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Introduction: Patient preferences should be taken into account by clinicians when treatment planning. The purposes of this study were to describe the number of visits patients preferred when undergoing root canal therapy (RCT) and to assess whether their preferences were related to hypothetical treatment success rates., Methods: Self-administered questionnaires were mailed to 351 consecutive patients scheduled for initial RCT appointments in the University of Iowa College of Dentistry's graduate or faculty endodontic clinic. The questionnaires ascertained demographic information; preferences for 1-visit versus 2-visit RCT given different hypothetical success rate scenarios for the 2 approaches, as well as patient dental history. Univariate frequency distributions were generated, and relationships between hypothetical success rates and patient preferences were evaluated., Results: Questionnaires were returned by 124 patients (35% response). Given equal success rates, 78% of respondents preferred 1-visit RCT, compared with 7% who preferred 2-visit RCT and 16% who would follow their dentist's recommendation. As success rates for 2-visit RCT went from equal to 5% better to 10% better to 20% better compared with 1-visit RCT, the proportion of respondents who preferred 2-visit RCT increased from 7% to 34% to 46% to 65%, respectively. Regardless of success rates, approximately 5% of respondents said they would prefer 2-visit RCT, and 20% would do whatever their dentist recommended., Conclusions: Although most respondents preferred 1-visit RCT regardless of success rates, many would prefer 2-visit RCT if its success rate were greater than that of 1-visit RCT. This finding confirms the importance of discussing success rates and considering patients' wishes when treatment planning., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The revitalization of a previously necrotic pulp space has been shown to be possible and even considered predictable. However, exact criteria for success are still lacking, and, in fact, some cases do not respond as predicted., Methods: In this case, the same operator treated 2 teeth similarly according to the principles laid out by Banch and Trope. The tooth that according to our expectations was more likely to be revitalized successfully failed to do so, whereas the second tooth that, in our estimation, was less likely to succeed was successful. In the tooth that failed to revitalize, auto-apexification occurred., Conclusions: Complete understanding for the criteria for predictable revitalization and apexification is still lacking., (Copyright © 2012. Published by Elsevier Inc.)

This paper presents clinical protocols for the emergency, early and post treatment complications of the avulsed tooth. The biological basis for these protocols is presented so that the reader understands the clinical decisions that have been made. Most of the protocols described in this article, but not all, have been adopted in the official guidelines of the International Association of Dental Traumatology. Some experimental results are promising and they have therefore been included in the review to stimulate colleagues to further research., (© 2011 John Wiley & Sons A/S.)

Introduction: The effect of endodontic involvement on tooth loss has not been quantified, so the present study aimed to assess this relationship after controlling for other relevant risk factors for tooth loss., Methods: We analyzed data from 791 participants (18,798 teeth) in the Veterans Affairs Dental Longitudinal Study. Potential tooth-level and person-level covariates were fitted into marginal proportional hazards models, including both apical radiolucencies (AR) and root canal therapy (RCT) status as time-dependent variables. Survival curves were plotted for teeth according to their AR and RCT status., Results: Both current AR and RCT status were associated with increased risk of tooth loss (P < .01), after controlling for baseline levels of periodontal disease, caries, tooth type, number of proximal contacts, number of teeth, age, education, and smoking history. Root canal filled (RCF) teeth seemed to have better survival than non-RCF teeth among teeth with AR but worse survival than non-RCF teeth among teeth without AR., Conclusions: Endodontic involvement was associated with tooth loss, controlling for other potential risk factors. Additional prospective studies are needed to provide better evidence as to the impact of endodontic involvement on tooth loss., (Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Traditional methods of treatment of immature root with necrotic pulp and apical periodontitis pose multiple challenges. These challenges include disinfection of the root canal with standard protocols that aggressively use endodontic files, filling the root canal with an open apex that provides no barrier for stopping the root filling material before impinging on the periodontal tissues, and the susceptibility of the teeth to fracture because of their thin roots. Disinfection using sodium hypochlorite, apical barrier formation using calcium hydroxide as well as mineral trioxide aggregate, and pulp revascularization of fractured tooth with the help of blood clot and collagen-enhanced matrix has been discussed in detail in this article., (Copyright 2010 Elsevier Inc. All rights reserved.)

