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An attempt has been made to describe a simple, straightforward technique for root-end surgery which, when properly performed, should improve the dentist's effectiveness in managing periapical dental pathosis of endodontic origin.
Eruption of rootless mandibular premolars and other dental defects in a girl suffering from congenital kidney disease are described. The successful management of these excessively mobile teeth allowed them to develop roots of sufficient length. Hypotheses of tooth emergence are viewed in the light of these rootless eruptions.
This study correlated clinical, radiographic, and histopathologic aspects of 50 endodontic failures involving the paste technique. All clinical and radiographic findings were recorded. The teeth were re-treated with gutta-percha/Kloroperka and lateral condensation. Subsequently, periapical surgery, including retrograde amalgam filling, was performed for the removal of material in the periapical tissue. The resulting biopsy specimens were processed for histologic evaluation. Although neutrophilic leukocytes predominated in some cases, all types of inflammatory cells were present. Macrophages and foreign body cells contained paste particles. The blood pigment distinguished hemorrhage due to surgery from pathologic circulatory changes. There was resorption/apposition of bone and root fragments. Epithelial strands and parts of cyst walls were observed. There was a correlation between a periapical radiolucency and inflammation but no correlation between amounts and types of inflammatory cells and pain. Paste placed beyond the foramen caused tissue damage and reduced prognosis.
The outcome of endodontic therapy in 16 patients irradiated for head and neck cancer was studied. Thirty-five postradiation endodontically treated teeth (54 roots) were included in the study. The follow-up period ranged from 6 months to 54 months. At the time of last follow-up, 46 of 54 roots were being maintained. No osteoradionecroses were seen in association with teeth that had been endodontically treated. From this review, it is clear that endodontic therapy is a viable method of treating diseased teeth in patients irradiated for oral neoplasms.
Endodontic treatment of teeth with anomalous root formation has been reported. This article reports four cases of anomalous root formation associated with the maxillary lateral incisor and the treatment regimens followed in each case. A discussion of the reasons for the success or failure achieved is provided and supports those cases previously reported.
By means of questionnaires, 303 endodontists were asked about their experiences in the diagnosis and treatment of incompletely fractured teeth. The present article discloses the results relative to which teeth are most likely to fracture, which predisposing factors involve higher or lower risk, how endodontists prefer to treat root-fractured teeth, and the success rate they have had with them. The endodontists also reported the frequency of endodontic treatment failures attributable to root fractures. These results are discussed with respect to the potential implications for clinical dental practice.
The principles, indications, and techniques of resinifying therapy and the composition of a resinifying agent are described in this article. The permeability and bacteriostasis of the agent and the volume change of the agent after treatment were observed, and 14C-labeled phenoaldehyde showed that the agent not only filled the main canals and accessory canals but also infiltrated into dentinal tubules with a depth one fourth to one third the total length of the tubules. The antimicrobial activity of the agent after polymerization for 2 to 6 months was determined. Even 9 months after treatment, no change in volume of the agent was found in vivo, and sealing of canals was maintained. Seventy-eight teeth in 69 patients with pulpoperiapical diseases were subjected to resinifying therapy and followed up for 6 to 12 months; the success rate was 82.05%. The histologic study indicated that, of the specimens experimentally treated for 6 to 12 months, 85.7% showed mild or no inflammation while 53.6% showed complete healing or an obvious healing tendency. Furthermore, the mechanisms and advantages of this therapy are discussed.
