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PubMed2002

Temporization for endodontics.

Teeth undergoing root-canal therapy are susceptible to microbial contamination from oral fluids both during and after treatment. With the exception of single-visit treatment, the use of a temporary restoration is mandatory. This review aims to provide an overview of the materials and techniques used for short- and long-term restorations during and immediately after endodontic treatment, and to make clinical recommendations. Further research is necessary to determine the effectiveness of temporary restorations in the conditions of the oral environment, especially with respect to leakage and functional demands.

Crowns↗
PubMed2003

Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 1. Intracanal drugs and substances.

Irrigation solutions and intracanal medicaments are used within the root canal to clean and aid in disinfecting the dentinal walls. Although these materials are intended to be contained within the root canal, they invariably contact the periapical tissues, either through inadvertent extrusion through the apex or leaching. This paper is a review on the methodology involved in biocompatibility testing followed by a discussion on biocompatibility of contemporary intracanal drugs and substances used in endodontics.

Animals↗
PubMed2003

Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 2. Root-canal-filling materials.

Root-canal-filling materials are either placed directly onto vital periapical tissues or may leach through dentine. The tissue response to these materials therefore becomes important and may influence the outcome of endodontic treatment. This paper is a review of the biocompatibility of contemporary orthograde and retrograde root-canal-filling materials.

Animals↗
PubMed2003

Periapical endodontic surgery: a 3-year follow-up study.

AIM: To monitor the outcome of periradicular surgery in a group of teeth treated with microsurgical technology and ultrasonic root-end preparation. METHODOLOGY: One hundred and twenty-eight teeth with failed conventional root canal treatment were included. The surgical procedure was completed using ultrasonic retrotips and a zinc oxide-EBA (Super Seal, Ogna Pharmaceuticals. Milan, Italy)-reinforced material was used to seal the root end cavities. Lesions were examined radiologically at 1. 3. 6. 12, 24 and 36-month intervals. Radiographs were independently analysed according to a previously published classification. RESULTS: Eight teeth were extracted due to fracture or perforations undetected radiologically: these cases were excluded from the study. Of the 120 teeth examined. the overall success rate was 92.5%; 94 healed with complete bone filling of the surgical cavity, 17 were considered to have healed by apical scar formation, four demonstrated uncertain healing and five were considered failures. Eighty of 120 teeth examined had successfully healed from a radiological point of view within 12 months. No differences in outcome occurred between anterior, premolar and molar teeth. Although all failures occurred in teeth with posts, no statistically significant difference was noted (Mann-Whitney U-test, P = 0.37). CONCLUSION: Modern surgical endodontic procedures associated and ERA (Super Seal, Ogna Pharmaceuticals, Milan, Italy) root end fillings were successful over 3 years in 92.5% of cases.

Adolescent↗
PubMed2003

Healing of apical periodontitis after endodontic treatment: a comparison between a silicone-based and a zinc oxide-eugenol-based sealer.

AIM: To assess the treatment results up to 1 year after endodontic treatment of apical periodontitis using a silicone-based sealer in comparison with Grossman's sealer, and to compare the results at 3 months after treatment with the 12-month follow-up to assess the prognostic value of a 3-month control. METHODOLOGY: A total of 199 teeth were treated at three centres. The sealer was randomly chosen at the time of filling. Treatment results were evaluated clinically and radiographically 3 and 12 months after root-canal filling. The periapical status was evaluated using the periapical index (PAI). RESULTS AND CONCLUSIONS: Average PAI scores decreased from 3.43 at start to 2.21 at 12 months for Grossman's sealer and from 3.40 to 2.26 for the silicon-based material. No significant difference between the groups at start or any of the follow ups was seen. The 3-month control was adequate in establishing significant healing in both groups. The improvement of the periapical condition continued at the 12-month examination.

Adult↗
PubMed2003

Rheological properties and biocompatibility of endodontic sealers.

