Success rate for root fillings in young patients. A retrospective analysis of treated cases.
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Adolescent↗
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Results for “Periapical Tissue”
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The incidence and location of micro-organisms following endodontic treatment.
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Animals↗
Calcium hydroxide in root canal therapy. A review.
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Animals↗
Allergic endodontic angio-oedema in response to periapical endomethasone.
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Administration, Topical↗
The acceptability of five periapical radiographic techniques to dentists and patients.
Dentists are now advised to use film holders as an aid to intra-oral radiography. The aim of this investigation was to compare a range of commercially available film holders for periapical radiography with the traditional bisecting angle technique using the patient's finger as support for the film, in terms of the ease of use for the dentist and patient comfort. Twelve general dental practitioners (GDPs) were asked to perform 50 periapical examinations using their conventional (bisecting angle) technique (BA) followed by 50 using, in turn, four film holders: the Stabe (S), the Eggen (E), the Rinn (R) and the 'Superbite' devices (SB). There was no difference between BA, S and SB techniques in terms of difficulty experienced by the GDPs. However, both E and R film holders led to an increase in examinations reported as 'difficult' to perform. There was no difference in patient discomfort between the BA and SB techniques, but the use of the E and R film holders and, to a lesser degree, the S film holder was associated with increased discomfort. There was no consistent association between dentists' assessments of examinations as 'difficult to perform' and patients' opinions on discomfort. It is concluded that SB film holders provide a simple means of intraoral radiographic positioning with no increase in patient discomfort.
Adult↗
An evaluation of periapical radiography with a charge-coupled device.
OBJECTIVES: To compare the standards of periapical radiography with a CCD-image receptor with film. METHODS: Three radiography technicians exposed a total of fifty teeth from all areas of the jaws using either size 1 or size 2 film and the Sidexis (Siemens, Bensheim, Germany) direct digital dental radiography system with the appropriate film holders. Image quality was assessed by two dental radiologists for nine individual criteria and overall, on a three-point scale. RESULTS: There was a significant difference between film and sensor exposures (P < 0.014). Six per cent of dental films required retakes compared with 28% with the sensor. CONCLUSION: Periapical radiography with a CCD sensor leads to more errors and thus more retakes than conventional film.
Evaluation Studies as Topic↗
Digital analysis of trabecular pattern in jaws of patients with sickle cell anemia.
OBJECTIVES: To characterize how the morphological features of the cancellous bone of the maxilla and mandible differ in patients with sickle cell anemia compared with normal subjects. METHODS: Periapical radiographs of 18 young African American patients with sickle cell anemia and 18 control African Americans were digitized at 600 d.p.i. A customized computer program measured 24 morphological features of the trabecular and marrow architecture in the anterior maxilla and mandible. The mean values for each of the features were determined for the sickle cell and control groups and compared by anatomical site. RESULTS: Patients with sickle cell anemia have a significant increase in area of the marrow (53% compared with 47% in controls) and a less complex trabecular structure as evidenced by fewer skeletal branch points per square cm (451 compared with 584 in controls in the anterior maxilla and, 553 compared with 678 in controls in the anterior mandible). All values are significantly different (P < 0.001). CONCLUSIONS: The data support the hypothesis that an automated image-interpretation program can distinguish patients with sickle cell anemia from normal individuals.
Adult↗
Periapical radiographic techniques during endodontic diagnosis and treatment.
The objective of this article is to describe various radiographic projections which can be used during endodontic therapy. Changes to the angulation of the X-ray beam in relation to the teeth and film can help diagnosis and treatment by producing images which provide additional information not always visible on radiographs taken with standard angulations. For example, changes in angulation can be useful to determine the number and curvature of roots and canals, to identify superimposed roots and to distinguish between anatomical landmarks and apical pathology. Although use of such techniques increases the diagnostic yield of films, it must be appreciated that such views lead to images that are less distinct because of inherent image distortion. Nevertheless, use of the various techniques during endodontics can provide substantial benefit for clinicians in their daily practice.
Dental Pulp Cavity↗
Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.
This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.
Bacteria↗
A histopathological study of the morphological changes at the apical seat and in the periapical region after irradiation with a pulsed Nd:YAG laser.
In this study, the effects of pulsed Nd:YAG laser irradiation on the apical seat and periapical region of instrumented root canals were investigated. One hundred and ninety-two teeth, including incisors and molars (239 root canals), in 18 healthy adult beagle dogs were used. After extirpation of the pulp under anaesthesia, each root canal was shaped up to at least a size 40 K-file, and then laser irradiated using the following parameters: 1 W, 15 pps for 2, 3, and 4 s; 2 W, 15 pps for 2 s. The effectiveness of debris removal and carbonization on the root canal walls immediately laser irradiation were examined and inflammation of the periapical region at 1, 2, and 4 weeks after laser irradiation was examined using light microscopy. Effective debris removal was observed in most cases in the laser-treated groups and was dependent on irradiated energy. Carbonization was observed in the irradiated root canals except at the parameter of 1 W for 2 s. Periapical inflammation was observed at 1 W for 2 s to the same extent as in the control group (P > 0.01). These results suggest that the pulsed Nd:YAG laser is useful for debris removal with no adverse effects immediately after extirpation of the pulp if appropriate parameters are selected.
