Periapical status of root-filled teeth exposed to the oral environment by loss of restoration or caries

Periradicular radiographic assessment in diabetic and control individuals

OBJECTIVE

The purpose of this study was to investigate the prevalence of radiographic periradicular radiolucencies in endodontically treated and untreated teeth in patients with and without diabetes.

STUDY DESIGN

The records of 30 subjects with diabetes and 23 control subjects attending the Endodontic Graduate Clinic at the University of Florida, Gainesville, were reviewed. The number of teeth with root canal treatments with and without periradicular radiolucencies and the number of teeth without endodontic treatment but with periradicular lesions were recorded.

RESULTS

There were no main effects of sex, diabetes diagnosis, or age (the covariate) on the 3 outcomes of interest- nonsurgical endodontic treatment (NSE) with lesions, NSE without lesions, and no NSE with lesions. However, there were significant interactions between sex and diabetes diagnosis for both of the endodontic outcomes, NSE with lesions (F = 4.292; P <.05) and NSE without lesions (F = 4.241; P <.05). This meant that men with type 2 diabetes who had endodontic treatments were more likely to have residual lesions after treatment.

CONCLUSION

Type 2 diabetes is associated with an increased risk of ill response by the periradicular tissues to odontogenic pathogens.

Periapical inflammation affecting coronally-inoculated dog teeth with root fillings augmented by white MTA orifice plugs

Placement of orifice plugs has been suggested to augment the seal of conventional root canal fillings. This study assessed in vivo the efficacy of white mineral trioxide aggregate (MTA) plugs in preventing periapical inflammation subsequent to coronal inoculation of root-filled teeth. The two-rooted mandibular premolars of six beagle dogs were conventionally prepared and filled with gutta-percha and sealer. A white MTA orifice plug was placed into one canal in each tooth. Pulp chambers were inoculated with plaque except for 12 teeth (negative control), and restored. Radiographs were taken at regular intervals. At 10 months, dogs were killed and jaw blocks processed for histology. None of the roots revealed radiographic or histologic evidence of severe inflammation. Mild inflammation was observed in 17% and 39% of the roots with and without an orifice plug, respectively (McNemar, p > 0.05). Without development of severe inflammation, the seal augmentation efficacy of MTA orifice plugs could not be determined.

Contemporary endodontic retreatments: an analysis based on clinical treatment findings

A prospective in vivo investigation was conducted to determine radiographic and clinical factors associated with contemporary nonsurgical endodontic retreatments. Approximately 1,100 failing endodontically treated teeth were screened to determine an appropriate treatment plan. Using magnification, 337 consecutive retreatment cases were evaluated and treated. The vast majority of the retreated cases involved multiple factors. Eighty-five percent of the cases presented with periradicular radiolucencies. Sixty-five percent of the cases demonstrated poor radiographic obturation quality. Associated pain was noted 51% of the time. Forty-two percent of the teeth had untreated canal space. It was statistically significant (Chi-square, p < or = 0.05) that additional canal space was located and treated in 89% of the cases that had previous radiographic asymmetrical obturations. Evidence of coronal leakage was noted in 13% of the retreated teeth. Tooth number, obturation materials, overfills, and previous surgical retrofillings were also recorded. Recommendations were made that might improve the rate of clinical success.

Apical healing of an endodontically treated tooth with a temporary restoration

A 35-yr-old, healthy male presented to the graduate endodontic clinic at Indiana University School of Dentistry for treatment of tooth #26. Two and one-half yr after treatment, the patient returned to the dental school for comprehensive treatment. The canal access opening had been restored with an intact interim restorative material restoration. The tooth was asymptomatic, and radiographic examination showed evidence of apical healing. In this article, a review of the literature concerning crown-down leakage is presented. A case report is given in which healing occurred after the tooth was restored with only an interim restorative material for an extended period of time.

Periapical health related to the quality of coronal restorations and root fillings

AIMS

To evaluate the impact of the quality of coronal restorations scored on a clinical and radiographic basis and the quality of root fillings on periapical health.

METHODOLOGY

Periapical radiographs were taken of 745 root-filled teeth, randomly selected from patients attending the Ghent University Dental School. The teeth had not received restorative treatment in the previous year. The coronal status was scored both clinically according to modified Ryge's criteria, and radiographically by evaluating the presence of signs of marginal leakage or decay. The quality of the root filling was scored according to criteria of length and homogeneity and the periapical status was categorized on the basis of presence or absence of radiographic signs of apical periodontitis. The relationship between coronal status, quality of root filling and periapical health was determined. The data were analyzed using Chi2 test, Odds ratio, Spearman's r(S) and logistic regression.

RESULTS

Thirty-three percent of the teeth had apical periodontitis as diagnosed radiographically. Teeth with good and poor coronal restorations scored clinically had apical periodontitis in 31.1 and 36.8%, respectively; this difference was not statistically significant. The quality of the coronal restorations scored radiographically had a statistically significant influence on the periapical condition (P<0.001) with apical periodontitis in 23.8 and 49.1%, respectively, for acceptable and unacceptable restorations. Marginal decay did not influence the periapical status. Teeth restored without a base under the coronal filling had apical periodontitis in 41.3%, whereas teeth with a base had significantly less (P<0.005) apical periodontitis (25.9%). Composite-restored teeth exhibited apical periodontitis in 40.5% of cases whilst amalgam-restored teeth had apical periodontitis in 28.4% of cases; this difference was statistically significant (P<0.01). Root-canal posts had no influence on periapical health. The length and homogeneity of the root-canal fillings had a significant influence (P<0.01 and P<0.001, respectively) on the presence of apical periodontitis, as well as the quality of the coronal restoration scored radiographically (P<0.001).

CONCLUSION

The importance of a good coronal restoration, as well as of a good root filling should be emphasized as the technical quality of both influencing the periapical status.

Long-Term bacterial leakage along obturated roots restored with temporary and adhesive fillings

The aim of this study was to examine whether obturated roots combined with several adhesive and temporary filling materials can be bypassed by bacteria. Standardized cavities were coronally prepared into 130 straight roots mimicking clinical access cavities. After obturation the roots were assigned to six test and three control groups and coronally sealed with either Clearfil, CoreRestore, IRM, Ketac Fil, or a combination of IRM/wax or Ketac Fil/wax. The roots were then fixed between a top and a bottom chamber each. The top chamber contained soy broth with 108 Staphylococcus epidermidis colony-forming units/ml, and the bottom chamber contained sterile soy broth. For 1 yr the mounts were checked on a regular basis for turbidity in their bottom chambers indicating bacterial growth. After 1 yr only three samples from the CoreRestore group and two samples from the Clearfil group resisted leakage. At termination there was no significant difference in number of leaking samples among the groups. At the beginning of the experiment IRM performed worst. Between months 5 and 10 Clearfil showed the least leaking samples; for some months this was statistically significant compared with IRM or Ketac Fil.