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PubMed1990

Understanding informed consent and its relationship to the incidence of adverse treatment events in conventional endodontic therapy.

Forty-three endodontic specialists recorded the occurrence of all adverse treatment events in 3308 consecutive conventional endodontic cases. Statistical analysis confirmed that retreatment cases and mid-treatment referral cases have a greater incidence of adverse treatment events. Since the doctrine of informed consent requires that the doctor inform the patient of reasonably foreseeable consequences of treatment, it is therefore important that the endodontist be cognizant of such events and decide what information is appropriate for disclosure. Since jurisdictional differences exist in the interpretation of what constitutes sufficient informed consent, it is important that local groups investigate the statutes in their state and construct reasonable informed consent documents.

Humans↗

PubMed1990

Failure of endodontic treatment due to a palatal gingival groove in a maxillary lateral incisor with talon cusp and two root canals.

A case is presented in which endodontic treatment of a maxillary lateral incisor with a talon cusp and two root canals failed following a mistaken diagnosis. What was first diagnosed as an endodontic lesion was, in all probability, a primary periodontal lesion caused by the advance of bacteria from the gingival crevice to the apex along the radicular groove between the main tooth and the talon cusp.

Adult↗

PubMed1990

Machining efficiency of endodontic files: a new methodology.

The ability of endodontic files to effectively remove hard tissues is difficult to assess as results from published investigations often vary considerably. An analysis is presented of errors occurring during efficiency assessments. It was found that the machining property varies around the circumference of a single file as well as between various files of the same brand. A new method is proposed for the assessment of the quantity and quality of the machining properties of an endodontic file.

Dental Cavity Preparation↗

PubMed1990

Microleakage of temporary endodontic restorations in teeth restored with amalgam.

Microleakage of seven temporary restorative materials was evaluated in endodontic access preparations made in teeth restored with amalgam. Ten teeth were used for each of the seven materials: Cavit, Cavit-G, TERM, zinc phosphate cement, polycarboxylate cement, glass ionomer cement, and IRM. A class I amalgam was placed in the occlusal surface of each experimental tooth and an endodontic access preparation was made entirely within the amalgam. Then the access preparation was restored with one of the temporary restorative materials, and microleakage was evaluated using a fluid filtration technique. The amount of microleakage was quantitated by measuring the fluid flow at 15 min, 1 h, 24 h, 1 wk, and 2 wk after insertion of the temporary restoration. Cavit, Cavit-G, TERM, IRM, and glass ionomer cement all provided excellent seals while zinc phosphate cement and polycarboxylate cement provided less effective seals.

Dental Amalgam↗

PubMed1990

Comparison of the Canal Master endodontic instrument and K-type files for enlargement of curved root canals.

Twenty mandibular molars with 40 mesial curved root canals were instrumented with a circumferential technique using K files and the Canal Master instrumentation technique by junior dental students whose only endodontic experience had been completion of a preclinical endodontic course. Preoperative and postoperative radiographs were taken facially and mesially with instruments in place. The canals were evaluated radiographically for transportation 1 mm and 4 mm from the apex. The mesial roots were cross-sectioned at the same level. The sections were evaluated for roundness of the canal preparation. It was concluded that the Canal Master instrumentation technique transported the root canal less and produced rounder preparations than the K file circumferential technique. There appears to be a greater tendency for breakage with the Canal Master.

Dental Pulp Cavity↗

PubMed1990

Comparative in vitro coronal microleakage study of new endodontic restorative materials.

Complete sealing of endodontic access openings between appointments and after completion of therapy is an essential element in achieving endodontic success. Recently, two new products for use as temporary restorative materials, TERM and Dentemp, have become available. The purpose of this study was to compare in vitro the sealing ability of Cavit, Cavit-G, Cavit-W, and IRM-Caps, with TERM, Hard-TERM, and Dentemp. Standard access cavities were prepared in 144 intact extracted human teeth. They were equally and randomly distributed into seven groups, and their access openings were temporized. Specimens were submitted to thermocycling (5 to 55 degrees C) for 7 days and stained with silver nitrate. The teeth were split in half, and the greatest depth of dye penetration at the tooth surface was recorded. TERM exhibited the least leakage, while Hard-TERM demonstrated the greatest leakage, at the tooth-restoration interface.

Dental Cements↗

PubMed1989

Cellulose fibers from endodontic paper points as an etiological factor in postendodontic periapical granulomas and cysts.

Histological sections of eight periapical granulomas and cysts developing after conventional endodontic therapy and displaying faintly hematoxylinophilic, birefringent foreign bodies were investigated by light and polarization microscopy, scanning electron microscopy, energy-dispersive X-ray, and chemical analysis. In addition to a variably dense mononuclear infiltrate, the granulomas and cysts revealed varying amounts of giant cells associated with the birefringent foreign bodies. These structures were identified as cellulose fibers, most probably originating from endodontic paper points, which in our opinion can be held responsible for the initiation and perpetuation of chronic postendodontic periapical lesions.

Cysts↗

PubMed1989

A persistent oronasal sinus tract of endodontic origin.

