Endodontic Problems Research Articles

The differential diagnosis of toothache from other orofacial pains in clinical practice

Teeth are a common and obvious source of orofacial pain. There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis. A retrospective survey of a sample of patients referred for endodontic treatment was analysed to determine the accuracy of the diagnosis and to identify non-dental cases. A separate prospective study of complex non-dental orofacial pain cases was performed to determine which cases had previously received dental treatment. Seventy-seven (88 per cent) of 88 patients referred for endodontic treatment had been correctly diagnosed with solely endodontic problems. Eight (9 per cent) had endodontic plus other orofacial pain problems and three (3 per cent) had no endodontic problems but other orofacial pain problems. Forty-four (44 per cent) of 100 non-dental orofacial pain patients had previously received either extractions or endodontics. Dentists need to carefully evaluate all toothache patients to ensure that the diagnosis is correct prior to the initiation of irreversible treatment.

The palatal groove: Application of computed tomography in its detection - a case report

Maxillary incisors are very susceptible to developmental anomalies that can lead to periodontal and/or endodontic problems. One such developmental anomaly is the palatal groove which is often associated with incorrect diagnosis, and subsequent treatment failure. This case report describes the use of spiral CT (Computed Tomography) scan to not only to accurately diagnose the groove on the maxillary right lateral incisor but also to confirm the depth and the relation of the groove to the pulp cavity. The management included a combination of endodontic therapy and periodontal regenerative techniques. Root canal therapy was performed followed by flap reflection, removal of granulation tissue and odontoplasty of the groove. Bone graft was placed followed by a resorbable barrier for guided tissue regeneration. Use of bone graft and a resorbable barrier in the treatment of palatal groove showed an improvement in clinical attachment, reduced probing depth and deposition of bone in the osseous defect.

Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology

To compare intraoral periapical radiography with 3D images for the diagnosis of periapical pathology. Maxillary molars and premolars and mandibular molars with endodontic problems and examined with periapical radiographs and a 3D technique (3D Accuitomo) were retrospectively selected and evaluated by 3 oral radiologists. Numbers of roots and root canals, presence and location of periapical lesions, and their relation to neighboring structures were studied. Among 46 teeth, both techniques demonstrated lesions in 32 teeth, and an additional 10 teeth were found in the Accuitomo images. As regards individual roots, 53 lesions were found in both techniques, and 33 more roots were found to have lesions in Accuitomo images. Artefacts were sometimes a problem in Accuitomo images. In 32 of the 46 cases, all observers agreed that additional clinically relevant information was obtained with Accuitomo images. A high-resolution 3D technique can be of value for diagnosis of periapical problems.

Morbidity of Chin Bone Transplants Used for Reconstructing Alveolar Defects in Cleft Patients

The aim of this study was to evaluate the objective and subjective morbidity of symphyseal chin bone harvesting used for reconstruction of alveolar defects in young cleft patients. All patients who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 1992 through 2000 at the Department of Oral and Maxillofacial Surgery of the University Hospital Groningen, Groningen, The Netherlands, were invited to participate in this retrospective study.Patients' acceptance, perioperative and postoperative morbidity were evaluated. A survey of the medical records was performed. In addition, the patients completed a questionnaire for their appreciation of the procedure. They were also subjected to a clinical and radiographic examination. Thirty patients (21 males and 9 females; mean age 11.8 +/- 3.6 years) participated in this study. Neither the medical records nor the experiences of the patients showed significant morbidity. The procedure was appreciated with 6.8 +/- 3.5 (scale 0 to 10). Postoperative pain was scored as 1.2 +/- 2.5 (scale 0 to 10). Three patients reported transient sensory disturbances at the donor site. Two patients showed a slight sensibility disorder in the symphyseal region. In three patients, an endodontic problem had developed in a lower incisor. This study showed that chin bone harvesting for reconstructing alveolar cleft in young patients is a well-accepted procedure with low objective and subjective morbidity. Notwithstanding this low morbidity, the patients (and their parents) have to be informed about the risk of objective and subjective disturbances of the sensibility in the donor region and the risk of dental pulp necrosis.

21st Century Endodontics: Part 2

The first paper in this series considered the subject of diagnosis and treatment planning for patients with endodontic problems. One of the factors to be taken into consideration when deciding whether or not to prescribe root canal treatment is the morphology of the root canal system of the root in question. Some information may be gleaned from the pre-operative radiograph, but much will be part of the practitioner's own knowledge. An understanding of the root canal morphology is also essential when cutting efficient and effective access cavities, remembering the endodontic cliché that 'access is success'. This paper will review canal morphology and access cavities, and then consider how teeth under treatment may be isolated from the oral environment to maintain a sterile operating environment.

