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Biomedical subjects

J L Gutmann

Publications and source records attributed to J L Gutmann.

At least 55 records · Page 3Linked to original sources
PubMed1999

Endodontic-orthodontic relationships: a review of integrated treatment planning challenges.

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention. Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a reduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress. A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment. During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patient signs and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.

Dental Pulp↗
PubMed1999

Tooth resorption.

Tooth resorption is a common sequela following injuries to or irritation of the periodontal ligament and/or tooth pulp. The course of tooth resorption involves an elaborate interaction among inflammatory cells, resorbing cells, and hard tissue structures. The key cells involved in resorption are of the classic type, which include osteoblasts and odontoclasts. Types of tooth resorption include internal resorption and external resorption. There are two types of internal resorption: root canal (internal) replacement resorption and internal inflammatory resorption. External resorption can be classified into four categories by its clinical and histologic manifestations: external surface resorption, external inflammatory root resorption, replacement resorption, and ankylosis. External inflammatory root resorption can be further categorized into cervical resorption with or without a vital pulp (invasive cervical root resorption) and external apical root resorption. Other variations of resorption include combined internal and external resorption and transient apical breakdown.

Humans↗
PubMed1996

Apical and coronal seal of roots obturated with a dentine bonding agent and resin.

The efficacy of sealing root canal systems with a dentine bonding agent and resin cement was compared with that of a glass ionomer sealer. Scanning electron microscopic examination of the bonding agent-dentine interface was also performed. The root canals of 50 single rooted teeth with mature apices were prepared chemomechanically and the smear layer removed with 17% REDTA and 5.25% NaOCl. Specimens were divided into two groups of 24 teeth each. One group had the dentine conditioned with a 10:3 citric acid-ferric chloride solution and obturated with the dentine bonding agent and resin, radiopaque C & B Metabond. The other group was obturated with the glass ionomer sealer, Ketac-Endo and a single cone of gutta-percha. After immersion in Indian ink for 90 h, the teeth were cleared and the quality of the apical and coronal seal was assessed using India ink dye penetration. There was a significantly better seal in both the apical and coronal directions when using the dentine bonding agent and resin obturation material. Scanning electron microscopic examination of the demineralized dentine and the C & B Metabond interface revealed the presence of the characteristic hybrid layer along with microtags of resin penetrating deep into the dentine tubules.

Boron Compounds↗
PubMed1996

Periradicular healing in response to Diaket root-end filling material with and without tricalcium phosphate.

The healing of the periradicular tissues was evaluated when the polyvinyl resin Diaket with and without tricalcium phosphate was used as surgical root-end filling material. Non-surgical root canal treatment was performed on 56 mandibular premolar roots in mongrel dogs. Following root-end resection, root-end cavity preparations were filled with Diaket, the comparative material, or Diaket in combination with tricalcium phosphate, the experimental material. Postsurgically, healing of the tissues adjacent to the filling materials and in the surrounding surgical site were evaluated at 30 and 60 days. There was virtually no statistically significant difference between the experimental and comparative group at or within the 30- or 60-day period with regard to inflammation, connective tissue formation, root-end encapsulation, cementum formation, or bone apposition. Findings suggest that cementogenesis occurred over both materials. The overall healing of the periradicular tissues was favourable.

Animals↗
PubMed1996

An in-vitro study of smear layer removal and microbial leakage along root-canal fillings.

The objective of this study was to determine the effect of removal of the smear layer on canal obturation as measured by penetration of bacteria from a coronal direction. Fifty-four extracted human teeth were decoronated and instrumented in a uniform manner. Following instrumentation the root canals of 20 teeth were rinsed with 17% EDTA and 5.25% NaOCl to remove the smear layer before obturation. A second group of 20 teeth were flushed with NaOCl alone. The teeth of both groups were obturated with Thermafil plastic carriers and Roth's sealer. The root canals of another 10 teeth, five rinsed with EDTA and five without, were obturated with Thermafil without sealer. Two teeth serving as positive controls were instrumented but not obturated, while another set of two were sealed coronally and apically to serve as negative controls. The root surface of each tooth was sealed with nail varnish. A small chamber was thoroughly sealed around the coronal aspect of each tooth so that bacteria placed therein could move only through the obturated canal space. Each tooth was placed in a test tube containing sterile trypticase soy broth (TSB). An inoculum of Proteus vulgaris in TSB was placed in each coronal chamber at five day intervals and daily observations were made for bacterial growth in the apical reservoir for 21 days. Both positive control teeth showed bacterial penetration after 24 h. Neither of the two negative control teeth demonstrated penetration for the duration of the study. The frequency of bacterial penetration through teeth obturated with intact smear layer (70%) was-significantly greater than that of teeth from which the smear layer had been removed (30%) P < 0.05. All but one tooth obturated without sealer exhibited bacterial penetration, irrespective of the presence or absence of smear layer. Removal of the smear layer enhanced sealability as evidenced by increased resistance to bacterial penetration.

Chi-Square Distribution↗
PubMed1996

Plasma catecholamine and haemodynamic responses to surgical endodontic anaesthetic protocols.

The effects of varying clinically relevant patterns of anaesthetic-vasoconstrictor combinations used for periradicular surgery on plasma concentrations of catecholamines and haemodynamic responses was studied in the canine model. Five mongrel dogs were anaesthetized with sodium pentobarbitol. A femoral cannula was inserted to measure central blood pressure and an ECG was used to monitor heart rate and any associated arrhythmias. Femoral venous blood samples were drawn before initial injection and at 3 and 10 min after injections. Plasma catecholamine concentrations were determined using high pressure liquid chromatography (HPLC). Injection protocols used three time periods, 30, 60 and 90 s, with solutions containing 1:100,000 and 1:50,000 adrenaline. No significant changes in heart rates or presence of arrhythmias were noted over the experimental protocol. Catecholamine levels in pico moles mL-1 were within the normal range at the 3-min sample level. At the 10-min sample time there was a more erratic range of concentrations, with most samples within the normal range. This may have been due to endogenous release of catecholamines in specific animals. The data identified trends in both the haemodynamic parameters and plasma catecholamine levels that can legitimately support the careful use of higher levels of a vasoconstrictor when patient profiles and surgical needs dictate.

