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Long-term Survival of Endodontically Treated Teeth at a Public Dental Specialist Clinic. J Endod 2015; 41:176-81. [DOI: 10.1016/j.joen.2014.10.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 10/02/2014] [Accepted: 10/02/2014] [Indexed: 11/19/2022]
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Tan KS, Yu VSH, Quah SY, Bergenholtz G. Rapid method for the detection of root canal bacteria in endodontic therapy. J Endod 2015; 41:447-50. [PMID: 25576208 DOI: 10.1016/j.joen.2014.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/22/2014] [Accepted: 11/29/2014] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Complete eradication of microorganisms is essential for successful root canal therapy. However, current methods to evaluate persistent bacteria after therapy are not widely practiced. Adenosine triphosphate (ATP) is an indicator of viable cells. The bioluminescence-based ATP assay is easy to perform, and results can be obtained in a clinically relevant time frame of 5 minutes. The aims of this study were to evaluate the sensitivity of the ATP detection method and the specificity of this assay for viable cells and to compare the ATP and culture methods from root canal samples of patients undergoing endodontic treatment. METHODS The sensitivity of the ATP assay was determined using bacterial species commonly isolated from root canals. Bacteria were treated with sodium hypochlorite; after which, culture plating and the ATP assay were performed. Forty-three root canal samples before (S1) and after (S2) instrumentation and 36 samples after the removal of calcium hydroxide dressing (S3) were collected from patients undergoing root canal treatment and subjected to ATP assay and anaerobic culture. RESULTS The sensitivity of the ATP assay was determined to be between 10 and 100 bacterial cells. This method of detection also correlated well with the presence of viable bacteria. The ATP readings obtained allowed clear segregation of anaerobic culture-positive and -negative samples obtained from infected root canals of patients. CONCLUSIONS The ATP detection method can be used as a rapid tool to determine the presence of viable bacteria during root canal therapy. This method may be potentially useful as an adjunct to root canal treatment.
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Affiliation(s)
- Kai Soo Tan
- Faculty of Dentistry, National University of Singapore, Singapore.
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Abstract
Veterinary dentists commonly encounter apical periodontitis in dogs. An overview of the disease is presented, concentrating on pathogenesis and mechanisms of healing. Assessment modalities are reviewed and interpretations of treatment success and failure are discussed. The limitations of readily available diagnostic equipment are illustrated. The benefits of identifying the causative agent and resultant pathosis should not be overlooked. Well-designed clinical studies evaluating various methods of long-term follow-up for apical periodontitis in dogs are needed.
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Cankar K, Nemeth L, Bajd F, Vidmar J, Serša I. Discrimination between intact and decayed pulp regions in carious teeth by ADC mapping. Caries Res 2014; 48:467-74. [PMID: 24852609 DOI: 10.1159/000358068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to evaluate an advanced magnetic resonance imaging (MRI) method, apparent diffusion coefficient (ADC) mapping, in the functional assessment of carious teeth. 38 extracted human teeth with scores of 0, 3 and 6 according to International Caries Detection and Assessment System (ICDAS) criteria were screened and subsequently analyzed by MRI at 2.35 T. Histology sectioning of teeth was used for the gold standard by analyzing two extreme cases (intact and severely decayed). ADC maps of the same teeth were calculated from corresponding diffusion-weighted images and used to obtain ADC distributions along dental pulp as functions of the relative pulp length measured from the occlusal pulp side. The measured distributions were analyzed for the best fit by a four-parameter three-segment linear regression model for ADC distribution along the pulp. MRI results were in good agreement with findings in histological sections of identical teeth. The best fit model parameters, relative decayed region depth, relative transition region width and ADC values of intact and decayed pulp tissue, showed statistically significant differences between the ADC values of intact and decayed pulp tissue (1.0 × 10(-9) m(2)/s vs. 0.74-0.89 × 10(-9) m(2)/s) and the relative decayed region depth progressing with ICDAS score (3 vs. 46% with ICDAS 3 vs. ICDAS 6). The results of this feasibility study confirmed relevance of ADC mapping for the discrimination and localization of intact and decayed regions in dental pulps of carious teeth.
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Affiliation(s)
- Ksenija Cankar
- Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
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Li GH, Niu LN, Selem LC, Eid AA, Bergeron BE, Chen JH, Pashley DH, Tay FR. Quality of obturation achieved by an endodontic core-carrier system with crosslinked gutta-percha carrier in single-rooted canals. J Dent 2014; 42:1124-34. [PMID: 24769108 DOI: 10.1016/j.jdent.2014.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/12/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The present study examined the quality of obturation in root canals obturated by GuttaCore, a gutta-percha-based core-carrier system with a cross-linked thermoset gutta-percha carrier, by comparing the incidence of gaps and voids identified from similar canals obturated by cold lateral compaction or warm vertical compaction. METHODS Thirty single-rooted premolars with oval-shaped canals were shaped and cleaned, and obturated with one of the three obturation techniques (N=10): GuttaCore, warm vertical compaction or cold lateral compaction. Filled canals were scanned with micro-computed tomography (micro-CT); reconstructed images were analysed for the volumetric percentage of gaps and voids at three canal levels (0-4mm, 4-8mm and 8-12mm from working length). The roots were subsequently sectioned at the 4-mm, 8-mm and 12-mm levels for analyses of the percentage of interfacial gaps, and area percentage of interfacial and intracanal voids, using scanning electron microscopy (SEM) to examine negative replicas of root sections. Data were analysed with parametric or non-parametric statistical methods at α=0.05. RESULTS Both micro-CT and SEM data indicated that canals obturated with GuttaCore core-carriers had the lowest incidence of interfacial gaps and voids, although the results were not significantly different from canals obturated by warm vertical compaction. Both the GuttaCore and the warm vertical compaction groups, in turn, had significantly lower incidences of gaps and voids than the cold lateral compaction group. CONCLUSIONS Because of the similarity in obturation quality between GuttaCore and warm vertical compaction, practitioners may find the GuttaCore core-carrier technique a valuable alternative for obturation of oval-shaped canals. CLINICAL SIGNIFICANCE The quality of obturation achieved by GuttaCore in single-rooted canals is not significantly different from that achieved by warm vertical compaction.
