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Algahtani FN, Almohareb R, Aljamie M, Alkhunaini N, ALHarthi SS, Barakat R. Application of advanced platelet-rich fibrin for through-and-through bony defect during endodontic surgery: Three case reports and review of the literature. World J Clin Cases 2023; 11:4168-4178. [PMID: 37388804 PMCID: PMC10303602 DOI: 10.12998/wjcc.v11.i17.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The use of advanced platelet-rich fibrin (A-PRF) membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.
CASE SUMMARY Herein, three patients presented to the endodontic clinic suffering from apical periodontitis, associated with large bone resorption and related to previously endodontically treated teeth. Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane. Cone-beam computed tomography (CBCT) was used to assess the cases before and after the surgery.
CONCLUSION Four months post-surgery, the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone. A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.
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Affiliation(s)
- Fahda N Algahtani
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Rahaf Almohareb
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Manar Aljamie
- Department of Endodontics, Vision Colleges of Dentistry and Nursing, Riyadh 11671, Saudi Arabia
| | - Nouf Alkhunaini
- Department of Dental, Specialized Medical Center Hospitals, Riyadh 11671, Saudi Arabia
| | - Shatha Subhi ALHarthi
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Reem Barakat
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Setzer FC, Kratchman SI. Present Status and Future Directions - Surgical Endodontics. Int Endod J 2022; 55 Suppl 4:1020-1058. [PMID: 35670053 DOI: 10.1111/iej.13783] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
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Affiliation(s)
- F C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - S I Kratchman
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Crossen D, Morelli T, Tyndall DA, Tawil PZ. Periapical Microsurgery: A 4-dimensional Analysis of Healing Patterns. J Endod 2019; 45:402-405. [DOI: 10.1016/j.joen.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Kumar Singh A, Saxena A. Treatment of Periradicular Bone Defect by Periosteal Pedicle Graft as a Barrier Membrane and Demineralized Freeze-Dried Bone Allograft. J Clin Diagn Res 2017; 11:ZD12-ZD14. [PMID: 28274066 DOI: 10.7860/jcdr/2017/22498.9161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
Abstract
The purpose of this case report is to describe the usefulness of Periosteal Pedicle Graft (PPG) as a barrier membrane and Demineralized Freeze-Dried Bone Allograft (DFDBA) for bone regeneration in periradicular bone defect. A patient with intraoral discharging sinus due to carious exposed pulp involvement was treated by PPG and DFDBA. Clinical and radiological evaluations were done immediately prior to surgery, three months, six months and one year after surgery. Patient was treated using split-thickness flap, PPG, apicoectomy, defect fill with DFDBA and lateral displacement along with suturing of the PPG prior to suturing the flap, in order to close the communication between the oral and the periapical surroundings through sinus tract opening. After one year, successful healing of periradicular bone defect was achieved. Thus, PPG as a barrier membrane and DFDBA have been shown to have the potential to stimulate bone formation when used in periradicular bone defect.
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Affiliation(s)
- Awadhesh Kumar Singh
- Professor, Department of Periodontology, Chandra Dental College and Hospital , Barabanki, Uttar Pradesh, India
| | - Anurag Saxena
- Junior Resident, Department of Periodontology, Chandra Dental College and Hospital , Barabanki, Uttar Pradesh, India
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Torabinejad M, Moazzami SM, Moaddel H, Hawkins J, Gustefson C, Faras H, Wright K, Shabahang S. Effect of MTA particle size on periapical healing. Int Endod J 2017; 50 Suppl 2:e3-e8. [PMID: 27977855 DOI: 10.1111/iej.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/08/2016] [Indexed: 12/01/2022]
Abstract
AIM To examine the effect of reduction in MTA particle size on dento-alveolar and osseous healing in dogs. METHODOLOGY Root canals of 24 mandibular premolars in four 2-year-old beagles were prepared and filled with gutta-percha and sealer. Two to four weeks later, during periapical surgery, the root-end cavity preparations in these teeth were filled with either grey ProRoot MTA or modified (reduced particle sizes with faster setting time) MTA. The animals were sacrificed 4 months later. Degrees of inflammation, type of inflammatory cells, fibrous connective tissue adjacent to the root-end filling materials, cementum formation over the resected roots and root-end filling materials and bone healing were examined. Data were analysed using the McNemar test. RESULTS No significant differences in healing of periapical tissues were found when comparing ProRoot MTA to a modified MTA containing reduced particle sizes. CONCLUSION Reducing the particle sizes of MTA did not impact its biological properties.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| | - S M Moazzami
