Conventional Root Canal Treatment Research Articles

Assessment of Photodynamic Therapy (PDT) in Disinfection of Deeper Dentinal Tubules in a Root Canal System: An In Vitro Study.

The success of endodontic treatment therapy depends on how well we eliminate pathogenic microflora from the root canal system as micro organism as the major cause of root canal infection. Conventional root canal treatment can fail if microorganisms cannot be removed sufficiently by thorough cleaning, shaping of root canal. Newer modalities such as photodynamic therapy are being tried now a days for disinfection of root canals. Aim & Objectives: The basic aim of this study was assessment of the antimicrobial efficacy of Photodynamic Therapy in deeper dentinal tubules for effective disinfection of root canals using microbiological and scanning electron microscopic examination in vitro. The study was conducted at Teerthanker Mahaveer Dental College & Research Centre. The teeth required for study was collected from Department of Oral and Maxillofacial Surgery. Only freshly extracted 20 intact, non carious single rooted teeth which were indicated for orthodontic treatment were taken for this study. Statistical analysis was done using Student's Unpaired t-test were at (p<0.001) was found to be highly significant. Microbiological examination of samples were done and colony forming units were counted to assess the disinfection potential of photodynamic therapy. Scanning electron microscopic examination of samples was done to check penetration of bacteria's into deeper dentinal tubules. On examination, there was a marked reduction in microbial growth after use of photodynamic therapy. On scanning electron microscopic examination, it was observed that there were less number of bacteria's in deeper dentinal tubules in case of PDT group as compared to control group. The results of the present study indicate that PDT can be effectively used during antimicrobial procedures along with conventional disinfection procedure for sterilization of root canals.

Lesion Sterilization Tissue Repair as Adjunct to Conventional Root Canal Treatment of Combined Periodontic-Endodontic Cases

ABSTRACT Background Treatment of perio-endo lesions is challenging for the clinician. A combination of root canal treatment and periodontal treatment is needed in order to provide good results. There is a high failure rate due to the difficulty in eliminating the microflora that colonizes and complicates the lesion. Conventional root canal treatment (RCT) sometimes is not enough to prevent failure in such lesions. Hence the Aim of this study was to evaluate of use of LSTR (Lesion Sterilization Tisssue Repair) therapy in conjunction with, periodontal therapy and RCT in management of combined perio-endo lesions. Materials and methods This study was conducted on 26 patients with perio-endo lesions, The affected teeth were tender to percussion, presented no mobility, and meticulous periodontal probing revealed all pockets to be more than 6 mm in depth. Periapical radiographs of the teeth confirmed the extensive coronal carious lesion involving the pulp and revealed large periapical lesion. The patients were classified into two groups, each of 14 patients, control group (A) RCT done by using conventional sealer, and group (B), RCT done by mixing sealer with LSTR material in equal proportions. All teeth were treated by open flap debridement. Results In group B patients, after follow-up for 3, 6, 9 and 12 months, we found excellent prognosis (98%), with no symptoms of pain and there was marked improvement in periodontal parameters for all teeth. However, on the other hand, in group A patients, the prognosis was found to be 90%. Conclusion According to results of this study, we highly recommend the use of LSTR with sealer in RCT together with periodontal treatment in management of perio-endo lesions to decrease the rate of failure and improve the periodontal condition. How to cite this article Saleh AA, Eid HA, Abdelaziz KM. Lesion Sterilization Tissue Repair as Adjunct to Conventional Root Canal Treatment of Combined Periodontic-Endodontic Cases. World J Dent 2014;5(1):47-52.

Clinical effectiveness of combining platelet rich fibrin with alloplastic bone substitute for the management of combined endodontic periodontal lesion

The term "endo-perio" lesion has been proposed to describe the destructive lesion resulting from inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. In most of the cases, clinical symptoms disappear following successful endodontic therapy. However failure after conventional root canal treatment calls for surgical intervention. A 35 year old male patient with endo-perio lesion in right maxillary lateral incisor was treated with platelet rich fibrin (PRF) and alloplastic bone substitute after conventional endodontic therapy. At the end of 6 months there was gain in clinical attachment, increased radiographic bone fill and reduction in probing depth which was maintained till 18 month follow-up. Present case report aims to evaluate the efficacy of PRF and alloplastic bone substitute in the management of intrabony defect associated with endo-perio lesion in maxillary lateral incisor because the healing potential of PRF and bone graft has not been widely studied in endodontics. The use of PRF allows the clinician to optimize tissue remodelling, wound healing and angiogenesis by the local delivery of growth factors and proteins. The novel technique described here enables the clinician to be benefited from the full regenerative capacity of this autologous biologic material.

