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PubMed2005

[Periodontal-endodontal interactions].

The periodontal ligament and the root canals system have a common developmental, anatomical and functional link. Those include the apical foramina, accessory canals and dental tubules whereas the pathological pathways perforation and vertical fractures. Similar microflora- bacteria, virus and yeast also have documented at the both nisus. This article describes the influence of the periodontium on the pulp and vise versa. The pulp is highly survivable and posses high ability to sustain the disease and treatment and periodontal disease and periodontal treatment exhibit small effect on the pulp. However, pulp necrosis is a risk factor to damage the periodontal ligament of the teeth.

Dental Pulp Cavity↗
PubMed2005

Physical properties of human premolar cementum: hardness and elasticity.

AIMS: To determine if the cementum on the maxillary right and left first premolars has identical physical properties. METHODS: Ten normal maxillary first premolar teeth, extracted from five orthodontic patients with a mean age of 14.0 years, were used. The teeth had not been subjected to an orthodontic force. The hardness and elastic modulus of the cementum were measured on the buccal and lingual surfaces of the roots at three locations: cervical third, middle third and apical third. RESULTS: There were no significant side-to-side differences in cementum hardness (Mean side-to-side difference: 0.0063 GPa; SD: 0.0279; p = 0.525) or elastic modulus (Mean side-to-side difference: -0.027 GPa; SD: 0.111; p = 0.814). The hardness and elastic modulus of the cementum decreased from cervical to apical regions on both root surfaces. CONCLUSIONS: Similar physical properties of the cementum on the maxillary right and left first premolars suggest that intra-arch comparisons can be used to investigate root resorption caused by orthodontic forces.

Adolescent↗
PubMed2005

Celebrex offers a small protection from root resorption associated with orthodontic movement.

UNLABELLED: Tooth movement results from alveolar bone resorption/deposition following application of orthodontic forces, and root resorption can be an undesirable complication associated with this process. No treatment for external root resorption is available to date. OBJECTIVE: To determine if COX-2 inhibitors like Celebrex are effective in protecting root resorption associated with orthodontic forces. METHODS: A force of 80 grams was applied to the left maxillary first molars of 7-week-old female Wistar rats using nickel titanium closed coil springs attached to the cervical area of the incisors with 0.010 stainless-steel ligature wires. Twenty animals were divided into three experimental groups: one receiving no treatment, the second receiving 25mg/kg, and the third receiving 50 mg/kg of celecoxib (Celebrex) in their drinking water. Rats were maintained on a soft diet and euthanized two weeks after initial placement of the force. Paraffin-embedded sections of the right (control) and left (experimental) maxillae were stained with H&E and the areas of root resorption were examined by counting the number of lacunaes in the roots. RESULTS: No difference in the distance of tooth movement (0.5 mm/two weeks) was seen in all three groups. The rats that received the low dose of Celebrex showed no statistically significant difference in root resorption than that of the rats that received no dose. The rats that received the high dose of Celebrex showed a lower number of lacunaes (mean = 3.5) than that of the control group (mean 10.2; p=0.02). CONCLUSIONS: Administration of Celebrex during the application of orthodontic forces does not interfere with tooth movement and appears to offer some slight protection against root resorption.

Animals↗
PubMed2006

Radiographic appearance of apical closure in apexification: follow-up after 7-13 years.

AIM: This was the radiographic evaluation of 15 maxillary incisors apexification treatment carried out on 7-9 years old patients with periapical pathology due to pulpal necrosis after dental trauma. MATERIALS AND METHODS: The treatment consisted of two phases. The aim of first phase was the formation of a calcified apical barrier through calcium hydroxide medications repeated twice with a three months interval. The aim of the second phase was the obturation of the root canal system once achieved a radiographic evidence of the formation of an apical barrier. The treated teeth were radiographed at six months and then periodically once a year for a period of 7 and 13 years. RESULTS: The radiographic analysis allowed to underline three different kinds of apical formation: a physiological development of the apical portion with a final root length equal to the contralateral tooth; the formation of a cap tissue and an apical development with the final root length slightly shorter than the contralateral tooth; or the formation of different layers of mineralised tissue that aggregate together trough the years. CONCLUSION: Apexification is not a static phenomenon and the apexified area undergoes through the years to a conspicuous readjustment involving bone, apical root tissues and root filling material.

