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At least 451 records · Page 25Linked to original sources
PubMed2001

Calcium hydroxide in endodontic retreatment after two nonsurgical and two surgical failures: report of a case.

AIM: To describe the role of calcium hydroxide in infection control during complex endodontic retreatment. SUMMARY: A case is presented in which two conventional endodontic treatments and two surgical interventions failed to bring periapical healing. Despite this history, a further conventional treatment augmented by long-term disinfection with calcium hydroxide finally delivered a successful outcome. KEY LEARNING POINTS: Periapical healing follows proper intracanal infection control. Despite repeated surgical and nonsurgical intervention, careful retreatment can often bring healing. Calcium hydroxide has long-acting antimicrobial and soft-tissue dissolving activity. It is a helpful adjunct in endodontic retreatment.

Calcium Hydroxide↗
PubMed2002

Hemisection for treatment of an advanced endodontic-periodontal lesion: a case report.

AIM: To emphasize the importance of primary endodontic treatment when dealing with endo-perio lesions and to demonstrate the considerable healing potential of the endodontic aspect. CASE REPORT: After several years of unsuccessful symptomatic periodontal treatment, an advanced endo-perio lesion on a right-mandibular first molar was successfully treated by root-canal treatment and hemisection after the re-evaluation of the lesion. This successful treatment appeared to have a positive effect on the patient's general well-being. KEY LEARNING POINTS: The origin of a combined endo-perio lesion is indicated by its clinical and radiographic appearance. The periodontal situation is often misinterpreted. The prognosis for the endodontic element of treatment is excellent. Local pathologic processes in the oral cavity may affect a patient's general health.

Female↗
PubMed2003

Endodontic treatment of developmental anomalies in posterior teeth: treatment of geminated/fused teeth--report of two cases.

AIM: Gemination or fusion is a rare occurrence in the mandibular posterior teeth. Endodontic treatment of these teeth needs special care and attention to the bizarre anatomy. The aim of this article is to describe the problems encountered and the strategy in treating such cases. CASE REPORT: Two cases of complex endodontic treatment of fused/geminated teeth are presented. The first is an 11-year-old girl with an anomalous 'double' first mandibular molar and premolar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin; the second is a 16-year-old boy with 'double' second and supernumerary mandibular molars, who was diagnosed with irreversible pulpitis. Both cases were treated successfully in multiple appointments. The common features and treatment modalities are discussed. KEY LEARNING POINTS: Failure to diagnose fused/geminated teeth leads to misdiagnosis and a treatment plan that could cause permanent damage and tooth loss. Generally, there is communication between root canal systems of fused/geminated teeth which should be treated as one entity. Use of magnification is an important aid during treatment.

Adolescent↗
PubMed2003

Endodontic and surgical treatment of a geminated maxillary incisor.

AIM: A geminated maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report describes the coordination of coronal division, root extraction, bone grafting, endodontic treatment and orthodontics in achieving treatment goals. It is the intention of this report to show how a difficult case could be managed by properly coordinated multidisciplinary care. SUMMARY: Pulp testing of the geminated central right maxillary incisor gave a normal response. Radiographic investigation indicated a connection of the pulp chambers. Both the mesial and distal root were filled with gutta-percha. The connection between the two root canals was sealed with a flowable dentine-bonded resin. After dividing the crown with a diamond bur, the mesial part of the tooth was removed and the extraction socket was filled with beta-tricalcium phosphate ceramic (Cerasorb). Radiographs taken immediately after surgery and after 6 months showed no periodontal or periapical lesions. No signs of external resorption were identified. The diastema between the central incisors was closed by orthodontic treatment. KEY LEARNING POINTS: Geminated teeth may present aesthetic and functional problems which require multidisciplinary care. Careful clinical and radiographic examination is essential to decide on the fate of the coronal and root halves involved. A proper coordination between endodontic and surgical treatment may result in maintaining one tooth half, even if a midroot connection between the pulp chambers becomes evident. Orthograde endodontic treatment, hemisection and orthodontics may solve the aesthetic problem of a geminated tooth.

Bone Substitutes↗
PubMed2003

Microbial causes of endodontic flare-ups.