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Affiliation(s)
- Guo-Hua Li
- Department of Stomatology, Fuzhou Dongfang Hospital, Fuzhou, China
| | - Li-Na Niu
- State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Lisa C Selem
- Department of Endodontics, Georgia Regents University, Augusta, GA, USA
| | - Ashraf A Eid
- Department of Dental and Biomedical Material Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Brian E Bergeron
- Department of Endodontics, Georgia Regents University, Augusta, GA, USA
| | - Ji-Hua Chen
- State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, China.
| | - David H Pashley
- Department of Oral Biology, Georgia Regents University, Augusta, GA, USA
| | - Franklin R Tay
- Department of Endodontics, Georgia Regents University, Augusta, GA, USA.
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Li GH, Niu LN, Zhang W, Olsen M, De-Deus G, Eid AA, Chen JH, Pashley DH, Tay FR. Ability of new obturation materials to improve the seal of the root canal system: a review. Acta Biomater 2014; 10:1050-1063. [PMID: 24321349 DOI: 10.1016/j.actbio.2013.11.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 11/25/2022]
Abstract
New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials.
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De Coster P, Rajasekharan S, Martens L. Laser-assisted pulpotomy in primary teeth: a systematic review. Int J Paediatr Dent 2013; 23:389-99. [PMID: 23171469 DOI: 10.1111/ipd.12014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to identify high-quality articles comparing laser with conventional pulpotomy procedures, and to assess whether laser treatment may offer an appreciable benefit over conventional approaches. METHODS A systematic search was implemented for MEDLINE, WEB of SCIENCE and Cochrane's CENTRAL databases (1980-2012) to identify eligible studies. Two reviewers independently assessed the methodological quality of the articles (Κ = 0.89) using specific study design-related quality assessment forms (Dutch Cochrane Collaboration). RESULTS Seven articles met the inclusion criteria, of which five randomized control trials (RCT) and two case series (CS), involving Nd:YAG, Er:YAG, CO₂ and 632/980 nm diode lasers. Although heterogeneity between pulpotomy studies was high, odds ratios (OR) were generally <1, indicating that laser is less successful than conventional pulpotomy techniques. CONCLUSION Given the paucity and high heterogeneity of high-quality articles, general recommendations for the clinical use of laser in pulpotomy in primary teeth can yet not be formulated.
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Affiliation(s)
- Peter De Coster
- Oral Biology, Dental School, Ghent University, Ghent, Belgium
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Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent 2013; 41:935-48. [PMID: 23994710 DOI: 10.1016/j.jdent.2013.08.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/12/2013] [Accepted: 08/17/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. METHODS To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. RESULTS By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. CONCLUSIONS Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.
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Cho SY, Seo DG, Lee SJ, Lee J, Lee SJ, Jung IY. Prognostic factors for clinical outcomes according to time after direct pulp capping. J Endod 2013; 39:327-31. [PMID: 23402502 DOI: 10.1016/j.joen.2012.11.034] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Direct pulp capping is a treatment option for teeth with carious-exposed pulp. Because pulp capping studies have exhibited fluctuations in success rates according to different follow-up times, investigating the clinical pulpal survival rate and the potential factors contributing to the survival with respect to time is necessary. METHODS A total of 175 patients treated between November 2007 and August 2010 met the inclusion criteria. During the follow-up, we investigated 7 clinical variables with respect to the survival of the pulp capping treatment: sex, age, maxilla versus mandible, tooth position, capping materials, temporary filling materials, and exposure site. Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazard regression model. RESULTS The Kaplan-Meier survival curves and log-rank tests revealed that only age, exposure site, and capping material had significant effects on the pulpal survival rate (P< .05). A Cox regression model showed that mineral trioxide aggregate was the sole factor affecting the survival of the treated pulps (P< .05). In the analyses performed separately according to time, there was no conspicuous factor that affected the survival rate before 100 days. However, after 100 days, the type of pulp capping material was the single most important factor influencing the survival rate (P< .05). CONCLUSIONS The results of this study indicated that careful patient selection and the type of pulp capping material should be taken into consideration when performing a pulp capping treatment.
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Affiliation(s)
- Sin-Yeon Cho
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
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60
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Gaitan-Fonseca C, Collart-Dutilleul PY, Semetey V, Romieu O, Cruz R, Flores H, Cuisinier F, Pérez E, Pozos-Guillen A. Chemical treatment of the intra-canal dentin surface: a new approach to modify dentin hydrophobicity. J Appl Oral Sci 2013; 21:63-7. [PMID: 23559114 PMCID: PMC3881810 DOI: 10.1590/1678-7757201302168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 01/19/2013] [Indexed: 02/08/2023] Open
Abstract
Objective: This study evaluated the hydrophobicity of dentin surfaces that were modified
through chemical silanization with octadecyltrichlorosilane (OTS). Material and Methods: An in vitro experimental study was performed using 40 human
permanent incisors that were divided into the following two groups: non-silanized
and silanized. The specimens were pretreated and chemically modified with OTS.
