Completion Of Endodontic Therapy Research Articles

Effect of the Time Interval of Functional Loading on the Periapical Healing of Endodontically Treated Mandibular Molar Teeth with Pulp Necrosis and Asymptomatic Apical Periodontitis: A Split-mouth Randomized Clinical Study

IntroductionThis prospective study evaluated the effect of immediate functional loading (IFL) of a full-coverage prosthesis on the clinical and radiographic outcome of nonsurgical endodontic therapy (NSET) performed on mandibular molar teeth with pulp necrosis and asymptomatic apical periodontitis. MethodsIn 20 subjects, standardized 2-visit NSET was performed in bilateral mandibular first molar teeth (split-mouth model) with a diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting a radiographic periapical index (PAI) score ≥3. In each subject, the nonvital bilateral mandibular first molar teeth were randomized to 1 of 2 groups: the IFL group or the functional loading after a time interval of 6 months group. Provisional full-coverage prostheses were provided within 7 days after the completion of endodontic therapy. The cases were followed up clinically and radiographically at 6 and 12 months. Radiographs were assessed for periapical healing based on PAI scores, which were dichotomized as healed (PAI score ≤2) or nonhealed (PAI score ≥3). The data were compared using chi-square and Fisher exact tests. ResultsA recall rate of 100% was achieved at the end of 12 months. All teeth in the IFL group and the functional loading after a time interval of 6 months group were clinically asymptomatic. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was a significant difference (P < .05). ConclusionsIFL of a full-coverage prosthesis in endodontically treated mandibular molar teeth with pulp necrosis and asymptomatic apical periodontitis delayed periapical healing.

Effect of Endodontic Treatment on Serum Glutathione (GSH) Levels in Patients with Chronic Apical Periodontitis: A Clinical Pilot Study

Aim: To assess the before- and after-treatment levels of glutathione (GSH) in the serum of patients with chronic apical periodontitis. Materials and Methods: The study involved 20 systemically healthy patients with radiographic evidence of chronic apical periodontitis in at least one tooth, of which 11 were finally assessed. 10 mL of the patient’s venous blood was obtained before commencing the endodontic treatment to assess the pre-operative serum GSH levels (T0). The canals cleaned and shaped, and irrigated with 2.5% sodium hypochlorite, and filled with a calcium hydroxide based intracanal medicament. At the subsequent appointment after one week, teeth were obturated. The patients were recalled 30 days after the completion of endodontic therapy, and blood samples were assessed again at time frame T1 for serum GSH. The difference in pre- and post-treatment values for T0 and T1 was statistically analyzed. Results: The mean age of the subjects ( N = 11) was 21.09±3.24 years, with 19.50±0.71 years in female group and 21.44±3.50 years in the male group. The mean GSH at T0 was 11.73±8.30 units, which was increased to 14.04±13.96 units at T1. However, no significant change was observed in the GSH level from T0 to T1 (change = –2.30, t-value = –0.49, P = .635). Conclusion: The results of this study suggest that endodontic therapy may play a role in restoring the systemic oxidative balance, as seen by the increase in post-treatment serum GSH levels.

Pre- and post-treatment levels of serum high-sensitivity C-reactive protein in patients with lesions of endodontic origin: A clinical pilot study

Objective: The objective of the study was to evaluate the impact of lesions of endodontic origin (LEO) and their treatment on the patients’ serum high-sensitivity C-reactive protein (hs-CRP) levels. Materials and Methods: A total of 20 healthy patients with radiographic evidence of LEO in at least one tooth were recruited for the study, of which 11 were finally evaluated. Before initiating the endodontic treatment, 10 ml of patient’s venous was taken from the antecubital vein to assess the pre-operative serum hs-CRP levels (T0). Canals were prepared with K-files till a suitable size and irrigated with 2.5% sodium hypochlorite. At the subsequent appointment after 1 week, teeth were obturated. The patients were then recalled 30 days after the completion of endodontic therapy. Again blood samples will be taken at time-frame T1 to assess the serum hs- CRP levels. The change in pre- and post-treatment values for T0 and T1 was statistically evaluated to assess the effect of treatment on serum hs-CRP levels. Results: The mean CRP (mg/L) at T0 ± SD (Range) at baseline was 6.18 ± 3.72 (0.96–11.02) and the mean CRP at T1 ± SD (Range) was 3.92 ± 3.59 (1.108–11.04) and mean change in CRP ± SD (Range) after 30 days follow-up was −2.26 ± 3.04 (−8.26–1.16). Significance of change in CRP levels (Paired t-test) was t = 2.458; P = 0.034. Conclusion: The results of the present study indicate that root canal treatment reduced the levels of hs-CRP in the serum of the patients having LEO. Timely diagnosis and treatment of these lesions may have some contribution in reducing systemic inflammatory burden.

Current Status and Call for Action: Regenerative Endodontics

From past few years, Endodontic therapy shows high rate of success to prevent diseased tooth. It help to decrease the pain and swelling, and after completion of endodontic therapy. In children are more prone to caries due to high carbohydrate diet and bed food habits. So in early case we have plan for regenerative endodontic procedures which help in replace the damaged tissue including dentin and root structures. Sir Dr. B.W. Hermann was first ever clinician to carry regenerative endodontic procedure in a patients. In his case report, he used calcium hydroxide paste in vital pulp amputation which shows great results after 21 days. In this review article we focus on current aspect of Regenerative endodontic procedures.