LITERATURE REVIEW: Inter-appointment flare-up is characterized by the development of pain, swelling or both, following endodontic intervention. The causative factors of flare-ups encompass mechanical, chemical and/or microbial injury to the pulp or periradicular tissues. Of these factors, microorganisms are arguably the major causative agents of flare-ups. Even though the host is usually unable to eliminate the root canal infection, mobilization and further concentration of defence components at the periradicular tissues impede spreading of infection, and a balance between microbial aggression and host defences is commonly achieved. There are some situations during endodontic therapy in which such a balance may be disrupted in favour of microbial aggression, and an acute periradicular inflammation can ensue. Situations include apical extrusion of infected debris, changes in the root canal microbiota and/or in environmental conditions caused by incomplete chemo-mechanical preparation, secondary intraradicular infections and perhaps the increase in the oxidation-reduction potential within the root canal favouring the overgrowth of the facultative bacteria. Based on these situations, preventive measures against infective flare-ups are proposed, including selection of instrumentation techniques that extrude lesser amounts of debris apically; completion of the chemo-mechanical procedures in a single visit; use of an antimicrobial intracanal medicament between appointments in the treatment of infected cases; not leaving teeth open for drainage and maintenance of the aseptic chain throughout endodontic treatment. Knowledge about the microbial causes of flare-ups and adoption of appropriate preventive measures can significantly reduce the incidence of this highly distressing and undesirable clinical phenomenon.

Dental Pulp Cavity↗
PubMed1997

Mechanical properties of endodontic posts.

Twenty-two commercially available endodontic posts were examined with regard to stiffness, elastic limit and resistance to fracture. Differences in mechanical properties were explained by differences in width, shape and surface structure. In the selection of an endodontic post, its stability rather than its retention should be of primary clinical concern. Accordingly, the authors advocate the use of endodontic posts that have a cylindrical coronal portion and a conical apical portion.

Dental Alloys↗
PubMed2004

Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery-- a randomized double blind clinical study.

The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

Adult↗
PubMed2000

Periapical central giant cell granuloma: a potential endodontic misdiagnosis.

This retrospective study ascertained the incidence and clinicopathologic features of central giant cell granulomas (CGCGs) associated with teeth with necrotic pulps or teeth that had received previous endodontic treatment and determined whether periapical CGCGs can result in endodontic misdiagnosis. Clinical and histopathologic data of biopsy specimens diagnosed as CGCG were collected from the archives of the Oral Pathology Laboratory, Temple University, and were reviewed. Over the 9-year period, 16 of 79 cases (20%) of CGCG were associated with a tooth that had a history of pulp necrosis. Of those, 14 (88%) were associated with previous root canal treatment. The data from this series of 79 cases of CGCG also showed that CGCGs were less common in women, less common before age 30, and did not cross the midline of the jaw as often as previously reported. Clinical and histopathologic data were compared from (1) CGCGs associated with teeth with vital pulps or that occurred in edentulous areas; (2) CGCGs associated with teeth with necrotic pulps; and (3) 194 cases of periapical granulomas and radicular cysts. These data strongly suggest that CGCGs associated with teeth with necrotic pulps are not directly related to periapical inflammation and may be misdiagnosed as endodontic lesions. Posttreatment follow-up and routine submission of periapical surgical specimens are emphasized.

Adolescent↗
PubMed2001

Intracanal use of a corticosteroid-antibiotic compound for the management of posttreatment endodontic pain.

OBJECTIVE: The purpose of this randomized, double-blind study was to determine the effect of a corticosteroid-antibiotic combination when used as an intracanal medicament for the treatment of posttreatment pain in endodontically involved teeth with vital pulp-test readings. STUDY DESIGN: Out of 988 patients, 480 experienced intratreatment pain. Endodontic treatment was completed in 3 visits. Patients who experienced pain after the first or second visit (postextirpation or postinstrumentation) were given an emergency visit during which no local anesthetic was used. The patients randomly received either intracanal corticosteroid-antibiotic compound or a placebo. Patients subjectively rated their pain on a scale of 1 to 4 as none, mild, moderate, and severe. The ratings were done at 1, 2, 4, 8, 12, and 24 hours postmedication. RESULTS: Intracanal use of the corticosteroid-antibiotic medication significantly reduced (P < .001) the mean pain score quite rapidly and was significantly superior to the placebo until the end of the study (P < .001). Furthermore, there were no reoccurrences of pain, and no side effects from use of the drug were noted. CONCLUSION: These results support the intracanal use of corticosteroid-antibiotic combination for controlling posttreatment endodontic pain.

Adolescent↗
PubMed2001

Vertical root fracture in endodontically treated teeth: a review of 25 cases.

OBJECTIVE: We sought to examine the clinical conditions under which 25 endodontically treated teeth underwent vertical root fracture (VRF) and to relate this condition to the time elapsed from endodontic treatment to fracture. STUDY DESIGN: This was a retrospective study in which we reviewed 25 case histories of patients with postendodontic VRF and studied the effect of various pretreatment and posttreatment factors as they related to VRF. RESULTS AND CONCLUSIONS: The mean time to VRF was 54 months; this was not significantly influenced by the presence or absence of prior restoration or by the presence or absence of a crown fitting. The use of a prefabricated, cylindrical, cemented intraradicular retainer increased the time between endodontics and VRF. Teeth restored with conventional amalgam took significantly longer to undergo VRF than those restored with composite or bonded amalgam. In contrast, amalgam-restored teeth suffered more coronal fractures before VRF than did teeth in the other 2 groups.

