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Endo tips    Better Endo    Endo abstracts    Endo discussions

Abstracts - Endodontics

Comparative outcome analysis of endodontic treatment and single implant restoration Endodontic failure: contributing factors Success and Failure in Endodontics Healing pattern and length of observation period One-visit apexification: technique Multifaceted use of ProRoot MTA root canal repair material Root perforation repair: surgical and nonsurgical management Obturation of a retained primary mandibular second molar Prophylactic treatment of dens evaginatus using mineral trioxide aggregate Mineral trioxide aggregate repair of lateral root perforations Mineral trioxide aggregate (MTA) as a root end filling material Mineral trioxide aggregate: a new material for endodontics Clinical applications of mineral trioxide aggregate Repairing iatrogenic root perforations Space maintenance--a review of treatment options Mineral trioxide aggregate: a new material for the new millennium Perforation repairs. Torabinejad, Repair of furcal perforations with mineral trioxide aggregate: Perforation during endodontic treatment Use of mineral trioxide aggregate for repair of furcal perforations 2587 Comparative outcome analysis of endodontic treatment and single implant restoration J. CARTER, D. JONES, E. SOLOMON, and J. HE, Baylor College of Dentistry, Dallas, TX, USA Endodontic treatment and implant-supported restoration are both viable treatment options to restore the functionality and esthetics of the dentition. Both treatment modalities have high success rate and predictability. Clinical decision making is often influenced by many factors in addition to success rate such as cost, time, function, and esthetics. Patient perception and preference play an important role in the ultimate clinical decision making. Objective: the purpose of this study was to compare endodontic treatment (Endo) and single implant restoration (Implant) regarding time to function, cost, and patient satisfaction. Materials and methods: 254 patient satisfaction surveys were sent to patients who received single implant restoration or endodontic treatment in the posterior mandible at Baylor College of Dentistry. Survey questions included patient satisfaction towards the cost, duration of the treatment, appearance and the ability to eat after the treatment. 53 responses from Endo patients and 36 responses from Implant patients were received. Treatment records of responded patients were reviewed to record the duration of the treatment, number of visits, treatment protocol, post-op intervention, and cost. Patient survey results were evaluated using Pearson chi square analysis to determine difference in the response to each question between the groups. Overall satisfaction was analyzed by Student's t-test using a derived summative score. Results: Time to function was significantly longer in Implant patients compared to Endo. Implant also required more post-op interventions. Endo patients were significantly more likely to report satisfaction with treatment cost ( p<0.05) and less likely to report dissatisfaction regarding treatment duration, as compared to Implant patients (p<0.05). However, there is no statistical difference in overall satisfaction between the two groups. Conclusion: Implant treatment requires more time and intervention to achieve function compared to Endo treatment. This delay causes significant dissatisfaction among patients. However, Endo and Implant treatments have similar overall patient satisfaction. 654 Pulp Biology; IADR June 2001 , 1 018 Endodontic failure: contributing factors. L. LIN*, N. CHUGAL, 0. T.-J. HUANG (Section of Endodontics, UCLA School of Dentistry, Los Angeles, CA, USA) Many factors have been suggested as the possible cause of root canal failures. The purpose of this study was to examine clinically, radiographically, and histobacteriologically the factors possibly related to root canal failures. The study consisted of 70 cases of root canal failures obtained from biopsies of periradicular lesions. Clinical signs and/or symptoms were recorded, and preoperative and postoperative radiographs were taken of all teeth. Strindberg's (1956) criteria of radiographic periapical status, completeness of root canal fillings, and treatment failures are used. The biopsied specimens consisted of resected root apexes and attached periapical tissues, and were processed for histobacteriologic examination. Modified Brown and Brenn stain was used to demonstrate bacteria in tissue. The results showed that among 70 cases of root canal failures, 59 cases were diagnosed as inflammatory periapical granulomas and 11 cases as inflammatory apical cysts. Thirty two cases were flush-filled, 14 cases underfilled, and 24 cases overfilled Stainable bacteria were observed in 61(87%) failure cases: among them 28(88%) cases flush-filled, 12(86%) cases underfilled, and 21 (88%) cases overfilled. Preoperative periradicular lesions were present in 55(76%) cases in which 22(69%) cases were flush-filled, 11(79%) cases underfilled, and 22(92%) cases overfilled. Stainable bacteria were found in 52(95%) cases