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PubMed1996

Endodontic retreatment: a rational approach to non-surgical root canal therapy of immature teeth.

The specificity of retreating immature teeth involves generally a broadly wide open apex and/or an inverted root canal conicity (apical opening wider than the root canal orifice), a periapical pathology leading often to a continuous canal exudation and thin and fragile dentinal walls. Nonsurgical endodontic retreatment of immature teeth consists at first in removing coronal and root canal iatrogenic obstructions in order to regain total canal patency. Apexification is then the treatment of choice, preceding a final gutta-percha obturation. The present article outlines a step-by-step rational approach to the root canal retreatment of immature teeth, pertaining to their biomechanical and pathological specificity.

Calcium Hydroxide↗
PubMed1997

Endodontic treatment of an unusual mandibular second molar.

A case involving unusual pulpal morphology due to fusion or gemination was treated by conservative endodontic treatment. Clinically, the involved mandibular second molar had an enlarged clinical crown and an extra cusp with a deep carious lesion. Careful negotiation, instrumentation and obturation of the root canal system led to successful treatment.

Adult↗
PubMed1997

Evaluation of technical quality of endodontic treatment--reliability of intraoral radiographs.

The purpose of this study was to evaluate: 1) the use of the conventional buccolingual radiographic projection for estimating the technical quality of endodontic treatment and 2) the effect of the surrounding tissues on these evaluations. The material consisted of three radiographs of each of 108 extracted roots: a clinical radiograph, an in vitro radiograph taken in the buccolingual projection, and an in vitro radiograph taken in the mesiodistal projection. The radiographs were analysed by two observers and consensus was reached and used in the analyses. The agreement between the two observers was good, but statistically significant differences were found between recordings of the seal in the clinical radiographs and the in vitro radiographs taken in the buccolingual projection. The length of the root filling in each of the three projections was interpreted to be the same, while both inadequate seal and visible lumen apical to the root filling were recorded less frequently in the clinical radiographs than in either of the two in vitro projections. This difference was most pronounced in molar teeth. It was concluded that the lengths of root fillings could be measured correctly in clinical radiographs. Due to the anatomy of root canals in incisors and canines, there was a risk of misinterpreting an inadequate seal as adequate in these teeth. The large amount of tissue surrounding molar teeth tended to cause an underregistration of both inadequate seal and lumen apical to the root fillings in these regions.

Evaluation Studies as Topic↗
PubMed1997

Delayed endodontic and orthodontic treatment of cross-bite occurring after luxation injury in permanent incisor teeth.

A case is presented in which combined endodontic and orthodontic therapy was performed in traumatically injured teeth 12 months after an accident. Calcium hydroxide treatment was used to halt any possible resorption during orthodontic treatment. The teeth were repositioned in a desirable manner without any complication by orthodontic treatment. Root canal obturation was accomplished after the completion of active orthodontic treatment. Recall examination 12 months after completion of root canal treatment showed clinical and radiographic evidence of healing.

Adult↗
PubMed1998

Prospective study of two retrograde endodontic apical preparations with and without the use of CO2 laser.

This article covers a 4-year study that reports 320 cases in which endodontic surgery was performed for residual apical lesions or lesions that could not be treated in a conventional way. Four groups of 80 teeth each were formed and they were followed up after a 12-month interval. The first group comprised cases treated with a micro bur, retrograde filling and IRM; the second, cases treated at the apical and radicular portions with a CO2 laser; the third, cases in which the retrograde cavity was prepared with an ultrasonic device instead of a micro bur; and the fourth group comprised cases treated in a similar way to the second group, i.e., cases treated at the apical and radicular portions, but with a CO2 laser instead of a micro bur. After 12 months, the results showed a better prognosis with ultrasonic treatment. Regardless of technique, the CO2 laser did not improve the healing process.

Adolescent↗
PubMed1999

Antimicrobial effect of six endodontic sealers: an in vitro evaluation.

