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Prospective study of two retrograde endodontic apical preparations with and without the use of CO2 laser.

This article covers a 4-year study that reports 320 cases in which endodontic surgery was performed for residual apical lesions or lesions that could not be treated in a conventional way. Four groups of 80 teeth each were formed and they were followed up after a 12-month interval. The first group comprised cases treated with a micro bur, retrograde filling and IRM; the second, cases treated at the apical and radicular portions with a CO2 laser; the third, cases in which the retrograde cavity was prepared with an ultrasonic device instead of a micro bur; and the fourth group comprised cases treated in a similar way to the second group, i.e., cases treated at the apical and radicular portions, but with a CO2 laser instead of a micro bur. After 12 months, the results showed a better prognosis with ultrasonic treatment. Regardless of technique, the CO2 laser did not improve the healing process.

Adolescent↗

Root resorption of replanted teeth: an SEM study.

Two replanted and subsequently expelled upper central incisors were observed under a scanning electron microscope to study the changes brought about by root resorption. The severity of resorption and the distribution of the affected areas were different in the two specimens. In the first case, large, deep excavations were found along a continuous bone defect which exposed the opposite root canal wall. Bacteria-like elements were found on the bottom of the eroded areas both on the outer and on the inner root surfaces. In the second case, resorption denuded the apical portion of the metal post. Erosive lacunae were visible in some areas while tubiform excavations were present close to the apical margin exposing the collagen network. The roots in the first case likely underwent inflammatory resorption while replacement resorption was thought to have occurred in the second case.

Adolescent↗

Infected immature teeth treated with surgical endodontic treatment and root-reinforcing technique with glass ionomer cement.

The authors propose surgical endodontic treatment of immature teeth characterized by necrosis and infection, especially after failure of apexification or in the presence of older, fibrous, and extensive lesion. A glass ionomer cement, autopolymerizable and condensable, is used as retro-filling material and as a reinforcement material for the canal walls. The variety of different cases presented here show that this rapid technique is reliable and reproducible.

Adult↗

Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA.

Thirty immature sheep incisor teeth were tested for their fracture resistance after various treatment modalities using calcium hydroxide (CH) or a mineral trioxide aggregate material (MTA) as a root filling. The incisors, having approximately 80% of their root growth completed, were removed from jaws of slaughtered sheep and divided into four experimental groups. The pulps were extirpated from all the teeth through the open apexes. (a) Saline group: the teeth were preserved in saline for 100 days at 6 degrees C. (b) CH group: the root canals were filled with CH and sealed apically with IRM and stored as above. (c) MTA group: the canals were filled with MTA and stored as above. (d) CH+MTA group: the canals were filled with CH and sealed with IRM. After 30 days, the CH was replaced with MTA and stored as above. At the end of the 100-day storage period, all teeth were embedded in plaster of Paris and tested for fracture strength at the cervical area in an Instron testing machine. The results showed a decrease in fracture resistance (a) of the incisors with CH in the root canals after 100 days of storage, compared to (b) teeth stored in intracanal saline and (c) teeth with 30 days of CH and then filled with MTA, and (d) those filled with MTA in the canals. In conclusion, when CH was kept in the canals of immature sheep teeth for only 30 days followed by root filling with MTA there was no significant decrease in strength of the root within an observation period of 100 days. This finding may be of importance in the decision of treatment plans for teeth with pulp necrosis and immature root formation.

Aluminum Compounds↗

When all else fails....

Endodontic surgery may be indicated if orthograde endodontic treatment cannot be carried out or is unsuccessful. Advances in instruments, materials and techniques have made surgical endodontics a more predictable procedure. A complex case that required surgical intervention is presented to illustrate this point.

Aged↗

Where is it coming from?

A case report is presented of an unusual situation where standard routine diagnostic methods failed to reveal the true origin of an endodontic infection.

Dental Fistula↗

Combined endodontic and surgical treatment of a three-rooted maxillary first premolar.

