Endodontic Research Articles

Introduction to endodontology and endodontics

Introduction to endodontology and endodontics

Become a master of endodontics

Become a master of endodontics

The effect of propolis on bacterial population isolated from necrotizing single canal tooth with chronic apical periodontitis versus chlorhexidine gluconate

Propolis is a sticky resinous material collected from flowers and plants or other botanical sources by honey-bee. It has antibacterial, antifungal, antiviral, antioxidant and anti-inflammatory activities. Effective debridement of the root canal system with chemical irrigants prior to obturation is the key to long-term success of endodontic therapy. An equally effective, but safe irrigant is desirable. The purpose of this study was to compare the antibacterial efficacy of propolis and chlorhexidine 0.12% as root canal irrigants on the bacterial isolates of necrosed teeth with apical chronic periodontitis. Seventeen necrosed single canal teeth with apical chronic periodontitis were used. After cavity preparation, two samples were taken of each canal and transferred to the lab in immediate media. After 3 to 5 days of incubation in presence and absence of irrigants in aerobic or anaerobic condition, the colonies were counted as CFU/ml. According to results, the mean percentages of bacterial growth inhibition in presence of chlorhexidine in aerobic and anaerobic conditions were 82.6 and 79% respectively, while in presence of propolis were 29.42 and 46.4%, respectively. It is revealed that in each condition chlorhexidin was significantly more effective than propolis also it is more effective in aerobic than anaerobic condition, non-significantly. Propolis is significantly more effective in anaerobic than aerobic condition. It can be concluded that propolis and chlorhexidine 0.12% have antimicrobial activity against aerobic and anaerobic bacteria. Chlorhexidine is a superior root canal antibacterial agent than propolis even though the antibacterial effect of propolis on the growth of aerobic and anaerobic is apparent. Key words: Antibacterial, chlorhexidine 0.12%, propolis, root canal irrigants.

Updates on rickets and osteomalacia. dental diseases in rickets

Rickets is characterized by mineralization defect in bone and cartilage. X-linked hypophosphatemic rickets (XLH) is the most common form of inherited rickets. Mineralization defect is observed in dentin as well as in bone and cartilage in XLH. The dominant feature is the occurrence of infectious periradicular abscesses on deciduous and permanent teeth, not associated with trauma or decay. Dental care including the maintenance of good oral hygiene and periodical examinations should be performed. A preventive sealing of occlusal surfaces can be considered. Endodontic treatment or extraction are carried out in the presence of periradicular abscesses. Further studies are necessary for elucidating mechanisms of dentin mineralization defect and the occurrence of periradicular abscesses and for developing preventive and curative measures in XLH.

A simple working classification proposed for the latrogenic lesions of teeth and associated structures in the oral cavity.

Iatrogenic lesions can affect both hard and soft tissues in the oral cavity, induced by the dentist's activity, manner or therapy. There is no approved simple working classification for the iatrogenic lesions of teeth and associated structures in the oral cavity in the literature. A simple working classification is proposed here for iatrogenic lesions of teeth and associated structures in the oral cavity based on its relation with dental specialities. The dental specialities considered in this classification are conservative dentistry and endodontics, orthodontics, oral and maxillofacial surgery and prosthodontics. This classification will be useful for the dental clinician who is dealing with diseases of oral cavity.

Influence of endodontic instrument-holder on sterilization efficacy. A pilot in-vitro study.

