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PubMed1991

Endodontic instrumentation.

Endodontic instruments are used within the tooth pulp chamber and root canal systems. An understanding of the armamentarium of endodontic instrumentation is necessary in the selection of, and proper use of, these instruments. This proper selection and use of instruments along with the meticulous use of the endodontic triad, can greatly increase the probability of success of endodontic procedures. The endodontic triad is canal preparation, sterilization, and obturation. The object of preparation is to prepare the canal to accept obturation with a positive seal and appropriate sealer. This article describes in detail, the types of endodontic instrumentation available.

Animals↗
PubMed1990

Problems associated with the diagnosis and treatment of endodontic disease.

The diagnosis of endodontic lesions in animal dentistry is complicated and restricted by the use of objective diagnostic procedures. Human endodontics uses subjective symptoms to a large degree, as well as objective symptoms. Subjective symptoms include patient pain; sensitivity to hot or cold; percussion; and foul taste or odor. Veterinary dentists must receive input from clients, as well as using their own clinical and radiographic evaluation. Many endodontic lesions remain undetected because the client fails to notice broken or discolored teeth, facial swelling, drooling, difficulty in chewing, chewing only on one side, and general malaise. An increased awareness of the endodontic problems that can occur in animals increases the level of veterinary care. Numerous techniques, including apexogenesis, apexification, direct and indirect pulp capping, and conventional and surgical endodontic therapy, can be used to treat various endodontic problems successfully.

Animals↗
PubMed1993

Principles of endodontic therapy.

Endodontics is that branch of dentistry concerned with the treatment of damaged or diseased dental pulp. Veterinarians are now being asked to preserve tooth function and structure rather than to extract injured or diseased teeth. A variety of instruments are available that facilitate endodontic treatment. Endodontic treatment involves preparation (filing), sterilization, and obturation (filling) of the pulp cavity. Properly performed, endodontic therapy can effectively preserve dental structure and function. Complications of endodontic therapy will be discussed in "Problem Solving in Veterinary Endodontics" on page 165 in this issue.

Animals↗
PubMed2007

Antimicrobial photodynamic therapy combined with conventional endodontic treatment to eliminate root canal biofilm infection.

BACKGROUND AND OBJECTIVE: To compare the effectiveness of antimicrobial photodynamic therapy (PDT), standard endodontic treatment and the combined treatment to eliminate bacterial biofilms present in infected root canals. STUDY DESIGN/MATERIALS AND METHODS: Ten single-rooted freshly extracted human teeth were inoculated with stable bioluminescent Gram-negative bacteria, Proteus mirabilis and Pseudomonas aeruginosa to form 3-day biofilms in prepared root canals. Bioluminescence imaging was used to serially quantify bacterial burdens. PDT employed a conjugate between polyethylenimine and chlorin(e6) as the photosensitizer (PS) and 660-nm diode laser light delivered into the root canal via a 200-micro fiber, and this was compared and combined with standard endodontic treatment using mechanical debridement and antiseptic irrigation. RESULTS: Endodontic therapy alone reduced bacterial bioluminescence by 90% while PDT alone reduced bioluminescence by 95%. The combination reduced bioluminescence by >98%, and importantly the bacterial regrowth observed 24 hours after treatment was much less for the combination (P<0.0005) than for either single treatment. CONCLUSIONS: Bioluminescence imaging is an efficient way to monitor endodontic therapy. Antimicrobial PDT may have a role to play in optimized endodontic therapy.

Anti-Infective Agents↗
PubMed2006

The endodontic workforce.

The amount of endodontic care provided in the US requires an understanding of the supply and demand for such care. The supply side includes the number and location of endodontists, type of provider, and productivity. The demand side consists of the changing demographics of the age groups that endodontists predominantly treat along with changes in their dental health. To address these issues, we have compiled and analyzed data from American Dental Association (ADA) with other sources such as US government census data and the National Health and Nutrition Examination Surveys (NHANES). From 1982 to 2002, the supply of endodontists increased at a rate greater than that observed with general practitioners or the other specialty areas. The growth of endodontists in relation to general practitioners is important. The latter are co-providers of endodontic care as well as a primary source for referral of patients to endodontists. Demographic and disease changes are likely to impact the need and demand for endodontic services. Endodontists' patients are generally between the ages of 25 and 64 yrs. Currently, the majority of endodontists' patients are members of the large baby boom generation who in 2000 ranged in age from their late 30s to their late 50s. During the next 20 yrs the Baby Boom generation will be replaced by the numerically smaller Generation-X cohort. This generation has experienced substantially less total caries than baby-boomers and they most likely will have fewer endodontic sequela as they age. A moderating factor that could partially offset the predicted decline in numbers of patients is the increased number of teeth that Generation-Xers are likely to retain. A flexible endodontic workforce strategy must assess the impending demographic and disease trends in relation to future growth rates of both endodontists and general practitioners.

