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At least 415 records · Page 23Linked to original sources
PubMed2001

Frequency of overinstrumentation with an acceptable radiographic working length.

The aim of this in vitro study was to determine how frequent a seemingly accurate working length ending radiographically 0 to 2 mm short of the radiographic apex resulted in an instrumentation beyond the apical foramen. Under simulated clinical conditions working lengths of 169 root canals were radiographically determined in 91 extracted teeth. In all cases the measuring files adjusted to the final working length (Iwork) were located 0 to 2 mm short of the radiographic apex. Iwork was subsequently compared with the actual reference length (Iref) representing the distance between the apical foramen and the coronal reference. Instrumentation beyond the apical foramen (Iwork > ref) occurred in premolars in 51% (95% confidence interval: 36%; 66%) of the cases, in molars in 22% (95% confidence interval: 14%; 30%), and in anterior teeth in no case. These results suggest that in premolars and molars a radiographically working length ending 0 to 2 mm short of the radiographic apex provides, more often than expected, a basis for unintentional overinstrumentation.

Bicuspid↗
PubMed2001

Bur extensor for root canal access.

Access to a tooth with a partial canal calcification was made. The access was possible only with a bur extensor connected to a LN bur. Calcification was bypassed, and the canal was completely prepared.

Adult↗
PubMed2001

Comparison of the first file that fits at the apex, before and after early flaring.

The purpose of this study was to compare the first file that fits to the apex (FFFA) in each canal before and after early flaring to analyze if the size of file to fit to the apex would increase after flaring. One hundred mesial canals of lower first and second molars with complete apical formation and patent foramens were selected. The samples were randomly divided into two groups of 50 canals each. A file was fit to the apex in each canal and that size recorded. Radicular flaring was completed using Gates-Glidden drills in group 1 and Rapid Body Shapers in group 2. After flaring a file was again fit to the apex in the same manner as before and its size recorded. The mean diameter of FFFA before flaring (file diameters in mm x 10(-2)) was 14.46 (+/-4.12) and after 23.3 (+/-7.2) for group 1 (p < 0.001), whereas in group 2 the mean diameter of FFFA was 17.2 (+/-4.96) before and 25.6 (+/-6.36) after (p < 0.001). A Wilcoxon t test indicates a significant difference (p < 0.001) between the diameter of FFFA before and after flaring in both groups. The increase in diameter was approximately two file sizes for both groups. From this observation it is concluded that early radicular flaring increases the size file that is snug at the apex, and awareness of that difference gives the clinician a better sense of canal size. Early flaring of the canal provides better apical size information and with this awareness, a better decision can be made concerning the appropriate final diameter needed for complete apical shaping.

Anti-Infective Agents, Local↗
PubMed2001

Effect of penicillin on postoperative endodontic pain and swelling in symptomatic necrotic teeth.

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of penicillin on postoperative pain and swelling in symptomatic necrotic teeth. Forty-one emergency patients participated and each had a clinical diagnosis of a symptomatic necrotic tooth with associated periapical radiolucency. After endodontic treatment patients randomly received a 7-day oral dose (twenty-eight 500 mg capsules to be taken every 6 h) of either penicillin or a placebo control in a double-blind manner. Patients also received ibuprofen; acetaminophen with codeine (30 mg); and a 7-day diary to record pain, percussion pain, swelling, and number and type of pain medication taken. The majority of patients with symptomatic necrotic teeth had significant postoperative pain and require analgesic medication to manage this pain. The administration of penicillin postoperatively did not significantly (p > 0.05) reduce pain, percussion pain, swelling, or the number of analgesic medications taken for symptomatic necrotic teeth with periapical radiolucencies.

Acetaminophen↗
PubMed2001

Operating microscope improves negotiation of second mesiobuccal canals in maxillary molars.

This in vitro study investigated the prevalence, location, and pathway of the second mesiobuccal canal (MB-2) in 45 first and second maxillary molars using the operating microscope (OM). Initially location and negotiation of MB-2 were attempted without magnification. Teeth in which MB-2 was not located or could not be negotiated were further explored under OM. Roots where MB-2 could not be negotiated even with OM were cross-sectioned and inspected microscopically. Morphometric measurements were performed to map the location of MB-2. Without magnification an apparent MB-2 orifice was located in 42 teeth and the canal negotiated in 31 (69%). With OM one additional apparent MB-2 orifice was located, and five previously identified canals were negotiated (total 80%). The root cross-sections confirmed the absence of MB-2 in all nine teeth where it was not negotiated. Location of MB-2 varied randomly. In conclusion MB-2 can be negotiated in 80% of maxillary molars, although an orifice is apparent in 96% of the teeth. Ability to negotiate MB-2 is facilitated by OM.