Endodontic problems

If modern clinical techniques were carefully followed, many common endodontic problems would never occur. Incorrectly designed access cavities may make root canals both difficult to identify and to instrument. Careful study of the pre-operative radiograph is essential. Various aids are available to remove fractured instruments and failed root fillings, but the problem must first be correctly diagnosed. As more patients seek cosmetic procedures, the practitioner should be familiar with the 'walking bleach' procedure, again after careful diagnosis of the cause of the discolouration. The practitioner should also be fully aware of the prognosis for this and other endodontic procedures.

Surgical Extrusion Technique for Clinical Crown Lengthening: Report of Three Cases

Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths < or = 3 mm around the teeth at all sites, without bleeding on probing. The teeth functioned normally, with near-normal mobility. Radiographs showed normal periodontal contour consistent with new bone formation in the periapical area. Radiographic analysis did not show any evidence of root or crestal bone resorption or endodontic problems. The technique presented could constitute an alternative surgical approach to performing crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

The presurgical workup before third molar surgery: how much is enough?

Purpose We sought to assess the indications for patient referral for computed tomography (CT) scan before third molar extraction. The influence of the data obtained from the CT scans on the surgical outcome and morbidity was also evaluated. Patients and methods There were 189 patients in the study (120 females and 69 males). Sixty-five patients were referred to receive CT and formed the study group. The remaining patients were included in the control group. Results There were no statistically significant differences between the groups with regard to demographic data and tooth and root angulations. Indications for tooth extraction such as pain, swelling, pericoronitis, caries, endodontic problems, pathology, and prosthetic considerations were similar. The proximity of the tooth root to the inferior alveolar canal was the only statistically significant difference between the 2 groups ( P < .001). The treatment plan outcomes for extraction, surgical extraction, and follow-up were comparable. The surgeon changed the initial decision from “surgical extraction” to “follow-up” in only 1 case after CT scan. Conclusions Within the limits of the present study, it can be concluded that the main reason for CT scan referral is the proximity of the third molar root to the inferior alveolar canal (<1 mm). The data obtained from the CT scan had minimal effect on the final surgical outcome. The routine use of CT scan in cases of third molar extractions cannot be recommended.

An Easy Solution to Endodontic Problems?

Treatment of Combined Endodontic Periodontic Lesions by Intentional Replantation and Application of Hydroxyapatites. L. Yu, B. Xu and B. Wu. Dental Traumatology 2003; 19: 60–63.

Radiographic evaluation of cases referred for surgical endodontics.

The aim of this study is to test the hypothesis that more patients with failed root-canal treatment or other endodontic problems are referred for periradicular surgery rather than nonsurgical re-treatment. Three sets of 100 periapical radiographs representing typical cases referred for surgical treatment were collected in three departments of oral and maxillo-facial surgery situated in different parts of the Netherlands. Of these, a total of 278 radiographs were evaluated to determine whether endodontic surgery was indicated or whether the primary endodontic treatment or endodontic re-treatment was a realistic option. An oral and maxillo-facial surgeon, an endodontist and a general dental practitioner viewed the radiograph independently under standard conditions. Overall, orthograde root-canal (re-)treatment was considered possible in 63% of the cases. The results differed between the three examiners with the oral surgeon reporting that 41% of cases were amenable to conventional treatment, for the general dental practitioner and the endodontists the figures were 67 and 80%, respectively. Based on these observations, it is concluded that most of the teeth referred for surgical treatment to an oral surgeon could be treated by orthograde nonsurgical root-canal treatment.

DentoCAT™—a novel design of a cone-beam CT scanner for dentomaxillofacial imaging: introduction and preliminary results

The application of innovative technologies in dentistry and orthodontics has been very interesting to observe. The development of cone-beam computed tomography (CBCT) as a preferred imaging procedure for comprehensive orthodontic treatment is of particular interest. The information obtained from CBCT imaging provides several substantial advantages. For example, CBCT imaging provides accurate measurements, improves localization of impacted teeth, provides visualization of airway abnormalities, it identifies and quantifies asymmetry, it can be used to assess periodontal structures, to identify endodontic problems, to plan placement sites for temporary skeletal anchorage devices, and to view condylar positions and temporomandibular joint (TMJ) bony structures according to the practitioner’s knowledge at the time of orthodontic diagnosis. Moreover, CBCT imaging involves only a minimal increase in radiation dose relative to combined diagnostic modern digital panoramic and cephalometric imaging. The aim of this article is to provide a comprehensive overview of CBCT imaging, including its technique, advantages, and applications in orthodontics.