with preoperative periapical lesions as compared to 9(60%) cases without preoperative lesions. Stainable bacteria were further found in 20(91%) flush-filled, 10(91%) underfilled, and 20(91%) overfilled cases with preoperative periapical lesions. In inflammatory apical cysts, bacteria were observed in 9(82%) cases. In conclusion, when root canal therapy has failed, completeness of root canal fillings is not an important contributing factor. Rather persistent root canal infection, or presence of preoperative periapical lesion. Success and Failure in Endodontics: Ulf Sjogren, 1996....excerpts. Criteria for evaluation of treatment outcome: Histological evaluation of the periapical tissues is the most stringent assessment of post-treatment healing. Brynolf (1967) investigated post-mortem specimens in an extensive histological evaluation of periapical healing. Comparing radiographs and histological sections, Brynolf (1967) tested the reliability of X-ray records to distinguish between healthy and diseased periapical tissue. The results showed that 98% of the cases with periapical lesions that were histologically identifiable could be detected by examining the continuity of the lamina dura and the shape and width of the periodontal ligament. The accuracy of interpretation of the periapical conditions can be increased by looking at detailed radiographic features (Brynolf 1967, Kaffe & Graft 1988). Brynolf’s (1967) findings provide a strong histological confirmation of the radiographic criteria developed by Strindberg (1956) for evaluating the outcome of conventional endodontic treatment. Strindberg (1956) used the normal contour and width of the periodontal ligament as radiographic signs that the treatment outcome was successful. Healing pattern and length of observation period: The healing of periapical lesions is a dynamic process, the duration of which can vary from case to case. A clinically relevant assessment of endodontically treated teeth cannot be conducted until the periapical tissue response and remodelling have stabilised. A healing tendency is a sign that the balance between the irritants and the host defense is tipped positively in favour of the latter. This process can, however, be transient and a reduction in the radiographic size of an apical lesion is no guarantee for eventual complete healing (Strindberg 1956, Seltzer et al. 1967, Bystrom et al. 1987). Studies on healing patterns indicate that most lesions resolve within 4-5 years after therapy (Strindberg 1956, Bystrom et al. 1987), but some cases may take as long as 10 years to heal (Strindberg 1956). Teeth with no periapical radiolucency before root canal treatment may sometimes develop radiographically detectable lesions after treatment. This periapical breakdown is usually due to chemical and/or mechanical irritation resulting from the root canal treatment and will usually revert to normal conditions within a span of 3-4 years (Strindberg 1956, Adenubi & Rule 1976). Studies based on observation periods of less than 4 years may include cases which have not attained a stable periapical condition, and the conclusions reached may therefore be erroneous. Because of this, the observation period following treatment is recommended to be at least 4 years. 1. Witherspoon, D.E. and K. Ham, One-visit apexification: technique for inducing root-end barrier formation in apical closures. Pract Proced Aesthet Dent, 2001. 13(6): p. 455-60; quiz 462. Numerous procedures and materials have been utilized to induce root-end barrier formation. Mineral trioxide aggregate (MTA) was introduced to dentistry as a root-end filling material. It has been advocated for filling root canals, repairing perforations, pulp capping, and root-end induction. Mineral trioxide aggregate reacts with tissue fluids to form a hard tissue apical barrier. As a result, MTA shows promise as a valuable material for use in one-visit apexification treatment, primarily for treating immature teeth with necrotic pulps. 2. Schmitt, D., J. Lee, and G. Bogen, Multifaceted use of ProRoot MTA root canal repair material. Pediatr Dent, 2001. 23(4): p. 326-30. Mineral Trioxide Aggregate (MTA) is a new material recently approved by the FDA for use in pulpal therapy. MTA has been reported to have superior biocompatibility and sealing ability and is less cytotoxic than other materials currently used in pulpal therapy. This report is a review of MTA's physical and biological properties and the clinical techniques of direct pulp capping, apexification, and repair of failed calcium hydroxide therapy. 3. Roda, R.S., Root perforation repair: surgical and nonsurgical management. Pract Proced Aesthet Dent, 2001. 13(6): p.467-72; quiz 474. Root perforation repair has historically been an unpredictable treatment modality with an unacceptably high rate of clinical failure. Recent developments in the techniques and materials utilized in root perforation repair have dramatically enhanced the prognosis of both surgical and nonsurgical procedures. This article presents a review of the literature pertaining to root perforation repair and illustrates, through clinical case presentations, the principles of extraradicular surgical repair and non-surgical internal repair of root perforation using mineral trioxide aggregate (MTA). 