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A mixture of Ca(OH)2 paste and ZnO powder as a root canal filling material for primary teeth: a preliminary study.

The present pilot study was conducted on five primary mandibular second molars requiring endodontic treatment to evaluate the clinical and radiographic success of root canal filling material which was a mixture of calcium hydroxide paste (1 cm), Zinc oxide powder (15 gms) and distilled water using hand operated lentulo spirals. All the five cases on clinical evaluation after 2,4,6,9, and 12 months were found to be asymptomatic with no history of pain, tenderness or abnormal mobility. Immediate post-operative radiographic evaluation revealed adequate root canal filling in all cases. The obturated material remained upto the apex of root canals till the beginning of physiologic root resorption. The roots of the primary teeth as well as the filling material mentioned above were seen to resorb at the same rate in one case.

Biodegradation, Environmental↗

Root resorption of mandibular second molar teeth associated with the presence of the third molars.

Although pressure resorption of second molars is associated with impacted and/or erupting third molars, the relationship between pressure resorption and age is unclear. In order to investigate this relationship, 3883 dental radiographs were studied in 3174 individuals of various ages. The incidence of superimposition of the second molar on the third molar was not elevated in any subgroup except that of women of 16-40 years of age. There were no age or sex differences for the incidence of second molar root resorption. In older individuals, root resorption associated with a completely impacted third molar was more frequent than with a partially impacted third molar, and root resorption at the apex was mainly seen in individuals over 50 years of age. There was a higher incidence of superimposition and root resorption in men than women. Apical root resorption may be seen long after the formation of completely impacted third molars in both genders.

Adolescent↗

Effect of retrograde cavity preparations on root apexes.

Ultrasonic cavity preparations in endodontic surgery has become a popular procedure with several advantages noted: Smaller cavities, deeper and cleaner preparations, less removal of surrounding bone needed for instrumentation and less removal of root apex dentin. Concern has been raised that lines of infraction have appeared in some instances when the ultrasonic instruments have been used. We wished to examine the result of cavity preparations in root apexes using five different methods: high and slow speed handpieces, sonic instruments, and ultrasonic instruments at two power settings, medium and high levels, respectively. The results showed that all the methods produced some infractions; the high power ultrasonics produced the most infractions while the lowest numbers were associated with the slow speed handpiece and ultrasonic instruments at the medium power setting.

Dental Equipment↗

In vitro evaluation of the reliability of the Endex electronic apex locator.

A new generation of electronic apex locators (Endex) that operates in moistened canals has been developed lately. An experimental comparison of this apparatus with the real, tactile, and radiographic measurements of the root canal length has been conducted. Results show that tactile determination is highly inaccurate and that the Endex is as accurate as radiographic measurements. It also demonstrates that the nonreproducibility of radiographic measurements is statistically significant, whereas that of the Endex is not significant.

Dental Instruments↗

Detection and measurement of endodontic root perforations using a newly designed apex-locating handpiece.

Access openings and lateral root perforations were prepared in 40 single-rooted extracted teeth. The distance to the perforations was measured visually and then with the Tri Auto ZX. The electronic device was used first in its apex-locating function and then in conjunction with its automatic reverse mechanism. On average, the electronically measured length was slightly shorter than the visually measured length (P < 0.05). When the automatic reverse mechanism was used, the values registered were either consistent with or slightly different (+/- 0.5 mm) from the electronically measured length (P > 0.05). The results of this study revealed that the Tri Auto ZX detected and measured endodontic root perforations within a range of clinically acceptable variations.

Dental High-Speed Equipment↗

Pulpal response to cavity preparation by an erbium, chromium:YSGG laser-powered hydrokinetic system.

The near red-pulsed erbium, chromium:yttrium-scandium-gallium-garnet laser hydrokinetic system, or Er,Cr:YSGG laser HKS, is effective in cutting dental hard tissues. In this longitudinal study, the authors studied the continuously erupting open-apex incisors of New Zealand albino rabbits and the constricted apex teeth of beagles to determine the effects of HKS-produced lesions at various energy levels and of preparations produced by a tapered fissure bur on dental pulp. No pulpal inflammatory responses could be identified either immediately or 30 days after surgery in HKS preparations that removed enamel and dentin without pulp exposure.

Aluminum Silicates↗

Root positioning and leakage to dye in extracted teeth using reduced pressure.

