Search

The morphic classification developed is a silver lining enabling projection, as well as retraction, for complex surgical approaches where ultimate decisions may have to be taken extemporaneously as the surgical case develops. From both a consent form and clinical standpoint, this approach brings clarity to the patient avoiding surprises and disappointment. It also guides the practitioner whose best clinician intention may not alway materialize and guaranty the best and most reasonable possible achievement.

Background: Posts and cores are often required for restoration of pulpless teeth and to provide retention and resistance for a complete crown, but conventional posts may increase the root fracture., Objective: This study was performed to compare the root fracture resistance of extracted teeth treated with different fibers reinforced with composite posts and treated teeth with conventional post and core systems., Materials and Methods: Root canal therapy was performed for 50 mandibular first premolars. The coronal portion of each tooth was amputated, and five post and core systems (cast, polyethylene woven, glass, carbon, and quartz fiber posts) were compared. Acrylic resin blocks were used for mounting, using a layer of elastomeric impression material covering the roots. The load was applied axially and measured with a universal testing machine., Results and Conclusion: Significantly, cast posts and cores had a higher failure threshold including teeth fracture; whereas, fiber posts failure was due to core fracture, with or without fractures in coronal portion of posts. Difference in FRC posts did not provide any significant difference in the load failure and the mode of fracture.

This cross-sectional study determined the prevalence of apical periodontitis in 1035 root canal-treated teeth from adult French patients and investigated the influence of the quality of canal fillings and coronal restorations on the periradicular status. Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periapical index scoring system. Overall, the prevalence of apical periodontitis in root canal-treated teeth was 33%. Only 19% of the teeth had endodontic treatments rated as adequate. The success rate (number of healthy teeth) for cases with adequate endodontic treatment was 91%, which was significantly higher when compared with teeth with inadequate treatment (61%). Teeth with adequate restorations had significantly decreased prevalence of apical periodontitis (29%) as compared with teeth with inadequate restorations (41%). The combination of adequate endodontic treatment and adequate restorations yielded the highest success rate (93.5%). The quality of the endodontic treatment was the most important factor for success, although the quality of the coronal restoration also influenced the treatment outcome.

Introduction: In patients with cardiovascular diseases several risk factors such as high blood pressure, diabetes, smoking and drinking habits, genetic disposition, and chronic inflammation must be considered. The aim of this study was to investigate whether there is a correlation between dental origin infections and the presence of an acute myocardial infarction (AMI)., Methods: A total of 125 patients who had experienced a myocardial infarction and 125 healthy individuals were included in this study. The oral examination was carried out following the consent of the ethics committee and the National Board for Radiation Protection and included the number of teeth, endodontically treated teeth, periodontal screening index (PSI), clinical attachment level, and radiographic apical lesions (radiograph examination). The medical examination included, among others, blood glucose level, C-reactive protein (CRP) serum levels, and leukocyte number., Results: The study demonstrated that patients with AMI exhibited an unfavorable dental state of health. After statistical adjustment for age, gender, and smoking, they exhibited a significantly higher number of missing teeth (P = .001), less teeth with root canal fillings (P = .0015), a higher number of radiologic apical lesions (P = .001), and a higher PSI value (P = .001) compared with individuals without myocardial infarction. The medical data showed a nonsignificant correlation between CRP and the number of radiologic apical lesions., Conclusions: This study presents evidence that patients who have experienced myocardial infarction also exhibit an unfavorable dental state of health in comparison to healthy patients and suggests an association between chronic oral infections and myocardial infarction.

Objectives: In healthy conditions, modeling and remodeling collaborate to obtain a correct shape and function of bones. Loads on bones cause bone strains which generate signals that some cells can detect and respond to. Threshold ranges of such signals are genetically determined and are involved in the control of modeling and remodeling. The present study aimed at assessing the deformations transferred to surrounding bone by endodontically treated maxillary central incisors restored with endocrowns made up of high or low elastic modulus materials., Methods: The solid model consisted of a maxillary central incisor, the periodontal ligament (PDL) and the surrounding cortical and cancellous bone. Both composite and alumina endocrowns were simulated under load and compared to a sound tooth. Dynamic non-linear analyses were performed to validate discretization processes. Non-linear analyses were performed on teeth and surrounding bone to estimate strain variations according to restorative techniques., Results: Strain values in cortical bone, spongy bone, alveolar cortex and tooth were evaluated. PDL allowed models to homogeneously transfer loads to bone. Strains developing in highly rigid restorations were estimated to activate bone modeling and remodeling., Significance: The higher deformability of composites could enable restorative systems to transfer limited strains to compact and spongy bone of tooth socket. Although composites could not prevent the physiological resorption of the alveolar bone, they could successfully reduce strain arising in tooth socket when compared to alumina. The PDL prevented bone to undergo high deformations, resulting in natural flexural movements of teeth.

This study compares the incidence, degree, and length of postoperative pain in 300 endodontically treated teeth, with and without apical patency, in relation to some diagnostic factors (vitality, presence of preoperative pain, group, and mandible of treated tooth). Of the questionnaires received back, apical patency was maintained during shaping procedures with a #10 K-file in one group (n = 115) and not in the other (n = 121). There was significantly less postendodontic pain when apical patency was maintained in nonvital teeth. If pain appeared, its duration was longer when apical patency was maintained in teeth with previous pain or located in the mandible. Maintenance of apical patency does not increase the incidence, degree, or duration of postoperative pain when considering all variables together.

