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In vitro computer analysis of crown discolouration from commonly used endodontic sealers.

The aim of this study was to assess the degree of staining of tooth crowns by commonly used endodontic sealers using a computer analysis method. Crown discolouration by root canal sealers AH26, Endofill, Tubliseal, Zinc oxide eugenol (ZnOE), Apatite root canal sealer III as well as gutta-percha and Cavizol (a filling material containing ZnOE) were tested on extracted human premolar teeth. The roots of the teeth were resected 3 mm below the cemento-enamel junction. The pulp chambers were then cleaned and irrigated. The samples were divided into nine groups of five samples each and filled with test materials. Ten teeth were used as control groups: five positive (amalgam) and five negative (distilled water). The degree of tooth discolouration was analysed at 3, 6 and 9 months. The crown discolouration was assessed by computer analysis of digital images taken from the samples using the CIE Lab colour system. Statistical analysis was carried out using anova, repeated measure anova and Tukey's HSD tests. All sealers caused a degree of tooth discolouration, which increased with time. Endofill and ZnOE caused the greatest discolouration and Apatite root canal sealer III caused the least discolouration after 9 months. The most discolouration during the test periods occurred in the cervical third of the crown.

Analysis of Variance↗

Endodontic treatment of primary teeth.

Endodontic treatment of primary teeth is undertaken by indirect pulp capping, direct pulp capping, formocresol pulpotomy and pulpectomy. The same treatment principles apply to both primary and permanent teeth with infected or necrotic pulps. The main differences are the use of formocresol for root canal medication and a resorbably zinc-oxide and eugenol paste for root canal obturation.

Child↗

Antibiotics and endodontics.

Antibiotics can be used as an adjunct to endodontic treatment in a number of ways--locally, systemically and prophylactically. The local or intra-canal use of antibiotics in the form of medicaments is common. However, the commercially available agents for this purpose may not be the ideal mixtures. Systemic antibiotics should be restricted to patients who have local signs of infection, malaise and elevated body temperature. Prophylactic use of antibiotics has been recommended for patients 'at risk' of infective endocarditis, in some pre-surgical situations and following avulsion and replantation of teeth. The tendency towards indiscriminate antibiotic use should be discouraged. The use of broad spectrum drugs should be restricted so that these medications remain effective in serious situations.

Anti-Bacterial Agents↗

Medicaments: aids to success in endodontics. Part 2. Clinical recommendations.

In order to predictably achieve bacteria-free root canal systems, especially in pulpless teeth, it is necessary to use intra-canal medicaments. Medicaments can also be used to influence the peri-radicular response to endodontic treatment. Consideration of a material's therapeutic action must be made when selecting a medicament for any pathological condition. In general, only two commercial preparations satisfy the general requirements for root canal medicaments. Guidelines and the rationale for the use of these preparations are presented.

Humans↗

Endodontic sequelae of dental erosion.

BACKGROUND: The incidence of pulp involvement in patients with excessive wear has not been extensively documented. METHODS: Clinical records of 448 patients with excessive tooth wear were reviewed and 52 cases (11.6 per cent) with near or frank pulp exposures or root canal treatments were found and their numbers and sites were tabulated. Light microscopy of study models was used to determine aetiology at each site of exposure as attrition, erosion or abrasion, scanning electron microscopy (SEM) was performed on some individual teeth. RESULTS: Forty sites of near exposure and 57 sites of frank exposures or root canal treatments were found, some cases had both types of exposure. The commonest sites exposed by erosion were the palatal surfaces of maxillary, and the incisal surfaces of mandibular anterior teeth. Posterior teeth were not commonly affected. Toothbrush abrasion had exacerbated some lesions as shown by SEM. CONCLUSIONS: Endodontic sequelae were found in 11 per cent of tooth wear patients as late stages of dental erosion. Near and frank exposures of the pulp thus constitute a small but significant, problem for the Australian dental profession's concern in the management of the tooth wear cases.

Adolescent↗

The healing potential of periodontal-endodontic lesions.

Osseous lesions involving the periodontium, and which are sometimes associated with discomfort and pathologic changes such as swelling or the development of a sinus tract, are not always due to periodontal disease. Thus, it is not uncommon to find a dentition with generally good periodontal health but with one tooth having a severe isolated bony periodontal defect. In other cases, periodontal treatment may result in a general improvement, except in relation to one tooth which does not respond to the therapy. Very often these cases are instances of combined periodontal-endodontic lesions, but which are solely of pulpal origin. This paper serves to help the dental practitioner recognise the disease process underlying the condition and appreciate its effective management with non-surgical root canal treatment.

Dental Fistula↗

Bacteriology of dental abscesses of endodontic origin.

Aspirates have been cultured from 10 dental abscesses of endodontic origin, all of which had penetrated beyond the bony alveolus to produce fluctuant swelling. Sampling was by syringe aspiration. Strict anaerobic techniques, including the use of an anaerobic chamber, were used for serial dilution and plating. Randomly selected colonies (100) from each culture were purified, characterized, and identified. Seventy percent of the bacterial isolates were either strict anaerobes or microaerophilic. One abscess yielded a pure culture of a viridans streptococcus, Streptococcus milleri. Streptococcus intermedius dominated the flora in a second abscess. The common oral streptococcus, Streptococcus sanguis, constituted only 2% of the isolates from one additional infection. Fusobacterium nucleatum, Bacteroides melaninogenicus, other Bacteroides including B. oralis and B. ruminicola, anaerobic diphtheroids, Peptostreptococcus micros, and Staphylococcus epidermis were other predominant isolates.

Bacteria, Anaerobic↗

PCR-based identification of bacteria associated with endodontic infections.

