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Membrane barriers used in conjunction with periodontal surgery have promoted regeneration of lost marginal attachment. Membrane barriers also may be indicated during surgical endodontics, in selected cases, where primary apical lesions are complicated by the loss of marginal attachment. The indications for using guided tissue regeneration in endodontic surgery are discussed and two cases are presented.
This in vivo study compared the effect of mineral trioxide aggregate (MTA), IRM, Super EBA and ZOE in a puttylike consistency, used as retrofilling materials, in the healing process of periapical tissue of pulpless dogs' teeth submitted to a conventional retrofilling technique. Twenty-four premolars obtained from three dogs were used. At the first intervention, the animals were anesthetized, coronal access was obtained and pulpectomy was done. Root canals were kept open to the oral environment for 180 days to induce the formation of apical lesions. After surgical removal of the lesions with curettes, 2 mm of the apical root was cut out perpendicular to the long axis of the teeth, and root-end cavities were shaped with a low-speed round bur. The bone cavities were irrigated and dried, and the root-end cavities were filled with MTA, IRM, Super EBA and ZOE in a puttylike consistency. The bone cavities were passively filled with blood and flaps were sutured. The coronal access openings were cleaned and double-sealed with ZOE and amalgam. After 180 days, the animals were killed by anesthetic overdose, maxilla and mandible were removed and the pieces were processed for histomorphologic analysis. Data were evaluated blindly on the basis of several histopathologic events and the scores obtained were analyzed statistically using the Kruskal Wallis test. No significant differences were observed among MTA, Super EBA and IRM (p>0.05). However, ZOE had a significantly more negative influence on the apical healing (p<0.05). In conclusion, MTA, Super EBA and IRM had similar histopathologic effects among each other and better performance than ZOE used in a puttylike consistency. Furthermore, only MTA stimulated hard tissue deposition in direct contact with the retrofilling material, even when it was inserted under critical conditions.
The purpose of this study was to evaluate the apical seal in root apex treated with different demineralization agents and retrofilled with mineral trioxide aggregate (MTA) using marginal dye leakage. Fifty-six, human single-rooted teeth were instrumented, filled, resected and had retrofilling cavities prepared with ultrasonic tips. Demineralizing agents were applied before the apical cavities were retrofilled with Pro Root MTA. The specimens were assigned to 4 groups (n=14), as follows: group 1 (no demineralizing agent); group 2 (35% phosphoric acid, for 15 s); group 3 (17% EDTA solution, pH 7, for 3 min); and group 4 (24% EDTA gel, pH 7, for 4 min). The extension of dye (2% rhodamine B, at 37 degrees C, for 24 h) penetration was measured in millimeters using a stereomicroscope. Results were statistically analyzed by ANOVA and Tukey's test at 5% significance level. Among the experimental groups, the least extension of dye penetration was observed in group 1 (1.89 mm), followed by groups 2 (2.18 mm), 4 (2.54 mm) and 3 (2.64 mm). No statistically significant differences (p<0.05) were found in marginal microleakage among groups 1, 2 and 4 and groups 2, 3 and 4. Based on the results obtained in this study, it may be concluded that the application of demineralizing agents cannot be recommended when MTA is used in periradicular surgeries.
Cyanoacrylate has been used in medicine and dentistry for many years. It has been used as a postextraction dressing and retrograde filling material in endodontic surgery. The aim of this study was to evaluate the cytotoxic effects of Histoacryl and other two homologue ethyl cyanoacrylates, Super Bonder and Ultrabond, on cultured fibroblasts, using the Trypan blue dye exclusion assay. The cyanoacrylates were applied to round glass coverslips, which were placed in contact with NIH 3T3 cells. After 0, 6, 12 and 24 h (short-term assay; viability) and 1, 3, 5 and 7 days (long-term assay; survival), the cells were examined under phase light microscopy and counted. The data were compared by the Kruskal-Wallis test. In the short-term experiments, only the cultures of the Ultrabond group (GIV) presented significant smaller percentages of cell viability than the cultures of the other groups (GI: control; GII: Super Bonder; GIII: Histoacryl). Although the cultures of the Super Bonder group (GII) presented smaller percentages of cell viability than cultures of the other groups (GI, GIII, GIV) at the long-term assay, this group was the only experimental group presenting a continuous and progressive cell growth. Our results have shown an in vitro biocompatibility of Histoacryl and ethyl cyanoacrylate homologues. These cyanoacrylates could therefore be of importance for endodontic purposes.