A case is reported in which endodontic treatment of a maxillary first premolar was complicated by the fact that the tooth had three roots. One of the roots was completely calcified and therefore could not be negotiated with endodontic files. There was a large periapical lesion associated with the tooth and this was surgically removed. During the surgical procedure a retrograde cavity was prepared on the calcified root using ultrasonic instruments and this was filled using Super EBA cement. Twelve months later the tooth was asymptomatic and the periapical tissues had completely healed.

Aged↗

Intentional replantation of a lower premolar.

Intentional replantation is the purposeful extraction of a tooth to perform extraoral endodontic treatment, curettage of apical soft tissue when present and the replacement of the tooth in its socket. This paper demonstrates the use of intentional replantation as a technique to successfully treat a case where conventional endodontic retreatment and apical surgery were considered unfeasible.

Aged↗

A laboratory study of glass ionomer cement as a retrograde root-filling material.

This laboratory study investigated the use of various glass ionomer cements for retrograde root filling from the point of view of sealing qualities, ion release and ease of application. The sealing qualities of the material were tested by dye penetration and microscopic and SEM examination. Fluoride and silver ion release tests showed an initial loss of these two ions from the glass ionomer cement. A modified system for mixing and application was developed. Dye penetration did not differ from that of controls using vertically condensed gutta-percha. Glass ionomer cement is possibly a clinical alternative for the sealing of retrograde cavities; however, the silver-reinforced materials may cause tissue irritation from release of silver ions and their corrosion products.

Cermet Cements↗

Root-end filling materials alter fibroblast differentiation.

UNLABELLED: Root-end filling materials are commonly used following endodontic surgical procedures; however, their effect on adjacent soft tissues is poorly understood. We predict that, due to the differences in their chemical composition, these materials will have profoundly different effects on the survival and differentiation of fibroblasts. Many of the root-end filling materials examined were initially cytotoxic to both PDL and gingival fibroblasts in co-culture experiments; however, this was reduced after the materials were washed in either mineral trioxide aggregate (MTA) or hybrid ionomere composite resin (HICR) for 2 wks. Additionally, PDL fibroblasts displayed enhanced proliferation on MTA and survival on amalgam when compared with gingival fibroblasts. MTA preferentially induced alkaline phosphatase expression and activity in both PDL and gingival fibroblasts. In contrast, HICR inhibited alkaline phosphatase expression and activity. In addition, MTA and HICR repressed pleiotrophin in PDL fibroblasts, while HICR repressed periostin in both fibroblasts. Thus, root-end filling materials differentially affect periodontal fibroblast differentiation. ABBREVIATIONS: mineral trioxide aggregate (MTA), zinc-oxide eugenol cement (ZOEC), hybrid ionomer composite resin (HICR), reverse-transcriptase polymerase chain-reaction (RT-PCR).

Alkaline Phosphatase↗

Five-year follow-up of successful intentional replantation.

Intentional replantation has been practised for many years as a treatment modality for pulpless teeth. Although the success ratio for intentional replantation is far below that for routine or surgical endodontics, one should consider this procedure as an alternative to tooth extraction. Two cases of mandibular second molars which were treated with intentional replantation and retrograde fillings are reported in this article. At the 5-year recall visit, the radiographs showed no evidence of pathological changes.

Adult↗

Current practice in endodontics: 6. Retreatments and periradicular surgery.

The prime aim of this series of six articles has been to improve the quality of endodontic treatment in general dental practice by considering what is currently being taught in dental schools. This final article considers what may go wrong following completion of root canal treatment, whether orthograde retreatment is possible and how it may be achieved, and if or when periradicular surgery may be indicated.

Dental Restoration Failure↗

Advances in surgical dentistry.

The introduction of the specialty of surgical dentistry is an advance in itself and has far-reaching implications for the future. Surgical specialists will have a significant impact on the provision and resources of surgical dental services. This paper explores recent developments within the field.

Adult↗