A Suspected Periradicular Scar: Treat or Not?

This paper presents an unusual case of a tooth with multiple adjacent endodontic problems. The diagnosis was complicated by a bony scar that untypically was located around the apex of one of the teeth.

Penggunaan Kalsium Hidroksida di Bidang Konservasi Gigi

Because of the capacity to promote environmental condition for tissue repair, calcium hydroxide can be used in management of a wide range of endodontic problems such as pulp capping, pulpotomy, root properties, it promotes mineralization, induced healing, and initiation of hard tissue formation. Although there have been many reports on the success, the exact mechanism is still poorly understood. Development of the use of calcium for endodontic therapy will be reviewed.

Endodontic Problems And Failures: How To Anticipate, Evaluate And Prevent Them

Australian Endodontic JournalVolume 25, Issue 1 p. 15-18 Endodontic Problems And Failures: How To Anticipate, Evaluate And Prevent Them Dr Harold M. Rappaport DDS, Dr Harold M. Rappaport DDS 5640 Paseo de Tampico. Tucson. AZ 85750–1036 USASearch for more papers by this author Dr Harold M. Rappaport DDS, Dr Harold M. Rappaport DDS 5640 Paseo de Tampico. Tucson. AZ 85750–1036 USASearch for more papers by this author First published: 11 February 2010 https://doi.org/10.1111/j.1747-4477.1999.tb00061.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume25, Issue1April 1999Pages 15-18 RelatedInformation

Alveolar ridge reconstruction and/or preservation using root form bioglass cones

Extraction of a tooth necessitated by factors such as developmental problems, trauma, severe periodontal disease and endodontic problems often causes deformities of the residual alveolar ridge in the maxillary anterior region. These cases are usually difficult to restore prosthetically and they result in poor esthetics and insufficient occlusal function. This study investigated the efficacy of root form bioactive glass cones implanted into (a) artificial sockets produced by bone splitting of previous extraction sites (group BS) and (b) fresh extraction sockets (group FES). We included conventional extraction sockets sutured without implanting the root form bioactive glass cones as a control (group C). A total of 16 patients were treated for whom extractions had been indicated due to severe periodontitis. 6 patients with 7 implant sites having Class II or III alveolar ridge deformities comprised the BS group. 5 patients with 10 implant sites comprised the FES group. Group C, comprised 5 patients with 10 extraction sites. Alveolar ridge width and height measurements were obtained using study casts preoperatively, immediately postoperatively, and at 3 and 12 months after operation. In the BS group, while the width of the alveolar ridge increased by 2.8+/-1.18 mm immediately after ridge augmentation procedure and by 2.4+/-0.93 mm at 1 year after operation (p<0.01), the height of the alveolar ridge increased by 1.8+/-1.99 mm and 1.4+/-1.74 mm respectively (p<0.05). In the FES group, the differences between preoperative original ridge height and width and postoperative measurements were not statistically significant, which demonstrated the efficiency of this method in preserving the alveolar ridge. In group C, while alveolar ridge width after 12 months had not significantly changed, alveolar ridge height decreased significantly (1.35+/-1.05 mm, p<0.01). After 12 months, no dehiscences were detected and the differences in height between the groups remained significant. The results of this study indicate that this procedure is efficient in reconstructing alveolar ridges deformed as a result of extraction, particularly relevant in relation to preparation for subsequent restorative treatment.

A sonic instrument for retrograde preparation

A surgical approach is required when a nonsurgical endodontic treatment is impossible or ineffective in resolving an endodontic problem (1). The successful outcome ofendodontic surgery requires a hermetic apical seal. Therefore, a retrograde filling is necessary when the apical sealing quality is doubtful (2). One of the prerequisites for a good filling is a good cavity preparation. A major difficulty in performing proper apical preparation is the limited working space. A conventional handpiece is often too bulky for preparing an apical cavity. A mini-head handpiece (DYNA DENT; Micro Motors, Santa Aria, CA) can be helpful, but it is usually still necessary to remove a certain amount of periapical bone to obtain a proper working position. In conventional root canal preparation, sonic as well as ultrasonic systems have been used as time-saving devices for root canal instrumentation. The Ultrasonic Retro-tips (Excellence in Endodontics, San Diego, CA) have recently been designed to be used in ultrasonic systems (ENAC; Osada Electric, Los Angeles, CA and Amadent, Cherry Hill, N J) and they have improved and simplified apical preparation and also minimized bone removal. Sonic handpieces are widely used in endodontic practice and therefore an attempt has been made to utilize a sonic instrument for apical cavity preparation. Tips were designed to be used in a MMI500 handpiece (Sonic Air MMI500 Endo System; Micro Mega, Woodside, NY) (Fig. 1). Extracted teeth were used to test the sonic instrument tips and to determine whether their energy level, which is lower than that of the ultrasonic instrument, was sufficient for the cavity preparation. It was possible to obtain a deep preparation which followed the original path of the apical root canal. These tips have also been tested clinically. It was found that FiG 1. Comparison of the sizes of the conventional handpiece, the mini-handpiece, and the surgical tip for the MM1500 Sonic Air Handpiece.

