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Dens invaginatus of a maxillary lateral incisor: endodontic treatment.

A right maxillary central incisor and an adjacent lateral incisor with a dens invaginatus were identified as requiring endodontic treatment. Both teeth were treated by nonsurgical means. Thirteen months postoperatively the central incisor showed evidence of periapical resolution, whereas the lateral incisor did not. The lateral incisor was then treated with apical curettage, an apicoectomy, and retrograde amalgam filling. One year after the surgical procedure the periapical tissues of both the lateral and central incisors exhibited satisfactory resolution. This case demonstrates that certain cases of dens invaginatus can be successfully treated only with a surgical approach.

Adult↗

A clarification on endodontic flare-ups.

In an article on endodontic flare-ups by Robert J. Matusow, our research and publications are discussed. Since we found what we consider to be distortions and misinterpretations of our work, it was decided to clarify the apparent discrepancies found in Matusow's article.

Acute Disease↗

Analysis of positive cultures from endodontically treated teeth: a retrospective study.

A study of 12,150 endodontically treated teeth from 11,797 patients in a private patient setup revealed an incidence of 10.2% positive cultures obtained just before obturation of the root canal. Streptococcal predominance was reflected by a presence of nearly 60% in the pure culture and nearly 98% in the mixed cultures. No significant changes in microbial predominance or bacterial sensitivities were detected over the 7-year period of study. Ampicillin, cephalothin, erythromycin, and penicillin were the most effective antibiotics against the viridans streptococci, the most prevalent organism in the infected teeth.

Adolescent↗

Scanning electron microscope study on the action of endodontic irrigants on bacteria invading the dentinal tubules.

Three groups of 10 maxillary anterior teeth each, which had been exposed to oral media, were flushed with 9 ml of tap water, physiologic saline solution, and alternating irrigation with NaOCl and hydrogen peroxide respectively. Residual caries, necrotic tissue remnants, intertubular cavitation, and dentinal tubule invasion by bacteria were searched for by means of the scanning electron microscope. Cuboidal sodium chloride crystals were very frequently found deposited in the main root canal, in lateral canals, and inside the dentinal tubules. This study discusses the important role NaOCl may play as a solvent of dental plaque and necrotic tissue remnants in the clinical endodontic treatment of infected teeth that had been exposed to oral media.

Adolescent↗

Tissue reaction to endodontic materials: methods, criteria, assessment, and observations.

The purpose of this study was to develop methods and criteria for the testing of the biocompatibility of endodontic materials. One hundred twenty-one teeth from 12 baboons (Papio anubis) were used to test three sealers: AH26, Kerr pulp canal sealer, and Kloroperka N.O. Gutta-percha cones were used as solid core in all cases. Under disinfected conditions, access preparation was performed, and with working length approximately 1.0 mm short of the foramen, the instrumentation of the root canal was started, using sodium hypochlorite (1%) for irrigation. After the root canals were cleaned and shaped, they were obturated with gutta-percha cones and the sealer, and by lateral condensation technique. Histologic periapical reactions were evaluated at 1, 7, 30, 365, 730, and 1095 days. The methods and criteria used were adequate for ranking of the biocompatibility of the tested materials in the short and long periods. At short observation periods (1 to 7 days) AH26 caused severe reactions, and Kerr pulp canal sealer and Kloroperka N.O., moderate and mild reactions, respectively. At 2- and 3-year observation periods the ranking was AH26, mild; Kerr pulp canal sealer, moderate; and Kloropercha N.O., severe.

Animals↗

Complications in the use of sodium hypochlorite during endodontic treatment. Report of three cases.

In endodontic treatment, solutions of sodium hypochlorite are widely used as an irrigating agent. It is an effective solvent of both necrotic and vital tissues, which makes it toxic to the surrounding tissues. Complications are rarely reported. Nevertheless, the acute symptoms caused by the toxic reaction must not be underestimated. Causes, treatment, and prevention of complications of sodium hypochlorite use are discussed, and three case reports are presented.

