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PubMed2000

Utilization of gutta-percha for retrograde root fillings.

Just as gutta-percha used with a root canal sealer is a recommended material for orthograde root fillings, it could similarly be the material of choice for retrograde fillings. Unfortunately, clinical accessibility and visibility do not always facilitate such a technique. The aim of this article is to present a new technique which enables retrograde fillings to be achieved with gutta-percha and a sealer. After the apex had been resected, a hole was drilled perpendicular to the plane of section of the apex about 1 mm coronally. The bucco-lingual depth required to reach the main canal was calculated. The cavity was then dried, coated with the sealer, and obturated with gutta-percha in accordance with thermo-mechanical compaction techniques. After excess filling material had been removed, the gutta-percha was cold burnished and the angles of the root were smoothed. Clinical cases illustrating healing of the periapical tissues are shown.

Apicoectomy↗
PubMed1993

An in vivo evaluation of Endex electronic apex locator.

Because of technical problems and hazards of radiation, dentists have desired alternative ways to determine the working length during root canal therapy. Attention has turned to electronic devices for measuring root canal length. Several such devices are now available. They show promise but their accuracy is hampered because moisture in the root canal can result in inaccurate responses. Recently, a new device, Endex, has been introduced, claiming ease of operation and accuracy in moist environments. Ten operators used the Endex to measure 185 root canal lengths (in 99 teeth). Endex measurements were compared with radiographic measurements. The Endex located the apical constriction accurately within +/- 0.5 mm in 89.64% of moist canals.

Adolescent↗
PubMed1990

Anatomical study of the position of the mesial roots of mandibular molars.

In order to determine the position of the anatomical apex of the mesial roots of the first and second molars, the horizontal distance from the outer surface of the buccal cortical plate to the apex and the vertical distance from the superior border of the neurovascular bundle to the apex were examined in 33 human cadaver mandible halves. The vertical distances were compared with measurements taken from periapical radiographs between the apex of each mesial root and the superior border of the mandibular canal prior to sectioning. The means of the horizontal buccal distances of the second molar were found to be significantly greater than those of the first molar. The means of the vertical distances of the second molar were found to be significantly less than those of the first molar. A high correlation was found between the vertical anatomic and radiographic measurements. In the majority of the sections, the neurovascular bundle was found in the lingual half of the mandible.

Adult↗
PubMed1993

Guided tissue regeneration (GTR) of nonsubmerged implants in immediate extraction sites.

The learning objective of this article is the placement of nonsubmerged implants immediately after extraction, with membrane barriers, according to the principles of guided tissue regeneration (GTR). Fixtures were immobilized by engaging bone beyond the apex and were exposed to the oral cavity during healing. The implants and cell-occlusive barriers were placed in 6 patients; all barriers were removed by week 10. Three patients received freeze-dried bone allografts. A systemic antibiotic, an oral antimicrobial rinse, and reinforced plaque removal were employed. Radiographic and attachment level measurements at 3 and 6 months indicated that osseous regeneration had taken place and was still ongoing. All fixtures were restored after each implant reached 6-month maturity.

Aged↗
PubMed2001

Efficacy of enamel matrix proteins on apical periodontal regeneration after experimental apicoectomy in dogs.

Adult dogs have a complex apical delta structure in all root apexes of teeth. This complex structure may affect the formation of apical lesions in the teeth such as apical abscesses. The purpose of this study was to evaluate the efficacy of enamel matrix protein (EMP) which was used for periodontal regeneration therapy after an experimental apicoectomy for an assumed apical lesions of the teeth in dogs. The maxillar canine roots and maxillar fourth premolar buccal mesial roots in five beagles were experimentally apicoectomized under general inhalation anesthesia. After the root apex was exposed and excised, EMP was applied on the surface of the exposed dentin. After 12 weeks, dogs were euthanized. and the experimental teeth together with the surrounding soft and hard periodontal tissues were collected for histological evaluation under a light microscope. In the EMP group, the size of the defect where the root apex was removed was smaller than that of the control group. New cementum was dominantly achieved in the EMP group compared to the control group. Furthermore, new collagen fibers that bridged area between the new cementum and new alveolar bone were detected only in the EMP group. The present results demonstrated marked apical periodontal regeneration after apicoectomy in the EMP group. These results, therefore, suggest that the application of EMP can effectively induce the regeneration of periodontal strUctures in apicoectomized dogs.

Animals↗
PubMed1996

The free rotated papilla autograft: a new bilaminar grafting procedure for the coverage of multiple shallow gingival recessions.

