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Apical periodontitis (AP) is a common dental condition that can be influenced by diabetes mellitus. This study aimed to investigate the impact of type 2 diabetes mellitus (T2DM) on the prevalence and severity of AP, considering the adequacy of endodontic treatments. A total of 180 patients selected based on specific dental criteria from a private clinic in Oradea, Romania, were included in this study. Clinical data were collected through medical records and panoramic radiographs. Statistical analyses were conducted using SPSS software, employing the Fisher test, Mann-Whitney test, and binary logistic regression to determine correlations between T2DM and AP in both endodontically treated and non-treated teeth. Additionally, we examined the relationship between diabetes and AP in teeth that received adequate root canal treatment (RCT), as well as the correlation of AP with the adequacy of endodontic treatment. Non-treated teeth were significantly more likely to have AP in patients with T2DM than in non-diabetic patients (OR = 5.3, P < 0.001). No significant difference in AP prevalence was observed between treated teeth in diabetic and non-diabetic patients. Inadequate RCT was associated with a higher incidence of AP, regardless of diabetes status (OR = 26.9, P < 0.001). The study concludes that DM significantly increases the risk of AP in untreated teeth, with diabetic patients showing a higher prevalence of AP than non-diabetic patients. However, this increased risk is not observed in adequately treated teeth. The quality of RCT is critical, as inadequate RCT is linked to a higher incidence of AP, regardless of diabetes status., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Introduction: At present, the incidence of diabetes mellitus (DM) is gradually increasing globally. In clinical practice, many patients with diabetes with apical periodontitis (AP) have poor and slow healing of periapical lesions. However, the potential relationship between the 2 is still unclear and controversial. The consensus is that DM can be deemed a risk factor for AP in endodontically-treated teeth. Therefore, we pooled existing studies and carried out a meta-analysis to explore the potential association between the 2., Methods: Studies that met the inclusion criteria were selected from the database, and relevant data were extracted. Stata SE 17.0 software was used to analyze the relevant data, and the Newcastle-Ottawa Scale was used to assess the literature's quality. The pooled odds ratio (OR) with a 95% confidence interval (CI) was used to determine the strength of the association between DM and the prevalence of AP after root canal treatment (RCT)., Results: After searching, 262 relevant studies were retrieved, fifteen of which met the inclusion criteria. A total of 1087 patients with 2226 teeth were included in this meta-analysis. According to the findings, diabetics showed a higher prevalence of AP after RCT than controls at the tooth level (OR = 1.51, 95% CI = 1.22-1.87, P < .01). At the patient level, DM increased the probability of developing AP in RCT teeth more than 3 times (OR = 3.38, 95% CI = 1.65-6.93, P < .01). Additionally, subgroup analysis was performed by blood glucose status, preoperative AP, and study design. Except for the status of blood glucose, the results were significant in the other 2 groups (P < .05)., Conclusions: Available scientific evidence suggests that DM may increase the risk of AP in endodontically-treated teeth. In teeth with preoperative AP, DM might promote the development of AP., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical root fracture (VRF) in endodontically treated teeth (ETT)., Methods: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Scopus, and Web of Science) were searched by 2 reviewers in October 2022 for clinical studies, in which at least either the clinical presentation or potential risk factors associated with a VRF were assessed. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of odds ratios (ORs) were performed separately for several signs or symptoms and risk factors., Results: Fourteen sources reporting on 2877 teeth (489 with VRF and 2388 without VRF) were included in the meta-analyses. Regarding the clinical presentation, the presence of sinus tracts (OR = 4.87; 95% confidence interval [CI], 1.58-15.0), increased periodontal probing depths (OR = 13.24; 95% CI, 5.44-32.22), swelling/abscess (OR = 2.86; 95% CI, 1.74-4.70), and tenderness to percussion (OR = 1.76; 95% CI, 1.18-2.61) were significantly associated with the presence of a VRF (P adj. value < .05). None of the assessed risk factors (sex, type of teeth, tooth location, posts, indirect restoration, and apical extension of the root canal filling) were found to be significantly associated with the presence of a VRF (P adj. value > .05)., Conclusions: Four clinical presentations were identified to be the most significant signs or symptoms for a VRF in ETT: presence of sinus tracts, increased probing depths, swelling/abscess, and tenderness to percussion. None of the assessed risk factors pointed out to be significantly associated with a VRF., Registration: CRD42022354108 (PROSPERO)., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

External apical root resorption (EARR) is a serious complication that should be avoided during orthodontic treatment; this pathology depends on multiple factors. Data from clinical studies should be assessed to determine the influence these factors have on the development of EARR. This systematic review aims to compare EARR produced by different factors (orthodontic systems, dental trauma, and dental vitality). The protocol was registered on the PROSPERO database. The search was performed on 5 databases. Accepted study designs included randomized controlled trials, nonrandomized clinical trials, and observational studies. Full-text articles from clinical studies of EARR associated with orthodontic treatment in English, Spanish, or Portuguese with no publication date restrictions were selected. Data from the studies, such as age, population, study groups, and outcome measures, were recorded. Multiple meta-analyses were performed with data from the included studies. Evidence suggests that EARR induced by orthodontic treatment is similar, regardless of the technique used. Evidence of the effect of previous dental trauma on EARR during orthodontic treatment is limited. There is less EARR associated with orthodontic treatment in endodontically treated teeth than in vital teeth. These conclusions should be considered with caution due to the low certainty of the evidence.

Objective: The successful management of odontogenic maxillary sinusitis (OMS) involves a combination of medical treatment with dental surgery and/or endoscopic sinus surgery (ESS). However, there is no consensus for the optimal timing of ESS. Although several studies have emphasized dental surgery as the primary treatment modality for OMS, there is recent evidence to suggest that ESS alone may be an effective treatment approach. The purpose of this study is to retrospectively investigate the pathophysiology of the current intractable OMS and the role ESS, especially ESS preceding dental treatment, plays in its pathophysiology., Methods: Ninety-seven adults (60 males and 37 females, 48 ± 12 years) who underwent ESS for intractable OMS were retrospectively examined., Results: In a great deal of the cases (85 cases, 87.6%), causative teeth of OMS were periapical lesions after root canal treatment (endodontics). The root canal procedures were not sufficient; hence, the root-canal-treated teeth had periapical lesions causing OMS. In postoperative nasal endoscopy and cone-beam CT scans for all patients, the natural ostiums and the membranous portions of the maxillary sinuses were enlarged and the ostiomeatal complexes remained widely open. The ventilation and drainage of all patients' maxillary sinuses seemed to be successfully restored. Temporary acute sinusitis recurrence after primary ESS for OMS was observed in 10 cases (11.8%) when the patients caught a cold. However, since the natural ostium and the membranous portion of the maxillary sinuses and the ostiomeatal complexes remained widely open, antibiotic administration alone without dental treatment cured the temporary acute sinusitis. Regarding the causative teeth (endodontic treated teeth), in 83 out of 85 cases (97.6%), causative teeth were able to be preserved with only antibiotic treatment and without dental retreatment. In two cases, extraction of the teeth was necessary because the teeth became mobile. Regarding the causative teeth after dental restoration, in 2 out of 2 cases (100%), causative teeth were able to be preserved with antibiotic treatment alone., Conclusion: ESS is highly indicated for OMS requiring surgery. The treatment results of intractable OMS are exceptionally good once the ventilation and drainage of the maxillary sinus is successfully restored after surgery. Consequently, ESS can be considered the first-line therapy for intractable OMS caused by root canal treatment (endodontics) and dental restoration, followed by close dental follow-up and dental treatment when necessary., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier B.V.)