A study was conducted in vitro to assess the root apex position on leakage to dye under reduced pressure (560 mm Hg). A total of 132 extracted single-rooted teeth were randomly allocated to four groups. The teeth were prepared using a step-back technique and sealed with the cold lateral condensation technique, using gutta-percha without sealer. No significant differences (P < 0.813) were found between horizontally positioned experimental groups under reduced pressure and those in passive immersion. In the group in which the apices were in an upright position, the mean leakage was significantly different (P < 0.024) from the mean dye penetration in the group of teeth positioned horizontally under reduced pressure. Those teeth with apices upright allowed the most linear leakage (0.51 mm), whereas the groups in which the roots were horizontally positioned (with and without reduced pressure) had the least dye penetration (0.21 mm and 0.19 mm, respectively). These results show that tooth positioning has a significant effect on linear dye penetration under reduced pressure and emphasize the need to standardize factors that may influence penetration when assessing leakage study methodology.

Coloring Agents↗

Determination of location of root perforations by electronic apex locators.

OBJECTIVES: This study was conducted to evaluate the accuracy of two electronic apex locators, the Sono Explorer Mark 2 Junior (Hakusui, Osaka, Japan) and Apit 2 (Osada, Tokyo, Japan) in detecting root perforations. The adequacy of radiographs for identifying root perforations was also assessed. STUDY DESIGN: Thirty-two extracted human teeth were perforated in the middle third of the root and embedded in alginate. Determination of all perforations were carried out with K-files no. 25 attached to the apex locators tested. Two radiographs were taken at two angulations after each electronic measurement. The actual location of the file tip in relation to the perforation was determined with a stereomicroscope. A total of 512 radiographs were evaluated to attempt to identify root perforations. RESULTS: The mean distance of the file tip from the external outline of the root surface was short for both instruments. A statistical difference (p < 0.05) was found between the two apex locators in dry canals or if saline solution was present. There was no significant difference between the two instruments in the presence of sodium hypochlorite. Evaluators radiographically identified 45% of the root perforations when located in buccal-lingual directions. CONCLUSION: Under the in vitro conditions of this study, both devices determined the location of the perforations in an acceptable clinical range short of the root surface. Radiographs were found to be less reliable in identification of perforation locations.

Chi-Square Distribution↗

Periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces.

The purpose of the study was to evaluate periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces. Ten teeth with hopeless prognoses because of extensive alveolar bone loss and deep pockets extending to the apexes only on one or two surfaces, but with a healthy periodontal apparatus on the other surfaces, were selected. A mucogingival flap was elevated and the teeth were extracted carefully so as not to damage the healthy remnant of the periodontal membrane remaining on the root surfaces. Thorough extra-oral debridement was performed on the contaminated root surface and the remnant was carefully conserved. Retrofilling was also done to eliminate an endodontic cause of attachment loss. The teeth were horizontally rotated and then replanted so that the healthy root would face the connective tissue at the initially periodontally involved sites, and the root planed surfaces, which had been periodontally involved, would face the surfaces of the alveolar sockets at initially healthy sites. The teeth were splinted with adjacent teeth. Clinical parameters and radiographic examination were performed pre-operatively, and at 3 or 6 months, 1, 2, and 3 years postoperatively. One tooth was extracted 1.5 years postoperatively due to reduced support and the treatment strategy of the patient. The other nine teeth were well maintained without any discomfort for the whole maintenance period of 3 years. In all teeth, areas that previously had no pocketing but were now against denuded root surfaces maintained the previous pocket depth readings. In areas where a deep pocket was present but now had a root surface with healthy periodontium, a distinct decrease of mean pocket depth was observed at the first reexamination 3 months postoperatively. The mean radiographic alveolar bone level increased from 0.3% to 45.3% in 2 years and was thereafter maintained for the entire observation period. Loss of periodontal space and possible root resorption were observed in only one case without other ankylotic symptoms. These results suggest that the healing without ankylosis of an extensive denuded root surface may occur by mechanisms other than the maintenance of a viable periodontal ligament on the root surface.

Adult↗

Accuracy of three different electronic apex locators in detecting simulated horizontal and vertical root fractures.

The aim of this in vitro study was to evaluate the accuracy of three electronic apex locators (EALs): Root ZX, Foramatron D10 and Apex NRG, in the detection of fractures in teeth having simulated horizontal and vertical root fractures. A total of 90 extracted intact, straight, single-rooted teeth were divided into six groups of 15 teeth each. In Groups A, B and C, an incomplete horizontal fracture was simulated by preparing a horizontal incision in the coronal, middle or apical portion of the root until the circumferential half of the canal was exposed in the horizontal plane respectively. In Groups D, E and F, an incomplete vertical root fracture was simulated by preparing a vertical straight incision to expose the canal in the coronal, middle or apical portion of the root all the way in the longitudinal plane respectively. The simulated fractures were 0.25 mm in thickness in all groups. The teeth were embedded in 1% agar and the canals were irrigated with saline solution during electronic measurement. Detection of the simulated root fractures was established with a size 10 K-file when the meter value reached 'APEX' on each EAL. In Groups A, B and C, Kruskal-Wallis tests revealed that there were no statistically significant differences between the three EALs. However, statistically significant differences were found among the EALs in Groups D, E and F (P < 0.0001, one-way anova and Tukey's post-hoc test). In conclusion, the three EALs tested were accurate and acceptable clinical tools in the detection of horizontal root fractures. However, the three EALs were unreliable in detecting the position of vertical root fractures.

