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Radiography in endodontics.

In endodontics, the paralleling technique has a geometrical advantage over the bisecting angle technique and results in radiographs with less distortion. Distortion is undesirable for endodontic radiography as it can significantly alter the apparent position of an endodontic instrument relative to the root apex. However, there are instances where the bisecting angle is preferable, and consideration should be given to this technique to improve the image quality when it is used.

Dental Pulp Cavity↗

Endodontic failures--changing the approach.

The underlying reason for endodontic failures is almost invariably due to bacterial infection. The bacteria may be situated within a previously missed or uninstrumented portion of a root canal, infiltrate via a leaky coronal restoration and root filling, or cause contamination from an extra-radicular infection. Management of the failing root canal filling begins with the identification of the source of persistent infection. Should the infection be present within the root canal system, such as a missed canal, orthograde retreatment is the choice of treatment. This is also true for asymptomatic cases which had been inadequately obturated and which require the placement of a dowel into the canal for restorative reasons. Periapical surgery is best reserved for cases with no sign of healing after orthograde retreatment and those with extra-radicular infection. This paper discusses the relationship between endodontics and restorative dentistry, treatment planning for endodontic failures, and the reported rates of success with orthograde and surgical retreatments.

Bacterial Infections↗

Failures, disasters and catastrophes--a hypothetical endodontics.

Failures occur in dentistry as a result of many factors some of which can be controlled by the operator whilst others are unavoidable. The long-term success rate of endodontic treatment has often been thought to be very high although studies reported in the literature do not support this perception. The number of failures can be reduced by adhering to accepted treatment procedures and by avoiding 'short cuts'. Recent work now points to endodontic failures being largely a consequence of failures of the coronal restoration rather than being due to failure of the root canal filling itself. Disasters are usually related to operator errors and they may have detrimental effects on the outcome of treatment in the long term, eventually becoming catastrophes. Endodontic disasters will require special techniques to salvage them whereas catastrophes usually result in loss of the tooth and every effort should be made to prevent such problems from occurring.

Dental Instruments↗

Principles of endodontic microsurgery.

With bright illumination and magnification under the operating microscope, and addition of many microinstruments, endodontic surgery has become microsurgery. The microsurgical approaches allow the clinicians to perform endodontic surgery with smaller osteotomies, shallow bevels, preparation of isthmuses, examination of resected root surfaces, retropreparation in line with root canal, and precise placement of new filling materials. This article illustrates the advantages of microsurgery in endodontics.

Alveolectomy↗

Controversies in clinical endodontics: Part 2. Single-appointment vs multiple-appointment treatment.

Endodontics is no stranger to controversies. For most of the first 50 years of the 20th century, a cloud hung over endodontic therapy of any kind, as problems with the focal infection theory were attributed to pulpless teeth causing a wide variety of maladies. Even recently, endodontic treatment has been attacked as being responsible for many chronic and acute illnesses, despite a multitude of information to the contrary. The controversies we discuss here, however, have nothing to do with the decision to treat, where we have no doubt as to the efficacy for therapy, but rather how such treatment should be rendered. Controversies have raged in the past, such as silver points vs gutta-percha as the canal filling material of choice, and to culture or not to culture, to name just two. The subjects discussed in this series of articles are those that have come up much more recently or older topics that have returned as areas for disagreement: (1) lateral canals: filling and significance; (2) single-appointment vs multiple-appointment treatment; (3) filling from the open position; and (4) calculation of working length. This article addresses single-appointment vs multiple-appointment treatment.

Appointments and Schedules↗

Restoring endodontically treated teeth.

It is impossible to guarantee success in every case. However, predictably successful endodontic therapy cannot be achieved without properly designing and executing restorations with careful consideration of potential periodontal complications. When prosthetic and periodontal considerations are addressed concurrently with endodontic treatment, patients leave the office with the best possible prognosis for teeth that otherwise have been lost. The information in this article is meant to aid dentists in the restoration of endodontically treated teeth. Practitioners must always use their best professional judgement, taking into account the needs of each individual patient when choosing a restorative plan. The Dental Journal neither expressly nor implicitly warrants any positive results nor expressly nor implicitly warrants against any negative results associated with the application of this information.

Cementation↗

Fracture resistance of endodontically-treated premolars adhesively restored.