Infection control is crucial in dentistry and various methods have been designed to assure its efficacy. However, little information exists regarding the influence it could have the instrument-holder of endodontic files. The aim of this research was to determine the influence of three instruments-holders on sterilization efficacy of endodontic files. Methods: A pilot in-vitro study. 60 endodontic files were contaminated by biomechanical preparation of extracted molars with periapical abscess, then processed according to the standard washing method. The endodontic files were divided into 3 groups (n = 20) and assigned to 3 instrument-holders: Metallic box (MB), surgical gauze (SG) and synthetic sponge (SS). Then, the files were packaged and sterilized by autoclaving (134°C/45min). Microbiological culture was performed in thioglycolate solution for each endodontic file (37oC/5days). Results: The overall sterilization efficacy was 91.7%, 80% for MB, 100% for SS, and 95% for SG, with no statistically significant differences (p = 0.06) between the groups. Conclusions: The lack of differences in the efficacy of sterilization may be due to the reduced sample; therefore, a full-size study is necessary to confirm this outcomes. The results of this study discourage the use of the MB as instrument-holder until a full-size study can confirm this data. Keywords: endodontics, sterilization, efficacy, instrument. El control de infecciones es crucial en odontologia y variados metodos se han disenado para asegurar su eficacia. Sin embargo, existe poca informacion respecto a la influencia que podria tener el porta-instrumento de limas endodonticas. El objetivo de esta investigacion es determinar la influencia de 3 porta-instrumentos sobre la eficacia de esterilizacion de limas endodonticas. Metodo: Estudio in-vitro piloto. 60 limas endodonticas fueron contaminadas mediante preparacion biomecanica de molares extraidos con diagnostico de absceso periapical, procesadas segun el metodo de lavado estandar, divididas en 3 grupos (n=20) y asignadas a 3 porta-instrumentos: caja metalica (CM), gasa quirurgica (GQ) y esponja sintetica (ES); luego empacadas y esterilizadas en autoclave (134oC/45min). Se realizo un cultivo microbiologico en solucion de Tioglicolato de cada una de las limas (37oC/5dias). Resultados: La eficacia de esterilizacion general fue 91,7%, para CM de 80%, ES de 100% y GQ de 95%; no se hallaron diferencias estadisticamente significativas (p=0,06). Conclusiones: La falta de diferencias en la eficacia de esterilizacion puede deberse a la muestra reducida, por lo que se necesita realizar un estudio con tamano completo. Los resultados de este estudio desaconsejan el uso de la CM como porta-instrumento hasta que un estudio de tamano completo confirme estos datos. Palabras clave: endodoncia, esterilizacion, eficacia, instrumento.

Vertical root fracture: prevalence, etiology, and diagnosis.

A vertical root fracture (VRF) is a frustrating complication that may occur following root canal treatment, and in almost every case leads to the extraction of the affected tooth. This type of fracture is usually diagnosed by secondary symptoms that develop some time after primary treatment, often when prosthodontic restoration has already been completed. The fracture line itself is often not directly visible, and therefore clinical and radiographic signs and symptoms indicate the diagnosis indirectly. Knowledge of the condition and pathogenesis of VRF is required in order to avoid hopeless trials of periodontal and/or endodontic therapy. Several etiologic factors are discussed that make teeth susceptible to VRF, such as the loss of substance due to restorative and endodontic therapy and stress factors associated with root canal debridement, and filling.

Treatment of a fused/geminated tooth: a multidisciplinary conservative approach.

To report a multidisciplinary treatment of gemination/fusion of the left maxillary first incisor. An 11-year-old boy presented to our clinic with the chief complaint of an unpleasant appearance of his anterior teeth. Clinical and radiographic evaluation revealed gemination/fusion of the left maxillary first incisor combined with an Angle's Class II relationship (skeletal), retruded mandible, deep bite, short lower face height, and proclinaion of the maxillary incisors. The multidisciplinary approached treatment included orthodontic treatment engaged with root canal treatment of the left maxillary first incisor followed by periodontal surgical separation of the mesial root of the left maxillary first incisor and restoration of the crown using resin restoration. Tooth shape anomalies in general dental practice may be rare, but the dentist should be aware of the nature of the problems encountered and the specific treatment needs. The treatment may be complex and contain various treatment protocols that may include interdisciplinary endodontic, surgical, and periodontal interventions.

