Biomedical subjects
Publications and source records attributed to J C Kulild.
The transmission of infections in an endodontic practice is a significant concern for both patients and dental health care providers. This article offers a review and practical application of infection control methods in the practice of endodontics.
Replacement resorption may follow the replantation of an avulsed tooth. Currently there is no effective treatment for replacement resorption. The purpose of this study was to investigate the effect of bisphosphonates and gallium nitrate, which have been shown to reduce bone resorption, on cells which resorb dentin. Osteoclast-like cells were obtained by culturing cells from prenatal chick tibeas. These cells were seeded onto slices of human dentin which had been soaked in either saline (control), or solutions of 10(-5) M 1-hydroxyethylidene-1, 1-bisphosphonic acid (EHBP), 10(-6) M dichloromethylene bisphosphonic acid (Cl2MBP), or 10(-6) M gallium nitrate. Resorption was measured by counting the number of resorptive lacunae produced by the cells. Results indicated that the experimental groups did not differ significantly from each other, but each exhibited significantly reduced resorption compared with saline controls (p < 0.01). These results suggested that the experimental treatment reduced dentinal resorption by the osteoclast-like cells, and that these agents might be useful to prevent or at least postpone replacement resorption in avulsed teeth.
Ten human maxillary incisors, extracted because of periodontal disease or nonrestorable caries, were obtained and instrumented to a size #70 K-Flex file at the working length using a standard stepback technique. Tritiated water (3H2O) was placed in the root canals and allowed to diffuse to the external surface of the roots until it reached a constant rate. The smear layer in each of the experimental roots was then removed using 0.5 M EDTA followed by 5.25% sodium hypochlorite (NaOCI). The constant rate diffusion of 3H2O was remeasured. The roots were then stored in deionized H2O for 2 months and the constant rate diffusion of 3H2O was remeasured. A statistically significant difference was noted between all three groups. A decrease in the diffusion permeability of the root to 3H2O was noted immediately after smear layer removal and the highest permeability was recorded after storage in the deionized water for 2 months.
Forty single-rooted teeth were sectioned transversely through the cementoenamel junction and instrumented to a size #50 K-Flex file at the working length by saline irrigation. Each root was placed in a dilution vial containing 10 ml of normal saline, and the pH and Ca2+ levels were recorded after 24 h. The roots in group 1 then received a final irrigation with 20 ml of normal saline. Group 2 received a final irrigation with 10 ml of 17% ethylenediaminetetraacetic acid followed by 10 ml of 5.25% NaOCl to remove the smear layer. Group 3 was irrigated in the same manner as group 2, but calcium hydroxide (CH) was placed into the root canal. Group 4 was irrigated with 20 ml of NaOCl, and CH was placed into the root canal. The pH and Ca2+ levels were recorded at 1, 3, 5, and 7 days. After 7 days a 3- x 3- x 1-mm external defect was created in the coronal one third of the root surface. The pH and Ca2+ levels were subsequently recorded at 1, 3, and 7 days. Groups 3 and 4 demonstrated significantly higher H+ and Ca2+ levels than did groups 1 and 2 three days after CH placement and at all subsequent intervals. Group 3 demonstrated significantly higher H+ and Ca2+ readings at some but not all intervals. The results demonstrated that CH diffuses from the root canal to the exterior surface of the root and that the removal of the smear layer may facilitate this diffusion.
Pilot studies conducted by the authors seem to indicate that obturation of a root canal system by the lateral condensation of gutta-percha using an electrically heated spreader results in a more homogeneous mass of gutta-percha than standard lateral condensation. This article describes an improved variation which prevents inadvertent dislodgement of the mass of gutta-percha during the obturation. The authors refer to this technique as "zap and tap" and a case report describes its use to obturate a C-shaped canal system of a mandibular second molar.
Simulated straight root canals in 30 transparent acrylic blocks were instrumented and obturated with gutta-percha without sealer using standard lateral condensation (group A). The "zap and tap" method of warm lateral condensation was then used on the same 30 canals (group B). A second treatment of warm lateral condensation was then applied to these same canals (group C). The acrylic blocks were weighed after initial canal preparation and after each subsequent obturation. A 14.63% increase in weight of the gutta-percha occurred in group B compared with group A, and a 2.43% increase in weight occurred in group C compared with group B. Both differences were statistically significant (p < 0.001).
The objective of this study was to compare the effects of a flame-heated endodontic plugger, an electrically-heated endodontic spreader, Peeso reamers, and GPX burs on the apical seal when gutta-percha was removed from the root canal for post space preparation. Eighty-nine human canines were instrumented and obturated with gutta-percha and sealer to a standardized working length of 15 mm. An 11-mm segment of gutta-percha was removed from the roots in each of the four experimental groups of 20 teeth to simulate post space preparation. The teeth were immersed in India ink for 7 days and rendered transparent. The extent of linear dye leakage was measured with a stereomicroscope. There was no statistically significant difference in linear dye leakage among any of the experimental groups when 4 mm of gutta-percha remained.
Seventy-five adult human mandibles were radiographed with a paralleling technique to determine the ability to visualize the mental foramen as well as its size and position. The foramen was seen on 75% of the horizontal periapical radiographs examined. When the foramen was not visualized, is was usually below the inferior edge of the film. The radiographic size of the foramen was smaller than the anatomical size previously reported. The position of the mental foramen was usually mesial and below the radiographic apex of the second premolar.
