Treatment of periapical areas in anterior teeth.
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Apicoectomy↗
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Results for “ROOT CANAL OBTURATION”
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The scope of surgery in endodontics for the retention of anterior and posterior teeth. 2.
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Apicoectomy↗
Surgical endodontics. Introduction, principles and indications.
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Apicoectomy↗
Treatment outcome of surgical and non-surgical management of endodontic failures.
The principal modalities available to manage endodontic treatment failures are orthograde retreatment and apical surgery. Both modalities have specific advantages, clinical implications, and risks, and their selection involves a complex decision-making process. A review of the literature pertaining to the treatment outcome of each modality was undertaken to establish an objective reference for practitioners involved in the management of endodontic treatment failures. Based on a weighted average calculation of the results reported in the reviewed studies, the orthograde retreatment of teeth associated with apical periodontitis results in a success rate of 66 per cent, an uncertain healing rate of 11 per cent, and a failure rate of 23 per cent. Apical surgery results in a success rate of 59 per cent, an uncertain healing rate of 22 per cent, and a failure rate of 19 per cent. These figures are discussed with reference to the characteristics of the reviewed studies. It appears that many of the reviewed studies have lesser relevance today, due to the current technical improvements in both treatment and modalities.
Apicoectomy↗
Does cold burnishing gutta-percha create a better apical seal?
This study investigated the seal created by cold burnishing the gutta-percha exposed after apical root resection of endodontically treated teeth. Sixty single-rooted extracted human teeth with a single straight canal were divided into four experimental groups of 15 teeth each. In two of the experimental groups the canals were instrumented and obturated well with laterally condensed gutta-percha and sealer. The remaining two groups were instrumented and poorly obturated with laterally condensed gutta-percha and sealer. The apical 2 mm of all the teeth were then resected and the effect of cold burnishing the exposed gutta-percha was investigated using a linear dye penetration technique. Under the condition of this study, cold burnishing gutta-percha after apical root resection of a well-obturated root canal resulted in a poorer apical seal than if no burnishing were performed. Cold burnishing the exposed gutta-percha after apical root resection of poorly obturated root canals improved the apical seal as compared with nonburnished poorly obturated canals.
Dental Leakage↗
Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population.
A random sample of 967 subjects selected from the total population in a Swedish county were examined radiographically regarding prevalence and quality of endodontic treatment and occurrence of periapical lesions. The relationship between the technical standard of endodontic treatment and the occurrence of periapical lesions was also analyzed. Of the selected individuals, 95% attended examination (751 dentate and 169 edentulous individuals). Of the 17,430 teeth examined, 1,492 (8.6%) were endodontically treated. Approximately 70% of the treated root canals were inadequately obturated; 10% showed excess of root filling beyond the apex. The prevalence of periapical lesions was 2.9%, and 24.5% of the endodontically treated roots demonstrated periapical lesions. Root fillings ending more than 2 mm from apex had a significantly lower frequency of periapical lesions than root fillings ending within 2 mm of the apex. No difference in the frequency of periapical lesions was found between properly and improperly obturated root canals. Excess of root filling material beyond the apex was related to a significantly higher frequency of periapical lesions.
Adult↗
The relationship of root canal enlargement to finger-spreader induced vertical root fracture.
The purpose of this study was to assess the effect of lateral condensation forces on the development of vertical root fracture (VRF) in teeth that have undergone controlled, measured internal root reduction (i.e. canal preparation). Thirty-four straight-rooted maxillary anterior teeth were used. For each tooth a simulated PDL was fabricated from a uniform 0.15 mm layer of silicone impression material. The teeth were mounted in resin to facilitate removal for observation. They were radiographed and measured at 2, 4, 6, and 8 mm from the apex. They were prepared with the step-back method so that the canal width was 20% of the total root width at 2, 4, 6, and 8 mm from the apex. They were obturated using a fine finger spreader attached to a jig that produced a static force of 3.3 kg for 15 s after placement of each gp point. Obturation was complete when the spreader did not penetrate apical to 8 mm from the apex. Twenty-four h after obturation the teeth were examined by transillumination for VRF. Teeth not exhibiting VRF were tested further after gp removal and canal enlargement of 30%, 40%, and 50% The teeth were sectioned at 2-mm increments with a diamond wafering saw and examined under stereomicroscope. No VRF occurred at 20% or 30%; 5 teeth fractured at 40% and 7 at 50%. These teeth had root surface craze lines that developed during testing. Craze lines had also developed in all 17 of the remaining unfractured samples. No VRF occurred after testing unless craze lines were previously present.