Adult↗
PubMed1994

The spatial distribution and geographic analysis of endodontic office locations at the national scale.

The major purpose of this article was to quantify and describe the spatial distribution of endodontic office locations at the national scale. This study consisted of 2858 US American Association of Endodontists member endodontists as subjects. Three research questions were developed and explored. The location quotient technique, the spatial autocorrelation approach, and the multiple-regression procedure were the major analytical methods. Major results were as follows: the highest concentration (2.09 to 2.62) of endodontic offices per 100,000 US population was located in just two states, Massachusetts and Connecticut; the spatial distribution of endodontic office locations did exhibit significant (p < or = 0.05, two-tailed test) spatial autocorrelation. Therefore, the spatial distribution of endodontic office locations was nonrandom. Individually, the most significant predictor of endodontic office locations was the location of general practice dentists (its beta coefficient was 0.960606, significant at p < or = 0.0001).

Adult↗
PubMed1994

Analysis of a referral-based endodontic practice: Part 1. Demographic data and reasons for referral.

There is little information in the dental literature regarding endodontic practice profiles and the reasons for referral to endodontic specialists. This study was undertaken to analyze various details of 2000 patients referred to an endodontist in Perth, Western Australia. The 2000 patients were comprised of 1295 (64.8%) females and 705 (35.2%) males. They were referred by 405 different dentists, clinics, or hospitals. The main reasons for referral were: management of pain (24.1% of patients), calcified/blocked canals (17.7%), endodontic retreatment (15.0%), trauma (12.9%), surgery (6.5%), and perforations (6.0%). Other reasons for referral included root resorption, fractured instruments, combined endodontic-periodontal lesions, second opinions, nervous patients, and medical complications. There were 312 people that did not require endodontic treatment, resulting in 1688 patients having treatment on 2221 teeth. Review appointments were attended by 50.2% of those patients due for recall examinations. The wide range of treatment procedures required and the high number of cases referred for diagnostic reasons indicate that endodontists must be highly skilled in all aspects of diagnosis, treatment planning, and treatment procedures.

Dental Pulp Diseases↗
PubMed1999

Application of titanium-alloy endodontic implants in conjunction with periradicular surgery.

OBJECTIVE: To evaluate the outcome of placement of titanium-alloy endodontic implants in conjunction with periradicular surgery. STUDY DESIGN: Twenty-four teeth were treated with endodontic implants with corresponding periradicular surgery by using SuperEBA cement (Harry J Bosworth Co, Skokie, Ill) as a sealer. The results of the endodontic implant surgery were evaluated clinically and radiographically from 2 to 4 years after treatment. RESULTS: Twenty-two teeth were treated successfully, whereas 2 teeth were treated unsuccessfully, for a success rate of 92%. CONCLUSIONS: Titanium-alloy endodontic implants in conjunction with periradicular surgery may provide good short-term results. Sealing between the endodontic implant and the dentin is likely an important factor for success.

Adult↗
PubMed1997

Undergraduate endodontic teaching in the United Kingdom: an update.

Anecdotal evidence and scientific surveys suggest that the quality of root canal treatment within the General Dental Services is often less than ideal. Six years ago, it was reported that endodontic teaching in the United Kingdom was given a low priority and that the time devoted to the laboratory practice of root canal treatment should be increased. In the following year, the European Endodontic Society (ESE) published guidelines for the teaching of Endodontology and made recommendations as to what should be included in the undergraduate curriculum. Shortly afterwards, the ESE published quality guidelines for endodontic treatment. The aim of this project was to determine the current pattern of undergraduate endodontic teaching within the dental schools of the UK. Data were gathered by questionnaire from all 14 undergraduate dental schools and supplemented with further detailed enquiries where necessary. The results were compared with that reported following an identical survey carried out previously. Although the ESE curriculum guidelines for endodontic teaching provide an overall framework for teaching, the results of this study confirmed that a number of topics were either not included or were covered only briefly. However, the average time devoted to the preclinical instruction of root canal treatment in the first clinical year had increased from 14 to 24 h, with additional time provided in subsequent years by the majority of schools. In most instances, staff teaching endodontology in the UK have no specialist training.