The aim of this study was to determine the in vitro antimicrobial effect of six endodontic sealers after 2, 20 and 40 days. The sealers studied were Apexit, Endion, AH26, AH-Plus. Procosol and Ketac Endo. The microorganisms used were Candida albicans, Staphylococcus aureus, Streptococcus mutans and Actinomyces israelii. Petri dishes were filled with sterile agar and 0.1-ml wells were prepared and filled with the sealers. The agar plates were stored for 24 h at 37 degrees C. The samples were then removed, immersed in 4.5 ml of culture medium and divided into three groups. The samples in group 1 were stored for 2 days at 37 degrees C whereas the samples of groups 2 and 3 were stored at 4 degrees C for 20 and 40 days respectively. The samples were then removed and discarded, and 0.1 ml of the culture medium was seeded on the agar plates in order to perform colony forming unit counts. Apexit, Endion and AH-Plus produced slight inhibition on Streptococcus mutans at 20 days and on Actinomyces israelii at every time interval. No effect was found on Candida albicans and Staphylococcus aureus. Ketac Endo only produced an antimicrobial effect on Actinomyces israelii at 2 and 40 days. AH26 and Procosol showed antimicrobial effect at 40 days on Candida albicans, at 20 and 40 days on Streptococcus mutans and Staphylococcus aureus, and an effective inhibition on Actinomyces israelii at every time interval. Statistical analysis revealed both sealers and microorganisms to be significant factors affecting results in groups 2 and 3. In conclusion, the sealers evaluated in this study showed different inhibitory effects depending on time span. Overall, sealers containing cugenol and formaldehyde proved to be most effective against the microorganisms at the time intervals studied.

Actinomyces↗
PubMed1999

Post-operative symptoms and healing after endodontic treatment of infected teeth using pulsed Nd:YAG laser.

Forty-four teeth in 38 patients, diagnosed with chronic apical periodontitis, were endodontically treated. Root canals were shaped using a step-back technique with 5% NaOCl and 3% H2O2 as irrigants. In half of the teeth the canal terminus was irradiated with pulsed Nd:YAG laser (1 W, 15 pps, 1 s). All canals were then obturated with laterally condensed gutta-percha points and sealer, and final radiographs were obtained. Occurrence of spontaneous pain was recorded 1 day after treatment. Percussion pain was recorded after 1 week, and then at 3 and 6 months after treatment. Radiographic follow-up was performed at 3 and 6 months. Percussion pain was significantly less (P < 0.05) in the laser-treated group than in the control group, both 1 week and 3 months after treatment. Other differences between the groups were not significant. These results suggested that the clinical application of pulsed Nd:YAG laser might be advantageous for the treatment of infected root canals.

Adult↗
PubMed1999

Detection and measurement of endodontic root perforations using a newly designed apex-locating handpiece.

Access openings and lateral root perforations were prepared in 40 single-rooted extracted teeth. The distance to the perforations was measured visually and then with the Tri Auto ZX. The electronic device was used first in its apex-locating function and then in conjunction with its automatic reverse mechanism. On average, the electronically measured length was slightly shorter than the visually measured length (P < 0.05). When the automatic reverse mechanism was used, the values registered were either consistent with or slightly different (+/- 0.5 mm) from the electronically measured length (P > 0.05). The results of this study revealed that the Tri Auto ZX detected and measured endodontic root perforations within a range of clinically acceptable variations.

Dental High-Speed Equipment↗
PubMed2004

Infected immature teeth treated with surgical endodontic treatment and root-reinforcing technique with glass ionomer cement.

The authors propose surgical endodontic treatment of immature teeth characterized by necrosis and infection, especially after failure of apexification or in the presence of older, fibrous, and extensive lesion. A glass ionomer cement, autopolymerizable and condensable, is used as retro-filling material and as a reinforcement material for the canal walls. The variety of different cases presented here show that this rapid technique is reliable and reproducible.

