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In vitro antibacterial activity of endodontic sealers.

OBJECTIVES: To evaluate the antibacterial activity of four endodontic sealers: one epoxy resin sealer (AH Plus), two zinc oxide eugenol (ZOE)-based sealers (Endomèthasone, Pulp Canal Sealer), and one sealer containing both ZOE and orthophenilphenol (Vcanalare). METHODS: A direct contact test (DCT) was performed. A 10 microl suspension of Enterococcus faecalis was placed on the test material 20 min, 24 h and 7 days after mixing. Bacteria were allowed to directly contact the sealers for 1h at 37 degrees C. Bacterial growth was then spectrophotometrically measured every 30 min for 7 h, and again after 24 h as well. RESULTS: All freshly mixed sealers showed complete inhibition of bacterial growth. Similar results were obtained with the 24-h-old samples, with the exception of AH Plus. Vcanalare was the only sealer still inhibiting bacterial growth 7 days after mixing. CONCLUSIONS: The antimicrobial activity of the tested sealers depends on the time interval between mixing and testing. All sealers exhibit bactericidal effect when freshly mixed, but only Vcanalare extended this effect until 7 days after setting.

Anti-Bacterial Agents↗

Incidence and factors associated with endodontic inter-appointment emergency in a dental teaching hospital in China.

OBJECTIVE: To assess the incidence of endodontic inter-appointment emergency (EIE) in a dental teaching hospital in China, and to correlate its occurrence with preoperative and treatment parameters. METHODS: Three thousand six hundred and ninety six cases were collected at root canal treatment appointments on demographics, presenting symptoms, treatment procedures and periradicular status. The operators consisted of faculty, undergraduate students and advanced trainees. Root canals were conventionally instrumented and then medicated. No systemic medication was prescribed. In cases EIE developed between appointments, an emergency visit was arranged and active treatment was carried out. The data of EIE cases were statistically analyzed using the chi-square test and a multiple logistic regression model. RESULTS: The overall incidence of EIE was 5%, which rate was 5.5% in females and 4.3% in males. Analyses of the potential factors revealed that patient age, tooth location, preoperative percussion pain and pulp status were the most important independent variables. CONCLUSION: EIE was significantly associated with some host factors (patient age, tooth location) and presenting factors (preoperative percussion pain, pulp status).

Adult↗

Combined endodontic-periodontic treatment of a palatal groove: a case report.

The palatal groove is a developmental anomaly that predisposes the tooth involved to a severe periodontal defect. When further complicated by pulp necrosis, these grooves often present a diagnostic and treatment planning challenge that requires an interdisciplinary treatment approach. This case report describes the successful collaborative management of a maxillary lateral incisor with an extensive palatal groove using a combination of nonsurgical endodontic therapy, odontoplasty, and periodontal regenerative techniques.

Adult↗

Bleaching teeth treated endodontically: long-term evaluation of a case series.

The chromatic stability of nonvital discolored teeth, subjected to the combined intracoronal bleaching technique and to endodontic treatment, was evaluated at a distance of 16 yr (1989-2005). The series comprised 50 patients (age range 7-30 yr) selected from among those attending the Dental Clinic at "Federico II" University, Naples, between 1987 and 1989. After 16 yr, only 35 cases could be evaluated: in 22 of these cases (62.9%) the color had remained stable and was similar to that of adjacent teeth, indicating a successful outcome of the combined bleaching technique. There were 13 cases (37.1%) classified as failures because of marked color relapse. Radiology showed none of the cases re-examined to have undergone internal or external root resorption. These results confirm the validity of the combined intracoronal bleaching technique in terms of efficacy, rapid esthetic result, and safety.

Adolescent↗

Identification of cultivable microorganisms from root canals with apical periodontitis following two-visit endodontic treatment with antibiotics/steroid or calcium hydroxide dressings.