4. O'Sullivan, S.M. and G.R. Hartwell, Obturation of a retained primary mandibular second molar using mineral trioxide aggregate: a case report. J Endod, 2001. 27(11): p. 703-5. This case report demonstrates Mineral Trioxide Aggregate obturation of the root canal system of a retained primary mandibular second molar where no succedaneous permanent tooth was present. The technique seemed to provide a biocompatible seal of the root canal system in this case. It is not recommended for obturation of primary teeth that are expected to exfoliate since it is anticipated that Mineral Trioxide Aggregate would be absorbed slowly, if at all. 5. Koh, E.T., et al., Prophylactic treatment of dens evaginatus using mineral trioxide aggregate. J Endod, 2001. 27(8): p. 540-2. Two case reports with dens evaginatus are presented. Each patient had one tooth affected. There was a prominent tubercle on the occlusal surface of the mandibular second premolar. Under local anesthesia and rubber dam isolation a partial pulpotomy was conducted and mineral trioxide aggregate was placed. After 6 months the teeth were removed as part of planned orthodontic treatment. Histological examination of these teeth showed an apparent continuous dentin bridge formation in both teeth, and the pulps were free of inflammation. These cases show that mineral trioxide aggregate can be used as an alternative to existing materials in the proplylactic treatment of dens evaginatus. 6.Holland, R., et al., Mineral trioxide aggregate repair of lateral root perforations. J Endod, 2001. 27(4): p. 281-4. This study was conducted to observe the healing process of intentional lateral root perforation repaired with mineral trioxide aggregate (MTA). Forty-eight root canals of dogs' teeth were instrumented and filled. After partial removal of the filling, an intentional perforation was made with a bur in the lateral area of the root. The perforations were repaired with MTA or Sealapex (control group). Histological analysis occurred 30 and 180 days after treatment. Results showed no inflammation and deposition of cementum over MTA in the majority of the specimens. In the 180-day period, Sealapex exhibited chronic inflammation in all the specimens and slight deposition of cementum over the material in only three cases. In conclusion, MTA exhibited better results than the control group. 7. Koh, E.T., Mineral trioxide aggregate (MTA) as a root end filling material in apical surgery--a case report. Singapore Dent J, 2000.23(1 Suppl): p. 72-8. Many root end filling materials for apical surgeries have been identified either for scientific evaluation or clinical usage but none meets the requirements of an ideal root end filling material. Recently a new cement, Mineral Trioxide Aggregate (MTA) was researched as a potential root end filling material and showed promising results. This paper reports the significant findings of research done on MTA as a root end filling material and presents a clinical case where apical surgery was performed using MTA as retrograde filling. 8. Schwartz, R.S., et al., Mineral trioxide aggregate: a new material for endodontics. J Am Dent Assoc, 1999. 130(7): p. 967-75. BACKGROUND: Mineral trioxide aggregate, or MTA, is a new material developed for endodontics that appears to be a significant improvement over other materials for procedures in bone. It is the first restorative material that consistently allows for the overgrowth of cementum, and it may facilitate the regeneration of the periodontal ligament. CASE DESCRIPTION: The authors present five cases in which MTA was used to manage clinical problems. These included vertical root fracture, apexification, perforation repair and repair of a resorptive defect. In each case, MTA allowed bone healing and elimination of clinical symptoms. CLINICAL IMPLICATIONS: Materials such as zinc oxide-eugenol cement and resin composite have been used in the past to repair root defects, but their use resulted in the formation of fibrous connective tissue adjacent to the bone. Because it allows the overgrowth of cementum and periodontal ligament, MTA may be an ideal material for certain endodontic procedures. 9. Torabinejad, M. and N. Chivian, Clinical applications of mineral trioxide aggregate. J Endod, 1999. 25(3): p. 197-205. An experimental material, mineral trioxide aggregate (MTA), has recently been investigated as a potential alternative restorative material to the presently used materials in endodontics. Several in vitro and in vivo studies have shown that MTA prevents microleakage, is biocompatible, and promotes regeneration of the original tissues when it is placed in contact with the dental pulp or periradicular tissues. This article describes the clinical procedures for application of MTA in capping of pulps with reversible pulpitis, apexification, repair of root perforations nonsurgically and surgically, as well as its use as a root-end filling material. 10. Behnia, A., H.E. Strassler, and R. Campbell, Repairing iatrogenic root perforations. J Am Dent Assoc, 2000. 