Calcium Hydroxide↗
PubMed2006

The relationship of the inferior dental canal to the roots of impacted mandibular third molars in a Jordanian population.

OBJECTIVE: The aim of this study was to evaluate the topographic relationship between the inferior dental canals (IDCs) and the roots of impacted mandibular third molars. METHODS: Preoperative orthopantomograms (OPGs) were examined and the proximity of the IDC to the roots of impacted mandibular third molars was categorized into the following: groups: superimposition, adjacent, perforation, grooving, notching, or none. The categories notching, grooving, and perforation were regrouped together and called the true relationship between the IDC and the root apices. The type of impaction, age, and sex of the patient were also noted. RESULTS: The positional category of 96.1% of the radiographs with bilateral impactions was identical on both sides of the mandible. Out of 2526 impacted mandibular third molars examined, 1146 (45.3%) belonged to the superimposition category, 663 (26.2%) were adjacent, 312 (12.3%) showed grooving, 78 (3.08%) showed notching, and 9 (0.35%) were actually perforating the IDC. The results showed 15.7% of the total cases were in true relationship with the IDC. There was a significant association (p = 0.000) between patient's age and true relationship. CONCLUSIONS: Identical positional relationship of the bilateral impacted third molars to the IDC was noted in 96.1% of the radiographs. The position of the IDC in relation to the roots of impacted third molars varied according to the patient's age.

Adolescent↗
PubMedDate not supplied

The complete endodontic obturation of an avulsed immature permanent incisor with mineral trioxide aggregate: a case report.

The use of mineral trioxide aggregate (MTA) for complete endodontic obturation of an immature maxillary central incisor is reported. The injured tooth of a 9-year-old male was avulsed secondary to a sports-related traumatic event. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful, as evidenced by radiographic signs of external inflammatory root resorption in the middle to cervical thirds of the root. Calcium hydroxide apexification over a 1-year period promoted cessation of the resorptive process, but was unable to adequately form an apical root canal barrier. Due to the extent of external resorption and the lack of an apical stop, a novel endodontic treatment using mineral trioxide aggregate was utilized. At 865 days post-injury, the tooth remained asymptomatic with clinical and radiographic evidence of periodontal health.

Aluminum Compounds↗
PubMedDate not supplied

Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide.

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) and calcium hydroxide (Ca(OH)2) for their efficacies and time taken for formation of apical biological calcific barriers and resolution of periapical radiolucencies, if present at baseline, in teeth with unformed apices. METHODS: Twenty nonvital permanent maxillary incisors with unformed apices, stratified according to the size of periapical radiolucencies and stage of root development, were equally allocated to MTA and Ca(OH)2 groups. In group 1 (MTA group), after 7 days of disinfection with Ca(OH)2, MTA was packed into the apical one third of the root canals and obturation with gutta percha (GP) was performed in 90% (9/10) of cases within 15 to 30 days. In group 2 (Ca(OH)2 group), obturation was performed following clinical and radiographic depiction of the apical stop. RESULTS: The mean time taken for apical biological barrier formation was 3 +/- 2.9 months for group 1 and 7 +/- 2.5 months for group 2 (P=.008). The periapical radiolucencies were resolved in 4.6 +/- 1.5 months for group 1 and 4.4 +/- 1.3 months for group 2 (P=.83). The total treatment was completed in 0.75 +/- 0.4859 months and 7 +/- 2.5 months for groups 1 and 2, respectively. CONCLUSION: The 2 materials were found to be equally efficacious in the management of nonvital teeth with unformed apices. Time taken to complete the treatment and the biological barrier formation in group 1 was significantly less than that for group 2. The healing time for periapical radiolucencies was almost identical.

Adolescent↗
PubMedDate not supplied

Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis).

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (Ca(OH)2) clinically and radiographically as a pulpotomy agent in immature permanent teeth (apexogenesis). METHODS: Fifteen children, each with at least 2 immature permanent teeth requiring pulpotomy (apexogenesis), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional Ca(OH)2pulpotomy (control) was performed, whereas in group 2, the MTA pulpotomy (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. RESULTS: The follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 2 teeth treated with Ca(OH)2. The remaining 28 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 2 teeth treated with Ca(OH)2 and 4 teeth treated with MTA. CONCLUSIONS: Mineral trioxide aggregate showed clinical and radiographic success as a pulpotomy agent in immature permanent teeth (apexogenesis) and seems to be a suitable alternative to calcium hydroxide.