Humans↗
[Canal obturation with the Canal Finder System in curved canals].
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Dental Pulp Cavity↗
A comparative sealability study of different retrofilling materials.
The purpose of this study was to compare the sealing ability of high-copper amalgam, glass ionomer cement, and silver glass ionomer cement as retrofilling materials when used with and without varnish. Seventy extracted human single-rooted anterior teeth were instrumented and the root canals obturated with laterally condensed gutta-percha and sealer. The apical 3 mm of each root was resected and a 2 mm-deep apical Class I preparation cut. The roots were then randomly allocated to six groups of 10 teeth and retrofilled with one of the experiment materials. Group I comprised high-copper amalgam; group 2, high-copper amalgam with cavity varnish; group 3, glass ionomer cement without varnish; group 4, glass ionomer cement with varnish; group 5, silver glass ionomer cement without varnish; and group 6, silver glass ionomer cement with varnish. Two groups of five roots each were used as positive and negative controls. The root surfaces were coated with nail polish and specimens immersed in 2% methylene blue solution for 14 days. After vertical sectioning, dye penetration was examined under a stereomicroscope. The results of the study were analysed statistically. The sealing ability of the conventional glass ionomer cement with varnish was significantly better while dye penetration was higher in silver glass ionomer cement without varnish group than the other groups (P < 0.01).
Acid Etching, Dental↗
A six-canal maxillary first molar: case report.
AIM: The aim of this case report is to describe an unusual six-canal maxillary first molar tooth. CASE REPORT: The maxillary left first molar of a young African-American male was treated as an emergency at the first visit. At the second visit, the five canals (MB1 and 2, Pal1 and 2 and DB) were easily identified at high magnification of 16-25 under an operating microscope. The canals were then instrumented and filled using the Microseal technique. A careful radiographic examination of the final fill indicated that there was a third canal in the palatal root as suggested by a slight extrusion of the filling material between the two canals. At the third visit, the fillings of the palatal canals were removed and the apical 4mm was re-examined. The existence of a third palatal canal exiting between the two apices was verified and subsequently instrumented and obturated. KEY LEARNING POINTS: It should be assumed that all molar teeth have more than the traditionally expected three canals. The location of root canals should be identified at high magnification under the microscope. Careful radiographic re-examination of the fillings should be done in order to identify possibly missed canals.
Adult↗
Relation of pre- and intraoperative factors to prognosis of posterior apical surgery.
The relation of preoperative and intraoperative factors to the prognosis of apical surgery was studied in 136 premolar and molar roots. The evaluated factors were: clinical signs and symptoms, size of the periapical lesion, root canal obturation, tooth restoration, apical retrofilling, and the operating surgeon. A significantly higher success rate was found in roots obturated 2 mm or shorter of the apex, in roots without post restoration, and after retrofilling of roots with apparently well-condensed obturation. The prognosis differed significantly following treatment by various operators but was unrelated to their experience.
Apicoectomy↗
Comparison of hand stainless steel and nickel titanium rotary instrumentation: a clinical study.
The aim of this study was to compare the effect of hand instruments and rotary nickel titanium Flex-Master files used by eight experienced dentists in private practice on the extent of straightening of curved root canals. In patients, 110 canals were prepared by FlexMaster instruments, and 84 canals were enlarged using hand instruments. After instrumentation, all canals were obturated. Preoperative and postoperative radiographs were taken of each tooth using customized bite blocks. Straightening of the canal curvatures was determined with a computer image analysis program. Preparation time and size of the master apical file were also recorded. The use of FlexMaster instruments resulted in significantly less straightening and a shorter preparation time (p < 0.0001) compared with hand instrumentation. Master apical file sizes were significantly greater for FlexMaster than for hand instruments (p < 0.01). This clinical study indicates that FlexMaster instruments prepared curved canals rapidly and with only minimal straightening.
