Evaluation of 3Mix-MP and pulpectomies in non-vital primary molars

Pulpectomies in primary molars are often hindered by several factors, including anatomical and physiological characteristics of posterior primary teeth and young patients' lack of cooperation with laborious treatments. This study was undertaken in search of easier but equally effective therapies that could eliminate infection, preserve the teeth and avoid extractions. The aim of the study was to estimate and compare clinical and radiographic success between pulp treatment with 3Mix-MP and pulpectomy with Maisto-Capurro paste in primary necrotic molars. A longitudinal prospective study was conducted at the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires (20152017). The study included 46 primary molars with necrotic pulp of children without immune or metabolic compromise. Children and their legal guardians provided assent and informed consent. Selected molars were randomly divided into 2 groups: G1: Pulpectomy treatment with Maisto-Capurro paste; and G2: Treatment with 3Mix-MP paste. Treatments were evaluated at 1, 3, 6,12 and 18 months (intra and inter-rater agreement 0.92 and 0.84). Clinical success was considered to be the absence of any of the following: pain, sensitivity to percussion or palpation, swelling, fistula and non-physiological mobility, while radiographic success was considered to be: absence of internal or external non-physiological resorption, no progression or reduction of radiolucent periapical/interradicular lesion and evidence of bone regeneration. Percentages, 95% C.I., and CHI2 were calculated for the comparison between groups. Overall clinical success was 91.5% and 87.5% (p=0.48) and overall radiographic success was 88.3% and 82.3% (p=0.31) for G1 and G2 respectively. No significant clinical or radiographic difference was found between groups. Both treatments showed similar clinical and radiographic behavior during the study periods.

Sodium hypochlorite accident in a pediatric patient

A sodium hypochlorite accident is a rare event in adults, but even more so in children. The purposes of this paper were to: report the case of a one-year, 10-month-old toddler who was treated under general anesthesia for early childhood caries, incurred a sodium hypochlorite accident following attempted pulpectomy in his primary maxillary central incisors, but made a full recovery without any sequelae after a typical four to six weeks course of disease; review the pertinent literature; and give recommendations on how to minimize the potential occurrence of such incidents.

Ectopic eruption of permanent incisors after predecessor pulpectomy: five cases

Pulpectomy in primary teeth is a common technique that preserves teeth in the oral environment and maintains or recovers periapical tissues to a healthy condition. This article describes the ectopic eruption of permanent incisors whose primary predecessors underwent pulpectomy using ZOE filler paste. In a group of 135 teeth that received pulpectomy therapy due to caries, 10 primary maxillary incisors had overretention and were followed for at least 3.5 years (mean time of 4.2 years), both clinically and radiographically, until the permanent teeth erupted. The proposed treatment included extraction of the overretained primary incisors based on permanent successor eruption chronology and contralateral eruption. Seven permanent teeth erupted ectopically. Autocorrection of the permanent tooth positions was observed in five cases. It can be concluded that periodic clinical and radiographic assessments are essential to verify radicular and filling paste resorptions and to avoid overretention and any subsequent malocclusion.

Sodium hypochlorite pulpotomies in primary teeth: a retrospective assessment

PURPOSE

In 2007, the University of Iowa's advanced training program in pediatric dentistry replaced the traditional formocresol vital pulpotomy technique with a 5% sodium hypochlorite (NaOCl) technique. The purpose of this study was to evaluate the clinical/radiographic success over 21 months of 5% NaOCl as the medicament in primary molar pulpotomies compared to published data for formocresol and ferric sulfate pulpotomies.

METHODS

A retrospective chart audit was performed to evaluate results for all primary molar pulpotomies completed during a 12-month period using NaOCl. Dental records were reviewed for clinical and radiographic findings subsequent to pulp therapy. Clinical and radiographic criteria used to determine pulpotomy success were based on scientific literature.

RESULTS

One hundred ninety-two NaOCl primary molar pulpotomies were completed in 118 patients; 131 (68%) primary molars from 77 children were available for follow-up examination (mean time since pulpotomy=10.5 months). NaOCl pulpotomies had a 95% clinical and 82% overall radiographic success rate. External root resorption was the most common pathologic finding. Pulpotomy success diminished over time.

CONCLUSIONS

Clinical and radiographic success rates in this study on NaOCl pulpotomies are comparable to formocresol and ferric sulfate pulpotomies reported in the literature. Further study with longer observation periods is warranted.

Zinc oxide-eugenol paste retained in gingival mucosa after primary teeth pulpectomy

AIM

Long-term follow-up evaluations of pulpectomy in primary teeth have revealed retention of ZOE filling particles in the periapical area even after root resorption.

