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PubMed2006

Influence of sterilization on mechanical properties and fatigue resistance of nickel-titanium rotary endodontic instruments.

AIM: To evaluate the effect of repeated sterilization cycles in dry oven or autoclave, on the mechanical behaviour and fatigue resistance of rotary endodontic Ni-Ti instruments. METHODOLOGY: New Ni-Ti instruments were subjected to five consecutive sterilization cycles in a dry oven or steam autoclave. Microhardness was measured in the nonmachined parts of the shanks of instruments using a Vickers indenter. Specimens of Ni-Ti wires were submitted to the same sterilization protocol and tensile tested until rupture. A group of instruments were fatigued to one half of their average fatigue life and then sterilized. New and sterilized instruments were fatigue tested until rupture. anova tests at alpha = 0.05 were used for statistical analysis. RESULTS: Sterilization procedures resulted in no significant changes in Vickers microhardness, nor in the parameters describing the mechanical behaviour of the wires. However, the number of cycles to failure was statistically higher for all instruments after dry heat or autoclave sterilization cycles. In the instruments previously fatigued to one half of their fatigue life, autoclave sterilization gave rise to an increase of 39% in the remaining number of cycles to failure. CONCLUSIONS: Changes in the mechanical properties of Ni-Ti endodontic instruments after five cycles of commonly used sterilization procedures were insignificant. The sterilization procedures are safe as they produced a significant increase in the fatigue resistance of the instruments.

Analysis of Variance↗
PubMed2006

Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology.

The assurance of the quality of a service rendered by a member of the dental profession is an essential feature of any system of peer review in dentistry. This document addresses two essential elements: (i) appropriateness of treatment modality and (ii) quality or level of treatment rendered. In revising these guidelines the European Society of Endodontology is responding to a public and professional need. In receiving care of a specialized nature such as endodontic treatment, patients need and deserve treatment that meets the standard of care generally given by competent practitioners. The European Society of Endodontology has the expertise and professional responsibility necessary to assist the dental profession by instituting guidelines on the standard of care in the special area of Endodontics. In accepting this responsibility the European Society of Endodontology formulated treatment guidelines that are intended to represent current good practice.

Europe↗
PubMed1977

Influence of different endodontic methods of treatment upon the process of apical closure of immature pulpless human teeth and the structure of the newly formed calcified tissue in apical opening.

A description is given of the pathohistological structure of the calcified tissue in the apical opening of four extracted immature pulpless human teeth treated by various endodontic methods. It is concluded that in the tooth treated by mortal extirpation there was neither histological healing nor any tendency for further apex formation. In both the tooth where vital extirpation was performed and in one of the teeth treated as apical periodontitis, the apices were formed from conglomerates of different calcified tissues, identical to the tissue which was formed under comparable conditions in experimental dogs. In the fourth human tooth also treated as apical periodontitis after treatment the apical opening closed with irregular dentine tissue. In this study consideration was given to the problem of the origin of the odontoblasts which co-exist with the hard destructive process present in some pulpless teeth. It is concluded that in the case presented in this study the irregular dentine was formed by the same odontoblasts which took part in the process of normal odontogenesis. This fact, should be respected in the course of endodontic treatment of immature pulpless teeth.

Animals↗
PubMed2006

A new approach to define defect extensions of endodontically treated teeth: inter- and intra-examiner reliability.

For endodontically treated teeth, there are no standardized measures available to define the extent of loss in tooth substance prior to final restoration. In this study, defect size was classified and the applicability of the classification was tested related to the inter- and intra-examiner reliability. For classification, three parameters were investigated: (i) remaining tooth substance in the vertical dimension (level A-D, aspect I), (ii) remaining tooth substance as regarded horizontally (mm; bucco-lingual and mesio-distal, aspect II), and (iii) size of the orifice (mm; aspect III). Four non-calibrated or (pre-trained) examiners were asked to gauge and classify 20 casts of clinically broken down teeth. The measurements were repeated twice every alternative week giving three separate readings. Inter-examiner reliability was determined at weeks 1, 3 and 5. The intra-examiner reliability was compared between readings 1 and 2, 1 and 3, and 2 and 3. As statistical tests, intra-class correlation (ICC) and Cohen's kappa (weighted) were used at a significance level of P < 0.05. Inter- and intra-examiner reliability for ordinal data (aspect I) revealed, with one exception, 'moderate' to 'very good' evaluations. Inter- and intra-examiner reliability (ICC) of metric data of aspect II and III was primarily 'excellent'. It may be concluded that the newly developed classification could be applied as an appropriate and reproducible method to define defect extension in endodontically treated teeth.