Chi-Square Distribution↗
Endodontic failures--changing the approach.
The underlying reason for endodontic failures is almost invariably due to bacterial infection. The bacteria may be situated within a previously missed or uninstrumented portion of a root canal, infiltrate via a leaky coronal restoration and root filling, or cause contamination from an extra-radicular infection. Management of the failing root canal filling begins with the identification of the source of persistent infection. Should the infection be present within the root canal system, such as a missed canal, orthograde retreatment is the choice of treatment. This is also true for asymptomatic cases which had been inadequately obturated and which require the placement of a dowel into the canal for restorative reasons. Periapical surgery is best reserved for cases with no sign of healing after orthograde retreatment and those with extra-radicular infection. This paper discusses the relationship between endodontics and restorative dentistry, treatment planning for endodontic failures, and the reported rates of success with orthograde and surgical retreatments.
Bacterial Infections↗
An evaluation of .06 tapered gutta-percha cones for filling of .06 taper prepared curved root canals.
AIM: To compare the area occupied by gutta-percha, sealer, or void in standardized .06 tapered prepared simulated curved canals and in mesio-buccal canals of extracted maxillary first molars filled with a single .06 gutta-percha point and sealer or lateral condensation of multiple .02 gutta-percha points and sealer. METHODOLOGY: Simulated canals in resin blocks with either a 30 degrees curve and radius of 10.5 mm (n = 20) or a 58 degrees curve and 4.7 mm radius (n = 20) and curved mesio-buccal canals of extracted maxillary first molars (n = 20) were prepared using .06 ProFiles in a variable tip crown-down sequence to an apical size 35 at 0.5 mm from the canal terminus or apical foramen. Ten 30 degrees and 58 degrees curved resin canals and 10 canals in the extracted teeth group were obturated with .02 taper gutta-percha cones and AH 26 sealer using lateral condensation. The time required to obturate was recorded. The remaining canals were obturated with a single .06 taper gutta-percha cone and AH 26 sealer. Excess gutta-percha was removed from the specimens using heat and the warm mass vertically condensed. Horizontal sections were cut at 0.5, 1.5, 2.5, 4.5, 7.5 and 11.5 mm from the canal terminus or apical foramen. Colour photographs were taken using an Olympus 35 mm camera attached to a stereomicroscope set at x40 magnification, and then digitized using a flatbed scanner. The cross-sectional area of the canal contents was analysed using Adobe PhotoShop. The percentage of gutta-percha, sealer or voids to the total root canal area were derived and data analysed using unpaired Student's t-test and the Mann-Whitney U-test. RESULTS: In the 30 degrees curved canals the levels had between 94 and 100% of the area filled with gutta-percha with no significant difference (P > 0.05) between the lateral condensation and single cone techniques. In the 58 degrees curved canals the levels had 92-99% of the area filled with gutta-percha, with the single cone technique having significantly (P < 0.05) more gutta-percha fill at the 2.5 mm level only. In the mesio-buccal canals of the teeth the levels had between 72 and 96% of the area filled with gutta-percha with no significant difference (P > 0.05) between the lateral condensation and single cone technique. The time for obturation was significantly (P < 0.05) greater for lateral condensation compared with the single cone technique in all groups. CONCLUSIONS: The .06 taper single cone technique was comparable with lateral condensation in the amount of gutta-percha occupying a prepared .06 tapered canal. The .06 single cone technique was faster than lateral condensation.
Dental Pulp Cavity↗
The effect of using an inverted master cone in a lateral compaction technique on the density of the gutta-percha fill.