The purposes of this study were to determine success and survival rates for implants and teeth adjacent to implants and the incidence of endodontic implantitis (E-I) (endodontic involvement in adjacent teeth causing implant failure) and implant endodontitis (I-E) (implant placement causing endodontic failure). The data were from 233 single-tooth implants placed in 116 subjects by postgraduate periodontal students with recall radiographs taken >or=9 months after implant placement. Three groups were analyzed: group A, implants with no adjacent teeth (n = 90); group B, implants with nonendodontically treated adjacent teeth (n = 123); and group C, implants with endodontically treated adjacent teeth (n = 20). The success and survival rates for implants were both 92.2% in group A, 98.4% and 99.2% for group B, and 85% and 95% for group C, respectively. For adjacent teeth, they were both 99.4% in group B compared with 75% and 90% in group C. However, after case review, none of the implants or adjacent teeth in group B were considered to have E-I or I-E, and one (5%) of the implants in group C had E-I and two (10%) of the adjacent teeth may have had I-E. The results of the present study agree with previous research, which suggests that endodontically treated teeth adjacent to single-tooth implants are usually successful and should be maintained.

A 2-year-old domestic feline patient was presented for evaluation of a complicated crown fracture of the right maxillary canine tooth. Clinical and radiographic examination revealed a non-vital immature permanent canine tooth with an open apex. This case report describes a two-visit technique using mineral trioxide aggregate in an apical barrier method for the treatment of a non-vital immature permanent canine tooth in a cat.

This is the first of two papers discussing the implications of dental trauma for patients requiring orthodontic treatment. This paper will focus on the factors the orthodontic specialist should consider when contemplating movement of traumatized teeth. The prevalence of dental trauma and the recognition and prevention of traumatic injuries are discussed. The evidence available in the literature relating to orthodontic tooth movement in vital and endodontically treated traumatized teeth is explored. The interdisciplinary management of root fractured and intruded teeth receive special attention. The second paper will look at the role of the specialist team in the management of failing anterior teeth and will outline possible treatment options for children and adolescents encountering such situations. Avulsion injuries and tooth transplantation are considered in particular detail.

Objective: To determine the fracture resistance of endodontically treated anterior teeth restored with a novel nonmetallic post in combination with self-etching adhesives., Materials and Methods: Extracted maxillary anterior teeth were sterilized with gamma irradiation, and each crown was severed 2 mm above the cementoenamel junction. Endodontic treatment was performed, and the teeth were divided into 7 test groups according to the post-adhesive combination used (n = 8 in each group). The following combinations of posts and adhesives were used: group 1, ParaPost stainless steel post with glass ionomer cement (control group); group 2, Light Post post with Clearfil SE Bond bonding agent and Panavia-F adhesive; group 3, Light Post post with Xeno-III bonding agent and Panavia-F adhesive; group 4, ParaPost Fiber White post with Clearfil SE Bond bonding agent and Panavia-F adhesive; group 5, ParaPost Fiber White post with Xeno-III bonding agent and Panavia-F adhesive; group 6, everStick post with Clearfil SE Bond bonding agent and Panavia-F adhesive; and group 7, everStick post with Xeno-III bonding agent and Panavia-F adhesive. Core build-ups to restore anatomic form were made from light-cured composite (TPH3). Specimens were stored in water at 37 degrees C. The roots of each tooth were embedded in an acrylic base, and the teeth were mounted at 135 degrees to the horizontal. The teeth were loaded in an Instron machine, and loading was applied to the point of fracture. Fracture loads were recorded, means and standard deviations (SDs) were calculated, and the data were analyzed with analysis of variance (ANOVA) and Tukey"s tests., Results: The mean fracture load (and SD) for each group was as follows: for group 1, 536.8 (75.1) N; for group 2, 1,000.1 (190.9) N; for group 3, 1,049.9 (231.5) N; for group 4, 1,548.5 (290.0) N; for group 5, 1,171.3 (296.9) N; for group 6, 1,711.7 (516.7) N; and for group 7, 1,825.7 (527.3) N. ANOVA revealed significant differences among the groups (p < 0.001). In addition, the mean fracture value for group 7 was significantly higher than those of the other groups p < 0.05) except for groups 4 and 6., Conclusions: Use of a novel glass fibre post (the everStick post) was associated with the highest mean fracture force for maxillary anterior teeth, regardless of the bonding agent used, whereas the stainless steel post was associated with the lowest mean fracture force.

Objective: The purpose of this study was to evaluate the relationship between the quality of root canal fillings and type of permanent coronal restorations and their association with the periapical status in a Turkish subpopulation., Study Design: There were 1268 endodontically treated teeth from 280 panoramic radiographs that were evaluated. Two observers assessed the radiographs using an x-ray viewer with 2 times magnification. Teeth were classified according to the type of restorations. The quality of root canal fillings were evaluated according to the criteria determined by Tronstad et al. Apical status was assessed by the Periapical Index scores (PAI) proposed by Ørstavik et al. Chi-square test was used for statistical analysis., Results: There were 59.5% of endodontically treated teeth that showed healthy periapex. Teeth with good endodontic treatment showed statistically significant high healthy periapex rates regardless of the type of the restoration. In addition, the evaluation of the entire material also showed that the roots with posts had significantly more periapical pathosis than roots without posts (P = .001)., Conclusions: It can be concluded that, although the quality of the root canal filling plays a key role in the outcome of endodontic therapy, the type of restoration can also be a contributing factor in the treatment outcome.

