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PubMed2003

Comparison of papilla healing following sulcular full-thickness flap and papilla base flap in endodontic surgery.

AIM: To compare the loss of papilla height when using the papilla base incision (PBI) or the standard papilla mobilization incision in marginal full-thickness flap in cases with no evidence of marginal periodontitis. METHODOLOGY: Twelve healthy patients referred for surgical treatment of persisting apical periodontitis, who were free from periodontal disease and had intact interdental papillae, were included in the study. The preoperative papilla height was recorded by measuring the distance between a reproducible coronal point on the tooth and the most coronal point of the papilla. The flap design consisted of two releasing incisions connected by a horizontal incision. The marginal incision involved the complete mobilization of the entire papilla in one interproximal space, and the PBI in the other interproximal space. The PBI consisted of a shallow first incision at the base of the papilla and a second incision directed to the crestal bone creating a split thickness flap in the area of the papilla base. Further, apically, a full-thickness flap was raised. In the other interproximal space, the buccal papilla was carefully incised and elevated completely. Following flap retraction, standard root-end resection and root-end filling were performed. Flap closure was achieved with microsurgical sutures. The PBI was sutured with two to three interrupted sutures (size 7/0) and the elevated papilla was reapproximated with vertical mattress sutures, which were removed 3-5 days after the surgery. The height of the interdental papilla was evaluated preoperatively and postoperatively after 1 month and at the 3-month recall, using plaster replicas. The loss of papilla height was measured using a laser scanner. Twelve papilla-paired sites were evaluated. The results were statistically analysed using the t-test. RESULTS: Complete closure of the wound was achieved in all treated sites followed by uneventful healing in all patients. The total mobilization of the papilla resulted in loss of papilla height of 1.10 +/- 0.71 mm at 1 month and 1.25 +/- 0.81 mm at the 3-month recall. At the 3-month recall, the retraction had increased in nine sites, whereas in three sites, the loss of height had slightly diminished compared to 1 month. In contrast, after the PBI, only minor changes could be detected: 0.07 +/- 0.09 mm at 1 month and 0.10 +/- 0.15 mm at 3 months. There was a significant difference between the two incision techniques studied (P < 0.007). CONCLUSIONS: In patients with healthy marginal periodontal conditions, the PBI allows rapid and predictable recession-free healing, whereas complete mobilization of the papilla led to a marked loss of the papilla height. In aesthetically relevant areas, the use of the PBI is recommended, to avoid opening of the interproximal space, when periradicular surgical treatment is necessary.

Adult↗
PubMed2003

Diagnostic accuracy of endoscopy in periradicular surgery - a comparison with scanning electron microscopy.

AIM: To compare the accuracy of endoscopic diagnostics with the scanning electron microscope (SEM) in evaluating elements of periradicular surgery. METHODOLOGY: The material consisted of 22 extracted human molars, which were subjected to the following treatments: orthograde root-canal obturation, root-end resection and root-end cavity preparation with diamond-coated sonic microtips. After each step, the cut root face was inspected with an endoscope, and subsequently, the roots were duplicated for SEM evaluation. Endoscope findings were compared to those obtained with SEM serving as the 'gold standard' with a blinded observer. The presence of the following structures was assessed including specificity and sensitivity: isthmuses, accessory canals, obturation gaps, microfractures and chipping of cavity margins. RESULTS: The specificity and sensitivity of the identification of isthmuses or accessory canals was 100% each for the endoscope compared to SEM. The sensitivity of identification of obturation gaps, crack formation or chipping ranged between 73 and 95% (except intradentine cracks with only 36% sensitivity). The specificity of the same parameters ranged between 77 and 100% for the endoscope compared to SEM. CONCLUSIONS: With the exception of intradentine cracks, the endoscope accurately identified microstructures following root-end resection and root-end preparation. The endoscope could be considered for use during intraoperative diagnostics in periradicular surgery.

Apicoectomy↗
PubMed2003

Orthograde retreatment and apexification after unsuccessful endodontic treatment, retreatment and apicectomy.

