The endodontic management of a late complication of intrusive luxation injury.
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Adolescent↗
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Results for “Tooth Apex”
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"In the eye of the beholder"--how radiographic image interpretation depends on who is looking and when.
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Analysis of Variance↗
Apexification following gross overfilling of gutta-percha.
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Adolescent↗
Evaluation and management of a suspected apical third perforation.
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Camphor↗
Discuss that the coronal seal is more important than the apical seal for endodontic success.
One of the main principles for successful root canal treatment is the prevention of microorganisms and toxins from the oral flora penetrating through the root canal system into the periapical tissues (1). This is achieved by obturating the root canal system completely, including the coronal and apical ends. Inadequate obturation of the root canal system has been found to be the most frequent cause of failure after endodontic treatment (2). A number of studies have indicated that leakage, whether from a coronal or apical direction, adversely affects the success of root canal treatment (3-7). The significance of the coronal seal has been increasingly recognized in the dental literature (4, 5, 8, 9) and in more recent times, it has been suggested that apical leakage may not be the most important factor leading to the failure of endodontic treatment--but that coronal leakage is far more likely to be the major determinant of clinical success or failure (10). This paper will discuss aspects of: endodontic success and failure; the use of leakage studies to assess the quality of the seal; the significance of both apical and coronal leakage; followed by a review of the literature.
Dental Bonding↗
Apexification: case report.
Apexification is a process/procedure well recognized and accepted by clinicians and researchers alike. Calcium hydroxide is most commonly used to induce an apical hard tissue barrier which may be composed of different tissues but its mechanism of action is still unknown. The epithelial cell rests of Malassez have been implicated in apexification although case reports exist which apparently dispute this. The following case report demonstrates an unusual case of apexification following root filling, surgery and retreatment where the role of the epithelial cell rests of Malassez is discussed.
Adult↗
Paediatric dentistry avulsion: case reports.
Children may present at a dental surgery for management of oro-facial injuries. Most general dental practitioners are able to handle straightforward cases but referral may be required for complex injuries. Successful healing following tooth avulsion depends on the amount of damage to teeth and supporting structures, emergency treatment, and follow-up treatment. All of these play a role in the long-term prognosis of avulsed teeth.
Child↗
A comparison of Kodak Ultraspeed and Ektaspeed Plus dental X-ray films for use in endodontics.
BACKGROUND: The advantage of using a faster film for length determination in endodontic therapy is obvious. However, for such a film to be generally accepted, it must demonstrate comparable diagnostic quality to traditionally used films. METHODS: The comparative accuracy of canal length determination of Ultraspeed and Ektaspeed Plus dental X-ray films was assessed in maxillary first and second molars; for different canals, for different teeth, for different exposures, and for different examiners (five general dentists and three endodontic specialists). RESULTS: In general, there were no significant differences between films, among examiners, or any interaction between films and exposures. That is, an assessor's ability to estimate lengths was not significantly influenced by the film type or by exposure used. There was a wide divergence in the individual assessor's ability to estimate lengths. Specialists estimated lengths more accurately than general practitioners and estimated lengths more accurately with Ektaspeed Plus film. Length determination in distobuccal and mesiobuccal canals was more accurate than in palatal canals. Most palatal canals were underestimated in length by more than 1mm. The use of file sizes larger in number than size 15 is recommended in these canals. CONCLUSION: For length determination, Ektaspeed Plus dental X-ray film is as effective as Ultraspeed film. Given the acceptable quality and accuracy of Ektaspeed Plus film, there seems to be no clinical reason to subject patients to greater radiation by using a slower film during endodontic therapy.
Dental Pulp Cavity↗
Morphological analysis of subgingival biofilm formation on synthetic carbonate apatite inserted into human periodontal pockets.
BACKGROUND: Details of the development of human subgingival biofilm are unknown due to the difficulties in conducting experiments and especially in obtaining undisturbed materials. METHODS: This study was performed using deposits on carbonate apatite that had been inserted into human periodontal pockets for up to three weeks. Scanning electron microscopy using the vertically sectioned method and transmission electron microscopy using the freeze-substitution method were adopted. RESULTS: The development of subgingival biofilm occurred in five sequential phases: pellicle formation, microbial adherence, initial colonization, microbial organization, and establishment. Certain species in each of the initial, secondary and tertiary colonizers were considered to have a predilection for biofilm formation. Gram-positive, bacillary initial colonizers and gram-negative, filamentous secondary colonizers organized one stable structure that served as the framework for biofilm formation, and gram-negative, rod-shaped tertiary colonizers with cell-surface vesicles showed multigeneric coaggregation. The microbiota in the tertiary colonizers underwent repeated microflora alteration. CONCLUSIONS: Subgingival biofilm is constituted by initial, secondary and tertiary colonizers. Microflora alteration which is suggested to be related to periodontal disease, frequently occurred in the tertiary colonizers.