Purpose: To compare the fracture resistance and failure patterns of endodontically-treated teeth with a progressively reduced number of residual walls restored using resin composites, with or without translucent glass fiber posts., Methods: Ninety extracted human single-rooted maxillary premolars were used. After endodontic treatment, the following groups were created: Group 1 (control group): endodontically-treated single-rooted maxillary premolars with four residual walls; Group 2: three residual walls; Group 3: two residual walls; Group 4: one residual wall, and Group 5: no residual wall. Groups 2-5 were each divided into two subgroups: subgroups "a" were restored with resin composites, while subgroups "b" were restored with translucent glass fiber posts and resin composites. Static fracture resistance tests and statistical analyses (P= 0.05) were performed., Results: The mean failure loads (N) were 502.4+/-152.5 (Group 1), 416.4+/-122.2 (Group 2a), 423.0+/-103.3 (Group 2b) 422.1+/-138.9 (Group 3a) 513.2+/-121.7 (Group 3b), 488.7+/-153.7 (Group 4a) 573.4+/-169.2 (Group 4b), 856.7+/-112.2 (Group 5a) and 649.5+/-163.5 (Group 5b), respectively. The samples restored with fiber posts exhibited predominantly restorable fractures. The number of residual cavity walls influenced the mechanical resistance of endodontically-treated teeth.

Purpose: The aim of this study was to evaluate the prevalence of neurosensory disturbances (NSDs) of the inferior alveolar nerve after dental procedures., Materials and Methods: A retrospective study of patient complaints for transient and permanent NSDs was achieved by means of a 10-year follow-up of claims to a national practitioner insurance company. Claims for 3 different dental procedures were analyzed from 157,292 contracts of insurance recorded during this period., Results: Three hundred eighty-two complaints of NSDs were recorded with 75 permanent injuries (19.6%). The incidence of endodontic treatment and surgical procedures in NSDs cases were 35.3% and 61.5%, respectively, and the prevalence of third molar removals in permanent loss of sensation was 46.6%., Conclusion: Impacted third molar removal appears to be the main etiology of permanent inferior alveolar nerve sensory deficiency, but endodontic treatments are often implicated and implant placement procedures can cause severe nerve injuries.

Initial root canal therapy and implant placement are both common treatment modalities, and, as such, prognostic factors that influence the treatment outcomes of these two restorations should be identified. In a retrospective chart review, 196 implant restorations and 196 matched initial nonsurgical root canal treated (NSRCT) teeth in patients were evaluated for four possible outcomes-success, survival, survival with intervention, and failure. Results showed that smokers had fewer successes and more failures in both groups (p = 0.0001), whereas NSRCT outcomes were affected by periradicular periodontitis (p = 0.001), post placement (p = 0.013), and overfilling (p = 0.003). Outcomes for both groups were not significantly affected by diabetes, age, or gender. Implant group outcomes were not affected by implant length (from 10 to 16 mm), diameter (from 3.25 to 5.5 mm), or an adjacent endodontically treated tooth, nor were NSRCT outcomes affected by the number of appointments for the procedure.

Objective: To demonstrate the existing difficulties and variability in the application of evidence-based dentistry by comparing the recommendations made by 4 dental experts for the treatment of a fractured tooth., Method and Materials: A case presentation was given to 4 specialists, who were asked to independently develop and explain their personal favorite treatment strategy, based on the best available external evidence and their clinical expertise. The entire case was then reviewed by an expert in evidence-based medicine and discussed with the first author., Results: Each of the 4 experts relied on different articles in justifying their clinical decisions. The minimal overlap in the literature they cited largely explains the different treatment suggestions: While the endodontist preferred a metal post-and-core and a porcelain-fused-to-metal (PFM) crown, both the operative dentist and the prosthodontist opted for a glass-fiber post/fiber-reinforced resin composite post. The perio-prosthodontist recommended a PFM crown with either a direct or indirect post and core. The citation analysis revealed that little high-quality information is available about what would be the best therapy for horizontal fractures of root-canal-treated anterior teeth., Conclusions: This article illustrates that, although it is now common practice in dentistry to base clinical decision making on external evidence from the literature, search strategies and the resulting clinical recommendations still vary greatly.

Background: In patients with periodontitis, a quantitative prognostic assessment is needed in order to make evidence-based decisions about retaining teeth or extracting and replacing them with a dental prosthesis., Methods: One hundred and ninety eight patients receiving active periodontal treatment in 1989 or 1990 and complying with supportive periodontal therapy (SPT) over an average of 11.8+/-2.3 years were included in the study. A generalized linear model was established and fitted via generalized estimating equations to identify predictors for tooth loss during SPT., Results: Of the 4559 teeth present at baseline, 166 (3.6%) were extracted during active treatment and 249 (5.5%) during SPT. Baseline findings of diabetes mellitus (OR=4.17), reduced alveolar bone levels (OR=1.04 for each 1% increment), increased tooth mobility (III versus 0: OR=5.52), multiple roots (OR=1.82), and non-vital pulp (OR=2.24) were significant (p<0.05) predictors for tooth loss during SPT. Based on these parameters, a prognostic model was constructed that provides estimates of tooth survival probability when periodontal therapy is rendered., Conclusion: Using a multivariate approach, a prognostic model was developed that may be of value for clinical decision making.