Humans↗
PubMed2004

Investigation of bacterial communities associated with asymptomatic and symptomatic endodontic infections by denaturing gradient gel electrophoresis fingerprinting approach.

The purpose of the present study was to investigate the bacterial communities associated with asymptomatic and symptomatic endodontic infections and to compare denaturing gradient gel electrophoresis (DGGE) fingerprinting patterns of these two clinical conditions. The root canal microbiota of teeth associated with asymptomatic or symptomatic periradicular lesions was profiled by the PCR-DGGE method and then compared, taking into consideration the banding patterns. Bacteria were present in all examined cases. Comparative analysis of the two clinical conditions revealed bands that were common to both symptomatic and asymptomatic cases, but most DGGE bands appeared to be unique for each clinical condition. No single band occurred in all profiles. The mean number of bands detected in the 16S rDNA community profiles were 12.1 +/- 9.4 (range 2-29) for symptomatic samples and 6.7 +/- 2.7 (range 2-11) for asymptomatic ones. Clustering methods and principal component analysis of DGGE banding pattern placed the samples according to the presence or absence of symptoms. Four intense bands that were excised from the gel and sequenced showed similarities to species of the Campylobacter genus (found in 5/12 asymptomatic and in 3/11 symptomatic cases), Fusobacterium genus (4/11 symptomatic cases), Acinetobacter genus (5/12 asymptomatic cases), and Enterobacteriaceae family (11/12 asymptomatic and 2/11 symptomatic cases). The profiles of the predominant bacterial community appeared to be unique for each individual. These findings confirm that endodontic infections are polymicrobial and showed that there are significant differences in the predominant bacterial composition between asymptomatic and symptomatic cases.

Acinetobacter↗
PubMed2005

Virulence, phenotype and genotype characteristics of endodontic Enterococcus spp.

BACKGROUND/AIMS: Enterococci have been implicated in persistent root canal infections but their role in the infection process remains unclear. This study investigated the virulence, phenotype and genotype of 33 endodontic enterococcal isolates. METHODS: Phenotypic tests were conducted for antibiotic resistance, clumping response to pheromone, and production of gelatinase, hemolysin and bacteriocin. Genotype analysis involved polymerase chain reaction amplification of virulence determinants encoding aggregation substances asa and asa373, cytolysin activator cylA, gelatinase gelE, gelatinase-negative phenotype ef1841/fsrC, adherence factors esp and ace, and endocarditis antigen efaA. Physical DNA characterization involved pulsed-field gel electrophoresis of genomic DNA, and plasmid analysis. RESULTS: Potential virulence traits expressed included production of gelatinase by Enterococcus faecalis (n=23), and response to pheromones in E. faecalis culture filtrate (n=16). Fourteen strains produced bacteriocin. Five strains were resistant to tetracycline and one to gentamicin, whereas all were susceptible to ampicillin, benzylpenicillin, chloramphenicol, erythromycin, fusidic acid, kanamycin, rifampin, streptomycin and vancomycin. Polymerase chain reaction products encoding efaA, ace, and asa were detected in all isolates; esp was detected in 20 isolates, cylA in six isolates, but asa373 was never detected. The gelatinase gene (gelE) was detected in all isolates of E. faecalis (n=31) but not in Enterococcus faecium (n=2); a 23.9 kb deletion sequence corresponding to the gelatinase-negative phenotype was detected in six of the eight E. faecalis isolates that did not produce gelatinase. Pulsed-field gel electrophoresis and plasmid analyses revealed genetic polymorphism with clonal types evident. Plasmid DNA was detected in 25 strains, with up to four plasmids per strain and a similar (5.1 kb) plasmid occurring in 16 isolates. CONCLUSIONS: Phenotypic and genotypic evidence of potential virulence factors were identified in endodontic Enterococcus spp., specifically production of gelatinase and response to pheromones.

Adult↗
PubMed2005

Microarrays complement culture methods for identification of bacteria in endodontic infections.