- Department of Endodontics, Mashad University, Mashad, Iran
| | - H Moaddel
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| | - J Hawkins
- Private Practice, Kennewick, WA, USA
| | | | - H Faras
- Department of Endodontics, Kuwait University, Kuwait City, Kuwait
| | - K Wright
- Department of Anatomy, Loma Linda University, Loma Linda, CA, USA
| | - S Shabahang
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
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Singh S, Podar R, Dadu S, Kulkarni G, Purba R. Solubility of a new calcium silicate-based root-end filling material. J Conserv Dent 2015; 18:149-53. [PMID: 25829696 PMCID: PMC4379657 DOI: 10.4103/0972-0707.153053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/05/2014] [Accepted: 01/06/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare solubility of a new calcium silicate-based cement, Biodentine with three commonly used root-end filling materials viz. glass-ionomer cement (GIC), intermediate restorative material (IRM), and mineral trioxide aggregate (MTA). MATERIALS AND METHODS Twenty stainless steel ring molds were filled with cements corresponding to four groups (n = 5). The weight of 20 dried glass bottles was recorded. Samples were transferred to bottles containing 5 ml of distilled water and stored for 24 h. The bottles were dried at 105C and weighed. This procedure was repeated for 3, 10, 30, and 60 days. Data was analyzed with one-way analysis of variance (ANOVA) test (P < 0.05). RESULTS Biodentine demonstrated significantly higher solubility than MTA for 30- and 60-day immersion periods. Statistical difference was noted between the solubility values of Biodentine samples amongst each of the five time intervals. CONCLUSIONS Biodentine exhibited higher solubility in comparison with all other cements.
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Affiliation(s)
- Shishir Singh
- Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India
| | - Rajesh Podar
- Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India
| | - Shifali Dadu
- Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India
| | - Gaurav Kulkarni
- Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India
| | - Rucheet Purba
- Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India
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Jung S, Mielert J, Kleinheinz J, Dammaschke T. Human oral cells' response to different endodontic restorative materials: an in vitro study. Head Face Med 2014; 10:55. [PMID: 25533283 PMCID: PMC4298870 DOI: 10.1186/s13005-014-0055-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/05/2014] [Indexed: 01/16/2023] Open
Abstract
Introduction The aim of this study was to compare the biological interaction of human osteoblasts and cells of the human periodontal ligament (PDL) with different endodontic restorative material as Mineral Trioxide Aggregate (MTA), Biodentine, amalgam and composite over a time period of 20 days. Materials and methods Human PDL cells and osteoblasts were harvested, cultured and according to standardized protocols. The cell populations were characterized with the corresponding surface markers following standardized procedures. The specimens were produced with special regard to constant dimensions and volume in the different groups. Cell attachment and proliferation were evaluated morphologically after Richardson staining and cell count was performed after 1d, 8d, 13d and 20d. All experiments were performed in triplets. The results were statistically analyzed using the ANOVA- and Tukey-test (p < 0.05). Results Morphological analysis proved good proliferation and cell attachment in both cements. A remarkable result was the organized spreading and parallel alignment of the PDL cells in contact with MTA and especially Biodentine (cells maturing in a second cell layer crossway to the first one). From 8d onward Biodentine showed the highest quantity of PDL cells (p < 0.05). Biodentine and MTA resulted in a significantly higher cell density in osteoblast and PDL cell culture. The other groups showed a lower PDL cell density from 8d and a lower osteoblast cell density from 13d when compared to control and cement samples (p < 0.05). Conclusions MTA and Biodentine showed a good biocompatibility in contact with the human osteoblasts and cells of the periodontal ligament. Regarding cell survival and proliferation particularly of PDL cells Biodentine showed good results and can be considered as a well-tolerated bioactive endodontic material. Electronic supplementary material The online version of this article (doi:10.1186/s13005-014-0055-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Jung
- Department of Maxillofacial Surgery, Albert-Schweitzer-Campus 1, Building W30, 48149, Münster, Germany.
| | - Jana Mielert
- Department of Maxillofacial Surgery, Albert-Schweitzer-Campus 1, Building W30, 48149, Münster, Germany.
| | - Johannes Kleinheinz
- Department of Maxillofacial Surgery, Albert-Schweitzer-Campus 1, Building W30, 48149, Münster, Germany.
| | - Till Dammaschke
- Department of Maxillofacial Surgery, Albert-Schweitzer-Campus 1, Building W30, 48149, Münster, Germany.
