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A case of conservative endodontic therapy for a mandibular second premolar with five root canals is described. A thorough knowledge of the root canal anatomy, careful interpretation of the radiographs, and access cavity modifications are essentials for enhancing intracanal procedures.
Contamination of the root canal system by persistent, enteric bacteria via leakage through interim restorations has been well documented. This in vitro study evaluated the ability of interappointment medications to prevent contamination of the root canal system by Enterococcus faecalis. Coronally unsealed, medicated tooth roots fixed in a closed system were contaminated daily with a standardized, aerobic, broth culture of E. faecalis. Four medications were evaluated (n = 15): group A, calcium hydroxide/methylcellulose paste; group B, camphorated parachlorophenol/calcium hydroxide paste; group C, 1% chlorhexidine/methylcellulose gel; and group D, calcium hydroxide points. The mean number of days to contamination as indicated by turbidity in the closed system was the following: group A, 37; group B, 46; group C, 16; group D, 5; and a positive control (no medication), 3. A one-way analysis of variance with a Scheffe post hoc test (p = 0.05) detected significant differences in effectiveness with A and B superior to C and D, and C superior to D.
This study was conducted to observe the healing process in dogs' teeth with apical periodontitis after root canal treatment in one or two appointments. Premolars and anterior dogs' teeth had their root canals opened to the oral environment for 6 months before being treated. After root canal negotiation they were filled by the lateral condensation technique with gutta-percha points and Sealapex in one appointment or after a dressing with calcium hydroxide for 7 and 15 days. Six months after the treatment the animals were killed and the tissues prepared for histomorphological analysis. Scores attributed to the different histomorphological events were submitted to statistical analysis, which resulted in ranking the experimental groups from the best to the worst in the following way: (a) calcium hydroxide 14 days; (b) calcium hydroxide 7 days; and (c) one appointment. It was concluded that the use of a calcium hydroxide dressing helps to achieve better results (p < 0.01) than the treatment in one appointment.
This article reports the results of an analysis to determine the relationships between the quality of restorative dental care for 1,466 patients and 9 categories of dentist characteristics for 102 volunteer Washington practitioners. In this study, patients were recalled and restorations were examined clinically. Questionnaires were administered to patients and dentists. The dependent measure is a weighted average of scores for operative dentistry and crown and bridge. Stagewise regression was used to adjust for differences in patient oral health and assessor bias. Models were postulated in each category of dentist characteristics and beta vectors were estimated by multiple regression. The best predictors formed a significant model (p = 0.000) which explained 26 per cent of the variance.
A study involving the immediate loading of Brånemark implants in the edentulous mandibles of 10 patients is reported. The design involved the immediate loading of four widely distributed implants with a transitional fixed implant-supported prosthesis at first-stage surgery, avoiding the need for a removable prosthesis. A sufficient number of additional implants are allowed to heal in the conventional manner to provide sufficient support for a definitive fixed prosthesis even if all of the immediately loaded implants fail. Preliminary results have been favorable, with all patients functioning with a fixed implant prosthesis from the day of first-stage surgery.
A prospective study was conducted on 13 consecutive patients who received immediately loaded mandibular fixed-implant prostheses. The exclusion criteria were 1) general: heavy smoking, demonstrated bruxism, or general ill health and 2) local: lesions in the bone area to be implanted or inadequate morphology requiring augmentation techniques. After suturing the surgical wounds, impressions were taken, and transitional prostheses were screwed in within 2 weeks of surgery. A total of 61 implants of four different designs were placed. Thirty-two of the implants were placed at the same time as performing the extractions of the residual dentition. In 13 of the implants, there was a 2-month period between extraction surgery and implantation. The other 16 implants were inserted in alveolar bone that had been edentulous for more than 12 months. Despite these differences, all 61 implants were immediately loaded. Parallel x-rays were taken of the 13 patients at the time of transitional prosthesis placement, at the time of definite prosthesis placement, and 6 months later at the first control. During the 18-month follow-up period, two implants failed, and the remaining 59 implants were found to be clinically immobile, asymptomatic, and free of any radiolucency, giving a survival rate of 96.7%. Analysis of radiographic bone levels gives us a cumulative success rate of 93.4%. These figures are comparable to those obtained in similar studies and are no different than those from implant prostheses loaded in the conventional delayed manner. Based on these preliminary results, we can conclude that the immediate loading of mandibular implants is a viable and efficient approach.
The immediate restoration or loading of dental implants has been an intense area of clinical trial and research in the field of dental implantology over the last several years. The ability to temporize implants that are placed and prevent the use of a removable transitional appliance is appealing to not only patients, but dentists as well. Additionally, the placement of implants into immediate extraction sockets, and the immediate restoration of those implants, is showing excellent success rates clinically. Enhancement of the healing phase using platelet rich plasma seems to be a key contributor to the healing and maturation rate of both the hard and soft tissues. This article will review the immediate restoration of implants placed into multiple extraction sockets and the use of platelet rich plasma to enhance the healing phase.