The aim of this study was to investigate the microbial composition of necrotic root canals using culture methods and microarray technology. Twenty uniradicular teeth with radiographic evidence of periapical bone loss and with no previous endodontic treatment were selected for this study. For molecular diagnosis a DNA chip with 20 different species-specific, 16S-rDNA-directed catcher probes was used. The microorganisms most frequently detected by the DNA chip were: Micromonas micros, Fusobacterium nucleatum ssp., Tannerella forsythia, Treponema denticola, Veillonella parvula, Eubacterium nodatum, Porphyromonas gingivalis, Actinomyces odontolyticus, and Streptococcus constellatus. As expected, additional important bacterial taxa were found by culture analysis, but microorganisms such as T. forsythia and T. denticola could not be identified. In conclusion, microarrays may provide significant additional information regarding the endodontic microbiota by detecting bacterial species that are otherwise difficult or impossible to culture.

Adult↗
PubMed2006

Antimicrobial susceptibility and molecular analysis of Enterococcus faecalis originating from endodontic infections in Finland and Lithuania.

BACKGROUND/AIMS: Enterococcus faecalis strains with multiple antibiotic resistances can cause infections that are difficult to treat. The microbial flora in treatment-resistant apical periodontitis is dominated by E. faecalis, and is a potential source of infections at other sites. MATERIAL AND METHODS: Sensitivities to a range of antibiotics were determined for 59 endodontic E. faecalis isolates from Finland and Lithuania. The DNA sequence of the gene responsible for the species' intrinsic quinupristin-dalfopristin resistance, lsa, was determined from two isolates with diminished resistance. Four pairs of isolates from the same root canal were typed by pulsed-field gel electrophoresis. RESULTS: A high prevalence of resistance to rifampicin was found, whereas all isolates were susceptible or showed intermediate susceptibility to penicillin and ampicillin and four isolates were unusually susceptible to cefotaxime. No vancomycin or high-level gentamicin resistance was detected. Nine of 59 isolates were susceptible to quinupristin-dalfopristin. A fully quinupristin-dalfopristin-susceptible isolate also susceptible to clindamycin produced a truncated Lsa polypeptide, and an isolate with borderline quinupristin-dalfopristin-susceptibility had mutations proximal to the predicted ribosomal binding site. Pulsed-field gel electrophoresis showed that the same root canal could harbor two different strains of E. faecalis during the course of the same infection. CONCLUSION: Despite the differing antibiotic usage in Finland and Lithuania, E. faecalis from endodontic infections in these countries showed similar susceptibility patterns with levels of resistance considered typical for the species, and decreased resistance to clindamycin and quinupristin-dalfopristin as well as lesions in the lsa gene which were similar to those described in other clinical isolates.

ATP-Binding Cassette Transporters↗
PubMed2005

Species-directed 16S rRNA gene nested PCR detection of Olsenella species in association with endodontic diseases.

AIMS: To investigate the occurrence of Olsenella uli and Olsenella profusa in samples taken from infections of endodontic origin using a devised 16S RNA gene-based nested PCR protocol. METHODS AND RESULTS: DNA extracted from clinical samples was initially amplified using universal 16S rRNA gene primers followed by a second round of amplification using the first PCR products to detect a specific fragment of either O. uli or O. profusa 16S rRNA gene. Olsenella uli was detected in 27% of samples from teeth with asymptomatic periradicular lesions and in 20% of pus samples taken from symptomatic (abscess) lesions. Olsenella profusa was detected in 7% of asymptomatic teeth and in 13% of symptomatic teeth. A new Olsenella phylotype was also detected. CONCLUSIONS: Olsenella species can take part in the microbiota associated with infections of the root canal of human teeth and a role in the pathogenesis of periradicular diseases is suspected. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study demonstrates that molecular genetic methods keep expanding the list of candidate endodontic pathogens to include Olsenella species.

Actinobacteria↗
PubMed1994

The prosthodontic management of endodontically treated teeth: a literature review. Part I. Success and failure data, treatment concepts.

Part I of this three-part literature review discusses the incidence of endodontic treatment required after prosthodontic procedures, whether crowns are needed on endodontically treated teeth, the primary purpose of posts, the causes of post and core failure, root fracture incidence data, and post design considerations. Pertinent questions are addressed based on the past 25 years of dental literature.

Crowns↗
PubMed1993

Black-pigmented gram-negative anaerobes in endodontic infections.