Statement of Problem: The published information is equivocal regarding the fracture resistance of endodontically treated teeth restored with fiber posts. Additionally, little is known about the biomechanical performance of glass fiber and zircon posts., Purpose: This in vitro study investigated the fracture resistance of anterior endodontically treated teeth prepared with a 2-mm ferrule, restored with glass fiber and zircon posts and composite resin cores or cast posts and cores., Material and Methods: Twelve matched pairs of teeth were obtained from 4 cadavers, and all were endodontically treated and prepared with a standardized 2-mm ferrule. According to a random number table, the 2 teeth from each matched pair were randomly divided into 2 groups. The test group consisted of 12 specimens restored with a glass fiber and zircon post (Fibio) and composite resin (Durafil) core. Twelve matching specimens restored with a nickel-chromium (NiCr) cast post and core served as the control. Specimens in both groups were cemented with resin cement (Panavia F). After cementation of cast NiCr complete crowns with zinc polycarboxylate cement (ShangChi), the specimens were loaded with an incremental static force at an angle of 135 degrees to the long axis of the root until failure occurred. A paired sample t test was used to compare the fracture resistance (N) of teeth restored with the 2 post-and-core systems (alpha=.05)., Results: The mean failure load of paired differences between the 2 groups was -261.3+/-237.3 N. The test group exhibited significantly lower failure loads than the control group (P=.004). All specimens displayed root fractures, most of which were oblique, with cracks initiating from the palatal cervical margin and propagating in a labial-apical direction., Conclusion: Within the limitations of this study, the teeth restored with glass fiber and zircon posts demonstrated significantly lower failure loads than those with cast NiCr post and cores. All specimens failed via root fractures.

The purpose of this study was to evaluate, radiographically, whether there is similarity in the apical root resorption found in endodontically treated teeth and untreated teeth when they are submitted to orthodontic treatment. From 2,500 treatment records examined, 16 patients were selected who had a maxillary central incisor treated endodontically before initiation of the orthodontic movement, and a vital homologous tooth (for control). Measurements were made by comparing the periapical radiographs taken before and after the orthodontic treatment. There was no statistically significant difference (p>0.05) in apical root resorption found in the endodontically treated teeth compared to the group of vital teeth.

The aim of this study was to investigate the number of existing teeth, prevalence of endodontically treated teeth, periapical lesions, caries and restorations in diabetic patients by taking periapical radiographs. Forty-six patients with Type I diabetes and 40 patients with Type II diabetes participated in the study. The control group consisted of 50 patients. There were significant differences between patients with Type I and Type II diabetes in the mean number of missing teeth surfaces and existing teeth.

Background: Many post systems are available to clinicians, yet no consensus exists about which one is better in restoring endodontically treated teeth., Purpose: This study evaluated the fracture strength of teeth with flared canals and restored with two fiber-reinforced resin systems (glass fiber: FRC Postec [Ivoclar Vivadent, Schaan, Liechtenstein]; quartz fiber: D.T. Light-Post [Bisco Dental Products, Schaumburg, IL, USA]), and one custom cast base metal (Ni-Cr) post and core system., Methods: Thirty anterior teeth had their crowns removed below the cemento-enamel junction and were endodontically treated. The canals were prepared for post fixation, and the canal walls were flared using a taper diamond bur. The prepared roots were randomly divided into three groups according to the post system. All posts were cemented with an adhesive resin cement. For the fiber-reinforced resin posts, cores were built up using microhybrid composite. Metallic crowns were luted using zinc phosphate cement. Specimens were loaded at 45 degrees in a universal testing machine at a crosshead speed of 0.5 mm/min until failure. The mode of failure was classified as repairable or nonrepairable., Results: Teeth restored with cast posts had fracture strength twice that of teeth restored with resin posts. Fiber-reinforced resin posts failed at a compressive force comparable to clinical conditions, but all failures were repairable., Conclusion: Fracture strength and mode of failure in anterior teeth with flared canals varied according to the type of post used to support a crown., Clinical Significance: Under the conditions of this study, cast posts are preferable to restore endodontically treated teeth with flared canals and no ferrule.

Objectives: To evaluate if the endodontic status has influence on the adherence of periodontal ligament (PDL) to extracted teeth and if the presence of "pathologic granules" is correlated to the endodontic status and/or the amount of adhering PDL., Study Design: Extracted teeth with different endodontic status and exhibiting no marginal periodontitis were histologically examined., Results: Observation of pathologic granules was related to a nonvital endodontium and to acute peroperative inflammation. Pathologic granules and denudation of the extracted roots were significantly related. Acute peroperative inflammation and low extraction forces were related to denudation of the roots. Such relation was not found for endodontic status, tooth type, root-form, and age of patients., Conclusion: The existence of pathologic granules in unexposed cementum is strictly related to teeth with a nonvital endodontium. There is no effect of the endodontic status on the adherence of PDL when an acute inflammation is absent.

Aim: To investigate a number of clinical and treatment variables that might have influenced the prevalence of apical periodontitis in root-filled teeth in a population of periodontally compromised patients., Methodology: This investigation was a retrospective cross-sectional study on data collected from periodontal charts in addition to intra-oral full-mouth radiographs from patients attending the Department of Periodontology of the Dental School of the Ghent University Hospital. Periodontal parameters (clinical attachment loss and the lowest marginal bone level, the history of periodontal treatment), endodontic treatment (length, homogeneity and overall quality of the root filling) and the quality of coronal restorations were related to the prevalence of apical periodontitis. A total of 272 root-filled teeth in 94 patients were evaluated., Results: The periapical condition was significantly influenced by the quality of the root filling and the coronal filling (P < 0.05). More apical periodontitis was seen when the coronal level of the root filling exceeded the marginal bone level (P < 0.005). The marginal periodontal condition seemed to influence the periapical status. Teeth with apical periodontitis were associated with significantly more extended marginal bone loss (P < 0.001). Significantly less apical periodontitis was seen in patients that had received marginal periodontal treatment (P < 0.005), compared with untreated periodontal patients., Conclusions: Signs of periodontal disease, as reflected by marginal bone loss, are of importance for the periapical condition of root-filled teeth. Efforts should be taken in preventing spread of infection through the periodontal-endodontic pathway by periodontal infection control and a high quality of root filling and coronal filling. Care should also be taken to seal the coronal cavity up to the level of the root filling, where it is advisable to reduce the coronal level of the root filling below or at least at the level of the surrounding marginal bone.

