Failure Of Endodontic Therapy Research Articles

Comparative Evaluation of the Apical Sealability of AH Plus and RealSeal SE Using 5.25% Sodium Hypochlorite with 17% EDTA and 10% Citric Acid as Irrigants-An In Vitro Study.

Apical microleakage is considered to be a common reason for the clinical failure of endodontic therapy. Three dimensional sealing of the root canal is one of the main goals of endodontic treatment and is essential for preventing reinfection of the canal and for preserving the health of the periapical tissues, Recently Epoxy resin sealers have been used because of their reduced solubility apical seal and micro-retention to root dentine. This in vitro study was done to evaluate and compare the apical sealability of AH Plus and RealSeal SE using 5.25% sodium hypochlorite with 17% EDTA and 10% citric acid as irrigants. Materials and methods: 44 single-rooted premolars were selected and the teeth are randomly divided into 4 groups (n=10) and 2 control groups (n=2). The extent of dye penetration, from the apical to the coronal part of the root canal, was assessed using a stereomicroscope at 10x magnification for all groups.One-way ANOVA and Kruskal-Wallis tests were performed to compare statistically significant differences among the groups, using SPSS software version 10.0. Group IV (Citric acid + RealSeal SE) showed a statistically lower mean microleakage when compared to all other groups. From, the present study, it was concluded that, RealSeal SE sealer with 10% citric acid as irrigant (group IV) showed better apical sealability followed by RealSeal SE sealer with 17% EDTA as irrigant (group III), when compared to AH Plus groups which showed least sealability.

Apicoectomy for Periapical Lesion Treatment after Post Endodontic Failure on First Maxillary Premolar (Case Study)

Introduction. Factors that cause failure of endodontic therapy include incomplete cleaning and shaping of root canals and unhermetic obturation. Endodontic failure can lead to periapical lesions. Apicoectomy is one of endodontic surgery treatment choice to preserving the tooth with endodontic treatment failure. Aim. The aim of this report was to show that in cases of failure of root canal treatment could be treat without extraction, however there was an alternative treatments such as apicoectomy that could be used to preserve the tooth and its function in the oral cavity.Case. A male 32 years old patient came to dentist with persistent pain on upper left first premolar. The tooth had been endodontically treated for ten years. Clinical examination tooth #24 had porcelain fused to metal on it, percussion test (+), bite test (+), pain on palpation. Radiographic examination showed that tooth #24 had fabricated post without gutta percha obturation on apical third. There was 3 mm round periapical lesion on the distal side of the tooth. Procedure Apicoectomy and retrograde filling with Mineral Trioxide Aggregate (MTA) and bone graft was performed to eliminate that periapical lesion. Conclusion Apicoectomy is one of main choice to preserve post endodontic tooth with periapical lesion and post core crown on it, as long as possible in oral cavity Keywords : Apicoectomy, Periapical lesion, Post endodontic treatment failure

Laser Assisted Root Canal Treatment: A Review

Complexity of root canal system leads to failure of endodontic therapy so to address this issue lasers have been investigated as an adjunctive. Lasers has been used in direct irradiation of root canal or adjunct to irrigants placed into the canals. Laser assisted root canal therapy has more benefits than traditional root canal therapy. It ensures complete sterilization of root canal.

The hunt for the hidden – Methods of locating root canals

Predictable endodontic therapy begins with good access preparation, which allows for the accurate location of any given orifice, facilitating the negotiating, securing, and shaping of the canal, as well as 3D disinfection and filling of the root canal system. Missed, unfilled, and untreated root canals have been identified as one of the leading causes of endodontic therapy failure in several investigations. With the advent of CBCT, magnification, ultrasonics and other diagnostic and treatment adjuvants, searching for and treating root canals has become easier and more predictable.

