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PubMed1994

Combined orthodontic-endodontic therapy: case report of orthodontic movement of a recalcified lateral incisor.

Unlike most cases of combined orthodontic and endodontic therapy that have been reported, in this case endodontic treatment with calcium hydroxide-induced calcification was utilized prior to orthodontic treatment. A 14-yr-old female required orthodontic therapy due to anterior crowding. Preoperative periapical radiographs indicated that the maxillary right lateral incisor demonstrated advanced lateral root resorption of the distal surface. It was decided to use calcium hydroxide therapy to halt any further resorption prior to orthodontic movement. Approximately 1 yr was required to gain calcification, fill the canal with gutta-percha, and place the maxillary closing arch. Subsequent orthodontic treatment did align the teeth in a desirable manner without jeopardy to the recalcified root.

Adolescent↗

PubMed1992

Porphyromonas (Bacteroides) endodontalis: its role in endodontal infections.

Porphyromonas endodontalis (formerly Bacteroides endodontalis) is a black-pigmented anaerobic Gram-negative rod which is associated with endodontal infections. It has been isolated from infected dental root canals and submucous abscesses of endodontal origin. The presence of P. endodontalis in infected dental root canals has been correlated with symptoms of an acute infection. It is occasionally found on oral mucous membranes and periodontal pockets. P. endodontalis has shown relatively low virulence in experimental monoinfections. In anaerobic mixed infections it can play an essential role. Differences in virulence between strains have been related to capsular material. On the basis of different types of capsules, three serotypes have been described. P. endodontalis is sensitive to a wide range of antibiotics, including the penicillins, the tetracyclines, and metronidazole.

DNA Fingerprinting↗

PubMed1995

Evaluation of success and failure after endodontic therapy using a glass ionomer cement sealer.

The purpose of this multicenter, prospective clinical study was to assess the treatment results following endodontic therapy using a glass ionomer cement sealer (Ketac-Endo) and to relate the results to various clinical factors. A total of 486 teeth were treated by three operators, using the "standardized technique" for canal preparation and either single cone or laterally condensed gutta-percha, in one or multiple treatment sessions. Six to 18 months postoperatively, the treatment results were assessed clinically and radiographically, and related to preoperative, intraoperative, and postoperative factors using a chi 2 analysis with 5% level of significance. Of 378 followed-up teeth, there was a 78.3% success, 15.6% incomplete healing, and 6.1% failure. Statistically, differences in the results were related to the number of canals (p < 0.04), primary treatment and retreatment (p < 0.02), pulp vitality (p < 0.001), periapical lesion (p < 0.001), preoperative symptoms (p < 0.003), operative complications (p < 0.001), and absence of restoration (p < 0.03). It was concluded that these treatment results were compatible with those reported in previous studies, and supported the clinical use of Ketac-Endo as an acceptable endodontic sealer.

Adolescent↗

PubMed1995

Microcomputed tomography: an advanced system for detailed endodontic research.

This study evaluated the value of microcomputed tomography (MCT) for use in endodontic research. Four periodontally involved highly calcified maxillary first molars were extracted and then scanned for evaluation by a MCT system. The teeth were then instrumented, and 2 of the 4 obturated before rescanning for comparison evaluation. Several capabilities of the MCT to advance endodontic research significantly were observed: the ability of the MCT to present accurately the external and internal morphologies of the tooth without tooth destruction; the possibility of showing changes over time in surface areas and volumes of tissues; the ability to assess area and volume changes after instrumentation or obturation; and the capability of evaluating canal transportation following instrumentation or instrumentation and obturation. The tremendous potential of this scientific tool was discussed.

Dental Pulp Calcification↗

PubMed1997

In vivo model for assessing the functional efficacy of endodontic filling materials and techniques.