After the chemical modification, the dentin hydrophobicity was examined using a
water contact angle measurement (WCA). The effectiveness of the modification of
hydrophobicity was verified by the fluid permeability test (FPT). Results and Conclusions: Statistically significant differences were found in the values of WCA and FPT
between the two groups. After silanization, the hydrophobic intraradicular dentin
surface exhibited in vitro properties that limit fluid penetration into the sealed
root canal. This chemical treatment is a new approach for improving the sealing of
the root canal system.
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61
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Qudeimat MA, Barrieshi-Nusair KM, Owais AI. Calcium Hydroxide vs. Mineral Trioxide Aggregates for Partial Pulpotomy of Permanent Molars with Deep Caries. Eur Arch Paediatr Dent 2012; 8:99-104. [PMID: 17555692 DOI: 10.1007/bf03262577] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To prospectively compare the clinical success rate of partial pulpotomy treatment in permanent molars using calcium hydroxide (CH) and mineral trioxide aggregates (MTA) as pulp dressing agents. METHODS Restorable permanent first molars (64) with carious pulp exposures were randomly assigned to two groups; CH and MTA. A standardized operative procedure was followed in both groups. Following isolation and caries removal, the exposed superficial pulp tissue layers were removed with a sterile flame shape diamond bur to a depth of 2-4 mm. Bleeding was controlled and pulp dressed with either a paste of non-setting Ca(OH)2 followed by a setting layer of Ca(OH)2, or with grey MTA. The dressing materials in both groups were then covered with a layer of light cured glass ionomer cement. The teeth were either restored using amalgam, or where grossly carious with preformed metal crowns. Patients were scheduled for follow-up at 3, 6, 12 months and annually thereafter. RESULTS There were 34 patients (17 males and 17 females) with 51 teeth available for evaluation. The age of patients at the time of restoration ranged between 6.8 to 13.3 years (mean of 10.3 +/- 1.8 years). The follow-up period ranged from 25.4 to 45.6 months with an average of 34.8 +/- 4.4 months. There was no statistically significant difference in the success rate of teeth treated with CH (91%) in comparison to teeth treated with MTA (93%). Radiographically, a hard tissue barrier under CH was noticed in 12 (55%) teeth compared with 18 (64%) teeth under MTA (p=0.4). CONCLUSIONS MTA has clinical success rate comparable to CH as a pulp dressing material for partial pulpotomy in permanent molars with carious exposures.
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Affiliation(s)
- M A Qudeimat
- Dept Developmental and Preventive Sciences, Kuwait University, Kuwait.
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62
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Paiva SSM, Siqueira JF, Rôças IN, Carmo FL, Leite DCA, Ferreira DC, Rachid CTC, Rosado AS. Clinical antimicrobial efficacy of NiTi rotary instrumentation with NaOCl irrigation, final rinse with chlorhexidine and interappointment medication: a molecular study. Int Endod J 2012; 46:225-33. [DOI: 10.1111/j.1365-2591.2012.02111.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/05/2012] [Indexed: 12/01/2022]
Affiliation(s)
- S. S. M. Paiva
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - J. F. Siqueira
- Department of Endodontics and Molecular Microbiology Laboratory; Estácio de Sá University Rio de Janeiro; Brazil
| | - I. N. Rôças
- Department of Endodontics and Molecular Microbiology Laboratory; Estácio de Sá University Rio de Janeiro; Brazil
| | - F. L. Carmo
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - D. C. A. Leite
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - D. C. Ferreira
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - C. T. C. Rachid
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - A. S. Rosado
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
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63
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Vera J, Siqueira JF, Ricucci D, Loghin S, Fernández N, Flores B, Cruz AG. One- versus Two-visit Endodontic Treatment of Teeth with Apical Periodontitis: A Histobacteriologic Study. J Endod 2012; 38:1040-52. [DOI: 10.1016/j.joen.2012.04.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Good M, El KIA, Hussey DL. Endodontic 'solutions' part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments. ACTA ACUST UNITED AC 2012; 39:239-40, 242-4, 246. [PMID: 22774686 DOI: 10.12968/denu.2012.39.4.239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual 'solution' or sequence of'solutions' could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic'solution' usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases.The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.
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Affiliation(s)
- Melissa Good
- Department of Restorative Dentistry, The Royal Hospitals, Belfast Health and Social Care Trust, Belfast, BT12 6BP, Northern Ireland, UK
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65
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Siqueira Jr JF, Rôças IN. Optimising single-visit disinfection with supplementary approaches: A quest for predictability. AUST ENDOD J 2011; 37:92-8. [DOI: 10.1111/j.1747-4477.2011.00334.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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66
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Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, Pashley DH, Tay FR. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod 2011; 37:895-902. [PMID: 21689541 DOI: 10.1016/j.joen.2011.04.002] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/31/2011] [Accepted: 04/02/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes. METHODS Literature search was conducted using the search terms "coronal restoration," "root canal," "periapical status," and "quality." Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected. Nine articles were identified and were reviewed by 3 investigators. Data were collected based on predetermined criteria. Percentages of teeth without apical periodontitis were recorded for each category: adequate root canal treatment (AE), inadequate root canal treatment (IE), adequate restoration (AR), and inadequate restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs). RESULTS After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61-2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001). CONCLUSIONS On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these 2 combinations.