The Antimicrobial Efficacy of four different Intracanal Medication to Microorganisms existing in the Failure of Endodontic Therapy: An in vitro study

Aim.This study aims to identify the efficacy of different intracanal medication formulations existing in end of endodontic therapy’s failure, and related to strains of Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus in Petri plates. Materials and methods. It was used diffusion test in agar where each Petri plate with the inoculated bacteria. Perforations of approximately 4 mm deep by 5 mm in diameter were made to prepare where the intracanal drug (25 µl) to be tested. The diameters of the bacterial inhibition zones were measured and registered to each tested medication at the period of 24 hours, 48 hours, 7 and 14 days respectively. Results. All the medications promoted inhibition halos. The inhibition halos were represented in mm. A higher elimination of micro-organisms can be significantly achieved through the association of different substances in the formulation of an intra canal medication, with emphasis to Ca (OH)2 combined with nitrofurazone and magnesium oxide respectively. Conclusion. Cleaning and shaping of the root canal system associated with the chemical combination of Ca (OH) 2 with antiseptic pastes or solutions considerably reduce the bacterial load.

The Antimicrobial Efficacy of four different Intracanal Medication to Microorganisms existing in the Failure of Endodontic Therapy: An in vitro study

Aim.This study aims to identify the efficacy of different intracanal medication formulations existing in end of endodontic therapy’s failure, and related to strains of Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus in Petri plates. Materials and methods. It was used diffusion test in agar where each Petri plate with the inoculated bacteria. Perforations of approximately 4 mm deep by 5 mm in diameter were made to prepare where the intracanal drug (25 µl) to be tested. The diameters of the bacterial inhibition zones were measured and registered to each tested medication at the period of 24 hours, 48 hours, 7 and 14 days respectively. Results. All the medications promoted inhibition halos. The inhibition halos were represented in mm. A higher elimination of micro-organisms can be significantly achieved through the association of different substances in the formulation of an intra canal medication, with emphasis to Ca (OH)2 combined with nitrofurazone and magnesium oxide respectively. Conclusion. Cleaning and shaping of the root canal system associated with the chemical combination of Ca (OH) 2 with antiseptic pastes or solutions considerably reduce the bacterial load.

Prevalence of middle mesial canals and Isthmi in mandibular molars in a subpopulation of Andhra Pradesh: an in vivo investigation using CBCT

Background: Pulp and root canal space is enigmatic and highly complex. Encountering rare has become a norm with the advancements in the technology of materials and types of equipment. The success of the root canal treatment depends on the effective removal of bacteria from the whole pulp space. A high percentage of the missed canal is reported for the failure of Endodontic therapy. Mandibular molars have complex root canal anatomy. Two roots with two canals in mesial root and one to two canals in distal root is a common occurrence. Nevertheless, the incidence of variation is relatively high, including separate distolingual, mesiobuccal, C-Shaped canals, isthmus, and additional canal in the mesial root. A wide range of the middle mesial canal occurrence, i.e., 3.1 to 46.1%, is reported in the world and 28.3% in North India. Aim: To identify the prevalence of the true middle mesial canal (MM) and configuration of Isthmi in the mesial root of the mandibular molar in the AP subpopulation of South India. Materials and methods: CBCT of 89 patients were randomly selected from the institutional database. Data entry was performed in Excel, and data analysis was done with the Statistical Package for Social Sciences (SPSS). Results: Four images (4.5%) revealed Middle Mesial canals with no statically significant occurrence. The frequency of isthmi in the mesial roots was 52.7%. This showed a considerable presence. Conclusion: MM canals are 4.5% in a subpopulation of Andhra Pradesh. Isthmuses are very common in the mesial roots of permanent mandibular molars. Isthmus about 58% was seen with Type II configuration that is the presence of two canals without a definite communication.

Analysis of anatomy and configuration of the canal system of the maxillary second premolar in the population of Bosnia and Herzegovina

<p>Introduction. Successful endodontic treatment depends upon the clinician's knowledge and ability to recognize and diagnose the presence of anatomical and morphological variations of the root and canal system. The aim of this study was to establish the number of roots and root canal configurations of the maxillary second premolar in the population of Bosnia and Herzegovina. Methods. The study sample was comprised of 150 maxillary second premolar teeth extracted for orthodontic or prosthetic reasons. Endodontic drills were used for trepanation of cavum dentis, and the number and patency of each root canal were determined by Kexpander # 15. Then, the samples were decalcified, made transparent and colored, to enable 3D viewing of the canal system. Decalcified teeth were observed from two projections (clinical and approximal) and analyzed in detail with a magnifying glass under 3 × and 5 × magnification in order to determine the number of roots, number of canals, root canal configuration using Vertucci's classification and number of anastomoses between canals. Statistical significance was obtained using Chi-square test. Results. The results obtained by decalcification of the teeth showed that, by radiographic analysis from the clinical projection, all the teeth had a single root. While, by the analysis from the approximal projection, 94.0% had one, 6.0% two roots. From the approximal projection, 70.7% with a single root canal and 29.3% with two root canals are visualized. The most common type of root canal configuration in the maxillary second premolars was Type I in both clinical (87.9%) and approximal projection (40.7%). Conclusion. These results emphasize the importance of knowing the variations in root canal morphology, because excluding the possibility of morphological variations can lead to failure of endodontic therapy</p>