Endodontic fillings were challenged with bacterial ingress in mandibular premolars of 4 beagle dogs. Groups 1, 2, and 3 (n = 9), had canals filled with gutta-percha and sealer, gutta-percha alone, and sealer alone, respectively. After 2 wk, pulp chambers were inoculated with plaque. Group 4 (n = 9) and group 5 (n = 5) had canals either filled as in groups 1 to 3 or unfilled, respectively, but not inoculated. Group 6 (n = 5) had canals unfilled and inoculated. Teeth were radiographed periodically for 14 wk, dogs terminated, and jaw blocks retrieved and processed for light microscopic examination. Rarefying osteitis appeared in group 6 at 3 wk and in groups 2, 3, and 5 at 11 wk. Periradicular inflammation was none, mild, or severe. Occurrence of severe inflammation in groups 1 to 6 was 0, 11%, 33%, 0, 60%, and 100%, respectively. Groups 1 to 3 combined differed significantly from group 4 (repeated-measures ANOVA, p < 0.05). This model could be used to assess the functional efficacy of endodontic fillings in vivo.

Animals↗

PubMed1993

Root resection of endodontically treated teeth by erbium: YAG laser radiation.

Root resection was performed on endodontically treated extracted human teeth exposed to pulsed erbium:YAG laser radiation at energy levels between 50 and 90 mJ/pulse in wet and dry fields. The lased surfaces were examined by optical and scanning electron microscopy. The smooth, clean resected root surfaces, devoid of charring (in wet fields), indicate that the erbium:YAG laser has a potential application in endodontic periapical procedures. In addition, researchers have shown that the zone of thermal damage and carbonization following erbium laser exposure on soft tissues and bone is appreciably less compared with other lasers, and therefore its use may result in improved healing and diminished postoperative discomfort.

Apicoectomy↗

PubMed1992

Dentin removal efficiency of six endodontic systems: a quantitative comparison.

The dentin removal efficiency of current endodontic systems, based on the amount of dentin removed in 1 mm of canal axial length, was determined for working times of 1 and 2 min. Six endodontic systems were compared: The Giromatic with Heli-Giro files, the Sonic-Air with Shapers, the Mecasonic with Shapers, the Cavi-Med with K files, the Cavi-Med with Shapers, the Excalibur with its own K files. Generally speaking, the efficiency of each device depends on the duration of instrumentation, on the type of file used, and on its mode of activation. For 1 min of instrumentation, the Mecasonic+Shaper was the most efficient system. For 2 min of instrumentation, the original adaptation of the Shaper on the Cavi-Med gave the highest activity. Concerning the files used in ultrasonics, the Shaper seems to be more efficient than the K file. As for the sonics, the Excalibur+file system gave results comparable to those of the Mecasonic+Shaper; both of these devices were twice as efficient as the Sonic-Air+Shaper.

Dental Cavity Preparation↗

PubMed1992

Effect of different endodontic treatment protocols on periodontal repair and root resorption of replanted dog teeth.

This study examined, histologically, the healing of intentionally damaged root surfaces of replanted teeth with either uninfected or infected root canals treated with short- and long-term calcium hydroxide. Thirty beagle dog incisors were randomly divided into four groups. In group 1, uninfected obturated incisors were extracted, the roots were longitudinally grooved and the teeth were replanted within 2 min. In group 2 the root canals were artificially infected followed by extraction, longitudinal grooving, and replantation as described in group 1. Fourteen days after replantation, the root canals were fully instrumented and medicated with intracanal calcium hydroxide. One week later the root canals were permanently obturated with gutta-percha and sealer. The teeth in group 3 were treated as described in group 2 but after 1 wk the calcium hydroxide dressing was repacked for the duration of the study. In group 4 (positive control) the teeth were treated as described in groups 2 and 3 but no endodontic treatment was performed. After 8 wk, sacrifice and histological preparation were carried out. In group 1 complete cemental repair was seen in all teeth. In groups 2 and 3, complete and incomplete cemental repair was seen in seven and two teeth, respectively. An ankylotic area was present in one tooth in group 3. None of the teeth in group 4 showed cemental repair. It was concluded that short- and long-term calcium hydroxide treatment resulted in similar healing patterns when endodontic treatment is initiated 14 days after replantation of teeth.

Animals↗

PubMed1992

Incidence of interappointment emergency associated with endodontic therapy.