Introduction: Recently, it has been shown that it is possible to treat an immature tooth with an infected pulp space and apical periodontitis in such a way as to heal and promote the ingrown of new vital tissue into the pulp space. However, the type of new-grown tissue is unclear., Methods: Based on the samples of a previously reported study, we further investigated histologically the types of tissues that had grown into the canal space., Results: The canal dentinal walls were thickened by the apposition of newly generated cementum-like tissue termed herein "intracanal cementum (IC)." One case showed partial survival of pulp tissue juxtaposed with fibrous connective tissue that formed IC on canal dentin walls. The IC may also form a bridge at the apex, in the apical third or midthird of the canal. The root length in many cases was increased by the growth of cementum. The generation of apical cementum or IC may occur despite the presence of inflammatory infiltration at the apex or in the canal. These cementum or cementum-like tissues were similar to cellular cementum. Bone or bone-like tissue was observed in the canal space in many cases and is termed intracanal bone (IB). Connective tissue similar to periodontal ligament was also present in the canal space surrounding the IC and/or IB., Conclusions: Our findings explained in part why many clinical cases of immature teeth with apical periodontitis or abscess may gain root thickness and apical length after conservative treatment with the revitalization procedure.

The critical step for successful treatment of an infected root canal system is to treat the root canal in such a way as to remove as many microbes as possible (in the case of a necrotic tooth) or to maintain the sterility of the canal (in the case of a vital tooth); this is called the microbial control phase of root canal treatment. This article describes the steps required for adequate microbial control. The rationale for minimal apical file sizes and irrigation and antimicrobial medicaments required are described in detail.

Objective: In this article, the authors report on an in vivo study in which they assessed the validity of two commonly used cold pulp tests (carbon dioxide [CO(2)]and 1,1,1,2-tetrafluoroethane) and an electrical pulp tester (EPT) in determining pulp vitality by using direct inspection of the pulp as the reference standard., Methods: One hundred fifty patients undergoing endodontic therapy at the University of North Carolina School of Dentistry (Chapel Hill) undergraduate clinic participated in this study. Before routine endodontic treatment, the authors classified participants by means of EPT, CO(2) and tetrafluoroethane as having either vital or necrotic pulps. Students recorded true pulpal status (vital/necrotic) by observing blood within the pulp chamber after an access cavity was made. The authors calculated the sensitivity, specificity and positive and negative predictive values of each test and the test combinations to describe their validity and clinical usefulness., Results: Ninety-seven percent of teeth responding positively to all three tests contained vital pulps, whereas 90 percent of the teeth that failed to respond to any of the tests contained necrotic pulps. Ten percent of the teeth not responding to any of the tests contained vital pulps. For all other combinations of test results, 54 percent of teeth contained vital pulps, and 46 percent contained necrotic pulps., Conclusions: These findings support the use of either of the cold tests and the EPT for diagnosis of pulpal status., Clinical Implications: Cold test and EPT used in conjunction resulted in a more accurate method for diagnostic testing.

This study investigated the effect of potent intracanal corticosteroids on periodontal healing of replanted avulsed teeth and evaluated the systemic absorption of these corticosteroids. Sixty-seven extracted dog premolar roots were randomly assigned to one of the following groups: groups 1-3 filled with gutta-percha and replanted immediately and after 40 and 60 minutes, respectively; groups 4 and 5 filled with 0.05% clobetasol; and groups 6 and 7 filled with 0.05 % fluocinonide. Groups 4 and 6 were replanted after 40 minutes and groups 5 and 7 after 60 minutes. After 4 months, roots were evaluated histologically for signs of periodontal healing. Roots treated with clobetasol and fluocinonide healed more favorably than roots filled with gutta-percha and were different from each other at 60 minutes. No change in the systemic corticosteroid blood concentration was observed in any group. Corticosteroids were efficacious in the beagle model as intracanal medicaments for promoting favorable postavulsion periodontal healing.