Aims: The aim of this study was to compare the effect of different restoration techniques on fracture resistance of endodontically treated teeth with different wall thicknesses., Materials and Methods: Extracted and endodontically treated 210 premolars were randomly divided into three thickness groups [2 mm (A), 1.5 mm (B), and 1 mm (C)] and, each group was further divided into seven restoration subgroups (n = 10): direct composite (control) (K), composite with fiber on cavity floor (KT), composite with fiber on occlusal level (KO), fiber post and composite (FP), inlay (L), fiber on cavity floor and inlay (LT), and inlay and fiber on occlusal level (LO). Fracture test was performed, and data were compared with Kruskal-Wallis and Mann-Whitney U tests (P < 0.05)., Results: There were no differences between the subgroups in A and C statistically (P > 0.05). However, in B, KO subgroup showed statistically higher values (P = 0.039)., Conclusion: Wall support of 2 mm was adequate, and support of 1 mm was completely insufficient. When the wall thickness was 1.5 mm, direct restoration with fiber at the occlusal level significantly improved resistance., Competing Interests: None

Aim: The prevalence of vertical root fractures (VRF) ranges from 2% to 20%, and is associated with endodontically-treated teeth (ETT). The aim of the present study was to analyze clinically and radiographically, at different intervals of time, some of the risk factors present in ETT that developed VRF., Methods: A classification model according to time measured the follow-up period of three groups. A match was made for times of occurrence (cases) and follow up (controls). An odds ratio (OR) test and a logistic regression model set at 95% confidence interval (CI) established the VRF probability when different clinical factors (patient, tooth, and endodontic or restorative treatment) were present., Results: The sample was composed of 197 ETT (41 cases and 156 controls). A classification model set the trend, thus defining three groups: group 1 (1-4 years of follow up): endodontic retreatment (OR: 8.01, 95% CI: 1.85-37.90, P=.0014), indirect restoration (OR: .202, 95% CI: .036-.979, P=.05); group 2 (5-8 years of follow up): primary treatment (OR: .052, 95% CI: .002-.680, P=.044) and the 'single tooth' category (OR: .042, 95% CI: .002-.453, P=.02) demonstrated a significant association with VRF; and group 3 (>9 years of follow up): no association., Conclusion: Endodontic retreatment had the highest risk association for VRF after 1-8 years of follow up. Indirect and individual restorations were not significantly associated with VRF., (© 2017 John Wiley & Sons Australia, Ltd.)

Introduction: The purpose of this in vitro study was to comparatively evaluate the fracture resistance of endodontically treated teeth restored with 2 fiber-reinforced composite resins and 2 conventional composite resin core buildup materials., Methods: Sixty noncarious unrestored human maxillary premolars were collected, endodontically treated (except group 1, negative control), and randomly divided into 5 groups (n = 10). Group 2 was the positive control. The remaining 40 prepared teeth were restored with various direct core buildup materials as follows: group 3 teeth were restored with dual-cure composite resin, group 4 with posterior composite resin, group 5 with fiber-reinforced composite resin, and group 6 with short fiber-reinforced composite resin. Fracture strength testing was performed using a universal testing machine. The results were statistically analyzed by 1-way analysis of variance and the post hoc Tukey test. Fracture patterns for each sample were also examined under a light microscope to determine the level of fractures., Results: The mean fracture resistance values (in newtons) were obtained as group 1 > group 6 > group 4 > group 3 > group 5 > group 2. Group 6 showed the highest mean fracture resistance value, which was significantly higher than the other experimental groups, and all the fractures occurred at the level of enamel., Conclusions: Within the limitations of this study, a short fiber-reinforced composite can be used as a direct core buildup material that can effectively resist heavy occlusal forces against fracture and may reinforce the remaining tooth structure in endodontically treated teeth., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to investigate whether number of non-vital teeth was an indicator of tooth loss during maintenance. Thirty-three general practitioners provided data on 321 patients undergoing maintenance over 10 years. The number of present teeth (PT), smoking status, level of bone loss, number of non-vital teeth, and reason for tooth loss during that period were investigated. Multiple logistic regression was performed to identify whether the number of non-vital teeth was associated with tooth loss. The average number of lost teeth was 1.07±1.82; that of PT at baseline was 24.4±3.9; and that of non-vital teeth at baseline was 5.4±4.5. Multiple logistic regression revealed a significant association between >8 non-vital teeth and tooth loss during maintenance (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.18-4.87). It also demonstrated relationships between >8 non-vital teeth and root fracture or caries (OR: 3.90; 95%CI: 1.68-9.03 or OR: 2.85, 95%CI: 1.14-7.10, respectively). The number of non-vital teeth was associated with tooth loss during maintenance. The results suggest that patients with many non-vital teeth before commencement of maintenance are particularly at risk of tooth loss due to root fracture or caries. Therefore, the number of non-vital teeth offers a useful indicator of potential tooth loss.

Statement of Problem: How the placement of fiber posts affects the fracture resistance of endodontically treated maxillary central incisors with cervical cavities is not well documented., Purpose: The purpose of this in vitro study was to evaluate the effect of fiber posts on the fracture resistance of endodontically treated maxillary central incisors with cervical cavities., Material and Methods: Fifty extracted human maxillary central incisors were selected and divided into 5 test groups (n=10) according to the restoration strategy: GHT, control group; endodontically treated teeth (ETT) without endodontic posts; GCV, ETT with cervical cavities simulating coronal destruction; GCF, ETT with cervical cavities and carbon fiber posts; GGF, ETT with cervical cavities and glass fiber posts; and GCP, ETT with cervical cavities and composite resin posts. After the fiber posts had been cemented with a resin cement and the foundations had been placed, all specimens were quasi statically loaded at 45 degrees in a universal testing machine until fracture. All specimens were evaluated for fracture modes. The data were then analyzed by 1-way ANOVA, followed by multiple comparisons with the Tukey HSD test (α=.05). The mode of failure was determined by visual inspection., Results: The mean ±SD failure loads for the groups ranged from 718.2 ±89.8 N to 943.8 ±93.1 N. In a 1-way ANOVA followed by post hoc testing, GGFs had a higher fracture strength than all other groups (P≤.05). However, GCPs had a lower fracture strength than all other groups. Statistically significant differences were observed among groups (P≤.05), except between the GHT group and the GCF and GGF groups (P=.075, P=.226). All groups except GHT showed complete favorable fracture mode within the cervical third of the roots., Conclusions: Within the limitations of this in vitro study, placement of glass fiber posts significantly improved the fracture resistance of endodontically treated maxillary central incisors with cervical cavities., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