AIM: To determine the flow characteristics and subcutaneous tissue reactions to five endodontic sealers. METHODOLOGY: The materials used were Procosol, AH26, Endomethasone, Sealapex and Endion. The sealers were prepared following the manufacturers' instructions, and 0.075 mL of each material was placed on a glass surface, which was then rotated 90 degrees. The samples were stored at 37 degrees C and 95% humidity. The displacement of the sealer was recorded by measuring the difference between its original position and the position recorded at 15 and 60 min. Three samples of each material were used. Two pockets were created in the back of Wistar rats, and one silicone tube, 1 mm in diameter and 1 cm in length, was implanted in each. One was filled with one of the materials under study, and the other empty tube was implanted as a control. Fourteen days after implantation, the animals were sacrificed, and samples of the skin containing the tubes were histologically processed. Histological and histomorphometric evaluations of the tissues adjacent to the open end of the tube were carried out the volume of tissue reaction was measured histomorphometrically according to standard stereological principles. Results were statistically analysed using analysis of variance and Duncan's test. RESULTS: The highest flow values were obtained with Sealapex and AH26. Time significantly affected the flow and the material (P < (1001). Procosol and Endion produced the most severe histological reactions: these were outlined by fibrous tissue; AH26. Endomethasone and Sealapex produced reactions of smaller size and with more moderately defined limits. CONCLUSIONS: The flow did not correlate with the degree of inflammatory response. Procosol and Endion produced the most severe tissue reactions, whereas Endomethasone, Sealapex and AH26 produced only minimum reactions.

Analysis of Variance↗
PubMed1999

Endodontic treatment of immature tooth with dens invaginatus: a case report.

The endodontic treatment of a dens invaginatus in an immature permanent upper lateral incisor of a 9-year-old boy is presented. Root canal treatment was performed using calcium hydroxide paste as a temporary root canal filling in order to achieve apexification. This was replaced after closure of the apex with a final root canal filling using gutta-percha and AH 26 as the sealer. The follow-up radiographic control demonstrated the effectiveness of nonsurgical treatment in a case of incomplete root formation in a tooth with dens invaginatus.

Calcium Hydroxide↗
PubMed1996

Pilot study comparing the photoelastic stress distribution for four endodontic post systems.

This pilot study compared stress distribution using photoelastic blocks for both vertical loading and oblique loading (26 degrees angle) for four groups of post systems (Flexi-Post, Flexi-Flange, ParaPost and AccessPost dowels). For each group, three test blocks of photoelastic material were prepared with simulated endodontic canals, and the specimens were then photographed. Minimal stresses were observed for all the posts after cementation in the unloaded state. Stress distribution for the Flexi-Post, Flexi-Flange and AccessPost were favourable under vertical loading at 134 N and oblique loadings of 89 N and 134 N. Stress patterns were symmetric over the entire length of these posts. Stress distribution for the ParaPost under vertical loading at 134 N generated stress patterns that were asymmetric with concentration of stresses apically compared to coronally. Stress distribution for the ParaPost during oblique loadings of 89 N and 134 N were asymmetric with stress concentrated apically as compared to coronally. Stress distribution for the Flexi-Post, Flexi-Flange and AccessPost were all favourable under loading conditions studied.

Birefringence↗
PubMed1998

Fracture resistance of endodontically treated roots after restoration.

This study evaluated the shear strength resistance of endodontically treated roots that were restored by two different techniques. Twenty-seven recently extracted single-rooted teeth with similar anatomic characteristics were sectioned to obtain the same length for all specimens. Group I (GI) consisted of 14 roots restored with cast post-core (nickel-chromium alloy) and cemented using zinc phosphate cement; group II (GII) consisted of 13 roots restored with steel prefabricated posts (FKG) cemented with zinc phosphate cement and rotated with caution for anchorage. The crown portion of this group was made using a hybrid composite resin (Prisma APH). Results showed that on all specimens of GI the fracture occurred in the cervical root structure while in GII the composite resin fractured in all specimens. Statistical analysis showed a significantly higher resistance to fracture for GI than GII. The specimens were sectioned longitudinally for stereoscopic microscope analysis (63x) and did not show fracture lines in the dentin anchorage post area for any of the specimens.