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Affiliation(s)
- Brian M Gillen
- Department of Endodontics, Georgia Health Sciences University, Augusta, GA 30912-1129, USA
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67
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Aguilar P, Linsuwanont P. Vital Pulp Therapy in Vital Permanent Teeth with Cariously Exposed Pulp: A Systematic Review. J Endod 2011; 37:581-7. [DOI: 10.1016/j.joen.2010.12.004] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 12/08/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
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68
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HAAPASALO MARKUS, SHEN YA, RICUCCI DOMENICO. Reasons for persistent and emerging post-treatment endodontic disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1601-1546.2011.00256.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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69
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Nam S, Won JE, Kim CH, Kim HW. Odontogenic differentiation of human dental pulp stem cells stimulated by the calcium phosphate porous granules. J Tissue Eng 2011; 2011:812547. [PMID: 21772958 PMCID: PMC3136101 DOI: 10.4061/2011/812547] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 02/07/2011] [Indexed: 12/15/2022] Open
Abstract
Effects of three-dimensional (3D) calcium phosphate (CaP) porous granules on the growth and odontogenic differentiation of human dental pulp stem cells (hDPSCs) were examined for dental tissue engineering. hDPSCs isolated from adult human dental pulps were cultured for 3-4 passages, and populated on porous granules. Cell growth on the culture dish showed an ongoing increase for up to 21 days, whereas the growth on the 3D granules decreased after 14 days. This reduction in proliferative potential on the 3D granules was more conspicuous under the osteogenic medium conditions, indicating that the 3D granules may induce the odontogenic differentiation of hDPSCs. Differentiation behavior on the 3D granules was confirmed by the increased alkaline phosphatase activity, up-regulation of odontoblast-specific genes, including dentin sialophosphoprotein (DSPP) and dentin matrix protein 1 (DMP1) by quantitative polymerase chain reaction, and greater level of dentin sialoprotein synthesis by western blot. Moreover, the cellular mineralization, as assessed by Alizarin red S and calcium quantification, was significantly higher in the 3D CaP granules than in the culture dish. Taken all, the 3D CaP porous granules should be useful for dental tissue engineering in combination with hDPSCs by providing favorable 3D substrate conditions for cell growth and odontogenic development.
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Affiliation(s)
- Sunyoung Nam
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 330-714, Republic of Korea
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Udoye CI, Jafarzadeh H, Aguwa EN, Habibi M. Flare-up incidence and related factors in Nigerian adults. J Contemp Dent Pract 2011; 12:120-3. [PMID: 22186755 DOI: 10.5005/jp-journals-10024-1020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To determine the incidence of flare-up and the effect of age, gender, visit type, treatment duration, preoperative pain and intraoperative pain on flare-up in Nigerian adults. MATERIALS AND METHODS A total of 175 participants, aged 18 to 60 years with a necrotic central incisor, with or without preoperative pain, participated. They received postoperative paracetamol tablets and were asked to report back if unbearable pain/swelling developed. RESULTS A 10% flare-up rate was recorded, while none of the studied factors had a significant relationship with flare-up. CONCLUSION The relationships between flare-up and studied related factors were not proven. CLINICAL SIGNIFICANCE Age, gender, visit type, treatment duration, preoperative pain and intraoperative pain have no effect on flare-up incidence.
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Affiliation(s)
- Christopher I Udoye
- Endodontic Unit, Department of RestorativeDentistry, Faculty of Dentistry, College of Medicine, University of Nigeria, Nigeria
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71
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Viennot S, Pernier C. [Adult orthodontics. Retention in adults]. Orthod Fr 2011; 82:145-154. [PMID: 21457700 DOI: 10.1051/orthodfr/2011109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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72
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Susin L, Liu Y, Yoon JC, Parente JM, Loushine RJ, Ricucci D, Bryan T, Weller RN, Pashley DH, Tay FR. Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system. Int Endod J 2010; 43:1077-90. [PMID: 20726910 DOI: 10.1111/j.1365-2591.2010.01778.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To compare canal and isthmus debris debridement efficacies of the manual dynamic irrigation (MDI) and apical negative pressure (ANP) techniques in the mesial root of mandibular first molars with narrow isthmi, using a closed canal design. METHODOLOGY Micro-computed tomography was employed to select 20 teeth, each containing a narrow isthmus. Each root was sealed at the apex with hot glue and embedded in polyvinylsiloxane to simulate a closed canal system. The teeth were submitted to a standardized instrumentation protocol. Final irrigation was performed with either the MDI or the ANP technique using the EndoVac system (N=10). Masson trichrome-stained sections were prepared from completely demineralized roots at 10 canal levels between 1 and 2.8mm of the anatomical apices. Areas occupied by canals and isthmus of each root and debris in the corresponding regions were digitized by the NIH Image J software and statistically analysed using two-way repeated measures anova. RESULTS For the instrumented canals, there were no differences between the two groups (P=0.131) in the area occupied by debris at all canal levels (P=0.343). Conversely, for the isthmus, less debris was found in the ANP group (P<0.001) but no differences were seen in each group with respect to the 10 canal levels (P=0.352). CONCLUSION Neither technique completely removed debris from the isthmus regions. However, the EndoVac system, which encompasses the ANP concept, removed considerably more debris from narrow isthmi in mandibular mesial roots.
