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Coronal Restoration (coronal + restoration)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Longitudinal tooth fractures: findings that contribute to complex endodontic diagnoses

ENDODONTIC TOPICS, Issue 1 2007
ERIC M. RIVERA
The purpose of this review is to describe and discuss the diagnostic and treatment challenges related to tooth fractures primarily in the vertical plane, that is, the long axis of the crown and/or root. This includes when and how to identify and determine the extent of the fracture, when a coronal restoration should be placed, when root canal treatment is needed, and when a tooth or root should be extracted based on the location and extent of the fracture. The term ,longitudinal fractures' is used because they usually represent vertical extensions of fractures over distance and time. These fractures often present problems with diagnosis and treatment, but should be considered as findings only. They are not to be considered as pulpal or periapical diagnoses, but as pathways for bacteria that may induce pulpal and/or periapical inflammation or disease. Longitudinal fractures are divided into five definitive classifications, generally from least to most severe: (1) craze lines; (2) fractured cusp; (3) cracked tooth; (4) split tooth; and (5) vertical root fracture. These differ but have frequently been confused or combined in clinical articles, creating misunderstanding and resulting in incorrect diagnosis and inappropriate treatment. These classifications have been devised to provide global definitions that researchers and clinicians can use to eliminate this confusion. This review is subdivided into these five classifications as to incidence, pathogenesis, clinical features, etiologies, diagnosis, treatment, prognosis, and prevention. [source]

Outcome of secondary root canal treatment: a systematic review of the literature

INTERNATIONAL ENDODONTIC JOURNAL, Issue 12 2008
Y.-L. Ng
Abstract Aims, (i) To investigate the effects of study characteristics on the reported success rates of secondary root canal treatment (2°RCT or root canal retreatment); and (ii) to investigate the effects of clinical factors on the success of 2°RCT. Methodology, Longitudinal human clinical studies investigating outcome of 2°RCT which were published upto the end of 2006 were identified electronically (MEDLINE and Cochrane database 1966,2006 Dec, week 4). Four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology), bibliographies of all relevant papers and review articles were hand-searched. Two reviewers (Y-LN, KG) independently assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were: (i) Clinical studies on 2°RCT; (ii) Stratified analyses available for 2°RCT where 1°RCT data included; (iii) Sample size given and larger than 10; (iv) At least 6-month post-operative review; (v) Success based on clinical and/or radiographic criteria (strict = absence of apical radiolucency; loose = reduction in size of radiolucency); and (vi) Overall success rate given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis which constituted the first strand of evidence. Secondly, the pooled weighted success rates by each study characteristic and potential prognostic factor were estimated using the random effect model. Thirdly, the effects of study characteristics and prognostic factors (expressed as odds ratios) on success rates were estimated using fixed and random effects meta-analysis with DerSimonean and Laird's methods. Meta-regression models were used to explore potential sources of statistical heterogeneity. Study characteristics considered in the meta-regression analyses were: decade of publication, study-specific criteria for success (radiographic, combined radiographic & clinical), unit of outcome measure (tooth, root), duration after treatment when assessing success (,at least 4 years' or ,<4 years'), geographic location of the study (North American, Scandinavian, other countries), and qualification of the operator (undergraduate students, postgraduate students, general dental practitioners, specialist or mixed group). Results, Of the 40 papers identified, 17 studies published between 1961 and 2005 were included; none were published in 2006. The majority of studies were retrospective (n = 12) and only five prospective. The pooled weighted success rate of 2°RCT judged by complete healing was 76.7% (95% CI 73.6%, 89.6%) and by incomplete healing, 77.2% (95% CI 61.1%, 88.1%). The success rates by ,decade of publication' and ,geographic location of study' were not significantly different at the 5% level. Eighteen clinical factors had been investigated in various combinations in previous studies. The most frequently and thoroughly investigated were ,periapical status' (n = 13), ,size of lesion' (n = 7), and ,apical extent of RF' (n = 5) which were found to be significant prognostic factors. The effect of different aspects of primary treatment history and re-treatment procedures has been poorly tested. Conclusions, The pooled estimated success rate of secondary root canal treatment was 77%. The presence of pre-operative periapical lesion, apical extent of root filling and quality of coronal restoration proved significant prognostic factors with concurrence between all three strands of evidence whilst the effects of 1°RCT history and 2°RCT protocol have been poorly investigated. [source]

Outcome of primary root canal treatment: systematic review of the literature , Part 2.

INTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2008
Influence of clinical factors
Abstract Aims, (i) To carry out meta-analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and (ii) to identify the best treatment protocol based on the current evidence. Methodology, The evidence for the effect of each clinical factor on the success rate (SR) of primary root canal treatment was gathered in three different ways: (i) intuitive synthesis of reported findings from individual studies; (ii) weighted pooled SR by each factor under investigation was estimated using random-effect meta-analysis; (iii) weighted effect of the factor under investigation on SR were estimated and expressed as odds ratio for the dichotomous outcomes (success or failure) using fixed- and random-effects meta-analysis. Statistical heterogeneity amongst the studies was assessed by Cochran's (Q) test. Potential sources of statistical heterogeneity were investigated by exploring clinical heterogeneity using meta-regression models which included study characteristics in the regression models. Results, Out of the clinical factors investigated, pre-operative pulpal and periapical status were most frequently investigated, whilst the intra-operative factors were poorly studied in the 63 studies. Four factors were found to have a significant effect on the primary root canal treatment outcome, although the data heterogeneity was substantial, some of which could be explained by some of the study characteristics. Conclusions, Four conditions (pre-operative absence of periapical radiolucency, root filling with no voids, root filling extending to 2 mm within the radiographic apex and satisfactory coronal restoration) were found to improve the outcome of primary root canal treatment significantly. Root canal treatment should therefore aim at achieving and maintaining access to apical anatomy during chemo-mechanical debridement, obturating the canal with densely compacted material to the apical terminus without extrusion into the apical tissues and preventing re-infection with a good quality coronal restoration. [source]

Histological evaluation of MTA as a root-end filling material

INTERNATIONAL ENDODONTIC JOURNAL, Issue 10 2007
P. F. E. Bernabé
Abstract Aim, To assess the histological response associated with grey mineral trioxide aggregate (GMTA) and zinc oxide eugenol (ZOE) as root-end filling materials in teeth where the root canals were not filled and the coronal access cavities were not restored. Methodology, Periapical lesions were developed in 24 premolar teeth in three dogs. The root canals were prepared and half of them were dried, filled and the coronal access restored (closed). The remaining teeth were not root filled and no coronal restoration was placed (open). Apical root-end resections were performed 3 mm from the apex, and root-end cavities were prepared with ultrasonic tips. These were randomly filled with either ZOE or GMTA in the same number of specimens using MAPSYSTEM device. After 180 days the animals were killed and blocks of tissues removed and processed for histological examination. Periradicular tissue reaction was evaluated, including severity of inflammation and cementum formation. Statistical analysis was performed using anova analysis and Tukey's test. Results, A significant difference was found between the levels of inflammation in the periradicular tissues of the GMTA/closed group, compared with the ZOE/open and ZOE/closed groups (P < 0.05) but not between GMTA/closed and GMTA/open groups. Cementum formation was not found over any ZOE specimens but over MTA in all specimens. No microorganisms were found in the interface between the material and the dentinal walls. Conclusions, GMTA was associated with less periapical inflammation and tissue response when used as a root-end filling material, even when no root filling or coronal restoration was present. [source]

Periapical status and quality of root fillings and coronal restorations in an adult Spanish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2004
J. J. Segura-Egea
Abstract Aim, To investigate the quality of root fillings and coronal restorations and their association with periapical status in an adult Spanish population. Methodology, A total of 180 subjects, aged 37.1 ± 15.7 years, who presented as new patients at the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all root filled teeth, excluding third molars, were examined. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. Radiographic signs of overhang or open margins associated with coronal restorations were also evaluated. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen's , test and logistic regression. Results, The total number of root filled teeth was 93, and 60 (64.5%) had apical periodontitis (AP). Presence of AP in root filled teeth was associated with inadequate adaptation of the filling (OR = 2.29; P = 0.06), inadequate length of the root filling (OR = 2.44; P = 0.048), and with poor radiographic quality of the coronal restoration (OR = 2.38; P = 0.054). Only 34.4% of the root fillings were adequate from a technical perspective. When both root fillings and coronal restorations were adequate the incidence of AP decreased to 31.3% (OR = 5.50; P < 0.01). Conclusions, The incidence of AP in root filled teeth was high. Many root fillings were technically unsatisfactory. Adequate root fillings and coronal restorations were associated with a lower incidence of AP; an adequate root filling had a more substantial impact on the outcome of treatment than the quality of the coronal restoration. [source]

Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation

INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2002
Y. Boucher
Abstract Aim This study was undertaken to examine the prevalence and technical quality of root fillings and the periapical status of endodontically treated teeth in a French subpopulation. Methodology Full-mouth periapical radiographs were obtained from 208 consecutive adult patients seeking care within the dental service provided by the Hôtel-Dieu in Paris. The occurrence and technical quality of root fillings were assessed for each root according to the position and the density of the obturation. The periapical status was evaluated using the Periapical Index Scoring System. The type of coronal restoration and the presence of posts were also noted. Results Of the 8743 roots included in the survey, 23% were root-filled. An acceptable standard of treatment was found in 21% of roots with 16% of these cases associated with signs of periapical disease. In roots with unacceptable root-fillings, 27% had periapical pathology. A post was seen in 26% of the root-filled canals, with 29% of these cases associated with periapical pathology. An intracoronal restoration existed in 30% of the filled roots, of which 22% exhibited a periapical lesion. An extra-coronal restoration was present in 60% of the filled roots, of which 24% had radiographic signs of periapical pathology. The remaining 10% of filled roots that had no coronal restoration were associated with periapical pathology in 33% of cases. At least one periapical lesion was seen in 63% of the patients. Conclusion The results demonstrate a high prevalence of root-filled teeth and poor technical quality of treatment. Roots presenting with acceptable root fillings were associated with a lower prevalence of periapical pathology (P < 0.001). Posts in roots were associated with periapical pathology significantly more than in roots without posts (P < 0.001). [source]

An in vitro investigation of the bulk flow of fluid through apical foramina during simulated tooth extraction: a potential confounder in microbiological studies?

INTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2001
A. Kapalas
Aim,The ,pumping action' induced during tooth extraction may cause bacteria suspended in tissue fluids to be transposed from one anatomical compartment to another. Apart from causing bacteraemia, this may lead to inaccuracies in studies evaluating the presence and distribution of bacteria in and around tooth apices. The aim was to investigate the bulk flow of fluid through apical foramina during simulated extraction of teeth in an in vitro model. The influence of the presence or absence of a coronal restoration was also evaluated. Methodology,Twenty extracted single-rooted, human, mature, permanent teeth were used. Standard access cavities were prepared and the root canals located. Standardized micrographs of the apical foramina were obtained and their area (µm2) was calculated by image analysis software. The teeth were then set and sealed into polyvinylsiloxane (rubber base) impression material. Crystal violet dye was inoculated into the coronal half of the root canal system. Tooth extraction movements were simulated in the impression matrix and the leakage of dyes with and without the presence of a coronal restoration was examined. The procedure was repeated, following application of safranin dye in a coronal trough within the simulated rubber base gingival margin at the CEJ. The results were analysed statistically with the independent-samples t -test and the McNemar test. Results,In the absence of a coronal restoration crystal violet leaked out of the apical foramina in 18/20 teeth; conversely safranin leaked into the teeth through the apical foramina in 11/20 cases when applied to the external root surface. In the presence of an intact coronal restoration crystal violet dye leaked out in 6/20 teeth and conversely safranin leaked into 7/20 teeth. The presence of a coronal restoration significantly reduced (P = 0.002) dye leakage out of the root canal system. No associations were found for leakage of dye into the root canal system when applied externally. In addition, the amount of dye leakage was positively correlated with the area of the apical foramen in the presence of a coronal restoration (P = 0.009). Conclusion,The presence of a coronal restoration significantly reduced leakage of dye out of the apical foramen. Microbiological studies on root canals and periapical lesions using extracted teeth should take potential contamination from this source into account. [source]

Microbial flora of root canal,treated teeth associated with asymptomatic periapical radiolucent lesions

MOLECULAR ORAL MICROBIOLOGY, Issue 6 2001
G. S. P. Cheung
This study aimed to investigate the composition of microflora in endodontically treated teeth associated with asymptomatic periapical lesions in southern Chinese patients. Twenty-four teeth which had received nonsurgical root canal treatment more than 4 years previously, and which presents an acceptable coronal restoration with a periapical radiolucent area, were re-treated nonsurgically. Bacteriological samples were obtained after removal of the old root canal filling. The samples were inoculated on enriched trypticase soy agar and four selective media for incubation at 37°C in both a carbon dioxide-enriched atmosphere and anaerobically. Eighteen teeth that had received gutta-percha root canal fillings were grouped for analysis, 12 (66.7%) of which contained cultivable microorganisms. The total colony forming units per ml of transport medium ranged from 0 to 2.3×105. The number of bacterial genera recovered ranged between 0 and 6, with facultative gram-positive cocci being the most prevalent group of bacteria isolated. Facultative anaerobic bacteria were present in all, whereas strict anaerobic bacteria were found in 3 out of the 12 teeth with positive growth. The size of the periapical rarefaction did not show any relationship with the quantity of microorganisms recovered. Coagulase-negative staphylococci, streptococci and Pseudomonas aeruginosa were most frequently isolated in this group of patients. The possible origin of these organisms is discussed. [source]

