The relationship between resting arterial blood pressure and acute postoperative pain in endodontic patients.

AIMS: To evaluate the relationship between preoperative resting arterial blood pressure and postoperative pain in patients undergoing nonsurgical root canal therapy. METHODS: Written informed consent was obtained from normotensive patients seeking treatment for teeth with a preoperative diagnosis of pulpal necrosis and periradicular periodontitis. Preoperative resting blood pressure was recorded, and nonsurgical root canal therapy was initiated using a standardized protocol. Patients recorded their pre- and postoperative pain intensity on a 100-mm visual analog scale (VAS) for 7 days after the procedure. A linear regression model to predict postoperative VAS intensity used preoperative pain and blood pressure values as covariates. Pearson correlations were calculated to assess the relationship between the measures of preoperative blood pressure and both pre- and postoperative pain. RESULTS: After controlling for preoperative pain, significant correlations were observed between preoperative systolic blood pressure and postoperative pain (P < .05), as well as between preoperative pulse pressure and postoperative pain (P < .005) on day 1. CONCLUSION: This study has provided further evidence of a functional interaction between the cardiovascular and trigeminal pain regulatory systems. Understanding this complex relationship may lead to enhanced pain management strategies.

A long-term follow up of spontaneously healed root fractures later subjected to orthodontic forces - two case reports.

There is evidence that many dental injuries which result in root fractures may not require active treatment in cases where the coronal fragment is minimally displaced and does not exhibit clinical signs or symptoms. This paper discusses two individual cases where spontaneous root fracture healing was observed and this healing was apparently not compromised by later orthodontic tooth movement. The observation periods for the two cases were 13 and 18 years since the original root fractures occurred.

Mineral trioxide aggregate (MTA): its history, composition, and clinical applications.

Mineral trioxide aggregate (MTA) has been a revolutionary material in endodontics. Since its introduction in the 1990s several studies have demonstrated its use in various clinical applications. MTA has been extensively studied and is currently used for perforation repairs, apexifications, regenerative procedures, apexogenesis, pulpotomies, and pulp capping. This article will review the history, composition, research findings, and clinical applications of this versatile endodontic material.

Effects of Antibiotics on Bone and Soft-Tissue Healing Following Immediate Single-Tooth Implant Placement Into Sites With Apical Pathology.

Overprescription of antibiotics can cause bacterial resistance problems, leading to life-threatening illnesses and public health crises. Clinicians often believe antibiotics can prevent dental implant failure and postoperative complications. In conjunction with implant surgery, antibiotics are therefore routinely prescribed for all cases. In this double-blind, randomized controlled trial, the effects of antibiotics on the clinical outcomes of immediate implant placement upon replacing a tooth with an apical pathology were examined to compare antibiotics (n = 10) and placebo (n = 10). In each subject, a tooth with a chronic apical lesion was extracted, thoroughly curetted, irrigated, and replaced with single implant with a screw-retained custom provisional abutment/crown. Postoperative pain/discomfort was measured at 1- and 4-week postsurgical follow-up visits using visual analog scales. Facial alveolar bone and soft-tissue changes were measured using pre- and postoperative cone-beam computerized tomography and impressions. We found survival rates of 100% (antibiotics) and 78% (control). However, there was no statistical difference in means for any clinical outcome (t tests with Bonferroni adjustment for multiple testing), except for midfacial soft-tissue changes: 0.43 mm (SD, 0.76) in the antibiotics group and 1.70 mm (SD, 1.06) in the placebo group (t15 = -2.89, P = .011). The average change of the midfacial alveolar plate was 0.62 mm (SD, 0.46) and 1.34 mm (SD, 0.91) for the antibiotic and placebo groups, respectively, which did not significantly differ statistically. No significant correlation (Spearman correlation) existed between the changes in facial alveolar bone and the facial gingival margin. Antibiotics appear to have little effect on immediate implant treatment outcomes.

Periapical microsurgery: the effect of root dentinal defects on short- and long-term outcome.

INTRODUCTION: The purpose of this prospective clinical study was to evaluate the clinical outcome of endodontic microsurgery on roots exhibiting the presence or absence of dentinal defects at 1-year and 3-year follow-up period. METHODS: One hundred fifty-five teeth were treated with periapical microsurgery using a modern microsurgical protocol in a private practice setting. The root apices were resected and inspected for dentinal defects with a surgical operating microscope and a 0.8-mm head diameter light-emitting diode microscope diagnostic probe light. After inspection, root-end preparations were performed using ultrasonic tips, and root-end fillings were placed. Follow-up visits occurred at 1 year and 3 years postoperatively. The primary outcome measure used was the change in the radiographic apical bone density, and the secondary outcome measure used was the absence of clinical symptoms. RESULTS: Of the 155 treated teeth, a total of 134 teeth were assessed at the 1-year follow-up and 127 teeth at the 3-year evaluation. In the "intact" group, 94.8% healed at 1 year, and 97.3% healed at 3 years. In the "dentinal defect" group, 29.8% healed at 1 year, and 31.5% healed at 3 years. The baseline root condition of either "dentinal defect" or "intact" showed a statistical difference in the healing outcome at both 1 and 3 years. CONCLUSIONS: This prospective periapical microsurgery study showed a significant superior clinical outcome for intact roots when compared with roots with dentinal defects at both 1 year and at 3 years postoperatively.

