Search

CBCT examination was introduce in endodontics in 1993. Compared to retrodentoalveolar radiography, the radiation dose received during CBCT in endo- dontics when the narrowest FOV is used is 2-3 times higher. Method: Our aim was to correlate clinical signs with the images obtained originally using digital retrodentoalveolar radiography in the cases of varied canal morphologies, followed by CBCT examinations in order to establish a correct diagnosis and perform an adequate treatment that is in accordance with the existing anatomy. The CBCT examination was carried out according to the ALARA principle, only in those cases in which the retrodentoalveolar radiograph was not enough in order to establish a clear diagnosis. Results: In the cases with intraoperatory difficulties such as a complex root canal system manifested in anatomical variations, radicular perforations, broken instruments inside the canal, it is prudent to take into consideration the CBCT examination, due to its high diagnostic value compared to the high radiation dose. Conclusions: The benefits for diagnosis and for choosing the most adequate therapy option by analysing CBCT sections far outweigh the fact that the patient is exposed to a higher radiation dose. [ABSTRACT FROM AUTHOR]

Several clinical cases outline the difficulties of root canal treatment, due to the morphological changes of the endodontic space in elderly patients. The changes in the shape of pulp chamber and root canal make the treatment more difficult. It is also shown that the pulp chamber diminishes, due to reparative dentin. Calcification of the pulp space makes more difficult the access to the cavity. The obliterated canals lead to a challenging negotiation of the root canals. To avoid errors in the appreciation of the general health condition of the patient, the specialists should have an accurate preoperative radiograph or cone beam computing tomography (CBCT), use magnification (dental operative microscope), safe-ended burs, consider carefully any morphological changes, and apply the most proper techniques. [ABSTRACT FROM AUTHOR]

The present study aimed at assesssing - by clinical, histological and radiological investigations - the influence of some external factors on the pulp-dentin complex, and at providing a causal interpretation of the structural changes observed. Materials and methods. Clinical and radiological exams were performed on 65 old patients with ages between 60-75, and also on 40 young patients with ages between 20-35, presenting different dental-periodontal pathologies. The pulp-dentin complex was submitted to a morphopathological examination, to highlight the structural changes observed at microscopic level. Fragments of dental pulp were imersed in a 4% formaldehyde solution with phosphate buffer 0.1 M., pH 7.2, for 12-14 hours, at a temperature of 4°C, and 3-5 µm thick slices were prepared. The slices were coloured with hematoxylin-eosine (HE), by the trichromic technique - Masson. Photographies were taken with a Zeiss microscope, with Kodak 200 ASA. Results. Significant differences were observed, between the two groups of patients, as to the external factors that produce structural changes on pulp-dentin organ. In the group of young patients dental caries and coronal fillings prevailed, while the group of old patients was mostly associated with atrition and chronic marginal periodontitis. Out of the 40 young patients, 30 presented chronic dental caries (75%), while, among the 65 old patients, only 24 presented dental caries (36.9%). The percentages of coronary fillings between the two study groups were close, which could be considered as one of the causes producing changes in the pulp-dentin organ, following aggresive preparation of cavities, the action of materials used for the protection of pulp-dentin complex or of the materials used for coronry fillings. Conclusions. Dental pulp has a remarkable ability to counteract the action of harmful factors, producing a mineral barrier and stimulating the reparatory processes. Changes in the endodontic space can be produced in both experimental groups, but more intensely and more frequently in the old patients. The endodontic space is modified, both physiologically and pathologically, including deposition of secondary or tertiary dentin (reactionary or reparative dentin), as well as pulp reactions, such as: inflammation, fibrosis, calcium degeneration or vacuolisis. At cell level, microsocopic images showed a decrease of the odontoblasts number and sizes, as well as a reduced fibroblasts/fibrocytes ratios. These changes are associated with progressive vascular and nervous changes, that can be considered both theis cause and effect. These pathological transformations are related with a more difficult preparation of the endodontic space and can be considered as having a major role in the failure of endodontic therapy. [ABSTRACT FROM AUTHOR]