Extraoral sinus tracts of endodontic origin may be confused with a wide variety of diseases. Although they may be located in a variety of sites on the face and neck, once diagnosed the treatment is relatively simple and successful. Endodontic therapy is the treatment of choice in these cases; however, periapical surgery may occasionally be required. A case of persistent oronasal sinus is described in which healing occurred only after surgical removal of the involved lesion.

Adult↗

PubMed1989

Microleakage of temporary restorations in complex endodontic access preparations.

The microleakage allowed by three temporary restorative materials used for the sealing of teeth with both endodontic access and multisurface cavity preparations was measured and evaluated. Extracted human incisor, canine, and premolar teeth with extensive carious involvement were prepared and restored with either Cavit, IRM, or TERM. Microleakage was measured by a fluid filtration technique at various time intervals and after thermal stress. The results indicated that the TERM restorations provided excellent seals and were statistically superior to Cavit and IRM for restoring complex endodontic access preparations. The IRM restorations demonstrated significantly greater microleakage after thermal stress, while the Cavit restorations were deemed clinically unacceptable because of extensive cracks, expansion, and extrusion from the tooth preparations. These defects were not observed with the IRM and TERM restorations.

Calcium Sulfate↗

PubMed1989

The use of dentinal etching with endodontic bleaching procedures.

The removal of the smear layer from dentinal surfaces has been shown to increase significantly the permeability of dentin in both vital and endodontically treated teeth by opening the orifices of the dentinal tubules. This knowledge has led to the practice of acid etching the intracoronal dentin of endodontically treated teeth prior to nonvital bleaching procedures in order to increase the speed and effectiveness of the bleach. In this study extracted human teeth, which had been stained in vitro, were used to compare the effects of dentinal etching of the pulp chambers with no acid etching in conjunction with "walking bleach" procedures. In one experimental group, the pulp chambers were acid etched with 50% phosphoric acid for 1 min to remove the smear layer prior to insertion of the 30% hydrogen peroxide/sodium perborate bleaching agents. The second group had the same chamber preparation except the acid etching was deleted. Evaluators were unable to distinguish a significant difference between the effectiveness of the bleaching procedures in the two experimental groups.

Acid Etching, Dental↗

PubMed1989

Absorbed radiation by various tissues during simulated endodontic radiography.

The amount of absorbed radiation by various organs was determined by placing lithium fluoride thermoluminescent chip dosimeters at selected anatomical sites in and on a human-like X-ray phantom and exposing them to radiation at 70- and 90-kV X-ray peaks during simulated endodontic radiography. The mean exposure dose was determined for each anatomical site. The results show that endodontic X-ray doses received by patients are low when compared with other radiographic procedures.

Dental Pulp Cavity↗

PubMed1996

Measurement of the cutting efficiency of endodontic instruments: a new concept.

The cutting efficiency of endodontic instruments was measured using an original experimental technique that incorporates new concepts to simulate clinical conditions. Five designs of #ISO 030 endodontic instruments, K-reamer (Maillefer), Flexofile (Maillefer), Helifile (Micro-mega), K-flex (Kerr), and Unifile (De Trey), were chosen and their cutting efficiency assessed at their full working length of 16 mm on two Plexiglas parallelepipeds tilted to follow the 2% conicity of the instruments. For each instrument, four series of 25 cuts were carried out and each cut made on a new flat, smooth Plexiglas surface with an even hardness of 33 VHN. Instruments were tested under a simulated clinical condition of a quarter clockwise turn ROTARY MOTION followed by a PULL ACTION at 16 mm/s rate, with a fixed load on the instrument of 325 g. Water irrigation at a rate of 85 ml/s was supplied before each procedure. Cutting efficiency was evaluated in terms of mass of Plexiglas cut (using a Mettler analytic balance with accuracy of 3 x 10(-5) g) per unit of energy used by the instrument, i.e. mg/J. Unifile was found to have the best cutting efficiency of 0.80 +/- 0.01 (Mean +/- SD) and lowest cutting efficiency loss followed by Flexofile 0.70 +/- 0.03 then Helifile 0.36 +/- 0.01 then K-flex 0.51 +/- 0.07. K-reamer was found to have the lowest cutting efficiency of 0.16 +/- 0.05.

Dental Instruments↗

PubMed1996

A new approach to the treatment of true-combined endodontic-periodontic lesions by the guided tissue regeneration technique.

Clinicians often have difficulty in the diagnosis and treatment of the combined endodontal and periodontal (endo-perio) lesion. A case of an endo-perio true-combined lesion on a maxillary premolar was first treated with conventional endodontic therapy. Periodontal surgery was then completed, which included scaling and root planing and apical curettage on the tooth. The facial bony defect was then filled with a decalcified freeze-dried bone allograft mixed with tetracycline powder. A non-resorbable Teflon membrane was then used to cover the bone material and the periodontal flap sutured over this. This combined treatment resulted in minimal probing depth (2 mm), maximal clinical attachment gain (8 mm), as well as radiographic evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the guided tissue regeneration technique combined with osseous grafting, will restore health and function to a tooth with severe attachment loss caused by an endo-perio lesion.

