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PubMed2002

Microleakage of resected MTA.

Forty-six single rooted extracted human teeth were used in this study. After cleaning and shaping, twenty canals were randomly selected for obturation with MTA placed in an orthograde manor (Group 1). Another twenty roots were obturated with gutta-percha and Kerr EWT sealer, using warm vertical compaction (Group 2). The apical 3 mm of each root in both groups were resected at approximately 45 degrees to its long axis. The teeth were aged for 48 h in a humidor. The root-ends of the teeth in Group 2 were then prepared and received MTA as a root-end filling material to a depth of 3 mm. Six roots were used as positive and negative controls. The roots of all teeth were placed in contact with India ink for 48 h. The roots were split and examined for dye leakage. There was no discernible leakage in teeth with resected MTA or those with MTA placed as a retrograde root-end filling material. We found no significant difference in dye leakage between resected MTA (Group 1) and non-resected MTA (Group 2). Based on these results it appears that the resection of set MTA does not affect its sealing ability.

Aluminum Compounds↗
PubMed2003

Repair of perforating internal resorption with mineral trioxide aggregate: a case report.

A case of internal resorption with buccal perforation was found in a maxillary central incisor. Because of the extensive lesion and continuous exudation, surgical intervention was used. The apical third was obturated with gutta-percha, and the perforated lesion was repaired with mineral trioxide aggregate. The residual canal space was filled by thermoplasticized gutta-percha technique, and the coronal cavity was restored with composite resin. The symptoms and signs ceased, and the results were satisfactory at 1-year follow-up.

Adult↗
PubMed2000

The use of 3D computerized reconstruction for the study of coronal microleakage.

AIM: The purpose of this study was to evaluate a new method for studying coronal microleakage associated with root-filled teeth. METHODOLOGY: Twenty human mandibular posterior teeth were prepared chemomechanically with the stepback technique and then divided into two groups of 10 teeth each. The canals were filled using lateral condensation of gutta-percha points; Roth's 801 was used as a sealer for the first group, and Ketac-Endo for the second. After 48 h, the temporary fillings in the access cavities were removed, the roots coated with three layers of nail polish and then the teeth were exposed to artificial saliva for 40 days. Subsequently, the crowns of the teeth were placed into Indian ink for 4 days before the coating was removed and the teeth embedded in a two-phase polyester resin. Serial cross sections were taken from each specimen using a microtome, and each cross section photographed under a stereoscopic microscope. The photographs of the cross sections were digitized using an image scanner and the contours of the external surface of the teeth, the obturated root canals and the boundaries of dye penetration were followed. Finally, a three-dimensional surface representation was achieved using the triangulation method. RESULTS: Although the sample size and the experimental methods were not designed to form valid groups, the results showed that all roots obturated with Ketac-Endo sealer had dye microleakage, whilst only three teeth of the Roth's 801 group had dye microleakage. CONCLUSIONS: The 3D reconstruction of dye microleakage proved to be an interesting method and a useful tool for the evaluation of coronal microleakage when using different types of root canal sealers.

Bicuspid↗
PubMed2003

Diagnostic accuracy of endoscopy in periradicular surgery - a comparison with scanning electron microscopy.

AIM: To compare the accuracy of endoscopic diagnostics with the scanning electron microscope (SEM) in evaluating elements of periradicular surgery. METHODOLOGY: The material consisted of 22 extracted human molars, which were subjected to the following treatments: orthograde root-canal obturation, root-end resection and root-end cavity preparation with diamond-coated sonic microtips. After each step, the cut root face was inspected with an endoscope, and subsequently, the roots were duplicated for SEM evaluation. Endoscope findings were compared to those obtained with SEM serving as the 'gold standard' with a blinded observer. The presence of the following structures was assessed including specificity and sensitivity: isthmuses, accessory canals, obturation gaps, microfractures and chipping of cavity margins. RESULTS: The specificity and sensitivity of the identification of isthmuses or accessory canals was 100% each for the endoscope compared to SEM. The sensitivity of identification of obturation gaps, crack formation or chipping ranged between 73 and 95% (except intradentine cracks with only 36% sensitivity). The specificity of the same parameters ranged between 77 and 100% for the endoscope compared to SEM. CONCLUSIONS: With the exception of intradentine cracks, the endoscope accurately identified microstructures following root-end resection and root-end preparation. The endoscope could be considered for use during intraoperative diagnostics in periradicular surgery.

