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Complete elimination of the root canal contents is imperative for predictable endodontic success. Establishing and maintaining apical patency of the root canal system is critical for proper cleaning, shaping and obturating objectives, despite timidity about this region in the past. Contemporary concepts are discussed.
Since the introduction of microsurgical principles in the 1990s, the field of endodontic surgery has made continuous and substantial progress. Particularly, root-end cavity preparation has been simplified and optimized by means of newly developed surgical microinstruments. However, the successful outcome of endodontic surgery depends to a large extent on accurate intraoperative diagnostics. Conventionally, micromirrors (retromirrors) and microprobes have been used for this purpose. Recently, the surgical microscope has been used to enhance visibility during dental procedures. In addition, endoscopy has been reported to provide the surgeon with outstanding vision and ease of use. This article describes the technical specifications and the diagnostic application of the endoscope during endodontic surgery.
The apical third of a root canal system is the most difficult section to clean and shape because of its ramifications and tortuosities. This article discusses the clinical anatomy of the root and lists the "10 commandments" of cleaning and shaping to achieve predictably successful endodontics.
During routine endodontic therapy, sodium hypochlorite inadvertently was forced out the apex of tooth No. 12. The patient experienced immediate severe pain, swelling, and hemorrhage from the canal access. Treatment was palliative, including patient education and reassurance, narcotic analgesics, cold and hot compresses, and multiple follow-up visits.
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After the introduction of the lateral compactage of gutta percha in endodontic clinic of OdontoStomatology Institute of Dakar in 1995; the immediate evaluation of the quality and the limit of the canal obturation due to a prospective study on 157 monoradicular teeth so be 168 canals (11 supplementary canals) has shown that 75% of canals are of type I of Vertucci and that the apical limit of security is reached within 80.25% of cases. The manual step back canal preparation (79.17%) and the technique of canal obturation by lateral compactage of gutta percha [(64.88%); Apical limit of security: 59.52%] permit to obtain a densities (95.83%) and homogeneous (79.57%) canal obturation. The indication of gutta percha compactage on monoradicular teeth (hermetic and tridimensional root canal filling) must avail to apical curved roots of lateral incisive, the use of adapted instruments in case of canines (31 mm) and apical stop cone on necrotic pulp teeth.
OBJECTIVE: The purpose of this study was to retrospectively assess the success of endodontic treatment that had been guided by audiometric (electronic) measurement. METHOD AND MATERIALS: The lengths of 66 infected root canals that demonstrated periapical pathosis were accurately measured by the Sono-Explorer before root canal obturation. The results over time intervals of 1 month to 20 years were evaluated on the basis of radiographic examinations. RESULTS: The rate of successful treatment was 90.4% for short-filled root canals, 94.5% for flush-filled root canals, and a low 50.0% for long-filled root canals. The rate of successful endodontic therapy was 87.8% for restorations that did not exceed the apical foramen but reached the apical constriction and 95.3% if cases in which the apical radiolucencies were disappearing were included as successes. If cases of unintentional long-filling (overextension) were excluded, the success rate was as high as 98.4%. CONCLUSION: The poor performance of overfilled root canals indicates that practitioners should not overextend these restorations. Use of the Sono-Explorer aided successful treatment of infected root canals.
An important goal of modern dentistry is to preserve a functional, esthetic, and pain-free dentition. If irreversible pulp pathology occurs in an immature permanent tooth from traumatic or carious exposure, normal apical maturation may be interrupted. Conventional endodontic obturation techniques, if necessary, will be difficult and may not be adequate in such a tooth. The endodontic techniques of apexogenesis and apexification have been successful in achieving adequate root development and apical construction. These conventional techniques and materials are reviewed along with a promising material called mineral trioxide aggregate.
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The objective of this study was to compare the apical leakage in root canal filled, apicectomised and retrogradely filled maxillary single rooted premolars with two canals of type II configuration. For this purpose the root canals of 51 maxillary type II premolars were shaped to size ISO #55, followed by a step-back preparation to size ISO #80. Subsequently, all teeth were obturated by means of lateral condensation and randomly divided into three groups, 17 teeth each. Group I was used as a control, whereas in group II and III an apicoectomy was performed. Retrograde glass ionomer restorations (Ketac Fil) were placed additionally in group III. The specimens were exposed to methylene blue for 24 hours, then cross-sectioned, and the deepness of dye penetration was measured. Data were analyzed and tested for significant differences between the various groups (Mann-Whitney test; alpha = 0.05). The teeth in group II showed the lowest mean dye penetration. The differences were statistically significant, if compared to group I (p < 0.001) and group III (p < 0.001). The dye penetration in group I was significantly lower than in group III (p = 0.024). In teeth with lateral canals, the mean dye penetration was higher (3,557 microns +/- 1,337 microns) than in teeth without lateral canals (3,096 microns +/- 1,931 microns). The teeth in group III showed a circular dye penetration in nearly all cases. For clinical purposes, the application of retrograde glass ionomer fillings must be considered very critically.
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This study investigated the effect of finishing/polishing techniques on the microleakage of resin-modified glass ionomer restorations. Class V preparations were made on the buccal and lingual/palatal surfaces of freshly extracted teeth. The cavities on each tooth were restored with Fuji II LC (FT [GC]) and Photac-Fil Quick (PF [3M-ESPE]) according to manufacturers' instructions. Immediately after light-polymerization, gross finishing was done with eight-fluted tungsten carbide burs. The teeth were then randomly divided into four groups and finishing/polishing was done with one of the following systems: (a) Robot Carbides (RC); (b) Super-Snap system (SS); (c) OneGloss (OG) and (d) CompoSite Polishers (CS). The sample size for each material-finishing/polishing system combination was eight. After finishing/polishing, the teeth were stored in distilled water at 37 degrees C for one week. The root apices were then sealed with acrylic and two coats of varnish was applied 1 mm beyond the restoration margins. The teeth were subsequently subjected to dye penetration testing (0.5% basic fuchsin), sectioned and scored. Data was analyzed using Kruskal-Wallis and Mann-Whitney U tests at a significance level of 0.05. Results of statistical analysis were as follows: Enamel margins: PF-OG<SS; FT-OG<RC; Dentin margins: PF-no significant difference; FT-OG & CS<RC. Regardless of the finishing/polishing technique, leakage at dentin margins was significantly greater than at enamel margins for FT. For PF, no significant difference in leakage scores was observed between dentin and enamel with the exception of finishing/polishing with OG. FT restorations had significantly less enamel and dentin leakage than PF restorations when treated with OG. The effect of finishing/polishing techniques on microleakage was both tissue and material dependent.