Endodontic management of maxillary first molar with two palatal canals

Having a thorough knowledge about the internal anatomy of a tooth and its possible variations is an important aspect for the success of a root canal therapy. Variations in the number of roots, root canals and configurations affect the treatment outcome. Moreover, missed canals make up for the highest chances of failure of endodontic therapy(1).
 
 A maxillary first molar shows lot of variations in the anatomy. Although finding MB2 canal has now become a routine procedure, but variations in the palatal canal is still aberrant which concerns the clinicians. With the advancements in radiographic procedures, it has now become an easy task to look for aberrations in tooth anatomy. One such advancement is the Cone Beam Computed Tomography (CBCT) which acts as the third eye for clinicians. It helps in accurate diagnosis and in negotiating the complex morphologic variations in root canals(2).
 
 This case report presents the endodontic management of a maxillary first molar presenting with five canals with two palatal canals confirmed with the aid of Cone Beam Computed Tomography.

Systematic Review on the Role of Lasers in Endodontic Therapy: Valuable Adjunct Treatment?

(1) Background: Adjunctive instruments, such as lasers have been investigated to address the risk of failure of endodontic therapy due to the complexity of the root canal system. Lasers have been used therapeutically, in direct irradiation of the root canals or adjunct to irrigants placed into the canals, in combination with a photosensitizer (antimicrobial photodynamic therapy) and in pain management (photobiomodulation). The purpose of this systematic review was to evaluate the evidence in clinical use within these three areas of therapy. (2) Methods: PubMed, Cochrane and Scopus search engines were used to identify human clinical trials regarding the use of lasers in endodontic therapy. (3) Results: After applying the keywords and additional filters, inclusion and exclusion criteria, the initial number of 1486 articles was reduced to 17. It was revealed that almost all studies (14/17) presented a statistically significant improved outcome in laser-assisted endodontic therapy, with the remaining three not showing any adverse effects. (4) Conclusions: The use of laser photonic energy of appropriate delivered parameters can be proposed as useful adjunctive when considering optimal treatment modalities in orthograde endodontics. Additionally, a tendency of research towards pain modulation in this field is developing.

Examining the Factors Affecting Endodontic Therapy Failure

The purpose of the study was to examine the factors affecting Endodontic Therapy Failure (ETF). The study was descriptive cross-sectional conducted at College of Dental Science & Research Centre.
 
 Dental school in Pune, India. In the present study, 90 patients were analyzed in the treatment ward. According to the results, the highest endodontic failure was observed in 41-50 years age group (41.11%) and the least was in 21-30 (24.44%). According to the tooth type, most endodontic failures were observed in maxillary molars (44.4%), mandibular molars (20%) and maxillary premolars (15.5%). Endodontic treatment by general dental practitioners (GDPs) showed the highest failure rate (78.8%). The factors contributing to the most common endodontic problems were under-filled canals (33.3%) and unfilled and missed canals (17.7%). The study concluded that ETF occurred when the treatment was not according to the accepted standards. The main causes of ETF are microbial infection in the root canal system and these patients' not attending the specialists.

Evaluation of the relationship between crown size and root canal morphology of mandibular incisors by cone beam computed tomography (CBCT).