Endodontic interappointment emergency (EIE) occurs in a low incidence following treatment by qualified operators. The purpose of this study was to assess the incidence of EIE after treatment by undergraduate students and to examine its correlation with preoperative and operative parameters. Randomly selected 334 records were retrospectively surveyed for unscheduled emergency appointments following endodontic treatment by undergraduate students. Treatment included step-back canal preparation in multiple visits with formocresol interappointment dressing. The incidence of EIE was 4.2%, and unrelated to the patients' sex and age or to tooth location. It was significantly higher in nonvital than in vital teeth (p < 0.05), with the highest occurrence in nonvital teeth unassociated with periapical radiolucency. Clinically, EIE was associated with swelling in half of the cases. It is concluded that the incidence of EIE following treatment by undergraduate students is low and related to tooth vitality.

Acute Disease↗

PubMed1993

Survey of endodontic retreatment methods used to remove intraradicular posts.

A survey was conducted to determine the frequency and popularity of contemporary methods used in endodontic retreatment to remove intraradicular posts. Opinions and rationales were also sought for the choice of surgical management instead of nonsurgical retreatment. A questionnaire was sent to 571 active Diplomates of the American Board of Endodontics with 324 members responding (56.7%). Hand instruments, such as hemostats or special forceps, were the most commonly used, often in conjunction with ultrasonic or sonic vibration to loosen the post or break down the cement interface. A wide range of rationales was identified for the use of surgical retreatment methods, with failure to remove the post after reasonable nonsurgical efforts being the most often cited.

Dental Instruments↗

PubMed1993

Anti-inflammatory effects of dexamethasone on periapical tissues following endodontic overinstrumentation.

An animal model was developed in which the anti-inflammatory effects of dexamethasone could be examined histologically in periapical tissues following endodontic overinstrumentation. Mandibular first molars containing vital or partially necrotic pulp tissue were instrumented beyond the apical foramen in rats. Fifty microliters of sterile saline or dexamethasone sodium phosphate (0.4 mg/ml) were administered in a blind manner by supraperiosteal infiltration into the buccal vestibule. The rats were killed after 6, 24, and 48 h. Block sections of the mandibular molars were processed for histological examination and stained with hematoxylin and eosin. The number of polymorphonuclear neutrophils present in the periapical tissues was counted in a blind manner and statistical analysis of the results was performed by two-way analysis of variance. Following endodontic overinstrumentation, local infiltration of dexamethasone produced a significant anti-inflammatory effect on the periapical tissues of teeth with vital or partially necrotic pulp tissue.

Analysis of Variance↗

PubMed1993

Successful single-visit endodontics during Operation Desert Shield.

This article reports on the incidence of success following single-visit endodontic therapy. Non-surgical endodontic therapy was performed on 210 teeth in 167 patients who were rapidly deployed during the initial stages of Operation Desert Shield. Upon their return, 97 patients were recalled for follow-up evaluation. This study evaluated 102 teeth. The recall rate was 58% with a success rate of 89%.

Adolescent↗

PubMed1995

The endodontic file is a disposable instrument.

Most cutting and machining tools wear when properly operated on intended substrates. Little is known about endodontic files when machining on human dentin. It was shown earlier that the efficiency of files was very variable when evaluated on Plexiglas substrates. The present study of seven different brands and types of files was undertaken to understand their wear better when machining human dentin. It was shown that all files evaluated rapidly deteriorated when machining dentin. This decline in efficiency was significant but different within, as well as, among brands. It was suggested that endodontic files be disposable.

Dentin↗

PubMed1990

An in vitro study of the effect endodontic access preparation and amalgam restoration have upon incisor crown retention.

Endodontic access preparation leads to a significant reduction in crown retention. This study sought to determine whether this retention can be regained after access. Eighteen extracted human maxillary incisors had PFM crowns fabricated. Crowns were cemented, retention measured, recemented, access preparations cut, and retention once again measured. Then, crowns were recemented and accesses restored with dental amalgam and new retention measured. This format allowed each crown to be used as a control of itself. For crowns cemented with zinc phosphate cement and restored with amalgam, a 126% increase over original retention was measured. For crowns cemented with polycarboxylate cement and restored with amalgam, a 237% increase over original retention was measured. For crowns cemented with polycarboxylate cement and restored with amalgam, a 237% increase over original retention was measured. These results suggest that recementing crowns secondary to endodontic access and restoring the access with amalgam regains and even surpasses the original retention.

