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PubMed1996

Periradicular healing in response to Diaket root-end filling material with and without tricalcium phosphate.

The healing of the periradicular tissues was evaluated when the polyvinyl resin Diaket with and without tricalcium phosphate was used as surgical root-end filling material. Non-surgical root canal treatment was performed on 56 mandibular premolar roots in mongrel dogs. Following root-end resection, root-end cavity preparations were filled with Diaket, the comparative material, or Diaket in combination with tricalcium phosphate, the experimental material. Postsurgically, healing of the tissues adjacent to the filling materials and in the surrounding surgical site were evaluated at 30 and 60 days. There was virtually no statistically significant difference between the experimental and comparative group at or within the 30- or 60-day period with regard to inflammation, connective tissue formation, root-end encapsulation, cementum formation, or bone apposition. Findings suggest that cementogenesis occurred over both materials. The overall healing of the periradicular tissues was favourable.

Animals↗
PubMed1996

Haemostasis in periradicular surgery.

The successful performance of endodontic surgical procedures is predicated on many factors. However, the ability of achieve sustained tissue haemostasis in the surgical site is crucial to the performance of these procedures. This achievement improves vision in the surgical site, minimizes surgical time, enhances the surgical procedures (root-end resection, preparation and filling), and reduces surgical blood loss, postsurgical haemorrhage and postsurgical swelling. A multitude of materials have used in dentistry and medicine to achieve both generalized and localized haemostasis, many without full assessment of their biological implications. The purpose of this paper is to provide a thorough and critical review of these materials from the perspective of surgical endodontics, highlighting their development, application and potential role in achieving proper haemostasis.

Antifibrinolytic Agents↗
PubMed2004

Resolution of persistent periapical infection by endodontic surgery.

AIM: To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms. SUMMARY: The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where Propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced.

Adult↗
PubMed2004

The influence of root-end resection and root-end cavity preparation on microleakage of root filled teeth in vitro.

AIM: To investigate in vitro the influence of root-end resection and root-end cavity preparation on leakage of root filled teeth. METHODOLOGY: The root canals of 48 roots, 16 mandibular premolars (G1), 16 mandibular incisors (G2) and 16 maxillary incisors (G3), 12 mm in length, were enlarged using a modified 'balanced force' technique and filled with gutta-percha and sealer using lateral compaction. After setting, leakage along the canal was measured using a fluid transport model. Root-end resection and root-end cavity preparation were then performed, leaving roots 10 mm in length with root fillings of 7 mm (groups R1, R2 and R3, respectively). Fluid transport was measured again along the remaining root fillings of all groups using the same experimental conditions. Results of leakage before and after root-end resection were analysed statistically using the Kruskal-Wallis and Wilcoxon tests. RESULTS: A total of 31% of the roots leaked before and 54% after root-end preparation; the difference was significantly different (P < 0.001). No significant differences were found either among groups G1, G2, G3 (P = 0.565) or among groups R1, R2, R3 (P =0.2628). Significant differences, however, were shown between groups G1-R1 (P = 0.0053), G2-R2 (P =0.0089) and G3-R3 (P = 0.0461). CONCLUSIONS: Root-end resection and root-end cavity preparation compromised the seal of 7 mm root fillings in all tooth groups. Increased leakage was recorded in the following order: mandibular incisors > mandibular premolars > maxillary incisors.

Apicoectomy↗
PubMed2004

Effect of root-end resection and root-end filling on apical leakage in the presence of core-carrier root canal obturation.

AIM: To evaluate the apical seal of canals filled with a core-carrier obturator following root-end resection with and without a root-end filling. METHODOLOGY: Thirty single-rooted human teeth with single canals were used. Root canal treatment was performed and canals filled with a core-carrier obturation technique. The teeth were then randomly assigned to three groups (n = 10). In the first group root canal filling only was performed. After orthograde filling, the teeth of the second group were resected apically, perpendicular to the major axis of the root. In the third group after apical resection, a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities filled with Super-EBA cement. During a period of 3 h and with a headspace pressure of 0.12 atm, methylene-blue solution was forced through a tube that was connected to the apical end of each tooth specimen. The coronal end of the tooth was connected to a capillary tube containing an air bubble. Leakage was evaluated by observing the distal displacement of the air bubble. The roots were then sectioned along their long axis. Using a stereomicroscope, linear dye infiltration at the dentine-cement interface was determined. Kruskal-Wallis and Mann-Whitney tests were used to compare the three groups. RESULTS: Linear dye infiltration was significantly greater in root canals filled with the core-carrier obturators and resected apically (0.9 +/- 0.9 mm) when compared with those that had root-end fillings (0.2 +/- 0.4 mm). Air bubble displacement was not observed. CONCLUSION: Root-end filling improves the sealing of roots with core-carrier obturation following root-end resection.