CASE REPORT

This paper reports a case of a child submitted to pulpectomy with ZOE paste in primary teeth. After 28 months, the filling particles remained, having migrated to the alveolar bone from the gingival vestibular mucosa during permanent dentition eruption. Aesthetics required periodontal surgical removal of the paste particles. Primary teeth submitted to pulpectomy should be evaluated carefully both clinically and radiographically to verify radicular and ZOE filling paste resorption. The consequences of retained particles during permanent dentition eruption are unknown.

Effect of sodium hypochlorite with the addition of a proteolytic enzyme on postoperative discomfort: a multicenter randomized clinical trial

AIM

The purpose of this study was to compare the patient's postoperative discomfort when root canal irrigation was performed either with standard sodium hypochlorite or with sodium hypochlorite with the adjunct of a proteolytic enzyme.

METHODS

Two hundred patients were endodontically treated in two clinics. The type of irrigant to be used during root canal instrumentation was randomly assigned. Final irrigation was done using EDTA 17%. The canals were filled by warm vertical condensation with guttha-percha and the coronal seal was made using IRM. Patients were given a questionnaire to assess pain and swelling and the number of analgesics and other drugs taken during the first week after treatment.

RESULTS

A total of 166 questionnaires could have been evaluated. No significant difference was found between groups for pain, swelling and analgesics taken. Moderate pain and swelling was reported only in the first two days after treatment. No antibiotics use was reported. No guttha-percha excess beyond root apex was found by radiographic assessment.

CONCLUSIONS

The irrigating solution containing a proteolytic enzyme does not produce greater postoperative discomfort as compared to the conventional sodium hypochlorite in patients undergoing endodontic therapy.

Spontaneous alignment of permanent successors after enucleation of odontogenic cysts associated with primary teeth

Pulpotomy and pulpectomy occasionally lead to cyst formation in the primary dentition. They show specific clinical features of large size, rapid growth, buccal expansion and displacement of permanent teeth. Complete enucleation of the cyst with extraction of the associated primary teeth and preservation of the permanent teeth appeared to be the most suitable treatment option. Normal alignment of the permanent teeth occurred spontaneously even their initial positions were highly unfavourable.

Pain-relieving effects of intravenous ATP in chronic intractable orofacial pain: an open-label study

PURPOSE

Chronic orofacial pain is often refractory to conventional pain therapies. We conducted an open-label study to determine whether adenosine 5'-triphosphate (ATP) could alleviate chronic intractable orofacial pain, and if so, which type of pain could respond to ATP.

METHODS

In 8 and 16 patients with non-neuropathic and neuropathic intractable orofacial pain, respectively, ATP was intravenously infused at a rate of 100 microgxkg(-1)xmin(-1) over 120 min. The magnitudes of spontaneous pain and brush-evoked allodynia were graded with a visual analog scale (VAS). When a VAS score for spontaneous pain was decreased by 50% or more by ATP, the patient was classified as a responder.

RESULTS

The patients could be clearly divided into 10 responders and 14 non-responders. Ten of the 16 patients (62.5%) with neuropathic pain, but none of the 8 patients with non-neuropathic pain, responded to ATP. In particular, all of 8 patients with neuropathic pain following pulpectomy, with or without subsequent tooth extraction, responded to ATP. In the 10 responders, VAS scores for spontaneous pain decreased slowly but progressively during the infusion period, and eventually, ATP reduced the VAS scores for spontaneous pain and allodynia by 82 +/- 15% and 74 +/- 9%, respectively. In these responders, the analgesic and anti-allodynic effects of ATP outlasted the infusion period for medians of 7 and 12 h, respectively.

CONCLUSION

Intravenous ATP did not relieve non-neuropathic orofacial pain. However, it exerted slowly expressed but long-lasting analgesic and anti-allodynic effects in patients with neuropathic orofacial pain, especially in those suffering from neuropathic pain following pulpectomy and/or tooth extraction.

[Periapical tissues microvessels reactivity study after pulp extirpation and on different stages of endodontic treatment]

Reaction of the microvessels in the gingival periapical tissues on pulp extirpation was followed by hyperemia development in microcirculatory bed, its expression increased in proportion as parodontal inflammation intensified and further strengthened after root canal filling. Microcirculation normalization in the gingival periapical tissues after endodontic treatment of chronic pulpitis and pulp extirpation as part of endodontic treatment was evident in 1 month in intact parodontium and in 6 months in case of its inflammation.

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.

