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Endodontic Treatment (endodontic + treatment)

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Medical Sciences	100%

Selected Abstracts

What We Leave Behind In Root Canals After Endodontic Treatment: Some Issues and Concerns

AUSTRALIAN ENDODONTIC JOURNAL, Issue 3 2005
Dr. Chee Peng Sum
The benefits of using sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) as endodontic irrigants, and calcium hydroxide as an inter-appointment medicament, are well known to dentists. Many steps undertaken during endodontic treatment and retreatment are rather mechanical in nature, and less attention is committed to understanding the biological issues underlying endodontic treatment and retreatment. It should be noted that dentine is the fundamental substrate in endodontic treatment, and its properties and characteristics are the key determinant of nearly all disease and post-disease processes in the teeth. In this article the effects and counter-effects of NaOCl and EDTA on root canal dentine, and some other related issues are reviewed. This information will enable clinicians to use the beneficial effects of these chemicals, while necessary steps are considered to reduce their harmful effects on dentine substrate. [source]

Diagnosis And Treatment Planning Are Essential Prior To Commencing Endodontic Treatment: Discuss This Statement As It Relates To Clinical Endodontic Management

AUSTRALIAN ENDODONTIC JOURNAL, Issue 1 2005
Ms Trudy Stewart
Diagnosis and treatment planning are essential to the practice of endodontics. Diagnosis aims to determine whether pathological involvement of the dental pulp has or is occurring. Treatment planning meanwhile, involves appropriately selecting cases, determining how difficult the treatment may be to perform on a specific individual and sequencing treatment procedures to achieve a healthy and functional dentition. In endodontic management, this may involve establishing whether the tooth is restorable and periodontally sound, the patient is able to tolerate the treatments and the clinician has the skills to perform the required treatment procedures. Careful consideration of these issues must be given prior to commencing treatment. [source]

Endodontic Treatment In The Primary Dentition

AUSTRALIAN ENDODONTIC JOURNAL, Issue 2 2004
Sajeev Koshy MBA
A number of factors are involved in the development of pulp and periapical disease in primary and permanent teeth, with dental caries being the main factor. Although these factors are similar, the clinical management of a primary or permanent tooth with pulp or periapical disease may be quite different. This is based mainly on the differences between the two types of teeth, with primary tooth longevity, coronal structural integrity, root canal morphology, and root anatomy being important features to be taken into account when treatment planning. This paper reviews some aspects of primary teeth and the various treatment options for the management of pulp and periapical disease. [source]

Lesions Of The Inferior Alveolar Nerve Arising From Endodontic Treatment

AUSTRALIAN ENDODONTIC JOURNAL, Issue 2 2000
Dr. R. Dempf
First page of article [source]

Apexogenesis after initial root canal treatment of an immature maxillary incisor , a case report

INTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2010
S. R. Kvinnsland
Abstract Aim, To present a case where a traumatized, immature tooth still showed capacity for continued root development and apexogenesis after root canal treatment was initiated based on an inaccurate pulpal diagnosis. Summary, Traumatic dental injuries may result in endodontic complications. Treatment strategies for traumatized, immature teeth should aim at preserving pulp vitality to ensure further root development and tooth maturation. A 9-year-old boy, who had suffered a concussion injury to the maxillary anterior teeth, was referred after endodontic treatment was initiated in tooth 21 one week earlier. The tooth had incomplete root length, thin dentinal walls and a wide open apex. The pulp chamber had been accessed, and the pulp canal instrumented to size 100. According to the referral, bleeding from the root made it difficult to fill the root canal with calcium hydroxide. No radiographic signs of apical breakdown were recorded. Based on radiographic and clinical findings, a conservative treatment approach was followed to allow continued root development. Follow-up with radiographic examination every 3rd month was performed for 15 months. Continued root formation with apical closure was recorded. In the cervical area, a hard tissue barrier developed, which was sealed with white mineral trioxide aggregate (MTA). Bonded composite was used to seal the access cavity. At the final 2 years follow-up, the tooth showed further root development and was free from symptoms. Key learning points, ,,Endodontic treatment of immature teeth may result in a poor long-term prognosis. ,,The pulp of immature teeth has a significant repair potential as long as infection is prevented. ,,Treatment strategies of traumatized, immature permanent teeth should aim at preserving pulp vitality to secure further root development and tooth maturation. ,,Radiographic interpretation of the periapical area of immature teeth may be confused by the un-mineralized radiolucent zone surrounding the dental papilla. [source]