Objective: Periapical granulomas, chronic periapical osteitis produced particularly by the bacterial continuous agression from the endodontic space, can develop accordingly, or they can transform in epithelial or cystic granulomas, their diagnosis being more difficult to determine at these stages. This study aimed to emphasize a few aspects that can conduce to an easier diagnosis establishment. Materials and method: 78 patients with periapical chronic periodontitis have been evaluated in order to assess their evolution to epithelial or cystic granulomas. These cases were monitorised during the endodontic treatment and, were necessary, endodontic surgery was performed and samples for the histopathologic exam were drawn, in order to make an accurate diagnose. Results: From the 78 cases of teeth with chronic periapical periodontitis, 18 required surgical approach: 4 curettages, 5 apicectomies, 9 extractions, from which 7 were labeled as cystic granulomas, after the microscope examination. Conclusions: Untill the comming out of an accurate diagnosis method for these lesions, the practitioner must consider all possible data from the anamnesis to the clinic and radiographic exam, the only relyable method to establish a correct diagnosis being the histopathologic exam. [ABSTRACT FROM AUTHOR]

Unlabelled: In recent years there has been a considerable increase in the number of temporary teeth injuries, this variability being determined by multiple etiologic factors, which we need to be aware of, as well as by predisposing conditions., Aim: To characterize the epidemiology, etiology and pathology of specific types of periodontal-dental trauma in a series of preschool children from Iasi County., Material and Methods: The study included a total of 672 subjects aged 3 to 7 years old, from both urban and rural areas of Iasi County. Statistical analysis was performed using STATISTICA software used in medical research., Results: Prevalence of periodontal-dental trauma in the study group was 19.64%. Gender distribution in the study group showed a preponderance of males (62.12%). The risk of periodontal-dental trauma in deciduous teeth was 1.63 times higher in boys compared to girls. Fall accidents (41.67%) closely followed by playground accidents (31.82%) were the most common causes of periodontal-dental trauma in the study group., Conclusions: The prevalence of temporary dental trauma in the study group was relatively high, requiring the implementation of oral health promotion strategies and prevention programs, primarily addressed to parents and educators.

Unlabelled: Root perforation is an unwanted incident which may occur at any stage of endodontic treatment and can adversely affect tooth prognosis., Aim: To compare the recovery rate after treatment of root perforations in the interradicular area of the molars, using two different materials: MTA and ceramic nanoparticles mineral cement DiaRoot BioAggregate, by a clinical-radiological and statistical analysis over a period of up to 24 months., Material and Methods: The study was conducted on 28 molars from patients of both sexes, mean age 33.29 +/- 6.2DS, with iatrogenic perforation of pulp chamber floor. The teeth were divided into 2 groups according to the applied material: group 1--gray MTA (ProRoot MTA, Dentsply, Tulsa Dental), and group 2--BioAggregate (Diadent Group International, Vancouver). Patients included in the study were monitored and assessed by radiological examinations at 6, 12 and 18 months., Results: Pulp chamber floor perforations are significantly associated with tooth location (chi2 = 35.60, r = 0.67, p = 0.00359, 95% CI). Both when the perforation was repaired with MTA and BioAggregate, the clinical improvement was significant (chi2 = 17.608, r = 0.58, p = 0.0035, 95% CI)., Conclusions: Based on the results of this study, both MTA and BioAggregate are excellent materials for root perforation repair.

Unlabelled: Our study aimed to assess the possibilities of healing in periapical lesions following endodontic therapy, using a standardised technique., Material and Methods: Study group included 34 patients with 15-45 age. 40 teeth with periapical granuloma and periapical difuse osteitis were endodontically treated. All teeth presented radicular obturations with adequate length and density consisting of gutaperca points and antiseptic sealer (Endoflas, Sanlor). Optimum coronal sealing was provided through prosthetic restorations or composite resins associated with glassionomer cements. All treated teeth were radiographically monitorised on a 24 months time interval. Periapical Index (PAI) were used for assessment of periapical healing processes. Recorded data were used for statistical analysis in SPSS 16 trial., Results: The assessment of periapical status after 24 months showed a complete periapical healing for 42.5% teeth (PAI 1-2), partial periapical healing for 52.5% teeth and 5% endodontic failures. Median values for PAI indices decreased from an initial 4.75 value to 4.30 after 3 months, 3.33 after 12 months and 2.60 after 24 months. Wilcoxon tests confirm significant statistical differences between PAI indices at different time intervals., Conclusions: Adequate radicular obturation associated with optimum coronal sealing provide a favourable environment for periapical healing processes, providing success in endodontic therapy of chronic apical periodontitis. Time interval represents a major factor that influences periapical remineralisation degree.