Adult↗

Healing of periapical radiolucencies after nonsurgical endodontic therapy.

Eighty-nine periapical radiolucencies treated by nonsurgical endodontic therapy were evaluated to better understand the healing rates of these lesions. After at least 3 months after treatment, radiographs revealed that 46.1% of the lesions had resolved, 48.3% had undergone partial resolution, 2.2% were unchanged, and 3.4% were larger. The average radiographic rate of repair was 3.2 mm2/mo. Less than 6 months after treatment, 17.6% of lesions demonstrated complete radiographic resolution, whereas 70.6% showed radiographic resolution at 12 months or longer.

Adult↗

Referred pain of muscular origin resembling endodontic involvement. Case report.

Referred pain is common in the orofacial region and can cause considerable difficulties in diagnosis. Referred pain is defined as pain that is referred to a part of the body other than the site of origin, and as a result, severe pain may arise without an associated causative lesion. A muscular trigger point that resembled a tooth with endodontic involvement is discussed.

Adolescent↗

Localization of anatomic structures before endodontic surgery with tomograms. Report of a case.

Tomograms taken before endodontic surgery can demonstrate the location of root apices relative to adjacent anatomic structures. This buccolingual perspective is not depicted on conventional periapical or panoramic radiographs. Accurate length determination from the root apex to the inferior alveolar canal is simplified, and the relationship of root surfaces to the buccal and lingual plates is well visualized on the tomographic images.

Adult↗

Mutagenicity of endodontic sealers.

Four endodontic sealer materials and some of their chemical constituents were subjected to Ames' test for mutagenicity with the Salmonella/microsome assay. Extracts of two zinc oxide-eugenol based materials and of one gutta-percha-zinc oxide-chloroform based sealer were negative in the test. Extracts of a synthetic polymer material, based on epoxy-bis-phenol A, induced mutations in Salmonella typhimurium TA 100 as did extracts of the epoxy-bis-phenol A resin alone. Formaldehyde, an active ingredient from one of the ZnO-based materials, induced mutations in both Salmonella typhimurium TA 98 and TA 100. The mutagenic activity of formaldehyde as well as of the epoxy material was reduced in the presence of rat liver microsomes.

Administration, Topical↗

Electrochemical study of endodontic silver cones used in root canal therapy.

In previous studies it was observed that endodontic silver cones placed in fine canals became dislodged as a result of corrosion. To investigate the corrosion of high purity silver, potentiostatic and potentiodynamic electrochemical techniques were used. Triangular potential sweeps made in physiological solutions and human plasma showed similar potential-current relationships. However, in human plasma, peak currents were lower and peak potentials were more anodic than those observed in the physiological solutions. The electron microprobe analysis and the EDAX of the film formed in the biological fluids revealed the presence of silver and chloride and a certain amount of carbon. The addition of small quantities of Na2S to the physiological solutions favoured metal dissolution and promoted the formation of a mixed film of AgCL and Ag2S. According to these results chloride and sulphide anions seem to be particularly aggressive towards the metal surface in implanted silver cones. Precautions to avoid direct contact of the cones with saliva and tissue fluids must be taken. Fractures and discontinuities present in the cement considerably increase the corrosion risks.

Electrochemistry↗

Early post-operative endodontic therapy limits inflammatory root resorption of autotransplanted maxillary canine teeth.

This study has provided information concerning the limitation of inflammatory root resorption of autotransplanted maxillary canine teeth. It has been shown that early post-operative endodontic therapy significantly decreases the occurrence of inflammatory root resorption (P less than 0.001) but does not change the prevalence of replacement root resorption. It is argued that by limiting inflammatory resorption the prognosis for autotransplanted teeth is considerably improved.

Adolescent↗

Influence of casting procedure on silver-palladium endodontic posts.

