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PubMed2000

Comparison of different techniques for obturating experimental internal resorptive cavities.

Forty extracted maxillary central incisors were instrumented at the working length to a #50 file. The roots were sectioned transversely with a diamond disk at 7 mm from the anatomical apex. At the opening of the root canal of each section, hemicircular cavities were drilled with a specially designed bur. The corresponding root sections were cemented with glue, thus obtaining root canals with similar cavities that simulated internal resorptions. Teeth were embedded in plaster casts to facilitate their handling. The specimens were randomly separated into four groups of 10. The following obturation techniques were evaluated: lateral compaction (group A), hybrid technique (group B), Obtura II (group C), and Thermafil (group D). AH26 was used as the sealer. After obturation, the plaster was removed and the teeth were radiographed in buccolingual and mesiodistal directions to evaluate the quality of the obturation at the IRC. The incisors were then cut with a scalpel at the same level as the previous section, to examine, under a stereomicroscope, the type of material that filled the IRC. Obtura II gave the best results and in most of the specimens obturated with this technique, the IRC were filled mainly with gutta-percha. Statistical analysis of the data indicated that the differences between group C and the other groups were significant (P < 0.05).

Bismuth↗
PubMed2004

Periapical status and quality of root fillings and coronal restorations in an adult Spanish population.

AIM: To investigate the quality of root fillings and coronal restorations and their association with periapical status in an adult Spanish population. METHODOLOGY: A total of 180 subjects, aged 37.1 +/- 15.7 years, who presented as new patients at the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all root filled teeth, excluding third molars, were examined. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. Radiographic signs of overhang or open margins associated with coronal restorations were also evaluated. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen's kappa test and logistic regression. RESULTS: The total number of root filled teeth was 93, and 60 (64.5%) had apical periodontitis (AP). Presence of AP in root filled teeth was associated with inadequate adaptation of the filling (OR = 2.29; P = 0.06), inadequate length of the root filling (OR = 2.44; P = 0.048), and with poor radiographic quality of the coronal restoration (OR = 2.38; P = 0.054). Only 34.4% of the root fillings were adequate from a technical perspective. When both root fillings and coronal restorations were adequate the incidence of AP decreased to 31.3% (OR = 5.50; P < 0.01). CONCLUSIONS: The incidence of AP in root filled teeth was high. Many root fillings were technically unsatisfactory. Adequate root fillings and coronal restorations were associated with a lower incidence of AP; an adequate root filling had a more substantial impact on the outcome of treatment than the quality of the coronal restoration.

Adult↗
PubMed1996

An immunohistochemical study of the pulpal nerve supply in primary human teeth: evidence for the innervation of deciduous dentine.

The innervation of pulp and dentine was studied in fully formed human deciduous teeth using antibodies to calcitonin gene related peptide (CGRP). Freshly extracted healthy teeth were divided, fixed, demineralised, cryosectioned and treated with antibodies to human CGRP which was then labelled with horseradish peroxidase. Bundles of nerve fibres passed from the apex of the root to the coronal region where a subodontoblast plexus was formed. In the cervical half of the root some nerve fibres branched away from the main bundles to supply both the odontoblast layer and the dentine. Branches from the coronal subodontoblast plexus also reached the odontoblast layer and the dentine. Most of the nerve fibres terminated in the odontoblast layer. In some areas a marginal plexus of nerves was observed between the odontoblasts and the predentine; intratubular nerve fibres arose either from this plexus or directly from the pulp. The dentine of the crown was more densely innervated than that of the root. In the crown the cervical one third had the most densely innervated dentine followed by the pulp horn and the middle third. The most densely innervated areas occurred in regions where the marginal plexus was present. Although many tubules contained a single nerve filament more complex patterns of termination were also observed. The maximum penetration of a nerve fibre into the dentine was 125 microns. The pattern of the deciduous innervation shows some similarities to the permanent dentition but among the differences is the high density of dentinal innervation in the cervical region. The latter point correlates with the clinical impression of greater sensitivity experienced by patients during invasive procedures performed without anaesthetic in the cervical area.

Calcitonin Gene-Related Peptide↗
PubMed1995

Comparative study of two filling techniques using glass-ionomer (Ketac-endo) root canal cement on fracture resistance of endodontically treated roots (in vitro).