Curriculum↗
PubMed2000

Lasers in endodontics: a review.

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

Dental Pulp↗
PubMed2000

Endodontic teaching in Philippine dental schools.

AIM: The aim of this study was to evaluate the pattern of undergraduate endodontic teaching in Philippine dental schools. METHODOLOGY: Data were gathered by sending questionnaires to the deans of the 23 dental schools in the country to determine details of the teaching of root canal treatment in permanent teeth. The covering letter requested that endodontic staff complete the questionnaire. RESULTS: Twenty of 23 dental schools returned completed questionnaires. Similarities were observed in the timing of undergraduate endodontic teaching, working length determination, and root canal preparation technique. Irrigating fluids recommended included one or a combination of the following: sodium hypochlorite, hydrogen peroxide, distilled water and EDTA. The root canal medicaments popularly employed were CMCP and eugenol. Most schools used slow-setting zinc oxide eugenol cement as sealer. Differences between schools were noted in the laboratory component of the course. The time allotted for the laboratory exercises, as well as the number of teeth used, differed greatly between each school. An inadequate tutor to student ratio was noted in the majority of schools. Teaching aids were limited and, in most instances, produced by faculty members. Most faculty members teaching endodontics had no specialist training. CONCLUSION: The results of this study have demonstrated that there is a need to review endodontic teaching in the majority of the Philippine dental schools to ensure that the course content and curriculum employed by all schools meet specified standards and that appropriate measures should be considered to enhance the learning experience of students.

Curriculum↗
PubMed2003

Factors influencing referral for specialist endodontic treatment amongst a group of Dutch general practitioners.

AIM: To analyse the need for endodontic referral amongst a group of Dutch general practitioners and to examine the current referral patterns and factors influencing the decision to refer. METHODOLOGY: A questionnaire was designed to investigate the perceived need for endodontic referral, the factors that influenced the decision process, the specialist to whom the case was referred and the frequency of referring. The questionnaires were distributed amongst 500 dentists attending a scientific meeting of the Netherlands Society for Endodontology (NVvE) and to 83 members of 10 study groups responding to a request in a newsletter. These groups were chosen to represent those dentists who possessed a similar degree of general dental knowledge and were acquainted with the requirements that endodontic treatment should meet. RESULTS: The response rate was 41%. Of the respondents, 93% felt the need to refer cases to specialists. The majority of dentists preferred to refer to an endodontist rather than an oral surgeon. The major factors considered to be important or very important (37 and 54%, respectively) for endodontic referral were the presence of an obstruction in the canal, followed by the presence of a perforation or resorption (43 and 34%, respectively) and persistent signs and/or symptoms (39 and 32%, respectively). NVvE members referred significantly less to oral surgeons than nonmembers. CONCLUSIONS: Amongst a group of Dutch general practitioners there is a substantial perceived need for referring endodontic cases to specialists.

Decision Making↗
PubMed2001

Endodontic decisions based on clinical appearance.

Too often, endodontically compromised teeth are ignored because they are not accurately identified, nor their significance realized. By systematically evaluating each potentially affected tooth, a practitioner can correctly diagnose endodontic cases and plan therapy accordingly. Endodontic pathology, with non-vital pulps and subsequent abscessation, can affect not only the tooth but also the rest of the patient. Physical examination, both external and oral, can be combined with tactile and transillumination assessment. Radiographic appraisal is essential in determining periapical health, both to determine the vitality of the tooth and to ascertain if endodontic therapy is appropriate, of if extraction is the best choice. This report aims to provide the reader with a clearer understanding of diagnosing endodontic cases to facilitate selection of the appropriate treatment.

Animals↗
PubMed2003

Patterns of endodontic care for a Washington state population.