Composite Resins↗
PubMed2000

Pilot study of the cyclic fatigue characteristics of five endodontic posts with four core materials.

This pilot study concerned the cyclic fatigue of five different endodontic post systems (AccessPost(R), Flexi-Flange(R), Flexi-Post(R), ParaPost(R), and Vlock(R)) with four different core materials (Tytin(R) Silver amalgam, Ti-Core(R), Ketac-Silver(R) and G-C Miracle Mix(R)). In vitro cyclic fatigue was performed using a fatigue machine that simulates masticatory fatigue forces. An instantaneous force of 5 lb was applied to each post and core combination for a test configuration of 4 000 000 repetitions or until failure occurred. The type of failure and number of repetitions at failure was recorded for each sample tested. Two-way ANOVA was used to compare groups. All posts/core samples with Ti-Core and Tytin Silver amalgam completed the test configuration of 4 000 000 cycles without failures. All posts/core samples with Ketac-Silver failed before the 4 000 000 test cycle configuration, all as a result of core failures. All posts/core samples with G-C Miracle Mix failed in a similar way. The Newman-Keuls multiple comparison test illustrated that Ti-Core and Tytin Silver amalgam were similar to each other and were superior to both G-C Miracle Mix and Ketac-Silver. Similar fatigue test results are found in the literature.

Bicuspid↗
PubMed2003

Clinical evaluation of a carbon fibre reinforced carbon endodontic post.

This study reports a prospective clinical trial comparing a carbon fibre reinforced carbon (CFRC) endodontic post with a conventional prefabricated post. Twenty-seven single rooted maxillary anterior teeth in 18 patients (nine males and nine females; age range 18-60 years) were restored either with a CFRC post or a wrought precious alloy control. Cast type III gold alloy cores were used in conjunction with both post groups. The CRFC posts (n = 16) were cemented with a composite luting agent and the conventional posts (control) were cemented with zinc phosphate. Four failures were recorded in the CFRC post group at 24, 29, 56 and 87 months, compared with one failure in the control group at 84 months. These results suggest that post-retained crowns utilizing a CFRC material and a composite resin luting agent do not perform as well as conventional wrought precious alloy posts.

Adolescent↗
PubMed2000

Relationship of intracanal pressure with viscosity of endodontic sealer during warm Gutta-Percha vertical compaction.

OBJECTIVE: To test the association between endodontic sealer viscosity and intracanal pressure during warm gutta-percha vertical compaction. STUDY DESIGN: An artificial tooth model and pressure-sensing apparatus were developed so that reproducible, quantitative measurements could be determined. Intracanal pressure was measured at 3 phases of obturation: cone insertion, heat application, and force application. Samples were randomly assigned to 3 sealer viscosity groups (most viscous, normal, least viscous) and to a no-sealer group. Evaluations were blinded to group assignments (4 groups, 15 samples per group). RESULTS: Differences in intracanal pressure were detected between sealer viscosity groups. The most viscous group had the largest intracanal pressure. Throughout the phases of obturation, intracanal pressure did not remain constant; values at the time of heat application were lower than at cone insertion and force application. CONCLUSIONS: The results indicate that intracanal pressure increases as sealer viscosity is increased, and that intracanal pressure does not remain constant during obturation.

Analysis of Variance↗
PubMed2000

Pattern of bone resorption in vertically fractured, endodontically treated teeth.