The purpose of this study was to assess the healing of periapical tissues using three different materials (IRM [L.D. Caulk Inc, Dentsply International Inc, Milford, DE], Geristore [Den-Mat, Santa Maria, CA], and MTA [ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK]) after endodontic microsurgery in an animal model. Using beagle dogs as a study model, 48 bicuspids were accessed, instrumented, and intentionally infected. The surgical procedures were performed after 30 days following the radiographic confirmation of periapical radiolucencies. The root canals were still infected and had no disinfection procedure carried out. The root ends were resected, retrograde preparations were completed, and the experimental materials were placed under surgical operating microscopy. After a period of 6 months, digital radiographic images of the periradicular areas were taken. The samples were prepared for histologic evaluation. Although Geristore showed no radiographic difference when compared with the other groups, it showed the least favorable healing in the histologic evaluation. Our histologic and radiographic results showed no statistical difference between MTA and IRM.

Porphyromonas gingivalis and Fusobacterium nucleatum are often coisolated from sites of infection, such as suppurative apical periodontitis. The synergistic pathogenicity of mixed infection of P. gingivalis HG 405 with F. nucleatum PK 1594 was studied in the mouse subcutaneous chamber model in groups of seven animals. The minimal dose for P. gingivalis HG 405 that was required to infect 100% of the chambers was reduced by 1,000-fold when animals were inoculated in the same chamber with 1 x 10(9)F. nucleatum PK 1594 (p < 0.001). To benefit from the presence of the fusobacteria, P. gingivalis HG 405 had to be coinoculated; inoculation in separate chambers for the same animal had no such effect (p < 0.001). Subinfective F. nucleatum inocula also benefited from the association with P. gingivalis HG 405 and uniformly established an infection when this partner was present (p < 0.001). These results suggest that the frequent and natural coexistence of P. gingivalis and F. nucleatum in diseased sites may express such a synergism in successful establishment and survival of small inocula.

We evaluated the association between radiographically assessed extension and density of root canal fillings and postoperative apical radiolucencies (ARs) by using data from 288 participants in the Veterans Affairs Dental Longitudinal Study. Study subjects were not Veterans Affairs patients; all received their medical and dental care in the private sector. Generalized estimating equations were used to account for multiple teeth within subjects and to control for covariates of interest. Defective root filling density was associated with increased odds of postoperative AR among teeth with no preoperative AR (odds ratio, 3.0; 95% confidence interval [CI], 1.3-7.1), although preoperative AR was the strongest risk factor for postoperative AR (odds ratio, 29.2; 95% CI, 13.6-63.0 among teeth with ideal density). Compared with well-extended root fillings, neither overextended nor underextended root fillings separately were related to postoperative AR, but when those 2 categories were collapsed into one poorly extended category, poor extension was related to postoperative AR (odds ratio, 1.8; 95% CI, 1.1-3.2).

The regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. However, our improved understanding of pulpal inflammation and repair and improved dental materials and technologies make vital pulp therapy a viable alternative to root canal treatment. This article explores our knowledge in this regard and the future potential of saving or even regenerating the pulp as a routine dental procedure.

The purpose of this study was to evaluate the clinical outcomes of root canal treatment in private practice and filled with Resilon. Immediate postoperative radiographs were compared to follow-up radiographs of at least 1 year in 82 randomly selected primary endodontic cases treated according to a nonstandardized protocol but root-filled with Resilon. The Periapical Index (PAI) and the Clinical Impression of Healing (CIH) quantification procedures were used to determine the status and change in the condition of the teeth. The PAI evaluation revealed that 90% of the teeth that were healthy at the initial reading (PAI, 1or 2) maintained the condition at follow-up evaluation. Of those teeth that were unhealthy (PAI, 3-5) at the initial reading, 73.3% were judged healthy (50%) or improved (23.3) at the last evaluation. In contrast, the proportion of healthy or healing with the CIH evaluation was 89.4%. The findings of this study support the contention that regardless of treatment protocol, healing rates for Resilon-filled teeth in private practice were within the range of success rates for studies with uniform treatment techniques mostly in university settings with gutta-percha root filling.