131(2): p. 196-201. BACKGROUND: Post preparation is an integral part of restoring endodontically treated teeth in indicated cases. Iatrogenic perforation of the root can result from preparing post space and can severely compromise the prognosis of the tooth. CASE DESCRIPTION: Two years after a patient's maxillary lateral incisor was restored with a post-retained composite resin, he went to a dental school emergency clinic with a chief complaint of soft-tissue swelling adjacent to the tooth. The authors took a periapical radiograph that revealed evidence of a circumscribed radiolucent lesion associated with the distal midroot area and a periapical radiolucency. Based on the radiograph, the authors suspected that the canal preparation for the post and the post placement had perforated the root at the base of the post. CLINICAL IMPLICATIONS: The authors used a combined surgical and orthograde approach with a biocompatible restorative material and a clear, plastic light-transmitting post to repair the iatrogenic perforation. 11. Blackler, S.M., Space maintenance--a review of treatment options to repair the iatrogenic perforation. Ann R Australas Coll Dent Surg, 2000. 15: p. 252-3. Management of intra-canal and furcation perforations can pose a significant clinical challenge. In such cases a biological matrix can provide the framework for healing of injured periodontal tissues and will facilitate placement of the perforation repair material. As a consequence the long-term prognosis for treatment of the iatrogenic perforation can be significantly improved and the need for surgical intervention can often be eliminated. 12. Germain, L.P., Mineral trioxide aggregate: a new material for the new millennium. Dent Today, 1999. 18(1): p. 66-7, 70-1. A midroot strip perforation can be a difficult problem to treat. Surgical treatment is arduous and has a poor prognosis. Variable success has been seen with the classic repair materials for nonsurgical treatment. Mineral trioxide aggregate seems to have incredible promise for sealing these defects with a good long-term prognosis. 13.Bruder, G.A., 3rd, et al., Perforation repairs. N Y State Dent J, 1999. 65(5): p. 26-7. Management of instrument perforations in the periodontal ligament space during endodontic or restorative procedures is an ongoing problem in dentistry. The introduction of microscopes, new instruments and materials has resulted in more controllable and predictable surgical and nonsurgical outcomes. This paper discusses some of the newer techniques and materials used to manage perforations effectively. 14.Arens, D.E. and M. Torabinejad, Repair of furcal perforations with mineral trioxide aggregate: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996. 82(1): p. 84-8. Furcal perforation is an unfortunate incident that can occur during root canal therapy or post preparation of multirooted teeth. Studies have shown that the materials currently used to repair these iatrogenic accidents are inadequate. The poor prognosis of furcation perforations is probably due to bacterial leakage or lack of biocompatibility of repair materials. On the basis of the recent physical and biologic property studies of the newly introduced mineral trioxide aggregate, this material may be suitable for closing the communication between the pulp chamber and the underlying periodontal tissues. These case reports support this hypothesis. 15. Valavanis, D.K. and G.N. Spyropoulos, [Perforation during endodontic treatment]. Hell Stomatol Chron, 1989. 33(1): p. 57-65. Perforations of the pulp chamber wall and area of root may occur during access opening of the pulp chamber and during root canal instrumentation. The authors in this paper describe in details the factors that can lead to perforations of pulp chamber or area of the root, the treatment and factors that affecting the repair and the prognosis of the perforations. 16.Ford, T.R., et al., Use of mineral trioxide aggregate for repair of furcal perforations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995. 79(6): p. 756-63. The histologic response to intentional perforation in the furcations of 28 mandibular premolars in seven dogs was investigated. In half the teeth, the perforations were repaired immediately with either amalgam or mineral trioxide aggregate; in the rest the perforations were left open to salivary contamination before repair. All repaired perforations were left for 4 months before histologic examination of vertical sections through the site. In the immediately repaired group, all the amalgam specimens were associated with inflammation, whereas only one of six with mineral trioxide aggregate was; further, the five noninflamed mineral trioxide aggregate specimens had some cementum over the repair material. In the delayed group, all the amalgam specimens were associated with inflammation; in contrast only four of seven filled with the aggregate were inflamed. On the basis of these results, it appears that mineral trioxide aggregate is a far more suitable material than amalgam for perforation repair, particularly when used immediately after perforation.
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