Adolescent↗
PubMed2004

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

AIM: To compare long-term loss of papilla height when using either the papilla base incision (PBI) or the standard papilla mobilization incision in marginal full thickness flap procedures in cases with no evidence of marginal periodontitis. METHODOLOGY: Twelve healthy patients, free of periodontal disease, who had intact interdental papillae were referred for surgical treatment of persisting apical periodontitis and included in the study. 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 but in the other interproximal space the PBI was performed. Further apically a full thickness flap was raised. Following flap retraction, standard apical root-end resection and root-end filling was performed. Flap closure was achieved with microsurgical sutures. The PBI was sutured with two to three interrupted sutures (size 7/0), the elevated papilla was reapproximated with vertical mattress sutures (size 7/0), which were removed 3-5 days after the surgery. The height of the interdental papilla was evaluated preoperatively and postoperatively after 1-, 3- and 12-month recall using plaster replicas. The loss of papilla height was measured using a laser scanner. Papilla paired sites were evaluated and statistically analysed. RESULTS: Most papilla recession took place within the first month after the surgery in the complete elevation of the papilla. Further small increase in loss of papilla height resulted at 3 months. After 1 year the loss of height diminished to 0.98 +/- 0.75 mm, but there was no statistical difference between the various recall intervals. In contrast, after PBI only minor changes could be detected at all times. There was a highly significant difference between the two incision techniques for all recall appointments (P < 0.001). CONCLUSIONS: In the short as well as long-term the PBI allows predictable recession-free healing of the interdental papilla. In contrast, complete mobilization of the papilla displayed a marked loss of the papilla height in the initial healing phase although this was less evident 1 year postoperatively. 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↗
PubMed2004

A comparative histological evaluation of the biocompatibility of materials used in apical surgery.

AIM: To evaluate the biological properties of a variety of materials that could be used in apical surgery. METHODOLOGY: The intraosseous implant technique recommended by the FDI (1980) and ADA (1982) was used to test the following materials: zinc oxide-eugenol (ZOE), mineral trioxide aggregate (MTA), and Z-100 light-cured composite resin. Thirty guinea-pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks, received one implant on each side of the lower jaw symphysis. The connective tissue response alongside the lateral wall outside the cup served as a negative control for the technique. At the end of the observation periods, the animals were killed and the specimens prepared for routine histological examination to evaluate their biocompatibility. RESULTS: The reaction of the tissue to the materials diminished with time. The ZOE cement was highly toxic during the 4-week experimental period, but this profile changed significantly after 12 weeks, when it showed biocompatible characteristics. MTA and Z-100 showed biocompatibility in this test model at both time periods. CONCLUSIONS: MTA and Z-100 composite were biocompatible at 4 and 12 weeks in this experimental model.

Aluminum Compounds↗
PubMed2005

Frequency and type of canal isthmuses in first molars detected by endoscopic inspection during periradicular surgery.

AIM: To analyse the occurrence of canal isthmuses in molars following root-end resection. METHODOLOGY: The material consisted of 56 mandibular and 32 maxillary first molars subjected to periradicular surgery. Based on radiographic, clinical, as well as intraoperative status, only roots with associated pathological lesions were treated. In total, 124 roots were resected (80 mandibular and 44 maxillary molar roots). The cut root faces were inspected with a rigid endoscope following apical root-end resection. The number of canals as well as the presence and type of canal isthmuses were recorded. RESULTS: In maxillary first molars, 76% of resected mesio-buccal roots had two canals and an isthmus, 10% had two canals but no isthmus, and 14% had a single canal. All disto-buccal and palatal roots had one canal. In mandibular first molars, 83% of mesial roots had two canals with an isthmus. In 11%, two canals but no isthmus were present, and 6% demonstrated a single canal. Sixty-four per cent of distal roots had a single canal and 36% had two canals with an isthmus. CONCLUSIONS: This clinical study during periradicular surgery and intraoperative endoscopic examination of first permanent molars found a high frequency of canal isthmuses at the resection level. Endoscopic inspection also demonstrated that none of the isthmuses were filled, emphasizing the difficulty of orthograde instrumentation and root filling of canal isthmuses.