BackgroundThe main reason for the failure of endodontic therapy is the incomplete knowledge about the anatomical variation of root canals. One of the most important factors that leads to the failure of root canal treatment, is missed and untreated major root canals.Objectivewith respect to the complexity of mandibular incisors treatment and high prevalence of the second canal, and the possibility of the relationship between the crown size and the extra canal in these teeth, the aim of this study was to determine the relationship between crown size and root canal morphology in mandibular incisors with CBCT.MethodsIn this cross-sectional study, mandibular permanent incisors were randomly collected in Qazvin City, Iran, and were mounted in eight ternary groups on a plastic slot, using putty molding material. After preparation of Scot view, the samples were scanned by CBCT NewTom 5G. Afterward, the mesiodistal and buccolingual dimensions were measured by the software’s measurement tool with a precision within tenths of a millimeter. In the next stage, a multi-planar option and 400% magnification tool of the software were utilized to study axial and cross sectional views of each tooth to determine canal type. Data were analyzed employing one-sample Kolmogorov-Smirnov, Levene, independent- samples t-test and Roc curve by SPSS version 20.ResultsThe majority of mandibular incisors have a single canal (63.9% of them had type I canal system). In addition, 36.1% of the roots had two canals, among which, type III was the most common. The mean of maximum mesiodistal and buccolingual diameters in type III was significantly bigger than that in type I (p<0.05), but the means of crown size in the two canal types were not significantly different.ConclusionDespite increase in mesiodistal and buccolingual dimension in two canal mandibular incisors with type III canal system, their crown sizes (M-D/F-L index) were not significantly different, in comparison to single canal incisors.

Assessment of treatment failure in endodontic therapy.

There is a paucity of guidelines for the dental profession to assess failure of endodontic therapy. While a successful treatment can be well defined by the absence of apical periodontitis and clinical symptoms after a period of observation, failed treatment has escaped a distinct standing over the years. This article highlights aspects of significance and concludes that research ought to better explore the general health properties of persistent apical periodontitis on root-filled teeth and finally confirm the extent there is an association between apical periodontitis and adverse systemic health effects. Clearing this condition will determine whether clinicians should take a serious or relaxed attitude to persistent apical periodontitis subsequent to endodontic treatment.

Evaluation of Root and Canal Morphology of Mandibular Premolars in Urban Indian Population:An In-Vivo Cone Beam Computed Tomographic Study

Background: Inability to recognize anatomical variations in roots and canal configurations remains one of the principal factors in failure of endodontic therapy. Mandibular premolars, due to their varied internal morphology, present an endodontic challenge more often than other teeth. Objective: To assess the root morphology and canal configuration of mandibular first and second premolars using three-dimensional cone-beam computed tomography imaging (3D CBCT). Methodology: Bilaterally, mandibular premolars were evaluated on 100 CBCT images independently by two experienced endodontists. Vertucci's classification was used to identify and divide the canal configurations. Results: 97% of first premolars and 99.5% of the second premolars were found to have one root. The most common canal configuration was found to be Type- I. Other types of canal configurations were 5.5% and 5% in first and second premolars respectively. Conclusions: Modern-day endodntist needs to be vigilant at all times to avoid missing canals and consequent failures.

Treatment Outcomes in Endodontics

ABSTRACT The success of endodontic treatment has been of great interest to practitioners for many years now. Endodontic failures, which are of particular interest to us, are due to either microbial or nonmicrobial reasons. It is often thought that procedural errors like ledging, perforation, overfilling, underfilling or instrument separation invariably result in failure. In reality, the fact is that such mishaps only impede the accomplishment of an ideal root canal treatment. It is often the concomitant presence of infection that ultimately results in failure. Numerous studies have evaluated the success or failure of endodontic therapy and reported a wide range of success rates from 40 to 93%. This wide range may be due to differences in clinical procedure, experimental design, criteria for evaluation and the length of the observation period. However, most authors conclude that the crucial factor influencing success is the preoperative status of the tooth. Teeth with an apical radiolucency show a 20% lower success rate than teeth without lesion. Till date, the main method of evaluating success is radiographic, using recall radiographs. This method, however, is not without its own limitations due to examiner bias and inconsistencies. The factors affecting treatment outcome include those related to diagnosis, preoperative condition of the patient and tooth, standard of care during treatment, postoperative factors and ongoing maintenance. This paper reviews the various factors influencing the outcome of endodontic treatment in light of modern thought. How to cite this article Srinivasan R, Raghu R. Treatment Outcomes in Endodontics. J Oper Dent Endod 2016;1(1):13-17.

The Sensitivity of Endodontic Enterococcus spp. Strains to Geranium Essential Oil.

