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Endodontic treatment of teeth with anomalous root formation has been reported. This article reports four cases of anomalous root formation associated with the maxillary lateral incisor and the treatment regimens followed in each case. A discussion of the reasons for the success or failure achieved is provided and supports those cases previously reported.
This case report describes the effect of tricalcium phosphate implantation in the treatment of a chronic periapical abscess. Ceramic implant materials are biocompatible and are currently being used to restore alveolar bone loss resulting from periodontal disease, endodontic infections, and residual alveolar ridge resorption. However, use of such a material in this case led to persistent infection and additional bone destruction. Thus, the use of a ceramic implant material to accelerate periapical bone repair is not recommended in areas where a chronic bacterial infection is present.
Root canals of dogs' premolar teeth were exposed to contamination and to the development of periapical inflammation over a period of 45 days. Root canals were overinstrumented 2 mm beyond the apical foramen with file No. 60 and were underfilled by 2 to 3 mm short of the roentgenographic apex. Ninety days after endodontic treatment, healing and ingrowth of connective tissue into the root canal occurred in 67.8% of the cases. These results suggest that the diameter of the apical foramen and the intensity of the canal contamination are determining factors for periapical tissue repair in cases of pulpal necrosis.
Freshly extracted teeth with single canals were instrumented and filled with laterally condensed gutta-percha and sealer. After obturation, the tooth apices were treated with various retrograde techniques. The sealing ability of these techniques, namely laterally condensed gutta-percha, heat-sealed gutta-percha, and silver amalgam retrofilling, was compared on the basis of dye penetration. The apical foramen of the treated canals was then coated with different sealing materials--HelioSeal (light-activated sealant), Delton pit and fissure sealant (chemically activated sealant), and varnish--to examine their effect on the leakage resistance of these materials. Statistical analysis indicated that laterally condensed gutta-percha, as well as retrograde amalgam filling, produced a statistically significantly better seal than heat-sealed gutta-percha. Coating of the apical foramen with different sealing materials showed that HelioSeal had significantly improved the sealing capacity of all the materials tested at each time period. Delton pit and fissure sealant did not increase the sealing ability in the first week. However, this material has significantly improved the sealing ability after the first week. On the other hand, sealing of the apical foramen with varnish did not produce any significant change in the sealing capacity of the filling materials. Finally, dye penetration around all the filling and retrofilling materials, in the presence or absence of the apical seal, continued and increased with time. However, root canals sealed with Helioseal consistently showed the least amount of apical leakage of all the canals tested.
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The sealing ability of cyanoacrylate as a retrograde root canal filling material was evaluated in vitro. Fifty roots were cleansed, shaped, and assigned to five groups of ten roots each. The root canals were obturated with gutta-percha and Grossman's sealer. The apical 2 mm of each root in the five groups was resected. In groups I, II, and III, retrofilling preparation was made and filled with amalgam, varnish and then amalgam, and cyanoacrylate, respectively. In group IV, a hot instrument was used to seal the gutta-percha, and in group V, a cold burnisher was used for the same purpose. All of the teeth were immersed in 1% methylene blue dye for 24 hours and sectional longitudinally; dye penetration was then measured. One-way analysis of variance performed on the means of the groups indicated that group III had the least amount of leakage (p less than 0.05). This study indicates that cyanocrylate may have potential as a retrograde filling material.
Gold leaf, made of fine and pure gold, is considered to be an alternative retrograde filling material. Apical surgery was performed in three cases with the use of gold leaves as filling material. The radiographs showed the excellent bone healing in the apical region. The operative procedure was easy with the use of gold leaf as filling material.
After an initial clinical test phase, the new method of replantation and transplantation with the use of aluminum oxide ceramic for retrograde root filling may be viewed as possible differential indications to other methods, even to apicectomy in the molar region. Twenty-three of the twenty-five replantations and eight of the nine transplantations may be regarded as having been successful. Contraindications are cases of wide apical foramina and oval or octagonal root canal cross sections.
Retrospective study was done on 118 patients who underwent nonsurgical endodontics and then surgical endodontics. Seventy-nine patients had pain before nonsurgical endodontics, and an additional 39 were pain free. After the open surgical procedure, six patients (5%) had continual pain and were considered failures. Three patients (2.5%) were thought to have had posttraumatic dysesthesia, and the other three (2.5%) were considered to have phantom tooth pain. Possible mechanisms for each chronic pain type are discussed.
