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PubMed1979

Avoiding perforation during endodontic access.

Planning for endodontic access should be as precise as possible and the dentist should consider several factors in his preoperative evaluation of teeth to avoid perforations. Anatomical characteristics of teeth can be helpful in establishing endodontic access, and valid and invalid points for orientation have been discussed. Seven suggestions have been offered for the establishment of access on difficult teeth. The ideal in establishing endodontic access can only be achieved by the deliberate, conscious application of a thorough knowledge of dental anatomy, and of possible variations from the norm, coupled with a thorough preoperative examination of the tooth. Although a casual approach may not be unsuccessful, precision will certainly yield a higher percentage of successful cases.

Dental Pulp Cavity↗
PubMed2026

Influence of endodontic access on the fracture resistance, retention and microleakage of full-coverage restorations in vitro: A systematic review and meta-analysis.

BACKGROUND: Endodontic access through retained full-coverage restorations (FCRs) is a preferred option for patients because of its high cost-effectiveness. However, the clinical performance of FCRs after repaired access cavity remains insufficiently characterized. This systematic review investigates the effects of endodontic access cavity preparation through retained FCRs on fracture resistance, retention, and microleakage based on in vitro studies. METHODS: A comprehensive search was performed in PubMed, Web of Science, and Scopus databases. Studies investigating the influence of endodontic access on the fracture resistance, retention, and microleakage of FCRs were included. Two independent reviewers conducted study selection, data extraction, and risk-of-bias assessment using the QUIN tool. Meta-analysis was employed to estimate fracture resistance and retention, with sensitivity analysis and subgroup evaluation also performed. Microleakage was summarized qualitatively. RESULTS: Twentythree studies were included: fracture resistance (n = 15), retention (n = 5), and microleakage (n = 3). Endodontic access significantly reduced fracture resistance for zirconia (p = 0.0002) and lithium disilicate (LD) restorations (p = 0.007), but not for resin-matrix ceramic (RMC) restorations (p = 0.25). Abutment tooth type contributed to heterogeneity within the LD and RMC subgroups. Retention was significantly reduced when access cavities were left unrepaired (p = 0.03), whereas appropriate repair protocols restored or enhanced retention relative to baseline. Accelerated aging increased microleakage in retained FCRs. Surface pretreatments and flowable resin liners tended to reduce microleakage, but findings were inconsistent. CONCLUSIONS: Endodontic access significantly reduces fracture resistance of zirconia and LD FCRs, whereas RMC restorations show no significant change. Appropriate repair protocols can restore or improve retention, potentially exceeding original values. Limited evidence suggests that effective sealing is achievable with appropriate materials. However, well-designed and in-vivo researches are needed to provide more detailed clinical guidance. CLINICAL SIGNIFICANCE: When performing endodontic access through retained FCRs, reduced fracture resistance must be carefully considered for zirconia and LD restorations, while RMC restorations may be exempt from this concern. Loss of retention with access can be restored after repair. Surface pretreatment and flowable resin liners help decrease microleakage.

Humans↗
PubMed1978

Histologic identification of mast cells in human dental pulp.

Previous investigators who attempted to identify mast cells in the dental pulp have used demineralizing or tooth-splitting procedures to obtain their tissue samples. However, Eda and Langeland15 found that the fluorescence of mast cells is destroyed by acid demineralizing agents. On the other hand, tooth splitting may damage the pulp by crushing it with forceps, or cutting and heating it with burs, stones, or discs. In the present study, we used the extirpated pulps from teeth in which endodontic access openings were made by means of high-speed rotary instruments with water spray. Metachromatic staining methods failed to demonstrate mast cells in any of the non-inflamed pulp specimens. Two of the inflamed pulp specimens revealed numerous mast cells which appeared intact and well preserved with no evidence of degranulation. As to the distribution of the mast cells, there was no correlation with the number and types of other inflammatory cells observed. Although several cells present in the specimens examined were suggestive of mast cells, only those cells that revealed definitive metachromasia were included in this study.

Cytoplasmic Granules↗
PubMed1978

Sealing quality of a temporary filling material.