Analysis of Variance↗

Complicated root canal morphology of mandibular first premolar in a Chinese population using the cross section method.

The purpose of this study was to assess the canal anatomy and morphology of mandibular first premolars in a Chinese population. Eighty-two extracted mandibular first premolars with intact roots were collected and stored in a glutaraldehyde solution. The teeth were embedded in clear resin and the root length was measured. The roots were resected perpendicular to the long axis at 3, 6, 9, and 12 mm from the apex. The resected root surfaces were polished, rinsed, dried, and stained with methylene blue. Digital photographs of the cross-sectional root surfaces were made at 24X. The incidence of multiple canals and varied morphology was determined by two independent examiners. The results indicated that 54% of the mandibular first premolars demonstrated a single canal. Twenty-two percent contained two canals and 18% percent had C-shaped configuration. The C-shaped root canal occurred predominantly in the 3 and 6 mm sections with one or two canals coronally. A unique finding was the circumferential canal (apical delta), which was characterized by a single canal splitting into 3 or 4 canals. The incidence of circumferential canal was 6% and occurred only in the apical 3 mm cross-sections. Identification of this unique apical canal configuration and the high incidence of multiple canals in mandibular first premolars may explain endodontic treatment failure in this tooth group.

Anatomy, Cross-Sectional↗

Clinical study of refractory apical periodontitis treated by apicectomy. Part 1. Root canal morphology of resected apex.

The morphology of the root apex was analysed by observation of the anatomy of specimens obtained by apicoectomy in cases of refractory apical periodontitis that did not respond to nonsurgical root canal treatment. Apical ramifications were present in 19 (70%) of the roots, while one were found in the remaining eight (3%) roots. This frequency is far higher than that reported by other investigators, suggesting that there is a close relationship between the anatomical complexity of the root canal and the occurrence of refractory apical periodontitis.

Apicoectomy↗

A retrospective study of 236 patients with teeth restored by carbon fiber-reinforced epoxy resin posts.

STATEMENT OF PROBLEM: The Composipost dowel is made of stretched, aligned carbon fibres embedded in an epoxy-resin matrix. It is widely used in Europe and Canada for the restoration of endodontically treated teeth and was introduced in the United States 2 years ago as the C-Post dowel. PURPOSE: This retrospective study evaluated treatment outcome of the Composipost system after 2 to 3 years. MATERIAL AND METHODS: A total of 236 patients treated during a 1-year period by seven Swedish dental practitioners were included. Of those, 146 patients consented and data were collected from the dental records of the remaining patients. Thus, the material comprised 236 teeth restored with carbon fiber-reinforced epoxy resin post, 130 maxillary and 106 mandibular teeth, with a mean restoration time of 32 months (range 27 to 41). Periodontal conditions, radiographic signs, and prosthodontic results were recorded. RESULTS: Five teeth (2%) had been extracted for reasons unrelated to the Composipost system. Periodontal conditions such as plaque accumulation, gingival health, bleeding on probing, and pocket depth around the teeth with Composipost dowels were similar to the control teeth. No dislodgment or root or post fractures were observed clinically or on radiographs. Radiographic examination of bone height measured from the apex to the bone margin mesially and distally showed differences on the mesial side but not on the distal surface (p < 0.05) between the Composipost-treated teeth and the controls. CONCLUSIONS: Promising results after 2 to 3 years of clinical service indicate that this system can be a viable alternative to conventional post-and-core systems.

Adult↗

Comparison of measurements obtained with hand files or the Canal Leader attached to electronic apex locators: an in vitro study.

AIM: The aim of the present in-vitro study was to combine directly the Canal Leader handpiece (SET, Olching, Germany) with the electronic apex locators ROOT ZX (Morita, Kyoto, Japan) and JUSTY (Yoshida, Tokyo, Japan) to find out whether the working length values thus obtained were identical to those resulting from the combination of the same electronic devices with hand files. METHODOLOGY: A total of 50 natural extracted teeth with single canals and mature apices were used. A radiograph was used as a control and the distance from the radiographic apex to the tip of the file was measured and compared with the results of the electronic length determination. RESULTS: For both electronic devices the differences amongst the distribution of the measurements were not statistically significant under the specified conditions (P > 0.05), indicating that the measurements with hand files and with the Canal Leader were identical for the majority of the cases. CONCLUSIONS: Under the conditions of this study the working length of canals obtained with electronically assisted hand files were similar to those obtained with the electronically assisted mechanical handpiece Canal Leader.