Adult↗

PubMed1996

Clinical evaluation of bacterial leakage of endodontic temporary filling materials.

This study was an in vivo comparison of the bacterial leakage associated with three endodontic temporary restorative materials: Cavit, Intermediate Restorative Material (IRM), and TERM. The access openings of 51 endodontically treated teeth were randomly sealed with a 4-mm thickness of one of the three materials. Three wk after placement of each temporary restoration, bacterial leakage was evaluated by sampling from beneath the temporary restoration and then culturing the samples both aerobically and anaerobically. Positive growth occurred in 4 of 14 TERM samples and in 1 of 18 IRM samples. Cavit did not demonstrate leakage in any of the teeth in which it was used. Cavit provided a significantly better seal than TERM over the study period.

Calcium Sulfate↗

PubMed1996

Torsional properties of stainless steel and nickel-titanium endodontic files.

The torsional properties of stainless steel (SS) endodontic files (Flex-O-File; Maillefer/L. D. Caulk Co., Milford, DE) and recently developed nickel-titanium (NiTi) endodontic files (Quality Dental Products, Inc., Johnson City, TN) were compared. File sizes 15, 25, 35, 45, and 55 were subjected to torsional load in clockwise (CW) and counterclockwise (CCW) directions independently. Results showed that SS files had a significantly greater rotation to failure in the CW direction, whereas the NiTi files had a significantly greater rotation to failure in the CCW direction. Despite these differences in rotation to fracture, there was essentially no difference between the SS and NiTi instruments in the torque that it took to cause failure in both the CW and the CCW directions. Therefore, whereas the number of CW and CCW rotations to failure differed for the two instruments, the actual force that it took to cause that failure was the same.

Alloys↗

PubMed1996

Relationship between endodontic preparations and human dentin permeability measured in situ.

Endodontic preparations may induce changes in the permeability of radicular dentin. The aim of this study was to analyze the variation of hydraulic conductance measured in situ after three endodontic preparations (manual K+H files, ultrasonic preparation, and manual with NaOCI and EDTA). Scanning electron microscopic analysis of the canal walls was made to permit correlations between variations of permeability and the amount of surface covered with smear layer or organic debris. There was an inverse relationship between the variations in dentin permeability and the presence of smear layer. The significance of this correlation was variable according to the techniques used. Dentin thickness was as significant a factor in influencing radicular permeability as was the smear layer. The use of EDTA induced a considerable increase in radicular permeability. The use of ultrasonics produced a similar but weaker effect.

Analysis of Variance↗

PubMed1997

EDTA inhibits in vitro substrate adherence capacity of macrophages: endodontic implications.

The disodium salt of ethylenediamine tetraacetate (EDTA) is a calcium ion chelator used in endodontics to enlarge root canals. This study investigated the effect of EDTA on substrate adherence capacity of rat inflammatory macrophages to determine if EDTA leakage to periapical tissues during root canal therapy can alter macrophage function. Inflammatory macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. Substrate adherence capacity assays were carried out in Eppendorf tubes for 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2. The adherence index (AI) was calculated. Results showed that EDTA decreased substrate adherence capacity of inflammatory macrophages in a time and dose-dependent manner. The lowest EDTA concentration that caused a significant inhibition of AI was 50 mM (p < 0.05), and the EDTA concentration that caused half-maximal inhibition (IC50) was 194 +/- 20 mM (p < 0.01). Calcium chloride (10 mM) increased the adherence index of macrophages by 17.1% (p < 0.05) and decreased the EDTA inhibitory effect on AI by 49.5% (p < 0.05). We conclude that an EDTA concentration lower than that used in endodontics decreased the substrate adherence capacity of macrophages significantly. Adhesion is the first step in the phagocytic process and in antigen presentation, but leakage of EDTA to periapical tissues during root canals preparation may inhibit macrophage function and reduce periapical inflammatory reactions.

Animals↗

PubMed1997

In vitro antibacterial activity of a glass ionomer endodontic sealer.

The aim of this study was to evaluate the antibacterial activity of a recently introduced glass ionomer endodontic sealer, Ketac Endo (KE), compared to a commonly used ZOE-based endodontic sealer, Roth's cement (RC). With the use of E. faecalis as a test organism, the agar diffusion test (ADT) and direct contact test (DCT) were performed. For the DCT, the sealers were mixed and placed on the side wall of microtiter plate wells. A 10 microL bacterial suspension was placed on the tested material samples 20 min, 24 h, and 7 days after mixing. Bacteria were allowed to directly contact the sealers for 1 h at 37 degrees C. Fresh media was then added and bacterial growth was measured every 30 min over 15 h. The results showed that in the ADT, freshly mixed KE exhibited a twofold greater inhibition zone than RC (p < 0.05); in the DCT, freshly mixed KE and RC completely inhibited bacterial growth. The 24-h and 7-day samples of KE showed no antibacterial activity, whereas RC continued to exhibit a strong effect with similar samples. It has been concluded that KE possesses a short-acting very potent and diffusable antibacterial activity, whereas RC extends its effect over 7 days after setting.

Anti-Bacterial Agents↗