The study was aimed at comparing the efficacy of disinfection of root canals with periapical radiolucencies when treated with either antibiotics/steroid medicaments (Ledermix or Septomixine) or a calcium hydroxide paste (Calasept). Microbiological samples were taken before and after two-visit endodontic treatment from 88 canals with apical periodontitis. All of the canals but one (87 of 88) had cultivable growth before treatment. After dressing with Ledermix, Septomixine, or Calasept, the percentages of canals remained with positive growth were 48% (13 of 27), 31% (8 of 26), and 31% (11 of 35), respectively. The chi(2) tests showed there were no significant differences in the number of canals with positive growth or mean colony forming units counts after instrumentation, irrigation and dressing. In the Ledermix group, 38 strains of bacteria were recovered. The Septomixine group had 25 strains, and the Calasept group had 25 strains. Gram-positive facultative anaerobic cocci (including staphylococci and streptococci) were more prevalent than the Gram-negative obligate anaerobic rods after treatment in all three groups. Similarities in the reduced number of canals with residual growth, and the prevalence of Gram-positive facultative anaerobic cocci suggest that the use of different inter-appointment dressings produced similar microbiological outcomes. However, factors other than the antimicrobial effectiveness of intracanal medicaments may also be responsible for the results observed.

Anti-Bacterial Agents↗

Treatment outcome in endodontics: the Toronto Study. Phase III: initial treatment.

The 4- to 6-year outcome of initial endodontic treatment was assessed for phase III (1998-1999) of the Toronto Study. Of the 532 teeth treated, 248 were from discontinuers (excluded), 142 from dropouts, 10 extracted, and 132 (50% recall) examined for outcome: healed (no apical periodontitis [AP], signs, symptoms) or diseased. Phase III was analyzed alone and combined with phases I, II (n = 373 teeth). Logistic regression performed on the combined phases I-III sample identified significant (p < or = 0.05) outcome predictors: preoperative AP (OR = 3.5; CI 1.7-7.2; healed: absent, 93%; present, 80%), number of roots (OR = 2.2; CI 1.0-4.7; healed: 1 - 92%; > or =2 - 83%), and intraoperative complications (OR = 2.2; CI 1.1-4.5; healed: absent, 88%; present, 76%). Treatment technique (OR = 2.8; CI 1.3-6.1; healed: Schilder, 89%; alternative, 73%) was suggested as an outcome predictor in teeth with AP, requiring confirmation from randomized controlled trials.

Adult↗

Endodontic management of a maxillary first molar with a single root and a single canal diagnosed with the aid of spiral CT: a case report.

The aim of this article is to present an endodontically managed maxillary first molar with an unusual morphology of a single root and a single canal, which has not been reported in the literature so far. An accurate assessment of this unusual morphology was made with the help of a Spiral computed tomography. This report extends the range of known possible anatomical variations to include teeth with lesser number of roots and canals. This report also highlights the role of Spiral computed tomography as an objective method to confirm the three-dimensional anatomy of teeth.

Acute Disease↗

Nonsurgical endodontic treatment of a two-rooted maxillary central incisor.

This case report presents an uncommon case of a two-rooted maxillary central incisor with a periapical radiolucent lesion. A 17-yr-old female patient was referred for dental consultation after a motorcycle accident. The maxillary left central incisor had a bifurcated root that was confirmed by radiographs taken at different angles. Nonsurgical endodontic therapy was performed. At the 1 yr recall examination, the tooth was asymptomatic and the radiograph showed that the periapical radiolucent lesion had healed.

Adolescent↗

Evaluation of cutting efficiency of ultrasonic tips used in orthograde endodontic treatment.

The purpose of the present study was to evaluate the cutting efficiency of the three different ultrasonic tips for orthograde endodontic treatment: stainless steel, zirconium nitride-coated, and diamond-coated tips. An ultrasonic handpiece was mounted on a custom-made automated balance, and each tip repeatedly penetrated dental stone blocks to a depth of 3 mm for 10 times. The amount of time taken to penetrate 3 mm of stone was measured. The diamond-coated tips showed significantly greater cutting efficiency than either stainless steel tips or zirconium-nitride coated tips. The stainless steel tips showed initial better cutting efficiency, but over time , there is no significant difference between the cutting efficiency of the stainless steel tips and the zirconium nitride coated tips. The diamond coated tips were the only group that showed breakage in this study.

Calcium Sulfate↗

Submandibular tuberculous lymphadenitis after endodontic treatment of the mandibular first premolar tooth: report of a case.

