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PubMed1996

Endodontic disease: development and treatment.

Endodontic disease requires the involvement of micro-organisms. Microbial contamination of the pulp-dentine complex occurs in a number of different ways. The loss of integrity of teeth and the penetration of the pulp-dentine complex by a mixed microbial flora characterises the disease processes which can lead to pulpal and periradicular inflammation and infection. Endodontology is that part of dental science which deals with the biology of the pulp-dentine complex in health and disease, an understanding of which is a prerequisite to the provision of sound conservative care. The principles of endodontic treatment require the control of micro-organisms and potential nutrients by the microbial decontamination of teeth, the denaturing of protein and the sealing of dentine to prevent recolonisation.

Dental Pulp Diseases↗
PubMed1998

Long-term prognosis of intentional endodontics and internal bleaching of tetracycline-stained teeth.

A total of 112 severely tetracycline-stained teeth in 20 patients were treated by endodontics and nonthermal internal bleaching. All teeth were healthy, intact, and had no history of trauma. The patients were monitored for 5 to 15 years. Excellent, permanent esthetic results were obtained with no side effects. The quality of endodontic treatment and lingual access restoration were important factors in the longevity of the bleaching results.

Adult↗
PubMed1999

Post removal techniques used in nonsurgical endodontic retreatment.

Removal of posts from root canals is often a tedious and difficult procedure. Factors such as type of post, cement used, interradicular relation of post to canal walls and accessibility of post affects the eventual success. It is necessary, therefore, for the clinician to evaluate his or her ability to remove posts when contemplating retreating endodontic cases. This paper discusses and evaluates a new technique and instruments used to facilitate post removal in nonsurgical endodontics.

Dental Cements↗
PubMed1997

Endodontic interappointment emergencies in a Singapore private practice setting: a retrospective study of incidence and cause-related factors.

One thousand and sixteen consecutive records of patients treated by the author for endodontic treatment was surveyed for the incidence of endodontic interappointment emergencies (EIE) and the major factors contributing to it. The overall incidence of EIE was 3.15% and unrelated to the patients' sex or tooth location. Caucasians were more likely to experience flare-ups than Chinese (p < 0.01). Patients < 20 years and > 60 years were less likely to experience EIE (p < 0.05). EIE was significantly higher in necrotic teeth than in vital teeth (p < 0.01). A clinical diagnosis of necrotic pulp with acute apical abcess (NP/AAA) increased the incidence of flare-ups significantly (p < 0.05). Retreatment cases also had a higher incidence of EIE and this was statistically significant (p < 0.01). The possibility of EIE was the highest after the first visit (p < 0.01) and this was reduced significantly with subsequent visits.

Adult↗
PubMed1999

Restoration of endodontically treated teeth with posts and cores.

This article is a review of the current technique and materials used in the restoration of endodontically treated teeth with post and core materials and procedures. It is intended to aid clinicians in making selections which are appropriate to their individual practices through the evaluation of relevant literature about the restoration of endodontically treated teeth.

Dental Prosthesis Design↗
PubMedDate not supplied

Endodontic working length determination--where does it end?

Obtaining a correct working length is critical to the success of endodontic therapy. Failure to identify this crucial measurement can result in untoward treatment outcomes, which may include increased patient discomfort, possible infection or cyst development, and extrusion or intra-canal medication into the periradicular tissue. This article reviews the classical and current terminology, philosophies, and techniques that are used at present to determine endodontic working length accurately, and describes their clinical application. Recent clinical advances such as the electronic apex locator, direct digital radiography, and the surgical operating microscope also are discussed.

Adult↗
PubMed2000

Effect of endodontic sealers on dowels luted with resin cement.