The aim of this clinical pilot study is to evaluate the possibility and from a statistical point of view, the predictability of a new mucogingival technique. The purpose of this surgical procedure is to cover the exposed buccal root surface with less than 5 mm clinical probing attachment loss either in corono-apical or mesio-distal aspects. This surgical procedure is particularly indicated in either single or multiple gingival recessions with perfectly preserved mesial and distal interproximal osseous crests, and with a papillary dimension not inferior to the defect which needs to be treated. A sharp incision is performed at a 90 degrees angle to the vestibule, following the mucogingival line. A sharp dissection is accomplished to create a partial thickness envelope flap on the underlying alveolar mucosa. The epithelium from the facial aspect of the papilla is debrided with a full thickness approach, the facial papillary tissue is removed from the underlying tissue bed. The papilla is then reversed in such a way that the base of the papilla is at the cemento-enamel junction (CEJ) and the apex is at the base of the gingival recession area. The papilla is then sutured in place and completely covered by a coronally displaced partial thickness flap. The results obtained either as root coverage, or as an aesthetic result, may be considered positive. This procedure has the decided advantage of a single surgical site, avoiding any palatal patient discomfort, good color compatibility with adjacent tissue, and healing by primary intention.

Adult↗
PubMed1992

Recent development in endodontic research.

In essence, endodontics as a clinical discipline is concerned with the prevention and treatment of pulpal and periapical infection. In recent research the infective process has been investigated as well as the mechanisms by which the pulp and periodontium deal with microbial insults. With regard to the pulp, findings on the hemodynamics of pulpitis suggest that the inflammatory response in this tissue is much less influenced by the special anatomic environment of the tooth than was previously believed. Pulpal diseases are being underdiagnosed, mostly because of inadequate examination methods. Laser Doppler flowmetry which gives a vascular rather than a nervous response may gain importance in pulpal diagnostics in the future. It is established that apical periodontitis with bone resorption cannot develop in the absence of bacteria in the root canal system. Root canal infection is characterized by a wide variety of combinations of relatively few anaerobic bacteria, and bacterial synergism plays an important role in maintaining the infection. Microbial invasion of an apical granuloma may take place. Non-oral and environmental organisms like Pseudomonas aeruginosa are frequently isolated from treatment-resistant cases. Success of endodontic treatment depends on the reduction or elimination of the infecting bacteria. This may predictably be obtained after a thorough chemo-mechanical instrumentation and disinfection of the root canal with calcium hydroxide. The standardized technique which entails the preparation of a cylindrical apical box with removal of significant amounts of dentin near the root apex predictably gives a clean canal. This technique has provided excellent clinical and radiographic results in well documented follow-up studies.

Dental Pulp Diseases↗
PubMed1992

Root canal configuration of the mandibular first premolar.

One hundred six human mandibular left and right first premolars, previously extracted due to nonrestorable caries, periodontal disease, or orthodontic reasons, were sectioned perpendicular to the long axis of the root starting at the cementoenamel junction. Three-millimeter sections were made with an ultrathin separating disc to the level of the anatomical apex. After 1 day in 5.25% NaOCl, each section was rinsed in phosphate-buffered saline, evaluated with a stereomicroscope, and photographed. The slides were projected and the shape of the canal, incidence of multiple canals, level of bifurcation, and any other variant anatomy were recorded. Seventy-six percent of the premolars demonstrated Type I canals and 24% contained Type IV. The shape of the canals was predominantly oval or round. An interesting finding was the number of C-shaped canals which were associated predominantly with Type IV canal systems. This occurred in 14% of the roots.

Bicuspid↗
PubMed1998

The external and internal anatomy of human mandibular canine teeth with two roots.

This study investigated the internal anatomy of 65 human mandibular canines with two well-defined roots. The teeth were decalcified and injected with gelatin coloured with india ink. Diaphanization was carried out using clear resin to allow permanent preservation. It was found that all mandibular canines with two roots had two root canals. Lateral canals were found in 68.9% of teeth and 19.7% had lateral canals at the bifurcation. The results of the external measurements (cusp tip to root apex) showed that the average buccal root length was 23.0 mm and the average lingual root length was 22.7 mm. The maximum and minimum buccal lengths were 26.7 mm and 17.9 mm respectively and the maximum and minimum lingual lengths were 27.2 mm and 17.1 mm respectively. The buccal root was the larger of the two in 47.7% of teeth and 43.1% had roots of equal size. The lingual root was larger than the buccal root in 9.2% of cases. Clinicians should be aware of the anatomical variation that exists for mandibular canines.

Cuspid↗
PubMed1998

Anatomic characteristics of the furcation and root surfaces of molar teeth and their significance in the clinical management of marginal periodontitis.