Forty freshly single rooted teeth were selected for this study. The coronal part of teeth were decapitated and the root canals were prepared by modified step-back technique with K-flex files to size 35# at the apex, five ml of 5.25% NaOCl was used as irrigating solution. According to the dentin thickness at the mesio-distal direction of the prepared roots, roots were divided into two groups: Group (I), dentin and cementum thickness from 1.5-2 mm, and Group (II), dentin and cementum thickness 1 mm. According to the filling technique used the teeth were subdivided into four subgroups each of five teeth; Subgroup (A) single gutta-percha cone and Ketac-endo root canal sealer, Subgroup (B) lateral condensation technique with gutta-percha and Ketac-endo sealer, Subgroup (C) laterally condensed gutta-percha with Roth 801 cement and Subgroup (D) teeth left unfilled as negative controls. The prepared roots were placed into acrylic resin so that 10 mm of the root was exposed. A slowly increasing force was applied vertically using a blunt punch with 1 mm tip thickness attached to Instron testing machine. The results showed that group (I) with 1.5-2mm dentin thickness required greater force to fracture in all experimental groups, than that of group (II) with 1 mm dentin thickness. So the amount of remaining dentin thickness significantly affected the resistance to fracture of the prepared roots.

Analysis of Variance↗
PubMed1999

Three years of clinical evaluation of endodontically treated teeth by 15 F CO2 laser microprobe: in vivo study.

OBJECTIVE: Evaluation of the efficiency of 15 F CO2 laser microprobe, in cases of periapical lesions. The elimination of the pathological reaction caused by certain species of bacteria by reduction of reinfection and stimulation of osteogenesis. SUMMARY BACKGROUND DATA: Until now, no suitable delivery fiber existed for CO2 laser endodontic radiation in the apical region where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, Sharplan Lasers designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal, thus favorably increasing the thermal effects. METHODS: The study was conducted on 900 teeth, corresponding to 1512 root canals, divided in two groups. Four hundred sixty-eight were new cases, carefully selected according to strict parameters such as wide periapical translucency over 1 mm, supported by digital x-ray, with a lesion of 3 mm and more. All root canals were mechanically prepared in the conventional method up to size 35, Physiological saline solution served as rinsing solution and the root canals were treated by 15 F CO2 laser microprobe for 60 pulses repeatedly. The temperature at the surrounding tissue of the root did not exceed 38 degrees C. RESULTS: Filling of the canal was possible at the same appointment, without antibiotic treatment. Four hundred thirty-two of the cases, which were referred to us by other dentists after an unsuccessful treatment according to the classic therapy, were treated by the same laser therapy. Follow-up was performed by clinical examination, and a digital x-ray was taken, during and after treatment as well as after 3, 6, 9, and 12 months. CONCLUSIONS: There is a 98% success rate in both study groups, according to objective criteria for successful treatment including reduction of apical translucency after 2-6 months, freedom from clinical complaints, and no need for periapical surgery.

Humans↗
PubMed2002

Micro-tensile bond strengths to sclerotic dentin using a self-etching and a total-etching technique.

OBJECTIVES: To evaluate the in vitro regional micro-tensile bond strengths of a self-etching/self-priming adhesive system to sclerotic dentin, in the absence or presence of phosphoric acid conditioning. METHODS: Naturally-occurring, non-carious cervical lesions on extracted premolars were hand-cleaned with a slurry of pumice and chlorhexidine, then bonded without further cavity preparation. One group was bonded using Clearfil Liner Bond 2V (Kuraray Co. Ltd., Osaka, Japan). The other group was first conditioned with K-etchant; 40% phosphoric acid gel (Kuraray) prior to the application of the self-etching primer. Artificially prepared wedge-shaped cavities were also made in sound premolars and bonded with the two methods as controls. Resin composite build-ups were made using Clearfil Protect Liner F and AP-X resin composite (Kuraray). After storage in water for 24h, the teeth were sectioned into 0.7 x 0.7 mm composite-dentin beams along the occlusal and gingival walls, and at the apex of the lesions. The use of two conditioning methods, two substrate types, and three different locations yielded 10-14 beams for each of the 12 groups. After testing for the microTBS, representative beams that were stressed to failure were examined with SEM. Remaining fractured beams were demineralized and processed for TEM examination. Statistical analysis was performed using a three-way ANOVA and Student-Newman-Keuls tests. RESULTS: Regardless of the conditioning methods, bond strengths to sound dentin were significantly higher than to sclerotic dentin (P< 0.05). With sclerotic dentin, there was no significant difference for the conditioning methods used, except that K-etchant significantly improved the bond strength at the gingival aspect of the lesions. Fractographic analysis revealed that the self-etching primer could not etch beyond the surface hypermineralized layer of sclerotic dentin. Interfacial failure occurred along the surface of the mineralized intermicrobial matrix and/or hypermineralized layer. With the use of phosphoric acid, a hybrid layer was only seen when the surface layers were thin. Incompletely removed sclerotic casts were evident in both groups. SIGNIFICANCE: Removal of the surface layers of sclerotic dentin and/or conditioning with stronger acids may be beneficial to obtain stronger bonding to sclerotic dentin.