Twelve block sections of mandibles containing incisors, canines, premolars, and molars were dissected from human cadavers (total, 26 teeth). Endodontic access was achieved, and a No. 10 k-type endodontic file was inserted to a point approximately 1 to 2 mm short of the radiographic apex. By securing the mandible and Rinn instrument with plaster mounts, exposures were made from identical angles and film and jaw placement remained constant in both techniques. Conventional film images were recorded on Kodak Ultraspeed film with six to eight impulses. Xeroradiographic images were recorded with four to five impulses. Radiographs and xeroradiographs were evaluated with the use of light from a masked viewbox. A magnifying glass was used to evaluate visualization of the following entities: the root apex; the periodontal ligament; the trabecular pattern; and the measuring instruments. The images were examined and categorized by three examiners, who used the following scores: 3, optimal for diagnostic information; 2, adequate for diagnostic information; 1, poor but providing diagnostic information; and 0, unacceptably poor. In all categories examined, the information provided by xeroradiographs was significantly greater than that provided by conventional radiographs (p less than .05). In terms of diagnostic value and lower patient dose, xeroradiographs are preferred to conventional radiographs.
Detection of periapical bone pathosis is an important part of the diagnostic process in dentistry. Xeroradiographs and E-speed films were taken to evaluate and to compare the diagnostic value for the radiographic interpretation of periapical lesions. Thirty-four patients undergoing endodontic treatment were chosen. Simultaneous exposures of the radiographic film and the xeroradiographic plates were made. The samples were viewed and categorized by the examiners using the following scores: 0 = unacceptably poor, 1 = poor but diagnostic, 2 = adequate for diagnostic information, and 3 = optimal for diagnostic information. A paired sample t test was performed on the result of the evaluation by the two examiners, and both showed that there were no significant difference at p less than 0.05 between xeroradiography and conventional radiography. A two-sample t test was performed on the means of the two examiner's evaluation, and there was no significant difference at p less than 0.05 between the means.
Teeth that were to be extracted because of periodontic-endodontic involvement, in six patients, were treated by hemisection or root amputation. The roots were processed histologically. All cases showed the presence of accessory root canals with remnants of pulpal tissue, bacteria, and necrotic debris. It was demonstrated in the cases studied that residual necrotic tissue in untreated root canals can result in periradicular pathosis. We may speculate that if the inflammatory process persists and drainage results via the sulcus, in time, plaque and then concretions may develop.
In this study, I review, clinically and radiographically, 303 patients with 460 single or multirooted endodontically treated teeth. In all teeth, the therapy was performed by me with the use of final restoration of the crown with or without post and full cast crown coverage after treatment. The teeth were functioning for at least 3 years, without having received any other type of dental work since then. I evaluated the existence of vertical root fracture, the function of the teeth, the type of root canal therapy, the type and length of the post, and the type of retention of the post used in all 460 teeth. After statistical evaluation of the results, I found that 3.69% of the teeth had had vertical root fracture. Computer analysis, simple correlation hypothesis, and distribution method with 1 degree of freedom revealed significant correlation between vertical root fracture and the technique of instrumentation and obturation of the canal (p = 0.025), the length of the post (p = 0.05), and the existence of the post (p = 0.05). On the contrary, I found no correlation between root fracture and type of retention of the prefabricated post used with respect to the method of obturation.
Von Willebrand's disease has been established as the most common hereditary hemorrhagic disease. Endodontic treatment, when possible, rather than extraction is the treatment of choice in patients suffering from such a disease. A case is presented in which, during regular endodontic treatment, uncontrollable bleeding occurred, suggestive of a generalized bleeding disorder. A thorough hematologic examination revealed von Willebrand's disease, which the patient was not aware of. The dental surgeon can play an important role in the diagnosis and treatment of such patients.
The purpose of this study was to evaluate the accuracy of examiners when asked to make file length adjustments with only a radiograph. The examiners viewed several radiographs under proper viewing conditions but without the aid of measuring devices. Two files of varying lengths (sizes 10 and 15) were placed in maxillary and mandibular premolars and molars from cadavers. The nine examiners were 67.91% in agreement of actual file length adjustment needed when adjustments of up to 0.5 mm were needed, 17.76% when adjustments of from 0.5 up to 1.0 mm were needed, and 14.33% when adjustments of greater than 1.0 mm were needed.
