Cause Of Endodontic Failure Research Articles

Diversity of Enterococcus faecalis Genotypes from Multiple Oral Sites Associated with Endodontic Failure Using Repetitive Sequence-based Polymerase Chain Reaction and Arbitrarily Primed Polymerase Chain Reaction

IntroductionThe aim of this study was to evaluate the diversity and similarity of Enterococcus faecalis genotype isolates from multiple oral sites using repetitive sequence-based polymerase chain reaction and arbitrarily primed polymerase chain reaction (AP-PCR). MethodsForty-two endodontically treated teeth with apical periodontitis were selected. A total of 126 microbial samples were collected from 3 different sites (saliva, pulp chamber, and root canals, all n = 42) during the nonsurgical retreatment procedures. After growth on m-Enterococcus agar, the colonies were isolated, characterized as gram-positive catalase negative cocci, and identified using an API 20 Strep kit (bioMérieux, Marcy-l'Etoile, France). Seventy-four colonies from 10 patients were confirmed as E. faecalis by polymerase chain reaction (16S ribosomal RNA). Repetitive sequence-based polymerase chain reactions using ERIC and AP-PCR using RW3A primers were performed in all 74 colonies. Fingerprints were analyzed and separated into genotypic groups based on the Dice coefficient percentage of similarity (82% or greater) as determined by ERIC reproducibility assays involving E. faecalis controls. ResultsSeven different E. faecalis genotypes (GTs) (GT1 = 27%, GT2 = 17.6%, GT3 = 1.3%, GT4 = 18.9%, GT5 = 9.5%, GT6 = 14.9%, and GT7 = 10.8%) were observed in different subjects and oral sites associated with endodontic failure. Remarkably, in 4 of 5 patients, the same GTs present in the infected root canals were also isolated from either the pulp chamber or the saliva samples. In particular, GT6 was detected in all 3 oral sites of patient 37. ConclusionsE. faecalis GTs isolated from saliva, the pulp chamber, and the root canal were similar using the Rep-PCR and AP-PCR methods. These findings suggest that coronal microleakage is a conceivable cause of endodontic failure.

Comparative evaluation of four different sterilization methods on contaminated endodontic files

Background: The reuse of instruments in the field of endodontics leads to cross infection due to contamination with microbes as the instruments come into direct contact with saliva, blood, and infected tissues. Since microbes are considered to be the major cause of endodontic failures, sterilization of endodontic instruments is mandatory for maintaining asepsis to prevent cross-contamination from one person to other. Hence, the present study was conducted to compare the effectiveness of four different methods of sterilizing contaminated endodontic files. Materials and Methods: A total of 48 stainless steel K files were divided into four groups based on the sterilization method followed – Group A: Autoclave, Group B: Glass bead sterilization, Group C: Glutaraldehyde, and Group D: Quitanet Plus (aldehyde-free solution). In all the tested groups, half of the files were contaminated with Escherichia coli and remaining with Enterococcus faecalis. Then, presterilization colony counts were recorded, followed by sterilization through respective methods. Later, the sterilized files were rinsed with distilled water and 100 ul of the diluted concentration was transferred and cultured onto the respective agar plates to determine the total microbial reduction. Results: Autoclave showed complete effectiveness in reducing the microbial count followed by Quitanet Plus, glass bead sterilizer, and glutaraldehyde. Conclusion: Autoclave is considered to be the best sterilization technique to prevent cross infection in endodontic therapy.

Antimicrobial Efficacy of Mixtures of Nanosilver and Zinc Oxide Eugenol against Enterococcus faecalis

This study aimed to assess the antimicrobial efficacy of 0, 0.5, 2, and 5 wt% nanosilver in conjunction with zinc oxide eugenol (ZOE) against Enterococcus faecalis. Nanosilver in 0.5, 2, and 5 wt% concentrations was added to ZOE and the antibacterial activity of the mixtures on E. faecalis was assessed using disk diffusion method, and the results were reported as the diameter of the growth inhibition zone. The diameters of the growth inhibition zones around 0, 0.5, 2, and 5 wt% concentrations of nanosilver particles were not significantly different at 24 and 48 hours and 1 week; however, the difference with the azithromycin disk was significant. Considering the lack of a significant increase in the diameter of the growth inhibition zones around 0, 0.5, 2, and 5 wt% ZOE containing nanosilver, it appears that addition of nanosilver up to 5 wt% cannot improve the antibacterial properties of ZOE sealer against E. faecalis. Microorganisms present in the root canal system of primary teeth are mainly responsible for endodontic infections. Enterococcus faecalis is the most important cause of endodontic failure. Application of sealers that decrease the adhesion and colonization of bacteria, as well as susceptibility to bacterial infections can greatly help in this regard. Using these sealers in conjunction with antibacterial agents, such as nanosilver particles may yield higher antibacterial efficacy.

