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For improving the endodontic-endosteal fixation method, an endodontic-endosteal fixing and capping pin was developed after six years of experience. Its form and adaptability to the widened root canal permits succesful fixation via the canal in a single session with only little technical means. At the same time the pin with its cap enables permanent anchorage of the crown.
The primary mission of the Dental Corps--maintaining the dental health of our soldiers at an optimum level to ensure their readiness to deploy and fight--is more important than ever in today's downsized, high-operational-tempo Army. A review of the literature indicates that 20 to 25% of all soldiers will report on dental sick call during a 1-year deployment, and approximately half will require endodontic intervention. This could cost a division more than 18,000 man-days of combat effectiveness in a theater of battle, an unacceptable loss. Approximately three-fourths of these sick call visits could be prevented if selected conditions were identified and treated before deployment. Endodontic conditions, which result in the majority of dental sick call complaints, should be given priority for treatment in garrison, and the identified soldier should be placed in dental fitness class 3 until the tooth is definitively treated.
The use of rubber dam for endodontic treatment in New Zealand was analysed by a national survey of general dental practitioners. The response rate was 79 percent. Rubber dam was used routinely by 57 percent, its use increasing among practitioners graduating since 1969. A greater percentage of practitioners with less than 10 years experience used rubber dam than did more experienced practitioners. Use of rubber dam was associated with sodium hypochlorite and EDTA as canal irrigants. Reamers were the favoured hand instrument of non-users of rubber dam. No significant differences were found in the canal obturation techniques of users and non-users, but rubber dam users used the long-cone paralleling method of radiography significantly more than non-users. Practitioners in solo practice used rubber dam significantly less than those in group practice. Rubber dam users attended significantly more refresher courses in endodontics than non-users.
A postal questionnaire was used to ascertain the views of practitioners on postgraduate education, and on the way they performed endodontic treatment. Attendance at postgraduate courses was low and was influenced by the style and content of courses as well as financial considerations. Hands-on courses were the preferred mode of delivery for postgraduate education. Most practitioners wished to change the way they carried out their endodontic treatment, and the majority felt this could only occur with an increase in fees.
Surveys have demonstrated that many dentists, even the recently qualified, do not carry out endodontics using currently recommended materials and techniques. To assess the scale and nature of this finding among young graduates, a questionnaire was sent to all graduates from the mainland United Kingdom dental schools qualified for either one or four years. Widespread reduction in the number of radiographs taken and rubber dam use was found. A minority had adopted techniques and materials without published guidelines. It is suggested that alterations are required in undergraduate teaching, vocational training and the United Kingdom National Health Service remuneration system in order to improve the standard of endodontics in general practice.
Laser technology has been developed rapidly in the last decade. New lasers with a wide range of characteristics are available now which are being used in various branches of dentistry. The application of these new technologies in endodontics has always been challenging. Today more experience and knowledge in applying lasers in endodontics is available.
Recent changes have made it possible to perform endodontic treatment more efficiently, with improved precision and greater patient acceptance. This article reviews these various concepts and highlights how endodontics now can be performed with enhanced abilities and clinical results.
This article reviews infection control procedures from an endodontic-specific perspective and offers comments and recommendations in context with the recently updated CDC Guidelines. Infection control implications for the following topics are reviewed: endodontic diagnosis, nonsurgical treatment, surgical treatment, and educational considerations. In areas of controversy, it is recommended that additional evidenced-based clinical research is needed to support the 2003 CDC Guidelines.