A retrospective assessment of zinc oxide-eugenol pulpectomies in vital maxillary primary incisors successfully restored with composite resin crowns

PURPOSE

The purpose of this retrospective study was to evaluate, via clinical and radiographic assessments, the treatment outcome of zinc oxide-eugenol (ZOE) pulpectomies performed in vital maxillary primary incisors successfully restored with composite resin crowns.

METHODS

Pulpectomized vital primary incisors were treated by a uniformed technique, filled with ZOE paste, and successfully restored with composite resin crowns. Those that remained intact and noncarious for the assessment interval were evaluated for the outcome (success or failure) based on clinical and radiographic findings and compared to: (1) the reason for treatment; (2) the canal filling extent; (3) the type of composite resin crown restoration performed; and (4) the eruption status of its succedaneous tooth.

RESULTS

For 104 maxillary primary incisors meeting the inclusion criteria, failure, as judged by presence of pathologic root resorption and/or apical lucency, was determined to be 24% (25/104), for a mean duration of 18 months observation. Failures were statistically associated with the reason for treatment (higher for trauma), the extent of ZOE paste filler in the pulp canal (higher for gross overfill), and the eruption status of the associated succedaneous permanent incisor (higher for delayed eruption).

CONCLUSIONS

This study determined a failure rate (24%) for pulpectomies-using ZOE paste and performed on vital primary incisors-comparable to that reported for nonvital pulpectomies. A statistically significant increase in failure rates was found for: (1) incisors treated for trauma (42%) vs those treated for dental caries (19%); and (2) grossly overfilled canals (80%) vs canals filled to the apex (0%).

The clinical and radiographic success of bonded resin composite strip crowns for primary incisors

PURPOSE

The aim of this study was to examine the clinical and radiographic success of the treatment of maxillary anterior primary incisors with composite resin strip crowns placed in a private practice setting.

METHODS

This was a retrospective, clinical study of patients who had strip crowns (SC) placed on maxillary primary incisors, returned for at least 1, 6-month recall examination, and whose parents consented to participate in the study. Radiographic and photographic examinations were used for evaluation. Two evaluators rated the images independently. When ratings were not in agreement, the 2 examiners reviewed the photograph or radiograph together and reached a consensus rating.

RESULTS

One hundred twelve restorations placed in 40 children were evaluated. The evaluations were performed after the crowns had been in place for an average of 18 months. None of the restorations were totally lost, and only 12% were rated as having lost some resin material, resulting in an 88% overall retention rate. There was no difference in restoration success if the crowns were placed 4 at a time, or if fewer crowns were placed in a single sitting; the failure rates were comparable. Teeth that had pulpal treatment were judged to have far more significant color match discrepancies than those teeth without pulpal treatment. Ninety-one percent of the teeth demonstrated healthy pulps. Eight percent had some pulpal changes but did not require immediate attention. Only 1 tooth showed radiographic evidence of pulpal necrosis. Only 11 teeth had pulpal treatment, but of these, 10 demonstrated clinical success.

CONCLUSIONS

Composite resin strip crowns for restoring primary incisors with large or multisurface caries performed well. Color match of these crowns with adjacent teeth may be significantly reduced when placed upon teeth that have undergone pulpectomy treatment and have been obturated with an iodoform paste. However, based upon the results of this study, the strip crown may provide an esthetic and durable restoration for carious primary incisors.

Tooth exfoliation and necrosis of the crestal bone caused by the use of formocresol

A 68-year-old woman received a formocresol pulpectomy of the right lower lateral incisor. The temporary restoration was lost within hours. The next day, the patient suffered continuous pain, the gingiva sloughed, and the alveolar bone was exposed. Four days after treatment, the patient complained of moderate pain. Six days after the pulpectomy, the tooth spontaneously exfoliated. At this time she was referred to our hospital. The clinical diagnosis was chronic alveolitis. Treatment consisted of irrigation of the area. Three weeks after the pulpectomy, the dull pain had subsided, but the alveolar bone of the area showed increased mobility. Five weeks after the pulpectomy, the mobility of the alveolar bone was more significant and a sequestrectomy was performed with the patient under local anesthesia. The sequestrum of necrotic bone was approximately 10 x 5 x 5 mm in size. The patient has been symptom-free for 2 years since the sequestrectomy.