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Affiliation(s)
- L Susin
- Department of Endodontics, School of Dentistry, Medical College of Georgia, Augusta, GA 30912-1129, USA
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73
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Parente JM, Loushine RJ, Susin L, Gu L, Looney SW, Weller RN, Pashley DH, Tay FR. Root canal debridement using manual dynamic agitation or the EndoVac for final irrigation in a closed system and an open system. Int Endod J 2010; 43:1001-12. [DOI: 10.1111/j.1365-2591.2010.01755.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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74
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Pasqualini D, Cuffini AM, Scotti N, Mandras N, Scalas D, Pera F, Berutti E. Comparative Evaluation of the Antimicrobial Efficacy of a 5% Sodium Hypochlorite Subsonic-activated Solution. J Endod 2010; 36:1358-60. [DOI: 10.1016/j.joen.2010.03.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/25/2010] [Accepted: 03/25/2010] [Indexed: 01/12/2023]
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75
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Komabayashi T, Zhu Q. Innovative endodontic therapy for anti-inflammatory direct pulp capping of permanent teeth with a mature apex. ACTA ACUST UNITED AC 2010; 109:e75-81. [PMID: 20416524 DOI: 10.1016/j.tripleo.2009.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Abstract
Direct pulp capping is treatment of an exposed vital pulp with a dental material to facilitate the formation of reparative dentin and maintenance of vital pulp. It has been studied as an alternate way to avoid vital pulp extirpation. However, the success rate of pulp capping is much lower than that of vital pulp extirpation. Therefore, direct pulp capping is currently considered controversial by many clinicians. To increase the success rate, a critical need exists to develop new biologically based therapeutics that reduce pulp inflammation, promote the continued formation of new dentin-pulp complex, and restore vitality by stimulating the regrowth of pulpal tissue. Bioengineered anti-inflammatory direct pulp-capping materials, together with adhesive materials for leakage prevention, have great potential to improve the condition of the existing pulp from an inflamed to a noninflamed status and lead to a high rate of long-term success.
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Affiliation(s)
- Takashi Komabayashi
- Department of Endodontics, Texas A&M Health Science Center, Baylor College of Dentistry, Dallas, TX, USA.
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76
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Hecker H, Bartha T, Löst C, Weiger R. Determining the apical preparation size in premolars: part III. ACTA ACUST UNITED AC 2010; 110:118-24. [DOI: 10.1016/j.tripleo.2010.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/23/2010] [Accepted: 03/03/2010] [Indexed: 12/14/2022]
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77
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Gala-Garcia A, Teixeira KIR, Wykrota FHL, Sinisterra RD, Cortés ME. Bioceramic/Poly (glycolic)-poly (lactic acid) composite induces mineralized barrier after direct capping of rat tooth pulp tissue. Braz Oral Res 2010; 24:8-14. [DOI: 10.1590/s1806-83242010000100002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 09/10/2009] [Indexed: 11/22/2022] Open
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78
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Critical Review on Methacrylate Resin–based Root Canal Sealers. J Endod 2010; 36:383-99. [DOI: 10.1016/j.joen.2009.10.023] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 10/13/2009] [Accepted: 10/18/2009] [Indexed: 10/20/2022]
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79
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Aubut V, Pommel L, Verhille B, Orsière T, Garcia S, About I, Camps J. Biological properties of a neutralized 2.5% sodium hypochlorite solution. ACTA ACUST UNITED AC 2010; 109:e120-5. [DOI: 10.1016/j.tripleo.2009.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 09/01/2009] [Accepted: 09/10/2009] [Indexed: 11/25/2022]
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80
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Abstract
Although fungi, archaea, and viruses contribute to the microbial diversity in endodontic infections, bacteria are the most common micro-organisms occurring in these infections. Datasets from culture and molecular studies, integrated here for the first time, showed that over 460 unique bacterial taxa belonging to 100 genera and 9 phyla have been identified in different types of endodontic infections. The phyla with the highest species richness were Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria. Diversity varies significantly according to the type of infection. Overall, more taxa have been disclosed by molecular studies than by culture. Many cultivable and as-yet-uncultivated phylotypes have emerged as candidate pathogens based on detection in several studies and/or high prevalence. Now that a comprehensive inventory of the endodontic microbial taxa has been established, future research should focus on the association with different disease conditions, functional roles in the community, and susceptibility to antimicrobial treatment procedures.
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Affiliation(s)
- J F Siqueira
- Department of Endodontics and Molecular Microbiology, Faculty of Dentistry, Estácio de Sá University, Av. Alfredo Baltazar da Silveira, 580/cobertura, Recreio, Rio de Janeiro, RJ, Brazil.
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81
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Abstract
The selection of indirect pulp capping requires appropriate case selection, delivery of optimal treatment, and careful clinical follow-up. In this section of our special Issue, we review recent clinical studies related to indirect pulp capping and discuss the potential strengths and limitations of the evidence supporting this approach.
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82
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83
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Sathorn C, Parashos P, Messer H. Australian endodontists' perceptions of single and multiple visit root canal treatment. Int Endod J 2009; 42:811-8. [PMID: 19619228 DOI: 10.1111/j.1365-2591.2009.01587.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To ascertain endodontist's point of view (treatment philosophy, rationale and preference) regarding single- and multiple-visit root canal treatment. To identify the basis on which the choice is made and how the information necessary for the choice is acquired. METHODOLOGY Endodontists registered with the dental practice board of every state in Australia were contacted, and if they agreed to participate, they were interviewed either face to face or by telephone. The following topics were addressed in an interview lasting 15 to 20 min: demographics, current clinical procedures, treatment rationales and preference. A hypothetical scenario was posed to investigate which treatment regimen they would prefer to deliver if biological concerns were eliminated from consideration. RESULTS Fifty-two endodontists (71% of all Australian endodontists) agreed to participate in the study. Almost all (51/52) participants had performed single-visit root canal treatment, but very few routinely performed it. A majority of participants were willing to provide single-visit treatment where patients had time constraints, and in vital cases (including elective endodontics). The most powerful factor of influencing practice change was interpersonal contact with colleagues. Publications in academic journals have a weak influence in practice change. CONCLUSIONS Australian endodontists strongly prefer multiple-visit over single-visit root canal treatment even in cases where biological concerns are not an issue. Operator preference rather than biological or patient considerations appear to be the primary determinant of treatment choice.
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Affiliation(s)
- C Sathorn
- Endodontic Unit, School of Dental Science, The University of Melbourne, Melbourne, Australia.