Soldiers' Dental Complaints Compared with Clinical Findings in the Military Hospital in Bologna, Italy

There is no previous data published on the frequency and reasons for dental emergencies in the Italian Army. In this study, all the 329 soldiers who sought dental help during a 5-month period in the Military Hospital in Bologna were investigated. Prior to clinical examination, the soldiers filled out a questionnaire concerning their subjective perception about their dental treatment needs. Data from the questionnaire were then compared with the actual status findings. The results showed that endodontic problems comprised the majority of the cases (37.1%), followed by surgical problems as the second most frequent emergency (33.1%). The subjects' own perceptions showed good agreement with the clinical record in cases with endodontal or surgical problems, excluding problems related to wisdom teeth, while those related to caries and periodontal disease were less frequently correctly assessed by the soldiers.

THE ENDODONTIST AND THE GENERAL DENTIST

As the title suggests, most of this article has discussed the relationship between the general dentist and the endodontic specialist. In attempting to shed some light on this very intricate referral process, one should not lose sight of the fact that it is ultimately the dental patient needing the root canal treatment who should be the recipient of any improvement that develops in this referral process. General dentists have always, and, most probably, will always provide the great majority of root canal treatments done in the United States. Many factors, however, will, from time to time, cause the thoughtful general dentist to refer at least some cases to endodontic specialists. Patients have very little to say in this process; however, we must all realize that they place a great deal of trust in both the general dentist and the endodontist to work together to come to the best resolution of their endodontic problems. The primary concerns of most patients seem to fall into the areas of fear of the treatment and fear of the cost. Costs are driven by expenses, insurance tables, and market factors. Although it cannot be said that endodontic treatment is inexpensive, it can usually be stated that there is good value received for the treatment given. This is particularly true if the end result is a quality job done with long-term retention of the problem tooth. As to the patient's fear concerning pain, it is incumbent on both the generalist and the specialist to develop the skills necessary to render modern endodontic treatment in a pain-free manner. This is within the standard of care, and is something the patients should not only expect but, in fact, demand. The other concerns that patients have are quite standard in the profession. They are, primarily, the desire for pleasant surroundings, pleasant staff, confident doctors, convenient pay arrangements, understanding of the procedure, and a perception of value for time and money spent. Working together, the endodontic specialist and the general dentist should certainly be able to provide these wishes for all patients.

A survey of endodontic procedures performed by practitioners in limited practice.

Patients are sometimes referred for treatment to dentists who limit their practices to endodontics. A survey of consecutive referrals to seven such dentists was undertaken. The most common reasons for such referrals were (i) for the retreatment of a tooth with a previous root filling, (ii) because the referring dentist was unable to control pain and/or swelling, or (iii) because the referring dentist was unable to diagnose the endodontic problem. Only 60 (12.8%) of the 469 reasons reviewed were in teeth that were symptomless, uncomplicated and untouched by the referring dentist.

Setting up an MSc programme in endodontics

The course has been designed to provide a suitable foundation for academic and general practice careers. Emphasis has been placed on developing diagnostic and practical skills. Students are encouraged to review their clinical practice critically in the light of recent advances in knowledge. The course begins with an intensive period of lectures and seminars covering general aspects of endodontics, and is generously supplemented by practical demonstrations and classes on a variety of procedures performed on laboratory models. The course continues with lectures and seminars designed to stimulate group discussion. These are complemented by supervised clinical sessions encompassing assessment, planning and treatment of a comprehensive range of conventional and surgical endodontic problems. The syllabus includes relevant basic sciences, pathology, differential diagnosis, pharmacology and therapeutics. The biological basis for endodontics is stressed and covers the following: maintenance of pulp vitality; effects of pulp capping pulpotomy and pulpectomy; the management and treatment of traumatic injuries to teeth; the management of medically compromised patients; the effect of various methods of instrumentation of root canals; radiology; restorative treatment of the endodontically treated tooth; the interface between endodontics and periodontics, prosthetics or orthodontics. Each student is required to undertake a research project and write a report.