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Membrane barriers used in conjunction with periodontal surgery have promoted regeneration of lost marginal attachment. Membrane barriers also may be indicated during surgical endodontics, in selected cases, where primary apical lesions are complicated by the loss of marginal attachment. The indications for using guided tissue regeneration in endodontic surgery are discussed and two cases are presented.
When a periapical lesion communicates with a deep periodontal pocket, the etiology can be either endodontic or periodontal. This article clarifies the relationship between pulpal and periodontal disease and presents a systematic approach to the diagnosis and management of endodontic-periodontal lesions. It also presents a case that demonstrates the successful treatment of teeth that appear to be hopelessly diseased.
Patient's perceived problems related to endodontically treated teeth are an important consideration for all dental practitioners. Chronic pain or restorative problems may occur that are not reported back to the attending dentist in a timely manner and thus may not be resolved. The authors conducted a study involving a one-year follow-up of endodontically treated patients. They offer suggestions for interventions that could minimize the reported problems.
For many decades, investigators have conducted studies of the interrelationship between endodontics and periodontics. This review article examines previously held concepts regarding the endodontic-periodontal continuum in light of new research and explores promising advances in understanding etiology and in diagnosis and treatment.
BACKGROUND: Mineral trioxide aggregate, or MTA, is a new material developed for endodontics that appears to be a significant improvement over other materials for procedures in bone. It is the first restorative material that consistently allows for the overgrowth of cementum, and it may facilitate the regeneration of the periodontal ligament. CASE DESCRIPTION: The authors present five cases in which MTA was used to manage clinical problems. These included vertical root fracture, apexification, perforation repair and repair of a resorptive defect. In each case, MTA allowed bone healing and elimination of clinical symptoms. CLINICAL IMPLICATIONS: Materials such as zinc oxide-eugenol cement and resin composite have been used in the past to repair root defects, but their use resulted in the formation of fibrous connective tissue adjacent to the bone. Because it allows the overgrowth of cementum and periodontal ligament, MTA may be an ideal material for certain endodontic procedures.
BACKGROUND: Endosseous root-formed implants occasionally fail to osseointegrate. Causes of failure include infection, overheating of the bone, habitual smoking, systemic disease, transmucosal overloading, excessive surgical trauma and implant placement adjacent to teeth demonstrating periapical pathology. CASE DESCRIPTION: In this article, the authors present another possible cause of implant failure. The cases of four patients who received endosseous root-formed implants are discussed. Each patient demonstrated signs of infection after initial implant placement. The common factor in each failing implant was its placement adjacent to an asymptomatic endodontically treated tooth with no clinical or radiographic evidence of pathology. CLINICAL IMPLICATIONS: These patients demonstrate the importance of evaluating and possibly retreating or extracting adjacent endodontically treated teeth before placing implants.
BACKGROUND: The authors evaluated the fracture resistance of endodontically treated teeth filled with either gutta-percha or a new resin-based obturation material. METHODS: The authors prepared and randomly divided 80 single-canal extracted teeth into five groups: lateral and vertical condensation with gutta-percha, lateral and vertical condensation with the new resin-based obturation material, and a control group with no filling material. The specimens were stored in 100 percent humidity for two weeks, mounted in polyester resin and loaded to failure. RESULTS: The authors found statistically significant differences among the experimental groups (P < .05). The groups with the new material displayed higher mean fracture loads and the gutta-percha groups lower mean fracture load values than the control unfilled group. However, the differences were not significant. The groups with the new material displayed significantly higher mean fracture loads than gutta-percha groups independent of the filling technique used. CONCLUSIONS: Filling the canals with the new resin-based obturation material increased the in vitro resistance to fracture of endodontically treated single-canal extracted teeth when compared with standard gutta-percha techniques. CLINICAL IMPLICATIONS; If other properties of the new resin-based obturation material compare favorably with those of gutta-percha for filling the root canal, it should be considered as a replacement for gutta-percha, as the results of this study indicate that it could provide enhanced resistance to tooth fracture.