AIM: To describe a case where a second orthograde retreatment was successful in the management of an infected mandibular right first molar that previously had received both orthograde and retrograde treatments. SUMMARY: Periapical surgery is unlikely to be successful unless the root canal system has been adequately debrided and sealed. A case is described where orthograde endodontic treatment, retreatment and apicectomy were unsuccessful in the management of and infected mandibular right first molar. The periapical radiolucency eventually disappeared following a second orthograde retreatment. Teh second retreatment included 12 months of intracanal calcium hydroxide placement to promote apexification, thus allowing subsequent controlled obturation with gutta percha and AH26. At a 5-year review following completion of treatment, the tooth remained asymptomatic and was in normal function. KEY LEARNING POINTS: Orthograde retreatment is a treatment option to manage refractory lesions in teeth that have previously received endodontic treatment, retreatment and apicectomy. Orthograde retreatment using long-term intracanal calcium hydroxide can help promote root-end closure of a resected apex.

Apicoectomy↗
PubMed2000

Use of N-butyl-2-cyanoacrylate in oral surgery: biological and clinical evaluation.

N-butyl-2-cyanoacrylate based tissue adhesive, Tisuacryl, was employed as a nonsuture method for closing wounds in oral surgery. One hundred thirty patients were treated with the adhesive and 30 with suture. The surgical procedures were apicectomy, extraction of molars, and mucogingival grafting. The studied product was well tolerated by the tissue and permitted immediate hemostasis and normal healing of incisions. When Tisuacryl was used as dressing material for donor sites and mucosal ulcerations, pain relief was observed.

Adult↗
PubMed2004

Intentional replantation - a 'last resort' treatment or a conventional treatment procedure? nine case reports.

Intentional replantation is an accepted endodontic treatment procedure in which a tooth is extracted and treated outside the oral cavity and then inserted into its socket to correct an obvious radiographic or clinical endodontic failure. This article reviews nine cases of intentional replantation (IR) that show the feasibility of the procedure in a variety of indications. Only one case of replantation showed evidence of pathosis that reflected root resorption or ankylosis. This report suggests that IR is a reliable and predictable procedure and should be more often considered as a treatment modality in our efforts to maintain the natural dentition.

Adult↗
PubMed2002

Routine follow-up after periradicular operations: current practice in UK hospitals.

Questionnaires were circulated to all Fellows of the British Society of Oral and Maxillofacial Surgeons in 1999, 75% of whom replied (n = 194). There was a wide range of responses for both the timing of review appointments and the taking of radiographs. Most patients were first followed up 1 week after operation (46%), but 38% were reviewed in the second week. Five surgeons did not review patients at all and two did not review until 6 or 9 months, respectively. Nearly two-thirds routinely offered a second follow-up appointment but only 14% offered more than two, the maximum being seven. Most arranged postoperative radio-graphs but the timing ranged from immediately postoperatively to 1 year after the procedure. Less than one-third requested a second postoperative radiograph between 1 month and 1 year. The largest disparity was in the time of discharge to the general dental practitioner, which ranged from immediately to 5 years, the most popular time of discharge being at 3 months. The wide variations may reflect unnecessary recall of patients and misuse of valuable clinical time.

Apicoectomy↗
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↗
PubMed2001

Revascularization after cryopreservation and autotransplantation of immature and mature apicoectomized teeth.

Autotransplantation of immature teeth can have a success rate of almost 98% if the tooth is atraumatically transplanted from the donor site to a suitable acceptor site and the extraoral time is kept to a minimum. When the tooth cannot be transplanted immediately, cryopreservation and storage in a tooth bank offer new possibilities for autotransplantation. However, the effect of cryopreservation on the revascularization of transplanted teeth is still unknown. The purpose of this study was to examine revascularization in immature teeth that have an open apex and in mature teeth that have had the apex cut. The study was carried out on 16 teeth in 2 dogs; 8 teeth were removed and immediately transplanted to the contralateral position and 8 teeth were cryopreserved and transplanted 1 week later. The results show that: (1) teeth can revascularize after autotransplantation if the original pulp tissue is removed at the time of extraction, (2) there is no significant difference in the amount of revascularization between teeth stored in a tooth bank for 7 days and those immediately transplanted without freezing, and (3) there is no difference in the ingrowth of new pulpal tissue between mature apicoectomized teeth and immature teeth.

Angiography↗
PubMed2003

Periapical and periodontal healing after osseous grafting and guided tissue regeneration treatment of apicomarginal defects in periradicular surgery: results after 12 months.