Effectiveness of prophylactic use of rofecoxib in comparison with ibuprofen on postendodontic pain

The purpose of this study was to determine if prophylactic rofecoxib would significantly reduce postendodontic pain, when compared with ibuprofen or placebo. An additional objective was to establish if any relationship exists between periapical diagnosis and the need for additional medication after completion of pulpectomy. A total of 45 patients consented to a double-blind, single-dose oral administration of 50 mg of rofecoxib, 600 mg of ibuprofen, or a placebo before conventional root canal therapy. The root canal treatment was performed in two appointments. Patient-reported visual analog scale ratings of pain intensity were conducted upon initial clinical presentation and at 4, 8, 12, 24, 48, and 72 h after completion of pulpectomy. Results showed that at the 4- and 8-h periods, both rofecoxib and ibuprofen provided significantly better pain relief than placebo. At the 12- and 24-h periods, rofecoxib demonstrated significantly better pain relief than both ibuprofen and placebo. Patients with a periapical diagnosis of acute apical periodontitis showed a significantly increased need for additional medication after completion of pulpectomy compared with all other periapical diagnoses.

A comparison of pain levels during pulpectomy, extractions, and restorative procedures

Most previous studies on pain in endodontics have focused on pain that occurs after root canal therapy. Very few studies have compared pain during the root canal procedure with pain occurring during other dental procedures. In the present study, 250 patients were queried following dental procedures regarding their pain levels prior to treatment and their pain levels during the treatment procedure. Of the total number of patients, 150 had a pulpectomy, 50 patients had a single extraction, and 50 patients had a single restoration. These patients reported significantly more pain during extractions than during root canal therapy. Ninety-two percent of patients undergoing root canal therapy reported that pain during the procedure was less than or much less than anticipated. Eighty-three percent of the patients undergoing root canal therapy experienced less pain during the treatment procedure than they experienced prior to the treatment.

Safety of dental treatment in patients with previously diagnosed acute myocardial infarction or unstable angina pectoris

OBJECTIVE

The purpose of this study was to assess the safety of invasive dental treatments, such as tooth extraction and pulpectomy under local anesthesia, in patients with unstable angina pectoris and within 6 months after onset in patients who had experienced acute myocardial infarction.

STUDY DESIGN

Cardiovascular complications during and after dental treatment and preoperative risk factors were explored in 63 patients who had experienced unstable angina pectoris or acute myocardial infarction.

RESULTS

A total of 79 dental treatments were performed with no intraoperative complications. Chest pain occurred in 8 patients within 1 week after dental treatment. Risk factors for postoperative complications were identified as a history of chest pain within 2 weeks before the dental treatment and failure to clear the Master Test Single stress test.

CONCLUSIONS

Many patients who had experienced unstable angina pectoris or acute myocardial infarction tolerated dental treatment when appropriate stress control measures were used. However, approximately 10% of the patients experienced postoperative problems. Acceptability of dental treatment should be determined on the basis of the comprehensive assessment of each patient.

[Effect of the quality of endodontic treatment on the longevity of fixed prostheses. Apropos of 64 pulpectomies]

64 teeth with well-fitting post-retained crown were examined radio graphically and clinically and a number of failures were assessed including the peri-apical condition and the quality of root filling. All the teeth were vital and prosthetic was the only reason of endodontic treatment. Results have shown that 25% of the teeth had areas of radiolucency around the root apices. Various criteria parameters were reviewed for possible correlation to the failures. 15 out of the 16 cases of failures could be related to the endodontic therapy procedures: lack of using a rubber dam during the treatment and an unsatisfactory condensed and sealed root filling. Only one case was related to the deviation of post from the line of canal suggest a lateral perforation. To perform a post-retained crown the quality of endodontics must be considered: the operative procedures should be more controlled and enough time should be observed after root canal therapy to ensure its successful.

Two radicular cysts associated with endodontically treated primary teeth: rationale for long-term follow-up

Although radicular cysts are relatively rare, they do occur. In addition, it appears that these lesions present in association with endodontically treated primary teeth. As shown in this paper and previous reports, cysts can be associated with a variety of pulp therapies. These lesions can lead to bony expansion and resorption. Radicular cysts may also cause displacement and damage to the developing permanent dentition. Given the severity of these sequelae it is prudent to recommend regular radiographic examination of primary teeth that have undergone pulp therapy.

Steroids reduce the periapical inflammatory and neural changes after pulpectomy

Root canal treatment, including obturation with gutta-percha and a zinc oxide and eugenol sealer, was conducted, under general anesthesia, on the canine teeth of 12 young ferrets. Six of the ferrets were given 0.5 mg/kg dexamethasone daily. Three months after the root canal treatment, under general anesthesia, the animals were perfused with fixative and the canine periapical tissues prepared for histological examination. The extent of periapical inflammation was measured and the degree of neural sprouting in the periodontal and subapical regions estimated. Periapical lesions in steroid-treated animals were 30% of the size of those in untreated animals. Innervation density in the subapical region of the steroid-treated animals was lower than that in the animals who did not receive steroids and not significantly different from controls. Reduction in periapical inflammation induced by systemic steroids is accompanied by a reduction in neural sprouting.

