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PubMed2003

Evaluation of root canal microorganisms isolated from teeth with endodontic failure and their antimicrobial susceptibility.

Studies of the microbiota from the canals of teeth with failure of endodontic therapy have revealed that it differs markedly from that of untreated necrotic dental pulps. This study aimed to evaluate the microbiota of 30 root-filled teeth with persisting periapical lesions and to test the antibiotic susceptibility of the most prevalent species. Microbial samples, isolation and speciation were done using advanced microbiologic techniques for anaerobic species. A total of 55 bacterial species were isolated, 80% were gram-positives and 58% facultative anaerobic microorganisms. The bacterial genera most frequently recovered were Enterococcus, Streptococcus, Peptostreptococcus and Actinomyces. Antibiotic sensitivity of Enterococcus faecalis and Peptostreptococcus spp. was accomplished with the E-test system. All species studied were susceptible to benzylpenicillin, amoxicillin, amoxicillin combined with clavulanate. However, 20% of the E.faecalis strains were resistant to erythromycin and 60% to azithromycin. It was concluded that microbial flora in canals after endodontic failure comprised predominantly facultative anaerobes and gram-positive species. E.faecalis was the species most frequently isolated and showed erythromycin and azithromycin resistance among the isolates.

Actinomyces↗
PubMed2000

Rationale for the use of low-torque endodontic motors in root canal instrumentation.

Fracture of nickel-titanium rotary files is an iatrogenic error which can seriously jeopardize root canal therapy. If a high-torque motor is used, the instrument-specific limit-torque (fracture limit) is often exceeded, thus increasing the risk of intracanal failure. A possible solution to this problem is to use a low-torque endodontic motor which operates below these values. If the torque is set just below the limit of elasticity for each instrument, the risk of fracture is likely to be markedly reduced. The purpose of this paper was to discuss mechanical properties of NiTi rotary instruments, the rationale for selecting low torque values, and to use clinically a new endodontic motor (step-motor) which operates below the limit of elasticity of each rotary file. The step-motor was found to be helpful in reducing the risk of instrument fracture. Irreversible material damage (plastic deformation) and instrument fracture were rarely seen. Low-torque instrumentation also increased tactile sense and, consequently, mental awareness of rotary instrumentation.

Computer Systems↗
PubMed2000

Bacteria of asymptomatic periradicular endodontic lesions identified by DNA-DNA hybridization.

Possible inclusion of contaminant bacteria during surgery has been problematic in studies of periradicular lesions of endodontic origin. Therefore, in this study, two different surgical techniques were compared. A second problem is that some difficult to cultivate species may not be detected using bacteriological methods. Molecular techniques may resolve this problem. DNA-DNA hybridization technology has the additional advantage that DNA is not amplified. The purpose of this investigation was to determine if bacteria from periradicular endodontic lesions could be identified using DNA-DNA hybridization. A full thickness intrasulcular mucoperiosteal (IS) flap (n = 20) or a submarginal (SM) flap (n = 16) was reflected in patients with asymptomatic apical periodontitis. DNA was extracted and incubated with 40 digoxigenin-labeled whole genomic probes. Bacterial DNA was detected in all 36 lesions. Seven probes were negative for all lesions. In patients with sinus tract communication, in teeth lacking intact full coverage crowns, and in patients with a history of trauma 4-13 probes provided positive signals. Seven probes were positive in lesions obtained by the IS, but not the SM technique. Two probes were in samples obtained with the SM technique, but not the IS. Only Bacteroides forsythus and Actinomyces naeslundii genospecies 2 were present in large numbers using either the IS or the SM technique. The SM flap technique, in combination with DNA-DNA hybridization, appeared to provide excellent data pertaining to periradicular bacteria. These results supported other studies that provide evidence of a bacterial presence and persistence in periradicular lesions.

Actinomyces↗
PubMed2003

Endodontic retreatment of an autotransplanted lower first premolar: a case report.

A 24-year-old female with no contributory medical history had been treated by orthodontic alignment and transplantation of the lower left first premolar to the upper left first premolar site to correct for congenitally missing upper premolars. Subsequently, the transplanted premolar was treated by conventional endodontics and apical surgery for persistent periapical periodontitis over a span of 12 years. A combination of conventional endodontic retreatment and periapical surgery resulted in periapical healing. This case outlines the need for careful preoperative case assessment.

Adult↗
PubMed2004

Endodontics: Part 7. Preparing the root canal.

