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Endodontic measurements in digital radiographs acquired by a photostimulable, storage phosphor system.

Digora is a newly developed digital system for intraoral radiography utilizing photostimulable storage phosphor image plates. The aim was to test the quality of the system in respect to the visibility of endodontic files and root apices at different exposures. In teeth from five dry mandibular jaw sections, Hedstrom files no. 15 were placed with the file tip at varying distances from the apex. The specimens were covered with soft tissue equivalent material and placed behind a 2-cm thick polymethyl methacrylate cylinder filled with water. Distance from focus to image plate was 30 cm. Exposures were made at 60 kV and 7 mA at 7 timer settings from 16 ms to 1000 ms in 50% increments. All images were viewed from the monitor by each of 8 observers allowed to use available contrast enhancement facilities to obtain subjectively good image quality. Utilizing built-in measurement functions, distances from file tip and root apex, respectively, to a reference line were measured in 0.1 mm. For measurements between file tip and reference line, and root apex and reference line, there was no statistically significant difference between measurements made at the lowest exposure, compared to the second lowest exposure but there was a statistically significant difference compared to the 5 highest. Measurements at the second lowest exposure were not significantly different from those obtained at the 5 highest exposures. Interobserver variability expressed as standard deviation between observers showed the largest value for measurements obtained at the lowest exposure. The mean observed distances between the tip of the file and the root apex were calculated and showed no statistically significant differences between different exposures. We concluded that the Digora intraoral image plate system provided reliable endodontic measurements even at very low exposures.

Analysis of Variance↗

Conservative treatment of root perforations using apex locator and thermatic compactor--case study of a new method.

Endodontic perforation, a serious complication in dental practice, is among the most common problems associated with endodontic procedures. Recommended methods of treatment are surgical or conservative using calcium hydroxide paste. A method in which perforations can be obturated immediately after their detection is described. The method utilizes an apex locator for measurement and detection of the perforation and a two-step treatment of thermatic compaction for filling the root canal as well as the perforation. A number of cases with a long follow-up are presented.

Adult↗

Morphological study of calcospherites in rat and rabbit incisor dentin.

Calcospherites from incisors of rats and rabbits were studied, by means of secondary and backscattered electron images, using scanning electron microscopy. Part of each incisor specimen was made anorganic to allow observation of the surface of the mineralization front by scanning electron microscopy; the other part was ground on one side for observation by scanning electron microscopy with a backscattered electron image detector. In both species the labial mineralization front was wavy and the image showed fused calcospherites, whereas the lingual mineralization front appeared to consist of a combination of linear and globular forms. In rat labial dentin the calcospherites were large and globular form, but they did not develop in the lingual dentin and were small and oval. The shape and size of rabbit incisor calcospherites varied from the pulp horn to the root apex. There were great differences between rats and rabbits with respect to the size and shape of the calcospherites at the mineralization front. This may be due to species differences and possibly the differing rates of dentinogenesis in rats and rabbits.

Animals↗

[Three dimensional finite element analysis of the upper incisor with different levels of periodontal support].

PURPOSE: To study the stress variation and distribution of the periodontium and the tooth initial displacement when the lingual fixate forces were applied to the depressed periodontal height. METHODS: Spiral CT (SCT) scanning technology, digital image transfer and transcription were used to obtain the initial 3-D data of the upper central incisor. The 3-D finite element models at six periodontal support heights were created by reducing the height of periodontal support tissues. RESULTS: With the loss of the alveolar height, the maximum equivalent stress and the principle stress of the upper central incisor periodontium increased. The maximum draw stress located on the lingual apex, while the maximum compressive stress located on the lingual crest of the ridge. The increment of periodontium stress was not proportional to the horizontal alveolar loss. CONCLUSIONS: With the horizontal alveolar loss, the rotation center moved toward the apex and the capacity of periodontal support decreased significantly. In orthodontic treatment, the force should be decreased in proportion to retain the physiological movement and to avoid further injury of the support tissues.

Alveolar Process↗

Rare courses of the mandibular canal in the molar regions of the human mandible: a cadaveric study.