This study evaluated the clinical efficacy of 2% chlorhexidine (CHX) gel on intracanal bacteria reduction during root canal instrumentation. The additional antibacterial effect of an intracanal dressing (Ca[OH](2) mixed with 2% CHX gel) was also assessed. Forty-three patients with apical periodontitis were recruited. Four patients with irreversible pulpitis were included as negative controls. Teeth were instrumented using rotary instruments and 2% CHX gel as the disinfectant. Bacterial samples were taken upon access (S1), after instrumentation (S2), and after 2 weeks of intracanal dressing (S3). Anaerobic culture was performed. Four samples showed no bacteria growth at S1, which were excluded from further analysis. Of the samples cultured positively at S1, 10.3% (4/39) and 8.3% (4/36) sampled bacteria at S2 and S3, respectively. A significant difference in the percentage of positive culture between S1 and S2 (p < 0.001) but not between S2 and S3 (p = 0.692) was found. These results suggest that 2% CHX gel is an effective root canal disinfectant and additional intracanal dressing did not significantly improve the bacteria reduction on the sampled root canals.

This study examined the ability of a collagen solution to aid revascularization of necrotic-infected root canals in immature dog teeth. Sixty immature teeth from 6 dogs were infected, disinfected, and randomized into experimental groups: 1: no further treatment; 2: blood in canal; 3: collagen solution in canal, 4: collagen solution + blood, and 5: negative controls (left for natural development). Uncorrected chi-square analysis of radiographic results showed no statistical differences (p >or= 0.05) between experimental groups regarding healing of radiolucencies but a borderline statistical difference (p = 0.058) for group 1 versus group 4 for radicular thickening. Group 2 showed significantly more apical closure than group 1 (p = 0.03) and a borderline statistical difference (p = 0.051) for group 3 versus group 1. Uncorrected chi-square analysis revealed that there were no statistical differences between experimental groups for histological results. However, some roots in each of groups 1 to 4 (previously infected) showed positive histologic outcomes (thickened walls in 43.9%, apical closure in 54.9%, and new luminal tissue in 29.3%). Revascularization of disinfected immature dog root canal systems is possible.

Objective: The objective of this study was to compare the in vitro antimicrobial activity of 2% chlorhexidine gel against Enterococcus faecalis with sodium hypochlorite in 2 different concentrations (1.5% and 5.25%)., Study Design: Eighty human lower premolars with single root canals were prepared, autoclaved, and infected for 7 days with E. faecalis monocultures. The roots were then separated into 5 experimental groups according to the irrigant solution used during the standardized preparation. To assess the antimicrobial action of the irrigant solutions, 3 microbial samples were taken: S1--initial (before the biomechanical preparation), S2--posttreatment (immediately after the biomechanical preparation), and S3--final (7 days after the biomechanical preparation). The microbiological samples were plated to count the colony-forming units (CFU)., Results: The 2% chlorhexidine gel and 5.25% sodium hypochlorite significantly reduced the E. faecalis CFU in the posttreatment and final microbiological samples. The 1.5% sodium hypochlorite also reduced the E. faecalis CFU immediately after the root canal instrumentation, but the E. faecalis CFU increased in the final sample showing no statistical difference from the control group., Conclusion: The 2% chlorhexidine gluconate gel and 5.25% sodium hypochlorite were effective in eliminating E. faecalis even 7 days after the instrumentation; moreover, the higher the concentration of sodium hypochlorite the better its antimicrobial action.