PURPOSE: To evaluate the clinical pattern of alveolar bone resorption associated with vertically fractured, endodontically treated teeth in correlation to clinical symptoms. MATERIAL AND METHODS: The pattern of bone resorption was evaluated in 66 maxillary premolars, 13 mandibular premolars, and 31 mesial roots of mandibular molars extracted during an 18-month period because of vertical root fractures. Type and duration of symptoms were recorded and correlated to the pattern of bone resorption. RESULTS: A V-shaped pattern osseous defect (dehiscence) was typical (91%) to the buccal plate rather than a U-shaped shallow, rounded, slow grade resorption in the palatal or lingual plate. Fenestration of the buccal plate was observed in 10 patients (9%). A positive correlation between type of symptoms and amount of buccal bone resorption was found (P <.0001). The resorptive defect was always facing the fracture line. CONCLUSIONS: A typical pattern of bone resorption in vertical root fracture cases as shown in this study can be helpful to the clinician in diagnosing vertical root fracture when an exploratory full flap surgical procedure is performed.

Alveolar Bone Loss↗
PubMed2000

Evaluation of root reinforcement of endodontically treated teeth.

OBJECTIVES: The purpose of this study was to test the root reinforcing capabilities of a glass ionomer sealer and to test whether pretreatment of the instrumented canal to alter or remove the smear layer might enhance the reinforcement. STUDY DESIGN: Ninety single-canaled roots of standardized dimensions were instrumented to International Standards Organization size 45 and were analyzed for resistance to vertical fracture. Six groups were tested (n = 15). RESULTS: No significant difference in fracture resistance was observed between any of the groups. CONCLUSIONS: Under the conditions of this study, reinforcement of endodontically treated mature teeth by placement of adhesive materials in the root was not demonstrated.

Analysis of Variance↗
PubMed2002

Influence of root canal dressings and sealers on repair of apical periodontitis after endodontic treatment.

OBJECTIVE: The objective of this study was to evaluate the histopathologic response of periapical tissues after root canal treatment of necrotic dog teeth with chronic apical periodontitis by using 2 calcium hydroxide-based root canal dressings and 2 root canal sealers. STUDY DESIGN: Seventy-eight root canals were instrumented by using 5.25% sodium hypochlorite as the irrigating solution, after which a calcium hydroxide paste (Calen/PMCC or Calasept) was placed for 30 days as a dressing. The root canals were then filled by using cold lateral gutta-percha condensation and an endodontic sealer (Sealapex or AH Plus). After 360 days, the animals were killed by anesthetic overdose; then, the teeth were histologically prepared, sectioned, and stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical tissue repair. RESULTS: Statistical analysis showed that the poorest histopathologic results were observed in the Calasept/AH Plus group and that the Sealapex sealer overall resulted in better apical repair than the AH Plus sealer. The histopathologic results of Calen/PMCC paste with both AH Plus and Sealapex and Calasept paste with only Sealapex were statistically similar but were different from the results of Calasept with AH Plus. CONCLUSIONS: The results of this study in the dog showed differences in apical and periapical tissue repair of teeth with chronic apical periodontitis by using 2 calcium hydroxide root canal dressings and 2 sealers. More research is necessary to determine the best combination of dressings and sealers.

Animals↗
PubMed2002

A comparison of D-, E-, and F-speed conventional intraoral radiographic films in endodontic measurement.

OBJECTIVES: We sought to compare observer measurement error and subjective ratings for International Standards Organization D-, E-, and F-speed direct exposure dental x-ray films used to determine endodontic working lengths. METHODS: Radiographs were exposed to achieve a standard background density of approximately 2.0. Three human maxillary posterior teeth for which No. 10 K-files had been placed at various lengths within 4 canals were studied in a cadaver section. A total of 30 radiographs were used (10 from each film type). Five licensed dentists excluding all authors viewed the radiographs independently and in random sequence. Distances from the file tips to the radiographic apices were measured and were compared with known lengths for error determination. The observing dentists also subjectively rated the images as desirable or undesirable. Statistical methods included a 3-factor ANOVA with Tukey honestly significant difference post hoc analysis to compare objective measurements and chi-square with respect to subjective ratings. RESULTS: No significant differences were attributable to film speed grouping or observers (P > .05); however, there was a specimen effect in that a significant difference was found in measurement accuracy among the 4 canals (P < .05). Differences in subjective ratings for the 3 film types were not statistically significant (P > .05). CONCLUSION: All 3 film types were similar in objective and subjective ratings. This being the case, the faster film is preferred to minimize the radiation dose to the patient.