Patients with odontogenic cutaneous sinus tracts usually seek treatment from a physician instead of a dentist and the etiology is frequently misdiagnosed. This case report describes a patient who sought treatment from a dentist because of a history of a previous cutaneous swelling on the ipsilateral side of his cheek. The etiology of the present swelling was a carious tooth. The patient was treated concurrently with both nonsurgical endodontic therapy and transcutaneous drainage by aspiration. This method of drainage precluded possible spontaneous drainage and avoided damage to proximal anatomical structures which may have occurred if an incision had been used.
In vitro intracanal temperatures produced during the war lateral condensation of gutta-percha were measured using a computerized recording system that allowed repeated obturations of a root canal model. The obturations were performed using a Touch 'n Heat unit. Temperatures were recorded to an accuracy of a hundredth degree centigrade by 16 intracanal themocouples connected to the computerized measurement system. The highest intracanal temperature recorded was 114.51 degrees C at a power setting of 6, while the mean intracanal temperature increase above the average room temperature ranged from 8.18 to 65.05 degrees C. In addition, the spreader was not uniformly heated to the same temperature throughout its entire length. The hottest point on the spreader was located 5 mm from the tip.
Panoramic radiographs were made of 75 dry, adult human mandibles. The size and position of the mental foramen in relation to the second premolar was determined. The mental foramen on panographic radiographs was slightly larger than reported on periapical radiographs. The average position of the foramen was mesial and below the radiographic apex of the tooth. Panoramic radiography may account for a distal shift of the foramen and a 23% increase in size of the mandibles examined.
One hundred six human mandibular left and right first premolars, previously extracted due to nonrestorable caries, periodontal disease, or orthodontic reasons, were sectioned perpendicular to the long axis of the root starting at the cementoenamel junction. Three-millimeter sections were made with an ultrathin separating disc to the level of the anatomical apex. After 1 day in 5.25% NaOCl, each section was rinsed in phosphate-buffered saline, evaluated with a stereomicroscope, and photographed. The slides were projected and the shape of the canal, incidence of multiple canals, level of bifurcation, and any other variant anatomy were recorded. Seventy-six percent of the premolars demonstrated Type I canals and 24% contained Type IV. The shape of the canals was predominantly oval or round. An interesting finding was the number of C-shaped canals which were associated predominantly with Type IV canal systems. This occurred in 14% of the roots.
A case report of a maxillary first molar is presented in which a drainage tube from a decompression procedure was removed 2 days following placement. The oral surgeon who removed the tube scheduled the patient for surgical enucleation of the large periapical lesion. The surgical appointment was subsequently cancelled and routine endodontic follow-up showed continued osseous repair at 3, 6, and 12 months. The decompression of a large periapical lesion is a conservative alternative to surgical enucleation.
An in vitro computerized temperature measurement system was developed to measure intracanal temperatures produced by different heated gutta-percha obturation techniques. The temperatures produced by low- and high-temperature thermoplasticized injectable gutta-percha systems were recorded and compared in this investigation. The mean intrachamber temperature of the Obtura syringe was 178.68 degrees C. The mean temperature of the Ultrafil heater was 93.06 degrees C. The mean temperature of the extruded gutta-percha was 137.81 degrees C from the Obtura syringe and 62.88 degrees C from the Ultrafil cannule. The intracanal temperature of the gutta-percha recorded for both systems showed that the gutta-percha cools rapidly after injection into the canal.
A new model system was developed which allows intracanal temperature measurements to be recorded during repeated obturations of a human tooth root canal. A human central incisor was embedded in clear orthodontic resin and sectioned longitudinally. Sixteen thermocouples were secured at 2-mm intervals along two surfaces of the root canal. The thermocouples were connected to a computerized temperature recording system to measure intracanal temperatures produced by high-temperature thermoplasticized injectable gutta-percha. The system was capable of recording 16 simultaneous temperatures every second with an accuracy of a hundredth degree centigrade. There was a linear increase in the recorded temperatures in the root canal. However, the actual temperatures were lower than expected.
This study compared the quality of obturation of high- and low-temperature thermoplasticized injectable gutta-percha techniques and standard lateral condensation. A new model system was developed to more closely simulate the clinical environment. All obturations were performed in this same model which allowed direct comparisons between the different techniques. The resultant mass of gutta-percha was visually examined and graded for each obturation. Statistical analysis of the results indicated that both thermoplasticized injectable techniques were significantly better than lateral condensation. There was no significant difference between either of the thermoplastic obturation techniques.
Seventy-five adult human mandibles were examined to determine the size, orientation, and position of the mental foramen. The average size of the foramen was found to be larger on the left side of the mandible and its usual direction of exit was in a posterior-superior direction. The most common location of the mental foramen was inferior to the crown of the second premolar and approximately 60% of the distance from the buccal cusp tip of that tooth to the inferior border of the mandible.
An in vitro dye leakage study was performed to evaluate the sealing ability of the following retrofilling materials: high- and low-temperature injectable thermoplasticized gutta-percha with and without sealer, a glass ionomer cement, and amalgam with and without varnish. The roots of 105 extracted human maxillary anterior teeth were instrumented and obturated with single cones of gutta-percha and sealer. The apical 3 mm of the roots were then resected and 2-mm deep retrograde preparations were prepared. Each root was then randomly placed into one of seven groups and retrofilled with one of the test materials. After 72 h in India ink, the roots were cleared and evaluated for leakage using a stereomicroscope. Statistical analysis of the results indicated that injectable high-temperature gutta-percha without sealer demonstrated significantly more leakage than the other materials. There were no significant differences in leakage among the other evaluated materials.