This study was designed to investigate the fracture strength of endodontically treated teeth temporarily restored with some commonly used interim materials. Of 90 extracted maxillary premolars used in this study, 15 were left intact as the positive control. Endodontic treatment was performed on the remaining 75 teeth. The endodontically treated teeth were then randomly assigned to 5 groups (n = 15). One group was not restored and served as the negative control. In the remaining 4 experimental groups, the teeth were restored with a temporary cement: Zonalin, IRM, Coltosol, or Fuji II LC resin-modified glass ionomer (RMGI). The fracture strengths of all teeth were measured with a universal testing machine. The fracture strength of teeth restored with RMGI was significantly greater than that of other groups (P < 0.001), including intact teeth (P = 0.025). The fracture strength of teeth restored with other temporary materials was significantly lower than that of intact teeth (P < 0.05) but not significantly different from that of the negative control. From a structural resistance standpoint, RMGI may be the best choice for short-term temporary restoration of endodontically treated teeth. Other types of temporary restorative material had no reinforcing effect on tooth structure.

Aim: To review the available evidence for the causes of failure of fibre posts., Materials and Method: A search of MEDLINE was conducted to retrieve available data on fibre posts used for restoration of endodontically treated teeth since 1980. The Cochrane Library was also separately searched for systematic reviews. Additionally, references of the retrieved articles were also hand searched for further relevant papers. All the selected papers were then critically appraised subject to meeting inclusion criteria., Results: Nineteen prospective clinical trials were included after critical appraisal of the papers. Causes of failure of fibre posts were identified as follows: adhesive failure, root fracture, post fracture, endodontic failure, secondary caries and periodontal complications. Risk factors for each of the failures were investigated and evidence-based recommendations for minimising these complications are discussed., Conclusion: Although laboratory studies showed favourable mechanical and physical properties of fibre posts, clinically, there has been a wide range of failures mechanisms are reported in the literature. Adhesive failure was reported in 16 of the 19 trials, making it the most frequent cause of failure. The available evidence does not indicate a difference in short-term survival probability between metal or fibre posts. A number of risk factors, which affect the longevity of fibre posts, were identified and discussed. Since there is considerable heterogeneity in study designs and reported survival rates of included studies, longer-term well-designed standardised clinical trails are required.

Purpose: The aim of this long-term cohort study was to evaluate the efficacy and complications of fixed partial dentures in a convenience sample of 100 patients with periodontal disease who were treated and maintained periodontal patients after 20 years., Materials and Methods: After active treatment, including periodontal surgery and endodontic and prosthetic treatment, patients were enrolled in a supportive periodontal care (SPC) program with 3- to 6-month recalls. All patients showed clinical data recorded at (1) the original consultation (T0), (2) the first SPC visit following the completion of prosthetic treatment (T1), and (3) at the latest SPC clinical session 20 years after T1 (T2). Multivariate analyses were performed to investigate the influence of clinical variables on the risk of prosthetic abutment (PA) loss after 20 years' visits., Results: The final sample comprised 100 patients. At T1, a total of 948 PAs represented the original sample of experimental teeth. At the 20-year follow-up, a total of 854 PAs (90.1%) were still in function, while 94 (9.9%) PAs in 41 patients (41%) were lost during SPC; 98% of lost PA were endodontically treated. Vertical root fracture (48%) was the major cause of PA loss, while progression of periodontitis caused 31% of PA loss. Age (P = .002), Full-Mouth Plaque Score (P < .0001), Full-Mouth Bleeding Score (P = .0002), and oral parafunctions (P = .0083) were associated with increased probability of PA failure. Among clinical-related factors, endodontic treatment (P = .0082), root resection/ amputation (P < .0001), multi-rooted teeth (P = .0005), and abutment associated with parafunction (P < .0001) were associated with increased risk of abutment loss after 20 years., Conclusions: Perioprosthetic treatment in compliant patients is highly successful after 20 years of SPC.

Introduction: External resorption usually occurs after dental trauma and the loss of root cementum. Because it has the ability to induce alkaline pH, calcium hydroxide is used in treatment of external resorption, which is reportedly not free from disadvantages. Driven by such understanding, the aim of this in vitro study was to compare the pH changes induced by calcium enriched mixture (CEM) and those of calcium hydroxide in simulated root resorption defects., Methods: Twenty-one paired extracted human premolars were cut to the length of 14 mm. Root canal preparation was performed by using ProTaper rotary system. Cavities of 0.7-mm depth and 1.4-mm diameter were prepared on the external root surface, 5 mm from the apex. Half of the teeth were filled with CEM and the other half with calcium hydroxide. Five premolars were also assigned as the negative control group and filled with normal saline. To be assured of the filling quality, a radiograph was obtained from each tooth. Subsequently, pH of the cavity was measured with a microelectrode at 20-minute, 3-hour, and 1-, 7-, 14-, 21-, and 28-day intervals after filling., Results: Mean pH in the CEM and in the calcium hydroxide groups were significantly varied during the study period, with pH of the calcium hydroxide group significantly higher than that of CEM in all of the measurements. However, no significant difference was observed between the pH of the calcium hydroxide group and that of the control group at the 7-day and 14-day measurements and between those of the CEM group and the control group at days 7, 21, and 28., Conclusions: In comparison with calcium hydroxide, CEM hardly maintained alkaline pH during the first month of use, and so CEM may be an inappropriate material in treatment of external root resorption., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

When planning a prosthetic rehabilitation of a periodontally compromised case, the clinician is often confronted with difficulties and dilemmas related to selecting the appropriate treatment modality that would provide a long-term longevity in terms of function and esthetics. In such cases, a correct diagnosis and prognosis of the intraoral situation supported by evidence-based dentistry is the basis for the establishment of a proper treatment strategy. In this two-part treatment planning series, a systematic approach of patient examination and prognosis of each tooth is presented. Furthermore, different removable and fixed treatment possibilities are described and the rationale governing the decision-making process is revealed. The execution of the final treatment plan as specified by the concept of comprehensive dental care is outlined and the final outcome is discussed according to the literature.

