Evaluation of Crack Formation and Propagation with Ultrasonic Root-End Preparation and Obturation Using a Digital Microscope and Optical Coherence Tomography

OBJECTIVE

This study is aimed at determining (1) the effect of root-end resection, ultrasonic root-end preparation, and root-end filling on the incidence of crack formation and propagation by using a digital microscope (DM) and optical coherence tomography (OCT) and (2) the performance of OCT on the detection of cracks by comparing with microcomputed tomography (micro-CT) as a reference standard.

METHODOLOGY

Thirty extracted lower incisors were endodontically treated and subjected to root-end resection and ultrasonic root-end cavity preparation. Then, the teeth were divided into three groups (n = 10, each), and the root-end cavity was either left unfilled or filled with mineral trioxide aggregate (MTA) or super-EBA. The resected surface was observed with OCT and DM after the root-end resection, ultrasonic root-end preparation, and root-end filling, and the frequency of incomplete and complete cracks were recorded. The observation was repeated after two weeks, one month, and two months, and micro-CT scans after two months were taken as the gold standard.

RESULTS

The DM results show dentinal crack formation in 47% of the samples following root-end resection and in 87% following ultrasonic preparation. After the ultrasonic preparation, no existing crack propagated to a complete crack, but new cracks were formed. MTA and super-EBA had no effect on crack formation. The Spearman correlation coefficient between OCT and DM was 0.186 (very weak correlation; p = 0.015). Sensitivity and specificity in comparison to micro-CT were 0.50 and 0.55 in OCT and 1.00 and 0.35 in DM, respectively. McNemar's test showed a significant difference between OCT and DM (p < 0.05).

CONCLUSION

Apical resection and ultrasonic preparation could form dentinal cracks. OCT and DM showed different detection frequencies of cracks with very weak correlation. DM showed superior sensitivity compared with OCT.

Factors associated to apical overfilling after a thermoplastic obturation technique - Calamus® or Guttacore®: a randomized clinical experiment

The aims of this study were to analyze whether age, tooth type and sex are related to radiographically visible extrusion of filling material as an unintended outcome in teeth undergoing endodontic treatment with a thermoplastic obturation technique (Calamus® or GuttaCore®) and to determine whether the presence of such overfilling is associated to postoperative pain. We selected 120 teeth with diagnoses involving vital pulp and indication for endodontic treatment. Biomechanical preparation was performed using the Protaper Next® system with X2 or X3 master apical file. Teeth were randomly divided into 2 groups (n=60). Teeth in Group 1 were filled with the Guttacore® system and teeth in Group 2 were filled with single cone technique and Calamus® obturation system. Thermoplastic obturation techniques were found to cause overfilling in 53. 33% of the total cases (64 teeth) (56. 66% in Guttacore® group and 50% in the Calamus® group). Anterior teeth were found to be associated to presence of overfilling (p= 0. 024) (OR = 4. 35). Of the 120 teeth treated, 10 (8. 33%) presented postoperative pain and radiographically visible overfilling. The association between presence of extruded filling material and mild/moderate pain was statistically significant withp = 0. 002. To conclude, endodontic thermoplastic obturation with Guttacore® and Calamus® systems are significantly associated with the probability of filling material extrusion, and overfilling is associated to postoperative pain. Anterior teeth are 4 times more likely to be overfilled with the obturation techniques tested.

Effect of root canal obturation with calcium silicate materials on pH change in simulated root resorption defects

This study evaluated the effect of 3 commercially available calcium silicate materials (CSMs) on pH changes in simulated root resorption defects. Simulated root resorption defects were prepared on the facial root surface of 40 mandibular premolars. The depth of each defect was individually calculated to standardize the remaining dentin thickness to 1 mm. Prepared canals were obturated with the 3 CSMs. Ten specimens were kept as controls, filled with unbuffered normal saline. The pH measurements were taken at 1 hour, 6 hours, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, and 2 months. All CSM groups exhibited an initial alkaline pH of 9.0-9.7. The pH decreased to 8.0-8.5 after 2 months of storage. There were no significant differences between pH measurements at other time intervals. The CSM groups exhibited higher pH levels than the control group. The results showed that intracanal placement of the CSMs maintained initial pH levels of 9.0-9.7 inside the simulated resorption defects; these measurements gradually decreased to 8.0-8.5 over the span of 2 months.

Factors associated with postobturation pain following single-visit nonsurgical root canal treatment: A systematic review

OBJECTIVE

Reducing the pain after root canal therapy is a key aspect in endodontic practice. The present systematic review aimed to identify the factors that influence postobturation pain (POP) in patients receiving single-visit nonsurgical root canal treatment.

DATA SOURCES

A literature search was performed manually and in Pubmed (Medline) database to identify relevant articles. A data extraction form was constructed and data were collected from the identified articles.

RESULTS

In total, 24 articles were identified for the systematic review, and factors associated with POP were tabulated.

CONCLUSION

Specific preoperative factors (old age, sex, molar teeth, mandibular teeth, presence of preoperative pain, and absence of periapical radiolucency) and procedures (administration of prophylactic drug, bupivicaine anesthetic agent, radiograph or apex locator working length determination methods, instrumentation, irrigating system, laser, cold lateral compaction obturation technique, reducing the occlusion, and postoperative drugs) were associated with POP.

A Prospective Randomized Comparative Study of Cold Lateral Condensation Versus Core/Gutta-percha in Teeth with Periapical Lesions

INTRODUCTION

The aim of this study was to compare the outcome of root canal treatment using either Thermafil (TF; Dentsply Maillefer, Ballaigues, Switzerland) or the cold lateral condensation (CLC) obturation technique in teeth with periapical lesions and to investigate the influence on postoperative pain and treatment outcomes.

METHODS

After standardized root canal preparation technique, 112 teeth were obturated with either the TF or the CLC technique during 2 sessions by single operator. Postoperative pain, obturation length, and treatment outcomes were recorded. The teeth were reviewed clinically and radiographically for 2 years.