Apicoectomy↗
PubMed2005

Calculus-like deposit on the apical external root surface of teeth with post-treatment apical periodontitis: report of two cases.

AIM: To report two cases in which calculus-like material was found on external root surfaces of (i) an extracted root and (ii) an apicected part of a root, both of which were removed due to post-treatment refractory apical periodontitis. SUMMARY: In each case, there was a fistulous tract, which did not heal after conventional root canal treatment. The first case did not heal even after apical surgery, and subsequent tooth extraction revealed calculus-like material on a root surface of complex anatomy. The second case showed radiographic signs of healing after apicectomy. Histology of the apical biopsy revealed a calculus-like material on the external surface of the root apex. It is suggested that the presence of calculus on the root surfaces of teeth with periapical lesions may contribute towards the aetiology of failure. KEY LEARNING POINTS: Biofilm on the external root surface has been implicated in the failure of apical periodontitis to heal, despite adequate root canal treatment. Calculus-like material was found, in two cases, on the root surface of teeth with post-treatment apical periodontitis, where the only communication externally was a sinus tract.

Adult↗
PubMed2005

SEM analysis of the integrity of resected root apices of cadaver and extracted teeth after ultrasonic root-end preparation at different intensities.

AIM: To compare the integrity of root apices of cadaver and extracted teeth after resection, ultrasonic root-end cavity preparation at medium and low ultrasonic power settings and retrieval. METHODOLOGY: Root canal treatment, perpendicular root-end resection and root-end preparation were performed on single-rooted anterior and premolar teeth (49 teeth in situ in maxillary and mandibular jaws from cadavers and 45 extracted teeth). Apical root-end cavities were prepared with the S12/90 degrees D tip and the Suni-Max ultrasonic unit (Satelec, Merignac, France) at the intensity prescribed by the manufacturer (power 7 at power mode S) (34 cadaver teeth, 30 extracted teeth) and at a lower intensity (power 4 at power mode S) (15 cadaver teeth, 15 extracted teeth). After ultrasonic preparation the cadaver teeth were retrieved from the jaws. Exaflex impressions (GC Corporation, Tokyo, Japan) were made of the root apices after resection, root-end preparation and retrieval. These impressions were processed for SEM analysis, and the recordings evaluated for cracks and marginal chipping. RESULTS: In general, extracted teeth showed significantly more cracks and chipping than cadaver teeth. Lowering the ultrasonic power from medium to low intensity resulted in equal scores for cracks on extracted teeth and for chipping on cadaver teeth, in higher scores for cracks on cadavers and in lower scores for chipping on extracted teeth. Complete cracks and cracks originating from the root surface occurred only in extracted teeth. CONCLUSIONS: The number of cracks and degree of chipping caused by ultrasonic root-end preparation was higher on extracted teeth than on cadaver teeth. Lowering the ultrasonic power from medium to low intensity cannot be recommended as it resulted in more cracks and equal chipping on cadaver teeth. Investigation of techniques and materials should be conducted in situ and not on extracted teeth.

Apicoectomy↗
PubMed2005

Periapical resurgery versus periapical surgery: a 5-year longitudinal comparison.

