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A retained root and a single root form implant were used to support individual crowns to restore a mandibular molar after hemisection. A favorable ratio was achieved between the restoration and the root form implant.
Dens invaginatus is an anomaly that has numerous complex forms. Whenever endodontic therapy involving such a tooth becomes necessary, the clinician must be aware of the various treatments available for proper care. We present a case report of a maxillary lateral incisor having the anomaly in which both nonsurgical and surgical treatment was performed.
The purpose of this investigation was twofold: (1) to search for clinical articles pertaining to success and failure of periapical surgery and (2) to assign levels of evidence to these studies except case reports. Electronic and manual searches were conducted to identify all the literature regarding success and failure of periapical surgery since 1970. Articles were reviewed, and each article was assigned to a level of evidence from 1 (highest level) to 5 (lowest level). This search located 79 clinical studies. Among these studies, there were no level of evidence-1 randomized clinical trial studies. Five of the seven level of evidence-2 randomized clinical trials compared postoperative pain between surgical and nonsurgical retreatment. Only two level of evidence-2 randomized clinical trials compared the outcomes of surgical treatment with that of nonsurgical treatment. The majority of frequently quoted "success and failure" studies were case series (level of evidence 4).
This study prospectively assessed the 4 to 8 yr outcome of apical surgery performed by graduate students in phases I and II of the Toronto Study. The study cohort included 155 teeth in 138 patients. Outcome was assessed by a blinded and calibrated examiner. Clinical and radiographic measures were used for a dichotomous outcome: healed (no signs and symptoms, Periapical Index score </= 2 or scar), or diseased (presence of signs and symptoms, or Periapical Index score >/= 3). The recall rate was 85% and the overall healed rate 74%. Healed rate was significantly higher for teeth with small (</= 5 mm) than larger preoperative lesions (chi, p = 0.02). Logistic Regression revealed an increased odds of disease persistence for teeth with larger preoperative lesions (OR = 3.81, CI = 1.2-12.1), and preoperative root-filling of adequate length (OR = 3.7, CI = 1.1-11.1). Preoperative lesion size and root-filling length were significant predictors of outcome of apical surgery.
Modern endodontic surgery involves both root-end preparation and proper sealing of all apical portals of exit. Both components are requirements for mechanical and biological success, but the management of soft tissues becomes increasingly important for an esthetically successful treatment. A healthy appearance of soft tissues plays an important role in the esthetic outcome of periradicular surgery. This is true considering maintenance of attachment levels and regarding the amount of possible recession after surgical procedures. Complete, recession-free and predictable healing of gingival tissue is one important goal of endodontic surgical treatment. A critical review of currently used techniques based on clinical and scientific data reveals great potential for improvements. Possible reasons for scar formation and recession specifically in healthy periodontal conditions requiring surgical endodontic intervention are highlighted. Based on anatomical considerations various incision types are evaluated and recommendations made. Clear understanding of wound closure and tissue-healing patterns call for the use of atraumatic procedures, nonirritating suture materials and adequate suturing techniques. This article gives an overview and guidance for integrating current and new successful flap designs and wound closure methods. The methods described have the intention of maintaining the attachment level and avoiding postoperative recession after surgical endodontic therapy.
The aim of this in vitro study was to compare the sealing effectiveness of the Erbium:YAG laser to the sealing effectiveness of an ultrasonic device in the preparation of similar retrograde cavities using different retrograde filling materials. After root-canal instrumentation and filling, apices of 60 single-rooted teeth were resected. Retrograde class I cavities 3 mm deep were prepared using an ultrasonic device (group A) and Er:YAG laser (group B). An ultrasonic unit was used with CT-5 retrotip at the frequency of 32 KHz. Laser beam parameters were a pulse of very short duration (100 micros), energy of 280 mJ, and repetition rate of 10 Hz. Cavities of each group of 10 samples were filled with mineral trioxide aggregate (MTA), Super-EBA, and IRM. Microleakage was measured using a fluid transport model. The results showed that cavities prepared with Er:YAG laser have significantly lower microleakage for all tested materials.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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A prospective study was set up to evaluate a one-visit apicectomy technique. Calcium hydroxide cement was used as the root canal filling material. The calcium hydroxide cement set rapidly and clearly revealed the position, size and outline form of the root canals at the level of resection. This facilitated preparation of the apical cavities to a depth of 3 mm. Each cavity was varnished before placement of the amalgam. Sixty-eight patients (93 teeth) were included in the study. Five patients (8 teeth) were lost to follow-up. The success rate, based on clinical and radiographic examination after a minimum of 2 years, was 91.8 per cent.