Dental Equipment↗

MTA apexification combined with conventional root canal retreatment.

Apexification aims to induce apical closure of the open root apex with a hard-tissue barrier, against which a root filling can be compacted. Despite the popularity of the apexification procedure, calcium hydroxide therapy has some disadvantages that include variability of treatment time, unpredictability of apical closure, difficulties with patient follow-up and delayed treatment. Mineral trioxide aggregate (MTA) is a potential apical barrier material with good sealability and a high degree of biocompatibility. This paper demonstrates the placement of an apical barrier using MTA as an alternative to conventional long-term calcium hydroxide therapy.

Adolescent↗

An experimental model to study intrusive forces in rats.

We have developed an experimental model for the study of the response of the periodontal ligament and bone to intrusive orthodontics forces in rats. Thirty-five Wistar rats, body weight 250 gr., were grouped as follows: control (GI), 48 hs (GII), 96 hs (GIII), 7 days (GIV). A steel band was cemented to the first upper right molar with a welded spring running to the occlusal surface of the second molar to exert a vertical force of 15 gr. The left side of treated animals was also used as control. The animals were sacrificed at the corresponding treatment times. Radiographs of the left and right halves of the jawbones were taken with an ultrafine grain industrial film. Seven measurements of the width of the periodontal ligament were taken. The data reveal narrowing of the periodontal ligament at the peri-apex and the furcation area for the animals in Group II. Conversely, Group III and IV animals exhibited widening of the periodontal ligament, particularly in the animals submitted to the force for 7 days. Statistical analysis of the data by Student's paired t test showed that the difference for the latter group was statistically significant (p < 0.05). The data for the horizontal measurements do not afford conclusive results. The present results confirm the value of the model to study the response to vertical intrusive forces.

Alveolar Process↗

Two canals in mesiobuccal roots of maxillary molars.

The purpose of this study was to examine extracted root canal treated maxillary molars cleared for: (i) the presence of a mesiopalatal (MP) canal in both first and second molars, (ii) the extension of MP canal from the pulp to the apical area, and (iii) the incidence of two foramina in the MB root. Seventy-two extracted maxillary molars (42 first and 30 second molars) were root canal treated by graduate students. The mesiobuccal (MB) roots of these samples were rendered transparent using a clearing technique. The results demonstrated that 52.3% of first and 40% of second molars had two canals obturated in the MB root. After clearing the same roots, the presence of MP canals rose to 80.9% and 66.6%, respectively. The MP canals were root canal treated as far as the foramen in 35.2% of first and 35% of second molars. However, after making them transparent, 91.1% and 90% showed the presence of this canal to the anatomical apex. The MB roots of the root canal treated first molars showed the presence of two foramina in 47% of cases but in 88.2% after clearing. The second molars showed 50% and 70%, respectively. The differences between root canal treated teeth before and after clearing were significantly different in almost all comparisons in both first and second molars. The only exception was when the presence of two foramina was compared before and after the clearing process in second molars (McNemar test P < 0.05).

Coloring Agents↗

Rate of mesial translation of mandibular molars using implant-anchored mechanics.

Retromolar dental implants served as anchorage to close first molar extraction sites in five adult patients. Rates of unidirectional space closure for mandibular second molars were assessed with periapical radiographs superimposed on anatomical landmarks and retromolar anchorage implants. Regression analysis revealed that mesial displacement of the midroot area of the leading root was less variable (r = 0.97) than for other landmarks on the same teeth: crown (r = 0.83), alveolar crest (r = 0.82) or apex (r = 0.90). When mesial root movement (uprighting) was the principal feature of the initial mechanics (4 of the 5 patients), mesial movement of the apex was about 0.60 mm/mo for the first 8 months and then decreased to about 0.34 mm/mo as the trailing (distal) root of the second molar engaged the relatively dense bone formed by the leading (mesial) root. During the last year of space closure, radiolucent foci were noted 1-2 mm ahead of the distal root. These data suggest: (1) sustained orthodontic translation is a physiological manifestation of bone modeling and remodeling throughout the adjacent alveolar process, and (2) rate of mandibular molar translation is inversely related to the apparent radiographic density of the resisting alveolar bone.

Adult↗