Aluminum Silicates↗
The control of haemorrhage at the operative site during periradicular surgery.
CLINICAL TECHNIQUE: Effective apical sealing in endodontic surgery requires a dry root-end cavity to insert the filling material. A number of procedures for controlling haemorrhage have been described in the literature. An improvement of these techniques is proposed in this paper: by using a mixture of surgical wax and fibres of calcium alginate. This device, easy to place, sterile and non-toxic, permits placement of a root-end filling under more favourable conditions.
Alginates↗
Radiographic evaluation of periapical healing after obturation of infected root canals: an in vivo study.
AIM: To radiographically compare periapical repair of roots with infected root canals obturated in one-step or with calcium hydroxide (Ca(OH)2) intracanal medication in two steps. METHODOLOGY: Standardized preoperative periapical radiographs were taken of 72 roots of vital dogs' teeth. All roots were then aseptically instrumented to ISO size 45. As negative controls, 12 roots were aseptically obturated. The remaining roots were infected with dental plaque and closed. Six weeks later, apical periodontitis was radiographically confirmed in the infected roots. The roots were divided into the following groups: group 1, one-step (n = 24); roots were irrigated with 10 cc saline, obturated, and permanently restored. Group 2, Ca(OH)2 (n = 24); roots were treated as in group 1, except that after saline irrigation Ca(OH)2 medicament was placed in the canal 1 week before obturation. Group 3, positive control (n = 12); the roots were irrigated with saline, access permanently closed but canals not obturated. Group 4, negative control (n = 12); previously aseptically obturated roots were permanently restored. After 6 months, standardized postoperative radiographs were obtained. Three independent evaluators blinded to the treatment groups evaluated the preoperative and postoperative radiographs. The evaluators were instructed to rate each root, based on changes on the radiographs, as failed, improved or healed. RESULTS: Radiographically, the percentage of cases that completely healed were similar for the one-step and Ca(OH)2 groups (35.3% vs. 36.8%). However, the Ca(OH)2 group had fewer failed cases (15.8% vs. 41.2%) and more improved cases (47.4% vs. 23.5%) than the one-step group. CONCLUSION: Power statistics demonstrated that at 43 cases per group, Ca(OH)2 treatment would be statistically superior to one-step treatment. We consider this number to be clinically important.
Animals↗
Periapical healing of mandibular molars after root-end sealing with dentine-bonded composite.
AIM: The purpose was to present the frequency of periapical healing in first and second/third mandibular molars, after root-end resections sealed with a dentine-bonded resin composite. METHODOLOGY: Root-end sealing of resected mandibular molar roots was made with dentine-bonded composite (Gluma-Retroplast) as a cover on the entire slightly hollowed root-end, in an attempt to prevent leakage. RESULTS: Out of the 834 roots recalled between 6 months and 12.5 years postoperatively, 92% showed complete apical healing, 1% uncertain healing and 7% exhibited failure. The healing result of 681 first molar roots was not significantly different (P = 0.21) from that of 153 second/third molar roots, and there was no significant difference in healing between mesial and distal roots (P = 0.32 for first molars, P = 0.86 for second/third molars) or amongst six age groups (P = 0.94). In the patient group: 71-89 years, 36 roots showed an average of 97% with complete healing. Out of 25 failures who were retreated surgically, 80% showed complete healing when examined subsequently. CONCLUSION: Root-end sealing of mandibular molars with dentine-bonded resin composite is a promising technique giving 92% complete healing in cases examined between 6 months and 12 years postoperatively.
Adolescent↗
Radiographic evaluation of cases referred for surgical endodontics.
AIM: The aim of this study is to test the hypothesis that more patients with failed root-canal treatment or other endodontic problems are referred for periradicular surgery rather than nonsurgical re-treatment. METHODOLOGY: Three sets of 100 periapical radiographs representing typical cases referred for surgical treatment were collected in three departments of oral and maxillo-facial surgery situated in different parts of the Netherlands. Of these, a total of 278 radiographs were evaluated to determine whether endodontic surgery was indicated or whether the primary endodontic treatment or endodontic re-treatment was a realistic option. An oral and maxillo-facial surgeon, an endodontist and a general dental practitioner viewed the radiograph independently under standard conditions. RESULTS: Overall, orthograde root-canal (re-)treatment was considered possible in 63% of the cases. The results differed between the three examiners with the oral surgeon reporting that 41% of cases were amenable to conventional treatment, for the general dental practitioner and the endodontists the figures were 67 and 80%, respectively. CONCLUSIONS: Based on these observations, it is concluded that most of the teeth referred for surgical treatment to an oral surgeon could be treated by orthograde nonsurgical root-canal treatment.