Comparative study of retention of fiber-reinforced post at middle and cervical one thirds of root canal cemented by polycarboxylate and zinc phosphate cements measured at different storage times

Background: The purpose of this study was to compare regional bond strength at middle and cervical thirds of the root canal among glass fiber-reinforced composite (FRC) endodontic posts cemented with different cements, using the push-out test to compare the performance (retention) of two types of luting cements; polycarboxylate cement and Zinc phosphate cement used to cement translucent fiber post and to compare the result of the push-out test at different storage times;1 week ,1month and 2 months. Materials and methods: Ninety caries-free, recently extracted single-rooted human teeth with straight root canals was used in this study, The root canals were endodontically instrumented at a working length of 0.5 mm from the apex by means of conventional instruments for hand use (Dentsply, Switzerland) up to size 35.then root canal filling was performed followed by post space preparation up to 8mm including cervical and middle one third of root canal then the fiber post was cemented into canal post space then the root was sectioned to get cervical (4 mm in length) and middle (4 mm in length) thirds ,these thirds were examined by push out test to get values of retention of fiber post inside these canal thirds . Results and Conclusions: The results of this study has been showed that there was no significant differences between push out bond strength between fiber post and root at cervical third as compared with middle third when using polycarboxylate cement or Zinc phosphate cement to cement the fiber post to the canal walls and the results showed that there was no significant differences in push out bond strength for polycarboxylate or Zinc phosphate cement after one and two months but there was highly significantly increase in push out bond strength for resin cements used to cement the fiber post to the root canal after one and two months

Experience of endodontic failure in 82 molars

Objective To investigate the causes of endodontic failure in molars.Methods The X-ray films of 82 molars in 76 patients before and after unsuccessful treatment were observed.And we analyzed the causes of failure from the length,shape,number,calcification and curvature of roots,and sum up the experiences.Results The reasons of endodontic failure in 82 molars included 56 cases (68.3％) with fistulous tract,discomfort and bite jaw pain in gingiva.16 cases (19.5％) needed repeated diagnosis for recovery treatment.10 cases (12.2％) of teeth defect or secondary caries.The 82 molars of endodontic failure manifested on missing of the root (62,75.6％),filling materials extruded (11,13.4％),apical leakage (5,6.1％) and root canal omissions (4,4.9％).Conclusion Molars' root canal treatment is very difficult.The operators must improve their technical levels and clinical experiences. Key words: Molar; Root canal treatment; Root canal filling; Root canal system

Double Root Anatomical Variations in a Single Patient: Endodontic Treatment and Rehabilitation of a Three-rooted First Premolar. Case Report

La interaccion anormal entre el epitelio oral y el tejido mesenquimatico subyacente durante la odontogenesis puede resultar en la formacion de un diente con una variacion anatomica. El primer premolar maxilar posee una anatomia relativamente variable, sin embargo, es especialmente poco frecuente (0,2% a 6% de los casos) la presencia de este diente con tres raices y tres canales radiculares. El primer premolar mandibular posee frecuentemente una raiz y un canal radicular (75% de los casos) y es bastante mas infrecuente encontrar este diente con dos raices y dos canales radiculares (19.5 a 22.5%). Un diagnostico acabado y preciso de es fundamental para lograr un exitoso tratamiento de endodoncia y posterior rehabilitacion. Este articulo describe el diagnostico, tratamiento de endodoncia y rehabilitacion (mediante protesis fija singular) de un primer premolar maxilar con tres raices y tres canales radiculares, ademas el reporte de un caso de un primer premolar mandibular biradicular con dos canales radiculares. Ambos se presentan en un mismo paciente.

Cutting your endodontic costs

Cutting your endodontic costs

Endodontic bacteria from primary and persistent endodontic lesions in Chinese patients as identified by cloning and 16S ribosomal DNA gene sequencing.

Few literatures pertain to the 16S ribosomal DNA (16S rDNA) analysis of bacteria contributing to primary and persistent endodontic lesions, with no information available for the Chinese population. As such, we investigated endodontic bacteria associated with primary and persistent endodontic lesions in adult Chinese patients living in Beijing, China using 16S rDNA gene sequencing techniques. Endodontic microbial samples were obtained from fourteen adult Chinese patients and subjected to DNA extraction. Pllymerase chain reaction (PCR) products were cloned and 100 clones from each generated library were randomly selected. Purified plasmid DNA with 16S rDNA gene inserts was sequenced, and the sequences were searched against GenBank databases using the BLASTN algorithm. Only significant identification with the highest-scored BLAST result and 99% minimum similarity was considered for phylotyping. More than 150 taxa were obtained. Primary endodontic infection was mainly associated with Burkholderia cepacia, Actinomyces, Aranicola spp. and Streptococcus sanguinis, whilst Burkholderia cepacia was predominant in the persistent endodontic infections. There is a difference in the species profile associated with endodontic infections of Chinese patients living in Beijing in comparison to other geographical or ethnic reports.