RESULTS

Although there were no significant differences between the techniques in the incidence of postoperative pain at 24 hours (P > .05), the incidence of pain was significantly higher in the TF group than in the CLC group at 48 hours (P < .05). During the 2-year follow-up period, there was no statistically significant difference in the success rate of the teeth treated with TF (96.4%) in comparison with those treated with CLC (98.2%) (P > .05).

CONCLUSIONS

In this study, the outcome of the root canal treatment of teeth using the TF and CLC techniques revealed that these techniques are useful for root canal obturation.

Re-treating a maxillary second molar with 6 root canals assisted by cone beam computed tomography

It is important to sterilize and obturate the entire expanse of the root canal system effectively to prevent endodontic failure. This article presents a case involving endodontic re-treatment of a maxillary second molar with an unusual morphology consisting of 6 root canals. Five were identified during clinical exploration, and the sixth was identified using cone beam computed tomography.

Periapical microsurgery: the effect of root dentinal defects on short- and long-term outcome

INTRODUCTION

The purpose of this prospective clinical study was to evaluate the clinical outcome of endodontic microsurgery on roots exhibiting the presence or absence of dentinal defects at 1-year and 3-year follow-up period.

METHODS

One hundred fifty-five teeth were treated with periapical microsurgery using a modern microsurgical protocol in a private practice setting. The root apices were resected and inspected for dentinal defects with a surgical operating microscope and a 0.8-mm head diameter light-emitting diode microscope diagnostic probe light. After inspection, root-end preparations were performed using ultrasonic tips, and root-end fillings were placed. Follow-up visits occurred at 1 year and 3 years postoperatively. The primary outcome measure used was the change in the radiographic apical bone density, and the secondary outcome measure used was the absence of clinical symptoms.

RESULTS

Of the 155 treated teeth, a total of 134 teeth were assessed at the 1-year follow-up and 127 teeth at the 3-year evaluation. In the "intact" group, 94.8% healed at 1 year, and 97.3% healed at 3 years. In the "dentinal defect" group, 29.8% healed at 1 year, and 31.5% healed at 3 years. The baseline root condition of either "dentinal defect" or "intact" showed a statistical difference in the healing outcome at both 1 and 3 years.

CONCLUSIONS

This prospective periapical microsurgery study showed a significant superior clinical outcome for intact roots when compared with roots with dentinal defects at both 1 year and at 3 years postoperatively.

[Clinical and immunomodulating activity of root canal fillers]

The study revealed higher frequency and intensity of pain after root canal filling with paste Foredent or Zn-eugenol paste in patients with bronchial asthma and showed significant change in the level of sIgA in saliva fluid depending on the filling material and reflecting the effect of root pastes on the local immunity of the oral cavity.

Repair of perforating inflammatory root resorption in a previously traumatized incisor: 36-month follow-up

Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. The purpose of this report was to present a case of perforating inflammatory root resorption in a previously traumatized young incisor tooth with incomplete root development. A 12-year-old girl, who had suffered a traumatic dental injury 4 years earlier, was referred with symptoms of pain and swelling in a permanent maxillary central incisor. The tooth had been root-filled and had thin dentinal walls and a wide open apex. During retreatment, a perforating resorption site was observed on the root's distal aspect. Because the entire root canal filling could not be removed, the resorption site was repaired with white mineral trioxide aggregate in the presence of the remaining gutta-percha. Clinical and radiographic follow-up was conducted for 36 months, demonstrating arrest of the resorptive process, regeneration of the periradicular tissues, and re-establishment of the periodontal space.

A nonsurgical technique for the removal of overextended gutta-percha

AIM

The present report describes and discusses a nonsurgical technique for the removal of overextended gutta-percha.

BACKGROUND

Mechanical irritation results from overextension and the overextended material used during root canal obturation could produce an inflammatory reaction with an area of rarefaction in the periapical tissues. The healing process is not affected by the presence of filling materials as it is well tolerate by the periapical tissues, but it is accepted that a higher failure rate is found in overfilled teeth.

CASE REPORT

This clinical report describes one case with an overextended gutta-percha cone and a new nonsurgical technique to remove this material.

CONCLUSION

The technique described is a conservative, safe and plausible option to remove extruded gutta-percha in periapical area.

CLINICAL SIGNIFICANCE

Overextended gutta-percha cones could increase the failure of endodontic therapy. Commonly surgical procedures are indicated to remove this overextended material, but this nonsurgical technique could be a better treatment alternative and could increase the chances of success.

Application of radiovisiography (digital radiology) in dental clinical practice

INTRODUCTION

Radiovisiography (RVG) as the latest imaging technique in dentistry with the minimal radiation exposure of the patient and numerous possibilities to process the images has many advantages over classic radiography.

CASE REPORT

We presented an interesting clinical endodontic case of primary posted diagnosis of traumatic periodontitis of upper right canine upon orthodontics treatment. As the patient previously had been exposed to alleged high dose of radiation the patient agreed to minimal exposition using digital RVG. The options of the tool bar of RVG Trophy device enabled the solving of ethiologic factor of presented periodontitis. The enigma of the symptoms on the 'overfilled' root canal was solved zooming and 3-D analysis avoiding periapical surgery owing to the patience of the patient and the dentist in a couple of days.

CONCLUSION

By applying RVG technique the time for diagnostic procedure is much shorter in comparison with traditional dental radiography enabling archiving and follow-up the presented case in the course of time.

Medico-legal aspects of altered sensation following endodontic treatment: a retrospective case series

OBJECTIVE

The objective of this study was to analyze cases of liability claims related to persistent altered sensation following endodontic treatments so as to characterize the medico-legal aspects of this complication.

STUDY DESIGN

A comprehensive search of an Israeli professional liability insurance database was conducted to retrospectively identify and analyze cases of persistent altered sensation following endodontic treatment.

RESULTS

Sixteen claims of persistent altered sensation following endodontic treatments were identified and analyzed. The typical profile of a claim was a female patient who underwent an endodontic treatment at a second mandibular molar, which was associated with overfilling. A significant correlation between the tooth location and the suggested cause of nerve injury was found. None of the claims were reported by the practitioners, and all cases were identified as a result of the patient's demand for financial compensation, either directly or by legal actions.

