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Biomechanical considerations in restoring endodontically treated teeth.

Various concepts for dental treatment have been established without appropriate documentation, such as restoration of endodontically treated teeth. Some researchers and dentists strongly recommend including a post with the restoration to strengthen the root. Other studies have indicated that posts may substantially weaken the roots and should be avoided. An additional approach suggested that the post did not improve the resistance to fracture during occlusion and did not support the restoration. Biomechanical problems are analyzed, and a recommended clinical approach is presented.

Biomechanical Phenomena↗

Endodontic emergency dilemma: leave tooth open or keep it closed?

Various methods of emergency endodontic treatment for teeth with vital pulps have been suggested, and some authors have advised that the access be left open if the tooth is tender to percussion. This study evaluated 225 open and closed teeth which were referred after emergency treatment where pulps had been vital. When the access had been left open, a statistically significant greater number of appointments were needed to complete treatment and more intratreatment exacerbations occurred than when the tooth was kept sealed.

Dental Pulp Exposure↗

The microbiologic approach in endodontics.

The results of an investigation of the microbiologic flora of gangrenous teeth are presented. The rationale of the concept of the microbiologic approach is discussed. A possible explanation for the small differences in the success of endodontically treated teeth obturated after positive and negative bacteriologic cultures is suggested.

Abscess↗

In vivo study of temporary filling materials used in endodontics in anterior teeth.

The sealing efficacy of temporary endodontic filling materials was tested in vivo. The following materials were studied: Cavit, Caviton, gutta-percha, three types of zinc phosphate cement, and zinc oxide and eugenol. All the materials were tested in the access cavity of the same anterior tooth in ten different patients for a minimum of 1 week. Seepage was determined bacteriologically by culturing a cotton pellet which was sealed into the access cavity. On the basis of the quantity of microorganisms grown anaerobically, differentiation was made between no leakage, minor leakage, and gross leakage. Findings with Cavit and Caviton are essentially the same and show no or minor leakage in the vast majority of tests. Gutta-percha showed gross leakage in six out of eight tests. Phosphate cements showed no leakage in more than two thirds of the tests.

Bacteria↗

Endodontic morphology. III. Canal preparation.

Three hundred nine root canals in 164 extracted human teeth were prepared with endodontic instruments for obturation by the lateral condensation technique. Variations in tooth lengths for each group of teeth were marked, pointing up the need for adequate control of instruments through careful assessment of tooth lengths in clinical practice. In most cases the canals were prepared to the desired depth and flared coronally with the assistance of chelates. Some instrument failures were noted, along with the tendency for files to force debris in an apical direction during instrumentation.

Dental Cavity Preparation↗

Preservation of rat liver tissue by endodontic therapeutic agents.

The preservation action of seven endodontic therapeutic agents has been tested on rat liver tissue. Such agents can be divided into three catagories: formaldehyde-containing, parachlorophenol-containing, and miscellaneous compounds. Besides their bactericidal and fungicidal effects, they also have a fixative action on tissue components. Because of this double action, they are called preservatives. In this series of experiments 25 percent formalin in 80 percent ethanol gave the best combination of bactericidal, fungicidal, and fixation properties.

Animals↗

Submergence of roots for alveolar bone preservation. I. Endodontically treated roots.

Mandibular premolars in four dogs were endodontically treated and then totally submerged. Histologic and radiographic findings showed that this procedure should be considered as an alternative to extraction of key teeth in an effort to preserve alveolar bone. 1. Periodic follow-up on this procedure should be done to rule out cystic formation. 2. Beveling the coronal portion to the buccal is advocated to compensate for the thin buccal plate. 3. The procedure should be done in two steps to allow the root canal sealer to set, or an amalgam should be placed over the pulp canal. 4. New cementum and connective tissue will form over the coronal surface separating the dentin from new bone.

Alveolar Process↗

The rheologic properties of endodontic sealers.

The rheologic properties of seven endodontic sealers were investigated with a rotational viscometer. The effects of time and rate of shear on the measured viscosities were determined. Results indicated that one material exhibited Newtonian behavior, whereas the others were characterized by pseudoplasticity.

Dental Cements↗

Effect of immediate dowel space preparation on the apical seal of endodontically filled teeth.