Enterococcus faecalis is frequently recovered from refractory endodontic infections and has been implicated in endodontic treatment failures. This study compared real-time quantitative PCR (qPCR) assay to cultivation for E. faecalis detection and quantitation during endodontic treatment. A reverse-transcription PCR (RT-PCR) assay was also developed to detect the bacterium clinically in the viable but nonculturable (VBNC) state. Intra-canal samples (n = 87) were collected upon access, post-instrumentation/irrigation and postcalcium hydroxide treatment from 15 primary and 14 refractory infections involving 29 single-rooted teeth, and analyzed by the three methods. The bacterium was up to three times more prevalent in refractory than primary infections at each collection step. Overall, qPCR detected significantly more E. faecalis-positive teeth and samples than cultivation (p < 0.001). VBNC E. faecalis was detected by RT-PCR in four samples that were negative by cultivation. These findings support qPCR and RT-PCR as more sensitive methods than cultivation for detecting E. faecalis in endodontic infections.

Gutta-percha (G) and sealer do not resist coronal leakage. In this study, the effect of orifice plugs using dentin-bonding/composite resin(C) or IRM on coronal leakage was evaluated in vivo. Sixty-one premolar roots in three beagle dogs were instrumented and filled with G and AH 26(S), or G alone. The coronal 2 mm was replaced with C or IRM, or left untreated. The access cavities were kept open for 8 months, the dogs were killed and the periapical regions of the roots were histologically examined. Periapical inflammation was observed in 89% of the group without plugs, but in those with plugs, the occurrence was decreased to 39% (C + G + S), 38% (IRM + G + S) and 58% (C + G), respectively. Furthermore, severe inflammation was observed in 50% of the former group but only 0 to 17% of the latter. The substantial reduction in apical periodontitis by the use of coronal plug underscores the clinical importance of providing an additional barrier to coronal leakage in comparison to that provided by gutta-percha and sealer alone.

This study compared the remaining filling material and working time when removing gutta-percha/AH 26 and Resilon/Epiphany from root filled extracted teeth. The root fillings were removed using chloroform and two different rotary systems (K3 and Liberator files). The amount of residual filling material on the canal walls was imaged and measured using image analyzer software. The group filled with Resilon/Epiphany and retreated with K3 files demonstrated the least residual filling material on the walls (p < 0.05). There was no statistically significant difference between the gutta-percha/AH26 and Resilon/Epiphany groups when the Liberator files were used (p > 0.05). In the groups filled with Resilon/Epiphany, the filling was removed faster than groups filled with gutta-percha/AH 26 (p < 0.05). K3 rotary system was faster than Liberator to remove both gutta-percha and Resilon (p < 0.05). Resilon/Epiphany was effectively removed with K3 or Liberator rotary files.

The objective was to evaluate the clinical efficacy of chemomechanical preparation of the root canals with sodium hypochlorite and interappointment medication with calcium hydroxide in the control of root canal infection and healing of periapical lesions. Fifty teeth diagnosed with chronic apical periodontitis were randomly allocated to one of three treatments: Single visit (SV group, n = 20), calcium hydroxide for one week (CH group n = 18), or leaving the canal empty but sealed for one week (EC group, n = 12). Microbiological samples were taken to monitor the infection during treatment. Periapical healing was controlled radiographically following the change in the periapical index at 52 wk and analyzed using one-way ANOVA. All cases showed microbiological growth in the beginning of the treatment. After mechanical preparation and irrigation with sodium hypochlorite in the first appointment, 20 to 33% of the cases showed growth. At the second appointment 33% of the cases in the CH group revealed bacteria, whereas the EC group showed remarkably more culture positive cases (67%). Sodium hypochlorite was effective also at the second appointment and only two teeth remained culture positive. Only minor differences in periapical healing were observed between the treatment groups. However, bacterial growth at the second appointment had a significant negative impact on healing of the periapical lesion (p < 0.01). The present study indicates good clinical efficacy of sodium hypochlorite irrigation in the control of root canal infection. Calcium hydroxide dressing between the appointments did not show the expected effect in disinfection the root canal system and treatment outcome, indicating the need to develop more efficient inter-appointment dressings.