The inferior alveolar artery, vein and nerve send some branches to the molar teeth via the mandibular canal to the mental foramen. The present study attempted to define the presence and course of the mandibular canal in the mandible with the alveolar process by macroscopic cadaveric dissection and computerized tomography (CT) in order to provide information that might prevent injuries to vessels and nerves at risk during root canal treatment. We identified the position of the mandibular canal within a 30% ratio of the distance from inferior border of mandible to the apices of the root for 39 out of 131 sides (mesial root of first molar, 20%; distal root of first molar, 22.6%; mesial root of second molar, 27.8% and distal root of second molar, 47%) on panoramic X-ray observation. In one cadaver (male, 64 years old), the root apex of the second molar was in close proximity to the upper bony mandibular canal. Macroscopic dissection and computerized tomography showed that the main trunks of the inferior alveolar artery, vein, and nerve were in tight contact with the apex of the second molar. These observations of the anatomic course of the mandibular canal will be important to consider during root canal treatment of mandibular teeth.

Adult↗

[Post-eruptive formation of the root apex. A scanning electron microscopic study].

During the course of root formation, histologic examination show many pictures; however, the last stage of root formation is not well documented. In this paper, we describe cellular and extracellular components of immature teeth with incompletely formed roots. The odontoblast cells were observed with reticular fibers. The cementoblasts and epithelial cells covered the cementoid tissue. The results are discussed.

Child↗

[Histopathological studies of periodontal tissue reactions following apical plugging with autogenous dentin chips].

After treating the infected canals, we investigated to determine the influence of autogenous dentin chips accidentally applied as filling in the root apexes. Materials were 15 mandibular premolars and molars obtained from healthy, mature dogs. According to standard procedures, after pulp extirpation, canals were temporarily filled with sandarac cotton pellets and left otherwise untreated for 4 weeks. At this time, the degree of infection was ascertained. After root-canal enlargement, root canals were filled with No. 55 gutta-percha points; and a sealer (Neotriozinc Paste, AH26, or Sealapex) was applied. The animals were sacrificed at the conclusion of either a short term (2 weeks) or a long term (16 weeks), and histological studies were performed. Conclusions In short-term specimens, no formation of new hard tissue was observed at the apical dentino-cemental junction; and inflammatory changes in the periapical soft tissue were remarkable. In long-term specimens, hard-tissue formation had resulted in apical closure in 6 out of 8 instances; and periapical inflammatory changes had decreased. Relations between dentin-chip density and histopathological conditions were as follows: In most of the specimens that were evaluated as good, dentin chips were very densely applied. Insufficient numbers of dentin chips produced poor results. In other words, dense applications of dentin chips result in good prognoses. Consequently, when root-canal enlargement has been adequately performed, application of dentin chips to the apex of infected canals stimulates hard-tissue formation resulting in biological apical closure. In infected canals, however, the degree to which dentin chips are infected can be a major factor.

Animals↗

Predicting and preventing root resorption: Part II. Treatment factors.

The main objective of this study was to determine which treatment factors are most clearly identified with external apical root resorption that is detectable on periapical radiographs at the end of orthodontic treatment. The records of 868 patients who completed fixed, edgewise treatment from experienced clinicians in private practice were examined. The horizontal and vertical displacement of the root apex of the maxillary central incisor was measured on cephalometric radiographs. Patients who underwent first premolar extraction therapy had more resorption than those patients who had no extractions or had only maxillary first premolars removed. Duration of treatment and the horizontal (but not vertical) displacement of the incisor apices were significantly associated with root resorption. No differences were found for slot size, archwire type, use of elastics, and types of expansion. However, there was considerable variation among the 6 offices that were surveyed; 1 office averaged nearly a full millimeter more of resorption per anterior tooth than the office with the least amount of root resorption. We conclude that the clinician should exercise caution with those patients in whom extraction therapy is planned for overjet correction that requires above average treatment time. Finally, each clinician should be aware that the root resorption seen in one practice may be different from the root resorption found in another practice.

Adolescent↗

Quality of root canal fillings performed by undergraduate dental students on single-rooted teeth.