Adult↗
Calcium hydroxide: a review.
Calcium hydroxide is a multipurpose agent, and there have been an increasing number of indications for its use. Some of its indications include direct and indirect pulp capping, apexogenesis, apexification, treatment of; root resorption, iatrogenic root perforations, root fractures, replanted teeth and interappointment intracanal dressing. The purpose of this paper is to review the properties and various indications for the use of calcium hydroxide.
Anti-Bacterial Agents↗
A Raman spectroscopic investigation of dentin and enamel structures modified by lactic acid.
Confocal Raman microspectrometry allows a thorough molecular analysis of mineralised dental tissues. The output information is provided in the form of curves representing the intensity of the signal according to the frequency, and its mathematical exploitation permits all sorts of comparative and quantitative analyses. By this process, we investigated the in vitro action of lactic acid on enamel and dentin from human permanent teeth. Modifications due to the acidic attack essentially concern phosphate grouping PO(4)(3-), which represents the mineral phase in enamel and dentin (hydroxyapatite): on Raman spectra, changes in intensity of the PO(4)(3-) band are linked to the type of dentin, to its anatomical location, and to the age of the subject. The variability of the dentinal chemical structure was confirmed by a quantitative statistical analysis, revealing a significant spectral difference between coronal and root dentin.
Adult↗
An in vitro study of affected dentin as a risk factor for the development of secondary caries.
The objective of the study was to investigate the association between the presence of residual caries (inner affected dentin) on the cavity walls of cavity preparations and the further development of secondary caries lesions. Two 2 x 5 x 2 mm cavities, one in the apical portion (A) and one in the cervical portion (C) of the root, were prepared on both the lingual (L) and buccal (B) surfaces of 18 extracted human roots. The apical cavities (AB and AL) were artificially demineralized for 30 min using a decalcifying solution, followed by staining with a caries detector dye and then excavation of irreversibly demineralized dentin, leaving behind a layer of inner carious dentin. The cervical cavities (CB and CL) remained intact with sound dentin on the cavity walls. All cavities were then restored with composite resin. Following restoration, lingual specimens (AL and CL) were completely covered by an acid-resistant varnish to prevent further demineralization. All specimens were then incubated in an in vitro microbial artificial mouth model for 3 days in order to develop secondary carious lesions. At the end of the study all specimens were processed for energy-dispersive X-ray analysis of Ca concentration adjacent to the border between dentin and restoration. Statistical analysis of Ca concentrations revealed that the presence of affected inner dentin does not increase the susceptibility to secondary caries. Therefore, it was concluded that conservative cavity preparations leaving behind affected dentin do not increase the risk of secondary caries development.
Analysis of Variance↗
Morphologic features of the root canal system of the maxillary fourth premolar and the mandibular first molar in dogs.
Root canal morphology was evaluated in 72 maxillary fourth premolar and 59 mandibular first molar teeth. An apical delta was present in all roots (n = 334). The apical delta represented approximately 12-18% of the total root length for all roots. Non-apical ramifications from the main canal were observed in 25.1% of roots. Secondary canal(s) were present in 20.6% of roots, while lateral canal(s) were present in 6.9% of roots. The distal root of the maxillary fourth premolar had the highest incidence (47.2%) of non-apical ramifications. Overall, 68.0 and 20.4% of maxillary fourth premolar and mandibular first molar teeth had non-apical ramifications, respectively. The prevalence and location of non-apical ramifications may influence clinical decision making when performing endodontic therapy.
Animals↗
Evaluation of endodontic files in digital radiographs before and after employing three image processing algorithms.
