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21st century endodontics. Part 5.

This series of papers has attempted to present the latest principles in root canal treatment. It is hoped that by comparing the techniques described with their own clinical procedures, the reader will have considered whether changes may be appropriate. These may have been immediate, for example introducing an EDTA solution as an additional irrigant, or more long-term, perhaps by planning to attend hands-on courses to perfect a new procedure before using it in vivo. Professor Dick Walker, an excellent and eminent endodontist, once said that he would not even think of doing something to a patient that he had not done at least twenty times, (and probably more), on an extracted tooth. Wise words indeed! Unfortunately even with practice and persistence, problems may arise during or after root canal treatment. The focus of this paper is on some of the more common problems that may be encountered and how endodontic treatment failures may be addressed.

Dental Instruments↗

Upregulation of intercellular adhesion molecule 1 and proinflammatory cytokines by the major surface proteins of Treponema maltophilum and Treponema lecithinolyticum, the phylogenetic group IV oral spirochetes associated with periodontitis and endodontic infections.

Treponema maltophilum and Treponema lecithinolyticum belong to the group IV oral spirochetes and are associated with endodontic infections, as well as periodontitis. Recently, the genes encoding the major surface proteins (Msps) of these bacteria (MspA and MspTL, respectively) were cloned and sequenced. The amino acid sequences of these proteins showed significant similarity. In this study we analyzed the functional role of these homologous proteins in human monocytic THP-1 cells and primary cultured periodontal ligament (PDL) cells using recombinant proteins. The complete genes encoding MspA and MspTL without the signal sequence were cloned into Escherichia coli by using the expression vector pQE-30. Fusion proteins tagged with N-terminal hexahistidine (recombinant MspA [rMspA] and rMspTL) were obtained, and any possible contamination of the recombinant proteins with E. coli endotoxin was removed by using polymyxin B-agarose. Flow cytometry showed that rMspA and rMspTL upregulated the expression of intercellular adhesion molecule 1 (ICAM-1) in both THP-1 and PDL cells. Expression of proinflammatory cytokines, such as interleukin-6 (IL-6) and IL-8, was also induced significantly in both cell types by the Msps, as determined by reverse transcription-PCR and an enzyme-linked immunosorbent assay, whereas IL-1beta synthesis could be detected only in the THP-1 cells. The upregulation of ICAM-1, IL-6, and IL-8 was completely inhibited by pretreating the cells with an NF-kappaB activation inhibitor, l-1-tosylamido-2-phenylethyl chloromethyl ketone. This suggests involvement of NF-kappaB activation. The increased ICAM-1 and IL-8 expression in the THP-1 cells obtained with rMsps was not inhibited in the presence of the IL-1 receptor antagonist (IL-1ra), a natural inhibitor of IL-1. Our results show that the Msps of the group IV oral spirochetes may play an important role in amplifying the local immune response by continuous inflammatory cell recruitment and retention at an infection site by stimulation of expression of ICAM-1 and proinflammatory cytokines.

Cell Line↗

Evaluation of universal probes and primer sets for assessing total bacterial load in clinical samples: general implications and practical use in endodontic antimicrobial therapy.

By re-examining 10 previously published "universal" PCR assays using the ARB phylogenetic software package and database with 41,000 16S rRNA gene sequences, we found that they differed considerably in their coverage of the domain Bacteria. We evaluated the broadest-range real-time quantitative PCR protocol for its efficacy in measuring the antimicrobial effects of endodontic treatments.

Adult↗

Surgical endodontics in dogs: a review.

Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage--a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst--a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez--cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwigs epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.

Animals↗

[Statistical study of endodontically treated teeth by undergraduate students from 1979 to 1989].

In clinical education in dentistry, it is very important and significant that the undergraduate students themselves treat the patients. According to the rapid progress of dental science, the complexity and the high degree of the quality of education increase more and more, so that it is a requisite to make our efforts to enrich the quality of the practice at all times. In this paper, we investigated and statistically analyzed the result of 3,359 cases (test cases: 304, general cases: 3,055) which were treated endodontically by the undergraduate students of Tokyo Medical and Dental University in the four classes of 1979, 1982, 1986 and 1989. Both the number of the treated cases and the patients decreased year by year. Only the patients above sixty years old showed a tendency to increase in number. The result of the test cases was not always representative of the result of the general cases. If the clinical instructors for the undergraduate students grasp the detailed results of this study, we can expect that they can guide and train the undergraduate students more effectively.

Adult↗

Survey of undergraduate endodontic curricula.

A survey of undergraduate endodontic curricula in 67 United States and Canadian schools has been carried out. The response rate was 82%, with 2 of the 53 responses being incomplete. The major findings were as follows: 1. There was an extremely wide range in curriculum hours, but the average number of clock hours (46 hours) for the preclinical lecture and laboratory period compared favorably with the minimum recommended in 1965.' 2. The average of about six teeth treated during the clinical period also compared favorably with the minimum recommended in 1965.' 3. The average time required for each clinical case (11 hours per tooth) might suggest a critical reevaluation of teaching methods and philosophy.