Recently, regular and white mineral trioxide aggregate (MTA) are being used in Dentistry as retrofilling materials. Genotoxicity and cytotoxicity tests form an important part of cancer research and risk assessment of potential carcinogens. Thus, the goal of this study was to examine the genotoxicity and cytotoxicity of regular and white MTA in vitro by the single cell gel (comet) assay and trypan blue exclusion test, respectively. Mouse lymphoma cells were exposed to two presentation forms of MTA at final concentrations ranging from 1 to 1,000 microg/mL for 3 h at 37 degrees C. The results showed that both compounds tested did not produce genotoxic effects at all concentrations evaluated. Likewise, no statistically significant differences (p > 0.05) were observed in cytotoxicity. Taken together, our results suggest that regular and white MTA are not genotoxins and are not able to interfere in cellular viability as assessed by single cell gel (comet) assay and trypan blue assay, respectively.
The purpose of this study was to evaluate the penetration of three dyes in MTA root-end fillings. In 30 single-rooted teeth, cavities for retrofilling were prepared with an ultrasound appliance and filled with MTA. The specimens were randomly assigned to three groups (n = 10) and immersed in the following solutions: 2% methylene blue (MET), 50% silver nitrate (NIT) and 0.2% rhodamine B (ROD). Two transversal slices (1 mm) of the retrofilling region were obtained and evaluated using the Image Tool 3.0 software to obtain a quantitative evaluation (in mm2) of the dye penetration around the retrofillings. Data were submitted to statistical analysis using Students t-test. The lowest degree of dye penetration was observed for the NIT group, in both slices (p < 0.05). Dye penetration was significantly larger in the ROD group when compared to the NIT group, in both slices (p < 0.05), and to the MET group, only in slice 1 (p < 0.05). Within the limitations of this study, it was concluded that the choice of dye could influence the penetration evaluation in root-end filling studies, and that the NIT had the lowest penetration capacity in the apical dentine.
Apical sealing is essential for the success of paraendodontic surgery, so any procedure that may favor an adequate sealing of the apical remainder should be performed. The purpose of this study was to evaluate the influence of diode laser irradiation on the apical sealing of root-end cavities with MTA retrofillings. Root canals in twenty extracted human teeth were shaped with K-files and filled with gutta-percha. The apexes were cut off and root-end preparations were performed. The roots were divided randomly in 2 groups. Group 1 (ten specimens) was retrofilled with MTA. Group 2 was irradiated with diode laser, with 1 W for 20 seconds, on the apical surface and root end cavity before retrofilling with MTA. The specimens had their external surfaces impermeabilized with cyanoacrylate, except for the apical surface, and were then immersed in 1% rhodamine B dye for 72 h and placed in plaster stone. After that, the specimens were submitted to longitudinal abrasion until half of the root remained. The linear dye leakage was observed in these mid-roots between the root canal wall and retrofilling. The linear dye leakage was measured with Image Lab software, and the results were statistically analyzed with Student's t test. There were no statistically significant differences between the two groups (p > 0.05). The diode laser irradiation did not improve the apical sealing of MTA retrofillings under the conditions of this in vitro study.
BACKGROUND: Chronic periodontic-endodontic lesions are not uncommon in clinical practice and their regenerative capacity has long been questioned. However, there are no published studies investigating the application of guided tissue regeneration techniques in combination with endodontic surgery using an induced perio-endo defect model. This study evaluated the clinical, radiographic, and histologic outcomes of three surgical procedures used to treat induced perio-endo lesions. METHODS: Pulpal necrosis was induced in foxhounds along with surgical removal of radicular buccal bone. After 4 weeks, chronic lesions were clinically and radiographically assessed. Treatment surgery consisted of apicoectomy, root canal instrumentation, and retrofilling with mineral trioxide aggregate. Teeth were then assigned to one of the following treatment groups: open flap debridement only (OFD), OFD with bioabsorbable porcine-derived collagen membrane (BG), or OFD with BG and anorganic bovine bone matrix (BO/BG). Clinical parameters and standardized radiographs were assessed at defect creation; treatment surgery; and at 1, 2, 4, and 6 months. Animals were sacrificed at 6 months and specimens prepared for histometric analysis. RESULTS: Clinical and radiographic conditions improved during the study period. Mean epithelial attachment was similar between all groups. Mean connective tissue attachment for groups OFD, BG, and BO/BG was 3.79 mm, 2.63 mm, and 1.75 mm, respectively, and mean radicular bone height was 2.16 mm, 3.24 mm, and 3.45 mm, respectively. Statistically significant increases in the amount of new cementum were observed in groups BG and BO/BG when compared with OFD (P <0.05). CONCLUSIONS: Treatment of combined induced perio-endo lesions using bioabsorbable collagen membranes alone or in combination with anorganic bovine bone matrix resulted in increased amounts of bone, periodontal ligament, and significant increases in the amount of new cementum when compared to open flap debridement in a canine model.