Necrotic dental root canal infections are polymicrobial infections dominated by anaerobic bacteria. The number of different species in one canal is usually low, approx. 4-7 species. The species isolated most frequently belong to the genera Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus, Eubacterium and Streptococcus. The frequency of isolation of black-pigmented Gram-negative anaerobes in endodontic infections varies from 25% to > 50%. Pr. intermedia is the most commonly found pigmented species, followed by Pr. denticola and two Porphyromonas species, P. gingivalis and P. endodontalis. Several studies have shown that P. gingivalis and P. endodontalis are closely related to the presence of acute symptoms in endodontic infections, whereas other black-pigmented Gram-negative anaerobes are not. However, several other species may also be involved in acute infections. Moreover, Porphyromonas species have occasionally been isolated from cases with no symptoms. Although Porphyromonas spp. are clearly related to symptoms at the beginning of therapy, they are not important for the prognosis of the treatment.

Bacteroidaceae↗
PubMed1997

The influence of endodontic treatment upon periodontal wound healing.

The interrelationship between periodontal and endodontic disease has aroused much speculation, confusion, and controversy. Pulpal and periodontal problems are responsible for more than 50% of tooth mortality today. Diagnosis is often difficult since these diseases have been studied primarily as separate entities. The toxic substances of the pulp may initiate periodontal defects through canal ramifications and patent dentinal tubules, thus impairing wound healing in regenerative procedures. Although no studies exist addressing the direct effect of pulpal infection on the outcome of guided tissue regeneration (GTR) procedures, several studies do indicate that pulpal status may play a significant role toward the end results of GTR. This review article discusses the potential influence of endodontic treatment on the long-term outcomes of GTR. Potential pathways between the pulp and periodontal ligament, which may be responsible for the failure of the regeneration of new periodontal attachment apparatus, are explored. Examination and review of the clinical and research findings in the literature relating to perio-endo lesions are made to demonstrate that a negative influence may exist between GTR outcomes and the status of the pulp.

Bacterial Infections↗
PubMed1983

Application of statistical decision theory to radiographic diagnosis of endodontically treated teeth.

The presence or absence of periapical radiolucencies, after a predetermined healing period, have been used as a criteria for therapeutic success or failure in endodontic treatment. However, in radiologic diagnosis it has been shown that variations within and between examiners are substantial. In the present study six endodontists evaluated the periapical tissues in radiographs of 119 endodontically treated roots using a five-graded rating scale. An earlier study on the same radiograph material served as reference and "true" states of the periapical tissues were established. True positive and false positive reports on the presence of periapical lesions could then be calculated. For each observer it was noticed that a higher true positive percentage always was coupled with a higher false positive percentage and vice versa. If pairs of true positive and false positive percentages were plotted on a two-dimensional graph they corresponded well to a Receiver Operating Characteristic (ROC) curve. Variations between the observers could be explained by their adoption of different criteria of periapical disease resulting in different positions on the ROC curve. Influence of observer variation on reported frequencies of periapical lesions was greater, the lower the prevalence of the disease. The best opportunities for revealing relative differences in disease prevalences was created when the examiner defined a strict criterion for disease and reported a positive finding only when absolutely certain.

Decision Theory↗
PubMed1988

Endodontic retreatment decision making among a group of general practitioners.

Large interindividual variations have been demonstrated when dentists suggest clinical management of endodontically treated teeth. Since variations also have been shown in radiographic diagnosis of the periapical tissues, a hypothesis was tested that explains variation in treatment as a function of variation in diagnosis. Fifty-four general practitioners suggested diagnosis and management of 32 endodontically treated roots. Spearman's rank correlation coefficient reached 0.298 when the examiners were definitely sure of the presence of a periapical lesion, and 0.356 when probable lesions also were included. Conclusively, the hypothesis seemed to have a limited value in explaining why dentists carry out retreatment. Instead a multi-aspect approach to this problem is suggested.

Attitude of Health Personnel↗
PubMed1992

Recent development in endodontic research.