Comparative Resistance of AH26 and a New Sealer Prototype to a Bacterial Challenge.

Objective. This study compared the leakage resistance of a New Sealer Prototype (NSP) with a traditional sealer (AH 26) in Resilon-filled roots subjected to a bacterial challenge. Study Design. 41 roots were instrumented to ISO size 50 apically. Group 1 (n = 20) contained Resilon and AH 26 sealer and roots in group 2 (n = 21) contained Resilon and NSP. Roots were embedded in a dual-chamber model with the upper chamber containing Streptococcus mutans inoculum. Evidence of bacterial penetration was observed for 1 month. Fisher's Test was used to analyze the data. Results. 8 of 20 roots (40%) in the AH 26 group demonstrated leakage whereas 3 of 21 roots (14%) in the NSP group leaked. The difference in leakage rates was not statistically significant (P = 0.053). Conclusion. The traditional sealer (AH 26) demonstrated increased leakage rates compared to the New Sealer Prototype (NSP), but the difference did not reach statistical significance in this study.

Tissue engineering strategies for immature teeth with apical periodontitis.

INTRODUCTION: Regenerative endodontic treatment on immature teeth with apical periodontitis is promising but still not well-established. The purpose of this study was to explore novel strategies to engineer a vital support structure within a root canal space by a combination of induced blood clot, exposure of dentin matrix, and a cross-linked collagen scaffold. METHODS: Apical periodontitis was induced in 6 dogs with immature teeth (n = 64). After disinfection, the following groups were randomly assigned: blood clot (BC) alone, BC with a cross-linked collagen scaffold (CCS), BC with exposure of dentin matrix by ethylenediaminetetraacetic acid (EDTA), and BC with CCS and EDTA. Positive (infected only) and negative controls (untreated) were also included. The dogs were followed up for 3.5 months and killed. Periradicular healing and root wall thickening were radiographically analyzed and statistically evaluated. The jaws were then fixed, demineralized, and subjected to histologic analyses. Newly formed mineralized tissues were histomorphometrically analyzed, quantified, and statistically evaluated. RESULTS: Radiographically there was significant difference in periradicular healing and root wall thickening (P < .05). Histomorphometric analysis showed significantly more mineralized tissue formation in the groups containing the scaffold (P < .05). Exposure of the dentin matrix by EDTA appeared to increase the adherence of the newly formed mineralized tissue to the root walls. CONCLUSIONS: The use of cross-linked collagen scaffold and exposure of dentin matrix combined with blood clot might provide an efficient approach to generate a vital support structure for the treatment of immature teeth with apical periodontitis.

Periapical inflammation and bacterial penetration after coronal inoculation of dog roots filled with RealSeal 1 or Thermafil.

INTRODUCTION: The purpose of this study was to subject 2 carrier-based root filling products to a 4-month microbial challenge in a dog model with histologic markers to assess periapical inflammation and bacterial penetration of the 2 filling materials. Histologic evidence of bacterial penetration and periapical inflammation were the outcome parameters used to compare the products. METHODS: Teeth were aseptically prepared and then filled with carrier-based Resilon (RealSeal 1 [RS-1], n = 25) or with carrier-based gutta-percha (Thermafil, n = 25) and were left exposed for 4 months. The first control group received a coronal seal over either RS-1 or Thermafil root fillings (n = 8). A second control group was instrumented and left completely empty (n = 8). RESULTS: Histologic evidence of periapical inflammation was observed in 29% of the Thermafil group and in 9% of the RS-1 group. This difference was only significant when controlling for a possible tooth position effect on inflammation presence (P < .05). Histologic evidence of bacterial penetration was present in 9% of the RS-1 group and in 70% of the Thermafil group. The difference in penetration rates between RS-1 and Thermafil was statistically significant when controlling for any dog or tooth position effects on bacterial penetration (P < .001). Furthermore, there was a statistically significant correlation between histologic evidence of inflammation and histologic evidence of infection (P = .002). CONCLUSIONS: RS-1 appeared to resist bacterial penetration more effectively than Thermafil under the conditions of this study.

Periapical microsurgery: an in vivo evaluation of endodontic root-end filling materials.

The purpose of this study was to assess the healing of periapical tissues using three different materials (IRM [L.D. Caulk Inc, Dentsply International Inc, Milford, DE], Geristore [Den-Mat, Santa Maria, CA], and MTA [ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK]) after endodontic microsurgery in an animal model. Using beagle dogs as a study model, 48 bicuspids were accessed, instrumented, and intentionally infected. The surgical procedures were performed after 30 days following the radiographic confirmation of periapical radiolucencies. The root canals were still infected and had no disinfection procedure carried out. The root ends were resected, retrograde preparations were completed, and the experimental materials were placed under surgical operating microscopy. After a period of 6 months, digital radiographic images of the periradicular areas were taken. The samples were prepared for histologic evaluation. Although Geristore showed no radiographic difference when compared with the other groups, it showed the least favorable healing in the histologic evaluation. Our histologic and radiographic results showed no statistical difference between MTA and IRM.