Research into root canal preparation has led to significant changes in instrumentation techniques. Hand files should be manipulated by the balanced-force technique. Recent designs of endodontic instruments have variable tapers giving improved shaping ability. Nickel-titanium rotary instruments will rapidly and safely open the main root canals creating deep space to permit full permeation of irrigant solutions. Practitioners considering changing their endodontic technique are advised to attend hands-on practical courses to gain competence before using these in clinical practice.

Anti-Infective Agents, Local↗
PubMed2005

Endodontic problems.

If modern clinical techniques were carefully followed, many common endodontic problems would never occur. Incorrectly designed access cavities may make root canals both difficult to identify and to instrument. Careful study of the pre-operative radiograph is essential. Various aids are available to remove fractured instruments and failed root fillings, but the problem must first be correctly diagnosed. As more patients seek cosmetic procedures, the practitioner should be familiar with the 'walking bleach' procedure, again after careful diagnosis of the cause of the discolouration. The practitioner should also be fully aware of the prognosis for this and other endodontic procedures.

Dental Instruments↗
PubMed2005

Severe tissue damage and neurological deficit following extravasation of sodium hypochlorite solution during routine endodontic treatment.

Endodontic therapy is a routinely practised clinical procedure with few reported complications. Sodium hypochlorite is often used as an irrigant during this procedure, but severe complications may occur if this solution extravasates beyond the root apex. We present a case demonstrating some of the severe sequelae that can occur following the misuse of sodium hypochlorite during endodontic treatment of an upper lateral incisor, which also resulted in the previously unreported complication of isolated facial nerve weakness.

Adult↗
PubMed1997

Application of computerised image analysis to monitoring endodontic therapy: reproducibility and comparison with visual assessment.

OBJECTIVE: To evaluate the intra- and interexaminer reproducibility of computerised image analysis for the assessment of periapical bone changes based on gray value ratio when compared with a visual method. METHODS: 353 radiographs obtained in a clinical endodontic study were analysed. Densitometric analyses were used to evaluate changes in bone density following endodontic treatment. The diseased area of apical periodontitis' (AP) and 'normal bone area' (AN) were defined and ratios of the gray values (AP/AN) were calculated for each radiograph. Periapical index (PAI) was used as the 'gold standard'. Correlation coefficient (r), Kappa (kappa), and t-test for matched pairs were used for the statistics. RESULTS: The method proyed to be reproducible for intra-examiner re-examinations, r ranging from 0.7 to 0.84 (P < 0.01). Kappa showed fair to good agreement for data divided into four or three categories (kappa = 0.25-0.64). Dichotomised data showed fair to moderate agreement (kappa = 0.33-0.4) when the whole process was repeated, and good to very good agreement (kappa = 0.64-0.85) for the delineation process alone. The interexaminer comparisons showed fair to moderate agreement (kappa = 0.3-0.49). Comparison with PAI showed a 61% sensitivity and 79% specificity in detecting severe lesions (corresponding PAI scores 4 and 5) and the kappa value of 0.40 showed moderate agreement. The image analysis was sensitive enough to detect healing one month after treatment in a group of teeth with substantial lesions (P < 0.05). CONCLUSIONS: The computerised image analysis system seems to be an appropriate tool to detect the periapical bone changes in dental radiographs at a group level.

Bone Density↗
PubMed1999

The effects of developer age on diagnostic accuracy: a study using assessment of endodontic file length.

OBJECTIVES: To examine the effects of developer age on image quality. METHODS: Endodontic files, size 10 and 15, were placed in upper and lower molars and premolars up to the root apex or 1.5 mm short. A series of radiographs were made with each of three film types: Dentus M2 (Agfa-Gevaert, Mortsel, Belgium), Ektaspeed Plus and Ultra-speed (Kodak Eastman Co, Rochester, USA). The films were processed bi-weekly using the same Agfa chemicals (Heraeus Kulzer, Dormagen, Germany) over a 6-week period. An additional set of Dentus M2 films was processed using Periomat chemicals (Dürr Dental, Bietigheim-Bissingen, Germany). The films were viewed by eight dentists who rated the position of the tip of the file using a 5-point confidence scale. ROC data were analysed by means of analysis of variance. Az value was the dependent variable, whereas observer age group was entered as between subject factor. The null hypothesis was rejected when P<0.05. RESULTS: The diagnostic accuracies of the three films were comparable during the first 4 weeks. In the sixth week Ultra-speed was significantly better than the other two films (P=0.046). The Periomat chemicals showed significantly greater consistency than the Agfa chemicals (P=0.004). Developer exhaustion significantly affected the performance of the older observers (P=0.008), especially when Agfa chemicals and file size 10 were used. CONCLUSION: Agfa chemicals older than 4 weeks significantly affect the assessment of endodontic file length. In earlier stages there are no significant differences between the three films tested. Dentus M2 and Ektaspeed Plus films should be used as they require lower exposures.