Bone tissue reactions to EBA, IRM, and cyanoacrylate cement (Base Liner) were studied in the rat mandible using an intraosseous implant method. Osseous cavities (1.4 mm in diameter) were surgically created in the mandibles, and materials were implanted in 60 male Wistar rats. Each specimen was evaluated histologically after 4 and 8 weeks. The development of fibrous connective tissue in direct apposition to the material was observed in the EBA and IRM groups at 4 weeks. A slight degree of macrophage infiltration was seen in the EBA group. After the 8-week observation period, IRM and EBA were frequently separated from the bone cavity by a fibrous connective tissue layer (p < 0.01). The Base Liner appeared to be in direct apposition to the osseous tissue in several areas (p < 0.01). These findings indicate that Base Liner reacts favorably with osseous tissue, compared with the EBA and IRM materials tested and seems to be a biocompatible material.
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We developed a new technique instead of usual retrograde apicoectomy for cases in which apical lesions appear after prosthetic treatment. The technique is as follows. After treatment of the apical area by raising a flap, part of the labial bone is removed and the labial surface of the root is exposed. Then the labial part of the root is removed and the root canal is opened. After that, the residual carious dentin is removed completely. At the final stage, the open root canal is filled with tooth adhesive and low viscosity composite resin (Clearfil-SC). This technique is indicated for cases in which the crown restoration is not removed for some reasons and treatment from apical side is not possible. This technique is clearly the last choice, but many teeth will remain.
We describe the enucleation of large radicular cysts to the maximum extent, and their treatment based on the concept of marsupialization and drainage after apicoectomy. Marsupialization requires a long period for healing, imposing a burden on the patient with regard to postoperative management. Considering this, together with the difficulty involved in the clinical diagnosis of radicular cysts, curettage of the cyst wall and drainage may be more effective for facilitating the healing process than use of marsupialization alone.
The purpose of this study was to compare root-end sealing using 4-META/MMA-TBB resin with that using conventional retrograde root filling technique, and thereby determine if 4-META/MMA-TBB resin offers long-term prevention against dye leakage from the root canal of human teeth. Thirty-five teeth had the apical 2.5 mm of the root resected. In the Sealing (SB) group, 4-META/MMA-TBB resin was applied to the resected surface. In the Filling (Am and EBA) groups, a root-end cavity was prepared and retrofilled with high copper amalgam alloy or reinforced zinc oxide-eugenol cement. Root canals were filled with methylene blue dye solution. Then, dye leakage outside the root canal was measured for 50 weeks. The integrated amount of leakage in SB group was significantly lower than those in Am group (p < 0.05) and EBA group (p < 0.05). Therefore, it can be concluded that root-end sealing using 4-META/MMA-TBB resin resulted in better, long-term sealing than conventional retrograde root filling.
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The tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol) were compared with that to amalgam. In 27 premolar teeth of beagle dogs (54 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periapical lesions. On each root, an apicectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 8 weeks (24 roots) and 4 weeks (30 roots); and they were prepared for histological examination. The tissue response to amalgam fillings after 4 and 8 weeks was marked by moderate or severe inflammation on all roots, and extended > 0.5 mm in 10 out of 18 roots. In contrast, after 8 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation while the tissue response to Vitrebond was the best of the three materials, and was also less extensive. After 4 weeks, the overall best tissue response was with Kalzinol, followed closely by Vitrebond. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were statistically significant (P < 0.01). Similarly, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Both Vitrebond and Kalzinol have potential as root-end filling materials as the tissue response was considerably more favourable than that to amalgam.
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Records of 302 root-filled teeth treated by dental undergraduates were reviewed by four lecturers in the Department of Conservative Dentistry, University of Malaya. Preoperative and operative factors were evaluated for their association with postoperative pain experience of patients during the visit immediately after completion of biomechanical preparation. Eighty four percent of patients did not experience any pain after biomechanical preparation whilst the remaining 16 percent only complained of slight or moderate pain. The incidence of pain after biomechanical preparation is not high even when performed by inexperienced undergraduates. Teeth with a pre-existing painful condition had a higher chances of postoperative of pain. The incidence of postoperative pain was halved when teeth were associated with a sinus tract.