Overview on the current antibiotic containing agents used in endodontics.

Antibiotics are systemically and locally used extensively in endodontics. However, local antibiotic application mode is considered more effective than systemic administration. The local mode enables the dentist to target bacteria in every nook and corner of root canal system, which is otherwise beyond reach if targeted by instrumentation or conventional root canal treatment protocols. Therefore, they are an important adjunct to conventional treatment of root canal. The present study reviews the various antibiotic containing dental agents used in endodontics. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.

Management of avulsions in Switzerland 2007-2010

More than 50% of all European children suffer a dental injury (DI), for which the emergency treatment is usually carried out by a general dentist. The aim of this survey was to assess the management of avulsions in Switzerland as the common treatment procedures used by Swiss dentists in such cases. As yet there are no published data on the treatment of DI in Switzerland. A 15-item questionnaire was distributed to all members of the Swiss Dental Society containing questions about the dentists' profile, the distribution of dental injuries they had encountered affecting permanent teeth, especially avulsions, the number of treated avulsions and questions about how the dentists had treated an avulsion in the past 3 years. The response rate was 41% (n = 1350). On average, two avulsions per practitioner had been seen in the past 3 years. The dental practitioners who encountered cases of tooth avulsion treated an average of 2.8 avulsions in that time frame. Most dentists applied conventional intraoral root canal treatment, which was performed on average 9 days after replantation. As the intracanal dressing, calcium hydroxide was used by 69.8% and Ledermix® by 49.3%, while Asphaline® was used by only 1.8% (multiple answers were possible). Seventy-eight percent (78.1%) of the respondents had received postgraduate dental trauma education. Dentists with such an education used Ledermix® significantly more often (P = 0.002), and the time until pulp extirpation was significantly shorter (P < 0.001). The favorite splint after replantation was the Titanium Trauma Splint®, followed by the wire composite splint and the bracket splint, while the aligner was used very rarely. The average splinting time was 11.2 days. Eighty-one percent (81.1%) of the respondents had a tooth rescue box in their office, 41.1% had Emdogain®, 25.9% had tetracycline for local application, and 14.7% had steroids for local application available. Although only a few patients with avulsions had presented in Swiss dental offices in the past 3 years, their treatment was closely aligned to current guidelines.

Treatment of a cervical resorptive defect in a mandibular first premolar: An 18-month follow-up

The objective of this report is to describe the multidisciplinary management of a cervical resorptive defect using periodontal surgery, endodontic treatment, mineral trioxide aggregate (MTA) and composite resin filling. The resorptive defect was obturated using MTA following the reflection of a mucoperiosteal flap and conventional root canal treatment was completed. The cervical extension of the MTA-filled cavity, which was evident following the suturing of the flap, was reduced and filled with a composite filling material. No complaints were noted by the patient and at the 18-month follow-up the prognosis was favorable. By appropriate multidisciplinary management, root resorptions may be treated successfully. MTA may serve as a good option in such situations owing to its multi-beneficial properties.

A recall program for the outcome of conventional root canal treatment performed in a teaching hospital