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Sato EY, Svec T, Whitten B, Sedgley CM. Effects of bone graft materials on the microhardness of mineral trioxide aggregate. J Endod 2012; 38:700-3. [PMID: 22515907 DOI: 10.1016/j.joen.2012.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Large through-and-through lesions have been reported to heal faster and better when filled with bone graft material at the time of an apicoectomy. It is unknown what effect these have on retrograde filling materials such as white mineral trioxide aggregate (WMTA). In this study, the null hypothesis was tested that the presence of bone graft materials does not affect the microhardness of WMTA. METHODS Freshly mixed WMTA was condensed into acrylic cylinders and preincubated aerobically at 37°C for 1 hour. Cylinders were immersed in simulated body fluid in close proximity to graft materials: xenograft (Bio-Oss, n = 60), freeze-dried bone allograft (MinerOss, n = 60), demineralized freeze-dried bone allograft (OraGraft, n = 40), and allograft (Puros, n = 60). Knoop microhardness of half the samples in each group was evaluated after 2 weeks of incubation and the remainder at 4 weeks. The values for each group were then compared with 2-way analysis of variance and Bonferroni post hoc tests. RESULTS WMTA microhardness values for Bio-Oss, MinerOss, and Puros groups were lower than those for OraGraft and control groups regardless of incubation period (P < .001); values for the OraGraft group were higher than those for the control group at 2 weeks (P < .001), with no difference at 4 weeks. Microhardness values were higher at 4 weeks compared with 2 weeks for MinerOss (P < .05), OraGraft (P < .01), and control (P < .001), with no differences for Bio-Oss and Puros groups. The null hypothesis was rejected. CONCLUSIONS Demineralized and mineralized graft materials appear to have a differential effect on the microhardness of WMTA.
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Affiliation(s)
- Erick Y Sato
- Department of Endodontology, School of Dentistry, Oregon Health and Science University, Portland, Oregon 97239, USA
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Effect of Guided Tissue Regeneration on Newly Formed Bone and Cementum in Periapical Tissue Healing after Endodontic Surgery: An In Vivo Study in the Cat. J Endod 2012; 38:163-9. [DOI: 10.1016/j.joen.2011.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/07/2011] [Accepted: 10/16/2011] [Indexed: 11/23/2022]
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Cells isolated from inflamed periapical tissue express mesenchymal stem cell markers and are highly osteogenic. J Endod 2011; 37:1217-24. [PMID: 21846537 DOI: 10.1016/j.joen.2011.05.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/17/2011] [Accepted: 05/21/2011] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We previously reported the presence of mesenchymal stem/progenitor cells (MSCs) in inflamed pulp tissue. Here we asked whether MSCs also exist in inflamed periapical tissues resulting from endodontic infection. The objectives of this study were to detect the expression of MSC markers in periapical inflammatory tissues and to characterize isolated cells from these tissues. METHODS Human periapical inflammatory tissues were collected and processed to detect MSC marker expression by immunohistochemistry. Cells were isolated and tested for cell surface marker expression by using flow cytometry and examined for multiple differentiation potential into osteogenic and adipogenic pathways. In vivo formation of mineralized tissues was assessed in a mouse model. RESULTS Immunohistochemistry showed positive staining for MSC markers STRO-1, CD90, and CD146. Isolated cells at passage 0 appeared as typical fibroblastic cells, and a few cells formed colony-forming unit-fibroblasts (CFU-Fs). After passaging, the CFU-F forming ability diminished dramatically, and the population doubling was up to 26. Flow cytometry data showed that these cells at passage 2 expressed low levels of STRO-1 and CD146 and moderate to high levels of CD90, CD73, and CD105. At passage 6, the levels of these markers decreased. When incubated in specific differentiation medium, cells demonstrated a strong osteogenic but weak adipogenic capacity. After in vivo cell transplantation, mineralized tissues formed in immunocompromised mice. CONCLUSIONS Human periapical inflammatory tissues expressed MSC markers, suggesting the presence of MSCs. Isolated cells exhibited typical mesenchymal cell immunophenotype with a capacity to form mineralized matrix in vitro and in vivo.