Increased levels of systemic inflammatory markers have been observed in patients with chronic dental diseases, such as marginal periodontitis. A canine model was used to determine if a systemic inflammatory response was evident during chronic apical periodontitis (CAP). Dental pulps in 10 dogs were exposed and infected with dental plaque to induce CAP. Blood samples were drawn preoperatively and postinfection when CAP was seen radiographically. In three of the 10 dogs, an intravenous challenge of Porphyromonas gingivalis A7436 was given subsequent to the development of CAP. An ELISA assay was used to measure the levels of C-reactive protein (CRP) and serum amyloid A (SAA) as markers of systemic inflammation. During CAP the levels of CRP and SAA were not statistically different from the preoperative values as determined by the Friedman test (p < 0.05). One dog, which had an unplanned trauma-induced laceration of the paw 2 days before blood sampling, showed a 40-fold increase in CRP. The 3 dogs challenged by intravenous P. gingivalis A7436 showed elevated levels of CRP, consistent with an acute phase response. These data demonstrate that the canine model provides a useful means for studying the systemic effects of apical periodontitis, and show that CAP is not associated with elevated CRP or SAA.

This study assessed the efficacy of a triple antibiotic paste in the disinfection of immature dog teeth with apical periodontitis. The canals were sampled before (S1) and after (S2) irrigation with 1.25% NaOCL and after dressing with a triple antibiotic paste (S3), consisting of metronidazole, ciprofloxacin, and minocycline. At S1, 100% of the samples cultured positive for bacteria with a mean CFU count of 1.7 x 10. At S2, 10% of the samples cultured bacteria-free with a mean CFU count of 1.4 x 10. At S3, 70% of the samples cultured bacteria-free with a mean CFU count of only 26. Reductions in mean CFU counts between S1 and S2 (p < 0.0001) as well as between S2 and S3 (p < 0.0001) were statistically significant. These results indicate the effectiveness of a triple antibiotic paste in the disinfection of immature teeth with apical periodontitis.

This study was conducted to determine the bacterial reduction using Profile GT files and a strict irrigation protocol utilizing 5.25% NaOCl and EDTA. The additive antibacterial effect of Ca(OH)2 was also evaluated. In addition, the study compared the bacterial reduction with the GT protocol versus larger instrumentation. Thirty-one subjects with apical periodontitis were recruited. Bacterial samples were taken upon access (S1), after instrumentation and a strict irrigation protocol (S2), and following >1 wk of Ca(OH)2 (SC). A log10 transformation of colony forming units was done since sample bacterial counts are not normally distributed. At S1, 93.55% of canals sampled bacteria. At S2, 52.72% of the cases sampled bacteria. At SC, 14% of the cases cultured bacteria. The McNemar test showed a significant reduction (p<0.0009) in bacteria between S1 and S2. This was also true between S2 and SC (p<0.0019). It was concluded the GT protocol significantly reduced the number of bacteria in the canal but failed to render the canal bacteria free in more than half of the cases Ca(OH)2 application significantly further reduced bacteria. Lastly, large apical instrumentation removed more bacteria than small apical instrumentation.

Objective: The dentin pH at different sites following placement of calcium hydroxide paste using 2 different methods was evaluated., Study Design: One hundred twenty Extracted teeth were instrumented and randomly divided into 6 different groups. Then they were dressed with calcium hydroxide by 2 different methods using paper points or Lentulo spiral, according to their respective groups, and stored. After the experimental period of time, half of the samples were cut transversally into slices and the other half split longitudinally and rinsed with distilled water. The dentin pH of cervical, middle, and apical thirds was measured from the root canal wall surface and 1 mm away from the root canal lumen in the inner dentin. The results were compared and statistically analyzed., Results: The highest pH values were obtained on the root canal walls when the calcium hydroxide was placed with Lentulo spiral filler (P > .05). There was a significant reduction in pH values in the inner dentin. When the cross sections of teeth were compared at 7 days, the Lentulo group was statistically different only in the apical third., Conclusions: Placement of the calcium hydroxide paste with a Lentulo spiral with subsequent compaction with the blunt end of a sterile paper point obtained a higher pH value on the canal walls and in the inner dentin than paper points only.