Cervical tuberculous lymphadenitis (scrofula) is an infectious granulomatous disease that requires a precise diagnosis. The differential diagnosis involves mainly the pathologic conditions involving the regional lymph nodes and the submandibulary salivary glands. Although tuberculous lesions generally develop secondary to pulmonary disease, clinical manifestations are occasionally seen with no evidence of involvement of the lungs. In this report, a case of tuberculous submandibular lymphadenitis developing after endodontic treatment of the mandibular first premolar tooth is described.

Adult↗

SEM observations and differential scanning calorimetric studies of new and sterilized nickel-titanium rotary endodontic instruments.

Scanning electron microscopy (SEM) and differential scanning calorimetric (DSC) studies were utilized to investigate surface and microstructure of two brands of rotary nickel-titanium (NiTi) endodontic instruments, in the as-received condition and after subjection to 1, 6, and 11 sterilization cycles. A total of 66 ProFile (n = 33) and Flexmaster (n = 33) files were examined. SEM observations indicated the presence of surface imperfections and adherent material in all new and sterilized instruments and an increase in surface roughness of the instruments that underwent multiple sterilizations. DSC measurements showed that the specimens of both brands, in the as-received condition and after 11 sterilizations, were completely austenite in the oral environment temperature, suggesting that they are capable of superelastic behavior in appropriate clinical conditions.

Analysis of Variance↗

Endotoxin content in endodontically involved teeth. 1975.

Fluid was aspirated from the root canals of 40 endodontically involved teeth. This fluid was assayed for endotoxin with the limulus lysate test. Pulpless teeth contained greater concentrations of endotoxin than those with vital pulps. Symptomatic teeth also contained more endotoxin than asymptomatic teeth.

Body Fluids↗

Coaggregation interactions between oral and endodontic Enterococcus faecalis and bacterial species isolated from persistent apical periodontitis.

Interactions between Enterococcus faecalis and other species found in root canal infections might be important for the development and persistence of periapical disease. The aim of this study was to investigate the coaggregation interactions between E. faecalis clinical isolates and species previously shown to survive and induce apical periodontitis in monkeys: Peptostreptococcus anaerobius, Prevotella oralis, Fusobacterium nucleatum, and Streptococcus anginosus. Intergeneric coaggregation assays were conducted in duplicate with observations scored immediately at 0 h, 1 h and 24 h after mixing of combinations of strains. All E. faecalis strains (n = 53) coaggregated with F. nucleatum; E. faecalis did not coaggregate with P. anaerobius or S. anginosus. One strain, E. faecalis E1, coaggregated with P. oralis, with aggregates visible at 1 h. Coaggregation interactions between E. faecalis and F. nucleatum observed in this study suggest a potential role for this combination in endodontic infections.

Animals↗

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants.

Initial root canal treatment and the replacement of a single tooth with implants are both viable treatment options, but various success rates have been reported for each treatment modality. This study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes- success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi(2) test for association of the two classifications (endo vs. implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT outcomes, respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single-tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.

Adult↗

An analysis of current analgesic preferences for endodontic pain management.

A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by chi2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4x a day) regardless of the severity of preoperative or postoperative pain (p<0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.

Analgesics↗

Adhesive dentistry and endodontics. Part 2: bonding in the root canal system-the promise and the problems: a review.

One of the recent trends in endodontics has been the development of bonded obturating materials, in an effort to provide a more effective seal coronally and apically. Materials utilizing dentin adhesive technology have been borrowed from restorative dentistry and adapted to obturating materials. This review discusses the obstacles to effective bonding in the root canal system, the progress that has been made, and possible strategies for improved materials in the future. Much of the literature reviewed and many of the principles discussed are taken from the restorative dentistry literature and applied to the unique environment of the root canal system.

Dental Bonding↗

Microleakage of endodontically treated teeth with different dowel systems.