OBJECTIVE: The aim of the present study was to evaluate the periapical and periodontal healing of apicomarginal defects 12 months after periradicular surgery and guided tissue regeneration in a series of consecutively treated patients. STUDY DESIGN: Patients with apicomarginal defects who were referred for periradicular surgery were included. Apicomarginal defects were grafted with Bio-Oss bone mineral and covered with a Bio-Gide membrane. Periodontal probing depths (PPDs) and relative attachment levels were measured preoperatively and 12 months postoperatively with a manual force-controlled probe. Periapical healing was assessed clinically and radiographically. RESULTS: Of the 23 defects in 22 patients for whom follow-up data were available, 19 were considered clinically and radiographically successful, 2 were doubtful, and 2 were failures. Overall, the baseline median PPD decreased from 9.0 mm to 3.0 mm, corresponding to a median relative attachment level gain of 2.8 mm. In the case of periodontic-endodontic lesions, the median baseline PPD decreased from 9.8 mm to 4.0 mm, corresponding to a median relative attachment level gain of 4.2 mm. Defects that involved a proximal root surface had a significantly higher residual PPD than did defects not involving a proximal root surface. CONCLUSIONS: Guided tissue regeneration treatment of apicomarginal defects yields good results in terms of periapical and periodontal healing after 12 months and should be considered as an adjunct to periradicular surgery in such cases.

Adolescent↗
PubMed2003

Effect of root resection on the apical sealing ability of mineral trioxide aggregate.

OBJECTIVE: The purpose of this in vitro study was to determine the minimum depth of mineral trioxide aggregate (MTA; ProRoot; DENTSPLY/Tulsa Dental, Tulsa, Okla) required to maintain an apical seal following root resection. Study design. In 10 instrumented teeth, MTA was used to obturate the apical 6 mm of the root canal and was allowed to set for 48 hours. Leakage was determined by means of a fluid filtration method at a pressure of 20 cm H(2)O. Leakage was measured before root resection, and after 3, 4, 5, and 6 mm apical resections. Data were analyzed by means of a Kruskal-Wallis one-way analysis of variance with P <.05. RESULTS: Fluid leakage was shown to increase after each resection, but did not reach statistical significance (P <.05) until 4 mm of the apex had been removed. CONCLUSION: The results indicate that root resection did not significantly affect the sealing ability of MTA when at least 3 mm of the MTA remained. Although there was a statistically significant difference in leakage following the 4 mm resection, it is unknown what the biological difference would be between the 3 mm and 4 mm resections.

Aluminum Compounds↗
PubMed2004

Chronic idiopathic orofacial pain. A long-term follow-up study.

Patients suffering facial pain that does not fit with the traditional diagnostic criteria and which does not respond to dental treatment constitute a clinical problem. These patients lack a proper diagnosis and are frequently exposed to excessive and inadequate invasive treatment. The aim of this investigation was to study the long-term development of pain and the result of treatment in a cohort of patients suffering chronic idiopathic facial pain. The 74 patients referred to the Facial Pain Diagnostic Group at the Karolinska Institute School of Dentistry between 1981 and 1992 were invited to take part in a follow-up study. As 16 subjects were unwilling or unable to take part in the study and 13 had died, the remaining 45 were interviewed either in accordance with a standard protocol or by filling out a questionnaire mailed to them. The interview revealed that 10 were free of orofacial pain, but only 2 were totally free of pain. Over the 9-19 years' follow-up period the relationship between facial pain and pain in the rest of the body had changed substantially. Of 14 patients and more than 100 extractions, permanent pain relief was felt by only 3 patients. It is concluded that a diagnosis was given in only 2 cases. The distribution of the pain has changed dramatically. The low success rate of invasive treatments suggests that such therapeutic methods are to be considered contraindicated in patients suffering from idiopathic orofacial pain.

Aged↗
PubMed2001

The use of Er:YAG, Nd:YAG and Ga-Al-As lasers in periapical surgery: a 3-year clinical study.