Adult↗
PubMed2006

Root resorption associated with an impacted mesiodens: a surgical and endodontic approach to treatment.

This article describes a case of root resorption of a maxillary non-vital immature incisor associated with an impacted and angulated mesiodens. The impacted tooth was surgically removed and the compromised incisor was subsequently endodontically treated. Over a period of 27 months the tooth was medicated with repeated applications of calcium hydroxide. Radiographically after 18 months, an incomplete hard tissue barrier was observed with full apical closure at the conclusion of 27 months of treatment. Once the patient was comfortable after surgical removal of the mesiodens, the tooth was asymptomatic and remained so for the duration of the treatment and after definitive restorative work had been completed.

Child↗
PubMed2005

Early loading of interforaminal implants immediately installed after extraction of teeth presenting endodontic and periodontal lesions.

BACKGROUND: Infection in tooth extraction sites has traditionally been considered an indication to postpone implant insertion until the infection has been resolved. PURPOSE: The aim of this study was to evaluate the survival rate of early-loaded implants placed immediately after extraction of teeth with endodontic and periodontal lesions in the mandible. MATERIALS AND METHODS: Twenty patients in need of mandibular implant treatment and with teeth showing signs of infection in the interforaminal area were included in the study. The patients received four to six implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in or close to the fresh extraction sockets and received a provisional prosthesis within 3 days. Final prostheses were delivered after 3 to 12 months. The surgical protocol paid special attention to the preservation of high implant stability and control of the inflammatory response. The patients were followed up for 15 to 44 months. RESULTS: No implants were lost, resulting in a 100% survival rate. A mean marginal bone loss of 0.7 mm (SD 1.2 mm) was registered during the observation period. No signs of infection around the implants were detected at any follow-up visit. CONCLUSION: A high survival rate can be achieved for immediately placed and early-loaded implants in the mandible despite the presence of infection at the extracted teeth.

Aged↗
PubMed1998

Esthetic restoration of endodontically treated teeth: factors that affect prognosis.

Restoration of endodontically treated teeth involves a complex system of components and component interfaces designed to resist force. Dental materials, forces on teeth, clinical circumstances, and restorative design determine restoration success. A new classification evaluates number of canals, amount of remaining tooth surface, chamber space, canal quality, and canal orientation.

Adult↗
PubMed2000

Lesions of the inferior alveolar nerve arising from endodontic treatment.

A lesion of the IAN following endodontic treatment of the lower molars and premolars is not a rare event and presents an uncomfortable situation both for the dental surgeon and the patient. Injury can result on the one hand by direct intrusion of the instrument through the apex into the mandibular canal, and on the other by the filling material which becomes forced into the mandibular canal. In the latter case, a nerve lesion will only result when the filling material contains neurotoxic substances such as paraformaldehyde. With a direct lesion or when forcing of resorbable filling material into the mandibular canal is suspected, one should first employ a wait-and-see approach, because usually the only nerve damage is in the form of neuropraxy or axonotmesis for which there is a high rate of spontaneous regeneration. However, if neurotoxic filling material is introduced into the direct vicinity of the nerves, the mandibular canal should be opened and the filling material should be removed as early as possible. If the filling material is forced directly within the endoneurium between the nerve bundles, the damaged nerve sections must be resected and bridged using transplants from the sural or greater auricular nerves.

Adult↗
PubMed2003

Cytotoxicity of a new endodontic filling material.

In vitro cell cultures have been widely used as a means of evaluating cytotoxicity of root canal filling materials. Following ANSI/ADA spec. no. 41, the aim of the present study was to investigate the biological compatibility of a new sealer (FibreFill) and compare it with some commercially available endodontic sealers (Bioseal and Acroseal). Mouse 3T3 fibroblasts were seeded and cultured and subsequently extracts of the cements were added. After 24 hours incubation, the cellular vitality of fibroblasts was evaluated by the neutral red uptake test (NRU), which measures the membrane permeability. Data were collected and statistically analysed. Results showed that all tested materials exhibited mild cytotoxic effects, which are compatible with normal clinical use, and no statistically significant difference was noted between FibreFill and the other tested materials. Therefore, selection amongst these sealers should be based on other factors.