Apicoectomy↗
PubMed1991

An analysis of success and failure of apicoectomies.

The radiographs from 715 patient charts were analyzed to study the effect of 11 factors on the success and failure of apicoectomies. Of these, 424 had recall radiographs of 6 months or more and were evaluated for changes in radiolucencies. The data were analyzed by cross-tabulation and chi-square analysis for significant relationships. Complete healing was found in 65% of the recall cases, while incomplete and unsatisfactory healing occurred in 29.4% and 5.6% of the cases, respectively. Complete healing was found to increase with patient age. Those over 60 yr of age had the highest percentage of complete healing. No statistical difference in healing was found between maxillary and mandibular teeth. Also, postsurgical healing associated with those teeth which were inadequately obturated with gutta-percha, silver points, or paste-filling materials did not differ significantly. No significant difference in healing was found between the teeth that were retreated nonsurgically before surgery and those that were not. Healing was independent of the placement of a retrofilling as well as the type of retrofilling period. Significantly better healing was seen with teeth that were permanently restored following surgery.

Adolescent↗
PubMed1998

The quality of ultrasonic root-end preparation: a quantitative study.

Ultrasonic root-end preparation techniques have recently been introduced and revolutionized the field of endodontic surgery. The purpose of this study was to compare quantitatively the quality of root-end preparation techniques prepared by a specially designed ultrasonic retrotip with those prepared in a traditional manner by a microhandpiece bur. Twenty roots with two canals and an isthmus from extracted maxillary human molars were selected for this study. After instrumentation, obturation, and root-end resection, root-end preparations were made using either an ultrasonic retrotip or a conventional microhandpiece bur. With the aid of the image processing and analysis system, the specimens were inspected under a stereomicroscope for further evaluation of the quality of the shape and size of preparation. The results of this investigation showed that the ultrasonic root-end preparations produced more conservative and less perforated cavities than those made with conventional microhandpiece bur preparations.

Evaluation Studies as Topic↗
PubMed1997

Excisional wound healing following the use of IRM as a root-end filling material.

Intermediate Restorative Material (IRM) has been advocated as a root-end filling material based primarily on reports of clinical success and various leakage studies. The objectives of this study were to determine the excisional wound healing responses of the periradicular tissues to IRM root-end filling material and to compare this with the wound healing responses to amalgam and orthograde gutta-percha root-end filling materials. Mandibular premolars in dogs were obturated, root-ends resected, and the healing responses associated with root-end fillings of IRM, amalgam, and orthograde gutta-percha were evaluated microscopically and radiographically at postsurgical intervals of 10 and 45 days. The excisional wound healing responses associated with IRM root-end fillings were normal at both postsurgical intervals. There was no evidence of inhibition of dentoalveolar or osseous wound healing associated with IRM, amalgam, or orthograde gutta-percha. Statistical analysis showed no difference in wound healing between the 3 root-end filling materials.

Alveolar Process↗
PubMed1998

Nonsurgical root canal therapy treatment with apparent indications for root-end surgery.

The recent introduction of the surgical microscope to the practice of endodontics, especially for surgery, has allowed clearer visualization of the periapex during root-end resection and filling. However, despite this and other technologic advances, it has not been demonstrated that in the absence of thorough canal debridement the success rate of periapical surgery has improved over the 50% to 60% demonstrated in most long-term prognosis studies. Therefore it remains important to fully instrument and obturate the root canal system with conventional therapy before surgery is considered; this considerably improves the long-term prognosis. Each of the case reports in this article involves a situation in which conventional treatment was performed when a surgical approach might have been considered as the treatment of choice. Surgery should not be considered to be the primary treatment when root canal treatment or retreatment may be readily achieved. Indeed, the operating microscope and other technical aids will probably allow more cases to be treated and retreated conventionally that might otherwise have required surgical intervention.

Adolescent↗
PubMed2006

Intentional replantation of a mandibular molar: case report and 14-year follow-up.

This case report describes the nonsurgical endodontic treatment and intentional replantation of a mandibular molar and its nearly 14-year follow-up. A 56-year-old woman sought treatment with complaint of discomfort and sensitivity in the mandibular left area. The radiographic examination showed that the mandibular left first molar was endodontically treated, with over-instrumentation of the distal root and unsatisfactory obturation on the mesial root. A large periapical lesion was observed surrounding the roots. In view of the patient's limited interocclusal space and objection to undergo an apical surgery, intentional replantation was suggested as an alternative. The patient returned for clinical and radiographic follow-up at 15 days, 40 days, 6 months, 12 months, and once yearly thereafter. At the last visit, after 14 years, no painful symptomatology was reported, probing depth was no greater than 3 mm, the periradicular area had normal appearance and no evidence of root resorption or periapical lesion.