Background and Objective: Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5 years., Methods: The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis., Results: TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance., Conclusion: IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this study was to investigate risk factors affecting 5- and 10-year survival in autotransplantation of third molars with complete root formation at dental clinics. Participating dentists were requested to provide information on transplantations performed between 1 January 1990 and 31 December 2009. After data screening and elimination, 183 teeth in 171 men aged 20-72 years (mean, 44.8 years) and 205 teeth in 189 women aged 20-74 years (mean, 42.0 years) were included in the study. A single-factor analysis using the log-rank test revealed that the following factors had a significant influence (p<0.05) on 5-year survival in transplanted teeth in men: recipient site in the maxilla and fewer than 25 present teeth; those for 10-year survival, on the other hand, were recipient site tooth extraction due to periodontal disease, recipient site in the maxilla, fewer than 25 present teeth, and Eichner index Group B1 to C. Cox regression analysis revealed that the odds ratio for 5-year survival for recipient site in the maxilla was 2.873 (95% CI, 1.073-7.695), while that for 10-year survival was 3.713 (95% CI, 1.601-8.609) for recipient site extraction due to periodontal disease, 2.190 (95% CI, 1.021-4.700) for recipient site in the maxilla, and 3.110 (95% CI, 1.470-6.581) for fewer than 25 present teeth. In women, the log-rank test indicated experience of less than 10-year in performing treatment as a significant factor (p <0.05) in 5-year survival. These results suggest that medium-term survival in transplanted teeth is influenced by operational risk factors in women, while long-term survival in transplanted teeth is influenced by individual oral status in men.

Objectives: The first objective of this study was to retrospectively evaluate zirconia-based restorations (ZBR). The second was to correlate failures with clinical parameters and to identify and to analyse chipping failures using fractographic analysis., Methods: 147 ZBR (tooth- and implant-supported crowns and fixed partial dentures (FPDs)) were evaluated after a mean observation period of 41.5 ± 31.8 months. Accessorily, zirconia implant abutments (n=46) were also observed. The technical (USPHS criteria) and the biological outcomes of the ZBR were evaluated. Occlusal risk factors were examined: occlusal relationships, parafunctional habits, and the presence of occlusal nightguard. SEM fractographic analysis was performed using the intra-oral replica technique., Results: The survival rate of crowns and FPDs was 93.2%, the success rate was 81.63% and the 9-year Kaplan-Meier estimated success rate was 52.66%. The chipping rate was 15% and the framework fracture rate was 2.7%. Most fractographic analyses revealed that veneer fractures originated from occlusal surface roughness. Several parameters were shown to significantly influence veneer fracture: the absence of occlusal nightguard (p=0.0048), the presence of a ceramic restoration as an antagonist (p=0.013), the presence of parafunctional activity (p=0.018), and the presence of implants as support (p=0.026). The implant abutments success rate was 100%., Conclusions: The results of the present study confirm that chipping is the first cause of ZBR failure. They also underline the importance of clinical parameters in regards to the explanation of this complex problem. This issue should be considered in future prospective clinical studies., Clinical Significance: Practitioners can reduce chipping failures by taking into account several risk parameters, such as the presence of a ceramic restoration as an antagonist, the presence of parafunctional activity and the presence of implants as support. The use of an occlusal nightguard can also decrease failure rate., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A vertical root fracture (VRF) is a frustrating complication that may occur following root canal treatment, and in almost every case leads to the extraction of the affected tooth. This type of fracture is usually diagnosed by secondary symptoms that develop some time after primary treatment, often when prosthodontic restoration has already been completed. The fracture line itself is often not directly visible, and therefore clinical and radiographic signs and symptoms indicate the diagnosis indirectly. Knowledge of the condition and pathogenesis of VRF is required in order to avoid hopeless trials of periodontal and/or endodontic therapy. Several etiologic factors are discussed that make teeth susceptible to VRF, such as the loss of substance due to restorative and endodontic therapy and stress factors associated with root canal debridement, and filling.

Objective: To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition., Method: A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN., Results: 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048)., Conclusion: Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

Objective: To provide an empirical description of the relationship between the spread of head and neck infections, and the causal tooth., Method and Materials: The hospital records of 155 patients presenting with odontogenic head and neck infections due to a single identifiable tooth from January 2000 to August 2011 were reviewed. The following data were collected: age, sex, clinical presentation, etiology, location, and spread of infection. The causal tooth and location of infection were subsequently compared to the literature., Results: In the present study population, the causal tooth most frequently (47.1%) consisted of the third mandibular molar. Infection of maxillary teeth most commonly spread to the buccal space, whereas infection originating in the mandible mostly spread to the submandibular, pterygomandibular, and buccal spaces. The literature search provided 18 usable articles. Fourteen studies discriminated between mandibular and maxillary origin of infection, and three articles elaborated on the direct relationship between causal tooth and location of infection. Spaces most frequently affected in the literature are the submandibular, masticator, lateral pharyngeal, buccal, and sublingual spaces. A large amount of discrepancy was found between studies., Conclusion: When describing the location of infection, most studies do not discriminate between maxillary and mandibular origin. Although the literature seems to be unambiguous about the predetermined spread, this article demonstrates that it is more difficult to predict the spread of an infected tooth than previously expected. Large studies with clearly noted causal teeth in relation to location of spread should shed more light on the discrepancies found in this review.

Objectives: To evaluate the influence of the ferrule effect (1) and the fibre-post placement (2) on the fracture resistance of endodontically treated teeth subjected to cyclic fatigue loading., Methods: 40 extracted single-rooted upper pre-molars were sectioned at the CEJ (groups a and b) or 2mm above the CEJ (groups c and d), and subsequently endodontically treated. After 24-h water storage at 37°C, specimens were restored according to four build-up approaches (n=10 per group): (a) NF-NP (no ferrule, no post), (b) NF-P (no ferrule, fibre-post), (c) F-NP (ferrule, no post) and (d) F-P (ferrule, fibre post). RelyX Posts (3M-ESPE) were used in groups NF-P and F-P, and were cemented with Panavia F 2.0 (Kuraray). A standardized composite core was built, after which specimens were restored with an all-ceramic crown (IPS Empress CAD, Ivoclar-Vivadent) Specimens were fatigued by exposure to 1,200,000 cycles using a chewing simulator (Willytech). All specimens that survived fatigue loading were fractured using a universal loading device (Micro-Tester, Instron). A two-way analysis of variance was used to determine the statistical significance of the factors ferrule and post on fracture resistance., Results: Only one NF-NP specimen failed under fatigue. The ferrule effect significantly enhanced the fracture resistance of the restored teeth, regardless the use of a post (p=0.003). F-NP obtained the highest fracture resistance (758.52±121.89N), which was not significantly different from F-P (647.58±132.95N); NF-NP presented the lowest fracture resistance (361.52±151.69N). For all groups, only 'repairable' failures were recorded., Conclusions: Avoiding extra-removal of sound tooth structure, rather than placing a fibre post, can protect endodontically treated teeth against catastrophic failure. However, when any ferrule can be preserved, a fibre-post may improve the retention and fatigue resistance of the restoration., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Smoking is associated with tooth loss. However, smoking's relationship to the specific reason for tooth loss in postmenopausal women is unknown., Methods: Postmenopausal women (n = 1,106) who joined a Women's Health Initiative ancillary study (The Buffalo OsteoPerio Study) underwent oral examinations for assessment of the number of missing teeth, and they reported the reasons for tooth loss. The authors obtained information about smoking status via a self-administered questionnaire. The authors calculated odds ratios (ORs) and 95 percent confidence intervals (CIs) by means of logistic regression to assess smoking's association with overall tooth loss, as well as with tooth loss due to periodontal disease (PD) and with tooth loss due to caries., Results: After adjusting for age, education, income, body mass index, history of diabetes diagnosis, calcium supplement use and dental visit frequency, the authors found that heavy smokers (≥ 26 pack-years) were significantly more likely to report having experienced tooth loss compared with never smokers (OR = 1.82; 95 percent CI, 1.10-3.00). Smoking status, packs smoked per day, years of smoking, pack-years and years since quitting smoking were significantly associated with tooth loss due to PD. For pack-years, the association for heavy smokers compared with that for never smokers was OR = 6.83 (95 percent CI, 3.40 -13.72). The study results showed no significant associations between smoking and tooth loss due to caries., Conclusions and Practical Implications: Smoking may be a major factor in tooth loss due to PD. However, smoking appears to be a less important factor in tooth loss due to caries. Further study is needed to explore the etiologies by which smoking is associated with different types of tooth loss. Dentists should counsel their patients about the impact of smoking on oral health, including the risk of experiencing tooth loss due to PD.