Enterococci are able to survive endodontic procedures and contribute to the failure of endodontic therapy. Thus, it is essential to identify novel ways of eradicating them from infected root canals. One such approach may be the use of antimicrobials such as plant essential oils. Enterococcal strains were isolated from endodontically treated teeth by standard microbiological methods. Susceptibility to antibiotics was evaluated by the disc-diffusion method. The minimal inhibitory concentration (MIC) of geranium essential oil was investigated by microdilution in 96-well microplates in Mueller Hinton Broth II. Biofilm eradication concentrations were checked in dentin tests. Geranium essential oil inhibited enterococcal strains at concentrations ranging from 1.8–4.5 mg/mL. No correlation was shown between resistance to antibiotics and the MICs of the test antimicrobials. The MICs of the test oil were lower than those found to show cytotoxic effects on the HMEC-1 cell line. Geranium essential oil eradicated enterococcal biofilm at concentrations of 150 mg/mL. Geranium essential oil inhibits the growth of endodontic enterococcal species at lower concentrations than those required to reach IC50 against the HMEC-1 cell line, and is effective against bacteria protected in biofilm at higher concentrations. In addition, bacteria do not develop resistance to essential oils. Hence, geranium essential oil represents a possible alternative to other antimicrobials during endodontic procedures.

Mandibular First Molar with Extra Distal Canal: A Rare Case Report

A clear understanding of all the potential aberrant canal morphologies is essential to ensure predicatble success in completing complex cases. Failure to identify and adequately fill a canal may be a major reason in the failure of endodontic therapy. The present case report describes successful endodontic management of a rare case of mandibular first molar with three distal canals.

An in vitro evaluation of the effect of dentin deproteinization on coronal microleakage in endodontically treated teeth.

Background:The most common cause of failure of endodontic therapy is inadequate apical and coronal seal. Proper coronal seal reduces the risk of endodontic failure. Hence, the present study was done to test the role of self-etching primers in reducing microleakage through coronal seal.Materials and Methods:Following root canal preparation and obturation, 46 specimen teeth were subjected to one of the test methods as follows: Group I – deproteinization with 3% sodium hypochlorite and etching with 37% phosphoric acid; Group II – deproteinization with 3% sodium hypochlorite and chelation with 15% ethylenediaminetetraacetic acid (EDTA) (Glyde) without etching. Group I and Group II were further divided into two subgroups with 10 specimens in each: In subgroup A, Clearfil Liner Bond 2V was used and in subgroup B, Excite was used. Group III (obturated without access restorative material) had six specimens.Results:Spectrophotometric analysis was done to quantitatively analyze the amount of dye leakage. Microleakage values obtained in Group I and Group II were comparable. In Group I, marginally better values were obtained with the Clearfil Liner Bond 2V in comparison with Excite. In Group II, microleakage values obtained with Clearfil Liner Bond 2V and Excite were similar and statistically not significant. In Group III (control) where no access restoratives were placed, maximum leakage was observed.Conclusions:Maximum leakage values were observed in Group III, when obturated without access restorative and when exposed to artificial saliva. Clearfil Liner Bond 2V as a self-etching primer showed better values in preventing microleakage. Deproteinization may be important to reduce microleakage when using the fifth-generation bonding system (Excite) and sixth-generation bonding system (Clearfil Liner Bond 2V).

Portland Cement Use in Dental Root Perforations: A Long Term Followup

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

Antimicrobial Substantivity of Alexidine and Chlorhexidine in Dentin

IntroductionThe use of irrigating solutions with long-lived activity helps to avoid failure of endodontic therapy. The aim of the present study was to evaluate and compare the antimicrobial substantivity against Enterococcus faecalis by using as carrier a dentin-volumetric unit exposed to chlorhexidine (CHX) and alexidine (ALX). MethodsStandardized dentin blocks of human molars were treated for 1 minute with 0.5% CHX, 2% CHX, 1% ALX, and 2% ALX. They were exposed to E. faecalis in suspension to determine antimicrobial substantivity during a period of 80 days. Results were analyzed by means of Kaplan-Meier survival analysis (P < .05). ResultsALX obtained the best results, with differences that were significantly different from CHX regardless of the concentration. Although all the samples treated with CHX were contaminated at the end of the study period, a direct relationship was seen between concentration and survival time. There was no statistically significant difference between 2% and 1% ALX. ConclusionsThe present study shows that 2% and 1% ALX used for 1 minute provide longer antimicrobial substantivity against E. faecalis than CHX when applied to 2% and 0.5%.