Anesthesia, Dental↗
PubMed1996

Haemostasis in periradicular surgery.

The successful performance of endodontic surgical procedures is predicated on many factors. However, the ability of achieve sustained tissue haemostasis in the surgical site is crucial to the performance of these procedures. This achievement improves vision in the surgical site, minimizes surgical time, enhances the surgical procedures (root-end resection, preparation and filling), and reduces surgical blood loss, postsurgical haemorrhage and postsurgical swelling. A multitude of materials have used in dentistry and medicine to achieve both generalized and localized haemostasis, many without full assessment of their biological implications. The purpose of this paper is to provide a thorough and critical review of these materials from the perspective of surgical endodontics, highlighting their development, application and potential role in achieving proper haemostasis.

Antifibrinolytic Agents↗
PubMed1996

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.

Afferent Pathways↗
PubMed1995

In vivo evaluation of root canal sealer distribution.

The effectiveness of sealer placement and its distribution in the prepared root canal system by an energized ultrasonic file was evaluated in vivo. One hundred patients had sealer placed into prepared root canals with either the master gutta-percha cone or an ultrasonic file. Before placement of sealer with the file, canals were irrigated, debrided, and flushed with water for 10 s and an energized #20 ultrasonic file at 1.0 mm from the working length. Canals were obturated with gutta-percha using lateral condensation, and evaluations were based on the presence or absence of sealer-filled accessory canals. Chi-square analysis showed that a statistically significant difference existed in the number of radiographically visible accessory canals filled when the ultrasonic file was used to place the sealer.

Chi-Square Distribution↗
PubMed1995

Sealability of the Trifecta technique in the presence or absence of a smear layer.

The aim of this in vitro study was to assess the sealability of a recently introduced thermoplasticized gutta-percha technique (Trifecta, Hygenic Corp., OH, USA) in the presence or absence of a smear layer. A total of 100 teeth with single straight root canals were included in the study. The teeth were decoronated and the canals prepared with a modified double-flared technique under constant irrigation with 2.5% sodium hypochlorite solution. The apical matrix was prepared to size 40 and apical patency subsequently confirmed with a size 10 file. Four teeth were discarded for technical reasons and the remaining 96 allocated randomly into two groups of 44 teeth and a group of eight teeth which acted as controls. Canals in group 1 were obturated randomly with either cold lateral condensation of gutta-percha or with the Trifecta technique. Canals in Group 2 were rinsed with 17% REDTA to remove the smear layer and then obturated with lateral condensation or the Trifecta technique. All teeth were suspended in India ink for 9 days, demineralized, and rendered transparent prior to the assessment of apical linear dye penetration. Apical extrusion of sealer and gutta-percha occurred commonly but there was no significant difference between the four obturation groups. However, overall, there was significantly more extrusion of sealer with the Trifecta technique compared with lateral condensation (P < 0.05). The majority of canals (79 out of 88) had no evidence of apical leakage and there was no significant difference between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium Hydroxide↗
PubMed1995

Multidisciplinary aspects of root resection failure: a case report.

Creative approaches to tooth maintenance often include tooth resection and retention of one or more of the roots. Although this procedure is reasonably successful, failure of supportive endodontic, periodontic, and restorative management of the retained roots can jeopardize a successful outcome. The following is a case report evaluating multiple aetiologies contributing to root resection failure.

Dental Leakage↗
PubMed1995

Reliability of reduced air pressure methods used to assess the apical seal.

The reliability of two commonly used methods of sealability testing, dye leakage under normal atmospheric pressure and dye leakage in a partial vacuum, was tested using a repeated studies design. Forty extracted teeth were instrumented and obturated using lateral condensation of gutta-percha and Sealapex sealer. One-half of the teeth were placed in India ink under normal atmospheric pressure and the other half underwent air evacuation before immersion in the ink. After 24 h the teeth were removed from the ink and rendered transparent for linear leakage analysis. A second study, repeated within the exact parameters of the first, was performed approximately 1 month later. Mann-Whitney U tests indicated that there was no significant difference (P>0.05) between the air and vacuum groups or within each group (air or vacuum) between trials, indicating that the methodology is repeatable and that application of reduced air pressure did not enhance reliability. A large majority of the teeth placed under partial vacuum showed evidence of vacuum-induced artefacts that may negate the value of vacuum as a research tool.

Air Pressure↗
PubMed1995

Implications, prevention and management of subcutaneous emphysema during endodontic treatment.

Subcutaneous emphysema (SCE) is a possible complication of both nonsurgical and surgical endodontic treatment. A review of the literature pertinent to endodontic intervention and SCE is highlighted, while the causes of and recommendations for the prevention of SCE are provided. A review of the pathways whereby compressed air may travel through potential spaces in the head and neck is also illustrated in an attempt to identify the possibility of morbidity and even mortality should operator induced SCE occur in a patient.

Humans↗
PubMed1995

Importance of anatomic variables in endodontic treatment outcomes: case report.

Surgical endodontic treatment was performed after a large periradicular lesion failed to resolve following nonsurgical intervention. The subsequent periradicular surgery resulted in healing with scar formation. Assessment of the resected root apex revealed a complex anatomy. The ramifications of these anatomical findings and the periradicular tissue response in healing are discussed relative to prognosis and ultimate treatment outcomes.

Adult↗