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Lin LM, Ricucci D, Lin J, Rosenberg PA. Nonsurgical root canal therapy of large cyst-like inflammatory periapical lesions and inflammatory apical cysts. J Endod 2009; 35:607-15. [PMID: 19410070 DOI: 10.1016/j.joen.2009.02.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 02/12/2009] [Accepted: 02/17/2009] [Indexed: 12/21/2022]
Abstract
It is a general belief that large cyst-like periapical lesions and apical true cysts caused by root canal infection are less likely to heal after nonsurgical root canal therapy. Nevertheless, there is no direct evidence to support this assumption. A large cyst-like periapical lesion or an apical true cyst is formed within an area of apical periodontitis and cannot form by itself. Therefore, both large cyst-like periapical lesions and apical true cysts are of inflammatory and not of neoplastic origin. Apical periodontitis lesions, regardless of whether they are granulomas, abscesses, or cysts, fail to heal after nonsurgical root canal therapy for the same reason, intraradicular and/or extraradicular infection. If the microbial etiology of large cyst-like periapical lesions and inflammatory apical true cysts in the root canal is removed by nonsurgical root canal therapy, the lesions might regress by the mechanism of apoptosis in a manner similar to the resolution of inflammatory apical pocket cysts. To achieve satisfactory periapical wound healing, surgical removal of an apical true cyst must include elimination of root canal infection.
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Affiliation(s)
- Louis M Lin
- Department of Endodontics, New York University College of Dentistry, New York, New York 10010, USA.
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von Arx T, Salvi G, Janner S, Jensen S. Scarring of gingiva and alveolar mucosa following apical surgery: visual assessment after one year. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1752-248x.2008.00039.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Relationship Between Histological Diagnosis and Evolution of 70 Periapical Lesions at 12 Months, Treated by Periapical Surgery. J Oral Maxillofac Surg 2008; 66:1606-9. [DOI: 10.1016/j.joms.2007.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 10/19/2007] [Accepted: 12/11/2007] [Indexed: 11/23/2022]
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Marín-Botero ML, Domínguez-Mejía JS, Arismendi-Echavarría JA, Mesa-Jaramillo AL, Flórez-Moreno GA, Tobón-Arroyave SI. Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: a double-blind, randomized-clinical trial. Int Endod J 2006; 39:368-77. [PMID: 16640635 DOI: 10.1111/j.1365-2591.2006.01081.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To compare healing responses to periosteal sliding grafts and polyglactin 910 periodontal mesh used as guided tissue regeneration (GTR) materials/techniques when both periapical and periradicular bone loss are present. METHODOLOGY Thirty patients with suppurative chronic apical periodontitis with apicomarginal communication were selected and allocated randomly into two groups according to the barrier technique to be used during periradicular surgery: periosteal graft group (n = 15) and bioabsorbable membrane group (n = 15). Clinical and radiological evaluations were completed prior to surgery, a week later and every 3 months after surgery up to 12 months to measure the periodontal pocket depth (PD), clinical attachment level (CAL), gingival margin position (GMP), size of periapical lesion, percentage reduction of the periapical rarefaction, and periapical healing. RESULTS Both groups showed highly significant (P < 0.001) reductions in periodontal PD, CAL and size of periapical lesion at 12 months whilst GMP was unaltered. No significant difference between the experimental groups was evident for these parameters, or for the percentage reduction of size of the periapical lesion and clinical-radiographic healing. CONCLUSION Guided tissue regeneration applied to apicomarginal defects using sliding periosteal grafts and use of bioabsorbable membranes led to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing, gain of periodontal support, PD reduction and minimal recession of the gingival margin.
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Affiliation(s)
- M L Marín-Botero
- Grupo de Investigación en Patología Oral, Periodoncia y Cirugía Alvéolo-Dentaria, Laboratorio de Inmunodetección y Bioanálisis Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
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Huang FM, Tsai CH, Yang SF, Chang YC. Induction of Interleukin-6 and Interleukin-8 Gene Expression by Root Canal Sealers in Human Osteoblastic Cells. J Endod 2005; 31:679-83. [PMID: 16123706 DOI: 10.1097/01.don.0000155227.86046.a2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Histological investigations have demonstrated that root canal sealers can induce mild to severe inflammatory alternations. However, there is little information on the precise mechanisms about root canal sealers-induced inflammatory reaction. Dysregulated cytokine productions at local disease sites have been considered to be major contributors to the development of inflammatory diseases. Interleukin (IL)-6 and IL-8 released have been reported to play an important role in the pathogenesis of inflammation. The aim of this study was to investigate the effects of root canal sealers N2 (zinc-oxide eugenol based) and AH Plus (epoxy resin based) on the expression of IL-6 and IL-8 mRNA gene in human osteoblastic cell line U2OS cells. The levels of mRNAs were measured by the semi-quantitative reverse-transcriptase polymerase chain reaction analysis. The exposure of quiescent U2OS cells to N2 and AH Plus resulted in the induction of IL-6 and IL-8 mRNA gene expression (p < 0.05). The intensity of IL-8 mRNA gene was found to be significant higher than IL-6 mRNA gene (p < 0.05). Taken together, the activation of IL-6 and IL-8 mRNA gene expression may be one of the pathogenesis of zinc oxide-eugenol based and epoxy resin based root canal sealers-induced periapical inflammation.