When root canal therapy is done according to accepted clinical principles and under aseptic conditions, the success rate is generally high. However, it has also been reported that 16% to 64.5% of endodontically treated teeth are associated with periapical radiolucent lesions. There are great variations among clinicians when suggesting treatment of these failed endodontic cases. This article will discuss factors influencing treatment decisions on these particular cases, and the pros and cons of nonsurgical retreatment versus surgical retreatment. The advancement of modern endodontic microsurgery will also be discussed.

Unlabelled: The aim of this study was to investigate the technical quality of root fillings in root filled teeth, their association with periapical status and prevalence of apical periodontitis., Material and Methods: The sample consisted of 83 subjects, presenting consecutively as new patients seeking dental care (prosthetic, endodontic and cariologic treatment) in the years 2005/2006. Clinical and radiographic examination on each patient was performed using the scoring system (Periapical index (PAI)) proposed by Ørstavik et al. From the periapical radiographs status of endodontically treated teeth was recorded. For each tooth the following items were surveyed: the presence of a root filling, its quality (lateral seal and length in the root canal) and the periapical status., Results: Of the 2186 functional teeth, 283 had undergone root canal treatment (13%). Amongst 283 root filled teeth, 122 teeth (43.1%) had radiological signs of a periapical lesion (PAI>2). Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. Inadeguate lateral seal of root filling was observed in 165 (58.3%) of 283 endodontically treated teeth. Inadequate length of endodontic treatment was discovered in 183 (64.7%) out of 283 teeth. Root filled teeth without voids had apical periodontitis in 25 (21.0%) out of 118 of cases, whereas if voids were detected, disease was present in 97 (58.8%) out of 165 teeth (p<0.001). Apical periodontitis was found in 23 (23.0%) out of 100 teeth with adequate length of root filling, whereas if the filling was too short or long, periapical lesions were present in 99 (54.0%) out of 183 teeth (p<0.001)., Conclusions: Apical periodontitis was present in 43,1% of root filled teeth. Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. The results of this study indicate that inadequate root fillings were more often associated with an increased prevalence of apical periodontitis. On the contrary, adequate root fillings significantly reduced the prevalence of disease. Many root canal treatments were technically unsatisfactory and substantial efforts must be made to improve the standard of endodontic treatment.

The aim of this study was to evaluate the resistance to fracture of endodontically treated teeth with flared canals restored with different post and core restorations under static and cyclic fatigue loadings. Sixty human maxillary central incisors were used. Two main groups (non-ferrule and 1-mm ferrule) were divided into three types of restoration: custom cast post-and-core (MPC), resin composite post-and-core (RCP), and resin composite core in combination with prefabricated carbon fiber post (FRC). Half of each group was subjected to a static loading test, and the other to a cyclic fatigue test. FRC exhibited a significantly higher number of load cycles than the other groups, and MPC showed the highest failure load among the tested groups. However, all FRC and MPC specimens demonstrated unfavorable root fractures. The results of this study suggested that RCP prepared with 1-mm ferrule was the most desirable restoration for structurally compromised roots, as relatively strong resistance to cyclic fatigue and fracture was revealed--given that all RCP specimens demonstrated favorable root fracture.

Background: The reactive correction of a single tooth anterior crossbite following periodontal therapy is described. This case report provides new information regarding correction of a crossbite relationship and con- firms existing reports of tooth movement following periodontal therapy., Methods: A 39-year-old woman in good general health presented with a history of recurrent periodontal abscesses of a maxillary incisor. Probing depths of the abscessed tooth ranged from 5 to 12 mm, and class 1 mobility was noted. Radiographs revealed that the tooth had previously been treated endodontically. The patient's periodontal diagnosis was generalized chronic moderate to severe periodontitis. Treatment considerations were complicated by a single-tooth crossbite relationship of the involved incisor and clinical evidence that the periodontal abscess communicated with an apical infection. Treatment of the abscess consisted of cause-related therapy, bone grafting, and occlusal adjustment., Results: Five months after surgical treatment, an edge-to-edge incisal relationship was observed, the first indicator of tooth movement. Further correction to a normal incisal relationship resulted 1 year after modification of the proximal contact. At this time, there was normal probing depth with only slight recession and mobility. Bone fill was radiographically noted., Conclusion: It appears that some cases of maxillary incisor crossbite that are complicated by periodontal disease may be corrected, without orthodontic appliances, following periodontal treatment.

Primary teeth and the permanent successors must be understood as interdependent units, where each one of them interacts with and depends on each other. Pulpal inflammation/infection of a primary tooth and the spread of this condition over the periradicular tissues can lead to alterations in the dental germ of the permanent successor and to the surrounding structures if no therapy is done, i.e. endodontics or extraction. This work will present cases of permanent teeth that showed alteration in eruption and / or in development, as a consequence of inflammation / infection of the preceding primary teeth, such as: hypoplasia, morphological alteration on the dental crown or total arrest of. radicular formation. The teeth analysed in this study belong to patients who attended the Universidade Federal de Santa Catarina Children's Dentistry Clinic. The earlier these lesions are diagnosed, the less were the destructive effects and the consequences on the primary tooth/permanent germ unit.

General dentists should realize that endodontic failures can be retreated successfully, avoiding tooth loss. Retreatment of endodontic failure and initial root canal therapy share similar biologic principles and treatment objectives. The criteria for successful root canal therapy are important factors that must be understood before teeth are retreated. This article demonstrates three retreatment modalities for managing endodontic failures as an alternative to tooth extraction.

