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Background: Calcified extraradicular deposits on the apical root surface of teeth (CEDARST) are rarely seen in the dental field, compared with dental calculus deposits, which are very frequent. However, the exact biomineralization process of this entity has remained unclear until now. Objective: To report a case of an exuberant calcified extraradicular deposit on the apical root surface of an anterior tooth with apical periodontitis and propose for the first time some potential mechanisms involved in this pathological mineralization, and thereby suggest directions for future research. Case Presentation: In brief, a root-canal-treated canine displaying a radiographic periapical radiolucency was treated, and the sinus tract persisted despite root canal retreatment in which high endodontic standards were maintained. Endodontic surgery was performed, and the curettage of the pathologic tissue revealed an exuberant calculus-like material attached to the outer root surface, around the exit of the apical foramen. Two-year follow-up radiography revealed complete bone healing, and the patient´s tooth was asymptomatic and functional. Conclusion: The development of CEDARST seems to depend on a fine synergic control exerted by specific microorganisms (mainly bacteria) on this pathological mineralization, as well as on the local chemical microenvironment of the apical lesion of the affected tooth. Microbial implications and inhibitors of mineralization seem to play a dominant role in CEDARST biomineralization.

The aim of this study was to present a new technique for plastic carrier removal in retreatment situations. The gutta-percha technique that uses plastic carrier obturators is one of the most commonly used; however, removing this core is tedious and time-consuming. Two clinical cases were performed by an expert in the field of endodontics, to expose this technique, in which a conical ultrasonic tip with an active point and a Hëdstrom hand file allowed the removal of the plastic carrier quickly and effectively. The use of magnification is indispensable for a predictable success with this method

AimTo study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Vastra Gotaland, Sweden.MethodologyDuring a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics.ResultsThe material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%).ConclusionsIn the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

Cilj endodontskog tretmana je da eliminise infekciju iz kanala korena, da prevenira reinfekciju i trodimenzionalnom hermetičkom obturacijom spreči eventualnu pojavu zapaljenja apikalnog parodoncijuma. Nakon adekvatno sprovedenog tretmana, očekuje se zalečenje odnosno zarastanje periapikalne lezije i smanjenje ili iščezavanje rasvetljenja tokom vremena. Najčešći razlozi koji vode neuspehu endodontskog lečenja su komplikovana anatomija kanalnog sistema, neadekvatna kontrola infekcije, komplikacije tokom endodontskog tretmana u vidu perforacije korena ili frakture kanalnih instrumenata, neadekvatna instrumentacija i obturacija kanala, odnosno mikrocurenje privremenih ili definitivnih koronarnih restauracija. Ponekad se neuspeh može javiti i onda kada je endodontska terapija korektno vodjena i sve procedure u potpunosti ispoštovane. Razlog za to je kompleksna anatomija kanalnog sistema i brojne ramifikacije i anastomoze izmedju glavnog i akcesornih kanala koje se ne mogu adekvatno obraditi niti obturisati postijećim instrumentima, materijalima i tahnikama. Neinstrumentirane regije endodontskog prostora mogu sadržati bakterije i nekrotično tkivo čak i onda kada se čini da je opturacija kanala radiografski korektna. Mikrobiološki status endodontski lečenih zuba se značajno razlikuje u odnosu na netretirani inficirani kanal korena. Pronađeno je svega nekoliko bakterijskih vrsta u kanalima zuba sa adekvatnim endodontskim tretmanom i perzistirajućim asimptomatskim zapaljenjem apeksnog parodoncijuma. To su uglavnom Gram-pozitivne koke, bacili i filamenti sa jednakom distribucijom fakultativnih i obligatnim anaeroba. Tehnikama kultivisanja bakterija i PCR-analizom identifikovani su Enterococcus i Streptococus, zatim Actinomyces, Peptostreptococus, Propionibacterium (ranije Arachnia) i Lactobacillus..., The aim of endodontic treatment is to eliminate the infection from the root canal, to prevent reinfection and to prevent the possible occurrence of periapical periodontal inflammation by three-dimensional hermetic obturation. After appropriate completion of the treatment, it is expected periapical lesions healing and the reduction or disappearance of the radiolucency over time. The most common reasons that lead to the failure of endodontic treatment are complicated anatomy of the root canal system, inadequate control of infection, complications during endodontic treatment in the form of perforation or fracture of the root canal instruments , inadequate instrumentation and obturation, and microleakage of temporary or definitive coronal restoration. Sometimes failure can occur when the endodontic treatment correctly conducted and all procedures are fully satisfied. The reason for this is the complex anatomy of the canal system and the numerous ramifications and anastomoses between the main and accessory canals that can not be adequately treated nor obturated by contemporary instruments, materials and techniques as well. Region of endodontic space that couldn’t be reached can contain bacteria and necrotic tissue even when it seems that the canal obturation is correct on intraoral X-ray. The microbiological status of endodontically treated teeth is significantly different compared to untreated infected root canal. Only a few bacterial species was found in the canals of teeth with adequate endodontic treatment and persistent asymptomatic apical periodontal inflammation. These are mainly Grampositive cocci, bacilli and filaments with an equal distribution of facultative and obligate anaerobes. Techniques of cultivation of bacteria and PCR analysis identified Enterococcus, and Streptococcus, Actinomyces then, Peptostreptococus, Propionibacterium (previously Arachnia) and Lactobacillus. There are some extraradicular factors that could adversely affect the postoperative heal