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Affiliation(s)
- Fu-Mei Huang
- Department of Dentistry, College of Oral Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Wang N, Knight K, Dao T, Friedman S. Treatment Outcome in Endodontics—The Toronto Study. Phases I and II: Apical Surgery. J Endod 2004; 30:751-61. [PMID: 15505504 DOI: 10.1097/01.don.0000137633.30679.74] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study prospectively assessed the 4 to 8 yr outcome of apical surgery performed by graduate students in phases I and II of the Toronto Study. The study cohort included 155 teeth in 138 patients. Outcome was assessed by a blinded and calibrated examiner. Clinical and radiographic measures were used for a dichotomous outcome: healed (no signs and symptoms, Periapical Index score </= 2 or scar), or diseased (presence of signs and symptoms, or Periapical Index score >/= 3). The recall rate was 85% and the overall healed rate 74%. Healed rate was significantly higher for teeth with small (</= 5 mm) than larger preoperative lesions (chi, p = 0.02). Logistic Regression revealed an increased odds of disease persistence for teeth with larger preoperative lesions (OR = 3.81, CI = 1.2-12.1), and preoperative root-filling of adequate length (OR = 3.7, CI = 1.1-11.1). Preoperative lesion size and root-filling length were significant predictors of outcome of apical surgery.
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Affiliation(s)
- Nancy Wang
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Ontario, Canada
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Tobón-Arroyave SI, Domínguez-Mejía JS, Flórez-Moreno GA. Periosteal grafts as barriers in periradicular surgery: report of two cases. Int Endod J 2004; 37:632-42. [PMID: 15317567 DOI: 10.1111/j.1365-2591.2004.00855.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To describe the usefulness of periosteal grafts as barriers for bone regeneration in periradicular surgery when advanced periodontal breakdown occurs. SUMMARY The treatment of advanced periodontal breakdown as a result of an associated endodontic lesion constitutes a multifaceted challenge to the clinician. If the source of the irritation cannot be removed by orthograde endodontic treatment, nonsurgical and surgical endodontic/periodontal intervention may be required. Two cases with suppurative chronic apical periodontitis with apicomarginal communication are described. Clinical and radiological evaluations were completed immediately prior to surgery, a week later and every 2 months after surgery for 10 months. Both patients were treated using split-thickness flaps and lateral displacement of the periosteum prior to suturing, in order to close the communication between the oral and the periapical surroundings. A remission of the clinical signs and symptoms, and successful healing in the short-term were achieved in these cases. KEY LEARNING POINTS Periapical and periodontal lesions are closely related through pathways of communication. Disruption of the cortical plate and the presence of dentoalveolar sinus tracts can have a deleterious effect on the regeneration process after periradicular surgery. The adoption of supplementary periodontal surgical techniques may help to solve some of the difficulties in the healing process in periradicular surgery. Periosteal grafts have been shown to have the potential to stimulate bone formation when used as a graft material.
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Affiliation(s)
- S I Tobón-Arroyave
- Centro de Investigaciones Odontológicas, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia.
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Apaydin ES, Shabahang S, Torabinejad M. Hard-Tissue Healing After Application of Fresh or Set MTA as Root-End-Filling Material. J Endod 2004; 30:21-4. [PMID: 14760902 DOI: 10.1097/00004770-200401000-00004] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to compare the effect of fresh mineral trioxide aggregate (MTA) with set MTA on hard-tissue healing after periradicular surgery. The root canals of 24 mandibular premolars in four 2-yr-old beagle dogs were filled with MTA. Two weeks later the root ends of half of the samples were surgically exposed and resected to the set MTA within the canals. After exposing and resecting the other 12 root ends, they were prepared with ultrasonic instrumentation and preparations were filled with fresh MTA. After 4 months, the animals were killed. Hard-tissue healing was analyzed histomorphometrically. The results indicated that although freshly placed MTA resulted in a significantly higher incidence of cementum formation (12 of 12 versus 8 of 12, p = 0.028), there is no significant difference in the quantity of cementum or osseous healing associated with freshly placed or set MTA when used as root-end-filling material.