CONCLUSIONS

When a nerve injury is diagnosed, the treating practitioner should be encouraged to seek medical and legal assistance so as to prevent permanent damage and to enable a better medico-legal response.

[Periapical surgery with histologic examination of the periapical lesion. A case report]

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign-body reponses towards filling materials, towards cholesterol crystals or radicular cysts might prevent complete periapical healing. Following enhanced microsurgical techniques in the last years the success rates of apical surgery have improved considerably. The aim of the current case report is to describe the therapeutical approach to a persistent periapical lesion and its histologic examination.

[Prevalence of fixed prosthesis-related periodontitis in Senegal]

The purpose of this study was to determine radiographically the prevalence of periapical periodontitis in teeth restored with crown in a Senegalese population. Full mouth periapical radiographs were obtained from 208 consecutive adult patients (6234 teeth) presenting as new patients to the Dental Service of the University. The presence of crown restorations, the periapical status and technical quality of root fillings associated were evaluated. 7.69% (n = 16) of patients had at least one tooth that was crowned. The total number of crowns assessed was 0.95% (n = 59). The molars were the teeth most crowned 40.67% (n = 24) followed by anterior teeth 30.50% (n = 18) and premolars 28.81% (n = 17). All the crowned teeth had previous root canal treatment of which only 16.94% (n = 10) were acceptable. 53 % (n = 32) of the teeth had apical periodontitis (PAI > 2). Unacceptable root fillings were associated with a higher prevalence of periapical disease (p < 0.05). Crown with a post extending more than 4 millimetres from the apex were associated with more periapical lesions 64.28% (p < 0.05). The results indicate a low prevalence of crowned teeth, an absence of vital preparation, a high prevalence of radiographic periapical disease and unacceptable root fillings associated.

Gross extrusion of endodontic obturation materials into the maxillary sinus: a case report

A gross extrusion of endodontic obturation materials occurred from tooth 3 into the right maxillary sinus. The patient had never been conscious of uncomfortable symptoms, both at tooth 3 or buccal regions. A computed tomographic (CT) scan showed cord-like foreign substances extruded from the apex of the tooth and the hyperplasticity of the sinal mucosa. The surgical removal of foreign substances and partial curettage of sinal mucosa were indicated to prevent the possibility of sinus infection. At the 4-month recall, the patient was symptom free. This case emphasizes that an open apex can become potentially dangerous when the vertical condensation method is used. If massive overfilling is recognized radiographically in molar regions, an examination using panoramic radiograph is indispensable to detect the gross extrusion into the maxillary sinus, such as in this case.

Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin

PURPOSE

Chronic maxillary sinusitis of dental origin (CMSDO) is a common disease that requires treatment of the sinusitis as well as of the odontogenic source. We present our surgical experience performing contemporary treatment of the odontogenic source and endoscopic sinus surgery (ESS) in patients with CMSDO.

PATIENTS AND METHODS

Seventeen patients with CMSDO underwent contemporary treatment of the odontogenic source and ESS. Five patients presented chronic oroantral fistula (OAF); 5 patients presented odontogenic cysts occupying the maxillary sinus; 2 patients had inflammatory cysts of the molars; 2 patients had maxillary sinus infection secondary to peri-implantitis; 3 patients had foreign bodies pushed through the root canal into the sinus. The first surgical step was the treatment of the odontogenic source. The second step was ESS with opening and calibration of the maxillary natural ostium.

RESULTS

Foreign bodies were extracted from the sinuses through the endonasal approach. No major complications after ESS were observed. The average time for ESS was +/-25 minutes. Good distant results without symptoms and complete closure of the fistula were obtained in all patients.

CONCLUSION

When significant sinus disease is found, an endoscopic approach to drainage in all of the involved sinuses can promote predictably successful closure of OAF. The endoscopic approach to chronic maxillary sinusitis of dental origin is a reliable method associated with less morbidity and lower incidence of complications.

Outcome of root canal obturation by warm gutta-percha versus cold lateral condensation: a meta-analysis

The purpose of this study was to evaluate clinical outcome differences of root canal obturation by warm gutta-percha (GP) or cold lateral condensation (CLC) through a systematic review and meta-analysis. There were 10 clinical studies evaluated. Postoperative pain, long-term outcomes, obturation quality, and overextension were the characteristics investigated. The results suggest that the two obturation techniques are not significantly different except in overextention. The relative risk (RR) value of warm GP versus CLC and 95% confidence interval (CI) of the first three criteria were 1.10 (0.71, 1.71), 0.78 (0.58, 1.05), and 1.31 (0.98, 1.76), respectively. Overextension was more likely to occur in the warm GP obturation group in comparison with the CLC group. The RR value and 95% CI were 1.98 (1.33, 2.93). In conclusion, warm GP obturation demonstrated a higher rate of overextension than CLC. Postoperative pain prevalence, long-term outcomes, and obturation quality were similar between the two groups.

Intentional replantation of a mandibular molar: case report and 14-year follow-up

This case report describes the nonsurgical endodontic treatment and intentional replantation of a mandibular molar and its nearly 14-year follow-up. A 56-year-old woman sought treatment with complaint of discomfort and sensitivity in the mandibular left area. The radiographic examination showed that the mandibular left first molar was endodontically treated, with over-instrumentation of the distal root and unsatisfactory obturation on the mesial root. A large periapical lesion was observed surrounding the roots. In view of the patient's limited interocclusal space and objection to undergo an apical surgery, intentional replantation was suggested as an alternative. The patient returned for clinical and radiographic follow-up at 15 days, 40 days, 6 months, 12 months, and once yearly thereafter. At the last visit, after 14 years, no painful symptomatology was reported, probing depth was no greater than 3 mm, the periradicular area had normal appearance and no evidence of root resorption or periapical lesion.