A dog model was used to assess and compare in vivo the efficacy of gutta-percha and AH26 sealer versus Resilon with Epiphany primer and sealer [Resilon "Monoblock" System (RMS)] filled roots in preventing apical periodontitis subsequent to coronal inoculation with oral microorganisms. There were 56 vital roots in the premolars of seven adult beagle dogs aseptically instrumented, filled, and temporized. The roots were randomly divided into four experimental groups (Coronal Leakage Model) and one negative control group and filled as follows: group 1-lateral condensation of gutta-percha and AH26 sealer (n=12); group 2-vertical condensation of gutta-percha and AH26 sealer (n=12); group 3-lateral condensation of RMS (n=12); group 4-vertical condensation of RMS (n=10); negative control (n=10)-gutta-percha and AH26 sealer or RMS root fillings using lateral or vertical condensation techniques as in groups 1 to 4. Positive control-57 additional premolar roots were instrumented, infected and not filled (beginning of the Entombment Model experiment). The premolars in groups 1 to 4 were accessed again, inoculated with dental plaque scaled from the dog's teeth, and temporized. This fresh innoculum of microorganisms was repeated on two more occasions at monthly intervals. The teeth in the negative control group were not accessed again and remained undisturbed. On the 14-wk postcoronal inoculation, dogs were euthanized, and jaw blocks prepared for histologic evaluation under a light microcope. Mild inflammation was observed in 82% (18 of 22) of roots filled with gutta-percha and AH26 sealer that was stastistically more than roots filled with RMS (19% or 4 of 21) and roots in the negative control (22% or 2 of 9) (McNemar paired analysis, p < 0.05). The Resilon "Monoblock" System was associated with less apical periodontitis, which may be because of its superior resistance to coronal microleakage.

Background: Extraction and endodontic therapy are treatment options for irreversible pulpitis. Extraction often is chosen for financial reasons. The authors conducted a study to investigate an alternative interim therapy., Methods: The authors recruited patients (N = 73) with irreversible pulpitis and whose teeth were restorable but who opted for extraction owing to financial reasons. After undergoing pulpotomy, the teeth were restored by random assignment with one of two intermediate restorative materials: Caulk IRM (Dentsply Caulk, Milford, Del.) (Group I, n = 38) or an IRM base with glass ionomer core (Fuji IX GP, GC America, Alsip, Ill.) (Group II, n = 35). The authors monitored the teeth over six and 12 months for pain, integrity of restoration and radiographic periapical status by densitometric analysis., Results: By six months, 10 percent of subjects remaining in the study (Group I, n = 27; Group II, n = 25) reported pain; by 12 months, 22 percent (Group I, n = 22; Group II, n = 18) reported pain. A two-tailed Fisher exact test showed no significant difference (P > or = .05) between groups at either time interval. No apical radiographic change was noted in 49 percent of teeth at six months (Group I, n = 18; Group II, n = 19) and 42 percent at 12 months (Group I, n = 16; Group II, n = 15). Chi2 analysis demonstrated no significant differences (P > or = .05) between groups. Seven of 22 restorations in Group I and four of 18 in Group II required repair at 12 months with no statistical difference (chi2 analysis, P > or = .05)., Conclusions: The interim treatment of eugenol pulpotomy using either restorative material reliably prevented pain for six months. For longer periods, both restorations may require repair., Clinical Implications: This option should preserve the integrity of the arch and extend the use of the tooth while the patient finds the means to finance complete endodontic treatment.