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22
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Abstract
The purpose of this study was to determine the effect of calcium sulfate (CS) on cementum deposition and osseous healing after periradicular surgery. The root canals of 24 mandibular premolars in four 2-yr-old beagle dogs were endodontically treated, followed 2 weeks later by periradicular surgery. Mineral trioxide aggregate (MTA) was used as root-end-filling material. The right or left side was assigned at random to receive CS alpha-hemihydrate or no material in the osteotomy sites before closure. The animals were killed after 4 months. Hard-tissue healing was analyzed histomorphometrically. All samples displayed evidence of cementum deposition adjacent to the root-end fillings and bone regeneration in the osteotomy sites. The data was analyzed using the Mann-Whitney U test, comparing the scores for cementum and osseous healing of the two groups at significance level of alpha = 0.05. The results indicated that placement of CS in osteotomy sites after periradicular surgery does not significantly affect periradicular healing.
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Affiliation(s)
- Erol S Apaydin
- Department of Endodontics, Loma Linda School for Dentistry, Loma Linda University, CA 92350, USA
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23
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Abstract
Adhesion of human osteoblasts to root-end filling materials (mineral trioxide aggregate (MTA), IRM, composite, and amalgam) was observed by scanning electron microscopy. Root-end filling materials were inserted into 96-well flat-bottomed plates and condensed to disks of approximately 1 mm thick and the same diameter as the wells. After the disks were set, they were placed in the bottom of Nunc four-well culture plates at one disk per well. Then human osteoblasts were seeded into the wells at 1.5 x 10(5) cells per well. After 1 day in culture the disks of root-end filling materials along with cells grown on their surface were examined with a scanning electron microscopy. Results showed that osteoblasts attached and spread on MTA and composite by forming a monolayer. Osteoblasts also attached on amalgam, but with few cells spreading. In the presence of IRM, osteoblasts appeared rounded with no spreading. These results indicate that osteoblasts have a favorable response to MTA and composite resin compared with IRM and amalgam.
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Affiliation(s)
- Q Zhu
- Department of Endodontology, School of Dental Medicine, University of Connecticut Health Center 06030-1715, USA
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24
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Zhu Q, Haglund R, Chiou JL, Dean JW. Effect of smear layer and direction of dentinal tubules on osteoblast adhesion to human dentin tissue. J Endod 2000; 26:318-20. [PMID: 11199745 DOI: 10.1097/00004770-200006000-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to investigate the effect of smear layer and direction of dentinal tubules on osteoblast adhesion to human dentin tissue in vitro. Dentin disks were made from human premolars extracted for orthodontic reasons. Dentin disks were cut either perpendicularly to the long axis of the tooth or at 45 degrees to the long axis of tooth. The smear layer was removed by 34% phosphoric acid gel from half of the dentin disk surface. Human osteoblast-like Saos-2 cells were grown in RPMI medium with 10% fetal bovine serum and 1% antibiotic/antimycotic cocktail under standard cell culture conditions. Cells were seeded into Nunc four-well culture plates at 1.5 x 10(5) cells per well with dentin disks in the bottom of each well. After 1 day in culture the dentin disks along with cells grown on their surface were examined with a scanning electron microscopy. Osteoblasts attached and spread on the dentin surface and formed a monolayer in the presence and absence of a smear layer. Cells spread over the dentinal tubules despite their direction. These results suggest that cell adhesion and spreading of osteoblasts is not influenced either by the existence of a smear layer or the direction of the dentinal tubules on the dentin surface.
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Affiliation(s)
- Q Zhu
- Department of Endodontology, University of Connecticut Health Center, Farmington, CT 06030-1715, USA
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25
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Abstract
AIM The purpose of this prospective study was to evaluate the prognosis of periradicular surgery using well-defined case selection and a rigorous surgical protocol. METHODOLOGY Teeth to be treated surgically demonstrated a periradicular lesion of strictly endodontic origin with or without clinical signs and symptoms of inflammation. A total of 114 teeth were treated. Following the reflection of a full mucoperiosteal tissue flap, residual soft tissues were curetted, root ends were resected with a fine high-speed diamond bur, root-end cavities were prepared ultrasonically with diamond tips, and IRM root-end fillings were placed. Cases were followed clinically and radiographically for a period ranging from 1 to 4 years. RESULTS The results of this study showed 91.2% success out of a total of 102 teeth available for follow-up, based on accepted parameters of evaluation. Cases were considered successful if there were no clinical signs or symptoms present and there was radiographic evidence of complete or incomplete healing (scar tissue). Factors related to case selection, parameters of healing and surgical technique are discussed in relation to the success rate identified in this prospective study. CONCLUSIONS Adherence to a strict endodontic surgical protocol and the use of contemporary techniques and materials will result in a predictably successful outcome in a wide range of teeth.