Silver-palladium alloys have been endorsed on clinical grounds as substitutes for gold alloys in posts and cores. However, carbon absorption during heating and casting can adversely affect the mechanical properties of silver-palladium alloys. In this study the tensile characteristics of endodontic posts cast in silver-palladium alloy using either a graphite or a ceramic crucible were determined. Graphite crucibles were associated with a significantly lower (2P less than 0.00001) percentage elongation than were ceramic crucibles. The need for a carbon-free casting environment for silver-palladium alloys was confirmed. The configuration of the cylindrical, serrated, vented post used in these tests resulted in mechanical properties lower than those achieved with standard metallurgical test procedures.

Ceramics↗

Endodontic working width: current concepts and techniques.

Root canal morphology is a critically important part of conventional and surgical endodontics (root canal therapy). Many in vitro studies have recorded the scales and average sizes of root canals, but there have been few clinical attempts to determine the working width. In the absence of a study that defines what the original width and optimally prepared horizontal dimensions of canals are, clinicians are making treatment decision without any support of scientific evidence. This article provides definitions and perspectives on the current concepts and techniques to handle working width-the horizontal dimension of the root canal system-and its clinical implications.

Dental Pulp↗

Flexural properties of endodontic posts and human root dentin.

OBJECTIVES: To evaluate the flexural modulus and flexural strength of different types of endodontic post in comparison with human root dentin. METHODS: Three different types of fiber-reinforced composite (FRC) posts and three metal posts each comprising 10 specimens (n=10) and 20 dentin bars were loaded to failure in a three-point bending test to determine the flexural modulus (GPa) and the flexural strength (MPa). Three randomly selected fiber posts of each group were evaluated using a scanning electron microscope (SEM) to illustrate the differences in mode of fracture. Data were subjected to a one-way ANOVA to determine significant differences between groups and the Bonferroni t-test multiple comparison was applied to investigate which mean values differed from one another with significance levels of P<0.05. RESULTS: The flexural modulus recorded for the dentin bars was 17.5+/-3.8 GPa. The values for posts ranged from 24.4+/-3.8 GPa for silica fiber posts to 108.6+/-10.7 GPa for stainless steel posts. The flexural strength for dentin was 212.9+/-41.9 MPa, while the posts ranged from 879.1+/-66.2 MPa for silica fiber posts to 1545.3+/-135.9 MPa for cast gold posts. The ANOVA test analysis revealed significant differences between groups (P<0.05) for flexural modulus and flexural strength mean values. SIGNIFICANCE: FRC posts have an elastic modulus that more closely approaches that of dentin while that for metal posts was much higher. The flexural strength of fiber and metal posts was respectively four and seven times higher than root dentin.

Carbon↗

Three-dimensional finite element analysis of strain and stress distributions in endodontically treated maxillary central incisors restored with different post, core and crown materials.

OBJECTIVES: The present comparative analysis aimed at evaluating which combination of restorative materials resulted in the most homogeneous stress and strain distributions. METHODS: A three-dimensional finite element analysis was performed. All the nodes on the external surface of the root were constrained in all directions. Eighteen experimental models with different material properties and configurations were simulated. An arbitrary load of 10N was applied at 60 degrees angle with tooth longitudinal axis on the palatal surface of the crown. Von Mises (equivalent stresses) energetic criterion was chosen. RESULTS: In all the models the values of both strain and stress recorded at the middle third of the buccal aspect of the root surface were at their maxima. On the contrary, the minimum values were noticed at level of both the apical portion of the post and the root apex. The maximum stresses were evidenced at level of the cemento-enamel junction (CEJ) on both the buccal and palatal aspects of root cement and dentin. Stress progressively decreased from the outer to the inner part of the root and from the CEJ towards the incisal margin of the crown as well. SIGNIFICANCE: The results of the present study would allow clinicians to make an informed choice from among available materials to restore endodontically treated teeth.

Cementation↗