The purpose of this study was to investigate in vitro the effect of using hot endodonic pluggers for immediate dowel space preparation on the apical seal of endodontically treated teeth filled by a chloropercha technique. The results demonstrated that, when the coronal half of the root canal filling material was removed immediately after placement with pluggers, there was a loss of the apical seal and leakage in thirteen of twenty teeth. There was also leakage in thirteen of twenty teeth in which dowel spaces were not prepared. This study did not demonstrate a significant difference statistically in loss of apical seal and leakage between teeth prepared with and those without immediate dowel space preparations with pluggers using a chloropercha filling technique. Immediate preparation of the dowel spaces had no effect on the apical seal. The chloropercha technique by itself showed evidence of very high leakage when used to fill the root canal.

Chloroform↗

Response of periapical pathosis to endodontic treatment in monkeys.

Response of induced periapical lesions in monkeys to a conventional endodontic technique was investigated at varying periods ranging from 15 to 365 days after treatment. The findings indicate that response to treatment is influenced by the extent of the root canal filling, the time lapse between treatment and death, and the presence or absence of bacteria in the apical portion of the canal.

Animals↗

Evaluation of 5,000 endodontic treatments: incidence of the opened tooth.

Five thousand endodontic cases treated by three endodontists were reviewed to determine the frequency of the need to leave teeth opened for drainage. The subsequent treatment of these teeth is described. Of the 5,000 cases reviewed, 518 were left open at some point during treatment. Two hundred and eighty-one cases (54.2 percent) remained closed after the first closure. Four hundred and twenty-six (82.2 percent) of the cases opened were eventually completed without surgical intervention. The need to prescribe antibiotics and perform a trephination is also stated.

Alveolar Process↗

Hard-tissue resorption and deposition after endodontic instrumentation.

Hard-tissue resorption and deposition following endodontic instrumentation were studied histologically in forty-one monkey teeth after 2, 7, and 42 days. No medicaments and no root canal filling materials were used. The number and length of lacunae and areas of resorption of the root canal wall, the root surface, and the lamina dura were counted and measured. Resorption, stimulated by instrumentation, was observed after 7 days at all sites. Resorption was slight at the root canal wall and at the root surface and was significantly more severe than normal osteoclastic replacement in the adjacent lamina dura. After 42 days the reaction had subsided at the three sites, but none of the tissue had returned to normal. Inflammatory reaction due to infection of the root canal appeared to enhance resorption after 42 days at the root canal wall and the lamina dura, but this was not observed at the root surface.

Alveolar Process↗

Comparison of endodontic measurement controls using a paralleling technique with a grid and a conventional measurement.

Pretreatment radiographs were taken using a paralleling device and measurement grid. The measurement controls obtained in that manner in 60 teeth were compared to measurements obtained from conventional radiographs taken during endodontic treatment. This study was undertaken to test the proposal that pretreatment radiographs taken with a paralleling device and measurement grid would make further radiographs for that purpose unnecessary, thus reducing patients' exposure to ionizing radiation.

Dental Pulp Cavity↗

Quantitative bacteriology of endodontic infections.

A technique is described for obtaining quantitative cultures of endodontic specimens. Paper point samplings were placed in a diluted salt solution, vortexed, and then cultured quantitatively using serial dilutions plated onto multiple media. Specimen weight was determined by weighing the point before and after specimen collection. This method was used in 10 nonvital teeth and showed a mean concentration of 10(7.7) bacteria per gram of sample. Nine specimens yielded a mixed aerobic-anaerobic flora, and there was an average of five different bacterial species per specimen in concentrations exceeding 10(5)/gm.

Anaerobiosis↗

Effect of temperature on collagen-dissolving ability of sodium hypochlorite endodontic irrigant.

The collagen-dissolving ability of both 2.6% and 5.2% sodium hypochlorite endodontic irrigating solutions was compared at room temperature (21 degrees C) and body temperature (37 degrees C). The 2.6% sodium hypochlorite solution at a temperature of 37 degrees C. was found to be equally effective as a collagen-dissolving agent when compared to 5.2% sodium hypochlorite at either 21 degrees C. or 37 degrees C.

Animals↗