Attitude of Health Personnel↗
Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms.
AIM: The purpose of the present study is to evaluate the healing of periapical lesions of teeth with positive and negative canal cultures at the time of obturation, and to evaluate the periapical healing of teeth treated in one visit (without) or in two visits with an interappointment dressing of calcium hydroxide. METHODOLOGY: Thirty-nine patients received root-canal treatment. In the first visit, teeth were instrumented, and 18 of these teeth were filled (after microbiological sampling) with calcium hydroxide in sterile saline. The other 21 teeth were obturated with gutta-percha and AH-26 sealer after microbiological sampling. Four weeks later, the teeth with calcium hydroxide were accessed again and after microbiological sampling they were obturated with gutta-percha and AH-26 sealer. Healing of periapical radiolucency was recorded over a period up to 4.5 years. RESULTS: In both the treatment groups, the size of the periapical lesions reduced significantly during the follow-up period. Complete radiographic healing was observed in 81% of the cases in the one-visit group, and in 71% of the cases in the two-visit group. The probability of success increased continuously over time for both treatment groups. Seven out of eight cases (87.5%) that showed a positive root-canal culture at the time of obturation healed. The number of colony forming units (CFU) in six out of eight positive canals was <10(2) CFU mL(-1). CONCLUSIONS: Within the limitations of this study, no significant differences in healing of periapical radiolucency was observed between teeth that were treated in one visit (without) and two visits with inclusion of calcium hydroxide for 4 weeks. The presence of a positive bacterial culture (CFU<10(2)) at the time of filling did not influence the outcome of treatment.
Adult↗
Periapical changes following root-canal treatment observed 20-27 years postoperatively.
AIM: The aim of the present study was to identify periapical changes 20-27 years after root-canal treatment. METHODOLOGY: The periapical condition of 265 roots filled by undergraduate students was evaluated in two series of intraoral radiographs taken 10-17 and 20-27 years after treatment. Roots (72) not recorded with a normal periapical situation on both occasions by two observers, were re-evaluated by other two examiners, separately and jointly. Final decisions about diagnoses were made by all four examiners. A strict definition was used for the identification of cases with an unfavourable outcome. RESULTS: Favourable outcomes were observed in 6.4% of the roots that had radiolucencies at the 10-17-year follow-up. Periapical radiolucencies after 20-27 years appeared in 1.5% of all other roots. The radiographic failure frequency for the total material was 4.9%. The percentage of cases with normal periapical findings at the final follow-up was 86.4%, whilst 8.7% were recorded with increased width of the apical periodontal space. Delayed healing owing to surplus root-filling material explained nearly all of the cases with favourable outcome assessed many years after treatment. CONCLUSIONS: Late periapical changes, with more successes than failures, were recorded when a 10-17-year follow-up period after root-canal treatment was extended for another 10 years.
Follow-Up Studies↗
Correction of anterior dental crossbite with composite as an inclined plane.
OBJECTIVE: The purpose of this study was to evaluate a passive method to correct anterior crossbite of only one incisor by constructing a composite inclined plane. SAMPLE AND METHOD: A total of 35 children aged 7-11 with a crossbite of only one incisor tooth were selected for this study. An inclined composite block 3-4 mm in size and 45 degrees to the longitudinal axis of the tooth, was constructed on the incisal edges of the related mandibular incisors. The occlusion was checked so that the only contact between both arches was at the level of these incisors. RESULTS: At the end of one week, 33 cases of crossbite were corrected by this method. Of the two cases which were not corrected one had a deep overbite and the second had a rotated incisor together with crossbite. CONCLUSION: The present results show that, a composite inclined plane is a useful technique to correct anterior crossbite of only one incisor tooth.
Child↗
A clinical and radiographic study of 25 autotransplanted third molars.
This paper is a report on 25 autotransplantations of third molars with complete root formations. The study consists of 23 patients in whom 25 third molars were transplanted. The mean age was 29.6 years (range 20-54). In nine cases third molars were directly transplanted into the new socket. In 11 cases the sockets were widened and made deeper with a bur. In five cases the recipient beds were made by splitting osteotomy of the alveolar region. The transplanted third molars were stabilized with silk sutures, resin, wire splint or circumferential wiring for 1-6 weeks. Two-three weeks after transplantation, the root canals were treated and filled. After operation, the marginal and the periapical conditions were examined clinically and radiographically. The transplanted teeth clinically appeared to become firmer with the passage of time. Progressive root resorption was not found and good results were obtained. This study shows that autotransplantation of third molars with complete root formation produces an acceptable result using the procedures outlined.
Adult↗