Post-endodontic treatment periodontal surgery: a case report.

Two patients were diagnosed with combined endodontic-periodontal lesions. Endodontic treatment was performed, followed by surgery. In addition, the regeneration process was supported by the application of an enamel matrix derivate alone or in combination with guided bone regeneration techniques. At recall visits after 24 months, the teeth were asymptomatic and marked bone regeneration had occurred in both patients. The successful post-endodontic treatment of combined endodontic-periodontal lesions, using periodontal surgery and as adjunct guided tissue regenerative techniques, is presented. Further, the possibility of saving teeth, even with severely apparent pathology, should be highlighted.

Flare-Ups in Endodontics – A Review

Flare-Ups in Endodontics – A Review

Novel decision tree algorithms for the treatment planning of compromised teeth.

In clinical practice, dentists are faced with the dilemma of whether to treat, maintain, or extract a tooth. Of primary importance are the patient's desires and the restorability and periodontal condition of the tooth/teeth in question. Too often, clinicians extract teeth when endodontic therapy, crown-lengthening surgery, forced orthodontic eruption, or regenerative therapy can be used with predictable results. In addition, many clinicians do not consider the use of questionable teeth as provisional or transitional abutments. The aim of this article is to present a novel decision tree approach that will address the clinical deductive reasoning, based on the scientific literature and exemplified by selective case presentations, that may help clinicians make the right decision. Innovative decision tree algorithms will be proposed that consider endodontic, restorative, and periodontal assessments to improve and possibly eliminate erroneous decision making. Decision-based algorithms are dynamic and must be continually updated in accordance with new evidence-based studies.

The effect of curvature angle and rotational speed on the cyclic fatigue of three types of rotary instrument (In vitro): comparative study

The fracture of instruments within root canal during endodontic treatment is a common incidence, fracture because of fatigue through flexure occurs due to metal fatigue, this study aimed to assess the effect of curvature angle and rotational speed on the cyclic fatigue of different type of Endodontic NiTi Rotary Instruments and compare among them. Materials and method: Three types of rotary instruments with tip size 0.25: ProTaPer F2 (Densply, Malifier) Revo-S SU( 0.06 taper, MicroMega) and RaCe system (0.06 taper, FKG, Dentaire), Forty file of each instrument were used within two canals with angle of curvature (40 &60 )at two speed (250&400)RPM, twelve group were formed for all instruments(total number=120),te n file for each group. The testing canals customized within stainless steel block covered with glass face, the time to fracture recorded and the mean of cycles to fracture (MCF) detected for each instrument. Data were analyzed statistically by ANOVA, LSD and Independent T-test at 5% significant level. Result: there was a highly significant difference of curvature angle and significant difference of rotational speed on the fracture resistance of instruments. RaCe revealed the best fracture resistance followed by ProTaper then Revo-S that showed the less resistance. Conclusion: The rotary instruments more prone to fracture when used at more curvature angle and higher rotational speed, as well as the rotary instruments differ from each other according to manufacturing process, taper, cross section and other factors.