The present study was performed to compare the incidence of endodontic flare ups in single with multiple visits treatment procedures, to establish the relationship between pre-operative and post obturation pain in patients attending for endodontic therapy in a Nigerian teaching Hospital. Patients were randomly assigned to either single visit or multiple visits group. Data collected at root canal treatment appointment and recall visits (1st, 7th and 30th day post obturation) include pulp vitality status, the presence or absence of pre-operative pain, presence and degree of post obturation pain. Presence of endodontic flare-ups (defined as either patient's report of pain not controlled with over the counter medication and or increasing swelling). The compiled data were analyzed using chi-square where applicable. P level < 0.05 was taken as significant. Ten endodontic flare-ups (8.1 %) were recorded in the multiple visits group compared to 19 (18,3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visits procedures, there were statistically significant correlations between pre operative and post obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post obturation pain (48.8%), while those with non vital pulps were found to have the highest frequency oh post obturation pain (50,3%), P = 0.9. Although the present study reported higher incidences for post obturation pain and flare-ups following the single visit procedures, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visits treatment.

Aim: To determine any patient, technique or material factors that were significantly associated with post fracture in metallic post systems., Summary: Eighty-five fractured metal posts were retrieved over a 5-year period from a total of 84 patients who attended a dental hospital for treatment. A record was kept of the patient's dentition to identify the tooth with the fractured post, the number of teeth present, the excursive guidance scheme and the likely post design and material. Radiographs of 67 of these teeth were available. The presence or absence of a periapical lesion was noted as was the quality of the root filling. Maxillary lateral incisors, followed by maxillary centrals were associated with most of the fractured posts. The median survival to fracture was 36 months. The number of teeth in the dentition had a mode of 28. The most commonly fractured post design was a serrated and parallel design with an average diameter of 1.2 mm at the site of fracture. Apical lesions were found in 67% of the teeth with radiographs. Only 12% of teeth with a 'good' apical filling as opposed to 55% with a 'poor' apical filling had apical lesions., Key Learning Points: . Maxillary lateral incisors, followed by maxillary central incisors are at greatest risk of having a fractured metallic post. . Having a large number of teeth in the dentition or an adequate length of post was not protective against metallic post fracture. . Teeth with fractured post-retained crowns had a high incidence of apical lesions., (Copyright 2004 International Endodontic Journal)

A 57-year-old woman sought treatment for mandibular swelling (of two weeks duration), pain, and paresthesia in the region of the left canine and first premolar. The teeth had undergone endodontic therapy; in addition, they partially supported a long-span fixed partial denture. The patient was concerned about the possibility of a serious neoplastic condition. The initial panoramic radiograph demonstrated a large periapical pathology area associated with the first premolar. Eventually, both the canine and first premolar teeth were retreated, although the paresthesia did not resolve for approximately four months. A brief review of endodontic-associated paresthesia is provided, along with a description of the therapy and postoperative radiographs taken 20 months later.

Purpose: This article presents a review of the literature on biomechanical factors affecting the treatment outcome of prosthetic treatment of structurally compromised dentitions, with the main emphasis on often-compromised endodontically treated teeth., Materials and Methods: Articles cited in a MEDLINE/PubMed search were reviewed with a focus on factors influencing the risk for fatigue failures., Results: Technical failures in connection with fixed prosthodontics are often caused by fatigue fractures. The abutments, cement, and reconstruction are all subjected to stress caused by occlusal forces, and fatigue fracture may occur at the weakest point or where the maximum stress occurs. The weakest point is frequently in connection with endodontically treated teeth restored with posts and cores., Conclusion: The literature points to nonaxial forces as a risk for fatigue fracture of teeth, cement, and restorative material. Favorable occlusal prosthesis design is probably more important for survival of structurally compromised endodontically treated teeth than is the type of post used.

This article presents a case report of radicular cyst associated with an endodontically treated deciduous second molar causing displacement of the permanent successor, with accompanying buccal expansion. Cystic sac was removed surgically along with the involved tooth under general anesthesia. Healing was uneventful. Histopathologically the cystic sac was consistent with the features of radicular cyst. Unusual amorphous, eosinophilic, atubular material incorporated within the cystic epithelium was observed.

Objective: To assess the effect of rehabilitation of flared root canal on the fracture resistance of root and post-core system., Methods: Thirty-two simulated tooth roots made of polymethyl methacrylate were divided into 4 groups, including the normal root canal group and 3 flared root canal groups. One flared root canal group was rehabilitated by light-cared composite, another group was rehabilitated by amalgam, and the third flared root conal group was not treated. Casting post and core restored every simulated tooth root. Each specimen was embedded in acrylic resin and then fixed in a special jig on the universal load-testing machine. A compressive load was applied at a 90-degree angle to the long axis of the core until fracture, at a crosshead speed of 1 mm/min; the maximum of load was recorded., Results: The means of load in normal root canal group, light-cared composite rehabilitated group, amalgam rehabilitated group, not treated group were 202.92 N, 194.60 N, 146.89 N, 142.09 N. It was shown that the load of normal root canal group is significantly greater than the load of not-treated group (P < 0.01); the light-cared composite rehabilitated group is significantly stronger than the not-treated group (P < 0.01), but there is no significant difference between the light-cared composite rehabilitated group and normal root canal group, and no significant difference between the amalgam rehabilitated group and not-treated group (P > 0.05)., Conclusion: The rehabilitation of flared root canal using suitable material not only changes the shape of root canal, but also increases the fracture resistance of root canal because of its thicker and stronger root canal wall which obviously improves the fracture resistance of post and core.