In essence, endodontics as a clinical discipline is concerned with the prevention and treatment of pulpal and periapical infection. In recent research the infective process has been investigated as well as the mechanisms by which the pulp and periodontium deal with microbial insults. With regard to the pulp, findings on the hemodynamics of pulpitis suggest that the inflammatory response in this tissue is much less influenced by the special anatomic environment of the tooth than was previously believed. Pulpal diseases are being underdiagnosed, mostly because of inadequate examination methods. Laser Doppler flowmetry which gives a vascular rather than a nervous response may gain importance in pulpal diagnostics in the future. It is established that apical periodontitis with bone resorption cannot develop in the absence of bacteria in the root canal system. Root canal infection is characterized by a wide variety of combinations of relatively few anaerobic bacteria, and bacterial synergism plays an important role in maintaining the infection. Microbial invasion of an apical granuloma may take place. Non-oral and environmental organisms like Pseudomonas aeruginosa are frequently isolated from treatment-resistant cases. Success of endodontic treatment depends on the reduction or elimination of the infecting bacteria. This may predictably be obtained after a thorough chemo-mechanical instrumentation and disinfection of the root canal with calcium hydroxide. The standardized technique which entails the preparation of a cylindrical apical box with removal of significant amounts of dentin near the root apex predictably gives a clean canal. This technique has provided excellent clinical and radiographic results in well documented follow-up studies.

Dental Pulp Diseases↗
PubMedDate not supplied

Electrophoresis of whole-cell soluble proteins of microorganisms isolated from bacteremias in endodontic therapy.

We have previously demonstrated that anaerobic bacteria are the microorganisms most frequently isolated from blood following endodontic therapy of teeth with apical periodontitis. Phenotypic characterisation of the isolates suggested that the bacteria in the blood originated from the root canal. The present experiment using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was carried out in an effort to verify these findings, and to further study the microorganisms involved in endodontic bacteremias. Soluble cellular proteins were extracted from 11 reference strains and 26 bacterial isolates recovered from the root canal and blood. These included Propionibacterium acnes, Peptostreptococcus prevotii, Fusobacterium nucleatum, Prevotella intermedia. Actinomyces israelii, Streptococcus intermedius, Streptococcus sanguis. The electrophoretic patterns mostly confirmed the identity of the isolates as determined by the biochemical and antimicrobial resistance tests. Furthermore, with this typing method the species Prevotella intermedia and Prevotella nigrescens could be differentiated. These species had been recovered from both root canal and blood. Also, differences between subspecies of Fusobacterium nucleatum became evident with SDS-PAGE, and the results indicated that the organism recovered from the root canal and blood was Fusobacterium nucleatum subsp. vincentii. The electrophoretic patterns of the different organisms isolated from the root canal and the blood were similar, providing further evidence that the bacteria found in the blood originated from the root canal.

Bacteremia↗
PubMed1990

Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules.

The effect of endodontic irrigants and dressings was tested on bacteria in bovine dentin specimens experimentally infected with Enterococcus faecalis, Streptococcus sanguis, Escherichia coli, or Pseudomonas aeruginosa. Standardized, cylindrical dentin test pieces were prepared and cleaned by ultrasonic treatment with EDTA and sodium hypochlorite. The specimens were infected with the test organism for periods up to 14 days, and the degree of infection into the tubules was monitored using Brown & Brenn stain, scanning electron microscopy, and culturing of dentin dust from sequential bur samples starting from the pulpal side. E. faecalis rapidly infected the whole length of the tubules; S. sanguis required up to 2 weeks for complete infection; E. coli only penetrated to some 600 microns, even after prolonged incubation periods. P. aeruginosa infected dentin quickly, but apparently in very low numbers. E. faecalis persisted for at least 10 d after withdrawal of nutrient support, whereas the other 3 organisms died within 4 to 48 h. Endodontic medicaments were applied to infected specimen for comparison of antibacterial potency. Camphorated p-monochlorophenol was generally more efficient than Calasept, and of the irrigants tested, iodine potassium iodide appeared more potent than sodium hypochlorite or chlorhexidine. The presence of a smear layer delayed, but did not eliminate, the effect of the medicaments.

Animals↗
PubMed1991

Delayed endodontic and prosthetic treatment of two traumatized incisors.

This case report describes the delayed endodontic and prosthetic treatment of two maxillary central incisors in a 16-year-old patient. Both teeth had been traumatized eight years previously. The examination revealed arrested root formation with wide open apices, periapical inflammation and inflammatory resorption. Endodontic treatment with calcium hydroxide led to formation of hard tissue barriers in both teeth so that definite obturation could be performed. One tooth was lost due to a deep crown-root-fracture and replaced by an intraosseous implant, whereas the other incisor was retained for nearly four years.

Adolescent↗