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Clinical performance of 3 endodontic sealers.

OBJECTIVE: Calcium hydroxide is used in endodontics as an interappointment dressing. Its inclusion in salicylate resin or zinc oxide-eugenol-based sealers for filling root canals also may lead to a better treatment outcome. The purpose of the present study was to compare the clinical/radiographic treatment outcome of 3 sealers, 2 of which contain calcium hydroxide. STUDY DESIGN: Two hundred and four teeth underwent a standardized endodontic treatment regimen and were assigned to 1 of 3 groups at the time of root filling: group PS, teeth filled with gutta-percha and Procosol sealer; group CR, teeth filled with gutta-percha and CRCS sealer; and group SA, teeth filled with gutta-percha and Sealapex sealer. The results of the treatment were assessed yearly for up to 4 years by clinical and radiologic (periapical index scores) controls. The ridit statistic (r) was used to compare PAI scores among the groups. RESULTS: The overall treatment results were comparable with, but slightly poorer than, results previously obtained from patients seen at the Dental School at the University of Oslo. During the first year after filling, the mean ridit value decreased from .51 +/- .039 to .31 +/- .042 (Deltar = .20) in the SA group. Corresponding values went from .43 +/- .030 to .38 +/- .035 (Deltar = .05) in the PS group and from 37 +/- .045 to .34 +/- .050 (Deltar = .03) in the CR group. At the 2-year examination, teeth in group SA had slightly better periapical conditions (r =.22 +/-.045) than did teeth in group PA (r = .30 +/- .037) or in group CR (r = .30 +/- 052). The difference was statistically significant at P = .01. By years 3 and 4, no significant difference among the groups was detected. CONCLUSIONS: The overall influence of the sealer on treatment outcome was small. Root fillings with salicylate resin containing Ca(OH)2 may support more rapid healing of apical periodontitis or operative trauma, but the results after 3 and 4 years were as good for zinc oxide-eugenol-based sealers with or without Ca(OH)2.

Bismuth↗

The contribution of trabecular bone to the visibility of the lamina dura: an in vitro radiographic study.

OBJECTIVE: The objective of this study was to determine the degree to which trabecular bone contributes to the radiographic visibility of lamina dura. STUDY DESIGN: Segments of human cadaver mandible were obtained and split longitudinally. Two identical radiographs were made of each segment (1) before the removal of any additional bone and after (2) the removal of a small amount of the lamina dura at the apex of a tooth, (3) block removal of trabecular bone, and (4) smoothing of the endosteal surface of the external cortex. The radiographs were projected in random pairs for each sample. Six dentists judged whether a difference in the amount of lamina dura could be detected between 2 sets of radiographs. RESULTS: Chi-square analysis revealed a significant radiographic difference between radiographs made initially and after removal of the lamina dura and trabecular bone. CONCLUSIONS: Fewer than half of the changes of lamina dura loss alone could be detected radiographically by the observing dentists, whereas nearly all cases of the loss of periapical lamina dura in conjunction with loss of trabecular bone could be detected.

Aged↗

Effects of root morphology on stress distribution at the root apex.

It is thought that the stress concentration at the root apex caused by orthodontic force induces root resorption. The purpose of this study was to investigate stress distribution at the root in cases of deviated root shapes using finite element models (FEMs). To clarify this, five three-dimensional FEMs divided by deviated root shape (normal, short, blunt, bent root apex, pipette shape) were constructed and, experimental orthodontic forces, applied in a vertical (intrusive) and horizontal (lingual) direction to the tooth axis. In the short-root model, significant stress was concentrated at the middle of the root. The blunt-shaped root model showed no significant stress concentration at the root. In the models with a bent or pipette-shaped root, significant stress was concentrated at the root apex. During orthodontic force application, stress concentration was observed in the root of the models with short, bent, and pipette-shaped roots, indicating that attention must be paid to root shape during orthodontic treatment.

Alveolar Process↗

Case 10.

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Alveolar Bone Loss↗

Evaluation of success rate of endodontic treatment performed by students with stainless-steel K-files and nickel-titanium hand files.

A previous study by our group found nickel-titanium (NiTi) 0.02 hand files maintained the original canal shape better than similar stainless-steel K-files (SS-K). Inexperienced dental students used both file types on molar teeth. The purpose of this study was to compare the 1-yr success rate of endodontic treatment of the same teeth used in our previous study. Twelve-month follow-up radiographs were compared with the immediate follow-up radiographs. Both sets of radiographs were taken with the same customized stent. Quantification of osseous changes using digital imaging was used. Thus, a reliable numerical estimation (densitometric ratio) of disease and healing processes could be established. Sixty-seven percent of the patients returned for the 12-month radiographs (19 NiTi vs. 21 SS-K). Immediate postoperative periapical status was found to be similar (p > 0.05). Teeth instrumented with the NiTi files demonstrated a higher mean change in densitometric ratio, compared with SS-K files (p < 0.05). Further tests of success (values: > or =0) and failure (value: < or =0) with the Fisher exact test showed more success (decreasing radiographic density) with NiTi files and more failures (increasing radiographic density) with SS-K type files (p < or = 0.03). This study indicates that maintaining the original canal shape after instrumentation leads to a better prognosis of endodontic treatment.

Absorptiometry, Photon↗

Calcium concentration and pH of the periapical environment after applying calcium hydroxide into root canals in vitro.