Prevalence of Unclassified Root Canal Configuration in Permanent Maxillary First Molar in Indian Population

Background: If a canal is left untreated, it is a foci of infection. Therefore, it is critical to know the usual configuration of the root canal along with the variations in root canal anatomy, in order to keep the cause of endodontic failure to a minimum. Aim: This study investigated the canal configuration in maxillary first permanent molar mesiobuccal root radiographically followed by histological evaluation in Indian population. Methods: Endodontic access preparation was performed on 100 human permanent maxillary I molars and all the canals were explored. The mesiobuccal root was separated and radiographed in mesiodistal and buccolingual direction. India ink dye was injected actively in the root canal of each sample. The root samples were prepared for histological viewing. The slides made were observed under light microscope and canal configurations were tabulated. Results: The radiographic interpretations by observers were correlated with histological findings and analyzed statistically (p value). The radiographic findings revealed a good inter observer agreement (Cohen kappa). On matching histological and radiographic interpretations, it revealed 69.2% Vertucci type I predominance. New unclassified canal configurations were also observed. Conclusion: To divulge three dimensional architecture of the root canal, application of alone conventional radiography is not enough.

Endodontic treatment of a mandibular 6 years molar with three roots: A pedodontist perspective

Nature has signified the importance of first permanent molar by giving it the first rank in eruption sequence of the permanent dentition. First permanent molar erupts at the age of 6-7 years and hence is also known as 6 years molar. The study of root and root canal anatomy of molars in children is important for a successful pediatric practice. Normally the permanent mandibular first molar has two roots, one mesial and one distal root. Rarely an additional third root is seen, which is found distolingually and is called as radix entomolaris (RE). This extra root is typically smaller than the distobuccal root and is usually curved, requiring special attention when root canal treatment is being considered for such a tooth. The most frequent cause of endodontic failure is a canal that is left untreated because a clinician fails to recognize it and subsequently leads to extraction of the fundamental 6 years molar. Hence, this paper reports an unusual case and clinical approach of RE in a mandibular 6 years molar.

Failure of endodontic treatment: The usual suspects.

Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.

Endodontic–periodontal management of a maxillary lateral incisor with a deep palatogingival groove

The existence of pulpal and periodontal disease can complicate the diagnosis and treatment planning and affect the sequence of care to be performed. A palatogingival groove is a developmental anomaly that often leads to the establishment of combined periodontal–endodontic lesions and can be an unidentified cause of endodontic failure. This case report describes a case of palatogingival groove in an upper right lateral incisor with endodontic failure. The diagnosis was confirmed with the help of spiral computed tomography and management included a combination of re-endodontic therapy and periodontal therapy.

Histological evaluation of the root apices of failed endodontic cases

Aim: The aim of this histological study was to evaluate the different causes of the failures of the endodontic treatment. Materials and Methods: Adult patients who were referred for endodontic surgery and for whom root-end resection was considered suitable were invited to participate in this study. The inclusion criteria were: (1) Patients aged between 18 and 65 years; (2) teeth with apical periodontitis that was diagnosed radiographically; (3) the tooth could not be adequately and better managed by root-canal retreatment; and (4) the crown of the tooth was adequately restored. One hundred root apices were surgically removed together with the periapical pathological tissue from 92 patients (56 males and 36 women).Histological sectioning was performed on calcified specimens that were embedded in a suitable medium. Results: The causes of endodontic failure identified through histological evaluation were as follows: Presence of bacterial and debris into canals (51%), apex transposition and overfilling (3%), presence of the isthmus (21%), bacterial colonization of root surface (2%), untreated canals (11%), and filling material outside root canal (4%). There was no significant difference between the distribution of teeth and the causes of endodontic failures (P = 0.32). Conclusions: The present study demonstrated that the most common cause of endodontic failure is the insufficient cleaning of the root canal system. It also explores the effectiveness of histological evaluation of the root apex following root-end resection in exploring the causes of endodontic failures.

Variant Anatomy of Mandibular First Permanent Molar: A Case Series

ABSTRACTThe advent of new dental imaging techniques and equipments, dental operating microscopes and loupes in endodontics have proved to be a boon for clinicians today. One of the causes of endodontic failure is missed canals. These technologies have greatly improved the ability to detect the presence of extra canals and thus seem to improve the success rate of endodontic treatment and the prognosis of endodontically treated tooth. The present article is a case series describing the endodontic management of two mandibular first permanent molars, one having two roots with six canals and other with three roots and five canals.How to cite this articleShenoi PR, Kubde R, Badole GP, Singare P. Variant Anatomy of Mandibular First Permanent Molar: A Case Series. J Contemp Dent 2015;5(2):113-117.