Intrabony oral non-Hodgkin lymphoma (NHL) is rare. We report 2 cases of NHL of the maxilla that initially presented as apical abscesses in endodontically treated teeth. Radiographic findings were nondescript, but tissue biopsy revealed diffuse large B-cell NHL in both instances. No other sites of disease were found. Both patients were treated by chemotherapy and radiation with good results. As primary NHL of the maxilla can mimic a dental inflammatory lesion, tissue biopsy is mandatory in cases where symptoms do not resolve after specific treatment.

Introduction: Vertical root fractures (VRFs) pose a clinical dilemma and a challenge to clinicians. Definitive diagnosis is often complicated by the lack of consistent signs and symptoms and the low sensitivity of conventional radiographs in the detection of VRFs. New radiographic imaging systems have recently become available for use in dentistry. Among these new imaging technologies is cone-beam volumetric tomography (CBVT). CBVT technology allows the precise visualization and evaluation of teeth with VRFs. The use of CBVT has great potential as a diagnostic tool to assist in the detection of VRFs., Methods: Seven cases are presented to demonstrate the use of CBVT in detection of VRFs in endodontically treated teeth., Results: Five specific findings on CBVT exam were consistent with confirmed VRFs., Conclusions: As demonstrated in this case series, CBVT can provide valuable additional diagnostic information in the detection of VRFs and may help prevent unnecessary treatment., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To assess the influence of cervical preparation on fracture susceptibility of roots., Material and Methods: During root canal instrumentation, the cervical portions were prepared with different taper instruments: I: no cervical preparation; II: #30/.08; III: #30/.10; IV: #70/.12. The specimens were sealed with the following filling materials (n = 8), A: unfilled; B: Endofill/gutta-percha; C: AH Plus/gutta-percha; D: Epiphany SE/Resilon. For the fracture resistance test, a universal testing machine was used at 1 mm per minute., Results: anova demonstrated difference (P < 0.05) between taper instruments with a higher value for group I (205.3 ± 77.5 N) followed by II (185.2 ± 70.8 N), III (164.8 ± 48.9 N), and IV (156.7 ± 41.4 N). There was no difference (P > 0.05) between filling materials A (189.1 ± 66.3 N), B (186.3 ± 61.0 N), C (159.7 ± 69.9 N), and D (176.9 ± 55.2 N)., Conclusions: Greater cervical wear using a #70/.12 file increased the root fracture susceptibility, and the tested filling materials were not able to restore resistance., (© 2011 John Wiley & Sons A/S.)

Purpose: The aim of this clinical retrospective study was to evaluate the clinical quality, estimated survival rate, and failure analysis of different all-ceramic restorations in a long-term analysis of up to 20 years., Materials and Methods: Different all-ceramic restorations (crowns [n = 470], veneers [n = 318], onlays [n = 213], and inlays ]n = 334[) were placed in 302 patients (120 men, 182 women) between 1987 and 2009 at Medical University Innsbruck, Innsbruck, Austria. Clinical examination was performed during patients' regularly scheduled maintenance appointments. Esthetic match, porcelain surface, marginal discoloration, and integrity were evaluated following modified California Dental Association/Ryge criteria. Number of restoration failures and reasons for failure were recorded. The study population included 106 (35.1%) individuals diagnosed with bruxism. The success rate was determined using Kaplan-Meier survival analysis., Results: The mean observation time was 102 ± 60 months. Ninety-five failures were recorded. The main reason for failure was fracture of the ceramic (33.68%). The estimated survival rate was 97.3% after 5 years, 93.5% at 10 years, and 78.5% at 20 years. Nonvital teeth showed a significantly higher risk of failure (P < .0001). There was a 2.3-times greater risk of failure associated with existing parafunction (bruxism, P = .0045). Cementation using Variolink showed significantly fewer failures than Optec Cement (P = .0217) and Dual Cement (P = .0099). No significant differences were found for type of restoration and distribution in the mouth., Conclusion: All-ceramic restorations offer a predictable and successful restoration with an estimated survival probability of 93.5% over 10 years. Significantly increased failure rates are associated with bruxism, nonvital teeth, and specific cementation agents.

Aim:   To analyse the medico-legal aspects of vertical root fracture (VRF) following root canal treatment (RCT)., Methodology:   A comprehensive search in a professional liability insurance database was conducted to retrospectively identify cases of VRF following RCT. The complaints were categorized as either financial risk bearing or financial nonrisk bearing, and related demographic, prosthetic and endodontic variables were analysed., Results:   Seventy-seven legal cases of patients with VRFs following RCT were identified. Most of the cases were either in premolars or in mandibular molar teeth (P<0.05). Poor-quality root filling was associated with an extended delay of diagnosis (P<0.05). The presence of a post significantly increased the financial risk assessment (P<0.05)., Conclusions:   Poor quality root fillings complicate the diagnosis of VRF, which in turn extends the time for achieving an accurate diagnosis and increasing the medico-legal risk. Premolar and mandibular molar teeth were more prone to medico-legal claims related to VRF following RCT. Post should be placed only when essential for additional core support to avoid medico-legal risk., (© 2011 International Endodontic Journal.)