STATEMENT OF PROBLEM: Several new esthetic dowel systems are available for the restoration of endodontically treated teeth, but little is known about how effectively these dowels seal the restored teeth. PURPOSE: The purpose of this in vitro study was to compare microleakage of 3 esthetic, adhesively luted dowel systems with a conventional dowel system. MATERIAL AND METHODS: The root canals of 41 human intact single-rooted extracted teeth were prepared using a step-back technique. The teeth were randomly divided into 4 experimental groups (n=10), and 1 tooth served as a positive control. The decoronated roots were obturated with gutta-percha using lateral condensation. Roots were restored with 1 of the following dowel systems according to the manufacturer's instructions: (1) stainless steel dowels (ParaPost), (2) glass fiber dowels (Snowpost), (3) resin-supported polyethylene fiber (Ribbond) dowels, or (4) zirconia dowels (Cosmopost). Using a fluid filtration method, coronal leakage of the specimens along the dowel space and root canal restorative material was measured. Fluid movement measurements were made at 2-minute intervals for 8 minutes to measure the presence of voids existing in the obturated canals, at 1 week, 3 months, and 6 months following dowel insertion. A repeated-measures analysis of variance (ANOVA) was used to analyze logarithmic transformations of data (time and dowel material) for significant differences. The Tukey HSD test and paired 2-tailed tests were used to perform multiple comparisons (alpha=.05). RESULTS: The data indicated that the leakage values varied according to the dowel system used (P<.01). There was significant interaction between dowel systems and time of testing (P<.01). The sealing ability of zirconia dowels decreased over time (P<.01), but sealing abilities of stainless steel and resin-supported polyethylene fiber dowels remained constant (P>.05). The sealing ability of glass fiber dowels increased at 3 months (P=.032) and remained constant over the next 3 months (P=.758). Statistically, resin-supported polyethylene fiber and glass fiber dowels showed the lowest coronal leakage when compared with stainless steel and zirconia dowels at all time periods (P<.01). There were no significant differences between resin-supported polyethylene fiber and glass fiber dowels at any time period. The initial leakage measurement in zirconia dowel and stainless steel dowels were similar (P=.914), but became significantly different at 3 and 6 months (P<.01). CONCLUSION: Resin-supported polyethylene fiber dowels and glass fiber dowels tested exhibited less microleakage compared to zirconia dowel systems. The latter system should be further evaluated because of its unacceptable level of leakage.

Acrylic Resins↗

In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations.

STATEMENT OF PROBLEM: The in vitro effectiveness of a uniform circumferential ferrule has been established in the literature; however, the effect of a nonuniform circumferential ferrule height on fracture resistance is unknown. PURPOSE: This in vitro study investigated the resistance to static loading of endodontically treated teeth with uniform and nonuniform ferrule configurations. MATERIAL AND METHODS: Fifty extracted intact maxillary human central incisors were randomly assigned to 1 of 5 groups: CRN, no root canal treatment (RCT), restored with a crown; RCT/CRN, no dowel/core, restored with a crown; 2 FRL, 2-mm ferrule, cast dowel/core and crown; 0.5/2 FRL, nonuniform ferrule (2 mm buccal and lingual, 0.5 mm proximal), cast dowel/core and crown; and 0 FRL, no ferrule, cast dowel/core and crown. The teeth were prepared to standardized specifications and stored for 72 hours in 100% humidity prior to testing. Testing was conducted with a universal testing machine with the application of a static load, and the load (N) at failure was recorded. Statistical analysis was performed with a 1-way analysis of variance and the Tukey Honestly Significant Difference test (alpha=.05). The mode of fracture was noted by visual inspection for all specimens. RESULTS: There was strong evidence of group differences in mean fracture strength ( P <.0001). Following adjustment for all pairwise group comparisons, it was found that the lack of a ferrule resulted in a significantly lower mean fracture strength (0 FRL: 264.93 +/- 78.33 N) relative to all other groups. The presence of a nonuniform (0.5 to 2-mm vertical height) ferrule (0.5/2 FRL: 426.64 +/- 88.33 N) resulted in a significant decrease ( P =.0001) in mean fracture strength when compared with the uniform 2-mm vertical ferrule (2 FRL: 587.23 +/- 110.25 N), the group without RCT (CRN: 583.67 +/- 86.09 N), and the RCT-treated tooth with a crown alone (CRN/RCT: 571.04 +/- 154.86 N). The predominant mode of failure was an oblique fracture extending from the lingual margin to the facial surface just below the insertion of the tooth into the acrylic resin. CONCLUSION: The results demonstrated that central incisors restored with cast dowel/core and crowns with a 2-mm uniform ferrule were more fracture resistant compared to central incisors with nonuniform (0.5 to 2 mm) ferrule heights. Both the 2-mm ferrule and nonuniform ferrule groups were more fracture resistant than the group that lacked a ferrule.

Crowns↗