- A case of severe crown fracture and luxation in the upper permanent incisors of a 9-year-old boy is reported. The treatment of one of the injured teeth included apexification with calcium hydroxide and endodontic treatment with gutta-percha obturation. The other incisor was also treated with calcium hydroxide, but as there was no apical stop after 3 years of treatment, it was decided to use a new root-end filling material: mineral trioxide aggregate (MTA). At follow-up 12 months later, the tooth was asymptomatic and radiographically showed the initial repair of the radiolucent apical lesion.

Objective: The purpose of this study was to evaluate the fracture resistance and the mode of failure of endodontically treated teeth restored with four post-and-core systems., Method and Materials: Forty intact human incisors were randomly divided into four groups. Teeth from each group received endodontic therapy and one of four post-and-core systems: serrated, parallel-sided, cast post and core; serrated, parallel-sided, prefabricated post and resin-composite core; carbon-fiber-reinforced (CFC) post and resin-composite core; and ceramic post and resin-composite core. A full-coverage metal crown was fabricated and cemented onto each tooth. Each specimen was subjected to a compressive load at a 45-degree angle to its axis until failure. The failure load was recorded and compared statistically. The mode of failure of the specimens was analyzed., Results: There was no significant difference in the failure loads among groups. More catastrophic root fracture was detected in the group restored with ceramic posts and resin-composite cores., Conclusion: The fracture resistance of endodontically treated teeth restored with these four post-and-core systems could be accepted clinically. Unfavorable tooth fracture was shown in all groups.

Background: Early detection and management of vertical root fractures, or VRFs, remain a vexing issue that has caused needless suffering for patients as well as for dentists. The authors present techniques to aid the dentist in recognizing VRFs., Methods: During a five-year period, the authors examined 36 patients who had VRFs. Absent control subjects and a larger number of patients, the authors did not design this investigation for statistical analysis. They diagnosed VRFs through dental histories and clinical and radiographic examinations., Results: The study revealed VRFs in 36 teeth, two of which were vital and 34 of which were nonvital (that is, endodontically treated). The 34 VRFs resulted from excessive operative procedures performed in the root canal after endodontic therapy. Thirty-one of these 34 VRFs were caused by poorly designed dowels (too long, too wide or both) or inappropriate selection of the tooth as a bridge abutment; two VRFs were caused by a restoration that exerted lateral pressure on the axial walls of the preparation; and one VRF was caused by overzealous endodontic forces. The VRFs in the two vital teeth were in men who had a history of bruxism or clenching., Conclusions and Clinical Implications: VRFs can be detected early by listening to the patient's chief complaints, carefully examining periapical and bitewing radiographs and performing a thorough clinical examination.

Objective: To perform a systematic literature review and meta-analysis on the effectiveness of interventions used in the emergency management of acute apical periodontitis in the permanent dentition., Methods: Electronic databases were searched from their inception to 2001. These searches, combined with manual searching, yielded 1,097 citations, of which 92 were relevant. Independent application of inclusion criteria by 2 teams of reviewers yielded 15 eligible randomized controlled trials. Data on population, interventions, outcomes (pain relief or change in intensity of pain as reported by patients or clinicians) and methodological quality were determined by independent duplicate review. Disagreements were resolved by consensus., Results: Meta-analysis showed that pre-emptive analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs]) in conjunction with pulpectomy provided a significant benefit (weighted mean difference -11.70, 95% confidence interval -22.84 to -0.56). Three interventions did not show significant benefit: systemic antibiotics, intracanal treatment with a steroid-antibiotic combination, and trephination through attached gingiva., Conclusions: In the management of pain associated with acute apical periodontitis, there is strong evidence to support the use of systemic NSAIDs in conjunction with nonsurgical endodontics. The use of antibiotics is not recommended.

This is a case study of an inflammatory follicular cyst associated with an endodontically treated deciduous molar with radiographic and microscopic diagnosis. This cystic lesion represents a typical follicular cyst that arose in association with periapical inflammation from a non-vital deciduous molar and involved the follicle of the unerupted successor premolar. This paper describes the case and discusses diagnosis, histogenesis, and controversies regarding terminology.

Every patient's description of the location of pain must be treated with caution. In order to arrive at a diagnosis of pain a logical method should be employed. This consists of the history and clinical examination including pulp tests and radiographs. Where the patient complains of pain on hot or cold, an attempt should be made to reproduce the patient's pain to check on the accuracy of its description and to aid in localisation. Patients frequently refer pain to previously endodontically-treated teeth. These may not be the cause of the problem. In order to facilitate the process of diagnosis the following hypothesis has been advanced. A tooth can only be the source of pain if there are objective signs associated with that tooth. Lack of response to pulp tests constitutes such a sign, provided the tooth has not previously been endodontically treated. If, however, such treatment has taken place, (regardless of whether this was well or poorly executed), a further objective sign other than lack of vitality is required before such a tooth can be implicated as the source of pain. The guidelines suggested are illustrated by means of clinical examples.

Background: The authors present two case reports of patients exhibiting pyogenic granulomas in the maxillary labial mucosa, which were related to an apical fenestration of a primary incisor., Case Descriptions: Several researchers have reported that the gingival wound and surrounding inflammatory tissue typically heal spontaneously after extraction of a fenestrated primary tooth. However, in the cases presented here, the gingival lesion did not heal after the fenestrated teeth were extracted., Clinical Implications: After extracting fenestrated teeth, clinicians need to examine the labial area at a follow-up appointment to ensure that the gingival hyperplasia heals properly. The authors suggest performing curettage of the surrounding abnormal tissue at the time of the tooth extraction.