Dental Pulp Cavity↗
PubMed2002

The effect of instrumentation with two different file types, each with 2.5% NaOCl irrigation on the microhardness of root dentin.

The aim of this study was to measure root-dentin microhardness after instrumentation with two types of files and using irrigation with 2.5% sodium hypochlorite. Thirty roots were instrumented with irrigation: 10 roots had the pulp extirpated only; 10 roots were instrumented with stainless steel files, and 10 roots were instrumented with rotary nickel-titanium (NiTi) files. Additionally, five roots were extirpated only without irrigation and served as a control. The roots were sliced and root-dentin microhardness was determined at depths of 500 microm and 1000 microm from the pulp-dentin interface. Significant differences were found between the microhardness at 500 microm and 1000 microm (p < 0.001) in all groups. Instrumentation with NiTi rotary files affected dentin microhardness significantly to a lesser extent.

Analysis of Variance↗
PubMed2002

Microscopic removal of dens invaginatus.

Endodontic treatment for teeth that exhibit the dental anomaly, dens invaginatus, can be difficult due to the bizarre anatomy and relative inaccessibility of the diseased pulp tissue. Surgical intervention or extraction are common approaches to dealing with this condition. This article reports the treatment of an extreme form of dens invaginatus, employing the dental-operating microscope and the ultrasonic instrument. Removal of the entire anomalous structure and pulp tissue was possible, and conventional orthograde obturation was accomplished. Two and 4-yr follow-up radiographs show that healing has occurred. The article demonstrates that the anomalous structure of dens invaginatus is a separate entity from the rest of the tooth. This implies that in many instances it may be entirely removed to facilitate conventional endodontic therapy.

Child↗
PubMed2002

Effect of drainage upon access on postoperative endodontic pain and swelling in symptomatic necrotic teeth.

The purpose of this retrospective study was to determine the effect of drainage upon access on postoperative endodontic pain and swelling in symptomatic necrotic teeth. One hundred twenty-four emergency patients participated and each had a clinical diagnosis of a symptomatic necrotic tooth with an associated periapical radiolucency. The occurrence of drainage upon access was timed and recorded. After endodontic treatment, patients received ibuprofen, acetaminophen with codeine (30 mg), and a 6-day diary to record pain, percussion pain, swelling, and number and type of pain medication taken. The majority of patients with symptomatic necrotic teeth had significant postoperative pain and required analgesic medication to manage this pain. Obtaining short-term drainage upon access (average of 1.85 min) did not significantly (p > 0.05) reduce pain, percussion pain, swelling, or the number of analgesic medications taken for symptomatic necrotic teeth with periapical radiolucencies.

Acetaminophen↗
PubMed2002

Antimicrobial efficacy of various root canal preparation techniques: an in vitro comparative study.

In this study, we compared the antimicrobial efficacy of various root canal preparation techniques and instruments in the root canals of 40 human first maxillary premolars extracted for orthodontic reasons. After extirpation of the pulp, teeth were sterilized in an autoclave. Then, the root canals were infected with Enterococcus faecalis suspension and the teeth incubated at 37 degrees C for 24 h. Thereafter, the teeth were divided into five groups: preparation with K-file or K-Nitiflex file (step-back technique; groups 1 and 2), K-reamer (standardization technique; group 3), irrigation only (group 4), and no treatment (group 5). Before and after treatments, samples were taken for culture. Results were evaluated after 24-h incubation in E67 selective culture medium. We observed a considerable reduction in bacterial population after mechanical preparation. No significant differences were seen among the efficacy of the various preparation techniques and files used.

Bicuspid↗
PubMed2004

Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol?

A new technique is presented to revascularize immature permanent teeth with apical periodontitis. The canal is disinfected with copious irrigation and a combination of three antibiotics. After the disinfection protocol is complete, the apex is mechanically irritated to initiate bleeding into the canal to produce a blood clot to the level of the cemento-enamel junction. The double seal of the coronal access is then made. In this case, the combination of a disinfected canal, a matrix into which new tissue could grow, and an effective coronal seal appears to have produced the environment necessary for successful revascularization.

Bicuspid↗
PubMed1996

Phantom tooth pain: a diagnosis of exclusion.

This case report addresses the difficult diagnosis of phantom tooth pain (PTP). This is a syndrome of persistent pain in the teeth and oral structures following pulp extirpation, extraction, or rarely, an inferior alveolar nerve block. The incidence of this often misdiagnosed condition is estimated to be 3% of the population undergoing pulp extirpation, and is similar to phantom limb pain. The diagnosis of PTP is discussed here as a diagnosis of exclusion, after numerous interventions. Various treatment modalities are outlined and the use of non-traditional pharmacological approaches for pain reduction are discussed.