The periapical tissue response to glass ionomer cement retrograde root fillings was investigated both in the presence and in the absence of fillings in the root canals of eight upper incisor teeth of four monkeys. The pulps of the teeth were extirpated and one canal in each pair was filled with laterally condensed gutta-percha immediately after canal preparation. The other canal was prepared but left open to oral contamination. Apicectomies were performed on both teeth in each pair 1 week later, and glass ionomer cement retrograde root fillings were placed. After 5 months, the teeth and surrounding tissues were removed and prepared for histological examination. All four of the teeth without root canal fillings showed severe periapical inflammation, and bacterial were present in the interface between the dentine and the retrograde root filling. The teeth with root canal fillings showed little or no periapical inflammation. This study showed that adhesive retrograde root fillings were successful when the root canal was completely filled, but in the absence of a gutta-percha canal filling they failed to provide a seal.
The purpose of this investigation was to study the effects of a Nd:YAG laser on the cut surface of teeth using scanning electron microscopy (SEM). Eighteen single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and root canal sealer. The apical 3 mm of each tooth were resected with a diamond fissure bur, and the teeth were randomly divided into two groups of nine teeth each. The resected surface of each root in one group was lased twice. The duration of lasing and the number of pulses were recorded for each tooth. The teeth were air dried, mounted on stubs, sputter-coated with gold-palladium and examined under SEM. Application of the Nd:YAG laser caused melting of apical dentine surfaces. The melted material resembled the appearance of glazed interconnected droplets. Resolidification and recrystalization of the melted areas appeared to be incomplete and discontinuous. Some areas between the glazed regions appeared similar to those of non-lased apical dentine resected root surfaces.
Changes in the serum levels of immunoglobulin IgA, IgG, IgM, positive acute phase proteins and complement activity, as well as the lymphocyte subpopulations and the neutrophil leucocyte-related chemiluminescence in the blood of patients with apical granuloma as related to endodontic and surgical treatment were investigated. Measurements were performed on admission, and 7 days and 3 months after the treatment. Elevated IgM concentration, positive acute-phase protein levels and spontaneous whole-blood chemiluminescence were noted at admission. However, a significant decrease in the serum level of each of the six investigated acute-phase proteins, and in the spontaneous chemiluminescence of blood was observed during the 3-month follow-up period. The significant increase in serum complement activity following therapy suggests that complement fixation might have occurred in these patients. A significant increase in the ratio of early sheep erythrocyte rosette-forming lymphocytes was also observed. The results of this study provide evidence for complete recovery after elimination of local inflammation by proper endodontic treatment and apicectomy in patients with apical granuloma.
A light-cured ionomer cement was investigated as a retrograde root seal, without a retrograde cavity. This was compared with the material used in a retrograde cavity, and with a conventional glass ionomer cement, as a seal. The adaptation and sealing ability of the test materials were assessed using a confocal optical microscope with a fluorescent dye. The root canals of 40 extracted human single-rooted teeth were prepared and filled with gutta-percha and sealer. All the teeth were subsequently apicected, then divided into four equal groups. In one group, a retrograde cavity was prepared, and the light-cured glass ionomer cement was placed as a retrograde root filling. No retrograde cavities were prepared in the three remaining groups. The light-cured glass ionomer cement was applied directly onto the apicected root face. Two different thicknesses of light-cured glass ionomer cement were tested, a thin layer (approximately 1 mm) in one group, and a thicker layer (> 1 mm) in another group. A conventional glass ionomer cement was used in the last group, and applied directly onto the root face in a single thickness (approximately 1 mm). In the group where the light-cured glass ionomer cement was used in a retrograde cavity, the material was often well adapted to one cavity wall, but gaps were found on the opposite wall. The light-cured and conventional glass ionomer cement retrograde root seals were well adapted to the root face, regardless of the thickness of material used. The thinly applied (approximately 1 mm) light-cured glass ionomer cement retrograde root seals permitted the least leakage.(ABSTRACT TRUNCATED AT 250 WORDS)
Careful management of the resected root end during endodontic surgery is critical to the overall success of the case. After resection, the root structure presents with multiple anatomical variations and considerations at both a macroscopic and microscopic level. These include root outline, canal anatomy, dentinal tubule configuration, presence of a smear layer and root canal filling material. Proper assessment of these variables will dictate the best methods for root-end management, along with the attainment of an anatomically compatible root face for optimal healing of the periradicular tissues.
Following extraction of a symptomatic mandibular premolar which had been subjected to two periradicular surgical procedures, significant apical healing was identified histologically. The implications of these findings are discussed in relation to contemporary advocated treatment regimens, case assessment, and interpretation for success and failure.