Objectives: This study investigated the long-term survival and the prognostic factors of endodontic treatments performed in a dental teaching hospital. The aim was to calculate the probabilities of success or failure according to the follow-up extent and to assess the time allowed for a complete periapical healing. Materials and methods. A cohort of 185 teeth were re-examined 1–4 years after treatment. The outcome was assessed on the basis of radiographic and clinical criteria as success, uncertain or failure. A survival analysis using the Cox model was used (i) to explore tooth survival and periapical healing over the time and (ii) to highlight the predictive factors of treatment outcome. Results. After 2 years, the appearance of an apical periodontitis remained lower than 3.5%, whereas only 22.8% of periapical healed cases were notified. The prognosis factors are: (i) for teeth with initial healthy periapical conditions, coronal leakage (p = 0.002) with the higher risk of failure (RR = 19.77), absence of correspondence filling length/shaping = 0.026), type of teeth (p = 0.041) and (ii) for teeth with apical periodontitis, number of root canals (p = 0.000,91), correspondence filling length/shaping length (p = 0.017) and over-filling (p = 0.09). New periapical lesions or tooth loss were recorded after 2 years. Half of the successful cases of periapical healing were observed during the follow-up from 2–4 years. Conclusions. This longitudinal study shows that coronal leakage is responsible for late failure and that periapical healing is long to achieve. Therefore, endodontic treatments may require a follow-up of over 2 years.

Non-Surgical Management of Mandibular Molar with Multiple Intra–oral Sinus Tracts: A Case Report

Multiple intra-oral sinus tracts of dental origin are an uncommon condition. Patients with this condition may undergo surgical extraction, biopsies and antibiotic regimens, but all of them fail with the recurrence of the sinus tract. A proper diagnosis and management are important, to avoid any complications. This case report has described the conventional root canal treatment of a patient who had three distant intra-oral sinuses which had occurred due to an intact tooth with pulp necrosis, who had a history of accidentally biting on a hard food object and having a periapical radiolucency which indicated a chronic periradicular abscess. At follow up examination, the tooth was found to be asymptomatic and radiographically, it showed repair of the lesion.

Endodontic mishaps among undergraduate dental students attending King Saud University and Riyadh Colleges of Dentistry and Pharmacy

Aim: The purpose of this study was to investigate procedural errors occurring during conventional root canal treatment performed by undergraduate students attending two dental schools in Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional survey was distributed to 600 undergraduate dental students from the Riyadh Colleges of Dentistry and Pharmacy (RCsDP) and the College of Dentistry at King Saud University (KSU) in Riyadh, Saudi Arabia. Participants were senior male and female dental students from the 4 th to 6 th years at RCsDP and the 4 th to 5 th years at KSU. Participants were asked to record their endodontic mishaps; these data were analyzed using IBM SPSS software. Chi-square (X2 ) tests were carried out to compare pairs of groups; significance was established at 5% (p < 0.05). Results: The percentage of endodontic mishaps was 68%. The majority of students who made endodontic mishaps were male (73.6%) (X2 =8.74, =0.002). Most mishaps occurred in the posterior area (63.96%) and those with curved roots (39.46%). Conclusion: The frequency of endodontic mishaps occurring at both schools was found to be higher in 4 th year students from KSU, but this dramatically decreased in the 5 th year. Variable results were obtained from the RCsDP 4 th year students, but they did not improve in the 5 th and 6 th year. We believe that the use of step-down techniques utilizing flexible nickel titanium files and more training in the lab will cause potentially fewer procedural complications at both schools.

Pulp Calcification: Case reports with difficult Endodontic Problem

Teeth with signs and symptoms with calcified pulp require treatment. If it is possible to introduce endodontic instrument into the canal, conventional root canal treatment is done. In cases where root canal treatment is not possible, surgical approach may be necessary [6]. In calcified canals, instrumentation is attempted very carefully because there often remains very fine pathway within the calcified materials. Once a fine file (no. 06) has reached the correct level, enlargement of the canal is a simple matter. Use of EDTA alone or RC preparation along with NaOCl irrigant will often help this stage of the operation. If instrumentation is not possible, one should use an engine driven instrument to grind away the stone with small round, long shanked burs. In symptomless tooth with calcification, no treatment is required. Such a tooth should be kept under yearly radiographic review, and if symptoms arise may best be treated surgically [1].DOI: http://dx.doi.org/10.3329/cdcj.v9i1.11833 City Dental College Journal Vol.9(1) 2012 19-22

