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A full crown with porcelain bonded to gold and a precision post and sleeve are used in a method to restore endodontically treated anterior teeth. Advantages include protection of the tooth from fracture in the future and utilization of the same sleeve later should another crown be needed.
Clinical and histopathologic findings are mixed in current endodontic classifications. A new system, based on symptomatology, may be more useful in clincial practice. The classifications are vital asymptomatic, hypersensitive dentin, inflamed-reversible, inflamed/dengenerating without area-irreversible, inflamed/degenerating with area-irreversible, necrotic without area, and necrotic with area.
Causes of tooth perforation include resorption, caries, and operator performance. The prognosis for a tooth with a perforation is related to the location of the perforation, negotiability of the canal, contamination, and treatment. Alternative treatment approaches include routine endodontic treatment, correction via the chamber, surgical correction, and stimulation of calcification. In most instances, a perforation can be treated so that satisfactory healing will occur.
The use of surgical fistulation after endodontic therapy caused clinical problems for two patients. Only one patient was treated successfully for restoration of a molar; for the second, surgery was not advised. Analgesics and antibiotics may be better initial therapy than use of fistulation.
A case of periapical actinomycosis is presented. Although apparently uncommon, actinomycosis should be considered when a chronic periapical lesion, often in the maxilla, is associated with an endodontically treated tooth or a previous history of trauma. Histologic examination of the tissue or the presence of "sulfur granules" in the exudate will usually establish the diagnosis. Treatment consists of local curettage and antibiotic therapy.
We have presented three cases of anesthesia and painful dysesthesia that occurred after the Sargenti technique was used in endodontic treatment of mandibular molars. Microsurgical techniques were used to alleviate painful causalgia and to restore functional sensation to the lower lip. The third patient refused treatment.
A case of Garre's osteomyelitis of the mandible is presented. The occlusal radiographs are good examples of the redundant cortical layering of the bone (onion skinning) that is classically found with this phenomenon. The cause of this case was a necrotic pulp in a carious molar with a periapical radiolucent area. We believe this is the first reported case in which an odontogenic source of infection (carious tooth) was treated not by extraction but by endodontic therapy. During the year after the root canal filling, the periapical radiolucent area filled in with new bone and the bony expansion of the mandible was completely resolved.
This study compares the fracture resistance of endodontically treated premolars with modified types of cavity preparations and restoration with either amalgam or composite resin. The greatest influence on fracture resistance was the remaining tooth structure. The effect of adequate wall support on tooth strength was compared with intact unprepared teeth.
Treating internal resorption is one of dentistry's most difficult challenges. This pathological process is difficult to manage in an advanced stage. The usual treatment involves surgery or, in many cases, extraction of the resorbed tooth. It is often difficult for the patient to understand and accept such a radical treatment approach. This report of case illustrates severe internal resorption that destroyed a major portion of a key abutment tooth supporting an eight-unit fixed partial denture. The resorptive pathosis was treated by a nonsurgical endodontic approach. The severely damaged abutment was reinforced and restored so that the existing eight-unit fixed partial denture could be preserved. The patient was pleased with the method of treatment and was commended for seeking regular recall professional care. It would have been easy to postpone treatment as the problem was asymptomatic. However, to do so probably would have resulted in loss of the resorbed abutment tooth, thus creating a complex restorative situation. The original prosthesis is currently 14 years old, functioning well, and showing no apparent evidence of pathosis. Costly and time-consuming remake procedures were avoided and patient satisfaction was maintained.
Periodontal surgery and biologic principles can be used to treat a variety of restorative and endodontic complications. Four cases illustrated the application of orthodontic therapy and periodontal surgery in the treatment of these difficulties.
Infection of pulpally involved teeth near the maxillary sinus sometimes spreads into the sinus and causes serious complications. This pathological complex, involving both antral and periapical tissues, is referred to as the endo-antral syndrome (EAS). It includes diagnostic difficulties, treatment considerations, and occasionally persistent pathological antral alterations after nonsurgical endodontic therapy. Surgical measures are occasionally required to stimulate healing and preserve the teeth.
The authors surveyed 360 general dentists and 291 endodontists to obtain information on routine, nonemergency endodontic treatments adapted to clinical practice. Frequent practices and recent advances in treatment modalities-including instrumentation, obturation, intracanal preparations, medications and restorations-are highlighted.
BACKGROUND: Sodium hypochlorite, or NaOCl, is one of the most commonly used irrigating solutions in endodontic practice. Its clinically proven antibacterial, solvent and lubricating properties make it a very appealing choice as an intracanal medicament. CASE DESCRIPTION: The authors present a case of facial hematoma formation after an inadvertent injection of NaOCl into the periapical tissues. The NaOCl solution caused extensive tissue destruction. Management of the condition required the hospitalization, intravenous antibiotic therapy and multiple intraoral surgical incisions to facilitate drainage. CLINICAL IMPLICATIONS: Use of NaOCl must be confined to the root canal system. This report reviews this intracanal medicament's potential toxicity and emphasizes the need for clinicians to remain cognizant of possible problems while using the solution.