PURPOSE: This clinical report describes an immediate tooth extraction, followed by placement and provisional restoration of a dental implant in the prepared socket of a right maxillary central incisor. MATERIALS AND METHODS: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. A flapless, transmucosal surgical approach was used to prepare the socket and insert a tapered implant. The implant was immediately restored with a provisional abutment and crown without occlusal contacts. An impression was made 22 days after implant insertion, and a definitive, all-ceramic restoration was placed 3 days later. RESULTS: During the period of provisional progressive loading, no significant soft tissue contraction was observed related to noninvasive operating techniques and the immediate insertion of the provisional restoration. The patient exhibited no clinical or radiologic complications through 8 months of clinical monitoring after loading. CONCLUSION: The Tapered Screw-Vent implant and all-ceramic restoration provided the patient with immediate esthetics, function, and comfort without any complications during the postloading follow-up period.
Successful implant dentistry is based on adequate training, proper selection of patients, careful surgery, preplanned restorations, and postoperative and supportive care. Although implant therapy is highly successful and predictable, it is not without possible early and/or late complications. The aim of this article is to highlight the importance of a relatively neglected subject of dehiscent wounds in the dental implant literature. This article covers the definitions of wound healing and wound dehiscence and some of the common risk factors related to suture line opening as an immediate postoperative complication. These factors appear to be largely iatrogenic in nature and partly related to patient neglect. Hence, it deserves documentation to confirm a strategy for their avoidance and management. A management protocol is presented on how to deal with different types of dehiscence and causal factors.
The soft tissue profile created around a conventional healing abutment may be inadequate to accommodate an anatomically shaped abutment that is larger than a standard machined abutment. This causes difficulties in its insertion and subsequent impression-making and provisional restoration fabrication. This article presents a simple technique to overcome these problems.
Cement-retained implant-supported prostheses are particularly indicated where access for screw placement is limited or impossible like in posterior locations or where there is limited jaw opening. The patient in this case report suffered from limited jaw opening as a result of a long history of temporomandibular joint ankylosis related to hemophilia. Cement-retained implant-supported prostheses coupled with serial extraction, serial implant installations, and chairside provisional restorations made uneventful treatment possible.
OBJECTIVE: To perform a histologic and histomorphometric analysis of the peri-implant tissue reactions and bone-titanium interface in 3 immediately loaded (provisional loaded) titanium implants retrieved from a man after a loading period of 4 months. MATERIALS & METHODS: A 35-year-old patient with a maxillary partial edentulism did not want to wear a provisional removable prosthesis during the healing period. It was decided to insert 3 definitive implants and use 3 provisional implants for the transitional period. The provisional implants were loaded the same day with a resin prosthesis in occlusal contact. During the second surgical phase, after 4 months, the provisional prosthesis was removed, and the provisional implants were retrieved with a trephine bur. Before retrieval, all implants appeared to be clinically osseointegrated. The specimens were processed for observation under light microscopy. RESULTS: At low magnification, it was possible to observe that bone trabeculae were present around the implant. Areas of bone remodeling and haversian systems were present near the implant surface. Under polarized-light microscopy, it was possible to observe that in the coronal aspect of the thread, the lamellar bone showed lamellae that tended to run parallel to the implant surface, while in the inferior aspect of the thread, the bone lamellae ran perpendicular to the implant surface. CONCLUSIONS: Histologic data pertaining to these 3 immediately loaded implants, and retrieved after a 4-month loading period, show that immediate loading did not produce untoward effects on peri-implant bone healing.
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AIM: To report a case of a cemental tear. SUMMARY: A case is reported of a patient with a history of trauma, root canal treatment and retreatment procedures to eliminate recurring sinus tracts. An exploratory surgery, extraction, and biopsy resulted in a diagnosis of cemental tear. KEY LEARNING POINTS: * The detachment of a fragment of cementum is described as a cemental tear. * Cemental tears have been reported in the periodontal literature associated with localized, rapid periodontal breakdown. Common causative factors are aging and traumatic occlusion but the exact aetiology is unknown. * Trauma may be considered as a potential aetiologic factor for cemental tears in addition to occlusal traumatism and aging.
OBJECTIVE: To produce a working clinical protocol for pulp therapy techniques in the extensively carious primary molar. INTRODUCTION: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. As such, a medicament that can be used to replace formocresol in clinical practice should be identified. METHODS: Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence-based protocol, for the management of the extensively carious primary molar. CONCLUSION: A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.
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A technique is described for fabricating autopolymerizing acrylic resin copings for CeraOne provisional restorations. This method has the advantage of providing a chemical bond rather than only a bond between the mechanical coping and the relined provisional crown, as is the case when using the provisional components supplied by the manufacturer. The technique describes provisionalization at the time of stage II surgery. This type of coping can also be used after a period of soft tissue healing when a healing abutment is employed. The benefits of the procedure include increased patient satisfaction and reduced chair time for repairs.