The desired "working length" for the biomechanical preparation and resultant obturation of the root canal system is one of the most important phases of endodontics. Traditionally, radiographs are used to confirm working length of the root length and to evaluate the subsequent obturation of the root canal system. This study attempts to determine if radiographs are an accurate method of root length determination in a period when electronic apex locators are proposed as their replacement. Eight-seven vital and 24 nonvital teeth were accessed and files placed to and the radiographic working length before the file and teeth were extracted for sectioning. Results showed that the radiographic distance of the file from the apical vertex was 0.7 mm shorter than the actual file position. This discrepancy can lead the clinician to try to get closer to the radiographic apex, when in reality the end of the file is closer to the vertex than is suspected. The average distance short of the vertex as established by Kuttler should be increased to lie between 1.5 and 2.0 mm from the apical vertex to prevent overfilling the root canal.
Perforations created in the pulpal floors of 30 extracted molars were repaired with amalgam, Cavit, and light cured glass ionomer cement. After the pulp chambers and access openings were filled with composite resin, the teeth were then immersed in 2% Erythrocin B solution for 1 week. After longitudinal sectioning of the teeth, dye penetration was measured. The results indicated significant differences between the three materials. Light cured glass ionomer exhibited the least dye penetration followed by Cavit and amalgam.
The accuracy of an electronic apex locator to measure canal length during instrumentation when nonrecapitulated dentin debris is present has not been evaluated. The purposes of this study were (1) to compare actual with electronic canal length before and after instrumentation, and (2) to compare the accuracy of electronic length in recapitulated and nonrecapitulated canals. Actual canal lengths of 30 mature anterior teeth were determined, teeth mounted in an in vitro system, and canal lengths determined with the electronic apex locator. Canals were step-back prepared to a size 35 file. Fifteen canals were recapitulated and the other 15 were not. Canals were dried and lengths again determined with the electronic apex locator. Data showed that for electronically determined versus actual lengths: 1) 63% were longer, 23% equal, and 13% shorter before instrumentation, 2) 30% were longer, 0% equal, and 70% shorter after instrumentation, 3) instrumentation caused a mean shortening of 0.63 mm, and 4) recapitulation of nonpatent canals was necessary to obtain length reading with the electronic apex locator.
Two light-cured materials, Vitrebond and Prisma VLC Dycal, were compared with two chemically cured materials, Ketac Fil and Dycal, for ability to seal furcation perforations. Access openings and furcation perforations were prepared in 60 teeth and randomly divided into four equal groups. Furcation perforations were repaired with each of the tested materials, and the access openings were filled with composite resin. After teeth were immersed in 2% erythrocin B dye solution for 10 days, they were sectioned longitudinally and dye penetration was measured. The light-cured materials allowed statistically significant less dye leakage than did the chemically cured materials.
The aim of this study was to determine the influence of orthodontic treatment on the pulpal and periodontal condition of 91 transplanted immature third molars. In patients with atrophy of the alveolar process or unfavorable root morphology, transplants had to be placed in extreme rotated or infraoccluded positions. After 3 to 6 months, these transplants were derotated (45 degrees to 90 degrees) to a correct position in the dental arch (derotation group; n = 28) or extruded to the occlusal plane (extrusion group; n = 21). Finally, approximal spaces were closed in both groups. A sample of 42 transplanted third molars with no orthodontic treatment need served as the control group. All transplants were followed clinically and radiologically for a mean period of 4.0 years. With respect to pulpal and periodontal conditions, no significant differences were observed between the control and the extrusion group. In contrast, compared with the control group, transplants in the derotation group had a significantly poorer pulpal and periodontal condition. In the derotated transplants, a significant correlation was detected between pulp necrosis and orthodontic treatment of multi-rooted transplants. This study indicates that orthodontic extrusion and minor lateral movements of autotransplanted immature third molars, as well as rotation of single-rooted third-molar transplants, represent no additional risk to transplant survival. In contrast, rotation of multi-rooted transplants seems to initiate later severance of the vascular and nerval supply to the pulp.