[Indications and prognosis for endodontic surgery].
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One of the problems faced by manufacturers is the difficulty in constructing a robust and reliable, angled applicator tip. This can be overcome by handmaking your own retrograde carrier. The applicator tip may be bent to about 50 degrees and, if a kink occurs while bending the tip, it can be replaced easily by a new modified needle. Because the wire used is flexible, it can adapt to the bend without a problem. Narrower carriers can also be made using a 20-G needle, perhaps more suitable for retrograde fillings of molar apices. Because the carrier is designed to be used once only, the problems of it being difficult to load and liable to blockages should not arise.
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The operating microscope allows the surgeon unparalleled visualization of the root end structures for periapical surgery. The ultrasonic root end preparation tips enable debridement of the resected root end 2 to 4 mm in the long axis of the root. These advances have allowed periapical surgery to be performed at a new level of excellence with, we believe, more predictable healing.
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Intentional Replantation (IR) has traditionally been considered a treatment of last resort due to complications during extraction, handling, and replantation. Root resorption and failure often resulted from drying of the root surface during extraoral manipulations. Replantation techniques have been recently modified to prevent desiccation. This article presents a modified IR technique with continuous immersion of the tooth in a tissue culture solution. This allows extension of the extraoral time period to permit inspection of the root surfaces, precise root-end resections and preparations, and placement of root-end fillings.
Many root end filling materials for apical surgeries have been identified either for scientific evaluation or clinical usage but none meets the requirements of an ideal root end filling material. Recently a new cement, Mineral Trioxide Aggregate (MTA) was researched as a potential root end filling material and showed promising results. This paper reports the significant findings of research done on MTA as a root end filling material and presents a clinical case where apical surgery was performed using MTA as retrograde filling.
Ultrasonic instrumentation has added a new horizon to endodontic treatment possibilities. It is a tool in the arsenal of instruments currently used by almost every endodontist in the United States. The use of ultrasonic instrumentation was formerly confined solely to periodontics, but has slowly come to be an indispensable tool in endodontics as well.
OBJECTIVE: The purpose of this study was to assess three modern root-end restorative materials with electrical and dye leakage tests. METHOD AND MATERIALS: Thirty-three human canine teeth were prepared and filled with gutta-percha and sealer. Stainless steel rods were inserted into the root canals as anodes, and the teeth were varnished. The apical 3 mm of each tooth was resected, and 3-mm root-end preparations were made ultrasonically. Mineral trioxide aggregate, Super EBA, and IRM were used to restore 10 teeth each, and three teeth were varnished as controls. Following 24 hours' setting in blood, the specimens were placed in 1% potassium chloride electrolyte, and leakage was recorded electrically for 70 days. The teeth were then submerged in methylene blue dye for 72 hours, sectioned longitudinally, and scored for leakage by six examiners. RESULTS: In both tests, the mineral trioxide aggregate restorations leaked significantly less than the IRM and Super EBA restorations. Super EBA showed significantly less leakage than did IRM restorations in the electrochemical test but not in the dye leakage experiment. The teeth sealed with mineral trioxide aggregate performed similarly to the varnished negative control teeth. CONCLUSION: The results of this study indicated that mineral trioxide aggregate provides a superior seal in root-end-restorations.
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A retrospective study was carried out on anterior teeth which had undergone apicectomy between 1995 and 1997. More maxillary teeth were treated (94.7%) than mandibular teeth (5.3%). Radicular cyst was the most frequently diagnosed reason for the treatment (47.3%), followed by chronic apical infection/granuloma (44.0%). The overall success rate was 71.9%, while treatment outcome was doubtful in 14.0% of the apicectomised teeth. The presence of pre- or postoperative signs and symptoms did not have any statistically significant effect on the treatment outcome. A higher percentage of roots with retrograde amalgam fillings healed successfully than roots with orthograde fillings, but the difference was not statistically significant (P > 0.05). More lesions classified histopathologically as radicular cysts healed successfully than those classified as granulomas (Fisher exact test, 2-tailed P value = 1.0).
Several clinical situations, such as lateral root or furcation perforation during endodontic treatment, apexification and/or apicoectomy, require the use of reliable materials and techniques to address the problem. The materials historically used for these conditions do not provide a reliable clinical outcome nor a long-term prognosis. New materials and technology may help this challenging issue. Ideally, the repair material should be nontoxic, bacteriostatic and nonresorbable; should promote healing; and should provide an optimal hermetic seal. Among different materials usually used for this purpose--amalgam, ZOE, ZOP, gutta-percha, IRM, Super-EBA, glass ionomers, calcium hydroxide, bonding agents, Cavit, hydroxyapatite and, finally, mineral trioxide aggregate--only the last has provided a substantial advantage.
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Studies by scanning electron microscopy showed that dentin of the root stump (resection of the root apex is an obligatory condition of retrograde filling) has numerous regular dentin tubules, in contrast to the apical part of the root. Mechanical treatment of dentin during preparation of the platform for retrograde filling leads to the formation of a thick "lubricating" layer on the surface of these platform. This layer consists of corpuscles of destroyed tissue substance (smudge) and completely covers the ends of dentin tubules, thus preventing the formation of strong bonds between the filling material and dentin surface. Treatment (pickling) of the platform surface with the conditioner notably improved the adhesion of Russian filling material Dentis to dentin. The best adhesive effect of retrograde filling was attained with Kemfil, the material requiring no pickling pretreatment.