Labiomandibular paresthesia caused by endodontic treatment: an anatomic and clinical study

Labiomandibular paresthesia after root canal treatment is an accident that is still too frequent despite the development of new endodontic techniques. The aim of this anatomical and clinical study is to advance the understanding of how accidents occur so as to avoid them. This anatomical study made it possible to determine the variability of proximity of the apex of the tooth root to the mandibular bundle, as well as the relationship between the nerve and its satellite artery, and to understand how endodontic filling material spreads into the cancellous bone. The clinical study, which included examination with conventional radiology as well as with imaging techniques, enabled us to identify the exact location of the filling material in relation to the mandibular bundle and to correlate this to the occurrence of clinical symptoms and their diverse manifestations.

Surgical treatment of amalgam fillings causing iatrogenic sinusitis

Iatrogenic maxillary sinusitis is a rare disease entity that can be fatal if not managed. Thirteen patients (five men and eight women) were referred to our clinic because of chronic iatrogenic maxillary sinusitis. Eight patients presented with a left-side maxillary sinusitis, four patients presented with right-side maxillary sinusitis, and one patient presented with right-side pan sinusitis. The sinusitis was caused by the intrusion of amalgam filling during root treatment of teeth. All of the patients were treated surgically with a Caldwell-Luc approach. In 12 patients, the amalgam was removed with the infected and inflamed maxillary mucosa. In one patient, the amalgam could not be removed with the Caldwell-Luc technique because it was in the deeper part of the root of the molar tooth. Histologic examination revealed four cases of aspergillosis; three cases of papillary and polypoid sinusitis; three cases of nonspecific pseudo-polypoid sinusitis; two cases of hyperplasic polypoid sinusitis; and one case of catarrhal sinusitis. All patients were relieved of their complaints that were related to sinusitis. Radiologically, the maxillary sinuses were clean 1 month after Caldwell-Luc intervention. Iatrogenic maxillary sinusitis should be considered a serious infection. A smear should be taken whenever a foreign body is intruded into the sinus. Foreign bodies can get jammed in the posterior wall of the sinus and can provoke chronic sinusitis with a risk intracranial extension. Hence, the disease should be managed surgically without delay. Furthermore, dentists should be cautious with dental amalgam filling.

Lack of correlation between ex vivo apical dye penetration and presence of apical radiolucencies

OBJECTIVE

The aim of this study was to determine if there is a significant correlation between the in vivo presence of periapical radiolucency and ex vivo apical dye penetration on the same human teeth.

STUDY DESIGN

Eighty-four endodontically filled teeth that were scheduled for extraction were classified into 2 groups according to the presence or absence of a periapical radiolucency and further divided into 2 subgroups according to the quality of the root canal filling. After extraction, the apical filling was evaluated by a dye penetration method.

RESULTS

The dye extraction evaluation showed no correlation between apical dye penetration and the presence of a periapical radiolucency (not significant), but a statistically significant correlation with the quality of the root canal filling (P = .03).

CONCLUSION

The results of the dye penetration study were correlated to the quality of the root canal filling but had no predictive value for the development of periapical radiolucency.

Evaluation of wear and subsequent dye penetration of endodontic temporary restorative materials

This study evaluated the wear resistance and sealing property of endodontic temporary restoratives by means of functional stressing using a wear simulator. The pulp chamber of 28 extracted molars was opened and filled with cotton, and then the cavity was filled with a temporary material--Caviton, Temporary Pack, Neodyne-alpha, or TERM. Specimens were subjected to a wear test, and data for wear and dye penetration were analyzed by one-way ANOVA independently (p < 0.05). Wear values of Neodyne-alpha (0.09 +/- 0.05 mm) and TERM (0.24 +/- 0.06 mm) were significantly less than those of Caviton (1.79 +/- 0.15 mm) and Temporary Pack (1.02 +/- 0.40 mm). In terms of dye penetration, Neodyne-a leaked significantly less than the other materials at 0.40 +/- 0.32 mm. On the other hand, there were no significant differences between TERM (1.30 +/- 0.57 mm) and Temporary Pack (2.10 +/- 0.12 mm), and between Caviton (2.60 +/- 0.41 mm) and Temporary Pack.

Aspergillus mycetoma of the Maxillary Sinus Secondary to Overfilling of a Root Canal

In nonimmunocompromised patients aspergillosis of the paranasal sinuses is a relatively rare disease. Root canal treated teeth with overextension of the root canal sealer or solid materials such as gutta-percha or silver cones into the sinus might be the main etiological factor for aspergillosis of the maxillary sinus in healthy patients. Root-filling materials based zinc oxide-eugenol is considered to be a growth factor for aspergillus. Aspergillus fumigatus needs heavy metals such as zinc oxide for proliferation and metabolism. Prognostic and histological studies showed that instrumentation and obturation should not extend beyond the apical foramen. When the sealer and/or gutta-percha is extruded within the sinus, this produce an inflammatory reaction and then Aspergillus growth. We report one case of healthy 60-yr-old male with overextension of root canal sealer in maxillary sinus. After surgical procedure, microscopic examination revealed aspergillosis. Overextension into the maxillary sinus with root canal cements has to be avoided.

Anesthesia following overfilling of a root canal sealer into the mandibular canal: A case report

The surgical treatment of a case of anesthesia that occurred with the extrusion of Endomethasone root canal sealer into the mandibular canal is presented. Endomethasone is a neurotoxic root canal sealer containing paraformaldehyde and eugenol. The literature indicates immediate surgical decompression on the extrusion of Endomethasone into the mandibular canal. In our case, the decompression surgery was done 3 weeks after the endodontic mishap. The nearly complete resolution of anesthesia 4 months following the decompression surgery suggests that the neurotoxic effects of Endomethasone are still reversible after 3 weeks.

Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults. A retrospective study

OBJECTIVE

The aim was to study periapical status and the technical quality of root-filled teeth in Swedish adolescents and young adults in Malmö, Sweden.