Difficulties in performing root canal treatment among dental students in Sudan

BackgroundThe technical quality of root fillings performed by undergraduate students indicated unsatisfactory results. AimThe aim of the present study was to investigate the difficulties and amount of time encountered by final year dental students during performing conventional root canal treatment for a molar tooth. MethodsA questionnaire was distributed to 325 students in four different Dental Faculties in Sudan. The levels of difficulties during performing access cavity preparation, instrumentation, isolation and obturation of the root canals of a molar tooth. Also information regarding the time spent on procedures were recorded based on categorized groups. ResultsResults showed that 64.9% had difficulty in maintaining an aseptic field. Moderate difficulty was recorded in both locating the canal orifices (48.3%) and mechanical preparation of the root canal (45.0%). Obturating the root canal was the most time demanding procedure among all other procedures according to 49.2% of the students. ConclusionIn conclusion, results seem to signify noticeable obstacles among undergraduate students to maintain an aseptic field. Also obturating the root canal appeared to be the most time demanding procedure.

Repairing invasive cervical root resorption by glass ionomer cement combined with mineral trioxide aggregate

Cervical invasive root resorption is a type of external inflammatory root resorption that is relatively uncommon and aggressive, and leads to loss of tooth structure. A diagnosis of cervical invasive root resorption depends on careful routine clinical and radiographic examinations. This report describes the diagnosis and successful treatment of a 41-year-old male patient with invasive cervical root resorption at tooth #21. The distinctive feature was a large resorptive defect at the cervicopalatal aspect of the maxillary central incisor involving the root-canal space. A radiographic examination revealed a large periradicular lesion and severe periodontal damage around this tooth. The defect was surgically repaired using resin-reinforced glass ionomer cement (GIC) and mineral trioxide aggregate (MTA) to restore the coronal half and apical half of the resorption cavity, respectively. Thereafter, conventional root-canal treatment was performed. The 11-month recall revealed good healing of both the periodontal and periradicular conditions and no obvious clinical symptoms. This case provides a new treatment modality to repair defects of cervical invasive root resorption and promote the healing of periodontal defects.

치근단 치주염을 가진 미성숙 제1대구치의 치수 재혈관화 : 증례 보고

치수 재혈관화 술식은 항생제를 이용하여 근관 내 감염된 조직을 무균 상태로 만들면 치근단에 존재하는 자가 재생 능력과 다분화 능력을 가진 줄기 세포가 미완성 치근을 가진 미성숙 영구치의 치수 재생을 유도한다는 개념이 적용된 것이다. 이 술식은 치근의 길이와 두께가 증가하며 치근단의 폐쇄가 이루어진다. 비정상적으로 근관이 얇거나 만곡이 심해 전통적인 근관 치료시 어려움이 예상되는 경우, 전신 질환 등으로 인해 진정 요법을 시행하기 어려운 경우, 그리고 장애인와 같이 협조를 구하기 어려운 경우에서 치근단 치주염을 가진 미성숙 대구치의 치수 재혈관화 술식을 고려해 볼 수 있다. 본 증례는 우식으로 인해 감염된 미성숙 제1대구치의 근관 내에 ciprofloxacin, metronidazole, minocycline의 3종의 항생제를 적용하여 치수 재혈관화 술식을 시도하여 양호한 결과를 보였기에 이를 보고하고자 한다. Revascularization of the pulp in a necrotic, infected immature tooth with apical periodontitis was attempting several years. Revascularization of partially necrotic pulp in an immature tooth is based on the concept that vital dental stem cells can survive pulpal necrosis. Revascularization procedure obtains longer and thicker roots in teeth with necrotic pulp diagnosis. Pulp revascularization for immature permanent molars can be possibly applied on cases having difficulty to use conventional root canal treatment due to abnormally thin root canal wall or severe root curvature. Also, when an uncooperative patient does not agree with sedative treatment the revascularization can be useful. And a patient with disability who is barely cooperative can be another indication of this treatment. In this case report, pulp revascularization using triple-antibiotics, metronidazole, ciprofloxacine and minocycline, was applied on the immature first permanent molar infected by caries.

