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Comparison of the sealing efficacies of two obturation techniques in curved root canals instrumented with and without ultrasonic irrigation.

Volumetric dye penetration into the canals of 131 teeth was studied spectrophotometrically. The teeth were first divided into three groups according to the degree of curvature. Each group was then subdivided into four groups, in which the Thermafil and lateral condensation techniques were used with or without ultrasonic irrigation. Significant microleakage differences were observed between group I (0-10 degrees) and group III (21-30 degrees) for lateral condensation filling with ultrasound irrigation and Thermafil filling without ultrasound irrigation (p < 0.05).

Analysis of Variance↗

Coronal leakage: endotoxin penetration from mixed bacterial communities through obturated, post-prepared root canals.

Coronal leakage has been considered as one of the major causes of failure in root canal treatment. Bacteria have been shown to penetrate the root canal obturating materials and influence the periapical tissues. Endotoxin, a component of Gram-negative bacteria, is a potent inflammatory agent and may be able to penetrate obturating materials faster than bacteria. This in vitro study examined the possible penetration of post-prepared canals by endotoxin and bacterial cells derived from mixed bacterial communities. Results showed that both bacteria and endotoxin were able to penetrate the obturating materials in post-prepared canals; however, endotoxin penetration was faster than bacterial. If one speculates that a similar sequence of events occurs clinically, then such a rapid penetration of endotoxin could lead to an early periapical reaction, with subsequent treatment failure and need for retreatment or periapical surgery. The need for an immediate and proper coronal restoration after root canal treatment is therefore reinforced.

Analysis of Variance↗

In vitro evidence that lipopolysaccharide of an oral pathogen leaks from root-end filled teeth.

AIM: The ability to achieve a complete apical seal of the root canal system is thought to be important in the success of non-surgical and surgical endodontics. The aim of this study was to establish whether or not root-end filled teeth allow leakage of lipopolysaccharide (LPS) from a known oral pathogen in vitro. METHODOLOGY: Lipopolysaccharide (LPS) from a virulent strain of Prophyromonas gingivalis (P. gingivalis) (A7436 from patient with refractory periodontitis), was isolated by the Westphall and Jann technique, dialysed extensively, lyophilyzed, resuspended in distilled water and analysed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Root canals from 10 teeth were instrumented endodontically and the apical 3 mm of resected roots were filled with gutta-percha. The teeth were mounted in 12 mL polypropylene vials by using sticky wax and root surfaces were covered with two layers of nail varnish. Teeth were filled with 3.3 mg mL-1 LPS and the vials filled with 11 mL of Tris Buffered Saline (TBS) containing 0.05% sodium azide. Both positive and negative controls were run in parallel with the experimental specimens. Aliquots were removed each day and subjected to slot blot analysis to quantitate the amount of LPS that had leaked into the bottom of the vials. The density of slots was analyzed using a laser densitometer and regression analysis was used to generate a standard curve, confidence intervals and experimental values. RESULTS: The data indicated that teeth obturated apically with gutta-percha leaked, whilst no LPS leakage was detected in teeth covered completely with nail varnish (P < 0.05). CONCLUSIONS: In vitro teeth with gutta-percha root-end fills can permit leakage of LPS from an identified oral pathogen.

Apicoectomy↗

Retreatment decisions--a comparison between general practitioners and endodontic postgraduates.

One of the most subjective areas with regard to interexaminer variations is the dental radiograph. The variations in radiographic interpretation lead to differences in treatment planning decisions. This study compared the endodontic retreatment planning decisions for endodontically treated teeth between 12 general practitioners and 12 endodontic postgraduate students. Utilizing dental radiographs of completed cases, both groups were asked to make treatment choices based on two hypothetical ages of a case: 1 or 3 yr postoperatively. General practitioners chose to initiate treatment at an earlier date and also chose more extensive treatment modalities. The age of the root filling was looked on as more important in treatment planning by the endodontics postgraduates.

Apicoectomy↗

When all else fails....

Endodontic surgery may be indicated if orthograde endodontic treatment cannot be carried out or is unsuccessful. Advances in instruments, materials and techniques have made surgical endodontics a more predictable procedure. A complex case that required surgical intervention is presented to illustrate this point.

Aged↗