Acid Etching, Dental↗
PubMed2006

Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA.

Thirty immature sheep incisor teeth were tested for their fracture resistance after various treatment modalities using calcium hydroxide (CH) or a mineral trioxide aggregate material (MTA) as a root filling. The incisors, having approximately 80% of their root growth completed, were removed from jaws of slaughtered sheep and divided into four experimental groups. The pulps were extirpated from all the teeth through the open apexes. (a) Saline group: the teeth were preserved in saline for 100 days at 6 degrees C. (b) CH group: the root canals were filled with CH and sealed apically with IRM and stored as above. (c) MTA group: the canals were filled with MTA and stored as above. (d) CH+MTA group: the canals were filled with CH and sealed with IRM. After 30 days, the CH was replaced with MTA and stored as above. At the end of the 100-day storage period, all teeth were embedded in plaster of Paris and tested for fracture strength at the cervical area in an Instron testing machine. The results showed a decrease in fracture resistance (a) of the incisors with CH in the root canals after 100 days of storage, compared to (b) teeth stored in intracanal saline and (c) teeth with 30 days of CH and then filled with MTA, and (d) those filled with MTA in the canals. In conclusion, when CH was kept in the canals of immature sheep teeth for only 30 days followed by root filling with MTA there was no significant decrease in strength of the root within an observation period of 100 days. This finding may be of importance in the decision of treatment plans for teeth with pulp necrosis and immature root formation.

Aluminum Compounds↗
PubMed2001

[Parapharyngeal and peritonsillar infection following mandibular third molar extraction].

Numerous complications following impacted third molar extractions have been described previously. Among these are swelling, infection, subdermal hematomas, nerve injuries, injuries to adjacent teeth and mandibular fractures. The parapharyngeal space is a funnel-shaped space with its base located at the base of the skull and its apex near the hyoid bone. It is bounded medially by the superior constrictor muscle and the tonsillar fossa and laterally by the medial pterygoid muscle, the mandibular ramus, the deep lobe of the parotid gland and the posterior belly of the digastric muscle. The junction of the buccinator and superior constrictor muscles at the pterygomandibular raphe forms the anterior border. The posterior border is formed by the vertebral column and the prevertebral muscles. Infratemporal and peritonsillar space infections following third molar extractions are relatively rare because of anatomical barriers that exist in that area, but complications of such infections are considered to be highly severe and sometimes even life threatening. These complications include septic thrombophlebitis of the internal jugular vein, septic aneurysms of the internal carotid artery and mediastinitis. This article presents a parapharyngeal and peritonsillar space abscess resulting from a third molar extraction. Several articles reviewed in this paper revealed similar signs and symptoms in parapharyngeal abscesses. The main radiological finding was soft tissue swelling in the prevertebral area. Cultures have demonstrated Klebsiella pneumoniae as the dominant microorganism in these infections. Early identification and correct diagnosis of parapharyngeal and peritonsillar abscesses are necessary to avoid life-threatening complications that may accompany such infections. Airway control should receive top priority in treatment, followed by extensive surgical drainage and administration of high dose organism-specific antibiotics as well as removal of the source of infection.

Adult↗
PubMed2003

Endodontic measurement accuracy and perceived radiograph quality: effects of film speed and density.