Adult↗
PubMed2002

Effect of three root canal sealers on the retentive strength of endodontic posts luted with a resin cement.

AIM: This investigation examined what effect three different sealers had on retention of endodontic posts (Parapost) luted with a resin cement (Panavia 21 OP). METHODOLOGY: Sixty-four single-rooted teeth were decoronated, filed, cleaned, and shaped with a size 5 Gates-Glidden drill and 0.12 taper G.T. rotary instrumentation (Dentsply/Tulsa Dental). Teeth were then divided into four groups of 16 each. Group 1 was not obturated, and served as a control. The other three groups were obturated with gutta-percha using a different sealer for each group. Group 2 used a eugenol containing sealer (Kerr Pulp Canal Sealer), group 3 a resin sealer (AH-26), and group 4 a calcium hydroxide sealer (Sealapex). After 1 week's storage at 100% humidity, 10-mm deep post spaces were prepared with a size 6 Gates-Glidden drill, and size 5 Paraposts were cemented. Following 48 h of storage, samples were mounted in a PVC pipe with acrylic, and the posts were removed vertically using a universal testing machine at 1 mm min-, with data recorded in kilograms. RESULTS: The mean values of force required to remove the posts were: group 1 = 61.80, SD = 16.21; group 2 = 43.14, SD = 14.66; group 3 = 48.54, SD = 17.84; group 4 = 53.52, SD = 18.77. Using anova and Bonferroni tests, group 1 demonstrated significantly greater mean retention strength values than group 2, but no other significant differences existed between groups. CONCLUSION: The chemical formulation of root canal sealers did not significantly affect the retention of endodontic posts luted with resin cement.

Analysis of Variance↗
PubMed1997

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↗
PubMed1997

Antibacterial activity of calcium hydroxide-containing endodontic sealers on Enterococcus faecalis in vitro.

Antimicrobial activity of endodontic sealers is an important factor in the prognosis of root canal treatment. The aim of this study was to analyse the antimicrobial activity of calcium hydroxide-containing endodontic sealers, Sealapex (SA) and CRCS compared to a ZOE-containing sealer, Roth's cement. The sealers were mixed and placed on the side wall of microtitre plate wells. A 10 microL suspension of Enterococcus faecalis was added to the surface of the sealers 1 h, 24 h, or 7 days after mixture. Bacteria were allowed to come into contact with the sealers for 1 h at 37 degrees C. Fresh media was then added and bacterial growth was measured every 30 min for 16 h. The results showed that in 1-hour-old mixture, CRCS and Roth's cement had a significantly better antimicrobial effect than SA. In 24-hour-old mixtures, ZOE-based sealer showed a more potent antimicrobial activity than calcium hydroxide-containing sealers, whereas SA showed a significantly better antimicrobial effect in the 7-day-old mixture. The antimicrobial activity of each tested sealer changes differently with the time interval between mixing and testing, suggesting different physicochemical properties and potentially diverse clinical applications.

Calcium Hydroxide↗
PubMed1998

Vertical root fractures in adjacent maxillary premolars: an endodontic-prosthetic perplexity.

Vertical root fractures in endodontically treated teeth occur frequently in teeth or roots in which their mesiodistal dimension is narrow, such as the maxillary upper premolars. Two cases of vertical root fractures in two adjacent maxillary reconstructed teeth are presented. As in many cases of vertical root fractures, the primary diagnosis was of endodontic treatment failure. The final diagnosis of the fractures was made either by the radiograph showing separation of root segments in one case, or by surgical exploration in the other. In both cases, tooth extraction was unavoidable.

Adult↗
PubMed1998

Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population.

The present epidemiological study is derived from a random sample of 322 residents of the Porto area, aged 30-39 years. Prevalence of apical periodontitis and results of endodontic treatment were evaluated from orthopantomograms, available from 179 of a total of 197 individuals attending for examination. The results indicated a prevalence of apical periodontitis in 27% of this population. The quality of a majority (54%) of the 69 root fillings observed were found to be inadequate, (i.e. short and/or poorly condensed), but only 15 (22%) of the endodontically treated teeth presented with apical periodontitis.

Adult↗
PubMed1998

Endodontic retreatment behaviour: the influence of disease concepts and personal values.