Discuss the factors that affect the outcome of endodontic treatment

AUSTRALIAN ENDODONTIC JOURNAL, Issue 2 2009
Akhil Chandra
Abstract Factors affecting the outcome of endodontic treatment are discussed from the theoretical viewpoint (microbes, foreign bodies and epithelium) and from a clinical aspect (preoperative factors, intraoperative factors and miscellaneous factors). The following conditions favour endodontic success significantly: the absence of a periapical infection, a well-condensed root filling, the root filling extending to 2 mm within the radiographic apex and not beyond, a satisfactory coronal restoration, use of a rubber dam during treatment and cases involving primary root canal treatment as opposed to retreatment. Other factors have the potential to affect success rates, but these have not yet been quantified. Although there is an array of potential factors that influence the outcome of endodontic treatment, success is most significantly dependent upon the elimination of root canal infection present when treatment starts and the prevention of contamination during treatment. [source]

Surgical extrusion of a crown-root fractured immature permanent incisor: 36 month follow-up

DENTAL TRAUMATOLOGY, Issue 6 2007
Zuhal K
Abstract,,, Crown-root fracture is defined as a fracture involving enamel, dentin and pulp and can be classified as either complicated or uncomplicated. The tooth with crown-root fracture presents a lot of problems during coronal restorations and extraction was formerly used in many cases. But loss of a permanent incisor in a young patient may create severe emotional problems and alternative treatment approaches must be considered. This report presents the successful results of a surgical extrusion of a complicated crown-root fractured, immature permanent incisor in a 9-year-old boy. Examination 36 months after the trauma indicated that the treatment had provided functional and esthetic results. [source]

Periapical status and quality of root fillings and coronal restorations in an adult Spanish population

The capacity of dental therapists to provide direct restorative care to adults

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009
Hanny Calache
Abstract Introduction: In Victoria, dental therapists are restricted to treating patients under the age of 26 years. Removing this age restriction from dental therapists' scope of practice may assist significantly in addressing workforce shortages, particularly in rural Victoria. Objectives: This study aims to assess the capacity of dental therapists to provide direct coronal restorations (dental fillings) to patients older than 25 years, on the prescription of a dentist. Its objectives include determining the success rate of restorations placed by dental therapists six months post placement; and patients' and dental therapists' satisfaction with the services provided. Methods: The project was carried out in 2007 at the Royal Dental Hospital of Melbourne. Seven dental therapists participated in the study, placed 356 restorations (115 patients) with the support of a dentist. These restorations were reviewed six-months post placement by dentists blinded as to which restorations were placed by the dental therapists. Patients' age ranged from 26 to 82 years (82% were >40 years). Results: At six months post-treatment, 258 restorations (80 patients) were reviewed. At review, 94.6% of the restorations were successful. Patients and dental therapists were satisfied with the experience. Conclusions: The standard of restorations provided by dental therapists was considered to be at least similar to that expected of a newly graduated dentist. Implications: Broadening the dental therapists scope of practice would create opportunities to design more flexible ,oral health' clinical teams enabling dentists to provide more complex procedures for patients most in need. This is significant in the public sector and rural areas where workforce shortages are most acute. [source]

An In Vitro Study Of Coronal Microleakage In Endodontically-Treated Teeth Restored With Posts

AUSTRALIAN ENDODONTIC JOURNAL, Issue 3 2003
Shohreh Ravanshad DMD.
Coronal microleakage has received considerable attention as a factor related to failure of endodontic treatment and much emphasis is placed on the quality of the final restoration. Posts are frequently used for the retention of coronal restorations. These can be custom-made or prefabricated. Many authors have examined coronal microleakage with respect to gutta-percha root fillings and plastic coronal restorations, but few have investigated the coronal seal afforded by various post systems. The seal provided by a cemented post depends on the seal of the cement used. The purpose of this study was to compare coronal microleakage around cast and prefabricated posts using a dye-penetration method. Sixty extracted single-rooted human teeth were chemomechanically prepared. The root canals were filled with gutta-percha and sealer and they were then prepared for standard posts. Six groups, each of 10 teeth, were restored with either cast post or prefrabricated post. The posts were cemented with either glass ionomer cement (GIC), Variolink II or Durelon. The teeth were thermocycled and placed in Indian ink for one week. They were then demineralised and rendered transparent. Linear coronal dye penetration around the post was measured and compared. The least dye-penetration was observed in roots restored with a cast post and Variolink II. Dentatus posts demonstrated the most microleakage. It appears that the dentine-bonding cements have less microleakage than the traditional, non-dentine-bonding cements and adaptation of the post with the canal may be more important than the cement used. [source]