INTRODUCTION: Root canal therapy is an accepted and successful form of tooth conservation. Educational guidelines require dental schools to ensure that their graduates are competent on graduation at performing root canal therapy. The aim of this investigation was to assess the technical quality of root canal fillings placed by undergraduate students in single-rooted teeth. MATERIALS AND METHODS: A total of 100 radiographs of root canal fillings placed by undergraduate students in single-rooted teeth were examined under even illumination in a darkened room using x2 magnification. These were graded as 'adequate', where the root canal filling was within 2 mm of the radiographic apex, 'under-filled', where the root canal filling was >2 mm from the radiographic apex, and 'over-filled', where the root canal filling was extruded beyond the radiographic apex. The presence of voids, fractured instruments, and root perforations were also noted. RESULTS: All teeth were obturated with gutta-percha and sealer (Roth Cement), using a cold lateral condensation technique. Of 100 teeth, 10% (n = 10) had voids. Of the remainder, 70% (n = 63) were judged to be 'acceptable', 21% (n = 19) were 'under-filled', and 9% (n = 8) were 'over-filled'. There was no evidence of fractured instruments or root perforations in any root filling examined. CONCLUSIONS: The quality of root canal fillings placed in single-rooted teeth by undergraduate dental students at the University Dental School and Hospital, Cork was acceptable (63% of root fillings placed in single rooted teeth were graded as 'adequate'). The probable reasons for this are multi-factorial, but may be linked to the amount of pre-clinical and clinical teaching in endodontics at the University Dental School and Hospital, Cork. It should be remembered that factors other than radiographic quality/evidence must be considered when determining the outcome of root canal therapy.

Bicuspid↗

Prenatal development of the grey lethal mouse. I. Teeth and jaws.

Osteopetrosis is a disease in which diffuse sclerosis of the entire skeleton results from an imbalance between the processes of bone formation and bone resorption. The grey lethal is the most severely affected of the three mouse mutants which have been described and its osteopetrosis is transmitted as a simple autosomal recessive gene. Affected mice develop a grey coat at 8-10 days of age and die before one month of age. Recently we (Hollinshead and Schneider, '73) reported that grey lethal mice could be identified at birth because the apex of their lower incisors lies anterior to the molar region in the mandible. In this study we show that it is possible to identify affected fetuses from day 18 of gestation using the same and other histologic criteria in examining their teeth.

Animals↗

[Accuracy of 2 electronic canal length measuring instruments].

Two electronic root canal length measuring instruments were used to measure the working length to "the apex" in 88 teeth scheduled for extraction. After extraction, the canal length was measured using X-Ray and microscopic observation after section of the teeth. The accuracy of the RCM apex locator in determining canal measurement within +/- 0.5 mm from the apical foramen varied around 62%. The "NO'X" allows a success rate of 41% in the same conditions. The conditions of this experiment shows that electronic root-canal length measuring instruments do not work in case of hemorrhage or swelling.

Adult↗

Canine "honing" in Australopithecus afarensis.

The maxillary canines of Australopithecus afarensis show a distal wear facet that extends from the apex of the crown to a point near the distal cingulum. Although these facets bear a superficial resemblance to the honing facets found on the projecting portions of the canines of other anthropoids, a more detailed examination provided in this paper shows that they are not homologous or functionally equivalent. The facets are not related to the use of the maxillary canine as a weapon or as an additional masticatory surface. Instead, their presence in A. afarensis represented a blunting or dulling of the posterior edge of C so that its occlusion with P3 would be consistent with cheek tooth occlusion.

Animals↗

Clinical evaluation of gold foil as an apical sealing material for replantation.

Intentional replantation of mandibular molars was performed in forty patients. Different materials were used for sealing the apex. Healing was assessed by measuring biting force at 2-month intervals for up to 6 months. Gold foil was found to be the best material for apical sealing when improvement in biting force was used as the criterion.

Adolescent↗

Alveolar ridge maintenance with solid nonporous hydroxylapatite root implants.

Animal studies were carried out to determine a simple technique of implantation of nonresorbable polycrystalline hydroxylapatite solid root forms and the biocompatibility of the material placed in fresh extraction sockets. An appropriately shaped root form was evaluated, and alveolar bone preservation was investigated in dogs and primates. It was found that bone and soft tissue would migrate across the HA root implant when placed 2 to 3 mm below the alveolar bone crest without soft-tissue closure. It was not necessary to use roots that fit the socket from the apex to the alveolar crest. An average of 2 mm more alveolar bone was preserved in fresh extraction sites as compared to control sites. The results of the animal studies indicated the appropriateness of a clinical trial in human beings.

Alveolar Process↗

Perception and response to gravity in higher fungi--a critical appraisal.