PCR primers that target the bacterial 16S rRNA genes (or the tuf gene for the genus Enterococcus) were used to identify 10 putative bacterial pathogens in root canals with necrotic pulp. In addition, the associations of these microorganisms with symptoms and a history of diabetes mellitus were investigated. Microbial samples from the root canals of 24 teeth with necrotic pulp were included in the study. PCR with universal bacterial primers identified bacterial DNA in 22 specimens; the remaining 2 specimens were from intact teeth that had been traumatized 6 months prior to treatment. PCR with specific primers showed that preoperative symptoms were significantly associated with the presence of Streptococcus spp. (P < 0.001 by chi-square analysis). There was also a nonsignificant trend for symptoms to be associated with Fusobacterium nucleatum and Porphyromonas gingivalis (odds ratio, >2) and for diabetes mellitus to be associated with P. gingivalis and Porphyromonas endodontalis (odds ratio, >2). Cloning and sequencing of the universal PCR product in one specimen revealed the presence of an organism related to the genus Olsenella, which has not previously been described in endodontic infections.

Bacteria↗

Composition and mechanical properties of gutta-percha endodontic points.

Gutta-percha endodontic filling points were found to contain approximately 20% gutta-percha (matrix), 66% zinc oxide (filler), 11% heavy metal sulfates (radiopacifier), and 3% waxes and/or resins (plasticizer). The mechanical properties were indicative of a partially crystalline viscoelastic polymeric material. They were found to obey Hooke's law and displayed a prominent upper and lower yield point when stressed beyond the proportional limit. The essential differences in mechanical properties of individual brands were found to be a function of the gutta-percha and zinc oxide concentration.

Elasticity↗

Collagen degradation in endodontically treated teeth after clinical function.

Endodontically treated teeth restored with posts are susceptible to coronal leakage after long-term function. We hypothesize that demineralized collagen matrices (DCMs) created in dentin by acidic zinc phosphate cement within the dowel spaces degrade with time. Forty-two post-restored teeth were extracted after three periods of clinical service and were examined, by means of scanning and transmission electron microscopy, for the status of the DCMs. SEM revealed a progressive degradation of the DCMs, becoming less dense after 3 to 5 years, losing structural integrity after 6 to 9 years, and partially disappearing after 10 to 12 years. TEM revealed evidence of collagenolytic activity within the DCMs, with loss of cross-banding and unraveling into microfibrils, and gelatinolytic activity that resulted in disintegration of the microfibrils. Bacterial colonization and the release of bacterial enzymes and of host-derived matrix metalloproteinases may contribute to the degradation of collagen fibrils in root dentin after clinical function.

Bacteria↗

Treponema denticola in disseminating endodontic infections.

Treponema denticola is a consensus periodontal pathogen that has recently been associated with endodontic pathology. In this study, the effect of mono-infection of the dental pulp with T. denticola and with polymicrobial "red-complex" organisms (RC) (Porphyromonas gingivalis, Tannerella forsythia, and T. denticola) in inducing disseminating infections in wild-type (WT) and severe-combined-immunodeficiency (SCID) mice was analyzed. After 21 days, a high incidence (5/10) of orofacial abscesses was observed in SCID mice mono-infected with T. denticola, whereas abscesses were rare in SCID mice infected with the red-complex organisms or in wild-type mice. Splenomegaly was present in all groups, but only mono-infected SCID mice had weight loss. T. denticola DNA was detected in the spleen, heart, and brain of mono-infected SCID mice and in the spleen from mono-infected wild-type mice, which also had more periapical bone resorption. The results indicate that T. denticola has high pathogenicity, including dissemination to distant organs, further substantiating its potential importance in oral and linked systemic conditions.

Alveolar Bone Loss↗

Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth.

There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth.

Adult↗

The periodontal-endodontic interface.

The periodontal tissues and the pulp-dentine complex form an intimate continuum through which pathological changes of either one may lead to infection of the other, and whose management can be fraught with diagnostic and therapeutic difficulty. The purpose of this review paper is to explain the nature of that relationship and to provide pointers which may assist in the diagnostic process and thus enable appropriate management from the outset. Traditional classifications of lesions affecting the periodontal-endodontic complex have caused confusion by attempting to form diagnoses which indicate the putative primary source of infection. We would suggest that the origin of the infection is irrelevant to the management process, and that what is important is whether either, or indeed both, of the tissues are viable or not. Successful therapy will only result from the establishment of an accurate diagnosis, and forming such a diagnosis requires a methodical multi-staged approach.

Dental Pulp Diseases↗

Current practice in endodontics: 5. Obturation.

The aim of this series of six articles is to improve the quality of endodontic treatment in general dental practice by considering what is currently being taught in dental schools. This article first considers the possible reasons for persisting symptoms following preparation of the root canals. It then reviews the many and varied methods of obturating the prepared root canal system that are available to the general dental practitioner. By considering the objectives of their treatment, and their own level of expertise, readers may decide that one or more new techniques may benefit their practice.

Dental Leakage↗

Current practice in endodontics: 6. Retreatments and periradicular surgery.

The prime aim of this series of six articles has been to improve the quality of endodontic treatment in general dental practice by considering what is currently being taught in dental schools. This final article considers what may go wrong following completion of root canal treatment, whether orthograde retreatment is possible and how it may be achieved, and if or when periradicular surgery may be indicated.

Dental Restoration Failure↗

Severe external root resorption arrested by conventional endodontic treatment.

A case is presented of inflammatory external root resorption detected on radiographic examination. Conventional endodontic treatment, including calcium hydroxide dressing for two weeks and obturation of the root canal system using the vertical compaction of warm gutta-percha technique was a simple and effective treatment modality for arresting the resorptive process and maintaining the integrity of the patient dentition.

Female↗