OBJECTIVE: We sought to measure and calculate the percentage of the gutta-percha-filled area in the apical root canal after the use of a standardized or inverted master cone in cold lateral compaction.Study design Two groups of extracted mandibular premolars with a single canal were instrumented with instruments of the same size; furthermore, they were obturated with laterally compacted gutta-percha cones with AH26 used as a sealer. In the first group, a standardized master cone was used with its narrow end in an apical position, whereas in the other group, an inverted master cone was used with its wide end in an apical position. The 2 master cones had the same apical diameter and fit in the apical canal. After lateral compaction, horizontal sections were cut at a level 3 and 5 mm from the apex of each filled tooth. Photographs of the sections were taken by using a microscope equipped with a digital camera; the photos were then scanned as tagged-image file format images. The cross-sectional area of the canal and the gutta-percha were measured by using an image-analysis program. The percentage of gutta-percha-filled area was calculated. RESULTS: At both levels, the inverted master cone produced a significantly higher percentage, statistically, of gutta-percha-filled area than did the standardized master cone (P =.001 at 3 mm; P =.012 at 5 mm). CONCLUSION: The use of an inverted master cone in cold lateral compaction may facilitate the apical placement of accessory cones, significantly increasing the volume of gutta-percha while reducing the volume of sealer in the apical root canal.
Bismuth↗
Obturation of accessory canals after four different final irrigation regimes.
The aim of this study was to evaluate accessory canal obturation after four different final irrigation regimes. Sixty-four extracted human lower premolars were instrumented, divided randomly into four groups, and finally irrigated as follows: no irrigation (NO), distilled water (WA), sodium hypochlorite ([SH] 6%, 20 ml for 15 min), and EDTA (15%, 8 ml for 3 min) combined with the SH regimen (ES). The System B and the Obtura II were used to fill the canals. The teeth were cleared and observed under a digital microscope. Obturation material penetration rates in length into the accessory canals were measured and the following values were obtained: 22.3% in group NO, 21.8% in group WA, 53.5% and 68.1% in groups SH and ES, respectively. Statistically significant differences were found when comparing each of the first two groups (NO and WA) with SH and ES groups (p < 0.05). The use of sodium hypochlorite alone or in combination with EDTA in final irrigation flushes may enhance a better obturation material penetration into the accessory canals.
Bicuspid↗
Factors influencing the success of conventional root canal therapy--a five-year retrospective study.
This retrospective study on the outcome of conventional root canal therapy was carried out on patients attending the Eastman Dental Hospital between 1970 and 1982. A minimum follow-up period of 5 years was required for patients to be included in the survey. The characteristics of the resulting sample group, the techniques for canal preparation and obturation and the obturating materials used were analysed. The type of obturating material used had no demonstrable effect on success rate but sex, age, preoperative vitality and periapical pathology were associated with significantly differing success rates. Technique also influenced success rate; the method of canal preparation and the position of the apical seal relative to the radiographic apex were both found to be significant. The overall success rate was 84.29%, representing 692 of 821 teeth included in the survey.
Adolescent↗
The influence of filling technique on depth of tubule penetration by root canal sealer: a study using light microscopy and digital image processing.
The purpose of this study was to compare the depth of sealer penetration into dentinal tubules by three root-filling techniques using light microscopy and digital image processing. Thirty-two maxillary central incisors were prepared. Two teeth were separated for the control group. The rest were divided into three equal groups and obturated as following--G1: lateral condensation; G2: warm vertical compaction of gutta-percha and G3: Thermafil system. Each sample was sectioned longitudinally and prepared for microscopic analysis. A sequence of photomicrographs with magnifications of X50, X200 and X500 were taken. Through digital image analysis and processing, measurements for each field were obtained. A non-parametric ANOVA Kruskal-Wallis analysis was used to determine whether there were significant differences among the groups. Significant differences between G2 and G1 (p = 0.034) and between G3 and G1 (p = 0.021) were identified. There were no significant differences between G2 and G3 (p > 0.05). The results of this research suggest that samples root-filled by thermoplasticised gutta-percha techniques lead to deeper penetration of the root canal sealer into the dentinal tubules.
Analysis of Variance↗