Afferent Pathways↗
PubMed2004

Assessment of a contrast medium as an adjunct to endodontic radiography.

AIM: To assess if a contrast medium improved diagnostic yield of endodontic radiographs. METHODOLOGY: Forty-five extracted mandibular premolar teeth were radiographed in bucco-lingual and mesio-distal planes. Access cavities were prepared, pulpal tissue extirpated and Ultravist contrast medium introduced under pressure. Radiographs were retaken and the teeth cleared following perfusion with India ink. Three examiners assessed all the films for: number of roots, number of root canals, curvature of root and/or root canal, presence of lateral canals, presence of a single foramen or apical delta and the presence or absence of canal obstructions. The examiners' interpretations were compared with the anatomy revealed by clearing. RESULTS: Kappa scores were calculated for each of the examiners, for each set of radiographs, to assess the level of intra- and inter-examiner agreement. Only moderate agreement was found throughout (kappa = 0.40-0.61). For multiple root canals a false-positive result was significantly more likely with contrast (P < 0.05). The use of contrast did not significantly improve the sensitivity of diagnosis of lateral canals or a single apical foramen. Contrast significantly increased the risk of falsely perceiving lateral canals (P < 0.002). Overall there was no statistically significant difference in the overall assessment of the anatomy of the root canals using contrast or plain radiographs (P > 0.2). CONCLUSIONS: Plain film radiographs confidently predict the presence of root or canal curvature but apical anatomy was assessed accurately in only 46% of cases. Plain radiographs were insensitive in assessing the number of root canals present, the presence of lateral canals and the occurrence of canal obstructions. The use of Ultravist contrast medium to improve diagnosis of root canal morphology of premolars is not supported.

Bicuspid↗
PubMed2005

The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis.

AIM: To examine whether an intra-oral injection of a nonsteroidal anti-inflammatory drug (ketorolac), in association with conventional local anaesthetic techniques, would improve the pulp extirpation rate in teeth with irreversible pulpitis. METHODOLOGY: A two group double-blind clinical trial was undertaken in the Dental Casualty Department of the University of Manchester School of Dentistry. Patients were randomly allocated to either the test or control group. The test group received an intra-oral injection of ketorolac (30 mg in 1 mL) in the buccal sulcus adjacent to the tooth being treated. After an interval of 15 min, they then received 2.2 mL of 2% lidocaine with 1 : 80 000 epinephrine by buccal infiltration in the maxilla or by inferior dental block in the mandible. The control group received an intra-oral injection of normal saline (1 mL) in the buccal sulcus adjacent to the tooth being treated, followed by the same local anaesthetic regime as the test group after the 15 min interval. Fifteen minutes after the local anaesthetic injections, pulp extirpation was attempted. All patients completed the short-form McGill pain questionnaire prior to treatment and completed identical questionnaires at 6 and 24 h after treatment. RESULTS: The study protocol set the number of patients to be treated at twenty. However, as the study progressed it became apparent that the intra-oral injection of ketorolac caused significant pain to four of the five patients who received it; therefore the study was terminated after ten patients had been treated. The results from the patients treated showed no significant difference in the pulp extirpation rate between the test and control groups. However, patients with higher pain scores at baseline were less likely to have the pulp completely extirpated, irrespective of whether they were in the test or control group. Pain scores for all patients decreased significantly from baseline to 24 h. CONCLUSION: An intra-oral injection of ketorolac did not improve the pulp extirpation rate in a small group of patients with irreversible pulpitis compared with a placebo. In addition, it was associated with such significant pain on injection that it cannot be recommended as a treatment in this situation.

Adult↗
PubMed2006

Root canal morphology of mandibular incisors in a Jordanian population.

AIM: To investigate the root canal morphology of mandibular incisors in a Jordanian population using a canal staining and tooth-clearing technique. METHODOLOGY: Four hundred and fifty extracted mandibular incisors were collected from dental clinics within north Jordan. Following pulp tissue removal and staining of the canal systems, the teeth were decalcified with 5% nitric acid, dehydrated with ascending concentrations of alcohol and rendered clear by immersion in methyl salicylate. Cleared teeth were examined by eye and the following features were evaluated: (i) number and type of root canals; (ii) presence and location of lateral canals and intercanal communications; (iii) location of apical foramina; and (iv) frequency of apical deltas. RESULTS: The majority of mandibular incisors had a single canal (73.8% of teeth possessed a Type I canal system). Although 26.2% of the roots possessed two canals, only 8.7% had two separate apical foramina. CONCLUSIONS: The prevalence of two canals in this group of mandibular incisors was 26.2% and is within the range of previous studies performed on populations of different racial origin.

Coloring Agents↗