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84
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Outcome of Root Canal Treatment in Dogs Determined by Periapical Radiography and Cone-Beam Computed Tomography Scans. J Endod 2009; 35:723-6. [DOI: 10.1016/j.joen.2009.01.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 01/16/2009] [Accepted: 01/28/2009] [Indexed: 11/23/2022]
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85
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Koch M, Eriksson HG, Axelsson S, Tegelberg Å. Effect of educational intervention on adoption of new endodontic technology by general dental practitioners: a questionnaire survey. Int Endod J 2009; 42:313-21. [DOI: 10.1111/j.1365-2591.2008.01511.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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86
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Silveira AMV, Lopes HP, Siqueira JF, Macedo SB, Consolaro A. Periradicular repair after two-visit endodontic treatment using two different intracanal medications compared to single-visit endodontic treatment. Braz Dent J 2009; 18:299-304. [PMID: 18278299 DOI: 10.1590/s0103-64402007000400005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 08/14/2007] [Indexed: 11/22/2022] Open
Abstract
The number of appointments necessary to treat infected root canals is one of the most controversial issues in endodontics. This study evaluated, in dogs, the response of the periradicular tissues to the endodontic treatment of infected root canals performed in a single visit or in two visits, using different interappointment dressings. Periradicular lesions were induced by inoculating Enterococcus faecalis in the root canals. After confirming that a periradicular lesion developed, the root canals were treated within one or two visits, using either ozonized oil or calcium hydroxide in camphorated paramonochlorophenol (CMCP) as an intracanal medication. After 6 months, the animals were sacrificed and the specimens were processed for histological and histobacteriological analysis. The root canals treated in a single visit showed a success rate of 46%. When a calcium hydroxide/CMCP-based interappointment intracanal medication was used, 74% of the cases were categorized as success. In cases where ozonized oil was used as the intracanal medication, a success rate of 77% was observed. These results of the present study demonstrated that the two-visit treatment offered a higher success rate compared to one-visit therapy. In addition, ozonized oil may potentially be used as an intracanal medication.
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Affiliation(s)
- Adriana M Vieira Silveira
- Department of Endodontics, School of Dentistry, José do Rosário Vellano University, Alfenas, MG, Brazil.
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87
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Abstract
Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. IPT has a significantly higher success in treating all primary first molars, but especially those with reversible pulpitis compared with FP. The purpose of this article was to review the dental literature and new research in vital pulp therapy to determine the following: (1) Is a pulpotomy indicated for a true carious pulp exposure? (2) Is there a diagnostic method to reliably identify teeth that are candidates for vital pulp therapy? (3) Is primary tooth pulpotomy out of date, and should indirect pulp therapy replace pulpotomy?
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Affiliation(s)
- James A Coll
- Department of Pediatric Dentistry, University of Maryland Dental School, Baltimore, Maryland, USA.
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88
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A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Investig 2008; 12:369-78. [DOI: 10.1007/s00784-008-0208-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 05/19/2008] [Indexed: 10/22/2022]
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89
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Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J 2007; 41:91-9. [PMID: 17956561 DOI: 10.1111/j.1365-2591.2007.01316.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this systematic review was to assess the evidence regarding postoperative pain and flare-up of single- or multiple-visit root canal treatment. METHODOLOGY CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research. REVIEW METHODS The included clinical studies compared the prevalence/severity of postoperative pain or flare-up in single- and multiple-visit root canal treatment. Data in those studies were extracted independently. RESULTS Sixteen studies fitted the inclusion criteria in the review, with sample size varying from 60 to 1012 cases. The prevalence of postoperative pain ranged from 3% to 58%. The heterogeneity amongst included studies was far too great to conduct meta-analysis and yield meaningful results. CONCLUSION Compelling evidence indicating a significantly different prevalence of postoperative pain/flare-up of either single- or multiple-visit root canal treatment is lacking.
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Affiliation(s)
- C Sathorn
- Endodontic Unit, School of Dental Science, University of Melbourne, Melbourne, VIC, Australia.
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90
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Londhe SM, Garge HG. Single Visit Root Canal Treatment. Med J Armed Forces India 2007; 63:273-4. [DOI: 10.1016/s0377-1237(07)80153-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 01/25/2007] [Indexed: 11/30/2022] Open
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91
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El Karim I, Kennedy J, Hussey D. The antimicrobial effects of root canal irrigation and medication. ACTA ACUST UNITED AC 2007; 103:560-9. [PMID: 17223590 DOI: 10.1016/j.tripleo.2006.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 06/17/2006] [Accepted: 10/04/2006] [Indexed: 10/23/2022]
Abstract
The role of microorganisms in the development and maintenance of pulpal and periapical inflammation have been well documented. The success of root canal treatment largely depends on the elimination of microbial contamination from the root canal system. Although mechanical instrumentation of root canals can reduce bacterial population, effective elimination of bacteria cannot be achieved without the use of antimicrobial root canal irrigation and medication. This review will discuss the antimicrobial effects of the known root canal irrigants and medicaments and explore future developments in the field.
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Affiliation(s)
- Ikhlas El Karim
- Department of Restorative Dentistry, School of Clinical Dentistry, Queen's University Belfast, Belfast, Northern Ireland.
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92
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Abstract
Chemomechanical preparation of the root canal includes both mechanical instrumentation and antibacterial irrigation, and is principally directed toward the elimination of micro-organisms from the root canal system. A variety of instruments and techniques have been developed and described for this critical stage of root canal treatment. Since their introduction in 1988, nickel-titanium (NiTi) rotary instruments have become a mainstay in clinical endodontics because of their exceptional ability to shape root canals with potentially fewer procedural complications. Safe clinical usage of NiTi instruments requires an understanding of basic metallurgy of the alloy including fracture mechanisms and their correlation to canal anatomy. This paper reviews the biologic principles of preparing root canals with an emphasis on correct use of current rotary NiTi instrumentation techniques and systems. The role and properties of contemporary root canal irrigants is also discussed.