Evaluation of the effect of ER: YAG laser on apical microleakage (in vitro study)

Apicoectomy and retrograde filling is indicated when conventional endodontic treatment is impossible or failed to achieve apical seal. The aim of this study was to evaluate the effect of ER: YAG laser on apical microleakage. Materials and Methods: Sixty extracted single-rooted teeth were used in this study. The roots were divided into six groups. Group 1: apicoectomy by fissure bur, and apical cavities prepared by round bur, then cavities were filled with MTA. Group 2: the roots preparations and fillings were the same as group 1, then the apical areas were treated by Er:YAG Laser. Group 3: apicoectomy by fissure bur, and apical cavities prepared by ultrasound retrotip and cavities were filled with MTA. Group 4: the roots preparations and fillings were the same as group 3, then the apical areas were treated by Er:YAG Laser. Group 5: the roots obturation with gutta percha, then the apices were resected using Er:YAG Laser. Group 6: the roots apices were resected with Er:YAG Laser, then the canals were obturates with gutta percha. Apical microleakage was measured by methylene blue dye penetration technique. Results: Significant difference between the groups. Group 1 shows the best apical seal, while group 5 shows the worse apical sealing ability. Conclusion: Apicoectomy by bur is better than apicoectomy by laser, and apical cavity prepared by bur is better than prepared by US. The use of ER: YAG laser in apicoectomy is preferred to be done before obturation of the root canal with gutta percha.

Analysis of the root morphology of European anterior teeth.

Aim of this study was to investigate the gross anatomy of the root of European anterior teeth. A review of the dental literature shows that in the past the root morphology was investigated from the inner pulp chamber for endodontic therapies. In order to be admitted to the study, the teeth had to be undamaged. Each tooth was identified by a serial number and gauged by a millimeter tape (for the root length), a goniometer (for the root angle), and a millimeter gauge (for the root diameter). Furthermore, a statistical elaboration of the data was performed to underline the shape variations of the surface around the different sides of the root. At the end of the analysis, 12 parameters for each single-root tooth were described. The study highlights significant differences (p<0.01) only in two teeth of the maxillary arch (central incisor and canine) and in one tooth of the mandibular arch (central incisor). In both cases, the observed differences may be due to the sinuosity of the cement-enamel line. The Tables for each measured parameter were obtained for all examined classes of teeth, but a comparison with literature data was possible only for the "root length" parameter. This study can be considered innovative for the absence, in the scientific literature, of a statistical analysis of all parameters with the exception of the "root length". Moreover, it gives a detailed updating of the data relative to the European population creating a useful tool as well for surgical interventions during periodontal therapy (for example in the choice of the right ultrasonic handpiece) as for new CAD/CAM assisted implant manufacturing techniques.

Evaluation of fracture strength of endodontically treated teeth restored by milled zirconia post and core with different post and core systems (An in vitro comparative study)

Restoration of root canal treated teeth with a permanent restoration affect in the success of endodontically treated teeth. This in vitro study was performed to evaluate and compare the fracture strength of endodontically treated teeth restored by using custom made zirconium posts and cores, prefabricated carbon fiber, glass fiber and zirconium ceramic posts. Materials and method: Forty intact human mandibular second premolars were collected for this study and were divided into five groups. Each group contains 8 specimens: Group1: Teeth restored with Carbon Fiber Posts; Group2: Teeth restored with Glass Fiber Posts; Group3: Teeth restored with Zirconium Ceramic prefabricated Posts; Group4: Teeth restored with Zirconium Posts and Cores (copy milling); Group5: (Control Group).For groups 1, 2, 3, and 4; crowns were removed horizontally at the level of cement-enamel junction. Endodontic therapy was then done for all specimens in these groups using step-back technique.These specimens received standardized posts preparation (10mm depth), and then mounted in acrylic resin blocks. Panavia F 2.0 dual cure resin cement was used for cementation. The core build up was done with composite (Filtek P60). The specimens were then stored in saline and were subjected to compressive loads parallel to their long axes using universal testing machine (WP 300) until failure. Results: Data obtained were analyzed by one-way analysis of varianceand student t-test. The results showed that zirconium posts and cores possessed the highest significant differences followed by glass fiber posts, carbon fiber posts, and prefabricated ceramic zirconium posts. There were no significant differences between glass fiber, carbon fiber, and control group. The specimens were examined to determine the root fracture patterns and locations. Conclusion: In the present study the fiber post treated teeth showed significantly more desirable fracture patterns compared to those restored with zircon posts.