The aim of this study was to compare vertical forces at fracture of endodontically treated mandibular incisors obturated with different types of root canal sealer. Four groups of 10 teeth each were tested; group 1 served as positive and negative controls (five teeth each), and groups 2, 3, and 4 were obturated by lateral condensation with gutta-percha and AH Plus, Tubliseal, or Ketac-Endo, respectively. All teeth were loaded vertically using a plugger tip inserted into the canal space until fracture occurred; the load at fracture and the pattern of fracture were recorded. Statistical analysis was performed using a one-way analysis of variance and post hoc Scheffé test at the 95% level of confidence. Force at fracture of roots obturated with Ketac-Endo was significantly higher than those obturated with AH Plus and Tubliseal. Most fracture lines were in a buccolingual direction. The results suggested that Ketac-Endo strengthens endodontically treated roots and may be used for weak roots, which are likely to be susceptible to vertical root fracture.

Aim: The present study tested the hypothesis that having two proximal contacts (PCs) at access is associated with improved survival of root canal treated (RCT) teeth, controlling for important presenting conditions, endodontic variables and restorative factors., Methodology: A treatment database at the University of Iowa College of Dentistry was used to identify permanent teeth undergoing obturation between 1 July 1985 and 31 December 1987. The list was restricted to teeth of patients with at least one dental visit in each two-year interval from 1985 to 1996, and a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 221 teeth satisfying study inclusion criteria. Multivariate Cox models were developed, with standard errors adjusted to account for clustering of teeth within patients., Results: The final Cox model showed that teeth with < or =1 PC at access were lost at a rate three times that of teeth with 2 PCs (hazard ratio = 3.1; 95% confidence interval = 1.9-5.1), controlling for tooth type, presence of radiographic caries at access, and presence of a crown before or after obturation., Conclusions: Because RCT teeth with two PCs at access experienced substantially better survival than teeth with fewer than two PCs, the influence of PCs on prognosis should be recognized during treatment planning. Future research should employ prospective study designs, capture additional variables, and provide data to support endodontic treatment decisions.

Aims: The aim of this study was to determine the occurrence and role of yeasts, enteric gram-negative rods and Enterococcus species in root-filled teeth with chronic apical periodontitis, and the antimicrobial effect of iodine potassium iodide (IKI) irrigation., Methodology: Forty symptom-free root-filled teeth with chronic apical periodontitis were included in the study. The patients were divided into two groups. In group A the canals were filled with calcium hydroxide for 10-14 days after cleaning and shaping; in group B the canals were irrigated with IKI for 5 min after cleaning and shaping followed by a permanent root filling. Microbiological samples were taken from the canals before and after the chemomechanical preparation and after iodine irrigation (group B)., Results: Microbes were isolated from 33 of 40 teeth in the initial sampling. Yeasts were isolated from six teeth, three of them together with E. faecalis. Enteric rods (Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis) were present in three teeth and E. faecalis was isolated from 21 of the 33 culture positive teeth, 11 in pure culture. Growth was detected in 10 teeth of the second samples. Six of the 10 cases were E. faecalis, with five being a pure culture. All third samples (after IKI) except one were negative. The number of microbial cells per sample did not correlate with lesion size. Two flare-ups were recorded, both in teeth with a mixed infection., Conclusion: The high prevalence of enteric bacteria and yeasts in root-filled teeth with chronic apical periodontitis was established. IKI improved the antimicrobial effect of the treatment.

Objectives: This study compared the fracture strength and survival rate of endodontically treated crowned maxillary incisors with approximal class III cavities and different core build-ups., Methods: Sixty-four caries free human maxillary central incisors were selected for standardized size and quality, endodontically treated and prepared with approximal cavities 3mm in diameter. Group 1 was restored with titanium posts, group 2 received zirconia posts, in group 3 the root canal was partially filled with a hybrid composite. In the control group, only the access opening was restored. All teeth were prepared for and restored with full cast metal alloy crowns and subsequently exposed to 1.2 million cycles in a computer-controlled chewing simulator with simultaneous thermocycling. In addition, the samples were loaded until fracture in a static testing device., Results: One specimen with composite reinforced root canal did not survive the dynamic load test. The following median fracture strengths in Newtons for the different groups were: titanium post 1038, zirconia 1057, composite resin 750, control (no post) 1171. The fracture load in group 3 (composite resin) was significantly lower (P<0.05) than in the other groups., Conclusions: The reconstruction of endodontically treated single rooted teeth with approximal cavities can be successfully performed by closure of the endodontic and additional cavities with composite. Cementation of endodontic posts offers comparable but no advantageous fracture resistance. Enlargement of the root canal space after completion of endodontic treatment should be avoided and cannot be compensated for by injection of composite resin. Less catastrophic failures were observed without post reconstruction.

Background: Endosseous root-formed implants occasionally fail to osseointegrate. Causes of failure include infection, overheating of the bone, habitual smoking, systemic disease, transmucosal overloading, excessive surgical trauma and implant placement adjacent to teeth demonstrating periapical pathology., Case Description: In this article, the authors present another possible cause of implant failure. The cases of four patients who received endosseous root-formed implants are discussed. Each patient demonstrated signs of infection after initial implant placement. The common factor in each failing implant was its placement adjacent to an asymptomatic endodontically treated tooth with no clinical or radiographic evidence of pathology., Clinical Implications: These patients demonstrate the importance of evaluating and possibly retreating or extracting adjacent endodontically treated teeth before placing implants.