To explain dentists' variation in endodontic retreatment decision making a praxis concept (PC) has been generated. PC assumes that practitioners operate along a health continuum. Various periapical conditions are then perceived as different stages on a continuous health scale, based on their radiographic appearance. PC suggests that an individual's placement of a cut-off point for retreatment on the health continuum to a large extent is dependent on the agent's personal values. In the present study value judgements (utilities) concerning two periapical health states in endodontically treated teeth were investigated among 82 dental students. The two methods used to elicit utilities, a Visual Analogue Scale (VAS) and the Standard Gamble (SG), produced large inter- and intra-individual variations. VAS frequently generated lower utility values. The results obtained in the study satisfy a necessary criterion for the validity of PC and strengthen the position of the theory.

Attitude of Health Personnel↗
PubMed2002

Stainless steel bands in endodontics: effects on cuspal flexure and fracture resistance.

AIMS: This study investigated the effect of stainless steel bands on cuspal flexure and fracture resistance of extracted maxillary premolars. METHODOLOGY: Twenty extracted maxillary premolars (10 matched pairs) with mesio-occluso-distal (MOD) cavities and endodontic access were subjected to occlusal loading tests (100 N) using a servo-hydraulic testing machine. Cuspal deflections were measured by an extensometer, with and without the band present. Ten teeth (one of each pair) then had the band removed, and all teeth were subjected to loading until fracture. RESULTS: Mean cuspal flexure of teeth with bands was one-half of flexure without bands (P < 0.001). Teeth with bands fractured at higher load than their matched pairs with the band removed (P < 0.001), with mean loads at fracture of 1282 N and 729 N, respectively. CONCLUSIONS: The study showed that stainless steel bands used in endodontics reduce the cuspal flexure of maxillary premolars and increase their fracture resistance.

Adolescent↗
PubMed2002

Combinations of bacterial species in endodontic infections.

AIM: This study was undertaken to investigate combinations of bacteria found in root-canal infections of teeth with periapical bone destruction without clinical signs and symptoms. METHODOLOGY: Endodontic samples from 58 root canals were cultured anaerobically and microorganisms were counted and identified. Eighty-one combinations of microorganisms were found and tested for a symbiotic relationship using the Fisher's exact test and Odds ratio calculation. RESULTS: All samples contained microorganisms with a median CFU mL(-1) of 8x10(4) per sample. Strict anaerobic species accounted for 87% of the microflora. The most prevalent bacteria were Prevotella intermedia, Peptostreptococcus micros and Actinomyces odontolyticus, present in 33, 29 and 19%, respectively, of the cultured canals. A significant relationship (P<0.05) and an Odds ratio >2 were found between P. intermedia and P. micros, P. intermedia and P. oralis, A. odontolyticus and P. micros, Bifidobacterium spp. and Veillonella spp. CONCLUSIONS: These results indicate that endodontic pathogens do not occur at random but are found in specific combinations.

Alveolar Bone Loss↗
PubMed2002

A survey of endodontic practice amongst Flemish dentists.

AIM: The purpose of this study was to gather information on routine endodontic treatment performed by Flemish (Dutch-speaking Belgian) dentists. METHODOLOGY: A postal questionnaire was sent to all the 4545 Dutch-speaking dentists registered in Belgium. The questionnaire was made up of 38 questions with multiple-choice answers. Results from 32 questions are presented, covering subjects, such as demographic and professional activity, root-canal preparation and instrumentation, emergency procedures and postoperative complications, choice of irrigants and disinfectants, and choice of obturation techniques. RESULTS: A total of 1143 questionnaires (25.1%) were returned. Approximately 94% of the respondents were general practitioners. The results indicate that there are discrepancies between daily practice and academic teaching, especially regarding the use of rubber dam (only 3.4% report using it as a standard procedure) and the detection and preparation of a second mesiobuccal canal in maxillary first molars (70% never or seldom). Most GDPs reported that they completed treatment in two visits. The majority of practitioners used manual instruments manipulated with a filing technique; 38.9% of the respondents prepared root canals 1 mm short of the radiographic apex. The most popular emergency procedure for acute pain was pulpectomy (40.2%); 48% performed pulpectomy, prescribed analgesics and antibiotics for acute apical periodontitis. Approximately 35% reported complications after cases with chronic apical periodontitis were treated. The first-choice root-canal irrigant was sodium hypochlorite and approximately 65% used intracanal medication. The most popular obturation technique was cold lateral condensation (60%) with 29% using AH26 as a sealer. A high proportion of GDPs (80%) performed re-treatments. CONCLUSIONS: The results of this study confirm that many Flemish general practitioners are not following quality guidelines for endodontic treatment.

Acute Disease↗