Injectable filling agents offer the promise of a better appearance without surgery and, among them, hyaluronic acid is the most commonly used. Although complications are rare, it is necessary to know the possible side effects and complications in order to be prepared for their management. That is why many researchers have been focusing on the interactions between hyaluronic acid and pathogens, inflammatory mediators, the immune system, and markers of oxidative stress to achieve efficient drug delivery, given that hyaluronic acid has widening applications in the field of nanomedicine. Here we report the case of a 37-year-old female patient who returned to our clinic with an abscess in her left cheek 3 months after a deep injection of 1 mL of stabilized hyaluronic acid in both cheeks. Steroid and antibiotic therapy was initiated without success, and abscess drainage was performed. Extraction of tooth 16 was performed 11 days after insertion of drains into the abscess. Laboratory blood tests showed acute inflammation of presumed bacterial etiology. Microbiological examination of pus was negative. Bacterial cultures were found in the extracted tooth. After antibiotic therapy, a complete reversal of the pathological process was observed. The present report highlights the need to assess periodontal problems prior to any aesthetic facial treatment. Analyses of further case reports and clinical studies are necessary to understand the potential role of hyaluronic acid in the formation of biofilm, and how to avoid this complication, thereby increasing the safety of hyaluronic acid-based procedures.

Introduction: Painful exacerbations of persistent periapical lesions have unknown incidence and impact on quality of life. This study examined the incidence and impact of painful exacerbations and evaluated potential predictive factors of pain associated with root-filled teeth with persistent lesions after root canal treatment., Methods: Patients from a university hospital clinic were screened to identify root-filled teeth with periapical lesions at time of treatment and not resolved at least 4 years later. A clinical and radiographic examination and questionnaire survey were conducted. Patient and treatment characteristics and details of pain experience were studied. Statistical analysis was carried out by using SPSS (version 18)., Results: One hundred twenty-seven patients with 185 persistent lesions were recruited. Median age of patients at recruitment was 56 years (range, 21-82 years). Median time since treatment was 5 years (range, 4-38 years). Overall incidence of flare-up (requiring an unscheduled dental visit) was only 5.8% 20 years after treatment. Less severe pain was more frequent, with a combined incidence of 45% pain at 20 years after treatment. Female patients (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-6.0; P < .05), treatment involving a mandibular molar or maxillary premolar (OR, 3.7; 95% CI, 1.6-8.6; P < .05), and preoperative pain (OR, 2.9; 95% CI, 1.3-6.7; P < .05) were significantly associated with pain after treatment. The most commonly affected activities during painful exacerbations were eating and tooth brushing, with minimal impact on daily living., Conclusions: The risk of flare-up among persistent lesions was very low. A lower degree of pain was more common, but generally with minimal impact on daily activities., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this clinical retrospective study was to evaluate the clinical quality, success rate, and estimated survival rate of anterior veneers made of silicate glass-ceramic in a long-term analysis of up to 20 years., Materials and Methods: Anterior teeth in the maxillae and mandibles of 84 patients (38 men, 46 women) were restored with 318 porcelain veneer restorations between 1987 and 2009 at the Medical University Innsbruck, Innsbruck, Austria. Clinical examination was performed during patients' regularly scheduled maintenance appointments. Esthetic match, porcelain surface, marginal discoloration, and integrity were evaluated following modified California Dental Association/Ryge criteria. Veneer failures and reasons for failure were recorded. The study population included 42 (50.0%) patients diagnosed with bruxism and 23 (27.38%) smokers. The success rate was determined using Kaplan-Meier survival analysis., Results: The mean observation time was 118 ± 63 months. Twenty-nine failures (absolute: 82.76%, relative: 17.24%) were recorded. The main reason for failure was fracture of the ceramic (44.83%). The estimated survival rate was 94.4% after 5 years, 93.5% at 10 years, and 82.93% at 20 years. Nonvital teeth showed a significantly higher failure risk (P = .0012). There was a 7.7-times greater risk of failure associated with existing parafunction (bruxism, P = .0004). Marginal discoloration was significantly greater in smokers (P ⋜ .01)., Conclusion: Porcelain laminate veneers offer a predictable and successful restoration with an estimated survival probability of 93.5% over 10 years. Significantly increased failure rates were associated with bruxism and nonvital teeth, and marginal discoloration was worse in patients who smoked.

Objective: To clarify the mode of root fracture in 32 endodontically treated teeth that resulted in vertical root fracture (VRF) despite the provision of a crown for fracture prevention., Method and Materials: The teeth included in the study underwent root canal treatment and were restored with crowns without the use of an intracanal post. All teeth underwent photo documentation. Clinical signs and symptoms as well as the patients' ages were recorded. The diameters of the roots and the root canal fillings were measured on radiographs. Fractured roots were investigated using a scanning electron microscope (SEM)., Results: The mean patient age was 60.2 years. The VRFs in the group occurred most frequently in the mesial roots of the mandibular first molars. The fracture was predominantly buccolingual. The mean ratio measured between the diameters of the root canal obturations and the outer root surfaces in the radiographs was 33.2%. SEM evaluation showed that most fractures ran from the inner to the outer root surface, and the cracks predominantly ran apical to coronal., Conclusion: Endodontically treated and crowned teeth without root canal posts can develop VRFs. The cracks start at the root canal wall in the apical part of the root and extend toward the outer root surface and coronally. Further investigation is necessary to determine the possible causes and evidence of fracture development.

Aim: To investigate ex vivo the influence of gamma irradiation therapy and restorative material on fracture resistance, fracture mode and strain of root filled human premolars., Methodology: Sixty extracted human maxillary premolar teeth were randomly divided into six groups (n = 10) determined by two study factors: (i) restorative materials: sound teeth, root filled teeth restored with composite resin, root filled teeth restored with amalgam; (ii) gamma irradiation: irradiated (subjected to 60 Gy of gamma irradiation in daily increments of 2 Gy) and nonirradiated. For the strain gauge test, two strain gauges per sample were attached on the buccal and palatal cusp surfaces (n = 5). Strain values were recorded during loading of 0-150 N. Fracture resistance (N) was assessed in a mechanical testing machine (n = 10). Strain gauge for each cusp and fracture resistance data were analysed by two-way anova (3 × 2) followed by the Tukey's honestly significant difference test (α = 0.05). The failure mode was evaluated using an optical stereomicroscope and classified according to the location of the failure., Results: Gamma radiation therapy significantly reduced the fracture resistance of intact teeth. The strain was higher for teeth restored with amalgam than for those restored with composite resin. The teeth restored with composite resin had similar strain values to sound teeth. Nonirradiated teeth had more restorable failures than irradiated teeth., Conclusions: Gamma irradiation significantly reduced fracture resistance and increased cusp strain. The use of composite resin resulted in better biomechanical behaviour than amalgam for restoring root filled teeth whether or not they were submitted to radiotherapy., (© 2011 International Endodontic Journal.)