PURPOSE: This study evaluated the retention of prefabricated parallel-sided dowels luted with resin cement in extracted teeth that were obturated with gutta percha using a eugenol sealer or a calcium hydroxide sealer. MATERIALS AND METHODS: Extracted maxillary incisor roots (N = 51) were instrumented to simulate conventional root canal therapy and divided into 3 groups (n = 17). One group was not obturated. Second and third groups were obturated with gutta percha using a eugenol-containing or calcium hydroxide-containing sealer. Gutta percha was removed using a heated plugger, and dowel spaces were prepared to a 7 mm depth. Dowel space walls were acid etched and primed, and prefabricated stainless steel dowels were luted using resin cement. After 24 hours, the load required to dislodge each dowel along a path parallel to its long axis was measured and recorded. A one-way analysis of variance (alpha = 0.05) was performed to identify differences in the means among groups. The incidence of failure within the cement or at the dentin-cement interface was also recorded. RESULTS: No statistically significant difference was found among the control (159.9 +/- 96.3 N), eugenol sealer (153.1 +/- 77.3 N), and calcium hydroxide sealer (192.0 +/- 89.3 N) groups. Nearly all specimens displayed adhesive failure at the dentin-resin cement interface. CONCLUSIONS: Conventional endodontic obturation using a eugenol-containing or a calcium hydroxide-containing endodontic sealer did not affect retention of prefabricated stainless steel dowels luted with resin cement.

Acid Etching, Dental↗
PubMed2000

Restoration of endodontically treated tooth containing wide or flared canal.

There has been much anecdotal information and misinformation disseminated regarding the restoration of endodontically treated teeth, which has comprised the foundation for our restorative protocol. In the past, it was considered appropriate to place a cast post and core in every pulpless tooth without regard to the amount of remaining supportive tooth structure present. Recent developments in available ceramics, greater cosmetic demands by patients, and the advent of adhesive bonding techniques have caused clinicians to reevaluate their restorative protocol. This article reviews the current literature with regard to restoration of the endodontically treated tooth and presents a method for restoration and reinforcement using a combination of polyethylene ribbon and a prefabricated fiber post to create a post and core that is retentive, supportive, cosmetic and able to impart reinforcement to a structurally compromised root.

Composite Resins↗
PubMed2000

Restoration of endodontically treated teeth with carbon fibre posts--a prospective study.

BACKGROUND: A prospective study was started in 1995 to evaluate the success of carbon fibre reinforced epoxy resin (CFRR) posts used to restore endodontically treated teeth. All the teeth in the study had lost more than 50% of their coronal structure. METHODS: Fifty-nine carbon fibre Composiposts cemented with Metabond and built up with Core Paste cores were placed into the teeth of 47 patients. Each tooth received a full-coverage restoration (porcelain fused to metal crown) and was followed for 6.7-45.4 months (average = 28.0 months, standard deviation = 10.7). RESULTS: Results for 52 teeth in 42 patients were analyzed. There were no fractures. The overall failure rate was 7.7% and the cumulative survival rate was 89.6% at the end of the follow-up period. The only statistically significant finding (p = 0.04) was that posts in lower premolars were at higher risk of failure. CONCLUSION: CFRR posts are among the most predictable systems available today. CFRR posts in the upper anterior teeth are associated with a higher success rate and longer life than those placed in premolars, especially lower premolars. This study contributes to the growing body of evidence that supports the use of CFRR posts in the restoration of endodontically treated teeth.

Adult↗
PubMed2001

Endodontic retreatment. Aspects of decision making and clinical outcome.