Correlation between clinical success and apical dye penetration

INTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2001
C. M. Oliver
Abstract Aim This study was undertaken to examine whether a correlation exists between apical dye penetration and the clinical performance of root fillings. Methodology Apical dye penetration into 116 roots of human teeth that had been root-filled at least 6 months prior to extraction was tested in vitro using a vacuum technique and by measuring the length of dye penetration. Endodontic treatment was classified as clinically successful or unsuccessful and results for these groups were compared using analysis of variance and the Student's t -test. Positive and negative controls were used to test the experimental system. Results All controls performed as expected. Dye penetrated significantly further in unsuccessful cases although the raw data suggested little difference. Overall, dye penetrated 99.5% of the specimens, indicating that the presence of dye in the canal is a poor indicator of whether the technique or material will succeed. However, the extent of dye penetration may be related to the clinical outcome. Conclusions Clinically placed root canal fillings do not provide an apical seal that prevents fluid penetration. The outcome of treatment cannot be predicted from the results of apical dye leakage studies. [source]

Endodontic treatment of a mandibular first molar with three mesial canals and broken instrument removal

AUSTRALIAN ENDODONTIC JOURNAL, Issue 2 2010
Article first published online: 27 JUL 2010
No abstract is available for this article. [source]

Endodontic treatment of a mandibular first molar with three mesial canals and broken instrument removal

AUSTRALIAN ENDODONTIC JOURNAL, Issue 1 2010
Farhad Faramarzi dds
Abstract To succeed in any dental procedure, the clinician's awareness of the patient's dental anatomy and its variations is crucial. In endodontic therapy, obtaining full information about the root canals' variations can affect the outcome substantially. This case report presents the endodontic treatment of a mandibular first molar exhibiting three mesial root canals with 4 mm of a separated K-file in the coronal third of the mesiolingual canal on an 18-year-old female patient. This case demonstrates the importance of locating additional canals in any roots undergoing endodontic treatment and how the clinician's awareness of aberrant internal anatomy may change the treatment results. [source]

Multidisciplinary approach to the treatment of an oblique crown,root fracture

DENTAL TRAUMATOLOGY, Issue 1 2010
Anna-Louise Bate
After removal of the fractured cusp, a provisional restorative build-up in this area was carried out, in order to carry out an endodontic treatment in a sterile environment. A glass fibre post and core were then constructed and over a 90-day period the tooth was extruded orthodontically by 4 mm. The periodontal fibres associated with this tooth were cut with a tiny surgical blade to help to prevent reintrusion of the tooth and achieve fine contouring of the gingival margins. The new tooth position was maintained with a retainer for a further 60 days and after a period with a provisional acrylic crown, a porcelain bonded crown was fitted. This case report demonstrates that such a multidisciplinary treatment approach to an oblique subgingival fracture is a reliable and predictable manner in which to save a tooth that would have otherwise been difficult, if not impossible, to restore with a resultant good long-term prognosis. [source]

Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision

DENTAL TRAUMATOLOGY, Issue 6 2009
Adeleke O. Oginni
The dental clinician faced with this condition has to make a difficult decision. The aim of this study was to evaluate the clinical signs and symptoms associated with teeth with PCO and to assess the status of the periapical tissues using the periapical index (PAI) as an aid in making a treatment decision. The study included teeth diagnosed with PCO in patients with a history of traumatic injury to the involved teeth. Histories of associated signs and symptoms including pain, swelling and drainage from a sinus tract were elicited. Tooth color, sensibility to electric pulp testing, mobility and percussion tenderness were recorded. The periapical status was assessed using the PAI. Two hundred and seventy-six teeth were diagnosed with PCO. One hundred and fifty-seven (56.9%) and 119 (43.1%) demonstrated partial or total PCO, respectively. Yellow discoloration presented most frequently, occurring in 186 (67.4%) teeth. Sixty-two (33.3%) of these had developed periapical lesions and reacted negatively to sensibility testing. Fifty-seven (30.7%) of these teeth presented radiographically with a normal periapical appearance and reacted normally to sensibility testing, whereas 67 (36.0%) presented with small changes in the periapical bone pattern and reacted in the high normal range to sensibility testing. Teeth with PAI scores ,2 presented with occasional spontaneous pain. Teeth with PAI scores ,3 presented with clinical symptoms and signs ranging from pain on percussion to spontaneous pain, and slight swelling to sinus tract drainage. Based on the findings of this study, endodontic treatment should be initiated in teeth with tenderness to percussion, PAI scores ,3 and a negative response to sensibility testing. [source]

Multidisciplinary approach of complicated crown fractures of both superior central incisors: a case report

DENTAL TRAUMATOLOGY, Issue 4 2008
Anca Silvia Vâlceanu
Since the development of the adhesive dentistry, many case reports of crown fractures restored using adhesive reattachment techniques were published. Complex cases, in which more than one tooth are involved, with fractures differing from each other, require specific treatment of each fracture, taking different advantages of the different remaining tooth structures. This case report describes a patient with dissimilar crown fractures of both superior central incisors. After the endodontic treatment, the patient was treated using the combination of several techniques: periodontal surgery (crown lengthening with apically repositioned flap and osseous resective surgery), adhesive technique and cast restoration plus esthetic crown. The periodontal procedure re-created the biologic width and proved to be a reliable adjunctive procedure to the adhesive and the prosthetic techniques used. [source]

Reattachment of subgingivally fractured central incisor with an open apex

DENTAL TRAUMATOLOGY, Issue 3 2007
Ece Eden
Abstract,,, A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function. [source]

Treatment choices for negative outcomes with non-surgical root canal treatment: non-surgical retreatment vs. surgical retreatment vs. implants

ENDODONTIC TOPICS, Issue 1 2005
STEVEN A. COHN
The revision of negative treatment outcomes is a significant part of current endodontic practice. Both non-surgical and surgical retreatment procedures share the problem of a significant negative outcome in the presence of apical periodontitis. More positive results may be achieved in certain teeth with a combination of both procedures rather than either alone. However, there are pressures to replace these ,failed' endodontically treated teeth with implants. When comparable criteria are applied to outcomes, the survival rates of endodontic treatment and implant placement are the same. Time, cost, and more flexible clinical management indicate that endodontic retreatment procedures should always be performed first unless the tooth is judged to be untreatable. Endodontists should be trained in implantology to assist patients and referring colleagues in making informed treatment decisions. [source]

The prognosis and expected outcome of apical surgery

ENDODONTIC TOPICS, Issue 1 2005
SHIMON FRIEDMAN
Clinicians should possess current knowledge about the prognosis and expected outcome of endodontic treatment, including apical surgery. This knowledge cannot be acquired by indiscriminate review of the many available studies because they vary in the level of evidence they provide. Therefore, seven studies that best comply with methodology criteria defining the levels of evidence were selected and used as the basis of this review. In spite of their methodological consistency, the outcomes reported in these studies still differ considerably, mainly because of differences in inclusion criteria. According to these studies, 37,91% of teeth can be expected to be healed, while up to 33% can still be healing several years after surgery. Importantly, 80,94% of teeth can remain in symptom-free function, even if they are not healed. Several pre-operative factors may influence the outcome of treatment; the outcome may be better in teeth with small lesions and excessively short or long root canal fillings, and it may be poorer in teeth treated surgically for the second time. With regard to intra-operative factors, the choice of the root-end filling material and the quality of the root-end filling may influence the outcome, while the retrograde retreatment procedure clearly offers a better outcome than the standard root-end filling. In summary, the expected outcome of apical surgery is good and therefore, before considering tooth extraction and replacement, apical surgery should be attempted when it is feasible. [source]