AIM: To monitor and compare the outcome of periradicular surgery in teeth that had previously undergone surgical treatment versus teeth that were undergoing a surgical procedure for the first time. METHODOLOGY: A total of 164 patients with 231 roots with previously unresolved periapical lesions were followed for up to 5 years following surgery. In all, 162 roots had received unsuccessful conventional root canal treatment (group AS) and 69 had been treated previously using apical surgery (group RS). The surgical procedure was completed using ultrasonic retrotips to prepare the apical root-end cavity, and a zinc-oxide EBA reinforced material was used to fill the apical root-end cavities. Lesions were radiologically examined from 1 to 5 years following the surgical procedure. Radiographs were independently analysed, according to a previously published classification. RESULTS: In all the roots examined after 5 years, the overall healing rate was 78%; in group AS, 140 (86%) healed with complete bone filling of the surgical cavity, 12 (7%) were considered to have incompletely healed and 10 (6%) were associated with post-treatment disease. In group RS, 41 (59%) healed completely, 12 (17%) were considered to have incompletely healed and 16 (23%) were associated with post-treatment disease. The difference between a second surgical procedure and a first surgical procedure was statistically significant (Mann-Whitney U-test, P=0.001). CONCLUSION: Surgical retreatment of teeth previously treated with surgery is a valid alternative to extraction. However, association with post-treatment disease was greater than after a primary surgical approach.

Adolescent↗
PubMed2005

The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study.

AIM: To determine the value of clindamycin prophylaxis in the prevention of postoperative wound infections in patients undergoing endodontic surgery. METHODOLOGY: This study included 256 patients undergoing endodontic surgery in a prospective double-blind placebo-controlled trial comparing oral administration of an oral placebo versus a preoperative 600 mg dose of clindamycin. After randomization the study medication was administered orally 1 h before surgery in a double-blind fashion. For a period of 4 weeks the postoperative course was observed according to clinical parameters of infection. Primary end-point was infection at the surgical site. RESULTS: The mean age of the study population was 44.4 years (SD 11.4, range 18-82 years) with a sex distribution of 147 females (47.4%) and 109 males (42.6%). Mean age of the patients in the clindamycin group was 44.7 years (SD 12.0), and the mean age in the placebo group was 44.1 years (SD 10.8) (P = 0.49). In the clindamycin group, the mean duration of surgery was 32.3 min (SD 8.8) and in the placebo group the mean duration of surgery was 32.5 min (SD 8.4) (P = 0.89). Two infections [1.6%; 95 confidence interval (CI): 0.48-4.72] were identified in the clindamycin group and four (3.2%; 95 CI: 0.42-1.33) in the placebo group (P = 0.448). CONCLUSIONS: No statistically significant difference was found between clindamycin prophylaxis and placebo with regard to the prevention of postoperative infection in endodontic surgical procedures.

Adolescent↗
PubMed2006

An ex vivo evaluation of a new root canal irrigation technique with intracanal aspiration.

AIM: To evaluate the effectiveness of a new root canal irrigation technique with intracanal aspiration in removing the smear layer and to assess irrigant extrusion ex vivo. METHODOLOGY: Thirty-five instrumented canals of extracted human canine teeth that had been resected apically by removing 3 mm of the root tip were divided into one control and four experimental groups of seven teeth each. The roots were fixed in a plastic case and surrounded with normal saline agar coloured with 1% acid red. No irrigation was performed in the control teeth. Each root canal in the experimental groups was irrigated with 9 mL of 14% ethylenediaminetetraacetic acid for 3 min, and then with 6 mL of 6% sodium hypochlorite (NaOCl) for 2 min. In the intracanal aspiration technique, the irrigant was delivered from the tip of an injection needle placed 12 mm from the apical root-end and an aspiration needle that was connected to a Root ZX apex locator placed 2 and 3 mm short of the apical root-end in groups 1 and 2, respectively. In the conventional method, the tip of an injection needle used for delivery of the irrigant and as an active electrode was placed 2 and 3 mm short of the apical root-end in groups 3 and 4, respectively, the tip of the aspiration needle was placed 12 mm from the apical root-end in these groups. The readings of the Root ZX during irrigation were recorded. The cleanliness of the canal was evaluated by scoring smear layer from scanning electron microscopy (SEM) images of the canal. Extrusion of NaOCl was detected by measuring the discoloured area of the agar around the apical root-end. The data obtained were statistically analysed by one-way anova, the Kruskal-Wallis test and Friedman's test. RESULTS: In the SEM study, the canals in groups 1-3 were significantly cleaner than those in the control and group 4 (P < 0.05). The mean Root ZX readings in groups 1-3 were approximately "0.5". The discoloured area in group 3 was significantly larger than the other groups (P < 0.05). CONCLUSIONS: Irrigation using the intracanal aspiration technique allowed more effective removal of the smear layer than that performed by the conventional method in an apically resected canine tooth. The intracanal aspiration technique produced limited extrusion of the irrigant beyond the apical foramen.