Treatment of periodontitis which involves the furcation area of molar teeth has always been a challenge. Sixty extracted human molar teeth were used for an anatomic study to clarify the possible morphologic factors which may affect the diagnosis, prognosis, and clinical management of periodontally involved teeth. Teeth were embedded in methylmethacrylate and cut in 70 microm cross sections from the cementoenamel junction to the apex. Cervical enamel projection, root and root trunk lengths, root proximities as well as depths of root concavities coronally, apically, and at the furcation roof were measured. Cervical enamel projections were observed in 30% of the teeth examined. The shortest root trunk was found at the buccal aspect of mandibular first molars, permitting furcation involvement at early stages of periodontal disease. The most apically located furcation was found at the distal site of maxillary first molars. Furcation roofs showed severe concavities and complex cementum morphology. Teeth exhibiting cervical enamel projection were found to have deeper root concavities compared to teeth without cervical enamel projection and mesial roots of mandibular molars possessed greater furcal concavities than distal roots. The presence of root concavities complicates the diagnosis of furcation involvement and restricts access of periodontal instruments, resulting in incomplete treatment. Furcation anatomy may also influence the long-term prognosis of the teeth by favoring the retention of bacterial deposits and making oral hygiene procedures almost impossible. The present study shows that knowledge of a tooth's unique anatomic characteristics is a prerequisite for effective periodontal therapy.

Dental Enamel↗
PubMed1987

Biologic evaluation of SPAD. II. A clinical comparison of Traitement SPAD with the conventional root canal filling technique.

Traitement SPAD is a new root canal filling material that is advertised as an efficient universal paste recommended for the treatment of all kinds of teeth in one visit. Pushing the paste beyond the apex is highly recommended by the manufacturer for the treatment of periapical lesions and to aid in rapid regeneration of the tissues. A clinical study was conducted to determine the response to this material and to compare it with the response to laterally condensed gutta-percha. SPAD was intentionally forced beyond the apex in some of the patients to evaluate its effect on periapical lesions and on the surrounding tissues. In the majority of patients, the periapical tissues were unable to absorb the excess material, which caused persistent pain and swelling and had to be removed surgically. After removal of the extruded material, which had set into a hard mass with rough surface texture, healing followed a normal course. The use of SPAD and the laterally condensed gutta-percha for filling root canals to their apical constriction provided equally high percentages of success.

Adolescent↗
PubMed2005

Accuracy of film-based, digital, and enhanced digital images for endodontic length determination.

OBJECTIVE: This study compared the accuracy of D- and F-speed intraoral radiographs and digital and enhanced digital radiographic images for endodontic file length determination. STUDY DESIGN: Size 15 K-files were bonded in 51 canals of 34 human cadaver teeth. The distance from file tip to root apex was measured on D- and F-speed film and on unenhanced and enhanced digital images. The quality of the images was rated by the observers. Overlying cadaver bone and root structure were subsequently removed to expose the file tip for actual measurement to the apex. The distance measured on each image was compared with the actual measurement. ANOVA, Kruskal-Wallis, sign test, and Pearson correlation statistical analyses were applied. RESULTS: There were no significant differences in measurement accuracy among the 4 image types (P < or = .05). Subjective ratings showed a preference for the quality of enhanced digital images. Conclusion All 4 image types were similar in accuracy of file measurement. The image quality of enhanced digital images was subjectively superior to the others.

Analysis of Variance↗
PubMed1977

Electronic ohmmeter. An electronic device for the determination of the root canal length.

The electronic ohmmeter was devised for the accurate determination of root canal length. Fifty-one maxillary anterior teeth of 43 patients and 25 posterior root canals from 10 patients were selected for the investigation. The presence of a lesion in periapical tissue, wide root apex, and exudates in the root canal contributed to inaccuracy in the determination of the root canal length. Correct length can be found if precautions are taken. The inaccurate results were corrected by repeating the procedures and taking precautions during the estimation of root canal length. Measurement in the dry canal gave correct estimation of the root canal length. When distilled water or normal saline was used as conducting medium in root canals, accuracy was not as good as in dry canals. The electronic ohmmeter is a useful and economical device and an endodontic aid for determination of the root canal length.

Adolescent↗
PubMed1989

Intrusion of incisors in adult patients with marginal bone loss.