Canada↗

Restoring teeth that are endodontically treated through existing crowns. Part I: Survey of pulpal status on access.

OBJECTIVE: The purpose of this study was to identify the pulpal findings encountered by practitioners when accessing complete-coverage crowns that require nonsurgical root canal treatment and the relevance of coronal leakage to the success of the RTC. METHOD AND MATERIALS: The survey package consisted of a cover letter stating the instructions, rationale, and purpose for the questionnaire, a questionnaire with 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists) was selected. Collected data were analyzed with the chi-square test. RESULTS: A 60% response rate was obtained. Statistically significant differences were found among the practitioner groups, depending on the question. General practitioners and endodontists obtain access through crowns and maintain these crowns as final restoration significantly more often than do prosthodontists. Practitioners responded that teeth with complete crowns require nonsurgical root canal treatment after 5 to 10 years. CONCLUSION: Respondents believe that leakage must be addressed when endodontic access cavities in artificial crowns are restored after nonsurgical root canal treatment. General practitioners perform nonsurgical root canal treatment more frequently than do prosthodontists. Practitioners indicated that when teeth with complete crowns require nonsurgical root canal treatment, treatment is most often performed 5 to 10 years after placement of the crown.

Attitude of Health Personnel↗

Restoring teeth that are endodontically treated through existing crowns. Part II: Survey of restorative materials commonly used.

OBJECTIVE: A survey was undertaken to categorize the materials used for the restoration of endodontic access openings through complete-coverage crowns after completion of nonsurgical root canal treatment. METHOD AND MATERIALS: The survey package consisted of a cover letter stating instructions, rationale, and purpose for the questionnaire, a questionnaire of 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists), was selected. Collected data were analyzed with the chi-square analysis. RESULTS: Most general practitioners (93%), endodontists (61%), and prosthodontists (75%) reported that they frequently or always permanently restore teeth after nonsurgical root canal treatment. Empress was the all-ceramic system used most commonly by prosthodontists (42%) and general practitioners (38%). A statistically significant difference in restorative material preference was found (P < 0.0001), depending on the type of crown used. CONCLUSION: Amalgam alone and in combination with bonding agents are materials of choice for restoration of access openings through all-metal complete crowns, while resin composite is the choice for all types of complete crowns involving porcelain. Endodontists preferred "other" materials.

Aluminum Silicates↗

[Endodontics of the 19th century].

The first steps of Endodontics, and specially those of the 19th century, are hardly known with unpublished and profitable to technical efforts for present specialty. We begin here a series of historic notes about the subject, hoping to know some further information to be provided by other colleagues verses in this matter.

Endodontics↗

Microscopes in endodontics.

The introduction of microscopes in clinical and surgical endodontics is fairly recent. Potential applications, including removal of fractured instruments, localizing calcified canals, soft tissue management and root-end procedures, are reviewed.

Apicoectomy↗

A multimedia patient simulation for teaching and assessing endodontic diagnosis.

Teaching and assessing diagnostic skills are difficult due to relatively small numbers of total clinical experiences and a shortage of clinical faculty. Patient simulations could help teach and assess diagnosis by displaying a well-defined diagnostic task, then providing informative feedback and opportunities for repetition and correction of errors. This report describes the development and initial evaluation of SimEndo I, a multimedia patient simulation program that could be used for teaching or assessing endodontic diagnosis. Students interact with a graphical interface that has four pull-down menus and related submenus. In response to student requests, the program presents patient information. Scoring is based on diagnosis of each case by endodontists. Pilot testing with seventy-four junior dental students identified numerous needed improvements to the user interface program. A multi-school field test of the interface program using three patient cases addressed three research questions: 1) How did the field test students evaluate SimEndo I? Overall mean evaluation was 8.1 on a 0 to 10 scale; 2) How many cases are needed to generate a reproducible diagnostic proficiency score for an individual student using the Rimoldi scoring procedure? Mean diagnostic proficiency scores by case ranged from .27 to .40 on a 0 to 1 scale; five cases would produce a score with a 0.80 reliability coefficient; and 3) Did students accurately diagnose each case? Mean correct diagnosis scores by case ranged from .54 to .78 on a 0 to 1 scale. We conclude that multimedia patient simulations offer a promising alternative for teaching and assessing student diagnostic skills.

Clinical Competence↗

[Approach to pulpal and pulpo-periodontal lesions of the temporary teeth using therapeutic endodontics].

The anatomical and physiological properties of deciduous teeth make them susceptible to caries and inflammatory and infectious complications. This specificity, the proximity of the germ of the underlaying permanent tooth, and the relation of the last one to the deciduous tooth, make delicate its conservation by endodontal therapeutics after a pulpal or pulpo-periodontal affection. The success of this attempt is related to a good case-selection, based on the general condition of the child, his and his parents motivation, the condition of cariogenicity of the mouth, the analysis of the unity deciduous tooth/germ of the underlaying permanent tooth, the follow-up of the case. A success spares young children extraction of the deciduous teeth before the physiological period of permutation.