A cost-effective simulation curriculum for preclinical endodontics

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2004
Roberta Pileggi
A challenge in contemporary dental education is to achieve a smooth transition from preclinical teaching environments to patient-care clinics in a cost-effective manner. The preclinical endodontic courses at The University of Texas, Dental Branch at Houston provide a unique learning environment that enables the student to perform endodontic treatment on extracted teeth in a typodont, and be involved in diagnosis and treatment-planning discussions. The specially designed stone typodont used has built-in radiographic capability, and is mounted at each chair in the clinic. During each preclinical session, students are assigned clinical cubicles and proper aseptic protocol is followed. Students are required to wear gloves, masks and eyewear, and place a rubber dam during treatment. Written self-assessment evaluations based upon prescribed criteria are utilised; feedback is given by faculty composed of both full-time endodontists and graduate students who periodically rotate and are calibrated on a regular basis. In the lecture phase, clinical case scenarios are presented to reinforce concepts of diagnosis and emergency care and to help integrate endodontics with other disciplines; a Socratic-like teaching style is established by the faculty facilitator to create an environment for developing critical-thinking and problem-solving skills. The overall feedback from graduating students has been very positive. Advantages of this format are an easier transition to patient management, a more keen interest in specialsation and a perceived increase in levels of confidence. [source]

Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2006
Lars Fabricius
The purpose of this study was twofold: first, to determine the influence on the healing of the periapical tissues when selected bacterial strains and combinations thereof remain after root canal treatment; and, second, the relationship to healing of the quality of the root filling. In eight monkeys, 175 root canals, previously infected with combinations of four or five bacterial strains and with radiographically verified apical periodontitis, were endodontically treated, bacteriologically controlled, and permanently obturated. After 2,2.5 yr, the periapical regions were radiographically and histologically examined. Of these teeth, 48 root canals were also examined for bacteria remaining after removal of the root fillings. When bacteria remained after the endodontic treatment, 79% of the root canals showed non-healed periapical lesions, compared with 28% where no bacteria were found. Combinations of residual bacterial species were more frequently related to non-healed lesions than were single strains. When no bacteria remained, healing occurred independently of the quality of the root filling. In contrast, when bacteria remained, there was a greater correlation with non-healing in poor-quality root fillings than in technically well-performed fillings. In root canals where bacteria were found after removal of the root filling, 97% had not healed, compared with 18% for those root canals with no bacteria detected. The present study demonstrates the importance of obtaining a bacteria-free root canal system before permanent root filling in order to achieve optimal healing conditions for the periapical tissues. [source]

A multivariate analysis of the outcome of endodontic treatment

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 3 2004
Dag Ørstavik
In the present study, multivariate analyses were performed on clinical and treatment variables that may influence the outcome of endodontic treatment. Data collected in a previous clinical-radiographic follow-up study were used. Of 810 treated, 675 roots in 498 teeth were followed for 6 months to 4 yr. Of these, 192 (the CAP group) had pre-existing, chronic apical periodontitis and 483 (the NAP group) had not. Root canal treatment followed a standard procedure with one of three sealers chosen at random. Demographic, clinical and radiographic variables were recorded at the start of, and during treatment. The periapical index (PAI) score was used to record the outcome of treatment, and applied in two different endpoint modes (END1 and END2) as the dependent variable for multivariate statistical analyses using logistic regression and the general model. The modes reflected increasing PAI scores (END1) and conventional success/failure assessment (END2). Dropouts were largely similar to the cases followed up. A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups. Several of these were not significant in univariate analyses (e.g. the effect of sealer). Conventional success/failure analyses (END2) identified fewer of the influential variables and had low explanatory power, whereas PAI scores on an ordinal scale (END1) were most sensitive in identifying variables of influence on the treatment outcome. [source]