Cilj endodontskog tretmana je da eliminise infekciju iz kanala korena, da prevenira reinfekciju i trodimenzionalnom hermetičkom obturacijom spreči eventualnu pojavu zapaljenja apikalnog parodoncijuma. Nakon adekvatno sprovedenog tretmana, očekuje se zalečenje odnosno zarastanje periapikalne lezije i smanjenje ili iščezavanje rasvetljenja tokom vremena. Najčešći razlozi koji vode neuspehu endodontskog lečenja su komplikovana anatomija kanalnog sistema, neadekvatna kontrola infekcije, komplikacije tokom endodontskog tretmana u vidu perforacije korena ili frakture kanalnih instrumenata, neadekvatna instrumentacija i obturacija kanala, odnosno mikrocurenje privremenih ili definitivnih koronarnih restauracija. Ponekad se neuspeh može javiti i onda kada je endodontska terapija korektno vodjena i sve procedure u potpunosti ispoštovane. Razlog za to je kompleksna anatomija kanalnog sistema i brojne ramifikacije i anastomoze izmedju glavnog i akcesornih kanala koje se ne mogu adekvatno obraditi niti obturisati postijećim instrumentima, materijalima i tahnikama. Neinstrumentirane regije endodontskog prostora mogu sadržati bakterije i nekrotično tkivo čak i onda kada se čini da je opturacija kanala radiografski korektna. Mikrobiološki status endodontski lečenih zuba se značajno razlikuje u odnosu na netretirani inficirani kanal korena. Pronađeno je svega nekoliko bakterijskih vrsta u kanalima zuba sa adekvatnim endodontskim tretmanom i perzistirajućim asimptomatskim zapaljenjem apeksnog parodoncijuma. To su uglavnom Gram-pozitivne koke, bacili i filamenti sa jednakom distribucijom fakultativnih i obligatnim anaeroba. Tehnikama kultivisanja bakterija i PCR-analizom identifikovani su Enterococcus i Streptococus, zatim Actinomyces, Peptostreptococus, Propionibacterium (ranije Arachnia) i Lactobacillus..., The aim of endodontic treatment is to eliminate the infection from the root canal, to prevent reinfection and to prevent the possible occurrence of periapical periodontal inflammation by three-dimensional hermetic obturation. After appropriate completion of the treatment, it is expected periapical lesions healing and the reduction or disappearance of the radiolucency over time. The most common reasons that lead to the failure of endodontic treatment are complicated anatomy of the root canal system, inadequate control of infection, complications during endodontic treatment in the form of perforation or fracture of the root canal instruments , inadequate instrumentation and obturation, and microleakage of temporary or definitive coronal restoration. Sometimes failure can occur when the endodontic treatment correctly conducted and all procedures are fully satisfied. The reason for this is the complex anatomy of the canal system and the numerous ramifications and anastomoses between the main and accessory canals that can not be adequately treated nor obturated by contemporary instruments, materials and techniques as well. Region of endodontic space that couldn’t be reached can contain bacteria and necrotic tissue even when it seems that the canal obturation is correct on intraoral X-ray. The microbiological status of endodontically treated teeth is significantly different compared to untreated infected root canal. Only a few bacterial species was found in the canals of teeth with adequate endodontic treatment and persistent asymptomatic apical periodontal inflammation. These are mainly Grampositive cocci, bacilli and filaments with an equal distribution of facultative and obligate anaerobes. Techniques of cultivation of bacteria and PCR analysis identified Enterococcus, and Streptococcus, Actinomyces then, Peptostreptococus, Propionibacterium (previously Arachnia) and Lactobacillus. There are some extraradicular factors that could adversely affect the postoperative heal