OBJECTIVES: In an attempt to increase the successful rate of endodontic surgical procedures this study proposes the use of an association of three lasers in apicectomy: Er:YAG laser, (wavelength 2.94 microm pulse mode), Nd:YAG laser (wavelength 1.064 microm, pulse mode), and Ga-Al-As laser, (wavelength of 790 nm, continuous wave). BACKGROUND DATA: Previous studies have shown the low success rate of apicectomy by conventional methods due to the presence of remaining bacteria in the surgical site. METHODS: The Er:YAG laser was used to perform osteotomy and root resection without vibration, discomfort, less contamination of the surgical site, and no smear-layer on the dentine surface. The Nd:YAG laser irradiation through a fiber performed sealing of the dentinal tubules and bacterial reduction of the cavity bone. In addition, the improvement of healing and better post-operative achieved with the Ga-Al-As laser encourages the use of those lasers in periapical surgeries. RESULTS: Three years follow-up examination of the clinical case showed radiographically significant decrease of the radiolucent periapical area and no clinical signs and symptoms. CONCLUSION: The outcome of this clinical case indicates that the use of those lasers could be considered an alternative, suitable, and useful method to perform an apicectomy.

Apicoectomy↗
PubMed2004

Comparative study of dentine permeability after apicectomy and surface treatment with 9.6 microm TEA CO2 and Er:YAG laser irradiation.

Failure of apicectomies is generally attributed to dentine surface permeability as well as to the lack of an adequate marginal sealing of the retrofilling material, which allows the percolation of microorganisms and their products from the root canal system to the periodontal region, thus compromising periapical healing. The purpose of this study was to evaluate dentine and the marginal permeability after apicectomy and surface treatment with 9.6 micro m TEA CO(2) or Er:YAG 2.94 micro m laser irradiation. Sixty-five single rooted human endodontically treated teeth were divided into five experimental groups: group I (control), apicectomy with high speed bur; group II, similar procedure to that of group I, followed by dentinal surface treatment with 9.6 micro m CO(2) laser; group III, similar procedure to group I followed by dentinal surface treatment with Er:YAG laser 2.94 micro m; group IV, apicectomy and surface treatment with CO(2) 9.6 micro m laser; and group V, apicectomy and surface treatment with Er:YAG laser 2.94 micro m. The analysis of methylene blue dye infiltration through the dentinal surface and the retrofilling material demonstrated that the samples from the groups that were irradiated with the lasers showed significantly lower infiltration indexes than the ones from the control group. These results were compatible with the structural morphological changes evidenced through SEM analysis. Samples from groups II and IV (9.6 micro m CO(2)) showed clean smooth surfaces, fusion, and recrystallized dentine distributed homogeneously throughout the irradiated area sealing the dentinal tubules. Samples from groups III and V (Er:YAG 2.94 micro m) also presented clean surfaces, without smear layer, but roughly compatible to the ablationed dentine and without evidence of dentinal tubules. Through the conditions of this study, the Er:YAG 2.94 micro m and the 9.6 micro m CO(2) laser used for root canal resection and dentine surface treatment showed a reduction of permeability to methylene blue dye.

Apicoectomy↗
PubMed1997

Erbium:YAG and holmium:YAG laser root resection of extracted human teeth.

Root resection of extracted human teeth was performed using the erbium:YAG (Er:YAG) and holmium:YAG (Ho:YAG) laser to investigate the clinical application of lasers on hard tissue. The CO2 laser and the mechanical drill were also used for comparison. After resection using these technologies, the morphological changes of the cut surface were investigated by optical and scanning electron microscope. Er:YAG laser irradiation produced smooth, clean resected surfaces without signs of thermal damages. Complete obturation of the root canal was maintained after Er:YAG laser irradiation. Ho:YAG laser irradiation, however, produced some signs of thermal damage. Relatively large voids between the gutta-percha and the canal walls were revealed after Ho:YAG laser irradiation. The sealing of the dentinal tubules was not completely attained as stipulated by original conditions of this study.

Apicoectomy↗
PubMed2005

Apicectomy with the Er:YAG laser or bur, followed by retrograde root filling with zinc oxide/eugenol or sealer 26.