Dental Restoration Failure↗
PubMed2002

Root-end fracture during retropreparation: a comparison between zirconium nitride-coated and stainless steel microsurgical ultrasonic instruments.

The purpose of this study was to evaluate a stainless steel (CT-5) and zirconium nitride coated (KiS) microsurgical ultrasonic instrument with regard to possible root-end fracture production during retropreparation. Forty extracted human central incisors were prepared in a crown-down fashion. Canals were obturated with gutta-percha by lateral condensation. Root-ends were resected. Teeth were placed in methylene blue for 48 h and evaluated by three independent evaluators under microscope. Teeth with existing fractures were eliminated from the study. The remaining teeth were randomly divided into two equal groups. Group A was prepared with the CT-5 tip and Group B with the KiS tip. Preparation time was recorded for all roots. The teeth were again immersed in methylene blue for 48 h and reevaluated. No root-end fractures were produced by either the KiS or CT-5 microsurgical ultrasonic instruments.

Apicoectomy↗
PubMed1989

Apical sealing efficacy of two reverse filling techniques versus cold-burnished Gutta-percha.

The apical seal produced by the cold-burnished gutta-percha method and two amalgam reverse filling techniques was investigated in an in vitro study using 36 extracted human single-rooted teeth. Following root canal obturation, 27 teeth were divided into three experimental groups and each group was subjected to one of the three following filling techniques: (a) cold-burnishing of gutta-percha; (b) amalgam reverse filling; and (c) amalgam reverse filling in conjunction with cavity varnish. The remaining nine teeth served as controls (4). The teeth were placed in methylene blue dye for a period of 1 wk, after which they were retrieved, washed, sectioned, and the apical dye penetration measured. The results showed that amalgam with cavity varnish demonstrated less dye penetration than the other experimental groups. The difference was statistically significant (p less than 0.0001).

Dental Amalgam↗
PubMed1993

Sealing ability of a mineral trioxide aggregate when used as a root end filling material.

This in vitro study used rhodamine B fluorescent dye and a confocal microscope to evaluate the sealing ability of amalgam, super EBA, and a mineral trioxide aggregate when used as root end filling materials. Thirty single-canal teeth were cleaned, shaped, and obturated with gutta-percha and root canal sealer. After application of nail polish to the external surface, the apical 3 mm of each root was resected and 3-mm deep root end preparations were made. The roots were randomly divided into three groups and the root end preparations filled with the experimental materials. All roots were then exposed to an aqueous solution of rhodamine B fluorescent dye for 24 h, longitudinally sectioned, and the extent of dye penetration measured using a confocal microscope. Statistical analysis showed that the mineral trioxide aggregate leaked significantly less than amalgam and super EBA.

Aluminum Compounds↗
PubMed1993

An evaluation of the effect of methylene blue dye pH on apical leakage.

The effect of varying the pH of 2% methylene blue dye on apical leakage was evaluated. Eighty-four roots of extracted human teeth were used in this study. The roots were endodontically cleaned and shaped, obturated, apically resected, and amalgam or Temporary Endodontic Restorative Material retro-fillings were placed. The roots were immersed for 7 days in dye solutions of controlled pH of 1, 2, 3, 5 or 7, or in a 2% unbuffered deionized water solution of methylene blue. The results demonstrated significantly less leakage in the pH 1 and 2 amalgam groups. All other amalgam groups and the Temporary Endodontic Restorative Material groups showed no significant differences attributable to pH. Temporary Endodontic Restorative Material retrofilling groups demonstrated statistically significantly less apical leakage at each pH evaluated than the amalgam-retrofilled groups. Additionally, a significant buffering effect of the root structure on the dye solutions was measured.

Composite Resins↗
PubMed1990

Effect of apical resections and reverse fillings on Thermafil root canal obturations.