The purpose of this case report is to demonstrate the importance of radiographic examination before suturing in periapical surgery. Corrective surgery was performed to eliminate excess amalgam left in the periapical region 6 years before. The result was favorable and demonstrates the importance of radiographic examination before flap repositioning and suturing. A roentgenogram should always be made before suturing and dismissal to verify the removal of amalgam particles and to confirm that no alteration is needed.
Healing capacity after apicectomy was investigated in a randomized clinical study of 105 teeth apically sealed with either amalgam or glass ionomer cement. The results were evaluated clinically and radiographically after 1 year. The success rate was high for both materials: 91% for amalgam and 89% for glass ionomer cement. Contamination with moisture and blood adversely affected the outcome for both materials and was significantly more frequent in unsuccessful cases.
Intravenous midazolam in doses of between 0.07 mg/kg and 0.1 mg/kg has been recommended for sedation in dentistry and some medical procedures and investigations. This study examined the variable sensitivity of patients to midazolam. One hundred and thirty-four fit but anxious patients between the ages of 16 and 63 years received midazolam intravenously for sedation for minor oral surgery. Doses required ranged from 0.04 to 0.40 mg/kg. Nineteen patients required doses less than 0.07 mg/kg; 59 patients required doses greater than 0.1 mg/kg. The mean dose per kilogram required for males was significantly less than for females. The wide variation in sensitivity to midazolam is confirmed.
Root perforations that result in a communication of the root space with the periodontal tissues occasionally occur during endodontic procedures. They may be induced iatrogenically, by resorptive process, or by caries. Identification of root perforations is possible by direct observation of bleeding, indirect bleeding assessment using a paper point, radiography, and an apex locator. Prognosis of a tooth with root perforation depends on the time lapsed before obturation of the perforation, location and size of the lesion, and the sealability of the repair material. Perforation defects may be repaired by nonsurgical or surgical techniques. A review of causes, diagnosis, prognosis, and management of root perforations provides information for avoiding, detecting, and treating of such defects.
The treatment of advanced periodontal breakdown as a result of an associated endodontic lesion continues to challenge the practitioner. Two cases of teeth with endodontic pathologic conditions that required apical surgery are presented. On raising the flap, no buccal cortical plate was found, significantly lowering the prognosis of the surgery. A barrier membrane was used in addition to the apical surgery, which on postoperative follow-up appears to have resulted in the reestablishment of the buccal cortical plate.
A retractor designed to give a wide field of vision and surgical access to apicectomy sites in the upper anterior region of the maxilla is described.
Oxethazaine is the most potent local anaesthetic in use. It is claimed to be 2000 times more potent than lignocaine and 500 times more potent than cocaine as assessed in rabbits eyes. Currently, oxethazaine is used in an antacid preparation for the topical relief of pain in conditions such as hiatus hernia, where the local pH is very low. Since oxethazaine is active in an acidic environment, it was decided to use oxethazaine, in a pilot study of 20 patients requiring minor oral surgery procedures, at a concentration of 0.1% at pH 3, to assess its value in achieving dental local anaesthesia. It was found that the local anaesthesia achieved was sufficient in all patients to allow the operative procedure to proceed. In two of the patients, who presented with acute periapical pathology, satisfactory local anaesthesia was achieved with 0.1% oxethazaine following a failure with lignocaine 2% and 1:80,000 adrenaline. The duration of anaesthesia was found to be similar to the average achieved with lignocaine 2% and 1:80,000 adrenaline.
Kaltostat, a haemostatic wound dressing made from non-woven sodium calcium alginate fibres is becoming more frequently and widely used by practitioners. We report a florid foreign body giant cell reaction elicited by Kaltostat which had been used to obtain haemostasis in an apicectomy cavity on an upper lateral incisor approximately 7 months earlier. The case demonstrates that alginate fibres left in situ may elicit a long-lasting and symptomatic adverse foreign body reaction. This material should be reserved for problematic haemorrhage and be removed from the tooth socket soon after haemostasis.
Anorganic bovine bone has been used previously to obturate bony defects following apical surgery with some reported success. However, no prospective trial has been carried out. We present the results of our trial showing that the placement of anorganic bovine bone (BIO-OSS) in defects created by apical surgery is contraindicated.