Phantom tooth pain: a diagnosis of exclusion

This case report addresses the difficult diagnosis of phantom tooth pain (PTP). This is a syndrome of persistent pain in the teeth and oral structures following pulp extirpation, extraction, or rarely, an inferior alveolar nerve block. The incidence of this often misdiagnosed condition is estimated to be 3% of the population undergoing pulp extirpation, and is similar to phantom limb pain. The diagnosis of PTP is discussed here as a diagnosis of exclusion, after numerous interventions. Various treatment modalities are outlined and the use of non-traditional pharmacological approaches for pain reduction are discussed.

Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition

This study evaluated factors that affected pulpectomy (PE) success and its effect on the succedaneous tooth's eruption and enamel formation. Sixty-five of 250 patients with PEs met the selection criteria and yielded 81 zinc oxide-eugenol PEs (30 incisors, 51 molars) followed a mean time of 90.8 months. Overall PE success was 77.7% with no difference between molars and incisors (P = 0.53). Enamel defects were observed in 18.7% of succedaneous teeth and were related (P = 0.005) to the pre-existing infection causing excess root resorption (>1 mm preoperative root resorption = 44.4% defects) but were not related to overretention of ZOE filler (P = 1) or length of fill (P = 0.36). The PE procedure was not related to causing succedaneous tooth defects since teeth replacing PEs showed no significant increase in the incidence of defects compared with untreated contralateral controls (P = 0.99). There was a 20% incidence of succedaneous tooth anterior cross-bite or palatal eruption following incisor PEs and 21.6% ectopic eruption of premolars following primary molar PEs. Most PEs (95.9%) were lost at their normal exfoliation time or earlier, but 35.8% needed extraction due to overretention by soft tissue at the time of shedding. Pulpectomy success rates showed that the most important preoperative predictor was the amount of primary tooth root resorption. Greater than 1 mm of root resorption resulted in only a 23.1% success rate, which was significant (P = 0.001). Pulpectomies filled short or to the apex had a significantly greater success (P = 0.011) than long fills. Pulpectomies correctly done do not appear to contribute to adverse effects on succedaneous tooth formation but have a 20% chance of altering the path of permanent tooth eruption.

Periapical neural changes after pulpectomy

Pulpectomy and pulpal necrosis result in severance of the nerves that supply the pulp as well as loss of their target organ. Inflammatory changes commonly extend into the periapical region to involve those nerves. The neural response to pulpal loss combined with periapical inflammation is a derangement of the periodontal plexus normally located in the center of the periodontal space around the apical third of the root; the result is the formation of a disorganized group of sprouting and branching axons that have some features in common with neuromas. The inflammatory and neural responses continue for at least a year even when pulpectomy is followed by canal debridement and obturation. Then the responses are reduced but not eliminated by steroids. Root canal therapy with techniques that do not leave residual inflammation still results in increased periapical innervation; the increase seems to be an organized addition to the normal periradicular plexus.

Timing of calcium hydroxide therapy in the treatment of root resorption in replanted teeth in dogs

The effect of time of the onset of calcium hydroxide (CH) pulpectomy on root resorption of 31 permanent dog incisors was investigated. CH pulpectomy was delayed 4, 9, 14 and 18 days after the teeth were extracted and replanted. Control teeth were replanted 1) without pulpectomy, 2) with a pulpectomy only or 3) with a pulpectomy and CH filling. All teeth were prepared for histologic evaluation 8 weeks after the teeth were replanted. Cross section were examined using a computer microscope and linear (micron) and/or square areas (micron 2) of surface (SRR), inflammatory (IRR), and replacement (RRR) root resorption were calculated. From this data the percentage of linear and area resorption was averaged for each group. Duncan multiple range t-test (P < or = 0.05) revealed that teeth in which a pulpectomy with CH filling was done extraorally had significantly greater SRR than the rest of the groups; teeth in which a pulpectomy without CH filling was done extraorally had significantly greater RRR than teeth in which CH pulpectomy was delayed for 18 days; there was no significant difference in SRR, IRR or RRR when CH placement was delayed 4, 9, 14 or 18 days after replantation. Although it was not significant the overall resorption was least when CH pulpectomy was delayed 18 days.