BACKGROUND: Aging people experience a number of changes in the root canal systems of teeth that, while they are normal, have the potential to compromise the pulp's response to injury. METHODS: To better understand the dental perspective on these changes, the authors mailed a questionnaire to diplomates of the American Board of Endodontics. The questions dealt with the respondents' experiences, ages of their patient population and their perception of root canal changes in aging patients. The authors analyzed the data in terms of number of diplomates providing a response and stratified them on the basis of the respondents' number of years in practice. RESULTS: Respondents indicated that the number of patients aged 65 years and older in their practices is increasing. Virtually all of the diplomates agreed that the root canal gets smaller with age, but that this diminution does not contribute to the failure of treatment of affected teeth. Most respondents indicated that aging patients' teeth are in poorer condition than those of younger patients. CONCLUSIONS: As the U.S. population ages, clinicians need to have a better understanding of the physiological changes occurring in older patients' teeth that may influence the treatment required to help patients retain their natural dentition. Further studies are needed to determine the impact of aging on dental disease and treatment modalities. CLINICAL IMPLICATIONS: Recognition of changes in the dentition of aging patients will lead to more successful treatment, retention of functional natural dentition and better maintenance of general health.
BACKGROUND: The authors compared the levels of anticipated and experienced pain of patients who received endodontic therapy, or ET, with selected patient and dental characteristics. METHODS: Sensory and affective pain outcome measures (pain and unpleasantness) were evaluated by 333 adult patients immediately before and after dental school faculty or residents performed ET. Dentists provided clinical evaluations and a pulpal diagnosis for each tooth and then rated the level of their patients' pain during treatment. RESULTS: Before ET, 43 percent of all patients anticipated high outcome levels, yet only 22 percent experienced high pain levels, and only 18 percent experienced high unpleasantness levels. Outcome levels did not differ by tooth type, pulpal diagnosis, ET history or dental care attendance. Women were significantly more likely to anticipate higher pain and unpleasantness levels than were men. Experienced outcome levels, however, did not differ by sex. Anticipated and experienced outcome levels significantly decreased with increasing age. Dentists' evaluation of their patients' pain levels correlated more highly for female than for male patients. CONCLUSIONS: Pain experienced during ET often is less than anticipated. Younger people anticipate and experience higher pain levels. Women are more likely than men to anticipate, but not necessarily experience, higher pain levels. Dentists are more closely attuned to the pain experiences of their female patients. Clinical Implications. Practitioners could better prepare younger patients and female patients for ET and improve pain communication with male patients. Findings suggest that patients perceive each ET experience as new, implying that dentists should manage patients who have had ET in the past as carefully as those receiving ET for the first time.
BACKGROUND: Dental pain is a common occurrence, whereas spontaneous dissection of an internal carotid artery is rare. CASE DESCRIPTION: The authors describe a patient who experienced a spontaneous dissection of an internal carotid artery that manifested initially as dental pain in an endodontically treated molar. CLINICAL IMPLICATIONS: It is important for dental practitioners to be familiar with unusual causes of dental pain. In this case in which the cause of dental pain was uncommon, the authors referred the patient appropriately, thus avoiding potentially serious complications.
BACKGROUND: The clinical decision as to whether an endodontically treated (ET) tooth requires a post and a crown poses a challenge to dental practitioners. The author conducted a review of the principles for the use of post and core and the newer materials such as ceramic and fiber-reinforced posts. TYPES OF STUDIES REVIEWED: Using a MEDLINE search and resulting cross-references, the author selected original research articles and previous review articles on the topic of ET teeth, as well as that of post and core. RESULTS: The author reviewed the principles for the use of posts in terms of when it is necessary to use a post, different types of posts, various post materials and designs. He also reviewed the criteria and technique for post space preparation and post cementation. Finally, he discussed the principles of core buildup, as well as options for the final restorations. CLINICAL IMPLICATIONS: The author provides a review of the principles for the use of post and core, crowns and the different materials available today to help clinicians make a clinical decision based on sound evidence.
The aim of this study was to determine the minimum inhibitory concentration (MIC) and antimicrobial effectiveness by the direct exposure test of 4 endodontic irrigants [1% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 1% calcium hydroxide (Ca(OH)2; prepared with 1 g of Ca(OH)2 and 100 mL of sterile distilled water), a solution of Ca(OH)2 + detergent (HCT20)] for S. aureus, E. faecalis, P. aeruginosa, B. subtilis, C. albicans and a mixed culture. Microbial growth was analyzed by two methods: turbidity of the culture medium that was confirmed by Gram stain and subculture in a specific nutrient broth. In the dilution test, NaOCl solution showed MIC equal to 0.1% for S. aureus, E. faecalis, P. aeruginosa and C. albicans and equal to 1% for B. subtilis and the mixed culture. CHX (2%) presented MIC equal to 0.000002% for S. aureus, 0.02% for E. faecalis, B. subtilis, C. albicans and the mixed culture and 0.002% for P. aeruginosa. Ca(OH)2 solution (1%) showed MIC greater than 1% for all the microorganisms except P. aeruginosa for which it was equal to 1%. Calcium hydroxide solution + detergent showed MIC equal to 4.5 mL for S. aureus, P. aeruginosa, B. subtilis, C. albicans and the mixed culture and greater than 4.5 mL for E. faecalis. In the direct exposure test, NaOCl had better antimicrobial effectiveness for all microorganisms at all times. CHX (2%) was effective for S. aureus, E. faecalis and C. albicans at all times, and ineffective for P. aeruginosa, B. subtilis and the mixed culture. The other solutions showed the worst results.