OBJECTIVE: This study evaluated the influence of root resection, by means of the use of erbium:YAG laser in sealing two different materials, OZE and Sealer 26, in retrograde obturations. BACKGROUND DATA: Few studies with sufficient data have been conducted in this area. METHODS: Forty uniradicular teeth were used. They were biomechanically prepared using the step-back technique and obturated using the lateral condensation technique. The teeth were divided into two groups of 20 teeth, one group using the erbium:YAG laser (350 mJ and 6 Hz) for the resection process and the other using the Zekrya Drill, in high rotation. Then, the retrograde cavities were prepared using a micro counter-angle with a number 2 spherical bur. After preparing the cavities, the teeth were impermeabilized and divided into two subgroups. One subgroup used the retrograde obturation technique with Sealer 26 cement, and the other subgroup used OZE. After completing the retrograde obturation, the teeth were immersed in 2% methylene blue for a 7-day period. Teeth were then removed from the dye, washed, scraped, and sectioned in the vestibule-lingual direction. RESULTS: The results were analyzed with the aid of a magnifying lens, and scores were attributed based on the magnitude of infiltration. The data were then submitted to statistical analysis. CONCLUSIONS: No statistical difference was noticed regarding the root resection methods; however, in comparing materials, Sealer 26 was statistically superior to OZE. In the subgroup comparison, a significant difference was noticed in the Laser and Sealer 26 and the Laser and OZE and bur and OZE.

Apicoectomy↗
PubMed2005

In vivo study of the Nd:YAP laser in persistent periapical lesion.

OBJECTIVE: The aim of this study was to evaluate the therapeutic effect of ND:YAP laser in persistent lesions through signs and symptoms such as the presence of fistulas and pain, respectively. BACKGROUND DATA: Periapical lesions with bacterial invasion, giving origin to bacterial infections, appear many times during the endodontic treatment, which aims at preparing and disinfecting the root canal system, in canals with mortified pulp. The endodontic treatment aim at eliminating infections and reinfection prevention; however, sometimes re-treatment is necessary, and it can be complemented with paraendodontic surgery due to reinfection, which can also persist. METHODS: Our study group consisted of six clinical cases (endodontic treatment), with the introduction of a 300-microm optic fiber through the fistula channel, where three applications were carried out with an interval of 15 sec, each with a discharge of 300 mJ of energy and frequency of 30 Hz. RESULTS: After a 7-day interval, the signs and symptoms were absent, even after a follow-up of 18 months. It was also observed, through a microbiological study, the decrease of the local microbiota. CONCLUSIONS: Our results supported the use of Nd:YAP laser, in part since it created an unfavorable environment for the continuing development of microorganisms.

Apicoectomy↗
PubMed2000

Effects of ultrasonic root-end preparation on microcrack formation and leakage.

Root-end preparations made with conventional ultrasonic (CUS) tips, diamond-coated ultrasonic (DUS) tips, and high-speed stainless-steel burs (HSB) were compared for the incidence of microcracks and dye leakage. One hundred twenty incisors were instrumented, obturated, and had 3 mm resected from their apices. Sixty teeth were used for microcrack evaluation before and after root-end preparation with CUS, DUS, or HSB. Three types of microcracks were observed: intracanal, extracanal, and communicating. Four of the five cracks observed after root resection (before root-end preparation) were of the extracanal or intracanal type. After root-end preparation, 19 of the 41 new microcracks that developed were the communicating type. There was no significant difference among CUS, DUS, or HSB for the number or type of cracks. Of the remaining 60 resected teeth, 25 were prepared with DUS, 25 with CUS, and 10 served as controls. All of the DUS and CUS teeth were filled with Super-EBA. Dye penetration was measured after immersion in Pelikan ink for 5 days. The dye penetration difference between DUS and CUS was not significant.

Apicoectomy↗
PubMed2000

Retreatment decisions--a comparison between general practitioners and endodontic postgraduates.

One of the most subjective areas with regard to interexaminer variations is the dental radiograph. The variations in radiographic interpretation lead to differences in treatment planning decisions. This study compared the endodontic retreatment planning decisions for endodontically treated teeth between 12 general practitioners and 12 endodontic postgraduate students. Utilizing dental radiographs of completed cases, both groups were asked to make treatment choices based on two hypothetical ages of a case: 1 or 3 yr postoperatively. General practitioners chose to initiate treatment at an earlier date and also chose more extensive treatment modalities. The age of the root filling was looked on as more important in treatment planning by the endodontics postgraduates.

Apicoectomy↗