PURPOSE: To investigate the cusp fracture resistance of endodontically treated teeth, adhesively restored with various materials. MATERIALS AND METHODS: MOD preparations and endodontic treatment was carried out on extracted sound maxillary premolars. The cavities were restored with the amalgam Valiant in combination with Superbond or Panavia bonding, the resin composites Z100, Herculite XRV or Clearfil RP with their respective bonding systems, Z100 in combination with the glass ionomers Ketac Fil, Fuji II and Vitremer, and Tetric in combination with Compoglass. Fracture resistance was measured by axial loading in an Instron testing machine. RESULTS: One of the restorative methods, resin composites in combination with dentin bonding systems in beveled MOD preparations rendered the tooth a cusp fracture resistance which did not differ significantly from that of sound natural teeth. Two other restorative methods, bonded amalgam and a sandwich of glass ionomer cement/resin composite in beveled preparations were significantly weaker in resisting cusp fracture than sound natural teeth, but still significantly stronger than the unrestored tooth with a MOD preparation. It was statistically apparent that several adhesive restorative systems could satisfactorily be used to restore teeth after endodontic therapy.

Analysis of Variance↗

Considerations for the aesthetic restoration of endodontically treated anterior teeth following intracoronal bleaching.

The major considerations in restoring the pulp chamber following bleaching of endodontically treated anterior teeth include aesthetics, function, appropriate endodontic access preparation, amount of remaining tooth structure, type of restorative material, prevention of microleakage, and prevention of iatrogenic perforation. The learning objective of this article is to review the considerations that must be made when placing aesthetic restorations in the pulp chamber and access opening of endodontically treated teeth following intracoronal bleaching. The advantages and disadvantages of the proposed techniques and materials are discussed, as are the methods for avoiding excessive removal of the tooth structure. Two case reports are used to demonstrate the clinical procedures. The authors suggest placing white gutta-percha stopping material in the pulp chamber and a composite restoration in the access opening following root canal treatment and/or bleaching procedures in the anterior dentition.

Adolescent↗

Development of a teaching model for surgical endodontic access sites in the dog.

A dolicocephalic canine skull was used to develop a teaching and study model for surgical endodontic access sites of the maxillary and mandibular canine teeth, the maxillary fourth premolar and the mandibular first molar teeth. Coronal endodontic access sites were created, and endodontic files were inserted through the access preparation into the root canal system. The teeth were radiographed to determine the ideal surgical access points. Barium markers were placed over these points and each tooth was radiographed again to confirm the appropriate location of the marker. Surgical accesses to the apices were created by drilling through the barium markers and underlying bone. Following localization of the apices, apicoectomies were performed, exposing the apical portion of the pulp canal. The maxillary and mandibular canine teeth, the maxillary fourth premolar tooth, and the mandibular first molar tooth and surrounding bone were harvested from a similar dolicocephalic dog following euthanasia. The specimens were embedded in methylmethacrylate, sectioned, and mounted on slides to reveal the structures located around the surgical access sites.

Animals↗

Criteria for the predictably restorable endodontically treated tooth.

This paper outlines criteria which allow the clinician to identify endodontically treated teeth that can be restored with a high level of predictability. The intent of the article is not to preclude the restoration of teeth that do not meet these criteria; it is to provide a science-based approach for identifying those teeth with a high probability of long-term success upon restoration. For an endodontically treated tooth not requiring a post, the requirements are for biologic width + ferrule length, (i.e. 4.5 mm of supra-bony solid tooth--dentin a minimum of 1 mm thick after preparation). A tooth requiring a post needs, in addition, enough root length to allow a 4 mm apical seal and a post length--apical to the crown margin, equal to the length of the crown. It is essential to assess the functional loads to which the restored tooth would be subjected. Teeth that are endodontically treated, or are likely to be in future, should be avoided as abutments supporting precision attachment RPDs, distal extension RPDs or cantilever FPDs.

Crowns↗

The management of endodontically treated teeth using a Computer-Aided Design and Computer-Assisted Manufacturing/Computer-Aided Design and Computer-Integrated Manufacturing system.

This article introduces a new approach for restoring endodontically treated posterior teeth. Significantly reduced natural tooth structure often remains not only because of previous restorative measures but also because of endodontic procedures. Cast restorations for these teeth are almost universally recommended. The exception to this is the rare instance in which only conservative endodontic access openings exist in teeth presenting with no former existing restorations. Typically, multiple clinical appointments are required to complete the final cast restoration. This article presents Computer-Aided Design and Computer-Assisted Manufacturing/Computer-Aided Design and Computer-Integrated Manufacturing applications for restorative dentistry that provide the necessary care in an expeditious manner.

Ceramics↗

State of the art and science of endodontics.