Tobacco smoking and dental periapical condition

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2004
Jan Bergström
The relation between smoking and apical periodontitis has been little studied to date. The aim of the present study was to investigate whether tobacco smoking might be associated with the prevalence or severity of periapical lesions. A total of 247 individuals, 81 current smokers, 63 former smokers, and 103 non-smokers participated in the study. The periapical condition was expressed as the number and percentage of radiographically detectable lesions and, in addition, as a severity index. The overall prevalence of apical periodontitis was 52% and the overall prevalence of endodontic treatment 58%. There was no significant influence of smoking on the prevalence of either apical periodontitis or endodontic treatment. The mean number (percentage) of periapical lesions per person was 1.9 (6%) in current smokers, 1.5 (4%) in former smokers, and 1.0 (3%) in non-smokers. Controlling for age, the association between smoking and periapical lesions was not statistically significant. The mean periapical severity index including all teeth, or teeth affected by periapical lesions alone, did not significantly differ between smoking groups. It is concluded that the present observations do not lend support to the assumption that tobacco smoking is associated with apical periodontitis. [source]

Restorations with extensive dentin/enamel-bonded ceramic coverage.

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2001
A 5-year follow-up
The durability of restorations with extensive dentin/enamel-bonded posterior partial and complete ceramic coverages were investigated. The effect of luting with a dual-cured and a self-cured luting agent was also studied. In 110 patients, 182 ceramic coverages (IPS Empress) were placed. In 58 restorations, Syntac was used in combination with the dual-cured resin composite Variolink. In the other restorations luted with the chemically cured resin composite Bisfil 2B, 25 were bonded with Gluma, 57 with Allbond 2, and 42 with Syntac. Of the 182 ceramics, 13 (7.1%) were assessed as non-acceptable after a mean observation period of 4.9 yr (range 4.3,7.5 yr). The reasons for failure were fracture (5), lost restorations (4), secondary caries (3) and endodontic treatment (1). No significant differences in failure rate were seen between the two luting agents or between the three dentin-bonding agents. Ceramic coverages placed on non-vital teeth failed in 9.7% of cases (3/31) and on vital teeth in 6.6% (10/151). The success rate of the dentin-enamel-bonded ceramic coverages reduces the need for a traditional full-coverage therapy and/or post or pin(s) and core placement. The technique investigated showed many clinical advantages such as less destruction of healthy tissue, and avoidance of endodontic treatment and/or deep cervical placement of restoration margins. [source]

Influence of endodontic treatment, post insertion, and ceramic restoration on the fracture resistance of maxillary premolars

INTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2010
K. Bitter
Bitter K, Meyer-Lueckel H, Fotiadis N, Blunck U, Neumann K, Kielbassa AM, Paris S. Influence of endodontic treatment, post insertion, and ceramic restoration on the fracture resistance of maxillary premolars. International Endodontic Journal, 43, 469,477, 2010. Abstract Aim, To investigate the effects of endodontic treatment, post placement and ceramic restoration type on the fracture resistance of premolars. Methodology, One hundred and twenty teeth maxillary premolars were allocated to four groups (A,D; n = 30). In group A, mesio-occlusal-distal-inlays with a buccal and palatal wall of 2 mm (MOD), in group B partial onlays with palatal cusp coverage and in group C total onlays with buccal and palatal cusp coverage were prepared. Group D served as untreated controls. Groups A,C were divided into three subgroups (n = 10): (i) teeth received solely the described preparations, (ii) teeth were root filled, (iii) teeth were root filled and quartz fibre posts were placed. Teeth were restored using Computer-assisted design/computer-assisted machining-ceramic-restorations and subjected to thermo-mechanical-loading; subsequently, the buccal cusp was loaded until fracture. Results, Group D revealed significantly higher fracture resistance [mean (standard deviation)] [738 (272) N] compared to all other groups (P < 0.05; post hoc test Dunnett). For groups A,C, fracture resistance was significantly affected by the restoration type (P = 0.043) and endodontic treatment/post placement (P = 0.039; 2-way anova). Group A [380 (146) N] showed significantly lower fracture resistance compared to group B [470 (158) N] (P = 0.048; post hoc test Tukey). Compared to non-endodontically treated teeth [487 (120) N], root filled teeth revealed significantly lower fracture resistance [389 (171) N] (P = 0.031). Conclusion, The restoration of cavities with a remaining wall thickness of 2 mm using ceramic MOD-inlays is inferior with respect to the fracture resistance compared to partial onlay restorations. Root filled teeth without post placement show lower fracture resistance compared to non-endodontically treated teeth. [source]