Fracture resistance of root filled premolar teeth restored with direct composite resin with or without cusp coverage

To evaluate the fracture resistance and fracture patterns of root filled maxillary first premolar teeth (with mesio-occlusal cavity preparation) restored with several composite restoration designs. One hundred extracted sound human maxillary first premolars were randomly divided into five groups. Group 1 remained untreated (negative control). Conventional root canal treatment with additional mesial-occlusal cavity preparation was carried out on teeth in groups 2-5. In group 2, the teeth were restored intra-coronally with direct composite resin (positive control). In group 3, the palatal cusps of the teeth were reduced, and the cavities were restored with composite resin covering the palatal cusp (partial coverage). In group 4, the buccal and palatal cusps along with the distal marginal ridges were reduced; the cavities and cusps were restored with composite resin (conventional full coverage). In group 5, the buccal and palatal cusps were reduced but the distal marginal ridges were conserved. The cavities and the cusps were restored with composite resin (modified full coverage). All teeth were subjected to a progressive compressive loading parallel to their longitudinal axis until fracture. Fracture resistance was analysed using the one-way ANOVA and Fisher's LSD test. Fracture patterns were analyzed with chi-square test. The significance level was set at 0.05. The fracture resistance (mean ± SD) of groups 1-5 was 1131 ± 207N, 904 ± 184N, 927 ± 224N, 1095 ± 289N and 1085 ± 243N, respectively (groups 1, 4, 5 > groups 2, 3; P = 0.004). Cusp fractures were recorded as the fracture pattern in 20 (100%), 19 (95%), 16 (80%), 8 (40%) and 12 (60%) premolars in groups 1-5, respectively (groups 1, 2 > groups 4, 5; group 3 > group 4; P < 0.001). When direct composite resin was used to restore root filled maxillary first premolar teeth involving a proximal surface, those restored with full-coverage designs had greater fracture resistance.

Diagnosis and Treatment of Inflammatory Root Resorption by Intentional Reimplantation

ABSTRACT External root resorption is a lytic process occurring in the cementum or cementum and dentin of the roots of teeth. It is frequently caused by trauma. Such cases are often difficult to diagnose especially if lesion is on buccal or lingual side, and at times may be difficult to treat using conventional root canal treatment, with extraction being left the only alternative. This article describes the diagnosis and treatment of a case of inflammatory resorption of palatal wall of palatal root of maxillary left first molar by intentional reimplantation. The provisional diagnosis was made from clinical and radiographic observations. The treatment consisted of intentional reimplantation. After extraction it was found that palatal wall of palatal root had been resorbed from furcation till apex. After the resection of the palatal root at the point of resorption, tooth was obturated, reimplanted and splinted. This tooth is serving well since 5 years. How to cite this article Saini SK, Bogra P, Saini A. Diagnosis and Treatment of Inflammatory Root Resorption by Intentional Reimplantation. Int J Experiment Dent Sci 2012;1(2):106-109.

Healing of the periapical lesion in posterior teeth with mineral trioxide aggregate using orthograde technique - Two case reports

Conventional root canal treatment (RCT) of the teeth has long shown high success rate. However, the endodontic treatment of a pulpless tooth with periapical radiolucency of a considerable size always has a question of success. In modern days, surgical exploration is avoided, especially in the posterior teeth. These types of cases may be successfully managed by orthograde Mineral Trioxide Aggregate (MTA) placement in the apical third of the root followed by proper obturation. The objective of our present case reports was to evaluate the periapical pathology of posterior teeth clinically and radiographically by using MTA in orthograde way and avoiding traumatic surgical exploration. In the first case, the patient reported with intraoral sinus and pus discharge related to tooth #45. On radiograph, open apex (blunderbuss) was found along with periapical radiolucency. In the second case, the patient reported with pain and swelling related to tooth #26, having large periapical radiolucency related to the palatal canal. On vitality test, both the teeth responded negative, i.e., non-vital. Conventional RCT was planned in both the cases with orthograde MTA- Angelus (Angelus, Londrina, PR, Brazil) apical plug followed by the proper obturation with gutta-percha (G.P.), and after that the patients were kept on periodic follow-up and the outcome-based clinical and radiographic criteria were assessed. The post-obturation assessment at 1-month interval showed changes in the size of radiolucency with a gradual decrease, and after 6 months a remarkable decrease of radiolucency or the defect was almost filled with bone formation visible around the roots.