Cementation↗
PubMed2001

A new bacterial species associated with failed endodontic treatment: identification and description of Actinomyces radicidentis.

OBJECTIVE: This report describes 2 endodontic patients who had persistent signs and symptoms after conventional root canal treatment. The aim of this study was to determine what microorganisms were present in the root canals of the teeth with failed endodontic therapy. STUDY DESIGN: After removal of the root fillings, the canals were sampled by advanced microbiological techniques and the isolates were characterized by various tests. RESULTS: Bacteria, which grew in pure cultures, were isolated in each case. The bacteria were similar to each other and were classified as Actinomyces on the basis of phylogenic and phenotypic evidence. The bacteria were different from others within the genus, thus warranting designation as a new species, Actinomyces radicidentis. CONCLUSIONS: The 2 cases of endodontic failure were infected with A radicidentis, a new Actinomyces species. This bacterium joins a restricted group of other microorganisms that have been associated with failure of root canal treatment.

Actinomyces↗
PubMed2002

A comparison of phosphor-plate digital images with conventional radiographs for the perceived clarity of fine endodontic files and periapical lesions.

OBJECTIVE: We sought to compare digital images with radiographs for the perceived clarity of small endodontic file tips at 2 different working lengths, as well as for the visualization of periapical bone lesions. STUDY DESIGN: Standardized conventional radiographic and phosphor-plate digital images were taken of 20 extracted permanent mandibular molars with 06 K-files placed in the distal root canal either 2 mm short or flush with the apical foramen. Similar images were obtained from mandibles with teeth that demonstrated large (n = 10) or small (n = 10) periapical lesions. Four evaluators ranked the clarity of the digital image with that of the radiograph. Results were analyzed by using the 2-sided sign test, ordinal logistic regression, and the kappa test. RESULTS: The perceived clarity of an endodontic file tip, at any position, and of a small or large periapical lesion was significantly (P < .01) less on all digital images compared with conventional films. CONCLUSION: Evaluator ratings indicated that the perceived clarity of fine endodontic files and periapical lesions was significantly less with phosphor-plate digital images than with conventional radiographs.

Dental Instruments↗
PubMed2002

Resistance to fracture of endodontically treated teeth restored with different post systems.

STATEMENT OF PROBLEM: Very little is known about the resistance to fracture of endodontically treated teeth restored with newly developed esthetic post systems. Purpose. This in vitro study compared the effect of 1 titanium and 3 esthetic post systems on the fracture resistance and fracture patterns of crowned, endodontically treated teeth. MATERIAL AND METHODS: A total of 40 recently extracted human maxillary canines with their crowns removed were endodontically treated. Four groups of 10 specimens were formed. Teeth were restored with titanium, quartz fiber, glass fiber, and zirconia posts and numbered as groups 1, 2, 3, and 4, respectively. All posts were cemented with Single Bond dental adhesive system and dual-polymerizing RelyX ARC adhesive resin cement. All teeth were restored with composite cores, and metal crowns were fabricated and cemented with glass ionomer cement. Each specimen was embedded in acrylic resin and then secured in a universal load-testing machine. A compressive load was applied at a 130-degree angle to the long axis of the tooth until fracture, at a crosshead speed of 1 mm/min. One-way analysis of variance and a Tukey test were used to determine the significance of the failure loads between groups (P<.001). A non-parametric chi(2) test was conducted for evaluation of the mode of failure (P<.001). RESULTS: The mean failure loads (kg) were 66.95, 91.20, 75.90, and 78.91 for groups 1 to 4, respectively. Teeth restored with quartz fiber posts (group 2) exhibited significantly higher resistance to fracture (P<.001) than the other 3 groups. Teeth restored with glass fiber and zirconia posts (groups 3 and 4) were statistically similar (P>.05). Fractures that would allow repair of the tooth were observed in groups 2 and 3, whereas unrestorable, catastrophic fractures were observed in groups 1 and 4 (P<.001). CONCLUSION: Within the limitations of this study, significantly higher failure loads were recorded for root canal treated teeth restored with quartz fiber posts. Fractures that would allow repeated repair were observed in teeth restored with quartz fiber and glass fiber posts.

Analysis of Variance↗
PubMed2006

Effect of incomplete crown ferrules on load capacity of endodontically treated maxillary incisors restored with fiber posts, composite build-ups, and all-ceramic crowns: an in vitro evaluation after chewing simulation.