An audit of intra-oral digital radiographs for endodontics

INTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2010
R. Austin
Aim, The aim of this study was to improve the quality of digital radiographs taken during endodontic treatment at King's College Hospital Dental Institute, UK. There were three phases. The first phase compared the Schick CDR system with Digora Optime. The second and third phases involved ways of improving the quality of the digital radiographs produced by the Schick CDR system. Methodology, The Faculty of General Dental Practitioners Royal College of Surgeons of England (FGDP) guidelines on Selection Criteria for Dental Radiography and Guidance Notes for Dental Practitioners on the Safe Use of X-Ray Equipment-National Radiological Protection Board enabled the use of a three point quality scale (one excellent, two diagnostically acceptable, three unacceptable), which took into consideration sensor angulation, positioning, contrast and focusing. The recommended FGDP guidelines are not less than 70% images scoring excellent. For the first phase 50 exposures recorded with the Schick CDR system were compared with 50 recorded using Digora Optime. For the second and third phases 50 radiographs for each phase were evaluated with images generated by the Schick system with training provided between the phases. Results, Images produced by the Schick system showed an inferior quality compared with the images generated by the Digora method. Both systems failed to reach the desired quality FGDP standard of 70% excellent (Schick 55% Digora 69%). Comparison of the results in the second and third phases showed that training the operator improved the quality but recommended the purchase of a size 1 or 0 Schick sensors to improve positioning errors. Conclusions, This study was carried out in order to minimise the ionising radiation dose to patients and to maximise the clinical and administrative benefits of using a digital system. It demonstrated an improvement in the quality of radiographs across all criteria measured up to and beyond the desired standard, from 55% of radiographs scoring excellent in the first phase to 80% in the third phase. As a result of the study it was decided to install the Schick CDR system because of the speed it produced images even though the first phase of this study demonstrated inferior image quality. The audit had clear, measurable standards with explicit targets. The audits have been through the entire audit cycle, data collection, change and a further data collection to provide evidence of the benefit of the change. A third data collection, demonstrated an ongoing commitment to quality. [source]

Apexogenesis after initial root canal treatment of an immature maxillary incisor , a case report

Rubber dam usage for endodontic treatment: a review

INTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2009
I. A. Ahmad
Abstract Rubber dam has been available to the dental profession for over 140 years. During this time, the use of rubber dam has been perfected, universally taught and recommended by professional organizations. Unfortunately, its consistent use has been rejected by many in the profession. The literature suggests that rubber dam is not used routinely by dental practitioners for root canal treatment. Many unfounded reasons have been cited for its lack of use, including concerns over patient acceptance, time required for application, cost of equipment and materials, insufficient training, difficulty in use and low treatment fees. Failure to use rubber dam has been shown to influence the choice of root canal irrigant, has a negative impact on treatment outcome and places the patient at risk of swallowing or aspirating materials and instruments. Methods to popularize rubber dam amongst general practitioners are discussed. [source]

Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant

INTERNATIONAL ENDODONTIC JOURNAL, Issue 10 2009
M. W. Pennington
Abstract Aim, To evaluate the cost-effectiveness of root canal treatment for a maxillary incisor tooth with a pulp infection, in comparison with extraction and replacement with a bridge, denture or implant supported restoration. Methodology, A Markov model was built to simulate the lifetime path of restorations placed on the maxillary incisor following the initial treatment decision. It was assumed that the goal of treatment was the preservation of a fixed platform support for a crown without involving the adjacent teeth. Consequently, the model estimates the lifetime costs and the total longevity of tooth and implant supported crowns at the maxillary incisor site. The model considers the initial treatment decisions, and the various subsequent treatment decisions that might be taken if initial restorations fail. Results, Root canal treatment extended the life of the tooth at an additional cost of £5,8 per year of tooth life. Provision of orthograde re-treatment, if the root canal treatment fails returns further extension of the expected life of the tooth at a cost of £12,15 per year. Surgical re-treatment is not cost-effective; it is cheaper, per year, to extend the life of the crown by replacement with a single implant restoration if orthograde endodontic treatment fails. Conclusion, Modelling the available clinical and cost data indicates that, root canal treatment is highly cost-effective as a first line intervention. Orthograde re-treatment is also cost-effective, if a root treatment subsequently fails, but surgical re-treatment is not. Implants may have a role as a third line intervention if re-treatment fails. [source]

Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment

INTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2009
M-K. Wu
Abstract The aim of this work was to identify the limitations of previously published systematic reviews evaluating the outcome of root canal treatment. Traditionally, periapical radiography has been used to assess the outcome of root canal treatment with the absence of a periapical radiolucency being considered a confirmation of a healthy periapex. However, a high percentage of cases confirmed as healthy by radiographs revealed apical periodontitis on cone beam computed tomography (CBCT) and by histology. In teeth, where reduced size of the existing radiolucency was diagnosed by radiographs and considered to represent periapical healing, enlargement of the lesion was frequently confirmed by CBCT. In clinical studies, two additional factors may have further contributed to the overestimation of successful outcomes after root canal treatment: (i) extractions and re-treatments were rarely recorded as failures; and (ii) the recall rate was often lower than 50%. The periapical index (PAI), frequently used for determination of success, was based on radiographic and histological findings in the periapical region of maxillary incisors. The validity of using PAI for all tooth positions might be questionable, as the thickness of the cortical bone and the position of the root tip in relation with the cortex vary with tooth position. In conclusion, the serious limitations of longitudinal clinical studies restrict the correct interpretation of root canal treatment outcomes. Systematic reviews reporting the success rates of root canal treatment without referring to these limitations may mislead readers. The outcomes of root canal treatment should be re-evaluated in long-term longitudinal studies using CBCT and stricter evaluation criteria. [source]

Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: three case studies

INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2009
B. Pasternak-Júnior
Abstract Aim, To describe three cases of extraoral sinus tracts, related to infected teeth, which were initially misdiagnosed as skin lesions and inappropriately treated. Summary, The extraoral sinus tracts were initially misdiagnosed as skin lesions. Dermatological surgery was performed and antibiotics prescribed but the lesions did not resolve. Then, a dental cause was sought, and identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. Key learning points ,,Dermatologists and other medical practitioners should be aware that dental extraoral sinus tracts can be confused with skin lesions. ,,A dental aetiology, as part of a differential diagnosis, should be kept in mind with oro-facial skin lesions. ,,If an extraoral sinus tract is of endodontic origin, then elimination of infection through effective endodontic treatment will lead to resolution of the sinus tract. ,,Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and/or surgical intervention. [source]

Complex endodontic treatment of an immature type III dens invaginatus.