Calcium hydroxide: A boon in complete healing of horizontal apical one-third root fracture

Introduction: A variety of traumatic conditions can cause root fractures. The root fractures are more likely to occur in fully erupted permanent maxillary central incisors with a completely formed root followed by the maxillary lateral and the mandibular incisors. They involve the dental pulp, supporting tissues, and the mineralized structures of a tooth. Diagnosis of the horizontal root fractures is mainly reached by the information obtained in clinical and radiographic examinations. Case Report: This case report describes the management of the horizontal apical one-third root-fractured tooth without surgical removal of the apical fragment, by long-term calcium hydroxide dressing with good signs of healing of fracture at 3 months followed by conventional root canal treatment with the follow-up examination for 1 year after the completion of treatment. Discussion: Calcium hydroxide has showed a miracle in successful healing of apical one-third root fracture.

Prevalence of and factors affecting post-obturation pain following single visit root canal treatment in Indian population: A prospective, randomized clinical trial

Aim:This prospective randomized clinical study (1) investigated the prevalence of post-obturation pain after single visit root canal treatment and (2) evaluated the influence of factors affecting the pain experience.Materials and Methods:One thousand three hundred and twenty eight (1328) patients were included in this study. Conventional single visit root canal treatment was carried out. The chemicomechanical preparation of root canals was done by a rotary protaper system with a combination of hand instruments. Post-operative pain was recorded by each patient by using visual analogue scale in well-defined categories at three time intervals, 12 h, 24 h, and 48 h. The data were analyzed using Fisher's exact test.Results:The prevalence of post-obturation pain (severe) within 48 h after treatment was 4% (n = 54) but less as compared to the pain experienced after 12 h (9%) and 24 h (8.6%). The factors that significantly influenced post-obturation pain experience were: Age (Fishers exact test = 46.387, P = 0.0), gender (Fishers exact test = 23.730, P = 0.0), arch (Fishers exact test = 11.710, P = 0.001), and presence of pre-operative pain (Fishers exact test = 67.456, P = 0.0).Conclusion:The presence of post-operative pain was low (4%). The important prognostic determinants of post-obturation pain were: Old age, female, mandibular teeth, and presence of pre-operative pain. The vital condition of the tooth does not affect the intensity and frequency of post-obturation pain.

Esthetic and endodontic management of a deep crown-root fracture of a maxillary central incisor

Treatment of trauma to anterior teeth should aim at preserving the affected teeth so as to restore function and esthetic appearance. Recently, patients have come to expect adequate esthetics immediately after trauma. In the present case, a deep crown-root fracture compromised the pulp and extended subgingivally on the palatal aspect. After using the fractured fragment as a provisional crown, the patient received conventional root canal treatment, which provided immediately satisfactory esthetic results and reliable short-term restoration of the crown-root fractured tooth. Rehabilitation of the fractured central incisor was performed with a post-core-supported prosthetic restoration.

Use of cone beam computed tomography in the diagnosis, planning and follow up of a type III dens invaginatus case

To present the case of a maxillary left lateral incisor with Oehlers' type III dens invaginatus in which cone beam computed tomography (CBCT) was used as an adjunctive resource in the diagnosis as well as in the planning and 2-year follow-up of the nonsurgical/surgical treatment. The tooth had two root canals: a primary (main) canal with vital pulp that appeared to be closed apically and an invaginated canal that was necrotic, wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. Radiographic tracking of a sinus tract in the labial gingiva of the affected tooth with a gutta-percha point revealed its origin to be the invagination. The CBCT scans revealed that the periapical radiolucency was significantly larger than seen radiographically as well as an increased thickness of the buccal cortical plate. Conventional root canal treatment of the primary canal was undertaken. As nonsurgical access to the invaginated canal was not possible, endodontic surgery was performed for curettage of the lesion, root-end cavity preparation using ultrasonic tips and root canal filling with white mineral trioxide aggregate (MTA). CBCT scanning after 17 months and clinical and radiographic follow-up after 24 months revealed complete periapical repair and absence of symptoms. The combination of nonsurgical and surgical treatments produced periapical repair in a tooth with type III dens invaginatus with two root canals. CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental anomaly.