OBJECTIVE: The aim of this study was to compare the fracture resistance of endodontically treated maxillary central incisors with incomplete crown ferrules after chewing simulation. MATERIAL AND METHODS: Forty caries-free maxillary central incisors were divided into 4 groups (n = 10). Endodontic treatment was performed. Teeth were decoronated 2 mm above the cemento-enamel junction (CEJ). Group I (control) provided a 360 degrees circumferential 2-mm ferrule. In group II, a 2-mm ferrule was present on the palatal aspect (status after occlusal overload), and in group III on the facial aspect (status after traumatic injury). In group IV, the ferrule was interrupted by bi-proximal cavitations (simulating caries treatment). The teeth received glass fiber reinforced posts and composite core restorations. All-ceramic crowns were adhesively cemented. Specimens were simultaneously exposed to thermal cycling and mechanical loading (1.2 million cycles; 6,000 cycles 5 degrees/55 degrees C) and finally statically loaded until failure in a universal testing machine (crosshead speed = 1 mm/min). For statistical analysis, the Kruskal-Wallis test was applied followed by the Mann-Whitney U-test as post hoc testing. RESULTS: The median fracture load values (min./max.) were: group I = 502 (326/561), group II = 658 (280/827), group III = 899 (396/1176), and group IV = 360 (279/646). Analysis revealed statistically significant differences between test groups, except between groups I and IV and groups II and IV. CONCLUSIONS: The fracture resistance of endodontically and post/core restored teeth is dependent on the degree of tooth conservation. An incomplete crown ferrule is associated with greater variation in load capacity and, despite high fracture values, inclines to fracture.

Composite Resins↗
PubMed2000

Effect of various mixing ratios on antibacterial properties and hardness of endodontic sealers.

Most chemically cured two-component dental materials, including endodontic sealers, are marketed with mixing instructions but with no strict mixing ratios. The present study evaluated the antibacterial properties and hardness of three endodontic sealers: Roth's cement (RC), CRCS, and AH26, mixed to four controlled consistencies within the range of the manufacturer recommendations. Using Enterococcus faecalis as the test microorganism, antibacterial activity was evaluated by agar diffusion and direct contact test. Surface hardness of sealers with the same consistency was evaluated on week-old specimens by the Knoop Hardness Number tester. In the agar diffusion test, light consistency of RC showed larger zones of inhibition than heavier consistency, whereas no significant differences were found with AH26 or CRCS. In the direct contact test, RC and CRCS exhibited complete inhibition of bacterial growth at all consistencies, whereas AH26 with the heavier consistencies did not inhibit bacterial growth at 24 h samples. The hardness of AH26 and CRCS was significantly lower with lighter consistencies. It is concluded that endodontic sealers possess different antibacterial and physical properties according to their mixing consistencies.

Anti-Infective Agents, Local↗
PubMed2000

Occurrence of Candida albicans in infections of endodontic origin.

Microorganisms are recognized as the etiological agent for the majority of pulpal and periradicular disease. Although bacteria have been the most studied, fungi have also been associated with infected root canals. The purpose of this study was to evaluate the contents of infected root canals and aspirates of cellulitis/abscesses of endodontic origin for the presence of Candida albicans using the polymerase chain reaction (PCR). PCR primers specific for the 18S ribosomal RNA gene of C. albicans were used to survey 24 samples taken from infected root canals and 19 aspirates from periradicular infections of endodontic origins. The presence of C. albicans was detected in 5 of 24 (21%) samples taken from root canals, but none was detected in the periradicular aspirates. The results indicate that PCR is an extremely sensitive molecular method that may be used to identify C. albicans directly in samples from infections of endodontic origin.

Candida albicans↗
PubMed2001

In vitro assessment of the antimicrobial action and the mechanical ability of chlorhexidine gel as an endodontic irrigant.

The objective of this study was to assess the chlorhexidine gluconate gel as an endodontic irrigant. First the ability of chlorhexidine gel to disinfect root canals contaminated in vitro with Enterococcus faecalis was investigated. A scanning electron microscope was also used to evaluate its cleansing ability compared with endodontic irrigants commonly used, such as sodium hypochlorite and chlorhexidine gluconate liquid. The results indicated that the chlorhexidine gel produced a cleaner root canal surface and had an antimicrobial ability comparable with that obtained with the other solutions tested. It was concluded that chlorhexidine gluconate in gel form has potential for use as an endodontic irrigant.

Anti-Infective Agents, Local↗
PubMed2001

Influence of structure on nickel-titanium endodontic instruments failure.

The purpose of this work was to investigate the process history on fracture life of nickel-titanium endodontics files. The results are based on microstructural investigations of nickel-titanium engine-driven rotary instruments based on X-ray diffraction, scanning electron microscopy, and microhardness tests. Endodontic files are very work-hardened, and there is a high density of defects in the alloy that can disturb the phase transformation. The microhardness Vickers confirmed these observations (dislocations and precipitates). The X-rays show that experimental spectrum lines are extended, typical of a distorted lattice. The surface state of the endodontic files (scanning electron microscopy) is an important factor in failure and fracture initiation.

Dental Alloys↗