented with zinc phosphate cement. Samples were restored and subjected to thermocycling, and the teeth were submitted to an axial compressive force. RESULTS: The cast inlay restorations that bonded with Panavia Ex resin significantly elevated the fracture resistance of endodontically treated maxillary premolars compared with the silver amalgam restorations. However, teeth restored with cast onlay restorations cemented with zinc phosphate cements recorded the best results. CONCLUSION: The increase of fracture resistance by MOD inlay cast restoration bonded with Panavia Ex resin suggested valid clinical application within the conditions of this study.

Analysis of Variance↗