Epidemiological surveys have reported that 25%-35% of root filled teeth are associated with periapical radiolucencies. Descriptive studies have demonstrated that clinicians' decision making regarding such teeth are subject to substantial variation. A coherent model to explain the observed variation has not been produced. In the present thesis a "Praxis Concept theory" was proposed. The theory suggests that dentists perceive periapical lesions of varying sizes as different stages on a continuous health scale. Interindividual variations can then be regarded as the result of the choice of different cut-off points on the continuum for prescribing retreatment. In the present study experiments among novice and expert decision makers gave evidence in favour of the theory. Data also suggested that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of original treatment. From a prescriptive point of view, the presence of a persistent periapical radiolucency has often been used as a criterion of endodontic "failure" and as an indication for endodontic retreatment. As an alternative decision strategy, the use of decision analysis has been proposed. Logical display of decision alternatives, values of probabilities, utility values (U-values) of the different outcomes and calculation of optimal decision strategy are features of this theory. The implementation of this approach is impeded by the uncertainty of outcome probabilities and lack of investigations concerning U-values. U-values of two periapical health states in root filled teeth (with and without a periapical lesion respectively) were investigated in a group of 82 dental students and among 16 Swedish endodontists. Two methods were used to elicit U-values: Standard gamble and Visual Analogue Scale. Large interindividual variation for both health states were recorded. The difference in U-values between the two health states was found to be statistically significant regardless of assessment method. Compared with Standard gamble Visual Analogue Scale systematically produced lower ratings. U-values were found to change considerably in both the short and long-term. Any significant correlation between endodontists' U-values and retreatment prescriptions could not be demonstrated. Surgical and nonsurgical retreatment were randomly assigned to 95 "failed" root filled teeth in 92 patients. Cases were followed clinically and radiographically for four years postoperatively. At the 12-month recall a statistically significant higher healing rate was observed for teeth retreated surgically. At the final 48-month recall no systematic difference was detected. Patients were found to be more subject to postoperative discomfort when teeth were retreated surgically compared with nonsurgically. Consequently, surgical retreatment tended to be associated with higher indirect costs than a nonsurgically approach. In the final part of the thesis it is argued that retreatment decision making in everyday clinical practice normally should be based on simple principles. It is suggested that in order to achieve the best overall consequence a periapical lesion in a root filled tooth that is not expected to heal should be retreated. Arguments to withhold retreatment should be based on (i) respect for patient autonomy, (ii) retreatment risks or (iii) retreatment costs.

Decision Making↗
PubMed2000

[The use of glass ionomer cements in endodontics].

Glass ionomer cements are currently used in endodontic therapy for sealing root canals (orthogradely and retrogradely), for sealing and restoring the pulp chamber, for repairing perforations and root resorption defects, and, rarely, for treating vertically fractured teeth. The successful use of these cements is the result of their particular characteristics: a chemical bond to dentin, which enhances the seal of the root canal and the reinforcement of the tooth; a good biocompatibility in the periradicular area and a fluoride release without loss of strength of the material. The fluoride release imparts an antimicrobial effect to combat root canal infection and attributes to bone mineralization after surgery. The present paper reviews the literature regarding the various applications of glass ionomer cements in present-day endodontics.

Dental Leakage↗
PubMed2000

Removal of fiber posts from endodontically treated teeth.

The removal of posts from endodontically treated teeth can be a major obstacle in the retreatment of teeth that have recurrent pathology, often leading to extraction of a tooth that could have been saved with endodontic retreatment. The use of a fiber post offers the advantages of a suitable elastic modulus and good bonding between post and cement, but also the advantage of easy removal, if so indicated by clinical findings. A special removal kit for fiber posts has been developed, and its use is illustrated, and described. The removal procedure can be completed in a very short time, usually less than 5 min. The tooth can then be restored with the same type and size of fiber post as was in the tooth prior to removal. Removal kits are found to be for single use only.

Carbon↗
PubMed2001

Uses of ultrasonic instrumentation in endodontics.

Ultrasonic instrumentation has added a new horizon to endodontic treatment possibilities. It is a tool in the arsenal of instruments currently used by almost every endodontist in the United States. The use of ultrasonic instrumentation was formerly confined solely to periodontics, but has slowly come to be an indispensable tool in endodontics as well.

Dental Pulp Cavity↗
PubMedDate not supplied

Survival rate and fracture strength of endodontically treated maxillary incisors with moderate defects restored with different post-and-core systems: an in vitro study.