OBJECTIVES: This study sought to determine the effects of direct exposure x-ray film speed and background density on observer assessment of endodontic working lengths and on perceived radiographic image quality. STUDY DESIGN: A human cadaver maxilla section with surrounding soft tissues was used for the study. The canal length to the radiographic apex was determined on 4 canals in maxillary posterior teeth by using Trophy RVG images and adjusting the position of a No. 15 file in each canal until the file tip coincided with the radiographic apex in images made at 3 different vertical angulations. The files were measured with a micrometer from the file stop to the file tip to obtain the length to the radiographic apex. Then No. 10 files were placed in the 4 canals at varying lengths short of this previously determined length, and 5 observers assessed the distance from the file tip to the radiographic apex on radiographs made with Kodak D-, E-, and F-speed and Flow D- and E-speed direct exposure x-ray films that were exposed to produce background densities of 1.5, 2.0, and 3.0. Subjective appraisal of radiographic quality was also assessed. RESULTS: Analysis of variance and Tukey honestly significantly different post-hoc analysis results concerning measurement errors made with each film type revealed significantly less error for Kodak Ektaspeed Plus (E-speed) intraoral x-ray film than for Kodak InSight (F-speed) and Flow E; however, no difference was detected among Kodak Ektaspeed Plus (E-speed), Kodak Ultra-Speed (D-speed), and Flow D. Films with a background optical density of 3.0 received 98% favorable ratings; radiographs with a background optical density of 2.0 received 77% favorable ratings; and those with background optical density of 1.5 received only 18% favorable ratings at the 95% confidence level. Flow D film received the most favorable ratings, but there was no statistically significant difference among other film types at the 95% confidence level. CONCLUSIONS: Underexposed radiographs are perceived as inferior to slightly overexposed radiographs for endodontic file length assessment regardless of the film speed used. Current Flow and Kodak E-speed and F-speed radiographs appear to be as accurate as other accepted radiographs used in determining endodontic working lengths. Image background density should be kept constant when making comparisons among x-ray films.

Absorptiometry, Photon↗
PubMed1990

[Morphological studies on the roots of maxillary premolars in Japanese].

Visual observations were made of 3,202 maxillary first premolars and 3,365 maxillary second premolars from subjects of known sex, age, and side attributes. The material belongs to the Okamoto Research Laboratory of Dentistry. Items observed for each donor included number of dental roots, shapes of root apexes, root grooves, root orientation and curvature, and conditions of the maxillary first and second premolars. Results 1) In 65.7% of all materials (55.4% in males and 76.1% in females), maxillary first premolars had primary single roots. Complete branched roots accounted for 25.5% of the male and 17.6% of the female materials. In both cases, there was significant distinction between the sexes. Triple root teeth were extremely rare in both male- and female-donor teeth, as were double rooted maxillary second premolars. 2) Protruding, circular, and flat root apex types occurred in both maxillary first and second premolars. Circular and flat types were common among males. Branched and double-root maxillary first and second premolars were of either the complete or the incomplete type, both of which were more common in males. 3) About half of the mesial surface grooves in single-root maxillary first premolars were deeper than distal surface grooves in the same teeth: In 1/4-branch double teeth, 28.8% of the mesial surface grooves were deeper than the distal-surface grooves. The corresponding percentage for 1/3-branch double teeth was 38.8%. In 7.6% of 1/4-branch and 17.4% of 1/3-branch double teeth, distal-surface grooves were deeper than mesial-surface grooves. In 36.4% of 1/4-branch double teeth and 28.9% of 1/3-branch double teeth, the lower portion of the root was web shaped. In maxillary first premolars, lingual roots of 1/3-branch double-root teeth were cylindrical, as were 28.9% of buccal roots. Root grooves occurred on the lingual sides of 61.7% of all specimens. For 1/2-branch double root teeth, 18.4% were cylindrical: and 62.7% had grooves on the lingual side. Results are essentially the same in both cases. 4) Straight dental roots occurred in 37.4% of maxillary first and 35.4% of maxillary second premolars. Roots inclined distally in 36.7% of maxillary first premolars and in 18.8% of maxillary second premolars. A variety of inclinations and curvatures was observed. Booth roots were straight in 47.5% of 2-branch maxillary first premolars, whereas 35.1% had 1 straight and 1 inclined root and 84.4% had 2 distally inclined roots.(ABSTRACT TRUNCATED AT 400 WORDS)

Bicuspid↗
PubMed2006

Synthesis of a potentially bioactive, hydroxyapatite-nucleating molecule.