This study evaluated in vitro the antimicrobial activity of rough extracts from leaves of Arctium lappa and their phases. The following microorganisms, commonly found in the oral cavity, specifically in endodontic infections, were used: Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis and Candida albicans. The agar-diffusion method allowed detection of the hexanic phase as an inhibitor of microbial growth. Bioautographic assays identified antimicrobial substances in the extract. The results showed the existence, in the rough hexanic phase and in its fractions, of constituents that have retention factors (Rf) in three distinct zones, thereby suggesting the presence of active constituents with chemical structures of different polarities that exhibited specificity against the target microorganisms. It may be concluded that the Arctium lappa constituents exhibited a great microbial inhibition potential against the tested endodontic pathogens.
This article presents the procedures that must be considered for periapical cyst repair after nonsurgical endodontic treatment. The case of a periapical cyst associated to the left maxillary lateral incisor is reported. Nonsurgical root canal therapy was performed and lesion healing was confirmed radiographically after 24 months. Differential diagnosis, endodontic infection control, apical foramen enlargement and filling of the cystic cavity with a calcium hydroxide paste were important procedures for case resolution.
The aim of this study was to evaluate the incidence of postoperative pain and the type of periapical repair, after one-appointment endodontic treatment in asymptomatic patients who presented with pulpal necrosis and radiographically visible chronic periapical lesions. For that, after biomechanical preparation through the step down followed by the step back technique, aided by copious irrigation with 5.0% sodium hypochlorite solution, the filling of the root canals was carried out through the conventional technique, with gutta-percha cones and zinc oxide-eugenol cement. In the immediate postoperative period, 16.6% of all patients presented with spontaneous pain, although the incidence of severe pain--flare-ups--was 3.3%. After twelve months, all patients were asymptomatic and free of fistula, nevertheless only 46.4% exhibited complete resolution of the radiolucent periapical areas. Therefore, in a medium term, the one-appointment endodontic treatment showed 100% of clinical success, but showed a reduced rate of radiographic success.
The endodontium and periodontium are closely related and disease of one may lead to secondary disease in the other. The differential diagnosis of endodontic and periodontal disease is of vital importance, so that the appropriate treatment can be done. Microorganisms play a primary role in endodontic and periodontal infections. The magnitude of the host response will be directly proportional to the virulence and the number of microbial cells present. Tissue damage caused by bacteria is mediated by either direct or indirect mechanisms. Direct harmful effects caused by bacteria involve their products, such as enzymes (collagenase, hyaluronidase, condroitinase, acid phosphatase), exotoxins and metabolites (bytrate, propionate, ammonium polyamines, sulphured compounds). In addition, bacterial components such as peptidoglycan, teichoic acid, fimbriae, outer membrane proteins, capsule, and lypopolysaccharide, stimulate the development of host immune reaction capable of causing severe tissue destruction.
The aim of this study was to measure in vitro the tensile bond strength of short composite posts in anterior primary teeth filled with calcium hydroxide and eugenol-based endodontic filling materials. Means of tensile strength ranged from 2.66 to 3.56 MPa. Statistical analysis (ANOVA) revealed that there were no statistically significant differences between the groups. It was concluded that the type of filling material used in the endodontic treatment did not interfere with the tensile strength.
The occurrence and surface properties of prevotella intermedia and P. nigrescens in healthy sites and in periodontic and endodontic infections were studied among 73 strains, tentatively identified as P. intermedia. Fifteen strains were from necrotic root canal infections, 41 were from periodontal samples, and 17 isolates were obtained from healthy gingival sites. Identification of isolates as either P. intermedia or P. nigrescens was based on differences in malate and glutamate dehydrogenase electrophoretic mobilities which allowed unambiguous separation of P. intermedia and P. nigrescens. The majority of strains from periodontal samples were P. intermedia (29 of 41 strains). In endodontic samples only 4 out of 15 isolates were P. intermedia, while all except 1 of 17 strains from healthy gingival sites were identified as P. nigrescens. SDS-PAGE of whole cell proteins revealed 31 and 38 kDa proteins in P. nigrescens which were not detected in P. intermedia. Surface biotinylation of cells, followed by Western blotting and detection by alkaline phosphatase conjugated extravidin, showed strong staining of the 31 kDa protein in P. nigrescens indicating that this protein is located on the surface of the cell. Corresponding staining was not seen in P. intermedia. Fimbria-like projections were observed using electron microscopy of negatively-stained cells of P. nigrescens. The results show that P. intermedia and P. nigrescens may have different site specificities and surface properties and thus emphasize the need for accurate identification of these two species for the evaluation of their role in the pathogenesis of oral infections.
