Periapical cemento-osseous dysplasia: a case report with twelve-year follow-up and review of literature.

AIM: To present a case report describing the long-term behaviour of periapical cemento-osseous dysplasia by observing the radiographic changes that took place over a period of 12 years. A review of the pertinent literature is also presented. SUMMARY: A healthy 26-year-old white female was referred to the Wilford Hall USAF Medical Center Endodontic Department for evaluation of an asymptomatic radiolucency at the apex of the right mandibular lateral incisor. Following a clinical evaluation that included pulp testing, a diagnosis of periapical cemento-osseous dysplasia (PCOD) was made. No treatment was rendered but follow-up visits were recommended. The patient was subsequently re-evaluated 8 times over a period of 12 years. During that time the lesion changed in appearance, displaying the various phases of PCOD. At the same time, lesions affecting the three adjoining incisors appeared and behaved in a similar manner. At the 12-year recall, the right lateral and both central incisors revealed no evidence of PCOD and an almost normal trabecular pattern of bone could be seen. Misdiagnosis and unnecessary treatment of PCOD may be avoided with careful pulp testing and knowledge of its most common locations of occurrence, radiographic appearances (phases) and benign behaviour.

An in vitro comparison of the sealing ability of materials placed in lateral root perforations.

The in vitro sealing ability of Tytin amalgam, Ketac-Silver, and Prisma VLC Dycal was compared. Roots of extracted teeth were perforated laterally. After the defects were repaired, the teeth were immersed in dye for 10 days and then sectioned, and the linear extent of dye penetration was measured. Statistical analysis showed that the Prisma VLC Dycal group exhibited significantly less dye penetration than the other two groups (p less than 0.01). No difference was found between the Tytin and Ketac-Silver groups.

A three-dimensional study of canal curvatures in the mesial roots of mandibular molars.

The degree and configuration of canal curvature was studied in the mesial roots of 100 randomly selected mandibular first and second molars. The teeth were radiographed in buccolingual (clinical) and mesiodistal (proximal) directions with #8 K files in place. One hundred percent of the specimens demonstrated curvature in both views. No correlation in degree of curvature was found to exist between the clinical and proximal views. Secondary curvature, in a direction opposite to that of the principle curve, was seen more frequently in the proximal view. In the proximal view, canals exhibited greater mean curvature than in the clinical view 38% of the time. Weine type II morphology (two canals, one foramen) demonstrated the greatest range in canal curvature when viewed from the proximal. Coronal flaring with Canal Master rotary instruments to a level just coronal to the curve significantly reduced the severity of curvatures in both views for most cases.

Effectiveness of a brush in removing postinstrumentation canal debris.

The purpose of this study was to evaluate the effectiveness of a brush in removing debris in the root canal after endodontic instrumentation. Seventeen extracted human maxillary first molars with mesiobuccal canal curvatures of 25 to 35 degrees were divided into two groups. After endodontic access and determination of working length, one group was hand instrumented to a #45 file and the other group to a #35 file at the working length. After the teeth were sectioned at the working length and at 2, 4, and 6 mm from the working length, they were evaluated for debris remaining in the canal space. The specimens were reassembled, brushed with an Endobrush, and reevaluated. The scores for instrumentation alone (controls) and instrumentation plus brushing were compared with paired t tests. Instrumentation with brushing was significantly better than instrumentation alone in debriding the root canal.

Cold sterilization of gutta-percha cones with formocresol vapors.

Cold sterilization of gutta-percha cones was accomplished by exposing them to formocresol vapors for 16 hours. The data obtained from this in vitro study indicate that gaseous sterilization with formocresol vapors is effective against a variety of gram-positive, gram-negative, and spore-forming microorganisms.

A new root canal instrument and instrumentation technique: a preliminary report.

Cleaning and shaping the root canal system has been and continues to be a challenge for even the most experienced endodontist. Curved, narrow canals, in particular, cause difficulties for the beginner as well as the specialist. A new instrument designed to incorporate new concepts was developed to ameliorate the problems in cleaning and shaping root canal systems. This new instrument has been given the name of SW (Senia and Wildey). The new SW instrument uses controlled right and left rotational forces. This motion was used to clean and shape simulated root canals in plastic blocks and root canals in extracted teeth. Instrumentation appeared to be easier, faster, and more precise than with conventional instruments, especially in curved canals where there was remarkable reduction of canal transportation. A mechanical version of the SW instrument was also developed. It was used to flare the coronal portion of the root canal system.

Another look at root canal instrumentation.

Several aspects of root canal instrumentation need additional research. Various factors must be considered in an analysis of instrumentation of the root canal system: the dentin that is cut; the technique used to cut it; the design of the instruments; the material and manufacturing process used to make the instruments; the irrigant used during the procedure; and the anatomic configuration of the root canal system. An analysis of these factors clearly indicates that existing root canal instruments and techniques are less than ideal and, in fact, do not accomplish what is expected of them. Root canals must be properly, but, at the same time, destructive and unnecessary removal of dentin should be kept to a minimum. The Flex-R and Canal Master instruments were developed to address some of the shortcomings of existing instruments and techniques. More scientifically based research is needed to fully evaluate these new instruments and techniques and to develop future instruments.

The diagnostic dilemma of barodontalgia. Report of two cases.

Although rare, barodontalgia can be a problem for those who fly. Two cases are presented, one which occurred during simulated high-altitude flight in the altitude chamber and the other during actual flight. The case that occurred during actual flight was resolved by treatment of the most suspect tooth after diagnostic tests failed to identify the problem. The other case was eventually treated successfully when symptoms became localized. The difficulties encountered in making a diagnosis are described.

A study of the odontoblast process with transmission electron microscopy.

Freshly extracted human third molars with completely formed roots were sectioned and placed in Karnovsky's fixative. The specimens were decalcified in ethylenediaminetetraacetic acid (EDTA) for 91 days, followed by digestion in collagenase. They were then fixed in a solution of buffered osmium tetroxide or ruthenium red and buffered osmium tetroxide, embedded in Spurr's plastic mixture, and sectioned for transmission electron microscopy. Each section was stained with uranyl acetate and lead citrate and viewed with a transmission electron microscope. No odontoblast processes could be identified at the cemental third of the dentin with the described technique.

Sterilization of complete dentures with sodium hypochlorite.

It is important to give the patient a denture that is clean and free from cross-contamination. This study was made to determine if Clorox could be used as a rapid, safe, and clinically effective way to sterilize complete dentures. The data obtained from this study indicate that a 5-minute immersion of dentures in undiluted Clorox accomplished sterilization against a variety of microorganisms, including a spore-forming bacteria and C. albicans.