A human phosphophoryn (PP) cDNA was previously cloned from immature root apex total RNA in our laboratory. This cDNA comprises 2,364 bp, encoding 788 amino acids. More than 80% of the sequences are arranged as (DSS)(n) (n = 1-16), DS, and NSS motifs. We hypothesize that the capability of PP to bind Ca(2+) and nucleate hydroxyapatite may depend on these repeated sequences. Two polypeptides were synthesized based on the human PP cDNA sequence to test the hypothesis. One polypeptide has the amino acid sequence DDPNSSDESNGNDD (synthetic polypeptide 1, SP1), which is from the N-terminal end of PP; the other polypeptide, DSKSDSSKSESDSS (synthetic polypeptide 2, SP2), is the PP repeated sequence motif. Phosphorylation of the polypeptides was accomplished by reacting them with adenosine triphosphate and casein kinases I and II. The ability of these molecules to cause mineralization was tested in a steady-state agarose gel system. The results show that phosphorylated SP2 (P-SP2) precipitated approximately 60% of the total Ca + PO(4) precipitated by PP. P-SP1 precipitated about 23% of that precipitated by PP and was similar to the amount precipitated in the control gel, that is, without added peptides. Transmission electron microscopy and X-ray diffraction analysis showed that the precipitate formed in the P-SP2-containing gel was hydroxyapatite. The capability of P-SP2 to nucleate Ca + PO(4) and precipitate hydroxyapatite is a result of the repeated sequence motif, which contains a high percentage of phosphorylated serine. This molecule could be used in the repair and regeneration of dental tissue.

Adenosine Triphosphate↗
PubMed1990

[Morphological studies on the roots of lower first molars in Japanese].

Morphological observation of the roots of 2,164 lower first Japanese molars of known sex and side attributes, obtained from the collection of the Okamto Research Laboratory of Dentistry, produced the following results. 1. Roots varied from single to quadruple, but double roots were most common (70.6% in males and 83.4% in females). Next most frequent were triple roots 28.6% in males, 15.75% in females). Single-root was 0.7% in males, 1.1% in females. 2. Quadruple root occurred in only 1, male case (0.04% of the total). 3. Apical ramification occurred in 19.0% of all roots in the double-root category; 16.2% were ramifications on the mesial side only. In triple-root teeth, the ratio was higher: 21.9% for mesial roots. 4. Double-root teeth demonstrated 3 types of form of root apex pointed, rounded, and flat. These types were subdivided into 8 categories. The pointed type was most common (18.9% of the total) for both mesial and distal roots. 5. Orientation and curvature in doubler-root teeth (mesial and distal) were of 2 types. The separated type (Type I), in which the mesial and distal roots separate on the apical side, was most common (96.6% in males, 95.3% in females). 6. In triple-root teeth, size, orientation, and curvature of distal-lingual roots diversified into 8 types. Type V, in which lengths were about 2/3 that of the buccal root, size about half, and general curvature in the buccal-distal cheek plane with general straightness in the mesial-distal plane, was most common, accounting for 40.9% of the males and 47.0% of the females. 7. In double-root teeth, ramification degree between mesial and distal roots was 20.97 degrees in males and 18.97 degrees in females. In triple-root teeth the corresponding angles were 21.33 degrees in males and 18.98 degrees in females. In both cases, the angle was larger in male specimens. 8. In double-root teeth, root length was 12.75 mm in males and 12.41mm in females; root-trunk length was 3.22mm for males and 3.42mm in females. Differences between the sexes were significant in both cases. The root-trunk-length index was 25.24 for males and 27.56 for females, and the ratio of the length of root trunk to the root was 1/4. In triple-root teeth, root length was 12.66mm for males and 12.28mm for females; root-trunk length was 2.99mm for males and 3.21mm for females. The distal-lingual root length in triple-root teeth was 11.48mm in males and 11.10mm in females.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