Neural changes in periapical lesions after systemic steroids in the ferret

This study was intended to clarify the relationship between the neural changes which occur around the apex of the ferret canine after pulpectomy and the inflammatory process induced by the procedure. In 12 young adult ferrets, under general anesthesia, the pulps in the mandibular canine teeth were removed and replaced with gutta percha and Grossman's sealer. Six of the animals were treated with dexamethasone to reduce the inflammatory response. Three months later, the animals, again under general anesthesia, were perfused with a fixative mixture. Three unoperated animals that had not been treated with dexamethasone were also perfused. The mandibular canine teeth and their supporting tissues were removed, processed, and serially sectioned. Three-dimensional reconstructions of the periapical lesions in each animal were assembled and their volumes measured. The density of innervation in the periapical region was estimated. The mean lesion volume in the pulpectomized animals not treated with dexamethasone was 3.54 (+/- 2.27) mm3 and in the dexamethasone-treated animals 1.33 (+/- 1.31) mm3. The differences were statistically significant when tested by the Mann-Whitney U test (p < 0.01). Bacteria were not seen within any of the lesions. The innervation density beneath the canines in the pulpectomized animals not treated with dexamethasone was 164 units per mm2 (+/- 80) and in the steroid-treated animals 151 +/- 68 units per mm2. In the control, untreated animals, the innervation density was 22 +/- 10 units per mm2. The difference between the steroid-treated pulpectomized animals and the untreated pulpectomized animals was not statistically significant (p > 0.5).(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective survey of hospital ambulatory dental emergencies. Part 2: Follow-up to emergency treatment

Two hundred and fifty-three patients treated for dental emergencies at the University Hospital dental clinic over a three-month period were surveyed by telephone 24 to 48 hours and one year after treatment. The purpose was to investigate the success of treatment in resolving the chief complaint of pain and to determine the compliance with further dental care for the original dental problem. The results of the telephone survey showed that: patients available for questioning totaled 49.1% at 24 to 48 hours and 28.9% at one year; an 80.7% success rate was recorded in resolving pain within 24 to 48 hours; and the original emergency problem did not motivate a large number of these patients to seek further dental care.

Human pulpectomy: incidence of postoperative pain using two different intracanal dressings

A clinical study using vital maxillary central incisors was performed to evaluate the incidence of postoperative pain after pulpectomy and dressing with a corticosteroid-antibiotic preparation or a calcium-hydroxide paste. Sixty teeth from 45 patients were prepared and dressed on the first visit and re-evaluated 7 days later. No difference was observed in the incidence of postoperative pain between the two groups.

Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis

Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.

Histology and lysosomal cytochemistry of the postsurgically inflamed dental pulp after topical application of steroids. I. Histological study

The purpose of this study was to histologically investigate steroid effects on the dental pulp. Three steroid preparations, hydrocortisone, betamethasone and triamcinolone, were locally applied to the exposed pulp tissue in rat incisor after pulpectomy. After 24 h, the effects on the tissues were assessed by light microscopy. The results showed that topical application of corticosteroids as an intracanal medicament reduced inflammatory changes in the pulp as compared with controls. Furthermore, triamcinolone and betamethasone demonstrated more potent anti-inflammatory effects than did hydrocortisone.

[Iatrogenic disease in pediatric dentistry. Report of a case]

The case history of a six-year-old girl who underwent endodontic treatment by a non recommended technique. It was decided to perform integral treatment anew, this time with techniques and materials adequate for the restoration and renewal of temporary dentition.

[After pulpectomy--dento-periodontal adaptation]

Recovery after an endodontic treatment can only be assessed clinically, on the basis of symptomatological and radiographic data, for lack of histo-clinical correlations. An anatomicopathological examination of damaged tissues pinpoints the anatomical obstacles and tissular modifications apt to undermine the success of root canal work. The aim of endodontic treatment is to maintain or reinstate an environment conducive to healing through the use of a non-traumatic endodontic technique, followed by functional rehabilitation of the dental organ in its periodontia structures.

[Biomechanical behavior of the pulpectomized tooth]

No accurate information is in fact available regarding the biomechanical properties of devitalized teeth. The time frame seems to be a more significant factor than nature of the pulpectomy itself, as far as the risk of fracture is concerned. The use of a pivot or other form of root anchorage does not seem to play a determining role in the long-term reliability of restorations. Partial restorations can be substituted for full coronoperipheral reconstruction insofar as they protect the cusps. Each clinical situation must be matched with the appropriate reconstruction.

[Resorption of roots of milk teeth treated by pulp amputation using formocresol]

Histological examination was carried out of milk molars involved by physiological or pathological resorption, i.e. accelerated, during treatment of pulp diseases by amputation using formocresol, and delayed in case of persisting milk teeth. The results showed that the histological pattern of accelerated resorption due to formocresol was not different from physiological resorption. Delayed resorption was associated with an evident repairing reaction in the resorption sinuses.