Cementation↗

PubMed1990

Treatment of the endodontic emergency: a decade later.

A questionnaire was sent to diplomates of the American Board of Endodontics to determine changing trends in the treatment of endodontic emergencies since Dorn's survey 10 yr ago. There is a definitely greater trend toward complete instrumentation of the root canals to the apex regardless of the emergency condition than there was a decade ago. The number of respondents who leave teeth open when the pulp is nonvital has dropped dramatically in the past decade. When there is no periapical involvement, over one third of the respondents are completing treatment in one visit. A decrease in the use of classic phenolic medicaments was noted with a corresponding increase in calcium hydroxide or no medication at all.

Calcium Hydroxide↗

PubMed1991

Evaluation of three silicone-based materials as potential retrograde fillings in surgical endodontics.

Endodontic therapy has played an important role in maintaining the integrity of the natural dentition as a fully functional and esthetic masticatory apparatus. Although the sealing of the root canal system is usually accomplished by the conservative endodontic approach, cases which have failed or which involve perforations, broken instruments, or post-crown restorations are almost always treated surgically by using zinc-free amalgam as a retrograde filling material. However, the literature is controversial concerning the health risks and benefits of this material. For this reason, the study presented here was initiated to evaluate the potential of (a) a medical grade silicone-titanium mesh compound; (b) Endo-Fill (Lee Pharmaceuticals, El Monte, CA); and (c) an experimental expanding Endo-Fill (Lee Pharmaceuticals) as alternatives to amalgam. The three silicone-based materials and amalgam were compared for linear apical dye leakage. The leakage study involved 80 teeth which were instrumented, obturated, and prepared surgically for one of the four test materials. Either the teeth were placed immediately into 1% methylene blue dye or the material was allowed to set for 24 h before placement into the dye. Endo-Fill showed significantly less leakage than did the other materials in both the immediately placed and the 24-h set groups. On the other extreme, the experimental expanding Endo-Fill allowed significantly more dye penetration than did amalgam and the other silicone variations.

Bicuspid↗

PubMed1991

Effect of endodontic procedures on root dentin permeability.

The purpose of this study was to quantitate the sequential effects of endodontic procedures on the permeability of human root dentin in vitro. Forty single-rooted teeth were used. Both the crown and the apical 2 mm of the root were removed. The hydraulic conductance of the root before and after various endodontic procedures was measured using a fluid filtration method. Measurements were also made of dentin thickness, intracanal diameter changes, and changes in intracanal surface area. The results showed that instrumentation by K files alone or in combination with Gates Glidden drills did not alter radicular dentin permeability when the cementum remained intact. After removing the cementum, the creation of a smear layer and smear plugs on the canal surface tended to offset the expected increase in dentin permeability created by increasing the intracanal surface area and decreasing root dentin thickness. EDTA treatment inside the instrumented canal to remove the smear layer did not increase permeability significantly. The use of K files followed by Gates Glidden drills tended to remove more cervical dentin, increased the intracanal surface area, and increased the hydraulic conductance of root dentin more than the use of K files alone.

Dental Cementum↗

PubMed1990

Torsional properties of twisted and machined endodontic files.

The torsional properties of conventionally twisted K-type endodontic files and recently developed machined K-type endodontic files were compared. File sizes 10 through 40 were subjected to torsional load in clockwise and counterclockwise directions independently. Results showed that a statistically significant reduction in clockwise rotation occurred at failure with all of the machined files except size 10. Counterclockwise rotation at failure was also significantly lower for the machined files in sizes 10 through 30. There was no difference in torsional strength between the file types regardless of rotation direction. Therefore, machined files exhibit less ductility than twisted files prior to fracture and may be more susceptible to torsional failure clinically.

Dental Stress Analysis↗