Objectives: The aim of this study was to assess the surface microhardness (SMH) of intracoronal dentin exposed to 38% hydrogen peroxide (HP) light-activated or not and to 2% sodium fluoride gel (F2%) or 5% varnish (F5%)., Study Design: Intracoronal dentin specimens were exposed to bleaching (B), bleaching and light activation (BL), or no bleaching (NB), followed by F2%, F5%, or no exposure (NF). SMH test was performed. Four specimens of each group were analyzed by scanning electron microscopy (SEM)., Results: Analysis of variance and Tukey test (α = 5%) showed higher SMH of NB than BL or B. Specimens exposed to F5% presented the highest SMH and differed from F2% and NF. BL + NF yielded inferior SMH and was similar to B + NF, BL + F2%, B + F2%, BL + F5%, and NB + NF. NB + F5% showed superior values and did not differ from NB + F2%, B + F5%, and NB + NF., Conclusions: Bleaching with 38% HP, light-activated or not, reduced the SMH of intracoronal dentin. F5% provided SMH to the level of unbleached specimens., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Aim: To evaluate the vertical root fracture resistance of maxillary central incisors filled with different root filling materials and sealers., Methodology: Forty maxillary central incisor root canals were instrumented and divided randomly into four groups. Each group was filled using lateral compaction, with gutta-percha and AH Plus, gutta-percha and RealSeal(®) sealer, RealSeal(®) cone and RealSeal(®) sealer, or RealSeal(®) cone and AH Plus, respectively. The roots were loaded vertically by a conical spreader tip inserted into the canal and attached to an Instron testing machine until root fracture occurred. The load at fracture and the pattern of fracture were recorded. Mechanical properties of both core materials were tested under compressive loading. Results were analysed statistically by two-way analysis of variance and post hoc Tukey's tests. An independent sample t-test was used to compare the mechanical properties of the filling materials., Results: Load at fracture of roots filled with gutta-percha and AH Plus (255 ± 74 N) and gutta-percha and RealSeal(®) sealer (237 ± 38 N) was significantly greater than those filled using the RealSeal(®) system (163 ± 29 N) and RealSeal(®) cone with AH Plus sealer (134 ± 17 N). Most fracture lines were in a bucco-lingual direction. In compressive tests of the core materials, RealSeal(®) had greater flow in response to load than gutta-percha, suggesting more efficient transmission of forces to the canal wall in the fracture tests., Conclusions: The lower fracture resistance of roots filled using RealSeal(®) is probably the result of more efficient transmission of forces within the canal, rather than a direct effect of the material itself., (© 2011 International Endodontic Journal.)

Introduction: The aim of this study was to investigate the relationship between smoking and the prevalence of apical periodontitis and root canal treatment in hypertensive patients., Methods: In a cross-sectional study, the records of 100 hypertensive patients, 50 smokers and 50 nonsmokers, were examined. Periapical status of all teeth was assessed by using the periapical index score., Results: Apical periodontitis in 1 or more teeth was found in 92% of smoker patients and in 44% of nonsmoker subjects (P=.000; odds ratio [OR], 16.8; 95% confidence interval [CI], 4.6-61.3). One or more root-filled teeth were found in 58% and 20% of smoker and nonsmoker subjects, respectively (P < .01; OR, 5.5; 95% CI, 2.3-13.5). Among smoker hypertensive patients, 6% of the teeth had apical periodontitis, whereas in the nonsmoker subjects, 2% of teeth were affected (P < .01; OR, 3.3; 95% CI, 2.0-5.4). The percentage of root-filled teeth in the smoker and nonsmoker groups was 3.6% and 1.2%, respectively (P < .01; OR, 2.9; 95% CI, 1.6-5.5)., Conclusions: The prevalence of apical periodontitis and root canal treatment was significantly higher in smoker hypertensive patients compared with nonsmoker subjects., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Endodontically-treated teeth are prone to fracture due to loss of tooth structure and altered mechanical behaviors. The stability and rigidity of post-restored teeth, particularly in cases involving periodontal destruction, has not been adequately investigated. This study examined the influence of post material on teeth with simulated bone reduction by a multiparametric evaluation. Sixty extracted premolars of similar sizes were endodontically treated then divided into six groups. Each group was restored with one of the combinations of three posts (a glass-fiber, a prefabricated titanium post, and a cast post) and two simulated bone conditions (2 or 6 mm below crown margins). After crown restorations, they were loaded with a 100 N force then the displacements were examined by the digital-image-correlation technique. Marginal integrity on the buccal and lingual crown margins was examined before and after the thermocycling. Finally, the teeth were loaded until failure to examine the strength and fracture patterns. The digital-image-correlation measurements revealed that tooth deformation was related to the support conditions, especially for the fiber post groups. The cast post groups showed less altered marginal integrity after thermomechanical loading than the fiber and titanium post groups did. In the fracture test, the fiber-post/reduced-support group exhibited inferior fracture strength. The reduced support significantly affected fracture strength and incidence of repairable root fracture. The marginal integrity was not correlated with tooth deformation, since the tooth flexed at the crest of the simulated bone. The root fracture resistance was determined mainly by post materials but was concurrently affected by the support conditions., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: The aim of the present investigation was to evaluate the caries susceptibility of endodontically versus nonendodontically treated teeth in relation to dental plaque-related factors., Methods: Twenty patients with 2 endodontically treated teeth (ETT) each were examined regarding cariogenic microflora of proximal plaque, in situ plaque pH drop after a sucrose rinse (Stephan curve), and de novo plaque formation. Recurrent caries and the quality of the coronal fillings/crowns of these teeth were also evaluated. ETT were compared with contralateral, nonendodontically treated teeth (NETT)., Results: Irrespective to the type of restoration, Streptococcus mutans count, de novo plaque formation, and recurrent caries were higher on the surface of ETT compared with NETT (P < .05). Moreover, the initial (resting) pH in plaque was significantly lower (P < 0.05) in ETT., Conclusions: ETT showed an increased susceptibility to caries as a result of either alteration in their biological environment or inadequacy of the marginal fit of the dental restoration. Clinicians should be aware of this risk., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The present study was set up to explore (1) a potential association between a person's caries risk profile and the presence or absence of root-filled teeth, and (2) the caries risk in endodontically treated teeth., Study Design: Two hundred Saudi adults were divided into an Endodontic Group (EG; n = 100), with a minimum of 2 root-filled teeth, and a Non-Endodontic Group (NEG; n = 100), without any root filling. Various caries risk factors were evaluated using a computer-based program (Cariogram). Clinical and radiographic examinations were also carried out., Results: Cariogram findings showed that "the chance of avoiding caries" was low in both groups (35% in EG and 37% in NEG), and there was no statistically significant difference between the 2 groups. However, DMFS, recurrent caries, and mutans streptococcus count in saliva were significantly higher in the EG compared to the NEG (P < .05). When teeth in the EG were evaluated independently, the proportion of recurrent caries to the total fillings associated with endodontically treated teeth was 31.6% versus 19.2% in the non-endodontically treated teeth., Conclusions: Data were not in favor of an association between caries risk profile and presence of root-filled teeth, but supported the notion that root-filling procedures might make the tooth more susceptible to caries., (Copyright 2010 Mosby, Inc. All rights reserved.)