PURPOSE: This study compares the survival rate and fracture strength of endodontically treated maxillary incisors with moderate coronal defects restored with different post-and-core systems after exposure to an artificial mouth. MATERIALS AND METHODS: Sixty-four caries-free human maxillary central incisors were selected for standardized size and quality, endodontically treated, and decoronated 2 mm coronal to the cementoenamel junction. Group 1 was restored with titanium posts and composite cores, group 2 received zirconia posts and a composite core, and in group 3 zirconia posts with a heat-pressed ceramic core were used. Teeth restored with cast posts and cores served as controls. All teeth were prepared and restored with complete cast crowns. All samples were exposed to 1.2 million cycles in a computer-controlled chewing simulator with simultaneous thermocycling. In addition, the samples were loaded until fracture in a static testing device. RESULTS: The survival rates of the different groups were: 94% for titanium/composite, 63% for zirconia/composite, 100% for the all-ceramic post and core, and 94% for the cast post and core. The following mean fracture strengths were obtained: titanium/composite = 425 +/- 155 N, zirconia/composite = 202 +/- 212 N, zirconia/ceramic = 378 +/- 64 N, cast post and core = 426 +/- 178 N. The lower fracture load in the group with zirconia posts and composite cores was statistically significant. The use of zirconia posts resulted in fewer oblique root fractures. CONCLUSION: Prefabricated titanium posts with composite cores, zirconia posts with heat-pressed ceramic cores, and cast posts and cores yield comparable survival rates and fracture strengths for the restoration of crowned maxillary incisors with moderate coronal defects. Survival rates and fracture strengths for zirconia posts with composite cores are significantly lower, so this combination cannot be recommended for clinical use.

Cementation↗
PubMed2001

Endodontics in the 21st century: the rotary revolution.

Endodontic therapy is becoming an increasingly routine facet of general dental practice. Advances in technology and techniques have made endodontics in the contemporary clinical environment more pleasant and predictable for both the patient and the provider. The development of rotary instrumentation with nickel-titanium files has revolutionized the cleaning and shaping aspects of treatment. A sequenced model is discussed that has been shown to have encouraging outcomes in both predoctoral and continuing education experiences. The protocol may use more instruments than some other approaches, but has evolved as a technique that provides reliable and predictable outcomes.

Dental Instruments↗
PubMed2002

[Short term evaluation of 24 cases of endodontic retreatment].

This study shows and evaluates the quality of the new root canal filling and periapical healing about 24 cases of endodontic retreatment, equivalent of 7.76% of endodontic treatments done at the clinic. The main consultation purposes were pain (54.17%) and pre-prosthetic control (40.90%) on these patients. 75% of teeth were treated in a single session attempt to 45 minutes. The root canal filling is performed in 91.65% of cases, with the safe apical limit reached in 88.13% and 94.11% per apical healing toward a short term results.

Adult↗
PubMedDate not supplied

Modern endodontic therapy for an incompletely developed tooth.

An important goal of modern dentistry is to preserve a functional, esthetic, and pain-free dentition. If irreversible pulp pathology occurs in an immature permanent tooth from traumatic or carious exposure, normal apical maturation may be interrupted. Conventional endodontic obturation techniques, if necessary, will be difficult and may not be adequate in such a tooth. The endodontic techniques of apexogenesis and apexification have been successful in achieving adequate root development and apical construction. These conventional techniques and materials are reviewed along with a promising material called mineral trioxide aggregate.

Aluminum Compounds↗
PubMed2000

Endodontic perforation repair with resin-ionomer: a case report.

Root perforations are significant complications of endodontic treatment. However, when teeth are of strategic value, perforation repair is clearly indicated. The successful utilization and placement of a subgingival resin-ionomer restoration to repair an endodontic root perforation is demonstrated. Sustained tissue health and minimal probing depths at the surgical site demonstrate clinical success.

Adult↗