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This case demonstrates an artificial apical barrier formation by using calcium-beta-glycerophosphate paste in a nonvital permanent tooth with an open apex communicating with the maxillary sinus. The long-term satisfactory outcome of this case depended on the resolution of periapical pathosis and root canal obturation without overextension.
AIM: To evaluate the crown-down preparation technique, and the use of hydroxylapatite based material for the definitive root canal obturation. METHODS: The investigation included 20 single-canal roots with chronic periapical inflammatory lesion. Biomechanical medicamentous canal preparation was done using the double-flared technique with balanced force, and the obturation was performed with hydroxylapatite sealer (unicone technique). Clinical and radiographic check-up performed 12 months after the treatment, used the following parameters: pain, swelling, percussion and palpation sensitivity, and the presence of fistula. RESULTS: The obtained results showed a successful treatment in 18 cases, while in the 2 cases the treatment failed. CONCLUSION: These findings suggested that the crown-down preparation technique efficiently cleaned and shaped the root canal, and that the hydroxylapatite-based material created the homogenous and hermetic root canal obturation, so this methodology could be recommended for the endodontic therapy.
The aim of this in vitro study was to assess the quality of root canal obturation and degree of apical dye penetration in teeth root-filled with either laterally condensed cold gutta-percha or Thermafil obturators. A total of 144 extracted teeth with single roots were included in the study. All canals were prepared with a standard technique using a sonic handpiece with copious irrigation. Radiographs taken of the teeth to show the maximum degree of canal curvature were then exposed and the angle, radius and position of curvature determined. This information about the canals, together with their working length and diameter at end-point was used to divide the teeth into two experimental and two control groups. A total of 71 teeth were filled with Thermafil obturators, 69 with lateral condensation while four teeth remained unfilled and acted as controls. Following obturation, the teeth were radiographed in two planes and the technical quality of fill assessed on a four-point scale. All access cavities were then sealed and the teeth immersed in dye for 48 h before being split longitudinally. Linear dye penetration via the apical foramen was then assessed. In both straight and curved canals obturation with Thermafil obturators was significantly quicker (P < 0.001) then lateral condensation. Apical extrusion of gutta-percha occurred significantly more often in straight canals obturated with lateral condensation (P < 0.005) but there was no difference in curved canals. There was little difference in the radiographic quality of fill in the apical halves of the root fillings but Thermafil obturators were significantly better in the coronal halves when viewed from the proximal.(ABSTRACT TRUNCATED AT 250 WORDS)
A previous report indicates that root canals obturated with a new glass ionomer cement endodontic sealer (Ketac-Endo, Espe, Germany) and laterally condensed gutta-percha can be retreated by ultrasonic instrumentation. To address the possibility of Ketac-Endo being used without condensation of gutta-percha, the purpose of this study was to evaluate the efficacy of ultrasonic retreatment in canals obturated with single-cone gutta-percha and Ketac-Endo. Thirty root canals were prepared in a standardized way to ISO size 40 and obturated with gutta-percha and Ketac-Endo. Either a size 40 gutta-percha cone was used with and without lateral condensation, or a size 25 single cone, without condensation. After 14 days, the canals were retreated using chloroform and ultrasonic instrumentation. The roots were split vertically, and the amount of residual debris on the canal walls was assessed by three examiners using a dissecting microscope. Debris was recorded in the apical, middle and coronal canal levels according to a preset evaluation scale. The mean scores for each group were compared by ANOVA and Mann-Whitney U-test, with a 5% level of significance. In the roots obturated with lateral condensation the amounts of residual debris in the coronal and middle canal levels was lower than in the other two groups, whereas in the apical level it was higher. Statistically, only the differences in the apical level were significant (P < 0.03). It was concluded that ultrasonic retreatment may be performed effectively in root canals obturated with single-cone gutta-percha and Ketac-Endo.
The aim of this in vitro study was to assess the quality of root canal obturation and degree of linear apical dye penetration in teeth root filled with either laterally condensed gutta-percha or Thermafil obturators. A total of 150 teeth with single roots were included in the study. All canals were prepared using a standard step-back technique with anticurvature filing. Radiographs taken of the teeth to show the maximum degree of canal curvature were then exposed and the angle, radius and position of curvature determined. This information about the canals, together with their working length and diameter at end-point, was used to divide the teeth into two experimental and two control groups. A total of eight teeth were excluded because of technical difficulties, 65 were filled with Thermafil obturators, 63 were filled with laterally condensed gutta-percha whilst 14 teeth remained unfilled and acted as controls. Following obturation, the teeth were radiographed in two planes and the technical quality of fill assessed on a four-point scale. All access cavities were then sealed and the teeth immersed in dye for 48 h before being split longitudinally. Linear dye penetration via the apical foramen was then assessed. Canal obturation with Thermafil obturators (0.7 min) was significantly quicker (P < 0.001) than lateral condensation (6.4 min). Apical extrusion of sealer and gutta-percha occurred significantly more often with Thermafil obturators but there was little difference in the technical quality of the fillings and no significant difference in dye penetration. Under the conditions of this study. Thermafil obturators proved a satisfactory alternative to lateral condensation of gutta-percha.