Solvents have been used in endodontic retreatment for a long time and the dissolving effect is well proven. Latterly chloroform has come in a bad light due to its possible carcinogenicity. Despite the negative health effect it is still used in dental environment. Other more biocompatible solvents have now reached the market and tests should be performed to evaluate the softening efficacy. The purpose of this in-vitro study was to evaluate the softening efficacy of four different solvents used in endodontics; chloroform, eucalyptol, tetrachloroethylene, orange-oil and a control group. 100 simulated canals filled with gutta-percha, epoxy amine resin based sealer, zinc oxide eugenol based sealer and non eugenolcalcium hydroxide based sealer were tested with hardness measurement before and after two minutes exposure time of medicament. Non-eugenol calcium hydroxide failed to set and was excluded from the test. A Shore A durometer was used to evaluate the hardness of the materials and all data was first analyzed with Kruskal-Wallis test and then Mann-Whitney test to compare with control group. With a digital camera connected to a microscope we also took pictures to compare the impressions with the different medicaments. The result showed that chloroform and tetrachloroethylene is significant better to soften gutta-percha than control group (p < 0.05) but only chloroform significant better than control group to soften epoxy amine resin based sealer and zinc oxide eugenol based sealer (p < 0.05). Even if the result was significant, we cannot draw any conclusions due to small sample size.

Solvents have been used in endodontic retreatment for a long time and the dissolving effect is well proven. Latterly chloroform has come in a bad light due to its possible carcinogenicity. Despite the negative health effect it is still used in dental environment. Other more biocompatible solvents have now reached the market and tests should be performed to evaluate the softening efficacy. The purpose of this in-vitro study was to evaluate the softening efficacy of four different solvents used in endodontics; chloroform, eucalyptol, tetrachloroethylene, orange-oil and a control group. 100 simulated canals filled with gutta-percha, epoxy amine resin based sealer, zinc oxide eugenol based sealer and non eugenolcalcium hydroxide based sealer were tested with hardness measurement before and after two minutes exposure time of medicament. Non-eugenol calcium hydroxide failed to set and was excluded from the test. A Shore A durometer was used to evaluate the hardness of the materials and all data was first analyzed with Kruskal-Wallis test and then Mann-Whitney test to compare with control group. With a digital camera connected to a microscope we also took pictures to compare the impressions with the different medicaments. The result showed that chloroform and tetrachloroethylene is significant better to soften gutta-percha than control group (p < 0.05) but only chloroform significant better than control group to soften epoxy amine resin based sealer and zinc oxide eugenol based sealer (p < 0.05). Even if the result was significant, we cannot draw any conclusions due to small sample size.

Introduction Endodontic retreatment is a complex intervention that requires detailed analysis of possible reasons for failure, and flawless practical execution of the procedure. Objective The aim of the study was to assess the outcome of endodontic retreatment based on clinical and radiographic criteria after a two-year observation period. Methods Clinical study included 49 teeth indicated for endodontic retreatment based on periapical index (PAI). All teeth were divided into two groups. Group I comprised teeth without any periapical lesion (PAI score of 1 and 2) while Group II consisted of teeth with visible periapical radiolucency (PAI score of 3, 4, and 5). Endodontic retreatment was completed in two visits with inter-appointment medication of 2% chlorhexidine and calcium hydroxide for two weeks. Outcome of endodontic retreatment was evaluated 12-24 months after final obturation. Results Endodontic retreatment was successful in 93.3% in Group I after 24 months. In Group II, successful treatment and complete healing was found in 52.9% of teeth, whereas 14.7% of teeth showed only partial healing. However, clinical symptomatology was not present in any of the cases. Considering the absence of clinical signs and subjective symptoms, retreatment was successful in 67.6% of cases where chronic periapical inflammation was present. Conclusion Endodontic retreatment was successful in high percentage in teeth with and without periapical lesions., Uvod Endodontski retretman je kompleksna intervencija koja zahteva detaljnu analizu indikacija, odnosno perfektnu praktičnu realizaciju ovakvog zahvata. Cilj rada Cilj ovog rada je bio da se na osnovu kliničkih i radiografskih kriterijuma proceni ishod ponovljene endodontske terapije nakon perioda od dve godine kod pacijenata sa različitim endodontskim indikacijama. Metode rada Klinička studija je obuhvatila 49 zuba indikovanih za ponovljeni endodontski tretman, koji su na osnovu PAI (periapikalni indeks) skora podeljeni u dve grupe. U prvu grupu su svrstani zubi bez periapikalnih promena (PAI skor 1 i 2), dok su drugu grupu činili zubi sa vidljivim znacima oštećenja apeksnog parodoncijuma (PAI skor 3, 4 i 5). Ponovljeno endodontsko lečenje podrazumevalo je medikaciju 2% rastvorom hlor-heksidina i suspenzijom kalcijum-hidroksidom u trajanju od dve nedelje u obe grupe zuba. Ishod preduzete terapije procenjivan je na kliničkim i radiografskim kontrolama 12-24 meseca nakon definitivne opturacije. Rezultati Ponovljena endodontska terapija u grupi zuba sa zdravim parodontalnim tkivima nakon 24 meseca bila je upešna u 93,3% slučajeva. U grupi sa periapikalnim promenama radiografski delimično poboljšanje zabeleženo je u 14,7%, a potpuno izlečenje u 52,9% slučajeva. S obzirom na odsustvo kliničkih znakova i subjektivnih simptoma, ponovljena terapija smatrana je uspešnom u oba slučaja, dakle u ukupno 67,6% zuba kod kojih su postojale hronične periapikalne lezije. Zaključak Ponovljena endodontska terapija je bila uspešna u visokom procentu i kod zuba bez izraženih kliničkih i radiografskih simptoma i sa njima.