Endodontic access cavities were prepared in forty extracted human teeth. The access cavities were obturated with Cavit and tested for leakage with methylene blue. The data suggested that at least a 3.5 mm. thickness of Cavit should be used in order to prevent leakage. Examination under the scanning electron microscope showed areas in which the constituents of Cavit were improperly mixed, which may lead to increased penetration.

Dental Cavity Preparation↗
PubMed1979

Endodontic perforations which resulted in alveolar bone loss. Report of five cases.

Five cases in which perforations of mandibular molars into the furca occurred during endodontic instrumentation of the canal are presented. This resulted in alveolar bone loss. All were relatively asymptomatic, which could present a problem in diagnosis of the periodontal defect. The prognosis is questionable. The only tooth retained was treated surgically by an apically positioned flap and opening of the furca area to make it accessible to cleansing. The best treatment is the avoidance of the perforation. This is accomplished by considering the configuration of the canals and the size of the reamer than can follow it. Overinstrumentation with an endodontic instrument that is too large in diameter should be avoided.

Adult↗
PubMed1977

In vivo study of temporary filling materials used in endodontics in anterior teeth.

The sealing efficacy of temporary endodontic filling materials was tested in vivo. The following materials were studied: Cavit, Caviton, gutta-percha, three types of zinc phosphate cement, and zinc oxide and eugenol. All the materials were tested in the access cavity of the same anterior tooth in ten different patients for a minimum of 1 week. Seepage was determined bacteriologically by culturing a cotton pellet which was sealed into the access cavity. On the basis of the quantity of microorganisms grown anaerobically, differentiation was made between no leakage, minor leakage, and gross leakage. Findings with Cavit and Caviton are essentially the same and show no or minor leakage in the vast majority of tests. Gutta-percha showed gross leakage in six out of eight tests. Phosphate cements showed no leakage in more than two thirds of the tests.

Bacteria↗
PubMed1976

Development and evaluation of a self-instructional program in endodontic diagnosis and treatment planning.

This study was undertaken to evaluate two methods of instruction, the traditional lecture and the slide-tape method, both used with learning material developed for a course in endodontic diagnosis and treatment planning. Student performance, the amount of time required to complete the work, and the attitude of the students toward the differing methods of instruction were studied. The student sample, consisting of 108 members of the freshman class at the University of Southern California, was divided into two groups; the lecture group received a traditional two-hour lecture, and the slide-tape group had access to two slide-tapes on the same material. Both groups received a pretest and a posttest, and the students evaluated the teaching material. Statistical analysis showed no significant differences in quality of performance, but the lecture group spent more time learning the material, and students in the slide-tape group of instruction had a more favorable opinion of both the instructor (the voice) and the course material.

Audiovisual Aids↗
PubMed1979

Differential diagnosis in endodontic failure.

Research in education has demonstrated the usefulness of verbal mediators as memory aides. The mediator or mnemonic POOR PAST can be of use to the dentist in recalling the list of alternatives in the differential diagnos of endodontic failures: P--perforation; O--obturation; O--overfill; R--root canal missed; P--periodontal disease; A--another tooth; S--split; T--trauma. With a comprehensive list of diagnoses, recall of the appropriate questions and tests in examining for each possibility is simplified. The diagnostician then proceeds to look for a specific symptom or symptoms that would confirm a particular diagnosis or that would limit the alternatives to two or three possibilities. Questioning about the nature and duration of the symptoms is useful in ruling out some diagnoses. Pulp tests, periodontal probing, radiographs from different angles, percussion, palpation, and sinus tract exploration each have special application to one or more of the possibilities on the list. The wise clinician also evaluates access preparations, occlusion, and those etiologic factors that could cause pulp or periodontal disease. Variations in the root canal, requirements of treatment, the nature of the healing process, expected results, and surgical principles are considered along with the foregoing in problem solving. After a case has been thoroughly investigated and if the POOR PAST alternatives have been ruled out the dentist may then conclude that for some as yet undetermined reason the lesion exceeds the recuperative powers of the host and that further consultation or surgical intervention will be necessary.

Dental Occlusion, Traumatic↗