This study sought to evaluate the influence of apical enlargement on the sealing ability of vertical compaction. Sixty anterior teeth were used. Half of these teeth were prepared to a size 25 file and the other half to a size 40 file. Then vertical compaction was performed. Apical microleakage was determined using pressurized fluid filtration at 90 min, 6 h, 1 day, 4 days, and at 1, 2, 4, 8, 12, 16, and 24 wk after root canal obturation. Leakage tended to increase over time for both groups. The size 25 file group showed significantly less apical leakage than the size 40 file group.
The last treatment step followings extirpation of pulp from an infected root canal is root canal filling. Before root canal filling is done, however, the canal must be enlarged enough and the infected dentin and debris removed thoroughly from the canal. Furthermore, re-infection from the apical foramen at the apex of the root canal should be prevented. In this study, we examined the root apex sealing ability of gutta-percha points applied by the lateral condensation method and the vertical condensation method, as well as the difference in root canal sealing ability of gutta-percha points when either a hand reamer or file or their combination was used for root canal enlargement. Extracted human upper incisors were used for root canal enlargement. The condition of the root canal wall after enlargement was observed by scanning electron microscope. The fitness between the wall and gutta-percha was determined by observation of replicas filled with gutta-percha. Furthermore, to assess the degree of apex sealing after root canal filling, we immersed the extracted teeth in Indian ink for 1 day, 3 days, 1 week, 2 weeks, or 4 weeks (Indian ink permeation test). The results obtained were as follows: 1. Reamer and K-file could smooth the root canal wall more than H-file by the scratch-up method. And also the instruments used by the rotation method formed a sure apical seat, which resulted in film apex filling. 2. By the observation of gutta-percha point-filled replicas we noted a border line between the apical seat and apical foramen when the lateral condensation method was used, whereas the line was not observed with the vertical condensation method. 3. Between the 2 filling methods there was no difference in the ink permeation by Indian ink permeation test, but high sealing ability was observed in the root canal in which a sure apical seat had been formed.
The purpose of this study was to examine changes in the endodontic status of selected teeth in a population over time, in order to get a long-term perspective of endodontically treated teeth. A random sample of the adult Swedish population was selected in 1974 and offered a clinical and radiographic examination. Eleven years later 351 of the selected persons attended a follow-up examination (1985). In radiographs, covering the mandibular premolar and molar regions, the status of 1974 was directly compared, tooth by tooth, with the status of 1985. The results showed that a number of endodontically treated teeth with an apical periodontitis healed during the observation period. During the same period, approximately the same number of endodontically treated teeth presented with a new apical periodontitis. This finding suggested that cross-sectional studies could provide reliable information on the long-term success rate of endodontic treatment at the population level. The periapical lesions that persisted or developed during the observation period were strongly related to incomplete root canal obturation, which is in agreement with observations in follow-up studies from teaching and specialist clinics.
With all the technology that has been introduced in endodontics, there are now several ways to instrument and obturate root canals. Practitioners often develop their own "hybrid" technique after sharing ideas with several colleagues. The purpose of this article is to describe a technique of obturation, hoping that others may incorporate some aspects into their own "hybrid" style.
OBJECTIVE: The ability of the laser irradiation to promote the cleaning and disinfection of the radicular canal system has become this type of treatment in a viable and real alternative in endodontics. The purpose of this study was to evaluate the apical marginal sealing of root canal fillings after the irradiation with the laser of Nd:YAG or of Er:YAG. MATERIALS AND METHODS: Forty-two human, extracted single-rooted teeth had their crowns sectioned and the root canals prepared with a no. 70 K-file. Then, they were dried and divided into three groups according to canal wall treatment: group 1: the canals were filled with EDTA for 3 min, followed by irrigation with 1% sodium hypochlorite solution; group 2: the canal walls were irradiated with Nd:YAG laser; and group 3: the canal walls were irradiated with Er:YAG laser. Afterwards, the root canals were obturated by the lateral condensation technique. The roots were externally waterproof, except in the apical foramen and immersed in 2% methylene blue aqueous solution during 48 hours. RESULTS: The results showed that the largest infiltrations happened in the group 3-Er:YAG (7.3 mm), proceeded by the group 1-EDTA (1.6 mm) and by the group 2-Nd:YAG (0.6 mm). The group Er:YAG differed statistically of the others (p < 0.05). CONCLUSION: It was concluded that the Er:YAG laser intracanal irradiation previously to the root canal filling must be used with caution until future research is define the best parameters for it's use.