This in vitro dye leakage study examined the influence of apical root resection and reverse amalgam fillings on the apical seal of root canals obturated with Thermafil. Fifty human canine teeth were instrumented and obturated with either laterally condensed gutta-percha or Thermafil using Roth's zinc oxide-eugenol Type I regular sealer. After 24 h, one of the following additional procedures was performed on 30 of the teeth: 2-mm apical resection, 4-mm apical resection, and 2-mm apical resection plus reverse amalgam filling 2 mm in depth and diameter. The external root surfaces were coated with enamel paint and the teeth were exposed to 1% methylene blue dye at 37 degrees C for 2 wk. The roots were split longitudinally and the depth of linear dye penetration was measured through a stereozoom microscope. Statistical analysis showed no significant differences in the linear dye penetration among the various groups of teeth.

Analysis of Variance↗
PubMed2000

Leakage of amalgam, composite, and Super-EBA, compared with a new retrofill material: bone cement.

An in vitro leakage study was conducted to compare the root-end sealing ability of amalgam with cavity varnish, composite with dentin bonding agent, and Super-EBA with a new retrofill material: bone cement. Eighty single-rooted teeth were instrumented and obturated with gutta percha, resected and retroprepared. The teeth were then randomly divided into 4 groups of 20, with each group receiving one of the previously mentioned retrofill materials. The bone cement group was either etched or unetched. The teeth were immersed in silver nitrate and developer for leakage assessment. The teeth were grooved and split longitudinally to measure leakage. Statistical analysis showed that amalgam leaked significantly less than Super-EBA and unetched bone cement; composite leaked significantly less than Super-EBA. Amalgam was not statistically different from composite or etched bone cement. No significant difference between composite and both bone cements was noted, nor between both bone cements and Super-EBA.

Bone Cements↗
PubMed1994

Evaluation of the bond strength of dentin bonding agents used to seal resected root apices.

A number of improved dentin bonding agents have recently become available, but have not been evaluated on apical radicular dentin. The purpose of this study was to compare the tensile bond strengths of four adhesive resins on resected root ends before and after blood contamination. Forty single-rooted human incisors were cleaned and shaped and obturated. The apical 3 mm was then resected at a 45-degree angle, bonded, and tested for tensile bond strengths using an Instron machine. The bonding systems evaluated included Prisma Universal Bond 3, Scotchbond MultiPurpose Dental Adhesive, Amalgambond, and All Bond 2. All bonding systems were then covered with Prisma APH light-cure composite resin. Results indicated that the bond strengths of the blood contaminated groups were significantly less than those of the control groups, except in the case of Amalgambond where no significant difference was noted. When the surface was contaminated with blood, Prisma Universal Bond 3 had significantly lower bond strengths, whereas Amalgambond had significantly higher bond strengths than the other subgroups.

Analysis of Variance↗
PubMed1994

A comparison between two root end preparation techniques in human cadavers.

The purpose of this study was to compare ultrasonic and bur root end cavity preparations with regard to retention, cleanliness, and root canal parallelism. Twenty anterior teeth from human cadavers were instrumented and obturated with gutta-percha and sealer. After raising a full-thickness flap, the apices of the roots were exposed and beveled at a 45-degree angle. Half of the apical cavities were prepared with an appropriate sized Carr alloy tip energized by an Amadent Ultrasonic unit. The other half was prepared with an inverted cone bur in a slow-speed handpiece. The teeth were then extracted, sectioned longitudinally, photographed, and scanning electron micrographs examined. The ultrasonic cavities produced more parallel walls and deeper depths for retention. In addition, the ultrasonic tips followed the direction of the canals more closely than those prepared by burs. Scanning electron microscopic examination of the cavity wall showed presence of cleaner surfaces of root end cavities prepared by ultrasonic tips than those made with burs.

Apicoectomy↗
PubMedDate not supplied

The complete endodontic obturation of an avulsed immature permanent incisor with mineral trioxide aggregate: a case report.

The use of mineral trioxide aggregate (MTA) for complete endodontic obturation of an immature maxillary central incisor is reported. The injured tooth of a 9-year-old male was avulsed secondary to a sports-related traumatic event. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful, as evidenced by radiographic signs of external inflammatory root resorption in the middle to cervical thirds of the root. Calcium hydroxide apexification over a 1-year period promoted cessation of the resorptive process, but was unable to adequately form an apical root canal barrier. Due to the extent of external resorption and the lack of an apical stop, a novel endodontic treatment using mineral trioxide aggregate was utilized. At 865 days post-injury, the tooth remained asymptomatic with clinical and radiographic evidence of periodontal health.

Aluminum Compounds↗