Considering that research on gravitropism in higher fungi has a history of over 100 years, the harvest of established fact is disappointingly meagre. We can be reasonably certain of the following. Hymenomycete 'mushroom' fruit bodies (polypore and agaric) exhibit a number of tropisms of which anemotropism, gravitropism, phototropism and thigmotropism have been clearly demonstrated. At any one time one tropism usually predominates but the inferior tropisms can be demonstrated if the predominating ones can be removed by manipulation of the growth conditions. In ascending order, the hierarchy appears to be: thigmotropism, gravitropism, anemotropism, phototropism. During the course of development of a fruit body different tropisms predominate at different times. The youngest fruit body initials grow perpendicularly away from their substratum. The nature of this tropism is completely unknown but perpendicular growth of fruit body initials has been remarked upon in experiments at a variety of light intensities and in gravitational fields from +/- 0 to 4.5 g. The fruit-body primordium then becomes first positively phototropic but later negative gravitropism predominates. The switch between predominance of the two tropisms has been associated with the onset of sporulation in a number of different studies. The major adjustment of the direction of growth in response to a tropic stimulus is made by the mushroom stem. It is the apex of the stem which makes the most immediate gravitropic response. Gravitropic growth curvatures are limited to the normal growth zones of the stem and seem to depend on re-allocation of available growth resources. If the fruit body is reoriented late in the growth of the stem, it may not be able to respond fully. In these cases gravitropic movements of the cap may still be able to bring the hymenophore back to the vertical. Mechanical forces may influence and contribute to the 'gravitropic' response but this has not been experimentally examined. The hymenophore (gill, tube or tooth) is positively gravitropic and responds independently of the stem. Bracket polypores do not show tropisms but exhibit gravimorphogenetic responses such that gross disturbance leads to renewal of growth to produce and entirely new fruiting structure suitably reoriented to the new spatial position. One experiment performed on an orbiting space station suggests that, in the absence of a light stimulus, gravity may be required for initiation of fruiting in Polyporus brumalis. Otherwise, the indications from both clinostat and space-borne experiments are that the basic form of the mushroom (overall tissue arrangement of stem, cap, gills, hymenium, veil) in agaric and polypore alike is established independently of the gravity vector. Abnormal stem growth has been observed in clinostat cultures of Panus (= Lentinus) tigrinus and Polyporus brumalis, but the morphogenetic event which seems most dependent on gravity is sporulation (in the broadest sense). Cultures of P. brumalis on orbiting space craft fail to produce the poroid hymenophore and in clinostat experiments on the ground even karyogamy was rare in similar cultures. Coprinus cinereus grown on the clinostat was able to produce apparently normal fruit body primordia which failed to produce spores and then aborted, forming a new flush of primordia on the old. Taken together with the clear association between observation of gravitropism and the onset of sporulation, the implication is that commitment to the meiosis-sporulation pathway both requires the gravity vector and couples it in some way to fruit-body growth. There is no convincing evidence for a graviperception mechanism in fungi. There is no evidence for any organised means of communicating the gravitropic stimulus once it has been perceived. Reports of three different experimental studies reveal the authors' conviction that the apparently coordinated expression of gravitropic response is in truth a common, but independent, response by the individual component hyphae of the structure concerned. There is some evidence that in the negatively gravitropic Phycomyces sporangiophore the vacuole floats in the protoplasm. If this is generally true it could affect protoplasmic volumes above and below the vacuole such that a greater proportion of the cell's potential for wall growth was adjacent to the lower wall. This is not only an attractive way of accounting for asymmetric wall growth, but since the relative density of the vacuole can presumably be controlled by regulation of water influx and efflux, it is also an attractive means of accounting for the control of gravitropic responses. Phycomyces also exhibits a response to the mechanical consequences of reorientation which is additional to (and different from) the longer term gravitropic response. [TRUNCATED]

Basidiomycota↗

Calcium hydroxide barrier over the apical root-end of a type III dens invaginatus after endodontic and surgical treatment.