Management of root resorption in maxillary first molar-radectomy

Preservation of tooth is one of the major goals of an Endodontist. This goal can be acquired either by non surgical or surgical approach. Root resection is one of the surgical approaches for preservation of molars with furcation involvement. This procedure results in a unique environment which is dictated by the contours of the remaining roots and the residual furcation between them. Root resorption is a viable treatment option to salvage and retain a part of multirootedteeth. This case report illustrates prognosis of root resection after completion of endodontic therapy for managing a case of root resorption. This case shows external root resorption of the distobuccal root of right maxillary first molar. Due to strategic value of maxillary first molar, it was decided to employ root resection. After completion of endodontic therapy root resection was carried out. After 6 months, the absence of periradicular radiolucent lesions, periodontal pocket, pain, and swelling indicated a successful outcome of root resection. Keywords: Endodontist, Multirooted teeth, Periradicular, Distobuccal, Resorption

Management of a Fractured Anterior Tooth by Reattachment using Fiber-reinforced Post

ABSTRACT Reattachment is an effective, economical, and conservative procedure to restore the natural shape, contour, translucency, surface texture, occlusal alignment, and color of the fractured tooth that results in positive emotional and social response in a patient. This case report details the multidisciplinary management of a fractured central incisor with fracture line extending subgingivally in the palatal region. Access opening was done through the fractured segment of 21 and it was detached and stored in saline. After completion of endodontic therapy, crown lengthening procedure was done. Fiber post was placed for added reinforcement and the fragment reattached. A new trauma occurred after 4 months, but the reattached fragment did not get detached. How to cite this article Alexander RN, Nair KR, Geetha P, John N, Raj A, Kumar MM. Management of a Fractured Anterior Tooth by Reattachment using Fiber-reinforced Post. Cons Dent Endod J 2017;2(2):56-59.

Root resection under the surgical field employed for extraction of impacted tooth and management of external resorption

This case report illustrates determination of prognosis and immediate resection carried out, before completing the endodontic therapy, during the surgery employed for managing a nonperiodontal problem. This case showed external pressure resorption in the distobuccal root of maxillary second molar caused by the impingement of impacted third molar. Extraction of third molar was decided when healing was not seen, despite initiating endodontic therapy in second molar. Following elevation of flap and extraction of third molar, the poor prognosis due to severe bone loss around the resorbed root was evident. But due to strategic value of second molar, it was found beneficial to employ resection. Therefore, immediate resection was carried out in the same surgical field before the completion of endodontic therapy. This prevented the need for another surgical entry with its associated trauma to carry out resection separately later. Resection followed by the completion of endodontic therapy and full crown assisted in salvaging the remaining functional portion of the tooth and prevented the occurrence of distal extension with its potential drawbacks.

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report

The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio-distal trimming was performed and the defects were restored with anterior resin composites in order to re-establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow-up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.

Periapical status of root-filled teeth exposed to the oral environment by loss of restoration or caries.

Studies in vitro carried out on extracted teeth have demonstrated that bacterial elements may penetrate root fillings from the coronal to the apical end after a period of exposure to artificial saliva or bacterial culture. To address the clinical significance of this so-called issue of coronal leakage, a retrospective cohort analysis was conducted of 55 patients with root fillings that had been exposed to the oral environment because of caries or absent restorations. Cases were matched 1-to-1 with regard to initial pulpal and periapical diagnosis, period after completion of endodontic therapy, tooth type, age of the patient, and the technical quality of the root filling. Only cases with a follow-up period of 3 years or more were included. Radiographs taken at the last follow-up examination were subjected to a masked evaluation. A total of 14 osteolytic lesions were recorded. In 43 of the 55 matched pairs (78%), there were identical periapical conditions. In 9 pairs, a periapical lesion was present in the "open" tooth category, whereas in 3 pairs, a periapical lesion was seen exclusively in the "intact" tooth. Though the odds-ratio for a lesion to be present in the "open group" was 3. 0, this was not a statistically significant result (P >.10). Data suggest that the problem of coronal leakage may not be of such a great clinical importance as implicated by numerous studies in vitro, provided instrumentation and root fillings are carefully performed.

The Treatment of Traumatized Permanent Anterior Teeth: Case Report &amp; Literature Review Part I - Mangement of Inruded Incisors

Abstract A case is reported in which an intruded incisor was initially treated by an endodontic dressing with calcium hydroxide and then extruded using a removable orthodontic appliance. A follow-up examination seven years after completion of endodontic therapy and bleaching showed a favourable response. A review of the relevant literature indicates that intrusion occurs in five to twelve per cent of luxation cases. In this type of injury maximum damage occurs to the pulp and all supporting structures because the tooth is driven into the alveolar process. Complications which have been reported include: pulp necrosis, apical radiolucencies, partial or total pulp calcification, root resorption (surface, inflammatory or replacement), marginal periodontal bone breakdown, and arrested or disturbed root development. The prognosis for pulp survival after intrusion is much more favourable for teeth with incomplete root formation than for teeth with complete root formation. Treatment options available to bring an intruded tooth into alignment are: to await spontaneous re-eruption which may occur if root formation is incomplete, uncovering of the intruded crown, orthodontic extrusion which is allied with gentle luxation if the tooth does not move, and immediate surgical repositioning.

The diagnosis of a multilocular periapical lesion

The case presented illustrates the importance of complete diagnosis prior to endodontic therapy. The completion of endodontic therapy on a single tooth resulted in total healing of a multilocular lesion involving two root apices. The case presented illustrates the importance of complete diagnosis prior to endodontic therapy. The completion of endodontic therapy on a single tooth resulted in total healing of a multilocular lesion involving two root apices.