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Affiliation(s)
- G R Young
- School of Dental Science, The University of Melbourne, Carlton, Victoria
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93
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Sousa CJA, Montes CRM, Pascon EA, Loyola AM, Versiani MA. Comparison of the Intraosseous Biocompatibility of AH Plus, EndoREZ, and Epiphany Root Canal Sealers. J Endod 2006; 32:656-62. [PMID: 16793475 DOI: 10.1016/j.joen.2005.12.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 11/30/2005] [Accepted: 12/01/2005] [Indexed: 11/25/2022]
Abstract
To evaluate the intraosseous biocompatibility of AH Plus, EndoREZ, and Epiphany root canal sealers as recommended by the Technical Report #9 of the Fédération Dentaire Internationale (FDI). Thirty guinea pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks, received one implant on each side of the lower jaw symphysis. At the end of the observation periods, the animals were killed and the specimens prepared for routine histological examination. After analyzing both periods, the inflammatory tissue reaction to EndoREZ was considered severe. In the AH Plus group, the reaction changed from severe to moderate, while it was observed biological compatibility to Epiphany with bone formation and none to slight inflammatory reaction. It was concluded that Epiphany root canal sealer was the only material that presented intraosseous biocompatibility within the two analyzed periods.
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Affiliation(s)
- Cássio J A Sousa
- Department of Endodontics, Faculty of Dentistry, Universidade Federal de Uberlândria, Uberlândia, Minas Gerais, Brazil.
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94
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Abstract
Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.
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Affiliation(s)
- P N R Nair
- Institute of Oral Biology, Section of Oral Structures and Development, Centre of Dental and Oral Medicine, University of Zurich, Zurich, Switzerland.
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95
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Wu MK, Dummer PMH, Wesselink PR. Consequences of and strategies to deal with residual post-treatment root canal infection. Int Endod J 2006; 39:343-56. [PMID: 16640632 DOI: 10.1111/j.1365-2591.2006.01092.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Bacterial sampling of prepared root canals is used to determine the presence and character of the remaining microbiota. However, it is likely that current sampling techniques only identify organisms in the main branches of the root canal system whereas it is unlikely that they can sample areas beyond the apical end-point of preparation and filling, or in lateral canals, canal extensions, apical ramifications, isthmuses and within dentinal tubules. Thus, it may be impossible by current techniques to identify residual post-treatment root canal infection. In histologic observations of root apices, bacteria have been found in inaccessible inter-canal isthmuses and accessory canals often in the form of biofilms. There is no in vivo evidence to support the assumption that these bacteria can be entombed effectively in the canal system by the root filling and thus be rendered harmless. As a consequence of this residual root infection, post-treatment apical periodontitis, which may be radiographically undetectable, may persist or develop as a defence mechanism to prevent the systemic spread of bacteria and/or their byproducts to other sites of the body. Histologic observation of root apices with surrounding bone removed from either patients or human cadavers has demonstrated that post-treatment apical periodontitis is associated with 50-90% of root filled human teeth. Thus, if the objective of root canal treatment is to eliminate apical periodontitis at a histological level, current treatment procedures are inadequate. It is essential that our knowledge of the local and systemic consequences of both residual post-treatment root infection and post-treatment apical periodontitis be improved. The continued development of treatments that can effectively eliminate root infection is therefore a priority in clinical endodontic research. Post-treatment disease following root canal treatment is most often associated with poor quality procedures that do not remove intra-canal infection; this scenario can be corrected via a nonsurgical approach. However, infection remaining in the inaccessible apical areas, extraradicular infection including apically extruded dentine debris with bacteria present in dentinal tubules, true radicular cysts, and foreign body reactions require a surgical intervention.
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Affiliation(s)
- M-K Wu
- Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
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96
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Wu MK, van der Sluis LWM, Wesselink PR. A 1-year follow-up study on leakage of single-cone fillings with RoekoRSA sealer. ACTA ACUST UNITED AC 2006; 101:662-7. [PMID: 16632281 DOI: 10.1016/j.tripleo.2005.03.013] [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] [Received: 11/18/2004] [Revised: 01/27/2005] [Accepted: 03/02/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to measure long-term leakage along single cone (SC) fillings. STUDY DESIGN Two groups of canines (n = 30) were prepared and a size 55 file was the apical master file. Step-back was performed using files of sizes 60, 70, and 80. The canals were filled by the single cone technique using RoekoRSA as sealer. To place sealer into each canal, a bidirectional spiral was used in 1 group, whereas a gutta-percha cone was used in the other group. Immediately after root filling, the coronal portion of root filling was removed by postspace preparation. Leakage along the 4 mm remaining apical root filling was measured after 1 week and again after 1 year using a fluid transport model. Ten additional canine roots were prepared and filled with gutta-percha cones without sealer, serving as positive controls. Occurrence of apical extrusion of materials was recorded. RESULTS The apical root filling in all 60 canine roots did not show leakage either at 1 week or at 1 year. All 10 positive controls showed gross leakage (>20 muL/h). In no case gutta-percha extruded through the apical foramen. Sealer extruded apically in 88% of the roots where a gutta-percha cone was used to introduce sealer, whereas in 28% of the roots where a bidirectional spiral was used to introduce sealer (by chi-square test, P < .05). CONCLUSION In wide and straight canals, SC fillings with RoekoRSA sealer prevented fluid transport for 1 year. Using bidirectional spiral to place sealer reduced sealer extrusion under the conditions of this experiment.