PURPOSE: To determine the importance of margin design on fracture strength and pattern of endodontically-treated teeth with 0 mm of coronal tooth structure. METHODS: Using the CELAY system (MIKRONA, Switzerland), 168 human maxillary central incisors, identical in size and shape, were replicated from bovine teeth. The fracture strength and pattern of 5 types of margin design, three core materials and two levels of remaining coronal tooth structure were examined after 24 hours of water immersion (37 degrees C) under 16 conditions and 83 hours under 6 conditions without cyclic loading, as well as after 83 hours of water immersion with 300,000 cyclic loading under 6 conditions. RESULTS: In the case of cast metal post-and-cores with 0 mm of coronal tooth structure, both beveled and shouldered shoulder margin designs resulted in a higher fracture strength than chamfer and shoulder ones, achieving almost the same strength of chamfer margin design with 1 mm of coronal tooth structure. In addition, pinhole preparation on the root surface increased the fracture strength of chamfer margin design to the level of those of the above-mentioned two desirable margin designs. From a fracture pattern viewpoint, however, all margin designs were unsuitable for re-restoration of the tooth. CONCLUSIONS: Both beveled and shouldered shoulder margin designs improve fracture strength of endodontically-treated teeth with 0mm of remaining coronal tooth structure.
We experienced two cases of inferior alveolar nerve paresthesia caused by root canal medicaments, which were successfully relieved by microscopic endodontic treatment. In the first case, the paresthesia might have been attributable to infiltration of calcium hydroxide into the mandibular canal through the root canals of the mandibular left second molar tooth. In the second case, the paresthesia might have been attributable to infiltration of paraformaldehyde through the root canals of the mandibular right second molar tooth. The paresthesia was relieved in both cases by repetitive microscopic endodontic irrigation using physiological saline solution in combination with oral vitamin B12 and adenosine triphosphate.
The purpose of this study was to evaluate coronal leakage inhibition using a resin-coating technique after endodontic treatment. Thirty-six human incisors were cut at the cementoenamel junction, and endodontic obturations were performed. The specimens were randomly divided into three groups according to post space preparation (10 mm depth), resin coating, and temporization. For the resin coating, the dentin surface was coated with either a combination of Clearfil SE Bond and Protect Liner F (SE/PLF) or RZII (RZ). Then, the specimens were stored in 37 degrees C distilled water for 24 hours and placed in 1% methylene blue solution for 48 hours. After which, the specimens were sectioned faciolingually along the root canal and the length of dye penetration was measured from the cementoenamel junction. Three-way ANOVA revealed that the dye penetration scores were influenced by post space preparation, resin coating, and temporization. Resin coating with RZ significantly reduced the dye penetration score and SE/PLF completely eliminated dye penetration.
A review of the literature was done to determine when posts are required for restoring endodontically treated teeth and to give guidance on preparation of post space, design of posts, and use of luting agents. Posts were deemed to be unnecessary when adequate coronal tooth structure was present to retain a core. It was found that tooth structure should not be removed to construct a stronger post. The thinnest post with adequate strength was recommended. For best retention, it was found that post surfaces should not be smooth. When resin reinforced glass ionomer cements were used, they were found to be potentially harmful to restored teeth. Remaining coronal tooth structure was found to have the highest correlation in regard to success of the final restoration of endodontically treated teeth.
Due to their enhanced optical properties (eg, translucency, value, chroma), ceramic systems can provide natural aesthetics for restorations placed in the anterior segment. In endodontically treated teeth with stained dentin, however, the use of translucent ceramic materials may be contraindicated unless the underlying discoloration can be masked. This article describes the use of a zirconium oxide post and core system with an all-ceramic crown for the restoration of an endodontically treated anterior tooth. This contemporary system allows optical and mechanical requisites to be resolved simultaneously.