MATERIAL AND METHODS

The sample, collected from dental records in the Public Dental Service, consisted of notes and radiographs of all root-filled permanent teeth in all 19-year-olds born in 1979 (mean age at root filling=16.2 years). The sample for assessing periapical status and technical quality consisted of 124-153 teeth. The criterion for inclusion for assessing periapical status was a follow-up time of at least one year. Periapical status was assessed with the Periapical Index (PAI). Technical quality was analyzed from radiographs in two respects: sealing quality of the root canal and distance from the root filling to the radiographic apex. The radiographs were analyzed independently by two observers with inter-examiner kappa values of 0.82-0.85.

RESULTS

Apical periodontitis was found in 52% of the teeth and occurred significantly more often among molars than among anterior teeth. As judged radiographically, 51% of the teeth were inadequately sealed. In 38%, the distance to the apex was >2 mm and overfilling was registered in 14% of the teeth. Compared with anterior teeth, significantly more root fillings of molars had a distance to the apex of >2 mm. Technical quality was statistically significantly correlated with periapical status at follow-up.

CONCLUSIONS

The technical quality and periapical status of root-filled teeth in adolescents and young adults were unsatisfactory in about half of the teeth.

Incidence of periapical lesions and clinical symptoms after pulpectomy—A clinical and radiographic evaluation of 1- versus 2-session treatment

OBJECTIVE

Outcome of pulpectomy in 2 treatment sessions with calcium hydroxide as an intracanal dressing was compared to a procedure comprising instrumentation and root-filling in 1 session.

STUDY DESIGN

Subjects with a vital pulp condition (N = 256) were recruited to a randomized clinical trial. Outcome parameters included radiographic signs of apical periodontitis and painful symptoms at clinical follow-ups 1 week and 1-3 years after treatment.

RESULTS

Of 244 subjects available for final recall, 17 presented with periapical radiolucency. Lesions were evenly distributed among the 2 treatment groups. Postoperative pain recorded 1 week after permanent filling was significantly associated with overfilling (P = .001), with no difference between treatment groups. There was no association with presence of overfilling and radiographic lesion at end point of recall.

CONCLUSIONS

Study confirms that pulpectomy may be carried out at a high rate of success if due attention is given to aseptic operating procedures, proper instrumentation and filling. Under these conditions an interappointment dressing with calcium hydroxide does not seem to influence outcome.

Apical periodontitis in root filled teeth associated with the quality of root fillings

The aim of this study was to investigate the technical quality of root fillings in root filled teeth, their association with periapical status and prevalence of apical periodontitis.

MATERIAL AND METHODS

The sample consisted of 83 subjects, presenting consecutively as new patients seeking dental care (prosthetic, endodontic and cariologic treatment) in the years 2005/2006. Clinical and radiographic examination on each patient was performed using the scoring system (Periapical index (PAI)) proposed by Ørstavik et al. From the periapical radiographs status of endodontically treated teeth was recorded. For each tooth the following items were surveyed: the presence of a root filling, its quality (lateral seal and length in the root canal) and the periapical status.

RESULTS

Of the 2186 functional teeth, 283 had undergone root canal treatment (13%). Amongst 283 root filled teeth, 122 teeth (43.1%) had radiological signs of a periapical lesion (PAI>2). Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. Inadeguate lateral seal of root filling was observed in 165 (58.3%) of 283 endodontically treated teeth. Inadequate length of endodontic treatment was discovered in 183 (64.7%) out of 283 teeth. Root filled teeth without voids had apical periodontitis in 25 (21.0%) out of 118 of cases, whereas if voids were detected, disease was present in 97 (58.8%) out of 165 teeth (p<0.001). Apical periodontitis was found in 23 (23.0%) out of 100 teeth with adequate length of root filling, whereas if the filling was too short or long, periapical lesions were present in 99 (54.0%) out of 183 teeth (p<0.001).

CONCLUSIONS

Apical periodontitis was present in 43,1% of root filled teeth. Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. The results of this study indicate that inadequate root fillings were more often associated with an increased prevalence of apical periodontitis. On the contrary, adequate root fillings significantly reduced the prevalence of disease. Many root canal treatments were technically unsatisfactory and substantial efforts must be made to improve the standard of endodontic treatment.

Effect of customization of master gutta-percha cone on apical control of root filling using different techniques: an ex vivo study

AIMS

(i) To compare the prevalence of extrusion of root filling material when placed using different root filling techniques, with or without customization of the master gutta-percha (GP) cone; and (ii) to investigate the effects of some factors influencing root filling extrusion and presence of voids.

METHODOLOGY

A total of 180 roots were selected, prepared and randomly allocated to three groups. Five general dental practitioners performed the root fillings; each filled one group of roots (n = 60) using each of three techniques; 'cold lateral compaction' (n = 20), 'warm vertical compaction' (n = 20) and 'continuous-wave' (n = 20) techniques. For each obturation technique, the master GP cone was customized using chloroform in 10 samples. Two groups of the roots were recycled to allow all five operators to fulfill their remit. Two observers, blind to operator and obturation technique, examined the radiographs (master apical file, post-obturation) to determine the presence of root filling extrusion and voids within the apical 5 mm, independently. Root filling extrusion was also confirmed by direct inspection of the root apex after obturation. The data were analysed using logistic regression models.

RESULTS

A total of 300 root fillings were performed; nine were excluded from the analysis. Most of the root fillings (80%, n = 233) were placed within 0.5 mm of the working length; only 20% (n = 58) were placed >0.5 mm beyond the working length. The odds of prevalence of extrusion (>0.5 mm) were significantly reduced by about 50% when cold lateral compaction or customization of GP were used. One operator produced 2.5 times more extruded root fillings than others. Curvature & length of root canal, apical size of prepared canal, as well as operator's preferred obturation technique had no significant influence on the prevalence of extrusion. Customization of GP was the sole factor to significantly reduce the prevalence of voids within the apical 5 mm of working length.

CONCLUSIONS

Root filling extrusion was significantly influenced by 'operator' and was reduced by cold lateral compaction and customization of the master cone. Customization of master cone was the only factor that reduced voids apically.

Comparison of cold lateral compaction and continuous wave of obturation techniques following manual or rotary instrumentation

AIM

To compare different combinations of root canal preparation and obturation technique.