The aim of endodontic treatment is to eliminate the infection from the root canal, to prevent reinfection and to prevent the possible occurrence of periapical periodontal inflammation by three-dimensional hermetic obturation. After appropriate completion of the treatment, it is expected periapical lesions healing and the reduction or disappearance of the radiolucency over time. The most common reasons that lead to the failure of endodontic treatment are complicated anatomy of the root canal system, inadequate control of infection, complications during endodontic treatment in the form of perforation or fracture of the root canal instruments , inadequate instrumentation and obturation, and microleakage of temporary or definitive coronal restoration. Sometimes failure can occur when the endodontic treatment correctly conducted and all procedures are fully satisfied. The reason for this is the complex anatomy of the canal system and the numerous ramifications and anastomoses between the main and accessory canals that can not be adequately treated nor obturated by contemporary instruments, materials and techniques as well. Region of endodontic space that couldn’t be reached can contain bacteria and necrotic tissue even when it seems that the canal obturation is correct on intraoral X-ray. The microbiological status of endodontically treated teeth is significantly different compared to untreated infected root canal. Only a few bacterial species was found in the canals of teeth with adequate endodontic treatment and persistent asymptomatic apical periodontal inflammation. These are mainly Grampositive cocci, bacilli and filaments with an equal distribution of facultative and obligate anaerobes. Techniques of cultivation of bacteria and PCR analysis identified Enterococcus, and Streptococcus, Actinomyces then, Peptostreptococus, Propionibacterium (previously Arachnia) and Lactobacillus. There are some extraradicular factors that could adversely affect the postoperative heal, Cilj endodontskog tretmana je da eliminise infekciju iz kanala korena, da prevenira reinfekciju i trodimenzionalnom hermetičkom obturacijom spreči eventualnu pojavu zapaljenja apikalnog parodoncijuma. Nakon adekvatno sprovedenog tretmana, očekuje se zalečenje odnosno zarastanje periapikalne lezije i smanjenje ili iščezavanje rasvetljenja tokom vremena. Najčešći razlozi koji vode neuspehu endodontskog lečenja su komplikovana anatomija kanalnog sistema, neadekvatna kontrola infekcije, komplikacije tokom endodontskog tretmana u vidu perforacije korena ili frakture kanalnih instrumenata, neadekvatna instrumentacija i obturacija kanala, odnosno mikrocurenje privremenih ili definitivnih koronarnih restauracija. Ponekad se neuspeh može javiti i onda kada je endodontska terapija korektno vodjena i sve procedure u potpunosti ispoštovane. Razlog za to je kompleksna anatomija kanalnog sistema i brojne ramifikacije i anastomoze izmedju glavnog i akcesornih kanala koje se ne mogu adekvatno obraditi niti obturisati postijećim instrumentima, materijalima i tahnikama. Neinstrumentirane regije endodontskog prostora mogu sadržati bakterije i nekrotično tkivo čak i onda kada se čini da je opturacija kanala radiografski korektna. Mikrobiološki status endodontski lečenih zuba se značajno razlikuje u odnosu na netretirani inficirani kanal korena. Pronađeno je svega nekoliko bakterijskih vrsta u kanalima zuba sa adekvatnim endodontskim tretmanom i perzistirajućim asimptomatskim zapaljenjem apeksnog parodoncijuma. To su uglavnom Gram-pozitivne koke, bacili i filamenti sa jednakom distribucijom fakultativnih i obligatnim anaeroba. Tehnikama kultivisanja bakterija i PCR-analizom identifikovani su Enterococcus i Streptococus, zatim Actinomyces, Peptostreptococus, Propionibacterium (ranije Arachnia) i Lactobacillus...