Apicoectomy↗
PubMed2007

Calcium hydroxide barrier over the apical root-end of a type III dens invaginatus after endodontic and surgical treatment.

AIM: To report the simultaneous endodontic and surgical treatment of a tooth associated with Oehlers type III dens invaginatus and a persistent periapical lesion, which comprised root-end resection, root-end filling and application of a calcium hydroxide barrier placed on the resected dentine surface. SUMMARY: Three root canals were identified in a tooth with a type III dens invaginatus, which presented with a necrotic pulp, wide foraminal opening and extensive periapical lesion, and with a previous history of acute abscess, intracanal exudate and fistula. After root canal preparation followed by intracanal application of calcium hydroxide pastes, the clinical-pathological status persisted. After periapical curettage and root-end resection, the root canals were filled, followed by root-end filling with Sealer 26 mixed with zinc oxide powder to a clay-like consistency. Calcium hydroxide paste was then applied over the exposed dentinal surface forming a covering over the root apex. At the 20-month follow-up examination the patient had no symptoms and no fistula; advanced periapical bone repair was obvious on the radiograph. KEY LEARNING POINTS: Because of the variable morphology and extent of invagination, type III dens invaginatus represents a challenge for conventional treatment, often leading to the need for a surgical approach. Sealer 26 thickened with zinc oxide powder provided satisfactory clinical properties for use as a root-end filling material. Application of a calcium hydroxide barrier over the resected root-end is a potential treatment option to encourage tissue repair.

Adolescent↗
PubMed1995

Maintenance of new attachment 1 and 4 years following guided tissue regeneration (GTR).

The aim of the present study was to evaluate periodontal tissue alterations during the maintenance phase following GTR therapy. 18 patients (average age 54 years, range 39-79 years) with 19 local periodontal defects were monitored longitudinally using clinical periodontal parameters and radiographic assessments of bone level changes. 6 out of originally 24 patients were not available at the 4-year examination (2 patients were unwilling to participate and in 4 patients root amputations or tooth extractions had to be performed). Evaluations were performed at baseline, 3 months, 1 year and 4 years following GTR therapy (using non-resorbable Gore-Tex Periodontal Material). The changes observed at the deepest site of each tooth treated by GTR were compared to those encountered in the entire dentition. Supportive periodontal therapy was performed according to the patient's individual needs between 3 and 12 times between the 1 and 4 years examination. The plaque index and the gingival index at the 4 years examination were assessed and had increased to almost double the value of baseline, although the BOP remained lower compared to baseline data. Between the 1 and 4 years examinations, 1.27 mm of clinical attachment was lost as a mean. Regarding the site of each tooth treated with GTR with the initially deepest probing pocket depth, 1.42 mm of clinical attachment was lost during the maintenance phase. However, compared to baseline data, 1.37 mm of new attachment could be maintained. The clinical attachment level was maintained within +/- 1 mm in 12 out of 19 sites during the 4 years of maintenance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Study of titanium screws as retrograde fillings using bacteria and dye.

The tightness of retrograde titanium screw fillings and retrograde amalgam fillings was compared in 17 human, single-rooted teeth using Serratia marcescens bacteria in vitro. The root canals were subjected to instrumentation and irrigation, after which 2 mm was cut off from the apical end. Eight of the teeth were sealed using retrograde titanium screw fillings and nine using retrograde amalgam fillings. The teeth were suspended by means of wires in test tubes, with the crowns upwards and the roots immersed in trypticase soy broth. Suspensions of Serratia marcescens bacteria were placed in the root canals, and samples from the broth were plated daily. The bacteria penetrated the apical titanium screw seals in 2 to 7 days, and the retrograde amalgam fillings readily on the first day. Thus, the titanium screws seemed to provide a tighter seal. Staining with India ink showed that penetration had occurred at the tooth-filling margin and that the instrumentation had not caused any fractures to the roots.

Apicoectomy↗