AIM: In the present retrospektive study the situation of the natural crown as well as the restoration types placed prior to endodontic treatment was examined. MATERIALS AND METHODS: A total of 782 teeth from 545 patients (54.3% men; 45.7% women; mean age: 49.9 +/- 12.1 years) were investigated. In addition to the evaluation of the medical history of the patients, x-rays and a clinical investigation were carried out in order to assess the clinical condition of the crown as well as the restoration types. Of special interest were: carious lesions, composite fillings, amalgam, ceramic or gold crowns and/or bridge restorations. RESULTS: 305 of the examined teeth were located in the mandible and 477 in the maxilla. 26.3% of the teeth were anteriors, 31.2% were premolars and 42.5% were molars. 24.2% of the teeth were restored with metal ceramic crowns, 15.1% were restored with gold cast crowns or served as abutment teeth for bridgework; untreated caries was found in 21.1%, and composite fillings were found in 13.7% of the cases. 23.8% of the front teeth, 26.6% of the premolars and 22.6% of the molars showed a metal ceramic restoration. 21% of all carious defects were found in the maxilla as well as in the mandible. CONCLUSIONS: In addition to the high number of untreated carious lesions, the presence of metal ceramics restorations was significantly higher than other restorations types. Carious lesions are main aetiological factors for endodontic measures, but also ceramic restorations including premature contacts have to be considered as causal factors for pulpal irritations.
One of the most difficult tasks, facing the dental educator is the evaluation of students' preclinical and clinical performance. This article describes the development of an evaluation system that eliminates some of the problems associated with the assessment of psychomotor skills including rater subjectivity and the validity of evaluation instruments. The evaluation system discussed is currently being used by the Department of Endodontics at the Louisiana State University School of Dentistry for both preclinical and clinical endodontics. The article focuses on the development of the system, use of the clinical rating scale, and an assessment of the system's effectiveness.
1. Computer-assisted instruction of stimulated clinical endodontic problems is superior to a slide-tape presentation for test selection but not for diagnosis and treatment planning. 2. The lack of a difference in diagnosis is likely due to the already superior performance of students in diagnosis at the University of Kentucky without computer assistance. A study with students of less background might reveal a difference in presentation methods. 3. Students with high GPSs score higher on a written test of endodontic clinical judgment. 4. Reliable results on the effects of a human tutor's supplementing machine instruction were not obtained. 5. Students felt that the problems presented in this study were useful in preparing for clinical treatment of patients. 6. After some exposure to machine methods of instruction, students divided into three sizable groups, one preferring a human teacher, another preferring a machine, and the third having no preference. The decision to use only machine or human instruction cannot then be made from student attitudes. 7. Students liked the active participation and immediate responses of the computer but not the time necessary to complete the problems. 8. Students liked the self-pacing, speed, and convenience of the slide-tape method but not the incompleteness of the problems presented by this method. 9. It appears that there is some justification from this study for offering both slide-tape and computer-assisted presentations to students.
The changes that have taken place in endodontic treatment over the past 25 years can be summarized succinctly. Although the methods and materials have changed markedly, the basic principles of asepsis, enlargement, and seal remained unchanged. Predictably successful endodontic treatment is an everyday occurrence in the 1980s. It is a result of understanding the basic principles of treatment, combined with the ability to deliver these services in an orderly, expeditious, and thorough manner. With future advances in research and technology, the elusive goal of 100 per cent success may become a reality in this century.
A study was conducted to determine the effects of seminars and computer-assisted self-evaluation (CASE) modules on third-year dental students' endodontic problem-solving abilities. Students studying by a combination of seminars and CASE modules did not differ in their ability to solve endodontic problems compared with students receiving CASE modules, but they demonstrated greater ability than did students in a control group or those participating only in seminars. Analysis of gain scores from pretest to post-test among the treatment groups showed significant improvement in learning after instruction, but failed to identify any method as more effective in facilitating this improvement. Previous grade point average was not a factor in problem-solving ability or in improvement instruction.
Pathologically movable anteriors with horizontal root fracture can be fixed by endodontal bone pins, unless the fracture is located in the cervical third of the root canal. The apical root fragment needs to be removed for fixation. As the anatomic conditions in monkeys do not permit adequate preparation of the root canal required for endodontal pin fixation, the histological findings can be transferred to man to a limited extent only.