Endodontic care, provided by 3,402 dental offices, was assessed from claims data maintained by the Washington Dental Service for 1999. Approximately 5.7 million dental procedures were provided to 880,317 patients by 2,796 general practitioners, 105 endodontists, and 494 other specialists. Of all dental services, 63,321 (1%) were endodontic procedures involving 52,911 (6%) patients. General dentists, endodontists, and other specialists performed 64.7%, 33.7%, and 1.6% of endodontic procedures, the majority of which were root canal therapy. The most frequent tooth types treated by root canal therapy were mandibular first molars (17.0%), maxillary first molars (15.2%), mandibular second molars (11.8%), maxillary second bicuspids (10.3%), maxillary second molars (9.1%), maxillary central and lateral incisors (8.8%), and mandibular second bicuspids (8.0%). Direct and indirect pulp caps by generalists and conventional retreatment and surgical therapy by endodontists made up the majority of the remaining endodontic services. Men had a greater procedure rate than women for most endodontic procedures.

Adolescent↗
PubMed1991

Setting up an MSc programme in endodontics.

The course has been designed to provide a suitable foundation for academic and general practice careers. Emphasis has been placed on developing diagnostic and practical skills. Students are encouraged to review their clinical practice critically in the light of recent advances in knowledge. The course begins with an intensive period of lectures and seminars covering general aspects of endodontics, and is generously supplemented by practical demonstrations and classes on a variety of procedures performed on laboratory models. The course continues with lectures and seminars designed to stimulate group discussion. These are complemented by supervised clinical sessions encompassing assessment, planning and treatment of a comprehensive range of conventional and surgical endodontic problems. The syllabus includes relevant basic sciences, pathology, differential diagnosis, pharmacology and therapeutics. The biological basis for endodontics is stressed and covers the following: maintenance of pulp vitality; effects of pulp capping pulpotomy and pulpectomy; the management and treatment of traumatic injuries to teeth; the management of medically compromised patients; the effect of various methods of instrumentation of root canals; radiology; restorative treatment of the endodontically treated tooth; the interface between endodontics and periodontics, prosthetics or orthodontics. Each student is required to undertake a research project and write a report.

Education, Dental, Graduate↗
PubMed2001

[Repair and revision 7. Endodontic treatment of crowned teeth: restoration replacement, removal or trephining].

Endodontic complications with crowned teeth are not uncommon in the daily practice. When a tooth, restored with a crown or a fixed bridge, requires endodontic (re)treatment the dentist has a choice to either discard the restoration, remove it and recement it after endodontics, or to trephine the restorations. Discarding is indicated when clear shortcomings of the crown or bridge are encountered. Removal facilitates endodontic treatment. If removal is not feasible, an endodontic access cavity is prepared in the restoration. Based on case reports practical advice is presented in this article.

Crowns↗
PubMed2003

Continuing professional education in endodontics in New Zealand.

OBJECTIVES: To determine the uptake of and wants of New Zealand general dental practitioners for continuing education in endodontics. DESIGN: Mail-out survey questionnaire. MATERIALS AND METHODS: A survey form was sent to general dental practitioners on the Dental Register and data were analysed using SPSS. RESULTS: The response rate was 79 percent. The majority of respondents (92 percent) stated they were either very interested or moderately interested in endodontics, with nearly 34 percent being members of the national endodontic society. Seventy-six percent had attended an endodontic course in the past three years and 85 percent wanted to attend a course. Hands-on courses were the most popular. CONCLUSIONS: Endodontics is a popular discipline in New Zealand, with over 75 percent of respondents having regularly attended refresher courses and wanting to attend further courses.

Education, Dental, Continuing↗
PubMed2005

[LASER applications in endodontics].

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of lasers with a wide range of characteristics are now being used in endodontic therapy. In the past two decades much experience and knowledge has been gained The first purpose of the present paper is to provide an understanding of the essential physical science behind laser technology and information on the effects of laser beams on tissue (tissue interaction). A second purpose is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, modification of the root canal walls, sterilization of the root canal system, cleaning--shaping--obturation of the root canal, and endodontic surgery. It will be clear that a number of endodontic procedures with conventional treatments cannot provide comparable results or are less effective.

Dental Instruments↗