Background: The authors evaluated the fracture resistance of endodontically treated teeth filled with either gutta-percha or a new resin-based obturation material., Methods: The authors prepared and randomly divided 80 single-canal extracted teeth into five groups: lateral and vertical condensation with gutta-percha, lateral and vertical condensation with the new resin-based obturation material, and a control group with no filling material. The specimens were stored in 100 percent humidity for two weeks, mounted in polyester resin and loaded to failure., Results: The authors found statistically significant differences among the experimental groups (P < .05). The groups with the new material displayed higher mean fracture loads and the gutta-percha groups lower mean fracture load values than the control unfilled group. However, the differences were not significant. The groups with the new material displayed significantly higher mean fracture loads than gutta-percha groups independent of the filling technique used., Conclusions: Filling the canals with the new resin-based obturation material increased the in vitro resistance to fracture of endodontically treated single-canal extracted teeth when compared with standard gutta-percha techniques. CLINICAL IMPLICATIONS; If other properties of the new resin-based obturation material compare favorably with those of gutta-percha for filling the root canal, it should be considered as a replacement for gutta-percha, as the results of this study indicate that it could provide enhanced resistance to tooth fracture.

A new technique is presented to revascularize immature permanent teeth with apical periodontitis. The canal is disinfected with copious irrigation and a combination of three antibiotics. After the disinfection protocol is complete, the apex is mechanically irritated to initiate bleeding into the canal to produce a blood clot to the level of the cemento-enamel junction. The double seal of the coronal access is then made. In this case, the combination of a disinfected canal, a matrix into which new tissue could grow, and an effective coronal seal appears to have produced the environment necessary for successful revascularization.

Coronal microbial leakage is an important cause of apical periodontitis and thus should be prevented if possible. The purpose of this study was to compare microbial leakage of new and standard obturation techniques over a 30-day period. A split chamber microbial leakage model was used in which Streptococcus mutans placed in the upper chamber could reach the lower chamber only through the obturated canal. Leakage was assessed every day for 30 days. One hundred forty single-rooted human teeth were used in this study, equally split between lateral, vertical, and Obtura II condensation; SimpliFill with Obtura II condensation; FibreFill; and a combination of FibreFill and SimpliFill. Cochran-Mantel-Haenszel row mean score statistics showed a high statistical significance when all groups were compared (p < 0.0001). Microbial leakage occurred more quickly in lateral and vertical condensation techniques compared with SimpliFill and FibreFill techniques. A combination of an apical plug of gutta-percha with SimpliFill and a FibreFill coronal seal was the best obturation technique used (SimpliFill-FibreFill group).

The aim of this study was to determine the relationship between histologic and radiologic signs of inflammation in human root-filled teeth. In addition, other factors with possible importance for apical inflammation were assessed. Fifty-three block sections of root-filled teeth were gathered from human cadavers. The blocks were radiographically exposed, sectioned, and stained with hematoxylin and eosin. Histologic sections were categorized as inflamed or uninflamed. Radiographically, the roots were assigned as apical lucency, widened periodontal ligament (PDL), or no lucency. Presence and contents of accessory canals were recorded (empty, tissue, or filling material). Statistical analysis was performed with the Chi-square test. All roots had accessory canals; 12 showed tissue remnants, and the others were empty. Of the cases, 49% were histologically uninflamed at the apex, and 52% appeared radiographically intact. The odds ratio of finding a histologically inflamed apex with radiologic lucency versus a radiographically intact apex was 9.2 (p = 0.002). The odds ratio of finding a histologically uninflamed apex with a radiologically tight coronal seal versus an unacceptable seal was 3.7 (p = 0.053). It may be concluded that there are relationships between radiologic and histologic signs of inflammation in human root canal-treated teeth. There appears to be a tendency that the radiologically determined quality of the coronal seal has an impact on the histologic state of the root-filled tooth. No relationship was detected between unfilled lateral or accessory canals and the status of inflammation at the periapex (51% inflamed, 49% uninflamed).