Aluminum Compounds↗
PubMed2006

Root resorption after orthodontic treatment.

BACKGROUND: Orthodontic treatment can result in root resorption. OBJECTIVE: To determine if apical root resorption is related to the type of appliance used and/or the direction and amount of tooth movement. METHODS: The pre- and post-treatment tooth lengths of the maxillary and mandibular first molars and incisors were measured on panoramic radiographs of 114 subjects. Associations between changes in the lengths of the incisors and positional changes in the upper and lower central incisors were determined for 45 subjects with pre- and post-treatment cephalometric radiographs. RESULTS: Taking into account the gender and OPT machine seven statistically significant differences were found between the appliance groups for the lengths of teeth 31 and 41. Within the groups four teeth decreased significantly in length when the pre-adjusted appliance was used (teeth 12, 11, 21, 26) and four teeth when the Speed appliance was used (teeth 26, 31, 41, 42). Only tooth 31 was shorter when the Tip-Edge appliance was used. Lower incisors were significantly shorter post-treatment if the apices were moved close to the lingual cortex. CONCLUSIONS: When panoramic radiographs are used to assess treatment-induced changes in the lengths of the incisors, apical resorption is only one factor that should be considered. The images of lower incisors proclined during treatment may be foreshortened and/or the apices may lie outside the focal plane: both may result in 'shorter' teeth post-treatment. Because of the confounding factors panoramic radiographs may not be a reliable method of determining apical root resorption.

Adolescent↗
PubMed1989

Morphometry of neural structures in the mouse periodontal ligament mesial to the mandibular first molar.

The periodontal ligament mesial to the mandibular first molars of three mice was analysed stereologically between the alveolar crest and the tooth apex. Ultrathin tissue sections were collected at statistically predetermined intervals, 50 and 200 microns apart, examined in the TEM and quantified using standard point counting procedures (Gundersen et al. 1988). Findings include evidence that, in the mouse, some unmyelinated axons arise from myelinated axons and that anatomically discrete arrangements of unmyelinated axons occur in the apericytic wall sections of postcapillary-sized venules. Morphometric data indicate that unmyelinated axons constitute approximately 95 percent of all periodontal axons. The greatest relative proportion of myelinated axons is the bone third of the ligament, at depths between 600 and 800 microns, where the ratio of unmyelinated to myelinated axons is 5:1. Ultrastructurally, the ligament contains a variety of anatomically discrete neural structures in juxtaposition to periodontal blood vessels. These structures include nerve endings contiguous with K-cells, partially exposed terminal axons, preterminal and terminal axons protruding into the vessel lumina, and lamellated receptors. Mitochondria-rich terminals and fine nerve endings approximated pericytes in the walls of postcapillary-sized venules and arteriovenous anastomoses. Typically, these neural structures were characterised by the presence of an associated oxytalan fibre meshwork. This study also provides quantitative parameters for axon distribution within the ligament.

Animals↗
PubMed1994

A non-destructive dental method for age estimation.

Dental radiographs have rarely been used in dental age estimation methods for adults and the aim of this investigation was to derive formulae for age calculation based on measurements of teeth and their radiographs. Age-related changes were studied in 452 extracted, unsectioned incisors, canines and premolars. The length of the apical translucent zone and extent of the periodontal retraction were measured on the teeth while the pulp length and width as well as root length and width were measured on the radiographs and the ratios between the root and pulp measurements calculated. For all types of teeth significant, negative Pearson's correlation coefficients were found between age and the ratios between the pulp and the root width. In this study also, the correlation between age and the length of the apical translucent zone was weaker than expected. The periodontal retraction was significantly correlated with age in maxillary premolars alone. Multiple regression analyses showed inclusion of the ratio between the measurements of the pulp and the root on the radiographs for all teeth; the length of the apical translucency in five types; and periodontal retraction in only three types of teeth. The correlation coefficients ranged from r = 0.48 to r = 0.90 between the chronological and the calculated age using the formulae from this multiple regression study. The strongest coefficients were for premolars. These formulae may be recommended for use in odontological age estimations in forensic and archaeological cases where teeth are loose or can be extracted and where it is important that the teeth are not sectioned.

Adolescent↗
PubMed1997

Microscopic management of procedural errors.