This study evaluated the efficacy of ProTaper Universal rotary retreatment system and hand files for filling material removal during retreatment and the influence of sealer type on the presence of filling debris in the reinstrumented canals. The canals of 60 palatal roots of first molars were obturated with gutta-percha and either a zinc oxide–eugenol–based or a resin-based sealer and reinstrumented: G1, EndoFill/hand files; G2, AH Plus/hand files; G3, EndoFill/ProTaper; G4, AH Plus/ProTaper. Roots were cleaved and examined with an optical microscope, and the amount of filling debris on canal walls was analyzed on digitized images. There was no significant difference (P > .05) among the root canal thirds within each group. G3 presented significantly more filling debris than G1 in the cervical third (P = .04). In the middle third, G2/G3/G4 showed more debris than G1 (P = .03). The techniques were similar (P = .64) in the apical third. All groups presented filling debris in the 3 canal thirds after reinstrumentation.

This study evaluated the efficacy of ProTaper Universal rotary retreatment system and hand files for filling material removal during retreatment and the influence of sealer type on the presence of filling debris in the reinstrumented canals. The canals of 60 palatal roots of first molars were obturated with gutta-percha and either a zinc oxide–eugenol–based or a resin-based sealer and reinstrumented: G1, EndoFill/hand files; G2, AH Plus/hand files; G3, EndoFill/ProTaper; G4, AH Plus/ProTaper. Roots were cleaved and examined with an optical microscope, and the amount of filling debris on canal walls was analyzed on digitized images. There was no significant difference (P > .05) among the root canal thirds within each group. G3 presented significantly more filling debris than G1 in the cervical third (P = .04). In the middle third, G2/G3/G4 showed more debris than G1 (P = .03). The techniques were similar (P = .64) in the apical third. All groups presented filling debris in the 3 canal thirds after reinstrumentation.

This study evaluated the efficacy of ProTaper Universal rotary retreatment system and hand files for filling material removal during retreatment and the influence of sealer type on the presence of filling debris in the reinstrumented canals. The canals of 60 palatal roots of first molars were obturated with gutta-percha and either a zinc oxide–eugenol–based or a resin-based sealer and reinstrumented: G1, EndoFill/hand files; G2, AH Plus/hand files; G3, EndoFill/ProTaper; G4, AH Plus/ProTaper. Roots were cleaved and examined with an optical microscope, and the amount of filling debris on canal walls was analyzed on digitized images. There was no significant difference (P > .05) among the root canal thirds within each group. G3 presented significantly more filling debris than G1 in the cervical third (P = .04). In the middle third, G2/G3/G4 showed more debris than G1 (P = .03). The techniques were similar (P = .64) in the apical third. All groups presented filling debris in the 3 canal thirds after reinstrumentation.

The aim of the present article was to propose examples of treatment alternatives for the management of 14 clinical cases. All these cases involved endodontically treated teeth and have been managed by the same practitioner. In this paper, the authors tried to show the variety of treatment alternatives as well as the complexity of the decision-making process and, not to consider that proposed alternatives were the most adequate.

AIM: The objectives of the present study were to: (i) evaluate the consensus, if any, amongst dental schools, students and their instructors managing the same clinical cases, all of which involved endodontically treated teeth; and (ii) determine the predominant proposed treatment option. METHODOLOGY: Final year students, endodontic staff members and instructors of 10 European dental schools were surveyed as decision makers. Fourteen different radiographic cases of root canal treated teeth accompanied by a short clinical history were presented to them in a uniform format. For each case the decision makers were requested to: (i) choose only one out of nine treatment alternatives proposed, from 'no treatment' to 'extraction' via 'retreatment' and 'surgery' (ii) assess on two 5-point scales: the difficulty of making a decision, and the technical complexity of the retreatment procedure. RESULTS: The results indicate wide inter- and also intra-school disagreements in the clinical management of root canal treated teeth. Analysis of variance showed that the main source of variation was the 'school effect', explaining 1.8% (NS) to 18.6% (P < 0.0001) of the treatment variations. No other factor explained as much variance. Decision difficulty was moderately correlated to technical complexity (Pearsons' r ranging from 0.19 to 0.35, P < 0.0001). CONCLUSIONS: No clear consensus occurred amongst and within dental schools concerning the clinical management of the 14 cases. The lack of consensus amongst schools seems to be due mainly to chance or uncertainty, but can be partly explained by the 'school effect'.