BACKGROUND: Advances in the art and science of endodontics have facilitated better understanding of disease processes and have led to development of treatment modalities aimed to restore health to the pulp and periradicular tissues. This article presents a summary of both basic and clinical breakthroughs in endodontics. RESULTS: The author indicates that, on the basis of the reviewed literature, pulp and periradicular diseases are primarily microbial. Basic research has led to development of methodologies that have allowed for specific and accurate identification of pathogens that are likely to cause persistent infections. Close examination of clinical data shows that meticulous débridement of the infected root canal system will result in a high probability of successful treatment outcome. Progress in visualization, mechanical and chemical disinfection, and biological seal of portals of entry will improve quality of care further. CONCLUSIONS AND CLINICAL IMPLICATIONS: A better understanding of the pathogenesis of pulp and periradicular diseases, inflammation and healing, as well as of pain pathways, will improve patient care and result in preservation of natural tissues.

Dental Pulp Diseases↗

Endodontic dowel retention with resinous cements.

This study compared the capability of three composite resin cements to sustain a standard endodontic dowel. All of the systems incorporated some form of smear layer removal on the dentin of the endodontic channel. One system that used a methyl ethyl ketone drying agent provided inadequate clinical resistance to dislodgment of 5.4 DaN. A second cementing system that used only smear layer removal resisted loads at 54.7 DaN. The third cementing regimen that included a surface-initiated dentinal adhesive and smear layer removal recorded retention of 77.4 DaN. This study supported the concept that passively cemented dowels with composite resin can be as effective as actively seated dowels.

Acrylic Resins↗

The diagnostic correlator: an endodontic teaching device.

A chart is proposed as an aid to assist students and practitioners to correlate clinical information and arrive at an accurate endodontic diagnosis. A brief description of current displays, the clinical examination, and an endodontic disease classification is given. A discussion and examples of how to use the chart are presented. The chart has been found to be a useful teaching aid.

Dental Pulp Diseases↗

Chairside decontamination of endodontic files.

Chairside decontamination. of files and reamers is attempted during root canal treatment. The purpose of this study was to evaluate some techniques for reducing the number of microorganisms of artificially contaminated endodontic files. Endodontic files were artificially contaminated with about 10,000 colony-forming units of either B. subtilis spores or S. mitis. The files containing the bacteria were then subjected to various decontamination procedures. Although sterilization was not achieved with any procedure, the bead sterilizer was found to be the most effective decontamination method tested. All gauze wipings showed reductions greater than 90 per cent. It was concluded that wiping with 2 by 2 inch gauze is a highly efficient and practical method of chairside decontamination

1-Propanol↗

Evaluation of the apical seal obtained with endodontic implant stabilizers and different cementing materials.

Preliminary research was conducted to evaluate in vitro the apical seal obtained with endodontic implant stabilizers in conjunction with four different cement sealers. Standard laterally condensed gutta-percha cones and sealer were used as a control. Apical leakage was measured with the use of methylene blue dye solution. Gross leakage patterns resulted from endodontic implants cemented with both zinc phosphate and polycarboxylate. However, leakage appeared notably reduced when the implants were cemented with cyanoacrylate and Kerr Tubli-Seal. Statistical analysis showed that the lateral condensation of gutta-percha cones and sealer yielded the largest proportion of favorable results. Even so, none of the techniques employed was totally effective for obtaining a hermetic sealing of the root canal.

Chemical Phenomena↗

A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: a PennEndo database study.

This study investigated the incidence of hand and rotary instrument separation (IS) in the endodontics graduate program at the University of Pennsylvania between 2000 and 2004. In 4,865 endodontic resident cases the incidence of hand and rotary IS was 0.25% and 1.68%, respectively. The odds for rotary IS were seven times more than for hand IS. The probability of separating a file in apical third was 33, and 6 times more likely when compared to coronal and middle thirds of the canals. The highest percentage of IS occurred in mandibular (55.5%) and maxillary (33.3%) molars. Furthermore, the odds of separating a file in molars were 2.9 times greater than premolars. Among the ProFile series 29 rotary instruments, the .06 taper # 5 and # 6 files separated the most. There was no significant difference in IS between the use of torque controlled versus nontorque controlled handpieces, nor between first and second year residency.

Bicuspid↗

Practical application of infection control in endodontics.

The transmission of infections in an endodontic practice is a significant concern for both patients and dental health care providers. This article offers a review and practical application of infection control methods in the practice of endodontics.

Disinfectants↗