This article provides the clinician with several methods of dealing with furcation and post perforation as well as separated instruments. The endodontist must first understand how to eliminate procedural accidents that can occur, then, accurately and predictably treat those teeth to which accidents have occurred. Techniques to repair furcation and post perforations and retrieval of fractured root canal instruments are presented. An in-depth description of each technique has been included. Lastly, clinicians must be cognizant of limitations in treating these difficult problems that will arise in dental practice. Active patient participation and communication must be maintained during the scope of treatment to provide patients with the highest quality of endodontic service possible. A challenging variety of problems present to even the most skilled dental practitioner over time. The ability to diagnose and treat these difficult conditions relies heavily on the ability to envision adequately the source of the problem. In the past, operating loupes and headlamps were the most effective option afforded to practitioners as a solution to magnification and illumination. Not only were these devices cumbersome to use, but also the dentist was limited to performing the entire procedure under one level of magnification. The advantages of using the microscope in the correction of procedural errors enhances the operator's ability to perform each step in a procedure with a heightened sense of knowledge. The practitioner is cognizant of the exact details of an iatrogenic development because he or she has visualized the area in great detail. The reconstruction of the tooth or removal of instruments can be carried out with confidence because the dentist has more control of the working environment than ever before. New restorative materials and instruments are available so deliberate precision can be implemented with the microscope's ability to illuminate and magnify the working field. In time, these improvements in technology and techniques will result in greater confidence and success in the prevention and treatment of procedural errors.

Communication↗
PubMed1997

Principles of endodontic microsurgery.

With bright illumination and magnification under the operating microscope, and addition of many microinstruments, endodontic surgery has become microsurgery. The microsurgical approaches allow the clinicians to perform endodontic surgery with smaller osteotomies, shallow bevels, preparation of isthmuses, examination of resected root surfaces, retropreparation in line with root canal, and precise placement of new filling materials. This article illustrates the advantages of microsurgery in endodontics.

Alveolectomy↗
PubMedDate not supplied

Temporary and permanent restorations for fractured permanent teeth with immature apices: a clinical study.

Clinical and radiological studies of the fractured teeth of patients between seven and eleven years old were conducted to assess the use of permanent and immediate (emergency) techniques for reconstructing anterior permanent teeth with immature apices. The general hypothesis states that, given the physical and biocompatible properties of the materials used in the immediate (emergency) technique, there are no significant differences between the two techniques as far as pulp vitality and apical growth are concerned. A sample of fifty-six patients was selected. They had Class I, II or III fractures, for which permanent and immediate (emergency) techniques were used in equal numbers. Thermal, mechanical, and electrical tests were used to evaluate pulp vitality compared with the homologous tooth. Apical convergence was the radiological criterion used for determining the end of the radicular process. After one year, both techniques allow preservation of pulp vitality. Results show that, unlike the conventional technique (permanent), radicular formation was completed first in teeth reconstructed using the immediate (emergency) technique. Statistical analysis shows no definitive relationship between the technique used and completion of apical growth time (P > 0.05). In conclusion, comparison between the mediate (permanent) and immediate (emergency) techniques shows that the immediate (emergency) technique is an adequate alternative for reconstructing fractured teeth, because of the greater esthetic and functional advantages at the patient's disposal.

Biocompatible Materials↗
PubMed1997

Root canals in two-rooted maxillary second molars.

The aim of this study was to register the root canal number, root canal position, and root canal cross-section in human two-rooted, permanent maxillary second molars. One hundred and fifty-nine such teeth extracted in Denmark were cross-sectioned at the mid-root level and apically in accordance with precise guidelines. The observations were made in a stereomicroscope, corresponding to the above-mentioned section levels. At mid-root there were two canals present in 11% of the teeth examined; the canals were located mesially and distofacially, mesiofacially and distally, or facially and lingually. Three canals positioned mesiofacially, distofacially, and lingually were observed in 89% of the teeth. At the same level 62% of the canal cross-sections were noncircular, some being, for instance, C-shaped, whereas 38% of the cross-sections were circular. Apically, two canals were found, representing 19% of the teeth, with the canal position as at mid-root; 81% of the teeth were three-canaled with the same canal position as at mid-root. At the apical level 60% of the canal cross-sections were noncircular, whereas 40% of the cross-sections were circular.

Anatomy, Cross-Sectional↗