AIM: To report the simultaneous endodontic and surgical treatment of a tooth associated with Oehlers type III dens invaginatus and a persistent periapical lesion, which comprised root-end resection, root-end filling and application of a calcium hydroxide barrier placed on the resected dentine surface. SUMMARY: Three root canals were identified in a tooth with a type III dens invaginatus, which presented with a necrotic pulp, wide foraminal opening and extensive periapical lesion, and with a previous history of acute abscess, intracanal exudate and fistula. After root canal preparation followed by intracanal application of calcium hydroxide pastes, the clinical-pathological status persisted. After periapical curettage and root-end resection, the root canals were filled, followed by root-end filling with Sealer 26 mixed with zinc oxide powder to a clay-like consistency. Calcium hydroxide paste was then applied over the exposed dentinal surface forming a covering over the root apex. At the 20-month follow-up examination the patient had no symptoms and no fistula; advanced periapical bone repair was obvious on the radiograph. KEY LEARNING POINTS: Because of the variable morphology and extent of invagination, type III dens invaginatus represents a challenge for conventional treatment, often leading to the need for a surgical approach. Sealer 26 thickened with zinc oxide powder provided satisfactory clinical properties for use as a root-end filling material. Application of a calcium hydroxide barrier over the resected root-end is a potential treatment option to encourage tissue repair.

Adolescent↗

[Pathomorphological study of maxillary invaginated incisor teeth].

Maxillary invaginated incisor teeth have been pathomorphologically investigated and some results have been obtained as follows: 1) The classification used in this study is as follows. That is, class I: Invagination is limited within the enamel. class II: Invagination extends toward the pulp chamber in a manner of pipe. class III: Invagination seen in class II expends at its end in the fashion of drop. class IV: Invagination occludes the whole coronal pulp chamber or extends toward the root apex beyond the cervical line. Frequent enamel-lined cavities of invaginated teeth were found to contain the contents (72.7%). Solid contents were found with considerable frequency in the cavities of the class I invaginated teeth of the author's classification (80.1%). On the other hand, the solid contents were rare in cavities of class III or IV (27.3%). In most cases, contents were found in limited areas of the cavity of class III or IV (72.7%). Any invagination corresponding to class II is not seen in this research. 2) The tissue composing the contents in the cavity of invaginated tooth was not clarified by the light microscopic observations of ground sections and film replicas. In class IV, poor hypomineralization was partly found in the inner enamel, and the dentin around the cavity was sclerotic. 3) As for the measurements of microhardess, the Vickers hardness number of contents in the cavities of invaginated teeth was approximately 1/4 of that of inner enamel. 4) The contents gave a higher radiolucency than the inner enamel by means of contact microradiography. 5) Electron microscopy revealed that the cavity contents of invaginated teeth was composed of poor inorganic elements resulting in a smooth aspect, and that, in most cases, a rod-having enamel was found in the surface layer of the contents and the rest of contents was composed of rodless enamel. An organic continuation of the tissue was observed between inner enamel and the contents. The results of electron microscopy, microhardness measurement, and contact microradiography, may indicate that the contents is composed of a hypomineralized enamel. 6) Caries incidence were found at a rate of 40.9% at cavity walls of invaginated teeth. Thus, it was suggested that cavity walls were susceptible of caries. In the contents of invaginated cavity, there was found primary caries appeared there.

Dental Caries↗

Quality of cold and warm gutta-percha fillings in oval canals in mandibular premolars.

AIM: The aim of this study was to determine the quality of cold and warm gutta-percha fillings in oval canals. METHODOLOGY: Two groups of mandibular premolars with oval canals were selected after bucco-lingual and mesio-distal radiographs indicated an internal long: short diameter of > or =1.6 at a level 5 mm from the apex. After instrumentation they were obturated, respectively, by cold lateral compaction of gutta-percha cones (cold GP) and vertical compaction of warm gutta-percha (warm GP). Leakage along apical root fillings was measured using a fluid transport model. After the leakage test, horizontal sections were cut 2 and 4 mm from the apex. The area of the canal and gutta-percha in cross-sections was measured using an image analysis program. The quality of root fillings was evaluated by calculating the percentage of gutta-percha-filled canal area (PGP). RESULTS: No significant difference in leakage was found between the two groups (P = 0.570). The warm GP group produced significantly higher PGPs than the cold GP group 4 mm from the apex only (P = 0.522 at 2 mm: P = 0.000 at 4 mm). CONCLUSIONS: The percentage of gutta-percha-filled canal area using warm GP was greater than that of the cold GP in oval canals.

Bicuspid↗