BACKGROUND AND OBJECTIVE: Until recently, the main field of Er:YAG laser application was the removal of dental hard substances within the scope of cavity preparation. Nowadays, several new delivery-systems are available, permitting the application of the Er:YAG laser in endodontics. The aim of the present study was to assess the effects of Er:YAG laser irradiation on root canals in vitro. STUDY DESIGN/MATERIALS AND METHODS: For this purpose, 220 extracted human teeth were endodontically processed and subsequently irradiated at different settings using an Er:YAG laser imitating in vivo irradiation procedures. The teeth were then subdivided into three groups and subjected to bacteriological evaluations, scanning electron microscopy, and temperature measurements. RESULTS: The bacteriological evaluation revealed a decisive bactericidal effect of the Er:YAG laser in the root canal. The bactericidal effect was dependent on the applied output power and specific for the different species of bacteria investigated. Scanning electron microscopy showed discrete removal of dentine from the root canal walls. The temperature rise during irradiation was moderate when standardized power settings were used. CONCLUSION: The investigations indicate that the Er:YAG laser is a suitable tool for the elimination of bacteria in root canals under in vitro conditions.
Prevotella nigrescens has recently been recognized as a new species distinct from Prevotella intermedia. The distinction is based largely on DNA-DNA hybridization, electrophoretic migration of malate and glutamate dehydrogenase, and peptidase and lipase activities of type strains. Gas chromatography of cellular fatty acids can be a useful adjunct for characterization and identification of bacterial species. In the present study, cellular fatty acid profiles were determined for seven strains of P. intermedia and six strains of P. nigrescens. Six of these 13 strains were isolated from the root canal and blood of three patients during endodontic therapy of teeth with Asymptomatic apical periodontitis. The bacteria were cultivated anaerobically in 10 mL prereduced anaerobically sterilized peptone-yeast extract-glucose broth for 24 h. Dried cells of each isolate were methanolysed and their fatty acid contents determined by the Microbial Identification System software package by MIDI. The data were treated by principal component analysis, which distinguished P. nigrescensfromP. intermedia. Cellular fatty acid profiles of these strains of the species in blood matched the profiles of their respective root canal isolates, as demonstrated by Euclidean Distance Square assessment. This suggested that the organisms in the root canal had spread to the bloodstream during endodontic treatment.
The purpose of the present study was to decide whether composite resin or conventional glass ionomer cement should be preferred as a base material in endodontically treated premolars. Twelve extracted human maxillary premolars were mounted in a universal testing machine at a 35 degrees angle. Cuspal stiffness was determined by applying a load of 75 N to the buccal cusp and recording the displacement of the cusp using inductive displacement transducers. In the same teeth, different cavity preparations and restorations were performed sequentially. Standard MOD cavities were enlarged to allow endodontic access. In addition, the cusps were undermined. Half of the teeth were restored to the level of the previous shallow cavities using conventional glass ionomer cement (Ketac Fil), in the rest of the teeth dentine bonding agent (Syntac) and composite resin (Tetric) were used instead. Finally, composite resin fillings (Tetric) were placed. All restorations were removed and the experiments were repeated twice. For each replication, the assignment of the base materials to the experimental groups was reversed, and ceramic inlays (Empress) were used as final restorations for the last replication. Improvement of cuspal stiffness achieved by conventional glass ionomer bases was very small, whereas composite resin bases increased cuspal stability by more than a factor of two. After placement of the final restorations, however, there was no longer a difference between teeth with different base materials. Nevertheless, composite resin bases might be preferred for two reasons. Firstly, deterioration of adhesive restorations will probably start at the cavosurface margins. The incidence of margin gaps, however, will not only compromise marginal seal but also the stabilizing effect of the restoration. In this situation, the resin base may still stabilize the tooth. Moreover, resin bases may reduce the risk of cusp fracture during the time between cavity preparation and the insertion of adhesive inlays.
In an in vitro experiment, the failure loads of 59 intact endodontically treated teeth with and without Kerr Endo-Post reinforcement were compared. Fifty-eight teeth fractured below the cementoenamel junction. One tooth fractured through the pulp chamber with a chisel fracture involving both the crown and root. Teeth without posts fractured through the middle or coronal one third of the root. Teeth with posts fractured through the body of the post. No statistically significant reinforcement was demonstrated by cementing a Kerr Endo-Post No. 100 into a sound endodontically treated tooth.