Endodontic management of maxillary first molar with three mesiobuccal root canals using cone beam computerized tomography

AbstractEndodontic treatment of maxillary first molar with three canals in mesiobuccal root using cone beam computerized tomography (CBCT). This case report presents a maxillary first molar with three mesiobuccal canals. Missing a canal during root canal therapy is one of the main causes of endodontic failure. The frequency of detection of extra canals has increased with better techniques in instrumentation, magnification and illumination. The present case shows three canals in the mesiobuccal root, which is an aberrant and rare anatomical presentation. CBCT proved to be an important tool in confirming the presence and location of the extra canals.

Antimicrobial activity of various irrigants against E. faecalis biofilm: An in vitro study

Aim: This study evaluated the antimicrobial efficacy of irrigants during the cleaning and shaping of the canal system. This in vitro study evaluated quantitatively and qualitatively, the antimicrobial activity of 2% chlorhexidine gluconate, 5.25% sodium hypochlorite and MTAD against E. faecalis. Materials and Methods: Eighty freshly extracted human single-rooted mandibular premolars were selected and sectioned below the cement-enamel junction at 15 mm length. E. faecalis ATCC 29212 strain and clinical strains were subcultured from nutrient agar plates in the laboratory. Single colonies of both strains were inoculated from nutrient agar cultures into 100 mL Tryptone Soya Broth (TSB) and incubated at 37°C and 150 rpm for 2 h. After 2 h, when the culture entered the logarithmic phase, the prepared teeth specimens were added and incubated at 37° C and 60 rpm for 7 days. Every 48 h, 75 mL of the culture was replaced with fresh TSB. The 80 samples were divided into two sets of 40 each: the first set of 40 specimens for ATCC 29212 and the second set of 40 specimens for clinical isolates. Each set was further subdivided into four groups of 10 teeth according to the selected irrigants. For quantitative assessment, six teeth from each group were used for viable count, and, for qualitative analysis, four teeth from each group sectioned vertically were used for fluorescent microscopy . Results: In the agar disc diffusion method, both Chlorhexidine and MTAD exhibited good antibacterial properties. Distilled water had no antimicrobial property. The colony counts in the clinical isolates and ATCC specimens when used with different irrigants were compared using one-way ANOVA. Conclusions: Sodium hypochlorite showed the most effective antimicrobial property among the three irrigants against E. faecalis biofilm. Clinical relevance to interdisciplinary dentistry Microorganisms remaining in the root canal space after treatment or recolonizing the filled canal system are the main cause of endodontic failures. Failure in Root canal therapy will lead reinfection which may become a problem which has to be handled with multidisciplinary approach such as endodontic surgery or therapy.

Canal Configuration in the Mesiobuccal Root of the Maxillary First Molar and Its Endodontic Significance

T he ultimate objective of endodontic therapy has been stated to be the obliteration of the prepared root canal space with an inert material in order to restore the integrity and state of good health of the treated tooth in the dental arch.l According to Ingle,2 the most common cause of endodontic failure is apical percolation, with the largest percentage of eases failing due to incomplete canal obliteration. Other reasons for failure in this category include leaving a canal completely unfilled and inadvertently removing a silver point. Quite often a canal is left unfilled because the operator has failed to recognize its presence. Rankine-Wilson and Henry3 and others 4p 5 have described the not uncommon finding of a bifurcated canal in mandibular incisors, cuspids, and premolars. Green6 gave an exhaustive description of the presence of auxiliary and secondary canals among all the teeth in the dental arch. Therefore, it is the obligation of those interested in endodontics to be thoroughly familiar with root canal anatomy, in both normal and abnormal situations, in order to keep this cause of endodontic failure to a minimum.

“Stereomicroscopic dye penetration study evaluating the sealing ability of three different furcation repair materials” - An in vitro study

Perforations have been found to be one of the most eminent cause of endodontic failures. Perforations of the root walls may be induced by iatrogenic causes, resorptive processes, or caries. The prognosis of endodontically treated teeth with perforations depends on factors such as the time lapsed before obturating the defect,the location of the perforation, adequacy of the perforation seal, size of the perforation and the material used to seal the perforation. Numerous materials have been recommended for the repair of perforations including gutta-percha, amalgam, indium foil, calcium hydroxide, tricalcium phosphate, cavit, zinc oxide eugenol, hydroxyapatite and plaster of paris. The objective of the present study is to evaluate the sealing ability of MTA when used as a furcation repair material and to compare its sealing ability with Light cured GIC and Cavit

Evaluation of the endodontic apical seal after post insertion by synchrotron radiation microtomography