[Effect of formalin-creosote on the rat periapical tissues after pulpectomy]

The purpose of the present study was to investigate histologically, histometrically and immunohistochemically the effect of formalin-creosote (FC) on the periapical tissues after pulpectomy in rats. Experiment I. Seventy-five rats were divided into 3 groups. In all Groups, the mesial root of the right mandibular first molar was removed. After pulpectomy, in Group A, a paper point containing saline was inserted into the root canal. In Group B, a paper point containing FC was inserted, whereas, in Group C, FC was applied and then a paper point containing FC was inserted. The access cavity was sealed with amalgam. The animals were killed at 1, 3, 7, 14 and 28 days. The periapical tissues were examined histologically. The vertical length and the area of the apical periodontal ligament were measured histometrically. The inflammatory cells and the fibroblasts per unit area in the apical granulation tissue were counted. Experiment II. Eighteen rats were divided into 3 groups. In all Groups, pulpectomy was performed as in the experiment I. In Group a, a paper point containing saline was inserted into the root canal. In Group b, a paper point containing FC was inserted, whereas, in Group c, FC was applied and then a paper point containing FC was inserted. The animals were killed at 14 and 28 days. The presence of macrophages in the granulation tissue was examined using polyclonal antibody to lysozyme immunohistochemical techniques. The results were as follows. Experiment I. Histologically, in Group A, severe inflammation was observed in the periapical tissues at 1 and 3 days. Inflammation became moderate and fibrous tissue proliferation was observed in the periapical tissues at 7 days. Inflammation became slight and fibrous tissue increased at 14 and 28 days. In Group B, severe inflammation was observed in the periapical tissues at 1 and 3 days. Inflammation became moderate at 7 and 14 days. Resorption of alveolar bone was observed after 7 days. Fibrous tissue proliferation and resorption of the apical root were seen after 14 days. Inflammation became slight at 28 days. In Group C, severe inflammation was found in the periapical tissues at 1, 3 and 7 days. Resorption of alveolar bone was seen after 7 days. Moderate inflammation remained and fibrous tissue proliferation was seen at 14 and 28 days. Resorption of the apical root was observed after 14 days. Histometrically, vertical length and area of the apical periodontal ligament in Groups B and C increased significantly compared with those in Group A at 14 and 28 days.(ABSTRACT TRUNCATED AT 400 WORDS)

[Root resorption of vital and endodontically treated teeth in orthodontic movement]

Orthodontic tooth movement frequently induces the resorption of the tooth root, although valuable information concerning the relationship between the root resorption and force magnitude, duration and types of tooth movement and the condition of periodontium obtained. However, it is incompletely known that the situation of candidated tooth itself of orthodontic movement in which pulpectomized non-vital condition influence the process of root resorption and subsequent repairing. Thus, the study was conducted to clarify the effect by the pulpectomy accompanied with tooth movement on the process of root resorption and regeneration of periodontium. A hundred and fifty Wistar rats, weight 180-200 g, 6 weeks old, were used as experimental animals. Prior to experimental tooth movement, first molars of 50 rats were received pulpectomy on both sides followed by filling of root canal (first group) and those of another 50 rats on single side (second group). Maxillary first molars of the other 50 rats were saved as a vital dental pulp control (third group). The first and the third groups of animals were then subjected to experimental tooth movement with the interproximal insertion of elastic rubber as described by Waldo (1953) for 3 days, 1, 2, 3 and 4 weeks. After tooth movement was terminated, animals were sacrificed by ether inhalation or by perfusion of glutaraldehyde fixation solution. The upper jaw from each rat was dissected and prepared specimens for non-decalcified section and light microscopic section. Root resorption and regeneration of cementum were evaluated quantitatively using the modular system for semiautomatic quantitative evaluation of images on the light microscopic section. Occurrence of external root resorption with multinucleated odontoclast associated with experimental tooth movement in pulpectomized tooth were lesser and later than those of vital teeth. These findings suggest that the dental pulp plays an important role in the processes of root resorption and remodeling of cementum associated with orthodontic tooth movement.

Radiographic evaluation of pulpal therapy for primary anterior teeth

A total of 144 anterior primary incisors with formocresol pulpotomies or pulpectomies comprised the study sample. Although the former had a moderately high success rate, those incisors treated with the latter procedure had a better prognosis. It may be the preferred treatment when the extent of pulpal involvement cannot be determined.

[Separation of endodontic instruments into the root canal]

One of the most common accidents during extirpation of the pulp and chemicomechanical preparation is breakage of the endodontic instrument in the root canal. In this paper the causes of the instrument breakage are reported. The methods of handling the accident are discussed, as well as the basic rules of prevention.