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Affiliation(s)
- M L Zuolo
- Department of Restorative Sciences, Graduate Endodontics, Baylor College of Dentistry, Texas A & M University Health Science Center, Dallas, Texas, USA
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26
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Zhu Q, Safavi KE, Spangberg LS. Cytotoxic evaluation of root-end filling materials in cultures of human osteoblast-like cells and periodontal ligament cells. J Endod 1999; 25:410-2. [PMID: 10530239 DOI: 10.1016/s0099-2399(99)80267-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The cytotoxicity of three root-end filling materials (amalgam, IRM, and Super-EBA) was evaluated in cultures of human periodontal ligament cells and human osteoblast-like cells. Ten-millimeter-long plastic test tubes were filled with 3 mm of freshly mixed root-end filling materials at one end (1.5 mm diameter). The opposite end was sealed and attached by heat to a 35-mm cell culture dish. Human periodontal ligament cells and human osteoblast-like cells were seeded in the dishes. The size of cell-free zones around the root-end filling materials and the total cell number per dish were calculated after 3 and 7 days. Empty test tubes used as controls did not influence the growth and distribution of the cultured cells. Cell density increased in all groups in the test period. Amalgam had a larger cell-free zone, compared with IRM and Super-EBA and showed a reduction in total cell number per dish for both tested cell types. IRM and Super-EBA also had a cell-free inhibition zone for both cell types, but no significant reduction in total cell number per dish. This study showed that amalgam had a higher cell toxicity to human periodontal ligament cells and human osteoblast-like cells than IRM and Super-EBA.
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Affiliation(s)
- Q Zhu
- Department of Restorative Dentistry and Endodontology, School of Dental Medicine, University of Connecticut Health Center, Farmington 06030-1715, USA
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27
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Affiliation(s)
- U M Wikesjö
- Department of Periodontology, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
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28
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Chong BS, Pitt Ford TR, Kariyawasam SP. Short-term tissue response to potential root-end filling materials in infected root canals. Int Endod J 1997; 30:240-9. [PMID: 9477810 DOI: 10.1046/j.1365-2591.1997.00077.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The short-term tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol), were compared with that to amalgam using a previously devised experimental model. In 24 premolar teeth of beagle dogs (47 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periradicular lesions. On each root, an apicoectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 2 weeks (23 roots) and 1 week (24 roots); they were then prepared for histological examination. The tissue response to amalgam fillings after 2 weeks and 1 week was marked by moderate or severe inflammation on all roots, and extended to < or = 0.5 mm or > 0.5 mm in 15 out of 16 roots. In contrast, after 2 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation, while the tissue response to Vitrebond was the best of the three materials, and was also the least extensive. After 1 week, the overall best tissue response was with Vitrebond, followed by Kalzinol. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were not statistically significant (P < 0.02). However, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Apart from amalgam, in which healing was marked by the persistence of a localized focus of inflammation adjacent to the root-end filling, even though there were intersample variations, there was little overall difference in the temporal and qualitative healing response to Vitrebond and Kalzinol. Both Vitrebond and Kalzinol have potential as root-end filling materials, as the tissue response was considerably more favourable than that to amalgam even in the short-term.
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Affiliation(s)
- B S Chong
- Department of Conservative Dentistry, United Medical and Dental Schools, Guy's Hospital, London, UK
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CHONG BS, PITT FORD TR, KARIYAWASAM SP. Short-term tissue response to potential root-end filling materials in infected root canals. Int Endod J 1997. [DOI: 10.1111/j.1365-2591.1997.tb00704.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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CHONG B, PITT FORD TR, KARIYAWASAM SP. Tissue response to potential root-end filling materials in inflected root canals. Int Endod J 1997. [DOI: 10.1111/j.1365-2591.1997.tb00682.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Intermediate Restorative Material (IRM) has been advocated as a root-end filling material based primarily on reports of clinical success and various leakage studies. The objectives of this study were to determine the excisional wound healing responses of the periradicular tissues to IRM root-end filling material and to compare this with the wound healing responses to amalgam and orthograde gutta-percha root-end filling materials. Mandibular premolars in dogs were obturated, root-ends resected, and the healing responses associated with root-end fillings of IRM, amalgam, and orthograde gutta-percha were evaluated microscopically and radiographically at postsurgical intervals of 10 and 45 days. The excisional wound healing responses associated with IRM root-end fillings were normal at both postsurgical intervals. There was no evidence of inhibition of dentoalveolar or osseous wound healing associated with IRM, amalgam, or orthograde gutta-percha. Statistical analysis showed no difference in wound healing between the 3 root-end filling materials.