The microleakage of four retrograde filling materials was compared in vitro. Fifty-three single rooted teeth were instrumentated and root filled with resin chloroform and gutta-percha. The gutta-percha cones were left extruding from the access opening. All teeth were apicected and retrograde fillings placed. The materials used were a non gamma 2 amalgam (Amalcap), a glass ionomer cement (ChemFil II), threaded titanium pins cemented with a glass ionomer cement (ChemFil II) and identical titanium pins cemented with a silicone material (Adheseal). After removal of the gutta-percha with tweezers, a radioactive isotope solution was placed in the teeth. Extraradicular samples were taken at 3, 7, 28, 77 and 104 days. All retrograde fillings showed some microleakage. The group with titanium pins cemented with silicone showed the least leakage: significantly less than the teeth with glass ionomer cement (P < 0.01) and with amalgam (P < 0.01). No significant differences were found between other groups.
Research in education has demonstrated the usefulness of verbal mediators as memory aides. The mediator or mnemonic POOR PAST can be of use to the dentist in recalling the list of alternatives in the differential diagnos of endodontic failures: P--perforation; O--obturation; O--overfill; R--root canal missed; P--periodontal disease; A--another tooth; S--split; T--trauma. With a comprehensive list of diagnoses, recall of the appropriate questions and tests in examining for each possibility is simplified. The diagnostician then proceeds to look for a specific symptom or symptoms that would confirm a particular diagnosis or that would limit the alternatives to two or three possibilities. Questioning about the nature and duration of the symptoms is useful in ruling out some diagnoses. Pulp tests, periodontal probing, radiographs from different angles, percussion, palpation, and sinus tract exploration each have special application to one or more of the possibilities on the list. The wise clinician also evaluates access preparations, occlusion, and those etiologic factors that could cause pulp or periodontal disease. Variations in the root canal, requirements of treatment, the nature of the healing process, expected results, and surgical principles are considered along with the foregoing in problem solving. After a case has been thoroughly investigated and if the POOR PAST alternatives have been ruled out the dentist may then conclude that for some as yet undetermined reason the lesion exceeds the recuperative powers of the host and that further consultation or surgical intervention will be necessary.
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The aim of this in vitro study was to determine the effect of three different root canal sealers on the bacterial penetration of obturated root canals. Eighty extracted human teeth with straight, single root canals were prepared using the modified double-flared technique with balanced force under copious irrigation until the master apical file was size 40. The teeth were divided randomly into experimental groups (60 teeth) and control groups (20 teeth). Twenty experimental teeth each were obturated by lateral condensation of cold gutta-percha with AH26, Apexit or Tubliseal EWT sealer. In the control groups, 10 teeth were obturated using the same technique with AH26, Apexit or Tubliseal EWT sealer. These teeth were completely sealed to serve as negative controls. The remaining 10 teeth were not obturated and served as positive controls. The root surface of each tooth, except the apical 2 mm, was sealed with nail varnish. The coronal part of each root canal was sealed with the cut end of a polypropylene tube and placed in a glass bottle containing sterile Todd-Hewitt Broth (THB). Aliquots of 0.5 ml of THB were injected into the polypropylene tube and the model system was centrifuged at 168 g. An innoculum of Streptococcus sanguis in THB was added to the tube at 5-day intervals and daily observations were made for bacterial growth in the apical reservoir for 90 days. All positive control teeth showed bacterial penetration within 24 h and negative control teeth remained uncontaminated throughout the test period. Leakage through the experimental teeth varied from 7 to 86 days. There was no statistically significant difference (P > 0.05) in leakage of the obturated canals between AH26, Apexit and Tubliseal EWT sealers.