METHODOLOGY

A total of 48 freshly extracted human maxillary central incisors were divided into two identical groups on the basis of root canal length and apical diameter. The root canals were prepared by manual crown-down pressureless technique or with a rotary system (ProFile; Dentsply Maillefer, Ballaigues, Switzerland) in a crown-down technique. The coronal diameter and apical size of the root canals were standardized in both preparation techniques. Each main group was then divided into two subgroups and obturated with either cold lateral compaction or continuous wave of obturation with System B (EIE-Analytic Technology, Orange, CA, USA). The distribution of filling material in each canal was assessed by stereomicroscopic examination of eight cross-sections on each tooth. Areas of sealer, gutta-percha and voids were measured on the digital images of a total of 384 samples. Manipulation time and apical extrusion for each group was also determined. Data were statistically analysed using Kruskal-Wallis, anova (Bonferroni/Dunn) or Student's t-test.

RESULTS

The percentage of sealer, gutta-percha and voids area between the obturation techniques was not significantly different (P > 0.05). Continuous wave groups had significantly more apical extrusion of sealer (P < 0.05), while none of the obturation techniques had gutta-percha extrusion. Rotary instrumentation was significantly faster than the manual technique (P < 0.05); continuous wave obturation was significantly faster than lateral compaction (P < 0.05). Total manipulation time in the rotary/continuous wave group was significantly shorter than the other groups (P < 0.0001).

CONCLUSION

The distribution of filling materials was similar in all combinations of instrumentation and obturation techniques. The continuous wave technique was faster than lateral compaction and it extruded more sealer.

Surgical resolution of chronic tissue irritation caused by extruded endodontic filling material

Controversy remains regarding the relative toxicity versus inertness of endodontic filling materials, including gutta-percha, in vital tissues.We discuss reaction to and possible toxicity of gutta-percha and sealers and present 2 cases of symptomatic chronic inflammatory reaction where gutta-percha and associated filling materials were found to have extruded past the confinement of the root structure and were embedded in soft tissue and bone. Successful surgical removal of the extruded gutta-percha with surrounding granulation tissue prompted proper healing and resolution of the long-term symptoms.

Antroliths: survey of the literature and report of a case

In the present report, a case with a radiopaque mass within the right maxillary sinus antrum is presented, and the clinical/radiographic features of the lesion are provided. The patient's dental history has revealed extrusion of calcium hydroxide into the periapical area during a previous endodontic treatment. This finding has underscored the need to discuss the potential role of endodontic materials in the development of calcified tissues within the adjacent body cavities.

Root Surface Temperature Rises In Vitro During Root Canal Obturation Using Hybrid and Microseal Techniques

The aim of this in vitro study was to measure the temperature rise on the outer surface of roots during filling with hybrid technique and Microseal. Twenty extracted human maxillary and mandibular premolars with a single canal were randomly divided into two groups of 10 teeth each. In the first group, the teeth were filled with hybrid technique (thermomechanical compaction with Engine Plugger used following lateral condensation of the apical part of the canal), the second group was filled using Microseal. After root canal obturation the filling material was removed and the obturation procedure was repeated. A total of 20 obturations in each group were performed. Temperature changes were measured using a thermal imaging camera. The temperature of certain regions of the mesial surface was analyzed and the highest temperature values were recorded. Statistical analysis was performed using the Mann-Whitney U test. The mean increase of temperature during the hybrid technique with Engine Plugger was 23.8 degrees C, while during Microseal it was significantly lower (p = 0.000001) at 5.5 degrees C. The temperature rise generated by Microseal was below the critical level and should not damage supporting structures, however, the hybrid technique generated a relatively high temperature rise that may cause periodontal tissue damage.

Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population

AIM

To estimate the prevalence of teeth with apical periodontitis (AP) and technically failed root fillings in an adult Belarusian population.

METHODOLOGY

Panoramic radiographs of all 1423 patients over 15 years of age not seeking emergency dental care, and attending the Dental School of the Belarusian Medical University for the first time during the period from 1 January to 31 December 2001 were examined. The quality of root fillings was scored according to criteria of length proposed by De Moor et al. [International Endodontic Journal 33 (2000) 113] and the periapical status of all teeth (except third molars) was categorized on the basis of presence or absence of radiographic signs of AP. The data were analysed using the chi-square test and odds ratio.

RESULTS

Radiographs indicated that 8632 teeth (22% in the maxilla; 21% in the mandible) were missing leaving a total of 31,212 teeth to be assessed. Twenty per cent of the teeth had some filling material in the root canal(s). AP was found in 1141 subjects (80%) and 12% of the teeth. AP was more frequently associated with molar teeth (23%) than premolar (14%), canine (4%) and incisor teeth (6%). AP was diagnosed in 45% of root filled teeth, the remaining cases with AP had not been root filled. Statistical analysis showed that the probability of radiological detection of AP in root filled teeth was 25-fold higher than when the root canals had not been filled (chi2 = 8636.04, P < or = 0.001, odds ratio with 95% confidence intervals: 23.01 < 25.17 < 27.45). Periapical radiolucencies with adequately filled root canals occurred significantly less often than with teeth in which the root canal was filled more than 2 mm from radiographic apex or when filling material was extruded through the apex.

CONCLUSION

The prevalence of AP in all age groups in Belarus was higher than in other populations. The probability of AP increased significantly after root canal treatment and was closely correlated with the quality of the root filling.

Comparison of Generated Forces and Apical Microleakage Using Nickel-Titanium and Stainless Steel Finger Spreaders in Curved Canals

The purpose of this study was to compare (a) forces generated during lateral compaction and (b) apical microleakage for nickel-titanium (NiTi) and stainless steel (SS) finger spreaders. Twenty-eight extracted human teeth were instrumented using a standardized rotary instrumentation technique. NiTi and SS #30 spreaders were used to obturate molar roots while the forces generated during obturation were measured on a Universal testing machine. Apical microleakage was determined using a fluid filtration method. There was no significant difference in microleakage between spreaders. NiTi spreaders produced significantly less force than SS spreaders in all specimens (p < 0.001).