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Affiliation(s)
- J W Harrison
- Department of Restorative Sciences, Baylor College of Dentistry, Dallas, TX 75246-2013, USA
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Crump TB, Rivera-Hidalgo F, Harrison JW, Williams FE, Guo IY. Influence of three membrane types on healing of bone defects. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:365-74. [PMID: 8899772 DOI: 10.1016/s1079-2104(96)80299-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine and compare osseous regeneration associated with three guided tissue regeneration membrane types (expanded polytetrafluoroethylene, dense polytetrafluoroethylene, and an absorbable polylactic acid/citric acid ester base) and removal forces required for expanded and dense polytetrafluoroethylene membranes. STUDY DESIGN Bilateral osseous defects were created in 30 adult rat calvaria; one defect was covered with a test membrane and the other received no membrane (control). After 2 or 4 weeks, forces required for membrane removal from the tissues were electronically determined, and the calvaria removed and decalcified. Sections through the defects were stained and evaluated electronically and microscopically. Data were analyzed statistically. RESULTS Microscopic evaluation with Mann-Whitney U test revealed that dense polytetrafluoroethylene was associated with significantly greater bone formation than expanded polytetrafluoroethylene (p = 0.02) at 2 weeks and absorbable polylactic acid/citric acid ester base (p = 0.004) at 4 weeks. Electronic evaluation of the linear degree of fill with one way ANOVA and Tukey's test found no significant difference (p > 0.05) among the experimental or the control groups. In addition, the Mann-Whitney U test indicated that removal forces required for dense polytetrafluoroethylene were significantly less than for expanded polytetrafluoroethylene (p = 0.003). CONCLUSIONS The use of dense polytetrafluoroethylene as a membrane barrier deserves further investigation as it allows osseous regeneration, it is easier to remove from healing soft tissues, and it is inexpensive. A study with larger sample sizes should be conducted.
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Affiliation(s)
- T B Crump
- Department of Periodontics, Baylor College of Dentistry, Dallas, Tex., USA
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Abstract
The purpose of this study was to examine possible tissue-dependent differences in rate of healing after mucogingival flap surgery. After intrasulcular incision and a vertical-releasing incision distal to the maxillary and mandibular cuspids, buccal, full-thickness mucogingival flaps were raised in four quadrants of 10 adult cats. The triangular flaps were left open for 30 min and then repositioned and sutured. Tissue reactions were studied histologically after 1, 3, 7, 14, and 28 days of healing. Although new collagen occasionally was observed in the wound space in the free gingiva at 3 days, collagenous union between the cut dentogingival fibers and the flap seemed well established at 7 days. Flap reattachment to the denuded cortical bone was seen at 14 days in the region of the attached gingiva. In the region of the alveolar mucosa, however, residual coagulum and inflammatory reaction was present as late as at 28 days in several specimens. These observations indicate a marked difference in rate of healing among the different interfaces involved. These variations seem to be related to variations in size of the resulting wound space when a full-thickness mucoperiosteal flap is readapted over cervical root surfaces, alveolar bone crest, and denuded cortical bone, respectively.
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Affiliation(s)
- K A Selvig
- Department of Dental Research, School of Dentistry, University of Bergon, Norway
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Craig KR, Harrison JW. Wound healing following demineralization of resected root ends in periradicular surgery. J Endod 1993; 19:339-47. [PMID: 8245756 DOI: 10.1016/s0099-2399(06)81360-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The objective of this study was to determine the effect of demineralization of resected root ends on the temporal and qualitative healing of the dentoalveolar (apical attachment apparatus) and alveolar (osseous) tissues in the excisional wound site created during periradicular surgery. Root end resections to orthograde gutta-percha obturations were performed on the mandibular premolars of six mongrel dogs. Twenty-four experimental root ends were demineralized by citric acid burnishing of the resected surfaces. The remaining 24 standard treatment root ends were not demineralized. Microscopic evaluations at postsurgical intervals from 4 to 45 days revealed that the demineralized root ends were associated with more rapid and complete healing than the nondemineralized root ends. It is proposed that demineralization enhances cementogenesis, the key to dentoalveolar healing, by removing the smear layer barrier and exposing the organic component (collagen fibrils) of resected cementum and dentin.
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Affiliation(s)
- K R Craig
- Baylor College of Dentistry, Dallas, TX 75246
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