Adult↗
PubMed2002

Dialister pneumosintes can be a suspected endodontic pathogen.

OBJECTIVE: Dialister pneumosintes is a nonmotile, nonfermentative, non-spore-forming, obligately anaerobic, gram-negative bacillus that has been associated with some infections in the human body. A species-specific nested polymerase chain reaction assay was used to investigate the occurrence of D pneumosintes in primary root canal infections. STUDY DESIGN: Samples were collected from 32 teeth with carious lesions, necrotic pulps, and radiographic evidence of periradicular bone destruction. Twenty-two teeth were asymptomatic, and 10 cases were diagnosed as acute apical periodontitis. DNA extracted from the samples was initially amplified with universal 16S ribosomal DNA primers. A second round of amplification used the first polymerase chain reaction products to specifically detect D pneumosintes. RESULTS: This bacterial species was detected in 17 of 22 asymptomatic cases (77.3%) and in 4 of 10 root canals associated with acute apical periodontitis (40%). No relationship was found between the presence of this bacterial species and the occurrence of symptoms. In general, D pneumosintes was detected in 21 of 32 root canal samples (65.6%). CONCLUSION: This study is the first to report a high prevalence of D pneumosintes in root canal infections of humans. Because of this high prevalence and the apparent pathogenicity of the microorganism, we suggest the inclusion of D pneumosintes in the selected group of putative endodontic pathogens.

Acute Disease↗
PubMed2000

Torsional resistance of crowns cemented to composite cores involving three stainless steel endodontic post designs.

STATEMENT OF PROBLEM: There are no studies analyzing the effects of a crown in relationship to torsional resistance for a titanium-reinforced core material supported by a post. PURPOSE: This study investigated the effects of post design on the torsional resistance of a crown supported by a titanium-reinforced composite core material (Ti-Core) and 3 endodontic posts (AccessPost, Flexi-Post, and ParaPost). MATERIAL AND METHOD: Three groups of 10 specimens per group were studied. A total of 30 recently extracted human single-rooted (incisors) teeth with their crowns removed were used. Post holes preparations were created according to manufacturer's instructions. All posts were cemented using Flexi-Flow with titanium cement. Scotchbond Multi-Purpose bonding system was used as the bonding system for all groups. All cores were fabricated with Ti-Core with titanium core material with hard copper bands as the matrix. The Ti-Core core material was allowed to set for 1 hour. Metal crowns were fabricated and cemented with zinc phosphate cement. Specimens were placed in a special jig and a clockwise torsional force was applied. Torsional force was measured on a Lebow 1102-200 torque transducer and recorded on a Hewlett Packard 7015B X-Y recorder in inch x ounce. A 1-way analysis of variance (ANOVA) was used to test for statistical significance (P < .001). RESULTS: The torsional values (inch x ounce) were AccessPost 77.2 +/- 30.3, Flexi-Post 162.2 +/- 51.2, and ParaPost 60.9 +/- 28.4. SNK and Scheffé comparison tests revealed that the Flexi-Post group had significantly greater resistance to torque loading than the AccessPost and ParaPost groups, which were statistically similar to each other. CONCLUSION: Post design has an effect on torsional resistance of a crown supported by titanium-reinforced core build-up and post. The threaded split-shank design of the Flexi-Post dowel offers significantly greater resistance to torsional loading than the passive posts studied.

Analysis of Variance↗