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Affiliation(s)
- Min-Kai Wu
- Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
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97
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Bergenholtz G. Advances since the paper by Zander and Glass (1949) on the pursuit of healing methods for pulpal exposures: historical perspectives. ACTA ACUST UNITED AC 2006; 100:S102-8. [PMID: 16037786 DOI: 10.1016/j.tripleo.2005.03.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Clinical observations and experimental studies in humans and laboratory animals have demonstrated that healing and repair of pulpal exposures by caries, trauma, or iatrogenic causes are possible with a variety of wound treatment methods. Yet clinical trials have shown that predictable long-term pulp tissue preservation may be an elusive goal and has led to doubts about pulp capping and pulpotomy as valid clinical procedures. Nevertheless substantial knowledge has accumulated over the years on the mechanisms and the treatment factors that are important to promote/support continued vital pulp functions. This article highlights some key contributions to our current knowledge base, which have come to light during the more than 50 years since a pioneering experimental study by Zander and Glass was published in the Triple O journal.
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98
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Bergenholtz G, Wikesjö UME, Sorensen RG, Xiropaidis AV, Wozney JM. Observations on healing following endodontic surgery in nonhuman primates (Macaca fascicularis): Effects of rhBMP-2. ACTA ACUST UNITED AC 2006; 101:116-25. [PMID: 16360616 DOI: 10.1016/j.tripleo.2005.02.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 01/03/2005] [Accepted: 02/25/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The potential of recombinant human bone morphogenetic protein-2 (rhBMP-2) to enhance bone healing following endodontic surgery was tested. The pattern and timing of de novo bone formation and cementum regeneration, and the potential for root resorption and ankylosis to accompany bone formation were evaluated. STUDY DESIGN Pulpal infections were induced in maxillary and mandibular incisor teeth in young adult Cynomolgus monkeys. The teeth received conventional endodontic treatment immediately followed by surgical root resection. In a randomized split-mouth design, contralateral apical bone defects received rhBMP-2 in absorbable collagen sponge (ACS) carrier or served as sham-surgery controls to provide histological and radiographic evaluations following 1 (mandibular incisors) and 4.5 (maxillary incisors) month(s) postsurgery. RESULTS At 1 month postsurgery trabecular bone filled the apical bone defects. The newly formed bone appeared considerably more mature and had assumed characteristics of the contiguous resident bone at 4.5 months postsurgery. The resected root tips were almost completely covered by new cementum with a maturing functionally oriented periodontal ligament. Localized inflammatory infiltrates were associated with the filled root canals and extruded root-filling material. Root resorption and ankylosis were not observed. There were no apparent differences in healing patterns between sites implanted with rhBMP-2/ACS and those serving as sham-surgery controls. CONCLUSIONS Under conditions where the influence of infectious elements and irritation caused by root filling material are minimized, bone formation and cementum regeneration appears rapid following endodontic surgery. rhBMP-2/ACS did not offer an obvious benefit above and beyond that of the native osteogenic potential in this animal model.
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Sum CP, Neo J, Kishen A. What We Leave Behind In Root Canals After Endodontic Treatment: Some Issues and Concerns. AUST ENDOD J 2005; 31:94-100. [PMID: 16392730 DOI: 10.1111/j.1747-4477.2005.tb00312.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The benefits of using sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) as endodontic irrigants, and calcium hydroxide as an inter-appointment medicament, are well known to dentists. Many steps undertaken during endodontic treatment and retreatment are rather mechanical in nature, and less attention is committed to understanding the biological issues underlying endodontic treatment and retreatment. It should be noted that dentine is the fundamental substrate in endodontic treatment, and its properties and characteristics are the key determinant of nearly all disease and post-disease processes in the teeth. In this article the effects and counter-effects of NaOCl and EDTA on root canal dentine, and some other related issues are reviewed. This information will enable clinicians to use the beneficial effects of these chemicals, while necessary steps are considered to reduce their harmful effects on dentine substrate.
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Affiliation(s)
- Chee Peng Sum
- Department of Restorative Dentistry, National University of Singapore.
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Tay FR, Pashley DH, Yiu CKY, Yau JYY, Yiu-fai M, Loushine RJ, Weller RN, Kimbrough WF, King NM. Susceptibility of a Polycaprolactone-Based Root Canal Filling Material to Degradation. II. Gravimetric Evaluation of Enzymatic Hydrolysis. J Endod 2005; 31:737-41. [PMID: 16186753 DOI: 10.1097/01.don.0000155225.40794.79] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Polycaprolactone is susceptible to enzymatic biodegradation via ester bond cleavage. This study examined the susceptibility of Resilon, a polycaprolactone-based root filling material to enzymatic hydrolysis. Resilon, gutta-percha, and polycaprolactone disks, prepared by compression molding, were incubated in phosphate-buffered saline, lipase PS or cholesterol esterase at 37 degrees C for 96 h. They were retrieved at different time intervals for gravimetric analysis and scanning electron microscopy. The materials exhibited slight weight gains when incubated in phosphate-buffered saline that can be attributed to water sorption. Gutta-percha showed similar weight gains in the two enzymes. Conversely, Resilon and polycaprolactone exhibited extensive surface thinning and weight losses after incubation in lipase PS and cholesterol esterase. Glass filler particles in Resilon were exposed following surface dissolution of the polymer matrix, creating rough surface topography. Biodegradation of Resilon by bacterial and salivary enzymes warrants further investigation of their activities using cultures of endodontically relevant microbes and human saliva extracts.
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Affiliation(s)
- Franklin R Tay
- Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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