Background: Root canal treatment (RCT) is commonly performed to preserve primary molars with an infected or necrotic pulp., Aim: This study evaluates the long-term effects of RCT in primary molars on the development and eruption of their permanent successors., Methods: This is a retrospective study of treatment of pulpectomised primary molars in a public dental clinic. All teeth were treated by the same operator using the same material (Endoflas F.S.) and the same method. Records of 194 patients with 242 pulpectomised primary molars (124 in 97 boys and 118 in 97 girls) met the inclusion criteria. The children's age at the time of treatment ranged from 5 to 11 years (mean 6.72). Follow-up time ranged from 6 to 113 months (mean 33.5)., Results: Eight (3.3%) of the 242 primary molars presented a new radiolucent defect or enlargement of existing periapical radiolucency. Of the 106 molars followed until eruption of the permanent successor, none had radiographic pathological signs. Of 17 permanent teeth evaluated clinically, three were erupted into a rotated alignment, and one premolar presented hypocalcified defect in the enamel., Conclusions: Failure of root canal treatment in primary molars may be evident from development of new radiolucent defects or enlargement of existing defects. No relationship was found between RCT in the primary molars and the appearance of enamel defects or the ectopic eruption of following permanent teeth.

Management of trauma to an immature permanent incisor is a challenge, especially when the pulp is necrotic. The aim of this study is to discuss the management of fractured maxillary right and left central incisors with immature root apex. Radiographic evaluation revealed that the tooth 11 had convergent apical walls, whereas tooth 21 had parallel apical walls; both the incisors were treated with pure calcium hydroxide paste to induce apical development. Follow-up clinical and radiographic examinations confirmed apical barrier at 3 months. Radiograph of tooth 11 with convergent roots showed continued apical development, whereas tooth 21 showed apical bridging, following which root canal was completed in both the teeth. Therefore, in view of the simplicity of this method, we believe that calcium hydroxide can be reemphasized as one of the treatment alternatives for fractured nonvital immature permanent incisors to induce apical barrier.

This paper describes the resolution of an extensive complicated crown-root fracture of an endodontically treated maxillary central incisor. Initially, the fractured crown was splinted to the adjacent teeth with orthodontic wire and composite resin. Subsequently, the crown fragment was reattached by means of a fiber post using a hybrid composite resin. Early stage success was achieved with the observance of normality in function, esthetics, and health of the tooth and surrounding periodontal structures. An athletic mouthguard was fabricated to prevent further trauma. Advantages, disadvantages, and prognosis of the treatment presented are discussed.

Introduction: Although long-term functional survival rates can be high for initial endodontically treated permanent teeth, they are generally more susceptible to fracture than teeth with vital pulps. Tooth extraction is often the consequence of an unfavorable prognosis after coronal and root fractures, but their occurrence in endodontically treated teeth might be reduced by identifying the risks for fracture associated with various operative procedures., Methods: This article presents an overview of the risk factors for potential tooth fractures in endodontically treated teeth on the basis of literature retrieved from PubMed and selected journal searches., Results: Postendodontic tooth fractures might occur because of the loss of tooth structure and induced stresses caused by endodontic and restorative procedures such as access cavity preparation, instrumentation and irrigation of the root canal, obturation of the instrumented root canal, post-space preparation, post selection, and coronal restoration and from inappropriate selection of tooth abutments for prostheses., Conclusions: Potential tooth fractures might be reduced by practitioners being aware during dental treatments of controllable and noncontrollable risks., (Copyright (c) 2010 American Association of Endodontists. All rights reserved.)

Aim: To determine whether patient age contributed to the fracture resistance of teeth subjected to root canal treatment and post placement., Methodology: Forty-five single-rooted, single-canal human teeth were mounted, instrumented, obturated and prepared for a post. The teeth were divided into young (18 < or = age < or = 35) and old (60 < or = age) groups and subjected to cyclic loading until fracture; those reaching 200,000 cycles without undergoing failure were then subjected to static loading to fracture. Statistical differences between groups were examined using one-way anovas, and correlations were identified using Pearson's r; significance was established at P < or = 0.05., Results: There was no significant difference between the two age groups in terms of the number of cycles to fracture (P > 0.05) or the load to fracture (P > 0.05). However, there was a significant correlation (P < or = 0.05) between the root fracture resistance and individual age, indicating that the susceptibility to root fracture increases significantly with increasing patient age. Also, the dentine thickness of roots that fractured was significantly less than those that did not (P = 0.04)., Conclusion: Vertical root fracture of teeth receiving root canal treatment with posts is more likely to occur in the teeth of older patients (60+) and particularly in those with low dentine thickness.

Objective: Teeth that have been endodontically treated and restored with postcore crown may experience fracture sometimes. Some researchers have analyzed the stress of the anterior teeth after postcore crown restoration, but the stress of the posterior teeth after such restoration has not been reported. We used three-dimension finite element methods to analyze the stress magnitude and distribution of remaining dentin in posterior tooth residual root restored with postcore crown. The binding material, loading direction, number, length and material of posts were studied., Methods: The models of residual root of maxillary first molar restored with postcore crown were created by CT scanning, mimics software and abaqus software. Different number, length and material of posts were used in the modeling. The posts were cemented with zinc-phosphate cement or composited resin. A load of 240 N was applied to the occlusal surface in four directions and tensile, shear, and von Mises stresses were calculated., Result: (i) The maximum stress on remaining dentin changed irregularly as the number and length of posts changed. (ii) The maximum stress on remaining dentin decreased slightly as elastic modulus of the material of posts increased. (iii) The maximum stress on bonding layer and remaining dentin was lower when bonded with resin luting agent than with zinc-phosphate cement. (iv) The maximum stress on remaining dentin increased markedly as loading angle increased., Conclusion: The number, length, material of posts, bonding material and loading angle all have influence on the magnitude and distribution of stress. The influence of loading angle is most apparent.

Introduction: The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate; therefore, current evidence is required to support the prognosis of this important procedure. The objectives of this study were (1) to assess the long-term outcome of apical surgery and (2) to identify significant outcome predictors in Phases 3-5 of the Toronto Study, pooled with the previously reported Phases 1 and 2., Methods: The 4- to 10-year outcome of apical surgery was prospectively assessed by a blinded, independent, calibrated examiner and dichotomized as "healed" (periapical index score 45 years, 84%, 10 mm, 53%)., Conclusions: In this 4- to 10-year cohort study, the outcome was better in subjects >45 years old, teeth with inadequate root-filling length, and crypt size of