PURPOSE: To clinically test the periapical healing of the method of recurrent electronic root canal measurement and the method of root canal obturation by the guttapercha-eucapercha method. METHODS: During 10 years of endodontic practice of the first author, endodontic interventions were performed on approximately 4500 patients, aged 12-75 years. The success of therapy was followed-up in 257 teeth with diagnosis K04.0 to K04.5 (according to the X international classification of diseases) for whom a preoperative and control radiograph during the investigation period existed. Root canal preparation started with the "crown-down pressureless technique" and proceeded with the method of recurrent electronic root canal measurement. Obturation was done by the guttapercha-eucapercha method up to the apical constriction. RESULTS: The result of therapy success was approximately 95% overall (t-test, ANOVA); for the diagnosis: necrosis and pulp gangrene (K04.1): 64%; for the acute apical periodontitis (K04.4): 88%; for the inflamed pulp (K04.0) and pulp degeneration (K04.2) 95%; chronic apical periodontitis (K04.5): 98%, and abnormally formed hard tissue in the pulp (K04.3):100%.
AIM: The purpose of this study was to compare the efficacy in vitro of gutta-percha removal from obturated root canals using ProFiles. METHODOLOGY: Forty-eight human root canals with curvatures ranging between 25 and 45 degrees were instrumented by a standardized method to an apical ISO size 30 and 0.04 taper. They were obturated with vertically condensed gutta-percha. Retreatment was performed with the following techniques: K-Flexofiles with chloroform; Hedstrom files with chloroform; ProFiles 0.04 taper with chloroform; ProFiles 0.04 taper alone. The time for each method was measured. A microfocal macroradiographic technique was used to evaluate the amount of debris remaining within the root canals after the retreatment procedure. Roots were divided into apical, middle and coronal parts and scored on a scale of 0 (no debris) to 3 (> 50% of walls covered with debris) by trained observers on two separate occasions. RESULTS: The scores for debris remaining within root canals for K-Flexofiles with chloroform and ProFiles with chloroform were the lowest and not significantly different at all three levels of the roots examined (P > 0.05), and Hedstrom files with chloroform and ProFiles with chloroform were not significantly different in the apical part. In general, coronal parts were cleaner than apical parts. The difference in scores at the three levels between ProFiles with chloroform and ProFiles alone were each significant (P < 0.01). Instrumentation using ProFiles with chloroform (mean 6.42 min) was significantly faster than using hand files (mean 11.67 min) (P < 0.01). CONCLUSION: The results indicated that ProFiles or hand files with chloroform produced similarly clean canals, but that ProFiles were faster.
It is assumed that above a critical level, microleakage causes periapical disease and jeopardizes periapical tissue repair. The purpose of this investigation was first to find out to what degree obturation prevents leakage of bacteria-sized particles or large protein molecules, and second if leakage of the commonly used dye methylene blue is comparable with that of a small bacterial metabolic product of similar molecular size. Sections, 9 mm long, obtained from 46 extracted human incisor roots had their root canals prepared in a standardized manner and obturated in four experimental ways using gutta-percha. The root sections were mounted in the middle of tubes that were closed at both ends with rubber membrane stoppers, which permitted sampling from the apical reservoir. The coronal reservoir was filled with a solution of 1 mg/ml latex beads, 4 micrograms/ml endotoxin, 0.5 per cent butyric acid, 0.1 per cent valeric acid and 0.1 per cent methylene blue water. After 1 and 2 weeks, samples were taken from the apical reservoir and tested for the presence of latex beads by phase-contrast microscopy, for endotoxin with a limulus lysate test, for butyric acid with gas-chromatography and for methylene blue with spectrophotometric analysis. Leakage of bacteria-sized particles and large-sized protein molecules could be prevented only when both sealer and pressure were used in obturating root canals with gutta-percha. Leakage of butyric acid proved to be comparable with leakage of methylene blue; microleakage of these small molecules could not be prevented in this study whatever method of filling was used.
Coronal leakage has been recognized as a cause of pulpal and periradicular disease. Although cleaning and shaping of the root canal system is considered paramount, obturation of the system is an important step in endodontic success. The purpose of this study was to evaluate coronal bacterial leakage in teeth obturated with the System B continuous wave of condensation technique, followed by an Obtura II backfill, versus teeth obturated using the lateral condensation technique. Sixty single-rooted bilaterally matched teeth were evaluated in this study. An anaerobic bacterial leakage model was used. Results indicate that microbial coronal leakage occurs more quickly using lateral condensation than with the System B continuous wave of condensation and Obtura II backfill. This difference was statistically significant (p < or = 0.05). However, there was no statistical difference between groups 1 and 2 in the numbers of teeth that demonstrated bacterial leakage at the end of the study.