INTERNATIONAL ENDODONTIC JOURNAL, Issue 10 2008
A case report
Abstract Aim, To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus. Summary, Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. The present case describes the complex endodontic treatment of a type III dens invaginatus in an immature maxillary central incisor with a necrotic pulp and abscess formation. The initial treatment goal was to achieve apexification of the pseudocanal root and conservative root canal treatment in the main canal. Following 1-year of treatment with calcium hydroxide dressings, radiography revealed a healing response, but no sign of a hard tissue barrier at the apex. Periapical surgery with the placement of a zinc oxide cement (IRM) root-end filling was considered successful at the 4-year follow-up. Key learning points ,,The complexity of the canal system and open apex in dens invaginatus present a challenge to endodontic treatment. ,,Correct diagnosis and treatment planning are fundamental to treatment of dens invaginatus. ,,Periapical surgery is indicated in cases of unsuccessful apexification in immature teeth with dens invaginatus and nonvital pulp. [source]

A preliminary study on the technical feasibility and outcome of retrograde root canal treatment

INTERNATIONAL ENDODONTIC JOURNAL, Issue 9 2008
P. Jonasson
Abstract Aim, To investigate the technical feasibility and outcome of retrograde root canal treatment. Summary, Endodontic access cavity preparation in abutment teeth may jeopardize the retention of the coronal restoration leading to prosthodontic failure. In such cases leaving the crown intact and performing retrograde root canal treatment might be an alternative approach. The potential to promote healing with retrograde endodontic treatment, and the technical feasibility to shape, clean and fill the canal was evaluated retrospectively. The study consisted of 21 incisors, canines and premolar teeth followed-up clinically and radiographically from 6 to 48 months. In 14 teeth the canals were completely negotiated. These cases were all judged as completely healed. In five cases no canal could be explored by files and a conventional ultrasonic root-end preparation and filling was performed. Two of these were classified as completely healed and three as ,uncertain'. In 2 two-rooted premolars a combination was performed with complete instrumentation of the buccal canal and the ultrasonic root-end preparation of the palatal root. One case was judged as a failure and the other was classified as completely healed. The results from this preliminary evaluation of retrograde root canal treatment are promising and merit a randomized clinical trial. Key learning points ,,Abutment teeth with vital pulps may develop pulp necrosis and apical periodontitis in 10% of cases. ,,Endodontic access preparation through an artificial crown may weaken its retention and jeopardize the longevity of a bridgework. ,,Retrograde root canal treatment is often feasible in maxillary teeth. ,,Results from this preliminary study suggest that treatment outcome for retrograde and orthograde root canal treatment is similar. [source]

A 20-year follow-up study of endodontic variables and apical status in a Swedish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 12 2007
M. Eckerbom
Abstract Aim, To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. Methodology, One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. Results, The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings. Conclusions, There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up. [source]

Longitudinal study of periapical and endodontic status in a Danish population

INTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2006
L.-L. Kirkevang
Abstract Aim, To describe and discuss changes in periapical and endodontic status in a general Danish population. Methodology, In 1997, 616 randomly selected individuals had a full-mouth radiographic survey taken. In 2003, 77% of the participants attended for a new full-mouth radiographic examination. Information on endodontic treatment and periapical status was obtained. The periapical index (PAI) was used to assess apical periodontitis (AP). Results, More participants had root filling(s) and AP in 2003 than in 1997. More teeth had AP and/or root fillings in 2003. Fewer of the root-filled teeth (RFT) had AP in 2003. Less than 3% of the teeth without root fillings (NRFT) that in 1997 had no AP, developed AP and/or received a root filling. Of the NRFT which in 1997 had AP, more than 35% still had AP and no root filling in 2003. Approximately, 30% of the NRFT with AP in 1997 received a root filling. Of the teeth that received a root filling, 40% had healed, whereas 60% had not. Approximately, 25% of the NRFT that in 1997 had AP had been extracted. In 1997 there were 618 RFT, 314 of the RFT had no AP in 1997. Almost 20% of the RFT that in 1997 were periapically sound, developed AP. Of the 304 RFT with AP in 1997, approximately 30% had healed, in 60% AP persisted, and 10% were extracted. Conclusions, The present study indicates that caution must be exercised when statements on the outcome of root canal treatment are made based on the cross-sectional studies. [source]