The purpose of the present study was to determine both calcium concentration and pH in the periapical region after application of 1 of 4 different calcium hydroxide preparations into experimental root canals. Fifty root canal models were divided into five groups: group 1--calcium hydroxide was mixed with distilled water at a powder/water weight ratio of 38%; group 2--calcium hydroxide was mixed with distilled water at 44%; group 3--calcium hydroxide was mixed with distilled water at 50%; group 4--calcium hydroxide powder only was used; and group 5-the control group, in which nothing was applied to the canals. All samples were immersed in distilled water maintained at 37 degrees C. Calcium concentration and pH of the distilled water were measured after 3 days, 7 days, and then at weekly intervals up to 15 wk, during which time the storage medium was renewed after each measurement. Calcium concentration and the change in pH of the distilled water were statistically quicker and greater in groups 1 to 3 (mixture groups) than group 4 (powder only) (p < 0.05). The highest calcium concentration (peak Ca2+ release) was observed after 3 days for the mixture groups, whereas that for the powder only group was found at 7 days. Peak pH change was found after 14 days for the mixture groups, whereas that for the powder only group was found at 49 days. After peaking, all groups showed a decline of the pH over time. These results suggest that the time required for optimum intracanal activity when using calcium hydroxide mixtures is at least 2 wk.

Analysis of Variance↗

Foreign body in the periradicular area.

A 12-yr-old child reported to the outpatient department of D.A.V. (C) Dental College & Hospital with a history of trauma 41/2 yr earlier with pain and swelling now present in the upper anterior area for 3 days. A radiograph showed the presence of a foreign object in the periapical area of a fractured and discolored maxillary central incisor. Reported here is an unusual case of a straight pin lying in the periradicular area.

Child↗

The effect of maintaining apical patency on periapical extrusion.

Thirty-three human maxillary incisors were secured in the openings of a glass vial. Root canals were instrumented to the apical constriction with a step-back technique and a patency file was not used throughout the root canal preparation. The irrigant, 1% NaOCl, was delivered by means of a plastic syringe with a 23-gauge needle and the overflow was suctioned with an aspirator. The total volume of irrigant used was 10 ml. Apically extruded debris and NaOCl were measured. The apical constriction was then deliberately enlarged. With a step-back technique a new 'apical constriction' was created, coronally to the original one. A patency file was again not used, and irrigation was identical to the that used during the initial root canal preparation. Extruded debris and NaOCl in each bottle were again measured. Results indicated that there was significant difference in the amounts of extruded material before and after the enlargement of the apical constriction with greater extrusion when the constriction remained intact.

Anti-Infective Agents, Local↗

The effect of endodontic therapy on periapical exudate neutrophil elastase and prostaglandin-E2 levels.

This study aimed to investigate periapical exudate neutrophil elastase (NE) and prostaglandin E2 (PGE2) levels and their relationships with clinical symptoms, and to determine the changes of their levels following first treatment visit. Periapical exudate samples were collected from the canals of 34 nonvital single-rooted teeth at two sequential treatment visits. Periapical exudate NE and PGE2 levels were found to be higher in the presence of clinical symptoms (pus discharge, swelling) (p < 0.05). The canals of teeth with larger periapical radiolucent area (>or=1 cm) contained more PGE2 levels than with smaller ones (<1 cm) (p < 0.05). Periapical exudate NE levels were significantly correlated with PGE2 levels (p < 0.05), and their levels at first treatment visit did not change following root canal therapy (p > 0.05). The periapical exudate NE and PGE2 levels may regulate periapical disease expression, but the results of this study were unable to reveal this association.

Adult↗

Enterococcus spp. in endodontically treated teeth with and without periradicular lesions.

The purpose of this study was to determine if Enterococcus spp. are more prevalent in endodontically treated teeth with periradicular lesions compared with teeth that require retreatment but have no periradicular rarefaction. Fifty-eight teeth that had received root canal therapy more than 1 yr previously and required retreatment were included. Designation of lesion versus no lesion was determined by two experienced endodontists. DNA extraction and PCR amplification were performed using ubiquitous 16S rDNA bacterial primers, as well as Enterococcus spp.-specific primers. The results showed that the overall prevalence of bacteria was 90% and Enterococcus spp. was 12%. chi analysis revealed a statistically significant relationship between the presence of a lesion and the presence of bacteria, as detected by the universal primers (p = 0.032). Using logistic regression, a statistically significant relationship was found between teeth with normal periapex and the presence of Enterococcus spp. (p = 0.023). This study revealed that bacteria are significantly associated with endodontic treatment failure but enterococci are not associated with disease.

Adult↗

Performance of short implants in partial restorations: 3-year follow-up of Osseotite implants.

Short-length implants should be at a performance disadvantage because of the more limited surface area with which to resist occlusal forces. Nevertheless, anecdotal observations find many short implants performing well in different restorative conditions. This retrospective, multicenter study seeks to compare formally implant performance based on length. The success of 7 and 8.5-mm Osseotite implants (Implant Innovations, Inc., Palm Beach Gardens, FL) was determined as: absence of mobility; no persistent and/or irreversible signs or symptoms of pain, infection, paresthesia, or violation of the mandibular canal; no evidence of peri-implant radiolucency; and no progressive crestal bone loss. Implant location, restoration type, bone density, and smoking status of the patients were recorded. A total of 188 patients received 311 short Osseotite implants that were placed mostly in soft bone and supported 216 partially edentulous cases in the maxilla or mandible. Most restorations (95.2%) are short-span fixed partial dentures placed in the posterior sextants. During 3 years of follow-up, 13 implants failed, yielding a cumulative success rate of 95.8%. In 9 of these cases, failure occurred before prosthetic loading, and in 4, the patient was a smoker. The overall success rate compares favorably with the available literature for the performance of implants in general, and short implants in particular.

Alveolar Bone Loss↗

Surgical endodontics.

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Dental Implantation, Endosseous, Endodontic↗