Child↗

Release of hydroxyl ions from calcium hydroxide preparations used in endodontic treatment.

PURPOSE: The purpose of our study was to compare the in vitro release of hydroxyl ions from several calcium hydroxide preparations used in endodontic treatment. MATERIAL AND METHODS: Equal quantities of the materials--nonsetting (pure calcium hydroxide, Biopulp, Calcicure), setting--canal sealers (Sealapex, Apexit) and points were placed in dialysis tubes which were then immersed in deionized water. The release of hydroxyl ions from the preparations was measured by the median pH of the deionized water used for dialysis, by means of a pH-meter. The results of our study were analyzed by means of Tukey's reasonable correlation. Significance difference (one-way variance analysis ANOVA) and Pearson's linear correlation coefficient (r2). RESULTS: Nonsetting preparations of calcium hydroxide have a significantly higher capability of hydroxyl ions release in comparison with sealers and points, irrespective of time (p < 0.05). Sealapex and "plus" points released hydroxyl ions to a much greater extent than both Apexit and "regular" points at most periods of the experiment (p < 0.05). Apexit released significantly more of hydroxyl ions than "regular" points, and Sealapex more than "plus" points in the later periods of the experiment (p < 0.05). The pH values of dialysis samples of all materials correlated positively with time and the pH. Almost all materials reached a maximum on the 8-th day of the experiment. CONCLUSIONS: To achieve maximum concentration of hydroxyl ions in tissues: for temporary root fillings nonsetting preparations of calcium hydroxide should be chosen rather than points and they should be placed for at least one week, for permanent root fillings it is more recommended to use Sealapex than Apexit as a sealer.

Calcium Hydroxide↗

[A study of the related factors and prophylactic measures of endodontic interappointment emergencies].

OBJECTIVE: To estimate the related factors and prophylactic measures of endodontic interappointment emergencies (EIE). METHODS: The clinical cases were divided into three groups. Cases in the routine group were treated according to the routine procedures of root canal therapy. Cases in the medicament group took dexamethasone tablets after the instrumentation. Root canals in the drainage group were prepared at the first visit and had been left open for two or three days. The related factors were recorded. The incidences and flare-up index (FUI) value of EIE were statistically analyzed. RESULTS: The EIE incidence of the routine group was 19.1%. The EIE incidence and FUI value of the overinstrumented teeth were significantly higher than those of other teeth (P < 0.05). EIE were not significantly related to the age, gender, tooth location and pathosis of the pulpal and periapical tissue (P > 0.05). The FUI value of the medicament group was significantly lower than that of the routine group (P < 0.05). Less severe EIE occurred in the cases of the drainage group than those of the control group (P > 0.05). CONCLUSION: The occurrence of EIE was significantly related to overinstrumentation. Taking dexamethasone may relieve EIE.

Dexamethasone↗

[Experimental substantiation of parameters and strength characteristics of new endodontic-endoosseous implant construction].

Postoperative tooth stump is not able to endure usual functional loads adequately that leads to enhanced resorption of bone tissues surrounding root and loss of the tooth. Based on math computer simulation of mode of deformation of biomechanical model "metal-ceramic construction--endodontic-endoosseous implant (EEI)--stump of operated tooth--bone tissue of the jaw" new domestic EEI parameters were elaborated which improved greatly biomechanical properties of tooth with operated roots. Strength characteristics of new EEI were studied. A set of instruments for EEI was developed.

Biomechanical Phenomena↗

[New technologies and ways of endodontic-endoossal implantation improving].

There were developed, tested and used in practice new transdental implants (TDI) considerably widening the indications to endodontic-endoossal implantation. Universal TDI has a number of advantages over the known analogs and meant for osseointegration and fibro-osseointegration. The implant provides full tooth fixation in small bone volume, on maxilla including.

Adolescent↗

Interdisciplinary approach to endodontic therapy for uncooperative children in a dental school environment.

The aim of this study was to describe an interdisciplinary approach for endodontic therapy of behavior-challenging children and to report the efficacy of sedation techniques for these procedures. Sedation records of thirty-two patients who received root canal treatment were reviewed. Age at treatment in months, gender, year of treatment, tooth type, status of root maturation (open or closed apex), etiological factor(s), sedation protocol, and outcome were the variables analyzed. The collected information was entered into a computerized flowchart and the data analyzed using descriptive statistics. Midazolam in combination with meperidine or hydroxyzine were the most common protocols used (46 percent and 40 percent of the cases, respectively). Only two (6 percent) treatments were aborted due to uncontrolled behavior during sedation. We conclude that cooperation between pediatric dentists and endodontists is fundamental to achieving success when providing root canal treatment for uncooperative child patients.

Anesthesia, Dental↗