Elongated and spaced incisors are common problems in patients suffering from severe periodontal disease. Thirty patients characterized by marginal bone loss and deep overbite were treated by intrusion of incisors. Three different methods for intrusion were applied: (1) J hooks and extraoral high-pull headgear, (2) utility arches, (3) intrusion bent into a loop in a 0.17 x 0.25-inch wire, and (4) base arch as described by Burstone. The intrusion was evaluated from the displacement of the apex, incision, and the center of resistance of the most prominent or elongated central incisor. Change in the marginal bone level and the amount of root resorption were evaluated on standardized intraoral radiographs. The pockets were assessed by standardized probing and the clinical crown length was measured on study casts. The results showed that the true intrusion of the center of resistance varied from 0 to 3.5 mm and was most pronounced when intrusion was performed with a base arch. The clinical crown length was generally reduced by 0.5 to 1.0 mm. The marginal bone level approached the cementoenamel junction in all but six cases. All cases demonstrated root resorption varying from 1 to 3 mm. The total amount of alveolar support--that is, the calculated area of the alveolar wall--was unaltered or increased in 19 of the 30 cases. The dependency of the results on the oral hygiene, the force distribution, and the perioral function was evaluated in relation to the individual cases. It was obvious that intrusion was best performed when (1) forces were low (5 to 15 gm per tooth) with the line of action of the force passing through or close to the center of resistance, (2) the gingiva status was healthy, and (3) no interference with perioral function was present.

Adult↗
PubMed1981

Determination of stress patterns in root-filled teeth incorporating various dowel designs.

A theoretical investigation has utilized the finite element technique to analyze mechanical stress patterns in a reconstructed maxillary central incisor. A series of designs for endodontic dowel posts incorporated into prosthesis has been comparatively evaluated. For the load condition considered, the results show that minor changes in the stress patterns are produced by the post diameter, length, and taper variations considered. 1. In general, larger post diameters decrease the maximum stresses for both the cylindrical and tapered designs. Variation of diameters over a 15% range produced stress variations of about 8%. 2. The effect of post length on the highest stresses in bending was less than the diameter changes. The real effect of the length changes was to change the location of the stress concentrations that occurred at the post apex in all cases. 3. The effect of taper was found to be slight if the local tapered-post diameter was comparable to the cylindrical post diameter in the high-stress region. 4. For the load considered in this study, the tapered-post design experienced slightly higher tensile and slightly lower shear stresses than the cylindrical post. 5. Using the peak stresses in the dentin and at the dentin-post interface as a criterion, the cylindrical post with the largest diameter is the best design among those examined.

Crowns↗
PubMed1990

[Experimental study on a mechanical root canal enlargement].

It is difficult for us to enlarge a root canal by using hand-instruments in a molar tooth, so we experimented by using mechanical equipment. We examined the human extracted premolar which we had preserved in physiological saline solution by using a speculative root canal enlarging machine. Then we observed the time and condition of enlarging root canal by X-ray. After slicing off, we examined with our eyes and with an electronic microscope. Afterward, we compared hand-instruments with the enlarging machine. As the results of this experiment; 1. Time by hand filing instruments took three or four times to make a root canal enlargement by a speculative enlarging machine. 2. After enlarging a root canal, we made a root canal filling. Observing them by X-ray and ground specimen, we recognized a good result in the root canal enlargement and in the condition of the root canal filling. 3. Observing the figure by electronic microscope, in the case of using a speculative machine, we found that the slicing aspects of dentin which had been enlarged by root canal were thoroughly smoothed in the center part of the root canal, but it was not smoothed in the root apex region. 4. It had a tendency to remain part of the cutting dentin near the apical area both by using hand cutting instruments and by using a speculative machine.

Bicuspid↗
PubMed1995

Effects of ultrasonic root-end cavity preparation on the root apex.

This study determined the effect of bur and ultrasonic preparation on the root apex. After cleaning, shaping, and obturation of root canals of 47 single-rooted teeth and resection of their apexes were done, 24 root-end cavities were prepared with a bur, and the rest were prepared with ultrasonic tips attached to two different ultrasonic units. After photographs of the prepared root ends were taken, their resin replicas were prepared and examined with a scanning electron microscope. Photographs and scanning electron microscope photomicrographs were examined for the presence or absence of cracks. The results showed a significantly higher incidence of crack formation in the walls of root-end cavities prepared by ultrasonic tips compared with those made by the bur.

Analysis of Variance↗
PubMed1995

Abscess formation around the apex of a maxillary root form implant: clinical and microscopical aspects. A case report.

This case report describes the occurrence of an abscess in the periapical area of a root form maxillary titanium implant, with a radiolucent appearance and purulent discharge. The removal of the infected periapical tissues was carried out but the clinical symptoms of infection persisted, an attempt at guided tissue regeneration with a freeze-dried dura mater membrane notwithstanding, and it was necessary to remove the implant. The microscopical examination showed that it was possible to observe nonviable bone tissue, with absence of bone cells and areas of bone resorption in the apical portion of the implant. These microscopical features were compatible with an acute localized suppurative osteomyelitis.

Adult↗