An electron microscopic analysis of the trans-synaptic effects of peripheral nerve injury subsequent to tooth pulp extirpations on neurons in laminae I and II of the medullary dorsal horn

To examine the effects of peripheral nerve injury on second-order neurons in laminae I and II of the medullary dorsal horn, tooth pulps of all mandibular teeth in adult cats on one side were extirpated. This procedure severed and removed the receptors and terminal branches of the primary trigeminal neurons which innervate the tooth pulps of these teeth. The empty pulp chambers were then filled with dental cement to prevent regeneration. At 30 and 60 days postoperatively, membrane-lined cavities had formed inside many of the small-caliber dendrites of second-order neurons in laminae I and II. Cavity formation occurred mainly in dendritic shafts less than 2 micron in diameter and involved dendrites with synaptic vesicles as well as those without synaptic vesicles. The cavities extensively hollowed out these dendrites, often occupying more than half the cross-sectional diameter of the shafts and extending for appreciable distances in the long axis of the shaft. The process of cavitation ultimately resulted in the destruction of the affected dendrites. Many cavities became patent to the intercellular space with the cavity membrane establishing continuity with the dendritic membrane. Many cavities often formed in a single dendrite, and such severely cavitated dendrites became reduced to a trabeculated shell which ultimately fragmented into several small pieces. The presence of synaptic connections from a number of different kinds of axonal endings, including scalloped and dome-shaped endings, was not sufficient to prevent cavitation. The actual severing of synaptic connections on the cavitated dendrite appeared to be a relatively late event in the process since small pieces of dendritic debris could still be found clinging to their axodendritic synapses. Evidence that dendrites were being lost from the neuropil was most readily apparent in many of the disrupted glomeruli in lamina II in which many of the scalloped depressions in the central axonal endings that normally contained small dendrites were empty. Many central axonal endings remained in synaptic contact with only a single dendrite which often showed signs of cavitation. Such central endings showed only subtle remaining traces of their normal scalloped contours. This study demonstrates that injury to the distal branches of primary trigeminal neurons which innervate tooth pulps resulted in trans-synaptic degenerative changes in the dendritic arbors of second-order neurons which destroyed fine-caliber higher order dendrites.

Differential diagnosis in endodontic failure

Research in education has demonstrated the usefulness of verbal mediators as memory aides. The mediator or mnemonic POOR PAST can be of use to the dentist in recalling the list of alternatives in the differential diagnos of endodontic failures: P--perforation; O--obturation; O--overfill; R--root canal missed; P--periodontal disease; A--another tooth; S--split; T--trauma. With a comprehensive list of diagnoses, recall of the appropriate questions and tests in examining for each possibility is simplified. The diagnostician then proceeds to look for a specific symptom or symptoms that would confirm a particular diagnosis or that would limit the alternatives to two or three possibilities. Questioning about the nature and duration of the symptoms is useful in ruling out some diagnoses. Pulp tests, periodontal probing, radiographs from different angles, percussion, palpation, and sinus tract exploration each have special application to one or more of the possibilities on the list. The wise clinician also evaluates access preparations, occlusion, and those etiologic factors that could cause pulp or periodontal disease. Variations in the root canal, requirements of treatment, the nature of the healing process, expected results, and surgical principles are considered along with the foregoing in problem solving. After a case has been thoroughly investigated and if the POOR PAST alternatives have been ruled out the dentist may then conclude that for some as yet undetermined reason the lesion exceeds the recuperative powers of the host and that further consultation or surgical intervention will be necessary.

Pulpectomy procedure for deciduous teeth with severe pulpal necrosis

Pulpectomies of deciduous teeth with severe pulpal necrosis should be considered as a possible treatment plan. Systemic and dental criteria have been devised to help the clinician to select cases in which successful results may be produced. A clinical success occurs when the pulpectomized tooth is painless, is firm in its alveolar socket, and is without a fistulous tract. Radiographically, any radiolucent area should be resolving with six months, and no pathologic root resorption should be observed. Research should determine whether pulpectomies may be done on children with severe systemic disease and should determine long-term consequences of underfilled and overfilled pulpectomies.

Avoiding perforation during endodontic access

Planning for endodontic access should be as precise as possible and the dentist should consider several factors in his preoperative evaluation of teeth to avoid perforations. Anatomical characteristics of teeth can be helpful in establishing endodontic access, and valid and invalid points for orientation have been discussed. Seven suggestions have been offered for the establishment of access on difficult teeth. The ideal in establishing endodontic access can only be achieved by the deliberate, conscious application of a thorough knowledge of dental anatomy, and of possible variations from the norm, coupled with a thorough preoperative examination of the tooth. Although a casual approach may not be unsuccessful, precision will certainly yield a higher percentage of successful cases.