Periapical status and quality of endodontic treatment in an adult Irish population

AIM

To determine the prevalence of apical periodontitis and the quality of root fillings in an adult Irish population using a retrospective analysis of orthopantomograms (OPGs).

METHODOLOGY

A systematic sample of clinical records and OPGs of 302 adult patients attending the Dublin Dental Hospital, Ireland, were screened by two examiners to determine the quality of root canal treatment and the prevalence of apical periodontitis. The operators who carried out the treatment were unknown. Two examiners inspected OPGs after inter-examiner correlation. European Society of Endodontology (ESE) guidelines were used to determine adequacy of root treatment.

RESULTS

Of the 7427 teeth examined 2% had root fillings. Apical periodontitis was evident in 1.6% of all nonroot filled teeth whilst 33.1% of the subjects had at least one tooth with apical periodontitis. Of the root filled teeth, 25% had apical periodontitis and 52.6% were considered technically inadequate by ESE guidelines. There was a statistically significant (P < 0.05) negative correlation between the quality of the root fillings and the prevalence of apical periodontitis. Posterior root filled teeth (premolars and molars) had a greater prevalence of apical periodontitis than anterior root filled teeth.

CONCLUSIONS

The technical quality of root fillings in an adult Irish population was poor and was consistent with a high prevalence of apical periodontitis.

Do procedural errors cause endodontic treatment failure?

BACKGROUND

This article reviews the effect of endodontic procedural errors, such as underfilling, overfilling, root perforations and separated instruments, on the outcome of endodontic therapy.

TYPES OF STUDIES REVIEWED

Filling the root canal more than 2 millimeters from the radiographic apex (underfilling) or beyond the radiographic apex (overfilling), perforations of the root canal system and instrument separation are possible complications of endodontic therapy. Although these procedural errors may have different causes, they all may affect the outcome of treatment.

RESULTS

Endodontic procedural errors are not the direct cause of treatment failure; rather, the presence of pathogens in the incompletely treated or untreated root canal system is the primary cause of periradicular pathosis. Procedural errors typically are due to several factors. Among them is a lack of understanding of the root canal anatomy, the principles of mechanical instrumentation and tissue wound healing.

CLINICAL IMPLICATIONS

Procedural errors impede endodontic therapy, thus increasing the risk of treatment failure, especially in teeth with necrotic pulps and periradicular lesions. However, procedural errors often are preventable.

[Endodontics and apical periodontitis]

The aim of this paper is to discuss the relation between root canal treatment and apical periodontitis (AP). AP is caused by micro organisms and is mainly a chronic inflammation. There is some evidence of an effect on the general health in immunocompromised patients. A higher incidence of AP on root filled teeth has been found. A number of preoperative and operative factors influence prevalence of AP on root filled teeth. Rubberdam placement and cleaning and shaping of the root canal during root canal treatment is important to create a clean canal to promote healing or prevent the development of AP. Placement of a good quality root filling and a well sealing coronal restoration are also important for the prevention of reinfection of the root canal. The quality of root fillings differs between clinical and epidemiological studies what is reflected in a lower prevalence of AP in the former.

Significance of crown-down root canal preparation technique in endodontic therapy by using the hydroxylapatite sealer

Aim.To evaluate the crown-down preparation technique, and the use of hydroxylapatite based material for the definitive root canal obturation. Methods. The investigation included 20 single-canal roots with chronic periapical inflammatory lesion. Biomechanical medicamentous canal preparation was done using the double flared technique with balanced force, and the obturation was performed with hydroxylapatite sealer (unicone technique). Clinical and radiographic check-up performed 12 months after the treatment, used the following parameters: pain, swelling, percussion and palpation sensitivity, and the presence of fistula. Results. The obtained results showed a successful treatment in 18 cases, while in the 2 cases the treatment failed. Conclusion. These findings suggested that the crown-down preparation technique efficiently cleaned and shaped the root canal, and that the hydroxylapatite-based material created the homogenous and hermetic root canal obturation, so this methodology could be recommended for the endodontic therapy.

Hard and soft tissue augmentation in implant therapy using acellular dermal matrix

The use of acellular dermal matrix to correct soft and hard tissue defects involving implants is described through three case reports. Correction of a ridge deformity caused by a root fracture, submerging of an existing implant and correction of recession defects around adjacent teeth, and ridge preservation for implant placement are presented. The use of acellular dermal matrix prevented the need for a second surgical site for donor material and the possible attendant postoperative complications. It also enhanced patient comfort and satisfaction with the procedure. All three cases demonstrated excellent functional and esthetic results for both the patients and professionals involved in the therapy.

Periapical status and quality of root fillings and coronal restorations in an adult Spanish population

AIM

To investigate the quality of root fillings and coronal restorations and their association with periapical status in an adult Spanish population.

METHODOLOGY

A total of 180 subjects, aged 37.1 +/- 15.7 years, who presented as new patients at the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all root filled teeth, excluding third molars, were examined. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. Radiographic signs of overhang or open margins associated with coronal restorations were also evaluated. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen's kappa test and logistic regression.

RESULTS

The total number of root filled teeth was 93, and 60 (64.5%) had apical periodontitis (AP). Presence of AP in root filled teeth was associated with inadequate adaptation of the filling (OR = 2.29; P = 0.06), inadequate length of the root filling (OR = 2.44; P = 0.048), and with poor radiographic quality of the coronal restoration (OR = 2.38; P = 0.054). Only 34.4% of the root fillings were adequate from a technical perspective. When both root fillings and coronal restorations were adequate the incidence of AP decreased to 31.3% (OR = 5.50; P < 0.01).

CONCLUSIONS

The incidence of AP in root filled teeth was high. Many root fillings were technically unsatisfactory. Adequate root fillings and coronal restorations were associated with a lower incidence of AP; an adequate root filling had a more substantial impact on the outcome of treatment than the quality of the coronal restoration.

Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: report of 4 cases treated by mandibular sagittal osteotomy

Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN) resulting in disabling sensory disturbances such as pain, dysesthesia, paresthesia, hypoesthesia, or anesthesia. Two fundamental mechanisms are responsible for the injury: the chemical neurotoxicity and the mechanical compression caused by the extruded material. Although spontaneous resorption has been described for some materials, early surgical exploration with removal of the material and decompression of the IAN should be performed, irrespective of the material used, given that the importance of nerve damage increases with the duration of the injury. We report 4 cases of disabling dysesthesia and paresthesia following endodontic treatment of lower molars in which sagittal osteotomy was used to remove the endodontic paste and to perform nerve decompression. All the patients experienced immediate relief of dysesthesia and paresthesia.

Mycetoma of the maxillary sinus: endodontic and microbiological correlations

OBJECTIVE

The purpose was to show the capacity of zinc oxide and eugenol to affect the growth of Aspergillus fumigatus.

STUDY DESIGN

An in vitro microbiological analysis was conducted on samples from infected maxillary sinuses and on 3 different endodontic sealers.

RESULTS

Tests showed that zinc oxide in solution favors the growth of Aspergillus fumigatus, while eugenol inhibits this growth, even when mixed with zinc oxide powder. This inhibiting effect decreases over time. A reduced effectiveness was demonstrated over a 75-day period.

CONCLUSIONS

The hypothesis is that the diminishing concentration of eugenol over time in endodontic sealers allows the zinc oxide to support growth of Aspergillus fumigatus. This is reinforced by clinical experience, where mycetoma has developed years after endodontic therapy with excess sealer in the maxillary sinus.

Inferior alveolar nerve injury caused by thermoplastic gutta-percha overextension

Injuries to the inferior alveolar nerve following trauma resulting in a mandibular fracture are well documented and are a well-known risk when surgical procedures are planned for the mandible in the region of the inferior alveolar canal. Such injuries are relatively rare following endodontic therapy. This article reports a case of combined thermal and pressure injury to the inferior alveolar nerve, reviews the pathogenesis of such an injury and makes suggestions for its management.

Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment

AIM

This longitudinal, prospective study (1) investigated the prevalence of post-obturation pain after root canal treatment and (2) evaluated the influence of factors affecting the pain experience.

METHODOLOGY

Twenty practitioners, comprising general dental practitioners, MSc graduates and Endodontists, participated in this study. The patient sample (n = 415) was derived from consecutive patients attending the practitioners' surgeries for root canal treatment on a single tooth. Demographic, medical history, preoperative and intra-operative data as well as pain experience on day 1 and day 2 after root canal obturation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models.

RESULTS

The prevalence of post-obturation pain within 48 h after treatment was 40.2% (n = 167) but less than 12% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The factors that significantly influenced post-obturation pain experience were: gender (OR = 0.434, P < 0.001), tooth type (OR = 1.733, P = 0.007), size of periapical lesion (OR = 0.493, P = 0.004), history of post-preparation pain (OR = 4.110, P = <0.001) or generalized swelling (OR = 3.435, P = 0.005) and number of treatment visits (OR = 2.604, P < 0.001).

CONCLUSIONS

The prevalence of post-obturation pain was high (40.2%). The important prognostic determinants of post-obturation pain were female, molar tooth, size of periapical lesion smaller than 3 mm, history of post-preparation pain or generalized swelling and single-visit treatment.

Apical Extrusion of Thermoplasticized Obturating Material in Canals Instrumented with Profile 0.06 or Profile GT

The purpose of this in vitro study was to compare the extrusion of thermoplacticized gutta-percha in teeth instrumented with Profile 0.06 or Profile GT, and obturated with Thermafil Plus and Thermafil GT, respectively. A total of 120, extracted, human maxillary central incisors were divided into four equal groups. Group 1 was instrumented with Profile 0.06 and obturated with Thermafil Plus. Group 2 was instrumented with Profile 0.06 and obturated using warm vertical condensation (negative control). Group 3 was instrumented with Profile GT and obturated with Thermafil GT. Group 4 was instrumented with Profile GT and obturated like Group 2 (negative control). Extrusion was graded as present or absent. Results found 9 of 30 extruded for group 1, 1 of 30 for group 2, 15 of 30 for group 3, and 2 of 30 for group 4. The results suggest that, in vitro, Thermafil GT may be more prone to extruding gutta-percha past the apical foramen than Thermafil Plus.

[Postobturation pain associated with endodontic treatment]

Postobturation pain of different origin after endodontic treatment was studied in 100 patients after treatment of 151 teeth with filling of 264 channels. 34.4% patients complained of pain. The incidence and intensity of pain were scored. Postobturation pain clearly depended on the number of treatment sessions, number of channels filled in one tooth, and excessive filling "beyond the apex". The method of "crown down" preparation using completely rotating profile instruments and GT rotary files proved to be most effective as regards prevention of postoperative pain.

Incidence of Flare-ups and Evaluation of Quality after Retreatment of Resorcinol-Formaldehyde Resin (“Russian Red Cement”) Endodontic Therapy

The purpose of this retrospective study was to evaluate the quality of treatment and incidence of flare-ups when teeth with resorcinol-formaldehyde resin are retreated in a postgraduate endodontic clinic. Fifty-eight cases were included in this study. Obturated and unfilled canal space was measured on radiographs. Forty-eight percent of the total canal space was filled before retreatment; 90% was filled after retreatment. After retreatment, obturations were rated as optimal in 59%, improved in 33%, unchanged in 6%, and worse in 2%. Seven patients (12%) had postretreatment flare-ups. Data were statistically analyzed using the Cochran-Armitage Test for Discrete Variables. No statistical difference in the incidence of flare-ups was found in teeth that before treatment had more than half the canal space filled compared to teeth with less than half, cases with pre-existing periradicular radiolucencies compared to cases with normal periradicular appearance, symptomatic cases compared to asymptomatic cases, or cases with optimal fillings after retreatment compared to less than optimal cases. It was concluded that teeth with resorcinol-formaldehyde fillings might be retreated with a good prognosis for improving the radiographic quality, but a higher than normal incidence of flare-ups may occur.