The commonly used methods for evaluating the endodontic apical seal, such as longitudinal and transversal section and diaphanization, show some operative difficulties and intrinsic limitation. This study suggests and describes a new method of analysis using a synchrotron radiation microtomography to analyse the root apex after post insertion, creating a three-dimensional image and analysing sections of the specimen every 5 μm. The study was performed at SYRMEP beam line at the Electra Synchrotron in Trieste using monochromatic X-rays of 32 KeV. Eleven monoradicular teeth were prepared using NiTi GT Rotary files instruments to an apical size 20 with conicity .06 and divided in four groups: in G1 ( n = 4 ) and G2 ( n = 2 ), the specimens were endodontically filled with guttapercha and a zinc-oxide sealer, in G3 ( n = 3 ) and G4 ( n = 2 ) guttapercha and a silicon-based sealer were used. An endodontic post was inserted in specimens of groups 1 and 3 following the manufacturer's instructions. Specimens were analysed using monochromatic X-rays of 32 KeV. A CCD detector with pixel dimension pf 5×5 μm 2 was used for the acquisition process. Seven hundred and twenty projections were performed over 180° range using a high-resolution rotator. The projections were reconstructed using standard algorithms for tomographic reconstruction. The apical infiltration was evaluated by verifying if black spots were detectable on the images. The specimens of groups 3 and 4 showed a better apical seal than the ones of groups 1 and 2. Post insertion, when a ZOE-based sealer is used, increases the apical gap even if it does not seem to be clinically relevant and sufficient to be a cause of endodontic failure. The new method for analysis appeared to be effective to detect small defects in endodontic obturation, analysing guttapercha–sealer and sealer–dentin interfaces.

Gutta percha obturation techniques

T h e most common cause of endodontic failure has been ascribed to incomplete obturation. Filling a root canal is intended to prevent microorganisms and toxins in the canal, as well as those present in the oral cavity, from passing along the root canal and moving out into the periradicular tissues. Matsumiya and Kitamura both demonstrated that bacteria remain in the deep portions of the endodontic system, even after chemical disinfectants. Healing of the periapical tissues occurs when the nutritional supply to the bacteria is stopped by the sealing properties of obturation. Unfortunately, the endodontic system is complex, including the accessory canals, anastamoses, and apical deltas. The inability to completely obliterate the irregularities of the endodontic system with a filling material and seal the apical delta foramen has been reported to account for nearly 60% of root-canal failures. Fluid percolation into the canal arises indirectly from the blood serum, water-soluble proteins, enzymes, and salts from both the apex and oral cavity. Once in the radicular space, those products undergo degradation and diffuse out to the periapical tissues and act as an irritant, which results in periapical inflammation. Bacteria will result in the producuon of toxic products in the root canal with periapical inflammation. In current endodontic treatment, is said that it is more important what comes out of the canal than what goes into So the emphasis seems to be placed more on cleaning and preparing the endodontic system than on filling it. This does not mean that obturation is less important; rather means that endodontic success depends on meticulous root-canal preparation. For a complete three-dimensional fill, proper instrumentation of the root canal makes a lot easier to facilitate. The objective of obturation of the radicular space is to fill the entire endodontic system and all of its complex anatomic pathways completely and densely with a nonirritating hermetic sealing agent(s), which results in a fluid-tight seal, especially at the apex, but also coronally (to prevent infection from the oral cavity). Success is dependent on the thoroughness of endodontic cavity design, shaping, and cleaning. The thoroughness of debridement and patency of the root-canal system facilitates its successful sealing in the three-dimensional phase. A three-dimensional fill is desired because it: 1) prevents percolation of the periapical exudate into the root-canal space (providing a culture medium for any residual bacteria); 2) prevents microorganisms from entering and reinfecting the root canal; and 3)

Etiologi dan Pencegahan Kasus-Kasus Iatrogenik dalam Perawatan Endodontik

Successful of root canal treatment is determined on elimination of microorganism from the root canal system, enlargement of the canals and a hermetic seal to prevent infection or reinfection of the periapical tissues. The Ingle study revealed that the two major causes of endodontic failure were imperfect instrumentation and incomplete obturation. Over 50% of incomplete obturation caused root perforation, meanwhile root perforation were about 15%. Further understanding of the principal of endodontic triad and operator skill, iatrogenic cases in endodontic treatment may be prevented.

Testing of sealing ability of endodontic filling materials.

Incomplete obturation of the root canal system is the major cause of endodontic failure. Endodontic filling materials with ability to seal the root canal are, therefore, essential for successful endodontic therapy. However, assessment of sealing ability is not included in the requirements specified in the current international standard covering root canal sealers. A number of different in vitro methods have been used to evaluate the sealing quality of endodontic filling materials. The tests have usually been leakage tests, i.e. based on assessment of penetration of a tracer along the obturated root canal. Leakage tests have poor reproducibility and are, therefore, not suited for standardized test programs. By selecting the properties necessary for sealing ability and testing them separately, it might be possible to find a number of tests, which individually are suitable for a standardized test program, and which combined will give information on the sealing ability of the test material.