3T3 Cells↗
PubMed2003

An in vitro study of coronal microleakage in endodontically-treated teeth restored with posts.

Coronal microleakage has received considerable attention as a factor related to failure of endodontic treatment and much emphasis is placed on the quality of the final restoration. Posts are frequently used for the retention of coronal restorations. These can be custom-made or prefabricated. Many authors have examined coronal microleakage with respect to gutta-percha root fillings and plastic coronal restorations, but few have investigated the coronal seal afforded by various post systems. The seal provided by a cemented post depends on the seal of the cement used. The purpose of this study was to compare coronal microleakage around cast and prefabricated posts using a dye-penetration method. Sixty extracted single-rooted human teeth were chemomechanically prepared. The root canals were filled with gutta-percha and sealer and they were then prepared for standard posts. Six groups, each of 10 teeth, were restored with either cast post or prefrabricated post. The posts were cemented with either glass ionomer cement (GIC), Variolink II or Durelon. The teeth were thermocycled and placed in Indian ink for one week. They were then demineralised and rendered transparent. Linear coronal dye penetration around the post was measured and compared. The least dye-penetration was observed in roots restored with a cast post and Variolink II. Dentatus posts demonstrated the most microleakage. It appears that the dentine-bonding cements have less microleakage than the traditional, non-dentine-bonding cements and adaptation of the post with the canal may be more important than the cement used.

Analysis of Variance↗
PubMed2004

Discuss the prevention and management of procedural errors during endodontic treatment.

Procedural errors in endodontics, or alternatively, any mistake that occurs at some point in the process of root canal treatment of a tooth can be a result of factors which the operator has both control, as well no control over. For the majority of these mistakes the operator is at fault, either through lack of operator knowledge or concentration during treatment. This is fortunate in the sense that this means these errors are, in the main, preventable. Keeping in mind that dentists, being human, will commit errors at some point in their career, knowledge as to how to manage these situations is indispensable. As there exists a multitude of possible procedural errors, the areas that are going to be focused on are those which occur more commonly, and those with more disastrous sequelae. These include: diagnosis, radiography, canal access, instrumentation, obturation, tooth isolation and coronal seal.

Humans↗
PubMed2006

Endodontics versus implantology: to extirpate or integrate?

An increasingly frequent dilemma in restorative dentistry is the question of whether to retain a badly damaged tooth and restore it, or to remove and possibly replace it. Given the ethical difficulties inherent in testing this question, it is unlikely that we will ever see a properly designed clinical trial that will provide an answer. One of the most strongly debated components of this question is whether endodontic treatment and restoration can compete with a dental implant-borne prosthesis in terms of longevity and success. In the current paper, the authors will attempt to: (i) answer this question based on our current understanding of the dental literature; and (ii) provide practitioners with guidelines that might be applied to their daily practices.

Dental Implantation, Endosseous↗
PubMed2006

Endodontic retreatment of a maxillary second molar with three separate buccal roots.

A rare case of a four-rooted maxillary second molar in a 39-year-old male patient is reported. After clinical and radiographic examination, two separate mesio-buccal roots were detected, and a treatment plan consisting treatment of the mesio-buccal roots and retreatment of the disto-buccal and palatal roots was made to resolve the previous treatment failure. The tooth was treated by orthograde endodontic retreatment in two visits. Mesio-buccal canals that were located in the separate mesio-buccal roots (which were missed in previous treatment) were found and treated. The case report underlines the importance of complete knowledge about root canal morphology and possible variations, coupled with full clinical and radiographic examination, in order to increase the ability of clinicians to treat difficult cases.

Adult↗