OBJECTIVES: Two digital image processing algorithms, one aimed at correction for exponential attenuation and one at correction for visual response, have been developed. The aims of the present study were to test whether digital radiographs processed with these algorithms improve determination of the length of endodontic files and whether such processed radiographs are comparable with the radiographs processed with a default image processing method employed by one commercially available digital intraoral system. METHODS: A dried human skull embedded in an acrylic compound was used for exposing radiographs of the upper and lower premolars and molars with endodontic files (Kerr files size 10 and size 15) positioned to the full length of the roots or 1.5 mm short of it. Radiographs were then processed in three sets. In one set, the radiographs were processed to compensate for exponential attenuation and the response of the human visual system. In the second, the radiographs were processed with the same compensation but with an additional shift in grey levels so that the output luminance in dentin at root tips corresponds to the mean of the luminance range of a computer monitor. In the third, the radiographs were processed with the default processing method in the Sidexis program. Ten viewers evaluated all radiographs. Receiver operating characteristic (ROC) curves were obtained and areas under the curves were calculated. RESULTS: For file size 10, ROC curves for processed radiographs were higher than that for originals, while for file size 15, ROC curves for processed and original radiographs were close to each other. Significant differences were found between processed and original radiographs regarding areas under ROC curves for file size 10 but not between the differently processed radiographs. For file size 15, no significant differences were found. CONCLUSION: Radiographs processed to correct for attenuation and visual response may improve determination of the length of thin endodontic files. Such processed radiographs are comparable with the radiographs processed with the default processing method in the Sidexis program.
Algorithms↗
Conventional and digital radiographic methods in the detection of simulated external root resorptions: a comparative study.
OBJECTIVES: The purpose of this study was to evaluate and to compare the efficacy of a conventional and a digital radiographic method in diagnosing simulated external root resorption cavities. METHODS: Human dry mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth from each dental group were investigated. Three periapical radiographs of each tooth were taken in an orthoradial, mesioradial and distoradial aspect using conventional film (Insight Kodak F-speed; Eastman Kodak, Rochester, NY) and a digital sensor (DRS Gnatus System; Gnatus, Ribeirao Preto, Brasil). The teeth were extracted using a forceps and had 0.7 mm and 1.0 mm deep cavities prepared on their vestibular, mesial and distal surfaces at the cervical, middle and apical thirds. Following preparation, each tooth was replaced in its alveolus and new radiographs were taken. Three dental professionals, an endodontist, a radiologist and a general practioner, evaluated the images. RESULTS: A larger number of cavities (P<0.05) were detected by the digital method when compared with the conventional method, for all depths of lesions. CONCLUSIONS: The results of this study suggest that the digital radiographic method is more sensitive than conventional radiography to detect simulated external root resorption cavities.
Animals↗
Surgical repositioning of an impacted dilacerated incisor in mixed dentition.
BACKGROUND: Treatment options for a dilacerated incisor are either extraction or surgery and orthodontic traction. Because patients with such incisors usually are young, and because of the root angulation of the impacted incisor, treatment usually is lengthy and complicated. Surgical repositioning provides another option for treatment of this unique problem. CASE DESCRIPTION: The author presents the case of a 9-year-old girl with an impacted dilacerated maxillary central incisor to demonstrate the timing, technique and results of the surgical repositioning treatment approach. The advantages of this approach include immediate esthetic improvement, use of a single and simplified surgical procedure, simple and short orthodontic therapy, a normal gingival margin and the possibility of the developing root's adapting to the new position. CLINICAL IMPLICATIONS: Surgical repositioning is a simplified treatment for dilacerated incisors. It is especially valuable in cases of difficult-to-treat impaction. Timing of surgical repositioning depends on the incisor's root development and the space available for the transplant.
Child↗
Restoration and retention of maxillary anteriors with severe root resorption.
BACKGROUND: The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth. CASE DESCRIPTION: The authors present the three cases of severe root resorption caused by ectopically erupting canines. They then discuss various prosthetic options; the indications, advantages and disadvantages of various treatment modalities; the long-term retention and esthetic concerns of the patients; and the inherent limitations of restorative treatment. CLINICAL IMPLICATIONS: Increased tooth mobility and long-term retention are significant concerns in cases of patients who have severe root resorption. Attaining stability with lingual splinting can cause esthetic problems. An interdisciplinary approach is necessary to provide optimal care for the patient.
Child↗
The importance of apical patency and cleaning of the apical foramen on root canal preparation.
The apical limit of root canal instrumentation has always been a matter of great controversy. Despite the large number of published studies on this subject, a consensus has not yet been reached. In fact, the recent discussion on apical patency and cleaning of the apical foramen, as well as the incorporation of these procedures to the endodontic treatment, seem to have raised even more polemics. It is likely that all this polemics has its roots in the lack of interrelation between the theoretical knowledge of pulp stump and periapical tissues and the real clinical practice. By addressing the most important aspects of this theme, this paper aims to present news concepts about the importance of apical patency and cleaning of the apical foramen during root canal preparation.
Humans↗